Contexte  Le cancer colorectal, deuxième par ordre de fréquence chez les femmes françaises, se développe principalement à partir de lésions précancéreuses, des adénomes. Les facteurs associés à l’obésité sont multiples, incluant des événements de début de vie, le niveau socio-économique et le comportement alimentaire ; l’obésité a aussi été associée de façon assez constante au risque de cancer colorectal. Cependant les associations entre des facteurs anthropométriques spécifiques ou au cours de la vie et le risque de tumeurs colorectales selon la filiation adénome-cancer ou selon le site sont moins claires. La ménopause est un événement de vie majeur et est associée à des modifications anthropométriques, tandis que le traitement hormonal de la ménopause (THM) est susceptible d’interagir avec les aspects anthropométriques mais aussi directement avec le risque de tumeur. De plus, la prescription du THM dépend de plusieurs paramètres, dont l’importance du suivi médical. Enfin, si le dépistage des tumeurs colorectales est conseillé à partir de 50 ans (soit aux environs de la ménopause) les attitudes vis-à-vis du dépistage varient selon de nombreux paramètres incluant les antécédents familiaux de cancer, le niveau socio-économique et les comportements de santé. Objectif  Le risque de tumeurs colorectales dépend ainsi de nombreux facteurs étroitement liés, parmi lesquels nous avons choisi d’étudier les relations complexes entre facteurs anthropométriques au cours de la vie, utilisation de THM et antécédents personnels de coloscopie, et le risque d’adénomes et de cancers colorectaux. Population  Les analyses ont été effectuées sur les données de la cohorte de femmes françaises E3N, comportant environ 1400 cas d’adénomes diagnostiqués parmi 17000 femmes ayant passé une coloscopie au cours du suivi (1993-2002) et 690 cas de cancers diagnostiqués parmi 92000 femmes au cours du suivi (1990-2008). Résultats  Notre étude a mis en évidence plusieurs aspects originaux. Tout d’abord, nous avons mis en évidence que les trois facteurs d’exposition principaux étudiés étaient associés au risque de tumeurs colorectales de façon significativement hétérogène en fonction du site, renforçant l’hypothèse selon laquelle il existe trois entités bien distinctes le long du cadre colorectal. Les caractéristiques anthropométriques typiquement occidentales (IMC et tour de taille élevés) étaient associées à un risque accru de tumeurs du côlon gauche, tandis que les associations originales que nous avons décrites entre taille assise et risque d’adénomes du côlon droit, et entre corpulence dans l’enfance et plus faible risque d’adénomes du rectum suggèrent de nouvelles pistes de recherche pour ces sites à l’étiologie mal connue. La mise en évidence d’une association positive entre prise de THM de type estrogènes seul (habituellement prescrit aux femmes hystérectomisées) et risque d’adénomes, en particulier du côlon gauche, et d’une association inverse entre le même type de THM et le risque de cancer, en particulier du côlon gauche, n’étant pas cohérentes avec les associations décrites dans la littérature, nous a conduit a explorer un éventuel biais de dépistage. La pratique de coloscopie était effectivement plus fréquente chez les femmes utilisant des estrogènes seuls (et donc aux antécédents d’hystérectomie), tandis que les antécédents de fibrome utérin étaient associés à un risque accru d’adénomes. De leur côté, les antécédents personnels de coloscopie étaient associés à une diminution de risque de cancer, surtout du côlon gauche, tandis que la réduction de risque des cancers du rectum devenait semblable à celle observée pour le côlon gauche dans la période la plus récente. Conclusion  En conclusion, nos résultats suggèrent qu’il existe des moyens efficaces de prévention des tumeurs distales, mais que la prévention des tumeurs du côlon droit demande des études spécifiques et peut-être de nouveaux paradigmes. / Background  Colorectal cancer, the second most common cancer in French women, mostly develops from precancerous lesions, the adenomas. Factors associated with adult obesity are multiple, including early life events, the socio-economic level, and eating habits; obesity has also been, in turn, quite consistently associated with colorectal cancer risk. However, associations between specific anthropometric components or lifetime anthropometry and colorectal tumours according to the adenoma-carcinoma sequence or to tumour site are less clear. Menopause is a major event in women, and is associated with changes in anthropometric features, while menopausal hormone therapy (MHT) may interact with post-menopausal anthropometry