Biomedical subjects

M F Silva de Sá

Publications and source records attributed to M F Silva de Sá.

At least 19 recordsLinked to original sources

PubMed2005

Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, randomized, placebo-controlled study.

BACKGROUND: The present study assessed the effects of low-dose acarbose on obese patients with polycystic ovarian syndrome (PCOS). METHODS: A double-blind placebo-controlled study was conducted on 30 obese hyperinsulinaemic women with PCOS treated with 150 mg/day acarbose or placebo for 6 months. The women were evaluated for hirsutism, menstrual regularity, body mass index (BMI), insulin resistance and glucose tolerance, sex hormone-binding globulin (SHBG), LH, FSH, testosterone and androstenedione, and side-effects. RESULTS: The patients in the acarbose group showed a reduction in BMI (35.87 +/- 2.60 versus 33.10 +/- 2.94 kg/m(2)) and in the Ferriman-Gallwey index (8.85 +/- 2.31 versus 8 +/- 1.82), and an increased chance of menstrual regularity (rate = 2.67). SHBG concentration increased (21.01 +/- 7.9 versus 23.85 +/- 7.77 nmol/l) and the free androgen index was reduced (14.81 +/- 9.06 versus 11.48 +/- 6.18). None of these parameters were modified in the placebo group. Mild side-effects occurred in 84% of the patients in the acarbose group and disappeared after the first 3 months. CONCLUSION: A low dose of acarbose administered to obese patients with PCOS promotes a reduction in free androgen index and BMI and an increase in SHBG, with improvement of hirsutism and of the menstrual pattern, and is well tolerated by patients.

Acarbose↗

PubMed2004

Estradiol and testosterone concentrations in follicular fluid as criteria to discriminate between mature and immature oocytes.

The objective of the present study was to examine the association between follicular fluid (FF) steroid concentration and oocyte maturity and fertilization rates. Seventeen infertile patients were submitted to ovulation induction with urinary human follicle-stimulating hormone, human menopausal gonadotropin and human chorionic gonadotropin (hCG). A total of 107 follicles were aspirated after hCG administration, the oocytes were analyzed for maturity and 81 of them were incubated and inseminated in vitro. Progesterone, estradiol (E2), estrone, androstenedione, and testosterone were measured in the FF. E2 and testosterone levels were significantly higher in FF containing immature oocytes (median = 618.2 and 16 ng/ml, respectively) than in FF containing mature oocytes (median = 368 and 5.7 ng/ml, respectively; P < 0.05). Progesterone, androstenedione and estrone levels were not significantly different between mature and immature oocytes. The application of the receiver-operating characteristic curve statistical approach to determine the best cut-off point for the discrimination between mature and immature oocytes indicated levels of 505.8 ng/ml for E2 (81.0% sensitivity and 81.8% specificity) and of 10.4 ng/ml for testosterone (90.9% sensitivity and 82.4% specificity). Follicular diameter was associated negatively with E2 and testosterone levels in FF. There was a significant increase in progesterone/testosterone, progesterone/E2 and E2/testosterone ratios in FF containing mature oocytes, suggesting a reduction in conversion of C21 to C19, but not in aromatase activity. The overall fertility rate was 61% but there was no correlation between the steroid levels or their ratios and the fertilization rates. E2 and testosterone levels in FF may be used as a predictive parameter of oocyte maturity, but not for the in vitro fertilization rate.

Adult↗

PubMed2004

Positive correlation of serum leptin with estradiol levels in patients with polycystic ovary syndrome.

