Congresso 2012 da FIGO, em Roma, vai até sexta-feira

Entre 7 e 12 de outubro de 2012 acontece em Roma, Itália o XX Congresso Mundial da Federação Internacional de Ginecologia e Obstetrícia - FIGO.  O evento é realizado com intervalos de 3 anos.

A Clínica Ginecológica da USP  participa com alguns trabalhos em Endometriose e Ginecologia Endócrina.
Alguns resumos (abstracts) podem ser acessados aqui no site.

Leia mais

EFFECTS OF MELATONIN ON PRO APOPTOTIC GENES AND PROTEINS EXPRESSION IN THE UTERUS OF RATS EXPOSED TO CONTINUOUS LIGHT

Citation: International Journal of Gynecology and Obstetrics Volume 119, Supplement 3 (2012), Page S545 J.M. Soares1, C. da S. Ferreira1, E.C. Baracat12, K.C. Carvalho2, A.P.R. Paiotti1, C.T.F. Oshima1, C.C. Maganhin1, M. de J. Simões1 1Gynecology, Federal University of São Paulo, São Paulo, São Paulo, Brazil 2University of São Paulo, São Paulo, São Paulo, Brazil  Objectives: To analyze the effects of melatonin on apoptosis in the rat uterus submitted to continuous light. Materials: 20 virgin adult rats (Rattus norvegicus, Wistar) with regular estrous cycle were divided into two groups submitted to continuous light: GContr, control that received vehicle and GExp treated with melatonin (0.4 ug/ml). Both groups were submitted to continuous light for 90 days. Methods: After the period of light exposure, all animals were euthanized and the uterus removed and processed for PCR Array SAbiosciences (qPCR) to analyzes apoptosis pathway. Also, we performed immunohistochemical analysis of pro apoptotic proteins involved in apoptosis. These results were evaluated by Student's t test with a level of rejection of the null hypothesis set at 5% (p < 0.05) and the results of qPCR were analyzed by specific software SAbiosciences and expressed as fold change. Results: In the animals of GExp there was predominance of many pro-apoptotic gene overexpression that are involved in both extrinsic and intrinsic pathways when compared to GContr ones. However, the protein expression of Bax, Fas, FasL and cleaved caspase-3 of GContr was similar to GExp. Conclusions: Our data suggest that melatonin may increase the expression of pro-apoptotic genes without changes in proteins involved in apoptosis.

ACTION OF MELATONIN ON THE OVARIAN GENE EXPRESSION OF PINEALECTOMIZED RATS

Citation: International Journal of Gynecology and Obstetrics Volume 119, Supplement 3 (2012), Page S547 J.M. Soares1, C.C. Maganhin1, C. da S. Ferreira1, L.F. Fuchs Portugal2, R.S. Simões2, M. de J. Simões3, E.C. Baracat2 1Gynecology, Federal University of São Paulo, São Paulo, São Paulo, Brazil 2University of São Paulo, São Paulo, São Paulo, Brazil 3University Federal of São Paulo – Morphology and Genetics, São Paulo, São Paulo, Brazil Objectives: to evaluate the ovarian gene expression after melatonin reposition on the adult female pinealectomized rats. Materials: Thirty pinealectomized female rats (Rattus norvegicus albinus). Methods: The animals were divided into two treatment groups: GI – control that received vehicle (n = 15); GII – experimental that received melatonin reposition (10 μg/animal), during consecutive 60 days. After that, all animal were sacrificed under anesthesia and the ovaries were removed and prepared for RNA extraction and the samples were submitted to cDNA microarray procedure using the Kit GeneChi® Rat Genome 230 2.0 Array of Affymetrix, following the manufacture instructions. The procedures were repeated three times. The results were normalized and confirmed by GeneChi® Operating software (Affymetrix Inc., Santa Clara, CA, USA) and NA-Chip Analyzer (dChip) software (www.dchip.org). We considered as positive or negative, when the data of experimental group were three times different than control one. Results: 100 and 27 genes of the experimental were up and down regulated, compared to control group, respectively. In relation to steroidogenesis, inhibin beta-A (INHBA), follistatin (FST), gremlin 2, cysteine knot superfamily, homolog (Xenopus laevis) (GREM2) were up regulated and the following gene were down regulated: prostaglandin D2 synthase (brain) (PTGDS), Rab40b, member RAS oncogene family (RAB40B). Conclusions: Our results suggested that melatonin reposition interfered with ovarian gene expression of pinealectomized rats and may influence the expression of genes related to steroidogenesis.

