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Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):306-311
, To compare laparoscopy with laparotomy for surgical staging of endometrial cancer.
A cohort of women with preoperative diagnosis of endometrial cancer who underwent surgical staging was retrospectively evaluated. The main study end points were: morbidity and mortality, hospital length of stay, perioperative adverse events and recurrence rate. Data analysis was performed with the software SPSS v25 (IBM Corp., Armonk, NY, USA), categorical variables using a Chi-square and Fisher test, and continuous variables using the Student t-test.
Atotal of 162 patientswere analyzed. 138 patientsmet the inclusion criteria, 41of whom underwent staging by laparoscopy and 97 by laparotomy. Conversions from laparoscopy to laparotomy happened in 2 patients (4.9%) and were secondary to technical difficulties and poor exposure. Laparoscopy had fewer postoperative adverse events when compared with laparotomy (7.3% vs 23.7%, respectively; p = 0.005), but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 175 vs 130 minutes, respectively; p < 0.001). Hospital stay was significantly lower in laparoscopy versus laparotomy patients (median, 3 vs 7 days, respectively; p < 0.001). No difference in recurrence or mortality rates were observed.
Laparoscopic surgical staging for endometrial cancer is feasible and safe. Patients have lower postoperative complication rates and shorter hospital stays when compared with the approach by laparotomy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):306-311
, To compare laparoscopy with laparotomy for surgical staging of endometrial cancer.
A cohort of women with preoperative diagnosis of endometrial cancer who underwent surgical staging was retrospectively evaluated. The main study end points were: morbidity and mortality, hospital length of stay, perioperative adverse events and recurrence rate. Data analysis was performed with the software SPSS v25 (IBM Corp., Armonk, NY, USA), categorical variables using a Chi-square and Fisher test, and continuous variables using the Student t-test.
Atotal of 162 patientswere analyzed. 138 patientsmet the inclusion criteria, 41of whom underwent staging by laparoscopy and 97 by laparotomy. Conversions from laparoscopy to laparotomy happened in 2 patients (4.9%) and were secondary to technical difficulties and poor exposure. Laparoscopy had fewer postoperative adverse events when compared with laparotomy (7.3% vs 23.7%, respectively; p = 0.005), but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 175 vs 130 minutes, respectively; p < 0.001). Hospital stay was significantly lower in laparoscopy versus laparotomy patients (median, 3 vs 7 days, respectively; p < 0.001). No difference in recurrence or mortality rates were observed.
Laparoscopic surgical staging for endometrial cancer is feasible and safe. Patients have lower postoperative complication rates and shorter hospital stays when compared with the approach by laparotomy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):307-307
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):307-307
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):307-310
DOI 10.1590/S0100-72032000000500009
Polymastia is a usual problem in Mastology clinics and the possibility of cancer must be taken into consideration, as much as in any other mammary tissue. In the present study the case of a 48-year-old patient, submitted to the excision of the left axillary breast for cosmetic purposes is reported. The histological examination showed an invasive ductal carcinoma with an extensive in situ component. The patient was submitted to a wide excision plus axillary lymphadenectomy and radiation therapy. The frequency, diagnosis, prognosis and treatment of cancer in supernumerary breasts is also reviewed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):307-310
DOI 10.1590/S0100-72032000000500009
Polymastia is a usual problem in Mastology clinics and the possibility of cancer must be taken into consideration, as much as in any other mammary tissue. In the present study the case of a 48-year-old patient, submitted to the excision of the left axillary breast for cosmetic purposes is reported. The histological examination showed an invasive ductal carcinoma with an extensive in situ component. The patient was submitted to a wide excision plus axillary lymphadenectomy and radiation therapy. The frequency, diagnosis, prognosis and treatment of cancer in supernumerary breasts is also reviewed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):307-312
DOI 10.1590/S0100-72032001000500006
Purpose: to evaluate the effectiveness of color Doppler as a diagnosis method for polycystic ovary syndrome (PCOS) through blood flow variations in the ovarian stroma, in the uterine arteries and in the subendometrial tissue. Methods: thirty patients divided into two groups were selected: fifteen patients with amenorrhea or oligomenorrhea, hirsutism (Ferriman and Gallwey score >8), body mass index >25 kg/m² and echographic examination identifying increased hyperechogenic stromal and ovarian polycystosis (study group), and an identical number of patients presenting normal menstrual cycles, with no signs of hirsutism and with normal ultrasonography (control group). Transvaginal Doppler flowmetry measured systolic peak velocity or maximal velocity (Vmax) pulsatility index (PI) and resistance of ovarian stromal vessels, uterine arteries and subendometrial layer. Results: Doppler velocimetry showed significantly higher Vmax layer (p<=0,0004) in the ovarian stromal of patients with PCOS (12.2 cm/s) when compared to the control group (8.05 cm/s); the uterine artery PI was also higher in the PCOS group (3.3 cm/s) versus the control group (2.7 cm/s); other Doppler velocimetry parameters did not show significant differences. As we established a cutoff = 9 cm/s for the sample for Vmax, we obtained the percentages of 95.2 for sensitivity, 80.0 for specificity, 83.3 for positive predictive value and 94.1 for negative predictive value. Conclusion: Doppler velocimetry might constitute an additional tool to be incorporated in clinical and ultrasonographic investigation concerning the PCOS diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):307-312
