Dissertations / Theses on the topic 'Female orgasm'

Previous research indicates that women prefer orgasms triggered by penile-vaginal intercourse (PVI) as compared to those triggered by direct manual stimulation of the clitoris. However, for reasons that are not well understood, most women are unable to reach PVI orgasms as often as they desire. In addition, it is unclear why many women prefer PVI orgasms to those triggered by direct clitoral stimulation. This study developed a more precise measure of PVI orgasm frequency and evaluated key predictors of this frequency, including duration of intercourse, physical and psychological health, and partner traits with implications for either mating quality or relationship quality. The present study also measured PVI orgasm importance and investigated why it is important for many women. The sample consisted of 835 adult women with experience in PVI. Mean PVI orgasm frequency was 50%, with 39.4% of women never or rarely having PVI orgasms, 37.1% sometimes having PVI orgasms, and 23.5% almost always or always having PVI orgasms. As a median response, women believed that PVI orgasm was “very important” and perceived importance was correlated with orgasm frequency (r = .31, p < .001), as were reasons for importance. Duration of intercourse showed a linear relationship with PVI orgasm frequency, but this finding was qualified for women at the low and high extremes of the orgasm frequency distribution. Body esteem, anxiety during intercourse, exercise, and general pain predicted PVI orgasm frequency. Sensitive male traits, although valued by women even more highly than alpha male traits, showed notably weaker relationships with PVI orgasm than did male alpha traits. This is consistent with evolutionary theories of orgasm, and it supports the view that the female orgasm may function to favor some males over others in terms of sire choice. Clinical and theoretical implications of the present findings are discussed.

This study presents cross-cultural research into women's sexuality, and orgasm in particular. Qualitative interviews of women who have undergone excision of the clitoris and women who have not form the core of my data. My analysis indicates that female orgasm in diverse societies is problematized and controlled, causing me to postulate numerous similarities between women despite cultural and physical differences. One of the most significant findings is that similar attitudes toward the clitoris might be invoked to explain both its removal, in excising societies, and clitoral-vaginal theoretical bifurcations in non-excising ones.
The originality of my theoretical approach is to examine various types of social constructionism. I demonstrate its pertinence to an understanding of the literal construction of the body through social practices or social imperatives which determine physical reality. My use of the term constructionism as anti-essentialism also enables me to identify common components of drive theory in diverse cultures, and to demonstrate their lack of correlation with sexual behavior. Finally, constructionism is a crucial element to my analysis of subjective beliefs concerning female orgasm. Interpretation of physiological response supports a belief in clitoral-vaginal opposition in defiance of the interdependence of these two organs, thereby reflecting the constructionist insistence upon reality as socially defined.
The originality of this research lies in its comparative perspective and resulting emphasis on similarities in culturally diverse groups. Female sexuality and orgasm are filtered through social existence. A physiological response can thus be denied or substantiated by social means.

The supraspinal control of descending inhibition of genital reflexes (such as ejaculation) is poorly understood but is important in our global comprehension of how neural signals are integrated to produce sexual behavior, and in our understanding of sexual dysfunction. Sexual dysfunctions, such as premature ejaculation/delayed ejaculation in men, and involuntary vaginal spasms, dyspareunia, and anorgasmia in women, are common. An underlying dysregulation of genital reflexes may produce these dysfunctions, especially in those individuals being treated for depression and anxiety with serotonergic drugs. The nucleus paragigantocellularis (nPGi) of the rat medulla has been described as a descending inhibitory system for genital reflexes in rats, and a homologue is known in humans. Through retrograde tracing of nPGi afferents with the tracer Fluorogold in rats, we found that a number of brain regions implicated in sexual behavior, such as the medial preoptic area, paraventricular nucleus of the hypothalamus, and periaqueductal gray (PAG) provide sexually dimorphic projections to the nPGi, and that many of these regions contain receptors for gonadal steroids and are active during sexual behavior. We also found that excitotoxic lesions of the nPGi with N-methyl-D-aspartate facilitate male sexual behavior by reducing the number of intromissions required for ejaculation, and decreasing ejaculation latency. In females, such lesions attenuated sexual behavior by reducing the amount of time the female spent mating and reducing the reinforcement value of vaginocervical stimulation. Lastly, we found that by removing the source of serotonin to the nPGi (from the ventrolateral PAG) with the serotonergic neurotoxin 5,7-DHT in male rats, we were able to mimic the effects of nPGi lesions and facilitated male sexual behavior indicating that serotonin neurotransmission at the level of the nPGi is critical for genital reflex control. Taken together our results indicate that the nPGi is an important site of integration of internal signals for the regulation of sexual behavior that is sexually dimorphic and under serotonergic control. Our understanding of normal and dysfunction genital reflex control, and possible treatment options in people, is complemented by these results.

Epidemiological research on sexual difficulties in women has reported high rates of sexual problems and dissatisfaction across the lifespan. Nevertheless, feminist scholars and social science researchers argue that an absence of research exploring women’s subjective interpretations of their sexuality and sexual difficulties exists, since prevalence studies do not address how the range of diverse socio-cultural, relational, biological and psychological processes interact to influence women’s sexuality across the lifespan. The current study aimed to narrow this research dearth by presenting an in-depth, qualitative exploration of heterosexual women’s accounts of their sexual experiences and their perceived sexuality. A phenomenological approach was utilised against the socially constructed notion of sex to understand women’s sexuality. Five core themes emerged from qualitative interviews with 18 women that were considered paramount to women’s subjective interpretations and experience of their sexuality and sexual difficulties. There were socio-cultural factors; inter-relationship factors; social roles and expectations; practices and preferences; and views on change. The current study highlights the multifaceted double standard within socio-cultural expectations of what it means to be a heterosexual woman, exemplified in the relationship between women’s sexual difficulties and idealistic sexual expectations, male-centred sexual socialisation, over-burdened social roles, unequal relationships, and inadequate sexual practices. Despite experiencing sexual difficulties with associated distress throughout the lifespan, participants did not identify with prevailing medicalised notions of sexual problems. Participants differentiated between sex as important and sex as a priority. Relationships between sexual maturity, confidence and sexual satisfaction as well as sexual knowledge and sexual agency emerged in the narratives. Clinical implications incorporating women-centred classification frameworks such as a New View of women’s sexual problems are discussed. Directions for future research are presented.

What is 'orgasmic slavery". This study interrogates the meaning of the term by analysing the racialised sexual exploitation of Black women. I examine the historical changes, differences, under-currents and complexities of the social construction of Black sexuality from the inferior position of African female slaves to the conditions of Black women in contemporary Britain. Refuting the premise that Black women are primarily sexual beings, this thesis examines the origins and consequences of this assumption. Through a literature review, the dominant British portrayal of both Black women and Black men in terms of pathological and rampant sexualities is evident. My work assesses how the British and American film industries contribute to such misconceptions. Utilising the research method of participant observation, the perceptions of men and women from different racial backgrounds about images of Black sexuality are addressed. A questionnaire survey queried opinions about the sexual proclivity and relationships of Blacks, whites, 'mixed race' and gays. Building upon this data, a pilot study that was based on images of Black sexuality and their influence upon identity and experiences, provided more information. Central to this debate were semi-structured interviews on the issues of images, identity and relationships as perceived to be related to Black female sexuality.