COMPARATIVE ANALYSIS OF APOPTOSIS MARKERS PROTEIN EXPRESSION BETWEEN UTERINE LEIOMYOMA AND MYOMETRIUM

Citation: International Journal of Gynecology and Obstetrics Volume 119, Supplement 3 (2012), Page S651 N. Garcia1, R. Borsari1, I.W. Cunha2, F.A. Soares2, G.A.R. Maciel1, E.C. Baracat1, K.C. Carvalho1 1School of Medicine – University of Sao Paulo, Sao Paulo, SP, Brazil 2International Research Centre – A. C. Camargo Hospital, Sao Paulo, SP, Brazil  Objectives: Our goal was to analyze bcl-2, caspase 3, bax, p16 and annexin protein expression as apoptosis markers in uterine leiomyoma and myometrium. Materials: Tissue Samples (33 lemyomioma and 29 myometrium), Slides for Immunohistochemistry, Reagents for Immunohistochemistry, Automated reactions by Ventana Medical Systems (Inc. Tucson, Arizona, USA) and Optical microscope (Axioskop 2 Plus, Carl Zeiss, Germany). Methods: Immunohistochemistry were performed using polyclonal antibodies in 33 samples of leiomyoma and 29 samples of myometrium. Sixteen samples of leiomyoma and fourteen myometrium belongs to patients treated with GnRHa (gonadotropin releasing hormone analogue). All patients underwent surgery on proliferative phase of the cycle. Statistical analyses were developed using tests of Spearman and Mann-Whitney. Results: p16, bcl-2 and annexin were detected with low intensity and frequency in our sample set. In the other side, caspase 3 presented higher expression in leiomyoma (30.3%) than myometrium (3.5%), while bax showed similar results for both the leiomyoma (33.3%) and myometrium (41.4%). None difference was observed in caspase 3 expression in GnRHa group. However, bax showed shift of expression profile in leiomyoma (3 cases) and myometrium (7 cases) in the treated group. Concerning to clinical data, statistical analysis showed a strong correlation between expression of caspase 3 and number of pregnancies (p < 0.0086) and size of tumor nodules (p < 0.047). Conclusions: Our results showed differential protein expression of caspase 3 between uterine leiomyoma and myometrium, while bax expression did not present significant differences in both groups. Apparently, bax expression was influenced by the hormonal environment, since that treatment with GnRHa affected its protein detection.

IATROGENIC PARASITIC MYOMA OF THE UTERINE CERVIX STUMP

Citation: International Journal of Gynecology and Obstetrics Volume 119, Supplement 3 (2012), Page S675 M.P.A. Mieli1, R.S. Simões1, E.C. Baracat2 1Hospital Universitário da Universidade de São Paulo, São Paulo, São Paulo, Brazil 2Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil  Objectives: To describe our experience in diagnosing and managing iatrogenic parasitic leiomyoma of uterine cervix stump which was developed as an unexpected late complication of laparoscopic morcellation. Materials: Parasitic leiomyoma of the uterine cervix stump. Laparoscopic surgery. Methods: We described our experience in diagnosing and managing iatrogenic parasitic leiomyoma of uterine cervix stump which was developed as an unexpected late complication of laparoscopic morcellation. The mass probably resulted from growth of missed fragment of uterine tissue after previous morcellation, culminating in development of symptomatic iatrogenic parasitic leiomyoma of the uterine cervix stump. We performed laparoscopic management for this case. Results: Parasitic myoma is an uterine leiomyoma which has become detached from the uterus and adherent to another peritoneal surface from which it obtains blood supply. Unless a colpotomy is performed, both laparoscopic myomectomy and supracervical hysterectomy usually require abdominal morcellation to remove the tissue. If these fragments are not identified and removed, they may then implant on any organ and form parasitic myomas. Meticulous inspection of the abdominal cavity is necessary after morcellation. In patients with a history of morcellation who have pelvic masses, iatrogenic parasitic myomas should be considered in the differential diagnosis. The mass, in this case, probably resulted from growth of missed fragment of uterine tissue after previous morcellation, culminating in development of symptomatic iatrogenic parasitic leiomyoma of the uterine cervix stump. Conclusions: We experienced a case of parasitic leiomyoma of uterine cervix stump that was managed by laparoscopic surgery in a patient with a history of previous supracervical hysterectomy that required abdominal morcellation to remove the tissue. Some fragments were probably not identified in that time and were not removed. Meticulous surgical technique with systematic surveying of the entire cavity and complete retrieval even of small fragments of morcellated tissue should be practiced so as not to iatrogenically increase the risk of morbidity associated with parasitic leiomyomas. Laparoscopic management of parasitic leiomyomas is feasible and safe.

