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Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(2):67-74
DOI 10.1590/S0100-72032008000200004
PURPOSE: to compare the epidemiologic and clinical characteristics, and the follow-up of breast cancer in women diagnosed under and over 40 years of age. METHODS: a retrospective study, case-control type, with analysis of information obtained from medical records of patients attended from January 1994 to June 2004. Cases of intraductal carcinoma and at stage IV were excluded. Three groups were formed: patients under 40 years old at the diagnosis (n=72); patients between 40 and 50 (n=68) and patients over 50 (n=75). Data about age at the moment of diagnosis, lesion largest diameter, clinical stage, type, histological grade, presence of hormonal receptors and state of the lymph nodes were collected and analyzed. The chi2 test was used for qualitative variables. For quantitative variables without normal distribution (such as number of axillary nodes with metastasis and follow-up duration), the Kruskal-Wallis' test was used. For delineating the curves of free-of-disease and global survival, the log-rank test was used. RESULTS: there was no difference among the groups in the stage distribution, concerning the tumoral differentiation grade or in the distribution of histological types, and in the estrogen receptor and c-erb-B2 expression. Difference was found in the RP expression, which was less frequent in the group of patients under 40, than in the group of patients over 50 (36.2% versus 58.4%) respectively. There was no difference among the groups in the mean tumoral diameter (5.1, 4.7 and 5 cm, respectively). There was also no difference among the groups, concerning the rate of axillary lymph node metastasis (63.9, 46.9 and 50%, respectively). The average follow-up was 54 months for all the groups. Disease recurrence occurred in 22.6% of patients under 40 years old, in 60% of patients between 40 and 50, and in 22.6% of patients over 50, with a significant difference among groups (p<0.0001). Death caused by the disease was higher among patients under 40 (46.9%) than among patients between 40 and 50 (26.9%) and over 50 (22.6%), p=0.0019. The logistic analysis showed that "age under 40" and the "presence of more than one metastatic axillary node" were independent death risk factors. CONCLUSIONS: age under 40 is an independent risk factor for breast cancer. The traditional prognostic indicators, such as stage, tumoral diameter, axillary involvement and presence of hormonal receptors are not associated with the disease evolution.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(2):67-74
DOI 10.1590/S0100-72032008000200004
PURPOSE: to compare the epidemiologic and clinical characteristics, and the follow-up of breast cancer in women diagnosed under and over 40 years of age. METHODS: a retrospective study, case-control type, with analysis of information obtained from medical records of patients attended from January 1994 to June 2004. Cases of intraductal carcinoma and at stage IV were excluded. Three groups were formed: patients under 40 years old at the diagnosis (n=72); patients between 40 and 50 (n=68) and patients over 50 (n=75). Data about age at the moment of diagnosis, lesion largest diameter, clinical stage, type, histological grade, presence of hormonal receptors and state of the lymph nodes were collected and analyzed. The chi2 test was used for qualitative variables. For quantitative variables without normal distribution (such as number of axillary nodes with metastasis and follow-up duration), the Kruskal-Wallis' test was used. For delineating the curves of free-of-disease and global survival, the log-rank test was used. RESULTS: there was no difference among the groups in the stage distribution, concerning the tumoral differentiation grade or in the distribution of histological types, and in the estrogen receptor and c-erb-B2 expression. Difference was found in the RP expression, which was less frequent in the group of patients under 40, than in the group of patients over 50 (36.2% versus 58.4%) respectively. There was no difference among the groups in the mean tumoral diameter (5.1, 4.7 and 5 cm, respectively). There was also no difference among the groups, concerning the rate of axillary lymph node metastasis (63.9, 46.9 and 50%, respectively). The average follow-up was 54 months for all the groups. Disease recurrence occurred in 22.6% of patients under 40 years old, in 60% of patients between 40 and 50, and in 22.6% of patients over 50, with a significant difference among groups (p<0.0001). Death caused by the disease was higher among patients under 40 (46.9%) than among patients between 40 and 50 (26.9%) and over 50 (22.6%), p=0.0019. The logistic analysis showed that "age under 40" and the "presence of more than one metastatic axillary node" were independent death risk factors. CONCLUSIONS: age under 40 is an independent risk factor for breast cancer. The traditional prognostic indicators, such as stage, tumoral diameter, axillary involvement and presence of hormonal receptors are not associated with the disease evolution.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(4):181-185
DOI 10.1590/S0100-72032007000400003
PURPOSE: to determine the efficacy of 10% lidocaine spray applied to the cervix before the procedure of diagnostic hysteroscopy, in order to reduce the painful process and the discomfort caused by the exam. METHODS: a total of 261 consecutive patients participated in the study, which was conducted from March 2004 to March 2005. The patients were randomly assigned to one of two groups: one group receiving topical lidocaine spray (lidocaine group - LdG) and the other, receiving no medication before the procedure (control group - CG). In the LdG patients, thirty milligrams of 10% lidocaine spray were applied to the surface of the cervix five minutes before hysteroscopy started. Immediately, after the end of the procedure, the patients from both groups were asked to respond to a questionnaire about pain and to quantify the pain, in centimeters, using a 10-cm non-graduated visual analog scale. The unpaired t test, the Mann-Whitney test and the chi2 test were used for statistical analyses, considering p significant if lower than 0.05. RESULTS: there was no statistically significant difference between groups regarding age, parity or percentage of patients in menacme or menopause, or regarding the indications for the procedure and the hysteroscopic findings. A biopsy was necessary in 57 of the 132 LdG patients and in 48 of the 129 CG patients (p=0.96). The mean pain score was 4.3±2.9 in LdG and 3.9±2.5 in CG (p=0.2). A difference in the mean pain score was observed only among patients in menacme and menopause receiving or not the lidocaine spray, with p=0.01 and p=0.04 respectively. CONCLUSIONS: the use of lidocaine spray during diagnostic hysteroscopy does not minimize the discomfort and pain of the patients and therefore should not be applied.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(4):181-185