but also with tumour risk per se. In addition, prescription of this MHT depends on various parameters including quality of medical follow-up. Finally, while screening for colorectal tumours is advocated after the age of 50 (thus around menopausal age), attitudes towards colorectal screening differ according to many factors including family history of cancer, the socio-economic level, and attitudes towards a healthy behaviour. Objective  Thus colorectal tumour risk depends on many interrelated factors, among which we chose to investigate the complex relationship between lifetime anthropometric features, MHT use and personal history of colonoscopy, and colorectal adenoma and cancer risk. Population  This study was based on data from the French E3N cohort, including approximately 1400 adenoma cases diagnosed among 17000 women who underwent a colonoscopy during follow-up (1993-2002), and 690 cancer cases diagnosed among 92000 women (1990-2008).Results  Our study brought out several original findings. First our findings regarding all three major studied exposures displayed significant heterogeneity between sites, thus enforcing the hypothesis of separate entities according to site along the large bowel. Typical Western anthropometric features (high BMI and high waist circumference) were associated with left colon tumours, while the original findings of sitting height associated with risk of right colon tumours and of a large silhouette in childhood inversely associated with rectal tumours may bring out new hypotheses regarding these less understood sites. The findings of a positive association between estrogens only MHT use (usually prescribed in hysterectomised women) and adenoma risk, especially left colon adenomas, and an inverse association between the same MHT and cancer risk, especially left colon cancer, which are not consistent with associations generally described in the literature, led us to explore potential screening biases. Indeed, colonoscopy screening was more common in women who used estrogens alone (so with a history of hysterectomy), while colorectal adenomas were more common in women with uterine leiomyoma. Colonoscopy screening in turn was associated with a reduced risk of colorectal cancer, especially left colon cancer, while the risk reduction for rectal cancers became similar to that of left colon cancer in the most recent years. Conclusion  Altogether, our findings suggest efficient ways to prevent distal tumours, while prevention of right colon tumours requires further specific investigations and new paradigms.

Contexte : Le cancer est la seconde cause de mortalité chez la femme en France, et la première chez les femmes âgées de 35 à 84 ans. Le cancer du sein est le cancer le plus fréquemment diagnostiqué, représentant 35 % des cas chez les femmes en France en 2012. De multiples facteurs, comportementaux et non-Comportementaux, augmentant le risque de cancer, tant en incidence qu’en mortalité, ont été identifiés dans la littérature, tandis que leur influence conjointe est très peu évaluée. Dans le cas du cancer du sein, certains facteurs diffèrent selon le statut ménopausique des femmes, suggérant une étiologie différente entre les cancers du sein diagnostiqués avant et après la ménopause. Objectif : Les données de la cohorte prospective française E3N ont été utilisées pour évaluer l’influence des facteurs comportementaux et non-Comportementaux sur le risque de cancer et de mortalité chez les femmes avant et après la ménopause. Nous avons également cherché à estimer leur impact relatif sur la population et à identifier les facteurs à forts pouvoirs prédictifs.Résultats : Nos résultats suggèrent que le mode de vie a une influence modeste sur le risque de cancer et de mortalité lors de l’adhésion à une seule recommandation de santé publique. En revanche, elle est conséquente lors d’une adhésion conjointe à plusieurs recommandations. Les facteurs comportementaux jouent ainsi un rôle non négligeable dans la survenue de cancer et sur le risque de décès prématuré. Dans le cas du cancer du sein, ces facteurs influencent particulièrement le risque après la ménopause, tandis qu’avant la ménopause leur impact est plus faible que les facteurs qui ne relèvent pas du mode de vie ou de choix personnels. Ces observations sont retrouvées lorsque l’on cherche à prédire le risque de cancer du sein avant et après la ménopause. En effet, la prédiction du risque de cancer du sein en préménopause s’établit principalement à partir de facteurs non-Comportementaux, alors que la prédiction du risque en postménopause est également déterminée par des facteurs comportementaux.Conclusion : Nous