Merkel cell polyomavirus (MCPyV) is an oncogenic virus exist in about 80% of Merkel Cell Carcinoma (MCC), an aggressive human skin cancer. Evidence of MCPyV existing in other kind of skin neoplasms such as cutaneous squamous cell carcinomas (SCCs) has been reported. Since the major type of cervical cancer is SCCs, MCPyV may be associated with cervical cancer tumorigenesis. A Japanese research group has documented the presence of MCPyV DNA in both cervical SCCs and cervical adenocarcinomas (ACs) from Japanese patients. Nevertheless, the association between MCPyV and cervical cancer remains inconclusive and the prevalence of MCPyV in cervical cancer may show demographic variation. This study is aimed to examine whether MCPyV is present in some of the most common gynaecological cancers, namely cervical cancer, ovarian cancer, endometrial cancer, and gestational choriocarcinoma, in Hong Kong patients. Genomic DNA was obtained from 50 cases of cervical cancer, 20 cases of ovarian cancer, and 35 common gynaecological cancers cell lines. Genomic DNA extracted from four MCC samples were used as positive controls. The integrity of the samples was first checked by β-globin PCR. Detection of MCPyV was then performed by MCPyV Large T antigen (LT-ag) PCR. Our PCR analysis showed that only 1 out of 50 (2%) of the cervical cancer samples was positive for MCPyV DNA. The PCR product was purified and cloned for sequencing analysis. Comparing the LT-ag sequence obtained from the only MCPyV positive cervical cancer with reference sequence and with the MCPyV sequence from one of the control cases revealed the presence of different MCPyV variants in Hong Kong patients. None of the ovarian cancer, endometrial cancer, or choriocarcinoma was positive for MCPyV. Our data did not support the notion that MCPyV is associated with gynaecological malignancies. MCPyV may hence be a fairly specific oncogenic agent for Merkel cell carcinoma.
published_or_final_version
Pathology
Master
Master of Medical Sciences

The objectivie of this study was to describe the splanchnology and topography of the female reproductive organs of the African lion. The reproductive organs of three embalmed cadavers from three-year-old known aged nulliparous lionesses weighing between 120 kg and 140 kg were studied. Two fresh carcasses from another study were used for some of the topographical photos since these rendered better quality images. The project was approved by the Animal Use and Care Committee and Research Committee of the University of Pretoria (protocol number V038-09). The topography and splanchnology of the reproductive organs were studied and described in situ and after removal. The kidneys were located far caudally in relation to the thirteenth ribs with the left kidney further caudal. The suspensory ligament was very well developed. It originated in a fan-like manner from the dorso-lateral abdominal wall lateral to the kidney extending up to a few centimetres cranial to the kidney. The proper ligament of the ovary was well developed and consisted of several clearly distinguishable bands. The broad ligament resembled that of the cat with the exeption of the cranial part of the mesovarium being very well developed. The round ligament was well developed and inserted on the medial femoral fascia. It therefore did not extend to the vulva as in other canine and feline species. The left ovary was longer, wider and heavier than its right counterpart and the ovaries were relatively small in relation to body weight. The ovarian bursa had a short mesosalpinx that did not cover any part of the ovary and the fimbriae extended the entire length of the ovary. The urethral tuberculum as well as the urethral crest was very well developed. The left uterine horn was longer than the right and the tip of the uterine horn was located dorsal to the proper ligament. The uterine tube was prominently convoluted, situated entirely on the lateral aspect of the ovary and was found to open directly into the tip of the uterine horn and not onto a papilla. The female reproductive organs of the African lion resemble that of the domestic cat and dog with some major differences especially to the size and development of certain structures. The clinical relevance of these differences has to be debated and some thoughts might include the following: 1) does the suspensory and proper ligaments of the gravid uterus contract to suspend the entire uterus closer to the body wall during hunting since the lioness is the primary hunter in the pride? 2) does the lioness have to roll on her back and extend her back legs after mating to facilitate sperm entering the dorsally located tip of the uterine horn while the round ligament stabilises the terminal part of the uterine horn, and does this have a bearing on the fact that multiple copulations are required over a prolonged period for conception by lions? 3) do more ovulations take place from the bigger left ovary and? 4) are more conceptusses borne by the longer left uterine horn? The anatomical information obtained during this study was subsequently applied in a surgical study on sixteen lionesses using laparoscopy to perform laparoscopic ovariectomy and salpingectomy. The availability of these two laparoscopic procedures subsequently led to a wider interest to its application in population control of lions in the smaller national parks of South Africa.
Dissertation (MMedVet)--University of Pretoria, 2012.
gm2014
Companion Animal Clinical Studies
unrestricted

Pelvic floor dysfunction in the form of pelvic organ prolapse (POP) is a common gynaecological condition, especially in the elderly. Although the aetiology is poorly understood, several risk factors such as vaginal childbirth, chronically raised intra-abdominal pressure (such as asthma and chronic constipation), ageing, previous hysterectomy and connective tissue disorders are thought to play a role in the pathophysiology of POP. Studies have shown that vaginal childbirth can result in both gross and micro-architectural distortion/alteration of the pelvic floor musculature and is thus considered to play a major role in the development of POP. Although ethnicity has been proposed as a risk factor, there are limited studies on this subject. Recently, transperineal ultrasound (TPUS) has been used to study the structural integrity and the dynamic interaction between the pelvic organs and pelvic floor musculature. Using a specified methodology we intended to determine and compare pelvic floor morphology, namely pelvic organ descent and levator hiatal distensibility in a multi-ethnic South African population (Asian, Caucasian and Black) in both asymptomatic nulliparous and symptomatic multiparous women. Secondly we also intended to study the association between prolapse symptoms and functional anatomy of the pelvic floor, and finally to determine the impact of vaginal childbirth on the pelvic floor morphology 3-6 month postpartum. For all the studies women were recruited from the local nursing school, general gynaecology and tertiary urogynaecology clinic. Pregnant women were recruited from the district antenatal clinic. This cohort included only Black pregnant women. After informed consent all ultrasound volumes were acquired at rest, maximal pelvic floor contraction and Valsalva maneuver. Volumes were deindentified and analysed 6-8 weeks later using GE Kretz 4D View (GE Kretztechnik Gmbh, Zipf, Austria). In the nulliparous cohort, we found that Black South African women had greater pelvic organ descent on ultrasound and clinically and greater distensibility compared to South Asian and Caucasian women. Multivariate modelling revealed that Black 2 ethnicity remained a significant factor for pelvic organ mobility on clinical examination, (P=0.024). In women with symptomatic POP, there was significant variation in clinical prolapse stage, levator distensibility and pelvic organ descent in this racially diverse population presenting with pelvic organ prolapse, with South Asians having a lower avulsion rate than the other two ethnic groups (P= 0.014). As regards the association between prolapse symptoms and functional anatomy of the pelvic floor we found a significant association between awareness, visualization and/or feeling of a vaginal lump and abnormal pelvic floor functional anatomy, that is, hiatal ballooning and levator avulsion (all P< 0.05). The fourth part of the study included eighty four women who returned at a mean of 4.8 months postpartum. We found significant alteration in pelvic organ support and levator hiatal distensibility after vaginal delivery i.e. a significant increase in mean values from ante to postpartum measurements, more so for the vaginal delivery group. 15% of Black primiparous women sustained levator trauma after their first vaginal delivery. In conclusion, to the author‘s knowledge this is the first study on pelvic floor morphology in South African women. Contrary to previous publications inferring that Black women rarely develop PFD, we have shown that this particular ethnic group had significantly different pelvic floor dynamics than Caucasian and South Asian women for both nulliparous and multiparous symptomatic women. Levator trauma occurs in 15% of Black women after vaginal childbirth.
Thesis (PhD)--University of Pretoria, 2017.
Obstetrics and Gynaecology
PhD
Unrestricted