Patients with polycystic ovary syndrome (PCOS) usually are obese, insulin resistant and hyperinsulinemic. The known association between leptin, obesity and insulin action suggests that leptin may have a role in PCOS but this has only been addressed peripherally. This study was designed to assess the relationship between serum leptin and the anthropometric, metabolic and endocrine variables of obese (body mass index, BMI (3)30 kg/m(2)) and non-obese (BMI <30 kg/m(2)) PCOS patients. Twenty-eight PCOS patients and 24 control women subdivided into obese and non-obese groups were evaluated. Leptin, androgens, lipids, gonadotrophins and insulin-glucose response to the oral glucose tolerance test were measured by radioimmunoassay in all participants. The assays were done all in one time. The areas under the insulin curve (AUC-I) and the glycemia curve were calculated to identify patients with insulin resistance. Mean leptin levels were not significantly higher in patients with PCOS compared to the control group (21.2 +/- 10.2 vs 27.3 +/- 12.4 ng/ml). Leptin levels were found to be significantly higher in the obese subgroups both in patients with PCOS (26.9 +/- 9.3 vs 14.1 +/- 7.0 ng/ml) and in the control group (37.3 +/- 15.5 vs 12.9 +/- 5.8 ng/ml). The leptin of the PCOS group was correlated with BMI (r = 0.74; P < 0.0001) and estradiol (r = 0.48; P < 0.008) and tended to be correlated with the AUC-I (r = 0.36; P = 0.05). Of the parameters which showed a correlation with leptin in PCOS, only estradiol and probably insulinemia (AUC-I) did not show a significant correlation with BMI, suggesting that the other parameters were correlated with leptin due to their correlation with BMI. Estradiol correlated with leptin in PCOS patients regardless of their weight.

Adolescent↗

PubMed2004

Effect of metformin on the clinical and metabolic assessment of women with polycystic ovary syndrome.

A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS), aged 27.20 +/- 5.02 years and treated with metformin (1500 mg/day)for 8 weeks. The patients were assessed for spontaneous menstruation, weight, body mass index (BMI), waist circumference, waist/hip ratio (WHR), glucose and insulin concentrations under fasting conditions and after a 75-g glucose tolerance test, lipid profile, testosterone, androstenedione, dehydroepiandrosterone sulfate, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF)-I. Spontaneous menstruation was observed in 81% of the women treated with metformin, with no changes in weight or BMI. Waist measurement and the WHR were reduced. The quantitative insulin sensitivity check index (QUICKI) improved from 0.33 +/- 0.03 to 0.35 +/- 0.04 (p < 0.005), and serum total cholesterol and low-density lipoprotein-cholesterol were reduced, while high-density lipoprotein-cholesterol was increased. Serum testosterone concentrations were also reduced. There were no differences in serum triglycerides, SHBG or IGF-I. The occurrence of spontaneous menstruation and changes in the pattern of body fat distribution, the reduction in serum testosterone concentrations, the improvement in lipid profile and the reduction of insulinemia with the use of metformin permit us to conclude that treatment with this drug is of benefit to women with PCOS.

Adolescent↗

PubMed2003

Effects of raloxifene therapy on the anticoagulant system in postmenopausal women.

BACKGROUND: Raloxifene therapy is associated with a three-fold increase in the risk for venous thromboembolism; however, its effects on the hemostatic system in postmenopausal women have not been well defined. OBJECTIVE: To determine the effects of raloxifene therapy on the levels of natural anticoagulant proteins in postmenopausal women. METHODS: Sixteen healthy postmenopausal women were enrolled in this prospective longitudinal study. The patients were treated with raloxifene hydrochloride (60 mg/day) for a period of 6 months. Antithrombin and protein C activities and protein S antigen levels were measured in all users at baseline, and after 1, 3 and 6 months of treatment. Statistical analysis included one-way analysis of variance (ANOVA) and the Bonferroni test for multiple comparisons among the study periods. RESULTS: Statistically significant 5.1% and 6.5% reductions of plasma antithrombin activity were observed at 3 and 6 months of therapy, respectively (p < 0.05). Compared with baseline, raloxifene did not significantly affect protein C activity or protein S level. CONCLUSIONS: The results of this prospective study show for the first time that raloxifene use is associated with a significant reduction in plasma antithrombin activity. This effect may contribute to a procoagulant state and partly explain the increased risk of venous thromboembolism in raloxifene users.

Aged↗

PubMed2001

Heart rate variability under resting conditions in postmenopausal and young women.