avons montré que l’étiologie du cancer du sein diffère selon la nature de la tumeur, et en particulier selon le statut ménopausique des femmes. À tout âge, le mode de vie a une influence sur le risque de cancer et de mortalité prématurée, particulièrement après la ménopause lorsque leur impact est supérieur à celui des facteurs non-Comportementaux. Ces résultats demandent, cependant, à être reproduits dans des études prospectives portant sur des femmes plus jeunes. / Background: Cancer is the second leading cause of mortality among women in France, and the leading cause of mortality among women aged between 35 and 84. Breast cancer is the most frequently diagnosed cancer, with 35% of cases among women in France in 2012. Multiple behavioural and non-Behavioural factors have been associated with increases in cancer incidence and mortality. However, the literature about their combined impact is scarce. Regarding breast cancer, some risk factors differed according to the menopausal status, suggesting a different etiology between premenopausal and postmenopausal breast cancers.Objectives: Data from the E3N prospective cohort of French women were used to evaluate the influence of behavioural and non-Behavioural factors on cancer risk before and after the menopause and on mortality. In addition, we aimed at estimating their relative impact on the population and identifying factors with the highest predictive power.Results: Our results suggest a modest influence of the lifestyle on cancer risk and mortality when adhering to only one public health recommendation. However, the influence is substantial with a combined adherence to several recommendations. Behavioural factors play a key role in the occurrence of cancer and mortality risk. Regarding breast cancer, these factors influence particularly the risk after the menopause, while before, their impact is lower than non-Behavioural factors. These observations were retrieved when aiming at predicting breast cancer risk according to menopausal status. Prediction was established by non-Behavioural factors in premenopause, while the prediction in postmenopause was driven by behavioural factors.Conclusion: We have shown that the etiology of breast cancer differs according to the nature of the tumour, and particularly according to the menopausal status of women. Whatever the age, lifestyle influence the risk of cancer and mortality, especially after the menopause when their impact is higher than the non-Behavioural factors’ one. New results from prospective study on younger women are warranted to confirm the results.

This study examines the production and the introduction of a fertility treatment which gained great attention both in Sweden and internationally during the 1960s. In the procedure, hormones were extracted from human pituitary glands which had been collected from autopsies. After this, the hormones were purified and injected into the female patients as a treatment for certain kinds of sterility. Carl Gemzell, professor of obstetrics and gynecology at Uppsala University, was a key figure in the development of the treatment. He was described by the media as a medical pioneer and later became one of Sweden’s most famous doctors and scientists. The fertility treatment also gained a lot of attention in the media as ”the miracle drug that made barren women pregnant”, especially since it often resulted in multiple pregnancies. In the 1960s, pregnancies with quadruplets, quintuplets, sextuplets and even septuplets became world sensations. By using the sociology of expectations as theoretical approach, which focuses on the performativity of expectations and visions in science production, this study aims to investigate how expectations of an effective fertility method were articulated in both the scientific sphere and in the media. This of course also relates to how the risks of the multiple pregnancies were dealt with. The analysis is divided into three chapters, where the first chapter examines the politics of science in Sweden during the post-war period and how Gemzell’s work in Uppsala generated expectations of a scientific milieu on the front line of fertility research. The next chapter is focused on the media’s interest in Gemzell and how he became a celebrity. A central argument for the study is that his public status helped to create scientific credibility for the treatment, especially among the public. The final chapter focuses on the media reporting about the multiple pregnancies. They were often treated as sensations, which was somewhat paradoxical as they were hazardous and frequently resulted in the death of the premature children.