This masters project was undertaken to have a better knowledge of the female lion reproductive tract and to equip the author for future surgical studies on this organ system. The objectives of this study were to describe the arterial supply and histology of the female reproductive organs of the African lion. The reproductive organs of three embalmed cadavers and two fresh carcasses from three-year-old known aged nulliparous lionesses weighing between 120 kg and 140 kg were studied. The project was approved by the Animal Use and Care Committee and Research Committee of the University of Pretoria (protocol number V038-09). The arterial supply of the reproductive organs was studied and described in situ and after removal and histology was subsequently performed. A novel technique in Veterinary anatomy involving the maceration of a silicone cast was used in the two fresh carcasses and all five specimens were incorporated in the comparative and arterial studies. Histology was performed on organs from the three embalmed cadavers. The anatomical information obtained during this study was subsequently applied in a surgical study on sixteen lionesses using laparoscopy to perform laparoscopic ovariectomy and salpingectomy. The availability of these two laparoscopic procedures subsequently led to a wider interest to its application in population control of lions in the smaller national parks of South Africa.
Dissertation (MSc)--University of Pretoria, 2013.
gm2014
Anatomy and Physiology
unrestricted

A survey of 31 African Americans were conducted at a rural church in the southeastern United States to determine if certain attitudes were more prevalent in that area and if education or age influenced donation patterns. Data were collected using a modified 1990 survey of Georgian's attitudes toward donation and transplantation. T-test was performed to determine if differences in attitudes existed. No differences in attitudes toward organ donation existed with regard to the demographic variables. Religious implications were revealed to have a influence on donation patterns. The theoretical framework used in this study was the cognitive and social learning theory will cause variation in the dependent variable of this study. No statistical significance was found in this study.

Kyoto University (京都大学)
0048
新制・課程博士
博士(農学)
甲第7893号
農博第1051号
新制||農||779(附属図書館)
学位論文||H11||N3256(農学部図書室)
UT51-99-G487
京都大学大学院農学研究科農芸化学専攻
(主査)教授 大山 莞爾, 教授 佐藤 文彦, 教授 關谷 次郎
学位規則第4条第1項該当

Abstract Problems of female urinary incontinence and pelvic organ prolapse are common. Traditional operative techniques in the treatment of these conditions have unsatisfactory efficacy outcomes and involve complications. Attempts have been made to solve this problem with synthetic meshes, but with the use of meshes mesh-related complications have appeared. The situation is difficult because the number of different meshes, techniques and instrumentations is numerous. The present study was conducted to investigate the safety issues and complication rates of four structurally different polypropylene meshes used in transvaginal surgery when treating female urinary incontinence and apical or posterior vaginal prolapse. Vaginal mesh exposures were under special interest. Subjective outcome and patient satisfaction of tension-free vaginal tape (TVT) and transobturator tape (TOT) methods in the treatment of female urinary incontinence were reported. Objective and subjective cures of posterior intravaginal sling (PIVS) and Elevate®Posterior procedures were investigated. The incidence of vaginal mesh exposure varied between different meshes. The highest exposure incidence, 16–25%, was found with heavyweight microporous multifilament mesh. The lowest mesh exposure incidence, 0.9%, was seen with lightweight macroporous monofilament mesh. The subjective cures of the TVT and TOT procedures were 84% and 80%, and patient satisfaction rates were 79% and 74%, respectively. The objective cure of posterior IVS was only 69% and patient satisfaction rate 62%, while Elevate®Posterior reached 84–98% objective cure rate, depending on the definition used. Subjective efficacy of this procedure was 86%. According to this study, the use of heavyweight microporous multifilament should be abandoned because of the intolerably high vaginal mesh exposure incidence. The subjective efficacy and patient satisfaction of TVT and TOT procedures are satisfactory. Both objective and subjective cure rates of posterior IVS are poor, whereas the Elevate®Posterior technique with lightweight macroporous monofilament mesh presents promising results
Tiivistelmä Virtsankarkailu ja emättimen monimuotoiset laskeumat ovat naisilla yleisiä. Näitä vaivoja perinteisillä leikkaustekniikoilla hoidettaessa leikkaustulokset ovat olleet epätyydyttäviä sekä tehon että komplikaatioiden ilmaantuvuuden osalta. Ongelmaa on yritetty ratkaista synteettisien verkkojen avulla, mutta verkkojen käytön myötä niihin on havaittu liittyvän myös ongelmia. Tilannetta hankaloittaa myös erilaisten verkkomateriaalien, tekniikoiden ja instrumentaatioiden runsaslukuisuus. Tässä tutkimuksessa selvitettiin neljän rakenteeltaan erilaisen polypropyleenistä valmistetun verkon turvallisuutta ja komplikaatioiden esiintyvyyttä hoidettaessa verkkoavusteisesti naisen virtsankarkailua ja emättimen pohjukan tai emättimen takaseinämän laskeumaa. Erityisenä kiinnostuksen kohteena olivat verkkoihin liittyvät eroosiot. Virtsankarkailun hoidon subjektiivinen teho ja potilastyytyväisyys selvitettiin käytettäessä tension-free vaginal tape- (TVT) ja transobturator tape (TOT) -tekniikoita. Laskeumien hoidon objektiivinen ja subjektiivinen teho arvioitiin käytettäessä posterior intravaginal sling- (PIVS) ja Elevate®Posterior -tekniikoita. Verkon eroosioiden ilmaantuvuus vaihteli rakenteeltaan erilaisten verkkojen välillä siten, että tiivistä mikroporoottista multifilamenttinauhaa käytettäessä eroosioiden ilmaantuvuus oli 16–25 %, kun taas kevyttä makroporoottista monofilamenttiverkkoa käytettäessä eroosioprosentti oli 0.9. TVT-menetelmällä saavutettiin 84 %:n ja TOT menetelmällä 80 %:n subjektiivinen teho. TVT-potilaista hoitoon tyytyväisiä oli 79 % ja TOT-potilaista 74 %. Posteriorinen IVS saavutti vain 69 %:n objektiivisen tehon pohjukan laskeuman hoidossa. Potilastyytyväisyys oli samaa luokkaa, 62 %. Sen sijaan Elevate®Posterior-menetelmää käytettäessä saavutettiin käytetystä tehon määritelmästä riippuen 84–98 %:n objektiivinen teho. Subjektiivinen teho tällä menetelmällä oli 86 %. Tämän tutkimuksen perusteella tiiviin mikroporoottisen multifilamenttiverkon käyttöön liittyvä verkkoeroosioiden määrä on sietämättömän suuri. Vakiintuneiden TVT- ja TOT-menetelmien subjektiivinen teho ja potilastyytyväisyys ovat hyväksyttäviä. PIVS-metodia käytettäessä sekä objektiivinen että subjektiivinen tulos on huono, kun taas Elevate®Posterior-menetelmän ja siinä käytetyn kevyen verkon käytöstä saadut tulokset ovat lupaavia

Thesis (M.S.)--University of Missouri-Columbia, 2007.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on March 21, 2008) Includes bibliographical references.