The aim of the present study was to compare the modulation of heart rate in a group of postmenopausal women to that of a group of young women under resting conditions on the basis of R-R interval variability. Ten healthy postmenopausal women (mean +/- SD, 58.3 +/- 6.8 years) and 10 healthy young women (mean +/- SD, 21.6 +/- 0.82 years) were submitted to a control resting electrocardiogram (ECG) in the supine and sitting positions over a period of 6 min. The ECG was obtained from a one-channel heart monitor at the CM5 lead and processed and stored using an analog to digital converter connected to a microcomputer. R-R intervals were calculated on a beat-to-beat basis from the ECG recording in real time using a signal-processing software. Heart rate variability (HRV) was expressed as standard deviation (RMSM) and mean square root (RMSSD). In the supine position, the postmenopausal group showed significantly lower (P<0.05) median values of RMSM (34.9) and RMSSD (22.32) than the young group (RMSM: 62.11 and RMSSD: 49.1). The same occurred in the sitting position (RMSM: 33.0 and RMSSD: 18.9 compared to RMSM: 57.6 and RMSSD: 42.8 for the young group). These results indicate a decrease in parasympathetic modulation in postmenopausal women compared to young women which was possibly due both to the influence of age and hormonal factors. Thus, time domain HRV proved to be a noninvasive and sensitive method for the identification of changes in autonomic modulation of the sinus node in postmenopausal women.

Adult↗

PubMed2000

Hypogonadotropic hypogonadism: retrospective analysis of 19 cases.

OBJECTIVES: To survey the clinical data of patients with isolated gonadotropin deficiency. METHODS: We retrospectively surveyed the medical records of 19 patients with isolated gonadotropin deficiency aged 16-31 years (mean: 20 years). The major complaint was primary amenorrhea in 100% of the patients, with 42.1% of them also reporting absence of secondary sex traits, and 10% reporting anosmia or hyposmia. Seventy-four percent of the patients had been submitted to hormonal replacement therapy. RESULTS: Bone densitometry was determined in 5 patients and revealed lumbar spine osteopenia in 3 patients and femoral osteopenia in 1. An association with urologic malformations was detected in 10.5% of cases and an association with gynecologic malformations was detected in 31.6%. CONCLUSIONS: Isolated gonadotropin deficiency can be easily diagnosed but requires early estrogen replacement therapy because of a higher risk of osteopenia and consequently of osteoporosis. Concomitant urogenital malformations are frequent and should be investigated.

Adolescent↗

PubMed1995

Cortisol levels alter the response to metoclopramide in patients with hypothalamic amenorrhea.

The reduction in frequency and/or amplitude of gonadotropin-releasing hormone (GnRH) pulses in patients with amenorrhea of hypothalamic origin has been attributed to increased dopamine activity. The objective of the present study was to determine the role of dopamine in the pathogenesis of hypothalamic amenorrhea. Fourteen patients with hypothalamic amenorrhea, nine of whom had psychogenic amenorrhea and five anorexia nervosa, were studied and compared with nine normal women during the early follicular phase. Metoclopramide (10 mg), a dopamine antagonist, was infused intravenously and blood samples were collected at 15-min intervals for 2 h for follicle-stimulating hormone (FSH) and luteinizing hormone (LH) measurement by radioimmunoassay. Both the hypothalamic amenorrhea (psychogenic amenorrhea and anorexia nervosa) and control groups were unresponsive to FSH, suggesting that dopamine may have little or no effect on FSH secretion. Five patients of the psychogenic amenorrhea group responded to LH (responsive psychogenic amenorrhea) and four did not (non-responsive psychogenic amenorrhea). No anorexia nervosa or control patient responded to the stimulus. Responsive psychogenic amenorrhea patients showed decreased basal cortisol levels compared to the non-responsive psychogenic amenorrhea and anorexia nervosa groups. It is possible that patients with exclusive alterations in the dopaminergic system are those who respond to metoclopramide (responsive psychogenic amenorrhea group), whereas patients who also have involvement of the hypothalamic-adrenal axis like the women with anorexia nervosa, are not responsive to metoclopramide and tend to have elevated cortisol levels. The non-responsive psychogenic amenorrhea group, with elevated cortisol levels, probably represents an intermediate step between the responsive psychogenic amenorrhea and anorexia nervosa patients.

Adolescent↗

PubMed1995

Insulin secretion in obese and non-obese women with polycystic ovary syndrome and its relationship with hyperandrogenism.