O tratamento do hipogonadismo hipogonadotrófico na mulher adulta com hipopituitarismo inclui diversas alternativas terapêuticas de estrógenos e progestágenos, sendo a via oral a de menor custo e a de maior comodidade à paciente. A rota estrogênica oral, entretanto, exerce marcada influência sobre o eixo hormônio de crescimento/fator de crescimento insulinasímile número 1 (GH/IGF-1) nessas mulheres. O tratamento com estrógenos orais, concomitante ao uso de GH em pacientes com hipopituitarismo, antagoniza as ações biológicas do GH e agrava as anormalidades de composição corporal e o metabolismo em geral. Presume-se que o estrógeno oral iniba a secreção/produção de IGF-1 através de um efeito de primeira passagem hepática, causando um aumento da secreção de GH através de inibição do feedback negativo de IGF-1 em mulheres normais. Isso é demonstrado clinicamente por redução da massa magra, aumento da massa gorda, perfil lipídico aterogênico e prejuízo do bem-estar psicológico. Alguns estudos apontam que os progestágenos com ação androgênica revertem o efeito de diminuição dos níveis séricos de IGF-1 induzida pelos estrógenos orais. Progestágenos neutros não apresentam esse efeito, porém, quanto maior a potência androgênica, maior será a reversão do efeito de diminuição de IGF-1. Na presente revisão da literatura, serão abordados os aspectos clínicos da reposição com estrógenos e progestágenos nas mulheres com hipopituitarismo, suas interações nas outras deficiências hormonais, bem como o impacto do uso de estrógenos sobre as ações metabólicas do GH. / Treatment of hypogonadotropic hypogonadism in adult woman with hypopituitarism can include a wide range of estrogen and progestogen treatment alternatives, and oral administration is the route of least cost and greatest patient comfort. The oral estrogen route has a major impact on the growth hormone-insulin-like growth factor I (GH-IGF-I) axis. Oral estrogen therapy, when given concurrently with GH to patients with hypopituitarism, antagonizes the biological effects of GH treatment and aggravates the abnormalities of body composition and the metabolism in general. It is presumed that oral estrogen suppresses the secretion/production of IGF-1 by a hepatic first-pass mechanism, resulting in increased GH secretion by means of suppressing the IGF-I negative feedback that is present in healthy women. This is manifest clinically in reduced lean body mass, increased fat mass, an atherogenic lipid profile and damage to psychological well-being. Some studies have indicated that progestogens with androgenic actions reverse the effect of reduced serum IGF-1 levels that is induced by the oral estrogens. Neutral progestogens do not exert this effect, however the stronger the androgenic potential, the more the effect of reduced IGF-1 will be reversed. This bibliographical review will deal with the clinical aspects of estrogen and progestogen replacement in women with hypopituitarism, their interactions with other hormone deficiencies and the impact of estrogen treatment on the metabolic actions of GH.

O tratamento do hipogonadismo hipogonadotrófico na mulher adulta com hipopituitarismo inclui diversas alternativas terapêuticas de estrógenos e progestágenos, sendo a via oral a de menor custo e a de maior comodidade à paciente. A rota estrogênica oral, entretanto, exerce marcada influência sobre o eixo hormônio de crescimento/fator de crescimento insulinasímile número 1 (GH/IGF-1) nessas mulheres. O tratamento com estrógenos orais, concomitante ao uso de GH em pacientes com hipopituitarismo, antagoniza as ações biológicas do GH e agrava as anormalidades de composição corporal e o metabolismo em geral. Presume-se que o estrógeno oral iniba a secreção/produção de IGF-1 através de um efeito de primeira passagem hepática, causando um aumento da secreção de GH através de inibição do feedback negativo de IGF-1 em mulheres normais. Isso é demonstrado clinicamente por redução da massa magra, aumento da massa gorda, perfil lipídico aterogênico e prejuízo do bem-estar psicológico. Alguns estudos apontam que os progestágenos com ação androgênica revertem o efeito de diminuição dos níveis séricos de IGF-1 induzida pelos estrógenos orais. Progestágenos neutros não apresentam esse efeito, porém, quanto maior a potência androgênica, maior será a reversão do efeito de diminuição de IGF-1. Na presente revisão da literatura, serão abordados os aspectos clínicos da reposição com estrógenos e progestágenos nas mulheres com hipopituitarismo, suas interações nas outras deficiências hormonais, bem como o impacto do uso de estrógenos sobre as ações metabólicas do GH. / Treatment of hypogonadotropic hypogonadism in adult woman with hypopituitarism can include a wide range of estrogen and progestogen treatment alternatives, and oral administration is the route of least cost and greatest patient comfort. The oral estrogen route has a major impact on the growth hormone-insulin-like growth factor I (GH-IGF-I) axis. Oral estrogen therapy, when given concurrently with GH to patients with hypopituitarism, antagonizes the biological effects of GH treatment and aggravates the abnormalities of body composition and the metabolism in general. It is presumed that oral estrogen suppresses the secretion/production of IGF-1 by a hepatic first-pass mechanism, resulting in increased GH secretion by means of suppressing the IGF-I negative feedback that is present in healthy women. This is manifest clinically in reduced lean body mass, increased fat mass, an atherogenic lipid profile and damage to psychological well-being. Some studies have indicated that progestogens with androgenic actions reverse the effect of reduced serum IGF-1 levels that is induced by the oral estrogens. Neutral progestogens do not exert this effect, however the stronger the androgenic potential, the more the effect of reduced IGF-1 will be reversed. This bibliographical review will deal with the clinical aspects of estrogen and progestogen replacement in women with hypopituitarism, their interactions with other hormone deficiencies and the impact of estrogen treatment on the metabolic actions of GH.