The management of advanced cervical and ovarian cancers remains a significant challenge as many women fail to respond to recommended therapy, resulting in disease progression and ultimately patient death. Because of tumour heterogeneity, it is rare for all cancers of a particular type to respond to a specific therapy. Many patients therefore receive treatment from which they derive little or no benefit, leading to increased morbidity and costs. A marker that could rapidly predict disease outcome would clearly be beneficial in allowing the administration of tailored therapy while reducing toxicity and cost. Novel functional imaging techniques have the ability to characterise biological tissues and non-invasively integrate physical and metabolic information. These include diffusion weighted MRI (DW-MRI), which is particularly sensitive to the microscopic motion of water molecules and changes in tissue cellularity, as well as dynamic contrast-enhanced MRI (DCE-MRI) which can assess tumour vascular characteristics during the passage of a paramagnetic contrast agent through tissues. Both imaging techniques have demonstrated potential as biomarkers of tumour response in various malignancies such as brain tumours, but have not been fully explored in gynaecological cancers.

Thesis (DMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: Chapter 1 is a literature review investigating the incidence of cancer in children and young adults. It describes the most important treatment options including chemotherapy, radiotherapy and surgery and the effect of treatment on future endocrine development and fertility. Different primary cancer sites are discussed in more detail. Chapter 2 is a literature review on the effects of cancer surgery in women and the options for fertility sparing. Cervical cancer and pre-cancer are discussed in detail with options for more conservative surgery in selected patients. A summary of the available published cases of trachelectomy with pregnancy outcomes is included. Other gynaecological cancers requiring surgery are also discussed with reference to conservative options. Chapter 3 is a literature review about the medical (pharmacological) options for protection of ovarian function in patients undergoing oncotherapy. The role of gonadotrophin releasing hormone analogues and hormonal contraceptives in ovarian suppression is discussed in detail. Chapter 4 This chapter examines germ cell physiology with reference to cryopreservation. It includes two major parts. Part 1 is the description of germ cell- and follicle physiology, the principles of cryobiology followed by a review of oocyte cryopreservation and ovarian tissue preservation. Both slow freezing and vitrification techniques are described. The second part of chapter 4 is a report on a randomised controlled evaluation of two different slow freezing cryopreservation protocols. This experimental study compared ultrastructural changes in fresh and previously cryopreserved ovarian cortical tissue after equilibration and thawing using two different cryoprotectants. This is the first randomised investigation into DMSO and PROH as cryoprotectants. Chapter 5 is an investigation into cryopreservation of ovarian tissue as a strategy to protect hormonal function and fertility against gonadotoxic treatment. This chapter consists of two parts. The first part is a thorough literature review of all the published work about grafting of previously cryopreserved ovarian tissue. The largest case series found from a single institution was five patients. Another report of six patients included patients from various sites in Denmark. Part 2 is a description of a cohort of patients followed up after re-implantation of previously cryopreserved ovarian cortical tissue. Follow-up hormone levels of 13 individual cases are described in detail. This is the largest case series ever reported. The experimental study described in Chapter 4 and the clinical study described in Chapter 5 was approved by the ethical research committee of the Faculty of Health Sciences, Stellenbosch University, project number N05/10/182. Chapter 6 provides an integrated overview of the incidence and treatment of cancer in young women and how its negative effects may be prevented or mitigated. Aspects of chemotherapy, radiotherapy and surgery are evaluated where it may affect future reproductive health. The role of oocyte and ovarian tissue cryopreservation is discussed. Guidelines are provided for clinicians.
AFRIKAANSE OPSOMMING: Hoofstuk 1 Hierdie is ‘n literatuuroorsig wat die insidensie van kanker in kinders en jong volwassenes ondersoek. Dit sluit die mees belangrike behandelingsopsies in, naamlik chemoterapie, radioterapie en chirurgie en die effek wat behandeling mag hê op toekomstige endokriene ontwikkeling en fertiliteit. ‘n Verskeidenheid kanker tipes word in meer detail beskryf. Hoofstuk 2 Hoofstuk 2 is ‘n literatuuroorsig oor die effekte van kankerchirurgie in vroue en die geleenthede tot beskerming van fertiliteit. Servikale kanker en voorlopers van servikale kanker word bespreek en die opsies vir konserwatiewe chirurgie in uitgesoekte pasiënte word gegee. ‘n Opsomming van die inligting wat beskikbaar is oor tragelektomie en swangerskap uitkomste word ingesluit. Ander ginekologiese kankers wat chirurgie mag benodig, word ook bespreek met verwysing na konserwatiewe hantering. Hoofstuk 3 ‘n Literatuuroorsig oor die mediese (farmakologiese) opsies vir die beskerming van ovariële funksie in pasiënte wat behandeling ontvang vir kanker. Die rol van gonadotropien-vrystellingshormoon-analoë en hormonale kontrasepsie vir ovariële onderdrukking word in detail bespreek. Hoofstuk 4 Hierdie hoofstuk ondersoek kiemselfisiologie met verwysing na vriesbewaring. Dit is verdeel in twee dele. Deel 1 is ‘n beskrywing van kiemsel- en follikelfisiologie en die beginsels van vriesbiologie. Dit word gevolg deur ‘n oorsig van oösiet vriesbewaring en ovariële weefselbewaring. Stadige bevriesing en vitrifikasie- metodes word bespreek. Die tweede deel van hoofstuk 4 is ‘n verslag oor ‘n gerandomiseerde, gekontroleerde evaluasie van twee stadige bevriesingsmetodes. Hierdie eksperimentele studie het die ultrastrukturele veranderinge vergelyk in vars en voorheen bevrore ovariële kortikale weefsel na ekwilibrasie en ontdooiing met twee verskillende vriesbeskermers. Dit is die eerste gerandomiseerde studie oor DMSO en PROH as vriesbeskermers. Hoofstuk 5 Hierdie hoofstuk handel oor ‘n ondersoek na vriesbewaring van ovariële weefsel as ‘n benadering tot beskerming van hormonale funksie en fertiliteit teen gonadotoksiese behandeling. Die hoofstuk bestaan uit twee dele. Die eerste deel is ‘n deeglike oorsig van die literatuur oor al die beskikbare werk wat handel oor terugplasing van voorheen bevrore ovariële weefsel. Die grootste pasiëntreeks van ‘n enkel instelling was slegs vyf pasiënte. ‘n Ander beskrywing van ses pasiënte het pasiënte van verskeie eenhede in Denemarke ingesluit. Deel 2 is ‘n beskrywing van ‘n groep pasiënte wat opgevolg is na oorplanting van voorheen bevrore ovariële kortikale weefsel. Opvolg hormoonvlakke van 13 gevalle word in detail bespreek. Hierdie is die grootste pasiëntreeks wat tot nog toe beskryf is. Die eksperimentele studie wat in hoofstuk 4 beskryf word en die kliniese studie wat in hoofstuk 5 beskryf word, is goedgekeur deur die etiese navorsingskomitee van die Fakulteit Gesondheidswetenskappe van die Universiteit Stellenbosch met die projeknommer N05/10/182 Hoofstuk 6 Hierdie is ‘n geïntegreerde oorsig van die voorkoms en behandeling van kanker in jong vroue en hoe die negatiewe effekte daarvan voorkom of verminder kan word. Aspekte van chemoterapie, radioterapie en chirurgie word geëvalueer ten opsigte van die effek op toekomstige reproduktiewe gesondheid. Die rol van oösiet- en ovariële weefselvriesbewaring word bespreek. Riglyne vir klinici word gegee.