DOI 10.1590/S0100-72032001000500006
Purpose: to evaluate the effectiveness of color Doppler as a diagnosis method for polycystic ovary syndrome (PCOS) through blood flow variations in the ovarian stroma, in the uterine arteries and in the subendometrial tissue. Methods: thirty patients divided into two groups were selected: fifteen patients with amenorrhea or oligomenorrhea, hirsutism (Ferriman and Gallwey score >8), body mass index >25 kg/m² and echographic examination identifying increased hyperechogenic stromal and ovarian polycystosis (study group), and an identical number of patients presenting normal menstrual cycles, with no signs of hirsutism and with normal ultrasonography (control group). Transvaginal Doppler flowmetry measured systolic peak velocity or maximal velocity (Vmax) pulsatility index (PI) and resistance of ovarian stromal vessels, uterine arteries and subendometrial layer. Results: Doppler velocimetry showed significantly higher Vmax layer (p<=0,0004) in the ovarian stromal of patients with PCOS (12.2 cm/s) when compared to the control group (8.05 cm/s); the uterine artery PI was also higher in the PCOS group (3.3 cm/s) versus the control group (2.7 cm/s); other Doppler velocimetry parameters did not show significant differences. As we established a cutoff = 9 cm/s for the sample for Vmax, we obtained the percentages of 95.2 for sensitivity, 80.0 for specificity, 83.3 for positive predictive value and 94.1 for negative predictive value. Conclusion: Doppler velocimetry might constitute an additional tool to be incorporated in clinical and ultrasonographic investigation concerning the PCOS diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(6):308-313
Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(6):308-313
Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):308-313
DOI 10.1590/S0100-720320150005343
To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors.
A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis.
Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size.
The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):308-313
DOI 10.1590/S0100-720320150005343
To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors.
A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis.
Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size.
The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(7):309-316
DOI 10.1590/S0100-72032013000700005
PURPOSE: To determine perinatal outcomes and factors associated with fetal brain sparing effect diagnosed by Doppler flow velocimetry in patients with arterial hypertension. METHODS: We performed a cross-sectional retrospective study including 129 pregnant women with arterial hypertension and submitted to Doppler flow velocimetry, within fifteen days before delivery. Women with multiple pregnancies, fetal malformations, genital bleeding, placenta praevia, premature rupture of membranes, smoking, illicit drug use and chronic diseases were excluded. We analyzed the biological, socio-demographic and obstetric characteristics, as well the perinatal outcomes. To determine the association between variables, we used the χ² test, Fisher's exact test and Student's t-test. Multiple logistic regression analysis was performed to determine the factors associated with fetal centralization. RESULTS: Pre-eclampsia was the most frequent hypertensive disorder (53.5%) and fetal brain sparing effect was observed in 24.0% of fetuses. The prenatal factors associated with fetal brain sparing were the persistence of bilateral protodiastolic notches in uterine arteries (OR 3.6; 95%CI 1.4 - 9.4; p=0.009) and intrauterine growth restriction (IUGR) (OR 3.3; 95%CI 1.2 - 9.3; p=0.02). The perinatal outcomes associated with fetal brain sparing were gestational age <32 weeks, small for gestational age (SGA) infants, birth weight <2,500 g and perinatal death. There was no association with other maternal or neonatal variables. CONCLUSIONS: The main factors associated with fetal brain sparing were persistence of uterine arteries notches, IUGR, and increased frequency of adverse perinatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(7):309-316
DOI 10.1590/S0100-72032013000700005