Insulin resistance has been reported to be associated with hyperandrogenism and polycystic ovaries. To study the prevalence of insulin resistance in patients with polycystic ovary syndrome (PCO) and the correlation between hyperinsulinemia and hyperandrogenism, 48 patients were divided into four groups: group 1, non-obese ovulatory women (n = 10); group 2, obese ovulatory women (n = 9); group 3, non-obese women with PCO (n = 14); group 4, obese women with PCO (n = 15). Each patient was submitted to an oral glucose tolerance test (OGTT). Glucose, insulin, androstenedione and testosterone levels were determined and the blood glucose and insulin response of women with PCO and normal women were compared. Glucose intolerance was observed in group 3 (28.6%) and group 4 (40%) but not in groups 1 or 2, and hyperinsulinemia was observed in group 2 (66.7%), group 3 (64.3%) and group 4 (86.6%). There was a correlation between androstenedione and testosterone levels and insulinemia in group 4. There was also a high prevalence of insulin resistance in patients with PCO regardless of obesity, and hyperandrogenism-aggravated insulin resistance.

Adolescent↗

PubMed1990

Ureteral blockage as a complication of Burch colposuspension: report of 6 cases.

Burch colposuspension for correction of urinary incontinence is rarely followed by complications. A very rarely described complication is ureteral kinking, which tends to occur in patients with previous pelvic surgeries. We present 6 additional cases of this rare complication and recommend appropriate intraoperative dissection as well as postoperative alert for early diagnosis, which improves prognosis.

Female↗

PubMed1989

Estriol reduces the reactivity of the human umbilical artery to mechanical stimuli.

The effect of estriol on the reactivity of the human umbilical artery to mechanical stimulation was studied using an in vitro perfusion method. The mechanical stimuli were produced by force applied to the outer surface of the vessel through a system consisting of a lever with equal length arms which was activated by small weights of known mass placed on one of the arms. The contractions of the preparations were proportional to the weights applied. When a 0.5-gram stimulus was applied, the mean contractile response of seven preparations was 46.7 +/- 2.72 mm Hg (mean +/- SEM). The addition of 10 micrograms/ml estriol to the nutrient fluid (Tyrode) caused a (mean 6.8 +/- 1.32 mm Hg) reduction of the response to the mechanical stimuli. We suggest that estrogens, and estriol in particular, play an important role in the modulation of the reactivity of the human umbilical artery during pregnancy in the presence of the mechanical stimulation caused by intrauterine fetal movements.

Estriol↗

PubMed1989

Progesterone alters the pituitary response to luteinizing hormone releasing hormone in postmenopausal women previously treated with estradiol.

The effect of luteinizing hormone-releasing hormone (LHRH) on LH release was studied in 5 menopausal women injected with progesterone. Each patient received 2 x 100 micrograms doses of LHRH administered intravenously 120 minutes apart under the following conditions: without any previous treatment (test 1); 16 hours after intramuscular injection of 10 mg progesterone (test 2); after 3-4 weeks of oral treatment with 50 micrograms/day of ethinyl estradiol (EE2) (test 3); 16 hours after intramuscular injection of 10 mg progesterone following treatment with 50 micrograms/day oral EE2 for 3-4 weeks (test 4). The interval between tests was at least 1 month. Progesterone decreased the total plasma hormonal increment (PHIt) of hypogonadal women, with a reduction in plasma hormonal increment both after the 1st stimulus (PHI1) and after the 2nd stimulus (PHI2), whereas estradiol increased PHIt, mainly due to an increase of PHI2. The administration of progesterone to hypogonadal women previously treated with EE2 maintained the increased PHIt caused by the latter, but not owing to a greater increase in PHI1.

Drug Interactions↗

PubMed1989

Dopamine might not be involved in the pathogenesis of polycystic ovary syndrome.