Kyoto University (京都大学)
0048
新制・課程博士
博士(農学)
甲第8416号
農博第1100号
新制||農||798(附属図書館)
学位論文||H12||N3373(農学部図書室)
UT51-2000-F320
京都大学大学院農学研究科農芸化学専攻
(主査)教授 大山 莞爾, 教授 關谷 次郎, 教授 佐藤 文彦
学位規則第4条第1項該当

4-Vinylcyclohexene (VCH) is released during rubber manufacture as an environmental contaminant. It causes destruction of ovarian follicles and ovarian cancer in mice. To determine its long term effects on the female reproductive system, female B6C3F1 mice were administered sesame seed oil or VCH (800 mg/kg) ip daily for 30 days. Mice were killed when in diestrus at 30, 60, 120, 240, or 360 days after VCH administration. Ovaries and uteri were weighed and ovaries prepared for histology. Primary and secondary follicles were counted and FSH determined by RIA. The number of estrous cycles differed from controls in the 30 day group. Uterine weight differed in the 30, 60, and 360 day groups. Primary follicles, secondary follicles and ovarian weight decreased in the VCH groups. FSH increased in the 240 and 360 day VCH groups. These studies indicate that VCH causes a dramatic and permanent reduction in ovarian follicles with a reduction in ovarian weight the most obvious indicator of follicle destruction.

Female pelvic organ dysfunction occurring in eastern and central Africa results in significant morbidity and adverse social and mental health sequelae.Lack of adequate resources available for health care compounds the suffering faced by these women. Obstetric fistula (OF), chronic 4th degree obstetric tears and severe pelvic organ prolapse(POP) are all common gynaecological morbidities seen in Uganda, D.R. Congo and Ethiopia. Despite successful closure of OF, bladder dysfunction and incontinece may persist due to detrusor overactivity, stress urinary incontinence and voiding dysfunction. Chronic 4th degree obstetric tears require effective surgical repair. Women suffering with severe POP need to be given surgical and non‐surgical options of treatment. Non‐surgical options include the availability and use of support pessaries. This research has focused on evaluation of post‐OF bladder dysfunction assessment and treatment options. In particular, urodynamic bladder function studies were utilized and a bulking agent used as an option for post-‐OF repair continence surgery. A surgical repair technique for chronic 4th degree obstetric tears has been described with post‐operative follow‐up of women giving encouraging results. Support pessaries have been introduced and evaluated for women experiencing severe POP. In order to be able to improve treatment and management options available for women affected with such pelvic floor dysfunction, additional information and understanding regarding risk factors and anatomical defects are needed. The relevance of height and age as risk factors for OF have been evaluated here. Pelvic floor anatomy as measured with 4D pelvic floor ultrasound includes levator hiatal dimensions and identification of levator muscle trauma. Assessment of nulliparous Ugandan women has documented differences in levator hiatal dimensions compared to non‐Ugandan women, and Ugandan women with OF,chronic 4th degree obstetric tears and severe POP have also been scanned and levator hiatal areas and incidence of levator muscle trauma compared. Significantly, the levator hiatal area in women with OF is smaller than in women with chronic 4th degree obstetric tears and severe POP. Possible reasons for these findings are discussed. The incidence of levator muscle 3 defects in women with pelvic floor dysfunction is compared with all 3 groups experiencing a similar high rate of complete levator muscle trauma. The social and mental health of women with pelvic floor dysfunction including risk of domestic violence has been assessed. High levels of loss of social cohesion and mental health dysfunction have been identified in women with OF, chronic 4th degree obstetric tears and severe POP. The social and mental health of women with pelvic floor dysfunction including risk of domestic violence has been assessed. High levels of loss of social cohesion and mental health dysfunction have been identified in women with OF, chronic 4th degree obstetric tears and severe POP. Through identifying and highlighting the health sequelae faced by women with pelvic floor dysfunction including OF, chronic 4th degree obstetric tears and severe POP, effective treatment and management options can be evaluated and promoted. Further research is required to consolidate the peri­operative outcomes of the surgical techniques described here with functional long­term outcomes necessary to guide future recommendations. Understanding risk factors associated with the development of pelvic floor dysfunction may guide strategies for prevention. Social and mental health dysfunction needs to be identified and addressed within this group of women with the availability of adequate support networks and treatment. In addition, there must be community­wide awareness of the prevalence of domestic violence with effective solutions promoted.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medicine
Griffith Health
Full Text

O Lobo-marinho-sul-americano (A. australis) apresenta particularidades em seu ciclo reprodutivo que revelam sua interação com o ecossistema onde habita. Dentre estas podemos citar o intervalo entre partos de 12 meses, a sincronização dos partos e cópulas no início do verão, umlongo período de diapausa e uma implantação do blastocisto no inicio do inverno, que ocorre 4 a 5 meses após a cópula. A anatomia e fisiologia reprodutivas desta espécie ainda não foram profundamente estudadas. O presente trabalho tem como objetivo, a partir do emprego de métodos não invasivos de pesquisa, descrever a anatomia, histologia, quando possível a ultraestrutura, e a vascularização arterial dos órgãos genitais femininos, bem como investigar proteínas e RNAs mensageiros de fatores de crescimento relacionados à vascularização nestes tecidos. Os dados morfológicos foram correlacionados com dados ambientais, oriundos de estações climatológicas próximas à área da colônia estudada. O A. australis apresenta especializações morfológicas passíveis de correlação com o ambiente, hábitos reprodutivos e ciclo reprodutivo sazonal. Estas estruturas foram identificadas como importantes em momentos específicos da biologia reprodutiva e auxiliam na manutenção do status de conservação da espécie. Análises dos dados climatológicos e sua relação com as variações durante o ano revelam que os eventos do parto, cópula e implantação embrionária, ocorrem em momentos onde as maiores variações ambientais acontecem. Os dados morfológicos revelam que existe uma interação entre o ciclo reprodutivo e as especializações anatômicas dos órgãos genitais femininos
The South-American-fur-seal (A.australis) presents unique features in its reproductive cycle, which reflect their interaction with the ecosystem where it lives. The parturition interval of 12 months, synchronization of parturition and copulation in the beginning of the summer, long diapause and implantation of the blastocyst in the beginning of the winter, which occurs 4 to 5 months after copulation are some of these features. The anatomy and reproductive physiology of this species have not been widely studied. This work describes the anatomy, histology, some ultrastructural characteristics, and the main arterial vascularization of the female genital organs using non invasive methods. Moreover, this study investigates the proteins and messenger RNAs of growth factors which are related to vascularization in these tissues. An association between morphological and environmental data from climatology stations near the area of the studied colony was investigated. A. australis presented morphological specialization in genital organs, which might be related to the environment, reproductive habits and seasonal reproductive cycle. Some of these identified structures are essential in specific stages of A. australis reproductive biology, and play an important role in the maintenance and conservation status of this species. Analysis of climatological data and their relation with changes over the year showed that parturition, copulation and embrionary implantation occur in time periods where the highest environmental variations take place. Morphological data revealed an interaction between the reproductive cycle and the anatomic specialization of female genital organs