The aim of this diploma thesis was to summarize the topic of the anterior cruciate ligament (LCA) injury dependency on the menstrual cycle phase of young women with regular sport activity. The general part describes basic knowledge about connective tissue, LCA, issues of LCA injury and related risk situations. Large chapter is dedicated to sex hormones and menstrual and ovarian cycle, which is crucial for understanding the whole topic. The main part is focused on impact of sex hormones and hormonal contraception on connective tissue, but also on muscle and nervous tissues, which might be as well important for LCA injury incidence. Next part of the thesis consists of a questionnaire survey. 52 respondents aged 15-35 with rupture or partial rupture of LCA answered the non-standardized questionnaire compiled specially for this thesis and the results were statistically processed. 14 respondents were using hormonal contraception, remaining 38 had physiological menstrual cycle. Based on the theoretical findings we expected highest incidence of LCA injuries among women without contraception in phases of menstrual cycle with highest levels of oestrogen (10th -15th day). That was confirmed (P-value: 0,0218) as well as overall lower incidence among women using contraception (P-value: 0,0006). Expected higher...

A acidez do solo é um dos principais fatores limitantes à produção vegetal. A toxicidade por alumínio, que ocorre apenas a pH baixo, tem sido extensamente investigada, enquanto o estresse causado pelo pH baixo tem recebido pouca atenção. Os estudos nesta área quase sempre presumem efeitos aditivos, e portanto independentes, da toxicidade por Al3+ e H+. Este provavelmente não é o caso, sendo que o pH baixo pode ser um fator de predisposição das células ao Al3+. As evidências indicam que o pH baixo causa desarranjos na parede de células em crescimento, gerando estresse que pode comprometer a sua funcionalidade e integridade. É provável que a susceptibilidade a este estresse deve ser dependente da pressão de turgor. Por sua vez, o metabolismo oxidativo e a geração de espécies reativas de oxigênio (ROS) na parede celular podem modular a sua extensibilidade por romper ou criar ligações dentro ou entre cadeias de polissacarídeo. Há grande interesse em se conhecer se, à semelhança do que ocorre em leveduras, as células vegetais possuem um sistema de percepção e resposta a estresse da parede. Os pêlos radiculares em crescimento são sensíveis a pH baixo e estresse hipo-osmótico e constituem um bom modelo experimental para estes estudos. Os objetivos deste trabalho foram: a) Otimizar um sistema experimental para o estudo de pêlos radiculares de tomateiro (Solanum lycopersicum L. cv Micro-Tom); b) Avaliar as respostas dos pêlos radiculares ao estresse por pH baixo e hipo-osmolaridade; c) Examinar o papel da modulação oxidativa da parede celular nestas respostas; e d) Avaliar a resposta de diferentes mutantes hormonais de Micro-Tom a estes fatores de estresse. Os principais parâmetros avaliados foram a taxa de alongamento (µm.min-1) e a freqüência de rompimento dos pêlos. Tanto o estresse por pH baixo quanto choques hipo-osmóticos resultaram em taxas de alongamento significativamente diminuídos e o rompimento de pêlos radiculares, mas os efeitos dos tratamentos hipo-osmóticos foram mais marcantes. Uma curva de resposta frente à osmolaridade da solução externa revelou que a taxa de alongamento aumentou com a diminuição da osmolaridade até alcançar um limiar em que houve redução drástica da taxa de alongamento e começou-se a observar o rompimento de pêlos. Também se observou uma interação entre hipo-osmolaridade e pH baixo. O emprego do inibidor difenileno iodônio não forneceu evidências do envolvimento de NADPH oxidases da membrana plasmática na resposta de pêlos radiculares a choque hipo-osmótico ou pH baixo. Já no caso do inibidor ácido salicilhidroxâmico, encontrou-se evidências do envolvimento de peroxidases da parede. Nos mutantes hormonais dgt (pouco sensível a auxina) e epi (super produtor de etileno), mas não em not (deficiente em ácido abscísico), os pêlos radiculares apresentaram uma melhor resposta de ajustamento a choque hipo-osmótico do que Micro-Tom, reduzindo o alongamento e o rompimento dos pêlos. Este trabalho fornece fortes evidências de que os pêlos radiculares possuem um mecanismo de percepção e resposta a estresse da parede visando à manutenção de sua integridade e que apresentam bom potencial como sistema modelo nesta linha de pesquisa / Soil acidity is a major factor limiting