The possible alteration in dopamine (DA) metabolism as an etiological factor was investigated in 31 normoprolactinemic patients with typical polycystic ovary syndrome (PCOS) in comparison with 14 normal women (early follicular phase). Subjects were submitted to intravenous infusion of 4 micrograms/kg DA per minute over a period of 3 hours and blood samples were collected every 30 minutes over a period of 5 hours. Two days later subjects were submitted to intravenous infusion of 10 mg metoclopramide (MCP) as a bolus and blood samples were collected every 15 minutes over a period of 2 hours. Dopamine infusion caused a similar maximum decrease (MD) in LH levels in both the PCOS and control groups (50.9% and 47.5%, respectively). No changes in plasma LH levels were observed in either group after MCP infusion. Dopamine caused a 50.2% and 60.4% MD in prolactin (PRL) in the PCOS and control groups, respectively, the difference being statistically non-significant. Metoclopramide increased PRL levels by 1261.0% and 1832.0% in the PCOS and control groups, respectively (not significant). In a double-blind study, the PCOS patients were treated with 5 mg/day bromocriptine (n = 16) or placebo (n = 15) over a period of 3 months and evaluated in clinical and laboratory terms during and after treatment. Seven patients in each group had monthly menstrual periods, but only 1 in each group had an ovulatory cycle (progesterone greater than 5 ng/ml). During treatment, median plasma PRL levels were significantly decreased only in bromocriptine-treated patients (10.8 vs 7.3 ng/ml). The present results lead us to question whether dopamine is indeed involved in the pathogenesis of normoprolactinemic PCOS and whether bromocriptine treatment is of benefit in this type of patients.

Adolescent↗

PubMed1988

Differences between serum and urinary LH in hypergonadotropic states.

In an attempt to investigate the relationship between molecular configuration, immunoreactivity, radioligand binding, and biological activity, we compared the elution profiles of immunoreactive and radioligand receptor-active LH following gel filtration over Sephadex G-100 (1.6 X 100 cm column). Samples of sera and urinary acetone-insoluble material from normal cycling women during the LH surge (n = 4) and postmenopausal (n = 2) and castrate women (n = 2) were examined. One major peak of LH immunoreactivity was present in the sera and the urinary samples from all subjects. However, this peak of immunoreactive LH in the urinary precipitate consistently occurred 8-10 fractions later than the peak activity observed in the sera. Despite the differences in the profiles of immunoreactivity between sera and urinary precipitates, the major peak of radioligand receptor activity for LH was observed in the same fractions in all samples and corresponded to the major peak of immunoreactivity observed in the sera. Thus, binding activity was sometimes observed in urinary fractions containing little immunoreactivity for LH. Bioassay of selected fractions using the rat interstitial cell-testosterone assay revealed good agreement between receptor activity and bioactivity but not between immunoreactivity and bioactivity. The ratios of total radioreceptor-active to total immunoreactive LH were consistently higher in the sera than in the urinary precipitates. These data suggest alterations in molecular form during metabolism and/or excretion of LH. Whether these alterations represent differences in peptide structure or merely carbohydrate moieties remains to be determined.

Chromatography, Gel↗

PubMed1988

Molecular forms of LH subunits in hypergonadotropic states.

To determine whether differences in subunits of LH exist in various hypergonadotropic states, we compared the elution profiles of immunoreactive alpha LH and beta LH following gel filtration over Sephadex G-100 (1.6 X 100 cm column) of sera and urinary acetone-insoluble precipitates from normal cycling women during the LH surge and untreated agonadal women and those receiving estrogen replacement. The elution profiles for the alpha subunit were similar in all subjects in both sera and urinary precipitates. In contrast, the elution profiles of beta LH varied between sera and urinary extracts among the 3 groups of subjects. Sera and urinary precipitates from the individual agonadal women eluted identically, but the profiles were distinct from those in samples from each of the cycling women. Exogenous estrogen therapy had no effect on the elution profiles of immunoreactive urinary beta LH in agonadal women but altered the ratios of beta LH/alpha LH excreted to those observed in normal cycling women. These data document the existence of immunoreactive subunits of LH in sera and urinary acetone-insoluble precipitates and confirm the existence of multiple forms of immunoreactive beta LH. The data further suggest that gonadal steroids may modulate the metabolism and/or excretion of beta LH in various hypergonadotropic states.

Chromatography, Gel↗

PubMed1988

Prolactin levels in blood from the intervillous space of the human placenta.