Orientador: Rogério Saad Hossne
Coorientador: Sidney Roberto Nadal
Banca: Fábio Vieira Teixeira
Banca: Maria Aparecida C. Arruda Henry
Resumo: O Papiloma Vírus Humano (HPV), é considerado um problema mundial de saúde pública, sendo a doença sexualmente transmissível mais prevalente. Guarda uma relação direta com o risco e a incidência do câncer do canal anal. Seu diagnóstico, tratamento e seguimento são de extrema importância. Neste sentido o escovado do canal anal tem um papel fundamental no rastreamento e seguimento das lesões HPV induzidas e consequente evolução para o câncer anal. Determinar a ocorrência de lesão HPV induzida em mulheres que participam dos programas de prevenção do câncer de colo uterino nas Unidades Básicas de Saúde (UBS) no município de Botucatu. Trata-se de um estudo transversal observacional que teve 228 mulheres submetidas ao escovado do canal anal a fim de estabelecer a ocorrência de lesão HPV induzida e suas correlações com dados sociais e comportamentais. Os 11 casos que apresentaram alteração de ASCUS e LSIL no escovado do canal anal traziam relação com estado civil, baixa escolaridade, não prática do sexo seguro, e a prática do sexo anal
Abstract: Human Papillomavirus (HPV) has been a world concern in Public Health, and it is the most prevalent sexually transmitted disease. It has a direct association with the risk and incidence of cancer in the anal canal. Its diagnosis, treatment and follow-up are extremely important. Using this approach, the smear of the anal canal has a crucial role in the screening and follow up of HPV-induced lesions and in the resulting development of anal cancer. To determine the occurrence of HPVinduced lesions in women who attended programs of uterine cervix cancer prevention in Basic Health Units (BHU) in Botucatu city. It is a cross sectional observational study, in which 228 women underwent brushing of the anal canal in order to establish the occurrence of HPV-induced lesion and its correlation with social and behavioral data. The 11 cases which had ASCUS and LSIL changes in the smear of the anal canal were associated with marital status, low education level, practice of unsafe intercourse and anal intercourse
Mestre