plant growth worldwide. Aluminum toxicity, which occurs only at low pH, has been extensively studied, whereas low pH stress has received much less attention. Studies on Al3+ and H+ toxicity make the underlying assumption that the effects of these stress factors are additive, and, therefore independent of each other. However, this is most likely not the case and low pH may be a factor which increases susceptibility to further injury by Al3+. There is evidence that low pH causes disruption in cell wall structure of growing cells, which might jeopardize cell wall functionality and integrity. It is likely that turgor pressure plays an important role in cell wall stress caused by low pH. The apoplastic metabolism of reactive oxygen species (ROS) can modulate cell wall extensibility by making or breaking bonds within and between cell wall polysaccharides. A major question is whether, similarly to yeast, plant cells have a cell wall integrity signaling and response system. Growing root hairs are sensitive to low pH and hypo-osmotic stress and are potentially good experimental systems for such investigations. The objectives of this study were: a) Optimize an experimental system to examine tomato (Solanum lycopersicum L. cv Micro-Tom) root hairs; b) Examine the response of root hairs to low pH and hypo-osmotic stress; c) Examine the role of oxidative modulation of the cell wall in these responses; and d) Evaluate the response of different hormonal mutants of Micro-Tom to these stress factors. Root hair elongation rates (µm.min-1) and the frequency of cell bursting were the major experimental parameters which were evaluated. Both low pH and, more markedly, hypo-osmotic stress caused significant reductions in elongation rates and the bursting of root hair tips. In a response curve to varying osmolarities of the external medium, root hair elongation rates increased with decreasing osmolarities until a threshold was reached and elongation rates decreased drastically and the bursting of root hairs began to be observed. Interactions between low pH and hypo-osmolarity were observed. The use of the inhibitor diphenylene iodonium (DPI) did not provide evidence for the involvement of plasma membrane NADPH in the response of root hairs to low pH and hypo-osmotic shock. However, a role for cell wall peroxidases was provided by use of the inhibitor salicylhydroxamic acid (SHAM). Root hairs of the hormonal mutants dgt (low sensitivity to auxin) and epi (ethylene super producer), but not not (deficient in abscisic acid), displayed a more effective response to hypo-osmotic shock than Micro-Tom, by decreasing elongation rates and cell bursting to a greater degree. This study provides strong evidence to suggest that root hairs have a cell wall integrity response system and that root hairs are potentially good cell model systems for such research

O tratamento do hipogonadismo hipogonadotrófico na mulher adulta com hipopituitarismo inclui diversas alternativas terapêuticas de estrógenos e progestágenos, sendo a via oral a de menor custo e a de maior comodidade à paciente. A rota estrogênica oral, entretanto, exerce marcada influência sobre o eixo hormônio de crescimento/fator de crescimento insulinasímile número 1 (GH/IGF-1) nessas mulheres. O tratamento com estrógenos orais, concomitante ao uso de GH em pacientes com hipopituitarismo, antagoniza as ações biológicas do GH e agrava as anormalidades de composição corporal e o metabolismo em geral. Presume-se que o estrógeno oral iniba a secreção/produção de IGF-1 através de um efeito de primeira passagem hepática, causando um aumento da secreção de GH através de inibição do feedback negativo de IGF-1 em mulheres normais. Isso é demonstrado clinicamente por redução da massa magra, aumento da massa gorda, perfil lipídico aterogênico e prejuízo do bem-estar psicológico. Alguns estudos apontam que os progestágenos com ação androgênica revertem o efeito de diminuição dos níveis séricos de IGF-1 induzida pelos estrógenos orais. Progestágenos neutros não apresentam esse efeito, porém, quanto maior a potência androgênica, maior será a reversão do efeito de diminuição de IGF-1. Na presente revisão da literatura, serão abordados os aspectos clínicos da reposição com estrógenos e progestágenos nas mulheres com hipopituitarismo, suas interações nas outras deficiências hormonais, bem como o impacto do uso de estrógenos sobre as ações metabólicas do GH. / Treatment of hypogonadotropic hypogonadism in adult woman with hypopituitarism can include a wide range of estrogen