PURPOSE: To determine perinatal outcomes and factors associated with fetal brain sparing effect diagnosed by Doppler flow velocimetry in patients with arterial hypertension. METHODS: We performed a cross-sectional retrospective study including 129 pregnant women with arterial hypertension and submitted to Doppler flow velocimetry, within fifteen days before delivery. Women with multiple pregnancies, fetal malformations, genital bleeding, placenta praevia, premature rupture of membranes, smoking, illicit drug use and chronic diseases were excluded. We analyzed the biological, socio-demographic and obstetric characteristics, as well the perinatal outcomes. To determine the association between variables, we used the χ² test, Fisher's exact test and Student's t-test. Multiple logistic regression analysis was performed to determine the factors associated with fetal centralization. RESULTS: Pre-eclampsia was the most frequent hypertensive disorder (53.5%) and fetal brain sparing effect was observed in 24.0% of fetuses. The prenatal factors associated with fetal brain sparing were the persistence of bilateral protodiastolic notches in uterine arteries (OR 3.6; 95%CI 1.4 - 9.4; p=0.009) and intrauterine growth restriction (IUGR) (OR 3.3; 95%CI 1.2 - 9.3; p=0.02). The perinatal outcomes associated with fetal brain sparing were gestational age <32 weeks, small for gestational age (SGA) infants, birth weight <2,500 g and perinatal death. There was no association with other maternal or neonatal variables. CONCLUSIONS: The main factors associated with fetal brain sparing were persistence of uterine arteries notches, IUGR, and increased frequency of adverse perinatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):309-313
DOI 10.1590/S0100-72031998000600003
Objective: to evaluate variations in body weight, arterial blood pressure, fasting glucose, HbA1C, insulin, total cholesterol, HDL-C, LDL-C, triglycerides, Sgot, SGPT, GGT and bilirubin in women bearing a single subdermal Silastic implant containing 55 mg (+ 10%) of nomegestrol acetate during two years. Methods: eighteen healthy volunteers of reproductive age who desired to use anticonceptive drugs and who did not present contraindications to hormonal contraception participated in the study. All women were investigated before starting treatment and were followed-up for two years. At the end of the first year the capsules were inserted. Results: body weight increased from 54.9 + 1.5 kg at admission to 55.3 + 2.0 kg at 12 months of use (p<0.05) and from 56.0 + 2.7 kg at 24 months of use. There was a slight increase in arterial blood pressure, both systolic and diastolic, at month 12 (p<0.01). At month 24, the arterial blood pressure was not significantly different from the values at admission. All values were within the normal range. Insulin, HbA1C, LDL-C and GGT remained unchanged during the use of the implant. A significant decrease in total cholesterol (p<0.05) was observed in the third month and of HDL-C (p<0.01) in the sixth month. All lipoprotein alterations were inconsistent and values were within the normal range. Significant increases in fast glucose (p<0.05 and p<0.01) were observed in the third and sixth months, respectively. Significant SGOT decreases (p<0.05, p<0.01 and p<0.05) were observed in months 6, 18 and 24, respectively, and of SGPT (p<0.05) in month 18. Significant bilirubin increase (p<0.05) was observed only in the third month of implant use. All these variations remained within the normal range. Conclusions: these results show that, within the normal range, fasting glucose variations do not correlate with alterations in insulin levels. The slight serum lipoprotein, SGTO, SGPT and insulin alterations were transient. No clinical effects could be observed regarding lipoproteins, carbohydrate metabolism, insulin levels and liver function among the users during the two years.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):309-313
DOI 10.1590/S0100-72031998000600003
Objective: to evaluate variations in body weight, arterial blood pressure, fasting glucose, HbA1C, insulin, total cholesterol, HDL-C, LDL-C, triglycerides, Sgot, SGPT, GGT and bilirubin in women bearing a single subdermal Silastic implant containing 55 mg (+ 10%) of nomegestrol acetate during two years. Methods: eighteen healthy volunteers of reproductive age who desired to use anticonceptive drugs and who did not present contraindications to hormonal contraception participated in the study. All women were investigated before starting treatment and were followed-up for two years. At the end of the first year the capsules were inserted. Results: body weight increased from 54.9 + 1.5 kg at admission to 55.3 + 2.0 kg at 12 months of use (p<0.05) and from 56.0 + 2.7 kg at 24 months of use. There was a slight increase in arterial blood pressure, both systolic and diastolic, at month 12 (p<0.01). At month 24, the arterial blood pressure was not significantly different from the values at admission. All values were within the normal range. Insulin, HbA1C, LDL-C and GGT remained unchanged during the use of the implant. A significant decrease in total cholesterol (p<0.05) was observed in the third month and of HDL-C (p<0.01) in the sixth month. All lipoprotein alterations were inconsistent and values were within the normal range. Significant increases in fast glucose (p<0.05 and p<0.01) were observed in the third and sixth months, respectively. Significant SGOT decreases (p<0.05, p<0.01 and p<0.05) were observed in months 6, 18 and 24, respectively, and of SGPT (p<0.05) in month 18. Significant bilirubin increase (p<0.05) was observed only in the third month of implant use. All these variations remained within the normal range. Conclusions: these results show that, within the normal range, fasting glucose variations do not correlate with alterations in insulin levels. The slight serum lipoprotein, SGTO, SGPT and insulin alterations were transient. No clinical effects could be observed regarding lipoproteins, carbohydrate metabolism, insulin levels and liver function among the users during the two years.