UVOD: Maligni tumori reproduktivnih organa nalaze se među vodećim uzrocima obolevanja i umiranja od malignih bolesti žena, kako u svetu, tako i u Srbiji. Jedan od najvažnijih puteva širenja ovih bolesti je limfogeni, a konvencionalna radiološka dijagnostika limfnih čvorova kod ovih pacijentkinja je neprecizna. Funkcionalna radiološka dijagnostika, uključujući i magnentno rezonantnu sekvencu difuzionog kretanja (DWI) i iz nje izvedenu ADC mapu koja omogućava kvantitativnu analizu difuzionih osobina unutar limfnog čvora, daju obećavajuće rezultate u mogućnosti razlikovanja benignih od maligno izmenjenih limfnih čvorova male karlice i ingvinuma kod pacijentkinja obolelih od malignih tumora ženskih polnih organa. CILJ: Cilj studije je 1. utvrđivanje dijagnostičkih mogućnosti magnetnorezonantne sekvence difuzionog kretanja (DWI) u razlikovanju benignih od maligno izmenjenih limfnih čvorova male karlice i ingvinuma kod pacijentkinja obolelih od malignih tumora ženskih polnih organa, poređenjem preoperativno načinjenog magnetnorezonantnog pregleda i postoperativnog patohistološkog nalaza; 2. analiza povezanosti osobina metastatski izmenjenih limfnih čvorova na sekvenci difuzionog kretanja (DWI) i gradusa primarnog tumora, i 3. utvrđivanje uticaja tehničkih karakteristika sekvenci difuzinonog kretanja (DWI) na magnetnorezonantu procenu metastatske infiltracije karličnih i ingvinalnih limfnih čvorova i postoperativnog patohistološkog nalaza. MATERIJAL I METODE: Istraživanje je sprovedeno u periodu od 2013. do 2016.godine, kao prospektivna klinička studija u Centru za radiologiju, na Operativnom odeljenju Zavoda za ginekologiju, Klinike za ginekologiju i akušerstvo i u Zavodu za patologiju Kliničkog Centra Vojvodine u Novom Sadu. Studija je obuhvatila 80 pacijentkinja obolelih od malignih tumora vulve, vagine, grlića materice, tela materice i jajnika. Na osnovu lokalizacije malignog tumora sve ispitanice su razvrstane u 5 grupa: grupa A- 3 žene obolele od carcinoma vulve, grupa B- 1 žena obolela od karcinoma vagine, grupa C-32 pacijentkinje obolele od karcinoma grlića materice, grupa D- 30 pacijentkinja obolelih od malignih tumora tela materice i grupa E- 14 žena obolelih od malignih tumora jajnika. Procena stadijuma bolesti definitivno je izvršena posle operacije na osnovu histopatološkog pregleda kompletnog hirurškog materijala uključujući i pregled uklonjenih limfnih čvorova na osnovu aktuelne FIGO klasifikacije stadijuma bolesti zasebno za svaku pojedinačnu lokalizaciju malignog tumora. Svim pacijentkinjama je preoperativno načinjen magnetnorezonantni pregled male karlice na uređaju za magnetnu rezonancu 1.5 T General Electric Signa HDx u Centru za radiologiju, Kliničkog centra Vojvodine. Kod istih pacijentkinja naknadno je sprovedeno standardno hirurško lečenje po protokolu hirurškog lečenja za dato maligno ginekološko oboljenje sa karličnom i/ili ingvinalnom limfadenektomijom. Postoperativno je izvršena patohistološka analiza hirurški uklonjenog materijala i limfnih čvorova razdvojenih po anatomskim grupama u karlici i ingvinalnoj regiji. REZULTATI: Ukupno 2320 limfnih čvorova je mapirano i patohistološki pregledano kod 80 pacijenata. Metastaze u limfnim čvorovima patohistološki su verifikovane kod 28 pacijenata (35%). Kod ovih 28 (35%) pacijentkinja, 152 (27,28%) od ukupno 557 limfnih čvorova bilo je metastatski izmenjeno na patohistološkom pregledu. Metastaze u limfnim čvorovima utvrđene su kod 2 pacijentkinje (7,14%) sa karcinomom vulve, 11 (39,28%) sa karcinomom cerviksa, 9 (32,14%) sa tumorima tela materice, te 6 (21,42%) sa tumorima jajnika. Od 28 pacijentkinja kod kojih su utvrđeni pozitivni limfni čvorovi, 14 pacijentkinja (50%) imalo je dobro diferentovan primarni tumor, 8 (28,57%) srednje diferentovan, dok je 6 (21,42%) imalo loše diferentovan primarni tumor. Od ukupno 152 metastatski izmenjena limfna čvora u našoj studiji, 8 limfnih čvorova (5,26%) pripadalo je ingvinalnoj grupi od čega 5 (3,289%) površnoj ingvinalnoj, a 3 ( 1,97%) dubokoj ingvinalnoj grupi, 8 (5,26%) parametrijalnoj grupi, 48 (31,58%) opturatornoj grupi, 40 (26,31%) spoljašnjoj ilijačnoj grupi, 36 (23,684%) unutrašnjoj ilijačnoj grupi, dok je 12 (7,89%) pripadalo zajedničkoj ilijačnoj grupi karličnih limfnih čvorova. Kraći prečnik limfnog čvora nije pokazao značajnu razliku između metastatskih ( mean ± SD, 8,3 ± 5.4 mm, raspon , 4.5-30 mm ) i limfnih čvorova koji nisu bili metastatski izmenjeni ( 6,3 mm ± 1,5 , 4,5-9,6 mm ; P= 0,191 ). Izmerena ADC vrednost bila je značajno niža kod metastatski izmenjenih limfnih čvorova (mean ± SD , ADC: 0,8725 x 10-3 mm2/s ± 0,0125) nego kod limfnih čvorova koji nisu bili metastatski izmenjeni (mean ± SD, ADC: 1,116 x 10- 3 mm2/s ± 0,1848; P=0,001). Prosečne vrednosti ADC kod b =800 s/mm2 i b =1200 s/mm2 nisu se značajno razlikovale između metastaski izmenjenih limfnih čvorova (mean ± SD, ADC: 0,8575 ± 0,0125 x 10-3 mm2/s, ADC:0,8859 ± 0,0125 x 10-3 mm2/s) i limfnih čvorova koji nisu metastatski izmenjeni (mean ± SD, ADC:1,0345 ± 0,1222 x 10-3 mm2/s, ADC:1,1125 ± 1638 x 10-3 mm2/s; P =0,657 i P = 0,877). Ako se koristi vrednost ADC od 0,860 x 10- 3 mm2 / s kao kritična vrednost za razlikovanje metastatskih od limfnih čvorova koji nisu metastatski izmenjeni, senzitivnost DWI MR iznosila je 89%, specifičnost 85% i ukupna tačnost 86%. Pozitivna prediktivna vrednost (PPV) DWI MR u detekciji limfnih metastaza u karličnoj i ingvinalnoj regiji iznosila je 30%. Negativna prediktivna vrednost (NPV) testa iznosila je 99%. Pozitivna prediktivna vrednost (PPV) MR zasnovana na kriterijumu ADC vrednosti značajno je veća u odnosu na sve kriterijuma veličine (P < 0,001). Negativna prediktivna vrednost MR zasnovanoj na kriterijumima veličine limfnog čvora i na ACD vrednosti nisu se međusobno statistički značajno razlikovali (P<0,05). Performanse dijagnostičke metode (MR) bile su značajno bolje za minimalnu ADC vrednost od svih kriterijuma baziranih na veličini limfnih čvorova ( P=0.001 za minimalnu ADC vrednost u odnosu na sve druge kriterijume). MRI na osnovu definisanog modela koji kombinuje kriterijum ADC vrednosti sa kriterijumom veličine ima sledeće dijagnostičke performanse za diferencijaciju malignih od benignih limfnih čvorova: senzitivnost od 95%, specifičnost 92%, sveukupna tačnost od 92,5%, pozitivnu prediktivnu vrednost od 46% i negativnu prediktivnu vrednost od 99.6%. ZAKLJUČAK: Kriterijum veličine limfnog čvora nije dovoljno precizan pokazatelj metastatske invazije limfnih čvorova. Sekvenca difuzionog kretanja (DWI) uvek se mora analizirati zajedno sa ADC mapom i visoko rezolutivnim T1 i T2 otežanim magnetnorezonantnim sekvencama. Studijom je dokazan visok stepen povezanosti između preoperativnog određivanja metastaske infiltracije karličnih i ingvinalnih limfnih čvorova malignih tumora ženskih polnih organa primenom sekvence difuzionog kretanja (DWI) i postoperativnog patohistološkog nalaza. Uz graničnu ADC vrednost od 0,860 x 10-3 mm2/ s, senzitivnost MRI DWI u otkrivanju metastatskih limfnih čvorova iznosi 89%, a specifičnost 85%. Kombinacija ADC vrednosti i morfoloških karakteristika limfnih čvorova konvencionalnim magnentno rezonantnim pregledom je najprecizniji prediktor postojanja metastatske infiltracije karličnih i ingvinalnih limfnih čvorova kod pacijentkinja sa malignim tumorima ženskih polnih organa. Tehničke karakteristike sekvenci difuzionog kretanja (DWI) u smislu razlike u visokim b vrednostima ne utiču na magnentno rezonantnu procenu metastatske infiltracije karličnih i ingvinalnih limfnih čvorova kod pacijentkinja sa malignim tumorima ženskih polnih organa. Studijom nije utvrđena statistički značajna razlika između preoperativno utvrđenih ADC vrednosti metastatski izmenjenih limfnih čvorova i stepena histološke diferencijacije ovih tumora. Sekvenca difuzionog kretanja (DWI) je brza, jednostavna, neinvazivna metoda koja značajno doprinosi dijagnostičkim mogućnostima magnetne rezonance u razlikovanju benignih od malignih limfnih čvorova male karlice i ingvinuma.
INTRODUCTION: Malignant tumors of reproductive organs are among the leading causes of morbidity and mortality in women, both in Serbia and worldwide. Lymphatic spread is one of the most important pathways of tumor dissemination. However, conventional lymph node imaging in these patients is imprecise. Functional imaging, including diffusion-weighted magnetic resonance imaging (DWI MRI) and derived ADC map which allows quantitative analysis of diffusion parameters within a lymph node, provide promising results in discrimination benign from malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. AIM: Aim of the study was: 1. To assess diagnostic performances of DWI MRI in differentiation between benign and malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies, by comparison of preoperative magnetic resonance and postoperative histopathological findings. 2. To analyze correlation between DWI characteristics of metastatic lymph nodes and grade of the primary tumor, and 3. To evaluate the influence of technical characteristics of DWI sequences on MR assessment of metastatic pelvic and inguinal lymph node and postoperative histopathological findings. MATERIAL and METHODS: The prospective clinical study was conducted in Center for Radiology, Surgery Department of Clinic for Gynecology and Obstetrics and Pathology Department of Clinical Center of Vojvodina from 2013 to 2016. It comprised 80 patients with malignant tumors of vulva, vagina, uterine cervix and body and ovaries. Based on the localization of the tumor, all patients were divided into 5 groups: group A-3 patients with vulvar cancer, group B- 1 patient with vaginal cancer, group C- 32 patients with cervical cancer, group D- 30 patients with uterine body tumors and group E- 14 patients with malignant ovarian tumors. Staging of the disease was performed after surgery based on histopathological examination of complete surgical specimen, including examination of removed lymph nodes, based on current FIGO classification separately for each primary tumor location. Preoperatively, all patients underwent MRI examination (1.5 T General Electric Signa HDx) at Center for Radiology, Clinical Center of Vojvodina. The same patients underwent standard surgical treatment according to the treatment protocol regarding the tumor type and stage, with complete pelvic and/or inguinal lymphadenectomy. Histopathological examination of surgically removed material and lymph nodes separated in pelvic and inguinal anatomic groups was performed after the surgery. RESULTS: The total of 2320 of lymph nodes were mapped and histopathologically examined in 80 patients included in the study. Metastases in lymph nodes were histopathologically confirmed in 28 patients (35%). In these 28(35%) patients, in 152 (27,28%) out of 557 lymph nodes histopathological examination confirmed metastases. Lymph node metastases were confirmed in 2 patients (7.14%) with vulvar cancer, 11 (39.28%) with cervical cancer, 9 (32.14%) with uterine body tumors and 6 (21.42%)patients with ovarian tumors. In 28 patients with positive lymph nodes, 14 patients (50%) had well differentiated primary tumor, 8 (28.57%) moderately differentiated, while 6 (21.42%) patients had poorly differentiated primary tumor. Out of 152 metastatic lymph nodes in our study, 8 lymph nodes (5.26%) were inguinal ( 5 (3.289%) superficial inguinal and 3 ( 1.97%) deep inguinal group), 8 (5.26%) were parametrial, 48 (31. 58%) obturatory, 40 (26.31%) external iliac, 36 (23.684%) internal iliac, while 12 (7. 89%) belonged to common iliac pelvic lymph nodes group. Shorter lymph node axis did not show significant difference between metastatic ( mean ± SD, 8.3 ± 5.4 mm, range , 4.5-30 mm ) and benign lymph nodes ( 6.3 mm ± 1.5 , 4.5-9.6 mm ; P= 0.191 ). Measured ADC values were significantly lower in metastatic (mean ± SD , ADC: 0.8725 x 10-3 mm2/s ± 0.0125) than benign lymph nodes (mean ± SD, ADC: 1.116 x 10-3 mm2/s ± 0.1848; P=0.001). Mean ADC values at b =800 s/mm2 and b =1200 s/mm2 did not differ significantly between metastatic (mean ± SD, ADC: 0.8575 ± 0.0125 x 10-3 mm2/s, ADC:0.8859 ± 0,0125 x 10-3 mm2/s) and benign lymph nodes (mean ± SD, ADC:1.0345 ± 0.1222 x 10-3 mm2/s, ADC:1.1125 ± 1638 x 10-3 mm2/s; P =0.657 i P = 0.877). If ADC value of 0.860 x 10- 3 mm2 / s is determined as a cut off value for discrimination of benign and malignant lymph nodes, DWI MRI sensitivity was 89%, specificity 85% and overall accuracy was 86%. Positive predictive value (PPV) of DWI MR in detection of pelvic and inguinal lymph node metastases was 30%. Negative predictive value (NPV) of the test was 99%. MRI PPV based on ADC value criteria was significantly higher compared to all size-based criteria (P < 0,001). MRI NPV based on size based and ADC values criteria did not differ significantly (P<0,05). Performances of diagnostic method (MRI) were significantly better for minimal ADC value compared to all lymph node size-based criteria ( P=0.001 for minimal ADC value compared to all other criteria). Combination of ADC value criteria and size-based criteria yields MRI the following diagnostic performances in discrimination between benign and malignant lymph nodes: sensitivity 95%, specificity 92%, overall accuracy 92.5%, positive predictive value 46% and negative predictive value 99.6%. CONCLUSION: Lymph node size is not sufficiently precise criteria for determination of metastatic lymph node involvement. DWI sequence always needs to be evaluated together with ADC map and high resolution T1W and T2W magnetic resonance sequences. The study shows high correlation between preoperative assessment of pelvic and inguinal lymph node metastases from gynecological malignancies using MRI DWI and postoperative histopathological findings. With a cut off ADC value of 0.860 x 10-3 mm2/ s, sensitivity of MRI DWI in metastatic lymph node detection is 89%, while specificity is 85%. Combination of ADC values and morphological lymph nodes characteristics assessed by conventional MRI is the most precise predictor of metastatic pelvic and inguinal lymph node invasion in patients with gynecological malignancies. Technical characteristics of DWI i.e. different high b-values do not influence MR assessment of metastatic pelvic and inguinal lymph node involvement in patients with gynecological malignancies. The study did not confirm statistically significant difference between preoperatively measured ADC valued of metastatic lymph nodes and histological grade of primary tumors. DWI MRI sequence is fast, simple, noninvasive method which aids significantly to MRI diagnostic performances in discrimination between benign and malignant pelvic and inguinal lymph nodes.