The secretory products of the human placenta are released in the intervillous space (IS), which also represents the main site of maternal-fetal exchange. This compartment, however, has not been studied in terms of prolactin (PRL) metabolism during gestation. In the present study we determined PRL levels in maternal peripheral (MP) blood, in blood from the IS and in blood from the umbilical artery (UA) and vein (UV) of 24 clinically normal parturients and their concepti. PRL levels in MP plasma (means = 111.7 +/- 5.5 ng/ml) did not differ significantly (p greater than 0.05) from those in IS plasma (means = 131.6 +/- 64.3 ng/ml). PRL levels in UA plasma (means = 206.2 +/- 67.5 ng/ml) also showed no significant difference (p greater than 0.05) from those in UV plasma (means = 243.8 +/- 86.1 ng/ml) but both were significantly higher than MP and IS plasma levels (p less than 0.01). These data permit us to conclude that the placenta may not be the source of PRL circulating in maternal peripheral blood.

Chorionic Villi↗

PubMed1988

Measurement of T4, T3 and reverse T3 levels, resin T3 uptake, and free thyroxin index in blood from the intervillous space of the placenta, in maternal peripheral blood, and in the umbilical artery and vein of normal parturients and their conceptuses.

T4, T3, and reverse T3 (rT3) levels and the free thyroxine index were measured in blood collected from the intervillous space (IVS) after placental expulsion and compared to the values in maternal peripheral blood and in umbilical artery and umbilical vein of 21 clinically normal parturients and their conceptuses. T4 levels in maternal peripheral blood did not differ significantly from T4 levels in the IVS, but were significantly higher than those detected in umbilical vein and artery (p less than 0.05). There was no difference in T4 levels between umbilical vein and artery. The free thyroxine index was similar for the maternal compartments (maternal peripheral blood and IVS), but differed significantly from the fetal compartments (umbilical vein and umbilical artery). T3 levels in maternal peripheral blood were significantly higher than in the IVS, both of these values being significantly higher than in the fetal compartments. There was no difference in T3 levels between umbilical vein and artery. rT3 levels of maternal peripheral blood were one third that of the IVS (p less than 0.05). rT3 levels of the umbilical vein were 1.5 times higher than those of the IVS (p less than 0.05) and 5.2 times higher than those of maternal peripheral blood (p less than 0.005). No significant difference was obtained between umbilical vein and artery. The increase in rT3 and the decrease in T3 in the IVS in relation to maternal peripheral blood support the hypothesis that the placenta may preferentially convert T4 to rT3 at the expense of T3. The present data, however, do not permit the identification of the site where this conversion takes place.

Chorionic Villi↗

PubMed1986

Effect of estradiol on the pituitary response to intravenous stimulation with luteinizing hormone-releasing hormone in menopausal women.

Five menopausal patients were submitted to stimulation with 100-micrograms doses of luteinizing hormone-releasing hormone (LH-RH) administered 120 minutes apart under three different types of conditions: (1) in a hypoestrogenic state (test 1); (2) in a hyperestrogenic state after acute intravenous bolus injection of 400 micrograms 17 beta-estradiol (E2) (test 2); (3) in a hyperestrogenic state after daily oral administration of 50 micrograms ethinyl E2 for 3 to 4 weeks (test 3). The results of the three tests showed that (1) the time needed to reach maximum LH values after LH-RH injection was longest in test 3; (2) the hormonal production rate (HPR) in test 1 was greatest after the first stimulus with LH-RH. In test 2, the two stimulations with LH-RH induced an equivalent HPR, whereas in test 3, the HPR was greatest after the second stimulation; (3) the correlation between basal LH values before LH-RH injection and the maximal values of the responses obtained after each injection changed throughout the experiment. In all three tests, the slope of the line (significant positive correlation) was always greater after the second stimulation. When the three tests were compared, the slope in test 3 was greater than in test 2, and the slope in test 2 greater than in test 1. These results clearly suggest the important role of estrogens in the regulation of LH release in women by acting not only at the hypothalamus but also at the pituitary level, and demonstrate a correlation between basal LH levels and the maximum response to LH-RH stimulation. This correlation is more marked during estrogen treatment and depends on the time of exposure to estrogen.

Estrogens↗