and progestogen treatment alternatives, and oral administration is the route of least cost and greatest patient comfort. The oral estrogen route has a major impact on the growth hormone-insulin-like growth factor I (GH-IGF-I) axis. Oral estrogen therapy, when given concurrently with GH to patients with hypopituitarism, antagonizes the biological effects of GH treatment and aggravates the abnormalities of body composition and the metabolism in general. It is presumed that oral estrogen suppresses the secretion/production of IGF-1 by a hepatic first-pass mechanism, resulting in increased GH secretion by means of suppressing the IGF-I negative feedback that is present in healthy women. This is manifest clinically in reduced lean body mass, increased fat mass, an atherogenic lipid profile and damage to psychological well-being. Some studies have indicated that progestogens with androgenic actions reverse the effect of reduced serum IGF-1 levels that is induced by the oral estrogens. Neutral progestogens do not exert this effect, however the stronger the androgenic potential, the more the effect of reduced IGF-1 will be reversed. This bibliographical review will deal with the clinical aspects of estrogen and progestogen replacement in women with hypopituitarism, their interactions with other hormone deficiencies and the impact of estrogen treatment on the metabolic actions of GH.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / The essential oil (EOs) extracted from plants Hesperozygis ringens and Lippia alba possess anesthetic and sedative properties and is an alternative to traditional anesthetics used in aquaculture for ease of handling and/or reduce stress. In this sense, the study aimed to investigate the effects of these EOs on the physiology of fish, through physiological, biochemical and endocrine indicators. In the article 1 was determined (a) the anesthetic activity of the EOs of H. ringens (EOHR) and L. alba (EOLA) and (b) its effects on silver catfish (Rhamdia quelen) after induction and recovery from anesthesia. Fish were subjected to one of the following treatments for each EO: basal group, control or anesthetized (150, 300 or 450 uL L-1 EO), evaluating the ventilatory rate (VR) during the induction period and thereafter transferred to anesthetics-free tanks for recovery from anesthesia. At 0, 15, 30, 60 and 240 min of recovery, samples of plasma and gills were collected to measure metabolic indicators and ionregulatory enzymes, respectively. In the article 2, the effects of prolonged exposure to low EOHR concentrations were studied on silver catfish. After 6 h of exposure to 0 (control), 30 or 50 uL L-1 EOHR added to water, it was analyzed: VR, metabolic indicators of stress in plasma, enzyme activity in liver, and expression of pituitary hormones (growth hormone - GH, prolactin - PRL and somatolactina - SL). In the manuscript, (a) evaluated the effectiveness of anesthesia EOLA on gilthead sea bream (Sparus aurata) and (b) we investigated the effects of 35 uL L-1 EOLA and 2-phenoxyethanol (2-PHE) on the stress response in gilthead sea bream undergoing persecution. After 4 h of exposure, the plasma was sampled (for the determination of cortisol, metabolites and osmolality), brain and pituitary (to evaluate the expression of endocrine indicators). In the article 1, anesthesia with EOs caused changes in some parameters measured in silver catfish, but did not prevent the restoration of most of the indicators assessed after 240 min of recovery. In the article 2, 50 uL L-1 EOHR led to an increase of glucose, lactate, protein and osmolality, as well as an increase in metabolic enzyme activity and reduced expression of GH and SL. In the manuscript, gilthead sea bream exposed to EOLA, stressed or not, exhibited higher levels of cortisol, glucose, lactate and osmolality. EOLA exposure added to the stress reduced the expression levels of CRH-BP (corticotropin releasing hormone bound to protein). PRL expression was reduced in the stressed control group and after exposure to EOLA and 2-PHE in fish not stressed. Higher expression of pro-opiomelanocortin (POMC) "a" and "b" were observed in fish stressed and exposed to EOLA and 2-PHE, respectively. We conclude that: (1) the EOLA is more efficient for silver catfish that EOHR in anesthesia concentrations; (2) for sedating the fish, it is recommended 30 uL EOHR L-1 (or less); (3) the EOLA was effective as an anesthetic for gilthead sea bream at 100-300 uL L-1, but for 4 h exposure, the 2-PHE was more effective in preventing the stress