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Espécies de lactobacilos são os principais componentes da microbiota vaginal e a manutenção do predomínio lactobacilar é importante para proteção desse ambiente contra possíveis patógenos. A vaginose bacteriana é uma condição em que se observa a perda de lactobacilos e substituição desses microrganismos por espécies bacterianas, anaeróbias em sua maioria. Tal condição pode acarretar inúmeras complicações ginecológicas e obstétricas, como o aumento do risco de aquisição de infecções sexualmente transmissíveis, parto prematuro e baixo peso ao nascimento. O principal método utilizado para o diagnóstico da vaginose bacteriana é o proposto por Nugent et al. (1991) e se baseia na classificação da microbiota vaginal em flora normal, intermediária e vaginose bacteriana. Enquanto que o perfil imunológico e microbiológico da vaginose bacteriana tenha sido amplamente estudado, pouco se sabe sobre tais características na flora intermediária. Portanto, o objetivo desse estudo foi caracterizar a flora intermediária quanto aos níveis cérvico-vaginais de Interleucina (IL)1-beta, IL-6, IL-8, IL-10, fator de necrose tumoral (TNF)-alfa, antagonista de receptor de IL-1(IL-1ra), sialidases bacterianas e quanto às cargas de Gardnerella vaginalise de bactérias totais, além de verificar se o perfil geral observado na flora intermediária se assemelha ao de mulheres com flora normal ou com vaginose bacteriana. Foi realizado um estudo transversal que incluiu 526 mulheres não grávidas em idade reprodutiva. Deste total, foram constituídos os grupos de estudo de acordo com o padrão de flora vagina, segundo Nugent et al. Todos os 145 casos de vaginose bacteriana foram incluídos nas análises, bem como os 63 casos de flora intermediária e 145 das 318 mulheres que apresentaram flora normal. A determinação dos níveis cérvico-vaginais de citocinas, sialidases e a carga bacteriana foram realizados por, respectivamente, ELISA, ...