TREATMENT OF SURGICALLY INDUCED ENDOMETRIOSIS IN RABBITS USING COPPER VAPOR LASER

Citation: International Journal of Gynecology and Obstetrics Volume 119, Supplement 3 (2012), Page S421 M.P.A. Mieli1, G.R. Mieli2, P.R.B. Pereira1, E.C. Baracat3 1Hospital Universitário da Universidade de São Paulo, São Paulo, São Paulo, Brazil 2Faculdades Metropolitanas Unidas, São Paulo, São Paulo, Brazil 3Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil  Objectives: Endometriosis has always represented one of the greatest gynecology's enigmas, being the subject of several studies, intending to uncover its physiopathology, aiming the search of new therapeutic modalities. The objective of this study is to present an experimental study with copper vapor laser for the treatment of endometriosis induced in rabbits. Materials: 42 New Zealand rabbits were submitted at the experimental induction of the endometriosis, in agreement with standardized surgical technique. Copper vapor laser. Methods: 42 New Zealand rabbits were submitted to experimental induction of the endometriosis, in agreement with standardized surgical technique. After 30 days of the induction, a group of 29 animals were submitted to treatment by cooper vapor laser in 2, 5, 15, 30 and 60 seconds and, other group of 13 rabbits, which served as control, had only a laparotomy, without any other treatment. After 15 days of the second laparotomy we made a macroscopic evaluation of the presence of adherences and studied an endometriosis's histopathology presence, glands, stroma, acute inflammatory process, chronic inflammatory process, chronic inflammatory granulomatosis process, necrosis, vascular neoformation and fibrosis. Results: The experimental model of endometriosis's induction at this work was adapted and easy to reproduce, with a hundred percent of effectiveness. The treatment with copper vapor laser was shown efficient, with destruction of the disease in 31% of the cases. In 69.8% of the rabbits that still had the lesion, there was a decrease in the number of glands. The destruction of the stroma happened in 41.4% of the cases, in the laser's group. With a total energy of 23 to 30 J, corresponding to the period of 15 seconds, less chronic inflammatory process was shown, as well as vascular neoformation and decidual fibrosis. Conclusions: Copper vapor laser is a promising tool in the treatment of human endometriosis.

SURGICAL MANAGEMENT OF DEEP INFILTRATING ENDOMETRIOSIS Citation: International Journal of Gynecology and Obstetrics Volume 119, Supplement 3 (2012), Page S161 M.S. Abrao1231Division of Endometriosis, Ob/Gyn Department, São Paulo University, São Paulo, Brazil 2Division of Reproductive Medicine of Sirio Libañes Hospital, São Paulo, Brazil 3SBE – Brazilian Endometriosis and Minimally Invasive Society, Brazil  The diagnosis of deep endometriosis is reached principally at the time of surgery. However, some clinical characteristics identified by physical examination and diagnostic imaging may suggest this form of endometriosis, following which the surgical approach and pathway are recommended for confirmation. Transvaginal ultrasonography still appears to offer the best cost/benefit imaging technique for cases of ovarian or recto-cervical endometriosis. The presence of a hypoechogenic lesion located in the area between the rectum and the vagina may suggest the diagnosis of endometriosis of this area. Treatment: There is a consensus in the literature that the treatment of this form of endometriosis is surgical. Access may be by laparotomy or laparoscopy, depending on the surgeon's experience and the extension of the disease. Whenever there is a clinical suspicion of deep endometriosis, adequate presurgical bowel preparation is indicated. We usually recommend the use of 3–4 liters of an oral solution of polyethylene glycol (PEG) the day before surgery, associated with one or two Fleet enemas or a mannitol preparation. Administration of antibiotics should be carried out during anesthetic induction, preferably using a second generation cephalosporin, endovenously, at the dose of 2 grams. When the imaging method permits identification of the depth of the lesion, this information can be used to define the type of surgery that will be performed. In the case of lesions that affect the serous and external muscular layers of the rectum or sigmoid, resection of the nodule alone may be indicated. If, on the other hand, the lesion is deeper, affecting the deep muscle, submucosa or mucosa layers, segmentary resection of the bowel is recommended.