response. / Os óleos essenciais (OEs) extraídos das plantas Hesperozygis ringens e Lippia alba possuem propriedades anestésica e sedativa, constituindo uma alternativa aos anestésicos tradicionalmente usados em aquicultura para facilitar o manejo e/ou reduzir o estresse. Neste sentido, o estudo teve por objetivo investigar os efeitos desses OEs sobre a fisiologia de peixes, através de indicadores fisiológicos, bioquímicos e endócrinos. No artigo 1 determinou-se (a) a atividade anestésica dos OEs de H. ringens (OEHR) e L. alba (OELA) e (b) seus efeitos em jundiá (Rhamdia quelen) depois da indução e recuperação da anestesia. Os peixes foram submetidos a um dos seguintes tratamentos para cada OE: grupo basal, controle ou anestesiado (150, 300 ou 450 μL L-1 OE), avaliando-se a taxa ventilatória (TV) durante o período de indução e, posteriormente, transferidos para aquários sem anestésicos para recuperação da anestesia. Nos tempos 0, 15, 30, 60 e 240 min de recuperação foram realizadas amostragens de plasma e brânquias para medir indicadores metabólicos e enzimas ionorregulatórias, respectivamente. No artigo 2, os efeitos da exposição prolongada de jundiás a baixas concentrações do OEHR foram estudados. Após 6 h de exposição a 0 (controle), 30 ou 50 μL L-1 OEHR adicionado à água, analisou-se: TV, indicadores metabólicos e de estresse em plasma, atividade enzimática em fígado e expressão de hormônios hipofisários (hormônio do crescimento - GH, prolactina - PRL e somatolactina - SL). No manuscrito (a) avaliou-se a eficácia anestésica do OELA em dourada (Sparus aurata) e (b) investigaram-se os efeitos de 35 μL L-1 de OELA e 2-fenoxietanol (2-PHE) sobre a resposta ao estresse em douradas submetidos à perseguição. Após 4 h de exposição, foram amostrados plasma (para determinação dos níveis de cortisol, metabólitos e osmolalidade), cérebro e hipófise (para avaliar a expressão de indicadores endócrinos). No artigo 1, a anestesia com os OEs provocou alterações em alguns parâmetros medidos em jundiás, mas não impediu a restauração da maioria dos indicadores avaliados após 240 min de recuperação. No artigo 2, 50 μL L-1 do OEHR provocou a elevação dos níveis de glicose, lactato, proteína e osmolalidade, bem como aumento na atividade de enzimas metabólicas e redução na expressão do GH e SL. No manuscrito, douradas expostos ao OELA, estressados ou não, exibiram maiores níveis de cortisol, glicose, lactato e osmolalidade. A exposição ao OELA somado ao estresse reduziu os níveis de expressão de CRH-BP (hormônio liberador de corticotrofina ligado à proteína). A expressão de PRL foi reduzida no grupo controle estressado e após a exposição ao OELA e 2-PHE em peixes não estressados. Maiores expressões de pro-opiomelanocortina (POMC) a e b foram observadas em peixes estressados e expostos ao OELA e 2-PHE, respectivamente. Conclui-se que: (1) o OELA é mais eficiente para jundiás que o OEHR em concentrações para anestesia; (2) para sedar os peixes, recomenda-se 30 μL L-1 do OEHR (ou menos); (3) o OELA foi eficaz como anestésico para dourada entre 100-300 μL L-1, mas para 4 h de exposição o 2-PHE foi mais eficiente em prevenir a resposta ao estresse.

Purpose: To evaluate the validity of the Gleason score after neoadjuvant hormonal treatment as predictor of diseasespecific mortality after radical prostatectomy. Patients and Methods: A total of 2,880 patients with a complete data set and a mean follow-up of 10.3 years were studied; 425 of them (15%) had a history of hormonal treatment prior to surgery. The cumulative incidence of deaths from prostate cancer was determined by univariate and multivariate competing risk analysis. Cox proportional hazard models for competing risks were used to study combined effects of the variables on prostate cancer-specific mortality. Results: A higher portion of specimens with a history of neoadjuvant hormonal treatment were assigned Gleason scores of 8–10 (28 vs. 17%, p < 0.0001). The mortality curves in the Gleason score strata <8 vs. 8–10 were at large congruent in patients with and without neoadjuvant hormonal treatment. In patients with neoadjuvant hormonal treatment, a Gleason score of 8–10 was an independent predictor of prostate cancer-specific mortality; the hazard ratio was, however, somewhat lower than in patients without neoadjuvant hormonal treatment. Conclusion: This study suggests that the prognostic value of the post-radical prostatectomy Gleason score is not meaningfully jeopardized by heterogeneous neoadjuvant hormonal treatment in a routine clinical setting.