DOI 10.1590/S0100-72032007000400003
PURPOSE: to determine the efficacy of 10% lidocaine spray applied to the cervix before the procedure of diagnostic hysteroscopy, in order to reduce the painful process and the discomfort caused by the exam. METHODS: a total of 261 consecutive patients participated in the study, which was conducted from March 2004 to March 2005. The patients were randomly assigned to one of two groups: one group receiving topical lidocaine spray (lidocaine group - LdG) and the other, receiving no medication before the procedure (control group - CG). In the LdG patients, thirty milligrams of 10% lidocaine spray were applied to the surface of the cervix five minutes before hysteroscopy started. Immediately, after the end of the procedure, the patients from both groups were asked to respond to a questionnaire about pain and to quantify the pain, in centimeters, using a 10-cm non-graduated visual analog scale. The unpaired t test, the Mann-Whitney test and the chi2 test were used for statistical analyses, considering p significant if lower than 0.05. RESULTS: there was no statistically significant difference between groups regarding age, parity or percentage of patients in menacme or menopause, or regarding the indications for the procedure and the hysteroscopic findings. A biopsy was necessary in 57 of the 132 LdG patients and in 48 of the 129 CG patients (p=0.96). The mean pain score was 4.3±2.9 in LdG and 3.9±2.5 in CG (p=0.2). A difference in the mean pain score was observed only among patients in menacme and menopause receiving or not the lidocaine spray, with p=0.01 and p=0.04 respectively. CONCLUSIONS: the use of lidocaine spray during diagnostic hysteroscopy does not minimize the discomfort and pain of the patients and therefore should not be applied.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):118-118
DOI 10.1590/S0100-72031998000200011
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):118-118
DOI 10.1590/S0100-72031998000200011
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):209-213
DOI 10.1590/S0100-72031998000400006
Fine-needle aspiration cytology (FNAC) is a simple method and free from complications, among great value in mastology. Its accuracy can suffer the influence of several factors, among which we can highlight the experience of the physician who performs it. With the objective of verifying the effectiveness of FNAC performed by general gynecologists, 341 patients were studied concerning the relationship between the results of FNAC and the histology of the breast lesion. We obtained sensitivity of 70.87%, specificity of 70.58%, predictive positive value of 92.40%, predictive negative value of 89.36% and accuracy of 70.67%. We concluded that FNAC is of great value in handling breast lesions and can be appropriately performed by general gynecologists. The method, however, may lead to errors of diagnosis. We do not recommend, therefore, the use of the result of FNAC as a definitive diagnosis; instead this result must be interpreted in the context of the clinical diagnosis and mammography.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):209-213
DOI 10.1590/S0100-72031998000400006
Fine-needle aspiration cytology (FNAC) is a simple method and free from complications, among great value in mastology. Its accuracy can suffer the influence of several factors, among which we can highlight the experience of the physician who performs it. With the objective of verifying the effectiveness of FNAC performed by general gynecologists, 341 patients were studied concerning the relationship between the results of FNAC and the histology of the breast lesion. We obtained sensitivity of 70.87%, specificity of 70.58%, predictive positive value of 92.40%, predictive negative value of 89.36% and accuracy of 70.67%. We concluded that FNAC is of great value in handling breast lesions and can be appropriately performed by general gynecologists. The method, however, may lead to errors of diagnosis. We do not recommend, therefore, the use of the result of FNAC as a definitive diagnosis; instead this result must be interpreted in the context of the clinical diagnosis and mammography.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(10):571-576
DOI 10.1590/S0100-72031998001000005
Purpose: to evaluate the advantages of the laparoscopic approach for conversion of abdominal hysterectomies in vaginal hysterectomies in patients with indication of concomitant adnexectomy, being considered the safety and the additional costs of the procedure. Patients and Methods: cases: 9 patients submitted to Laparoscopically Assisted Vaginal Hysterectomy (LAVH) associated with adnexectomy. Controls:18 patients submitted to Abdominal Hysterectomy (AH) associated with adnexectomy. Both groups were compared regarding preoperative characteristics and the results of the procedure. The patients submitted to LAVH and AH are similar concerning age, parity, cesarean deliveries, previous surgeries and body mass index. Results: the average surgery time was 163.9 minutes for patients submitted to LAVH and 142.8 minutes for patients submitted to AH. No patient in the LAVH group presented postoperative complications, while in the AH group 2 patients presented suture deiscence and there was 1 case of incisional hernia. The median of hospital stay was 1 day in the LAVH group and 2 days in the AH group, those of convalescence periods were 2 and 4 weeks, respectively. 55.6% of the patients in the LAVH group and 100% in the AH group needed analgesics in the postoperative period. Conclusions: LAVH was shown to be advantageous in relation to AH in terms of better recovery and lower incidence of complications in the postoperative period. The procedure is feasible and safe in a University Hospital, and without additional costs.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(10):571-576
DOI 10.1590/S0100-72031998001000005
Purpose: to evaluate the advantages of the laparoscopic approach for conversion of abdominal hysterectomies in vaginal hysterectomies in patients with indication of concomitant adnexectomy, being considered the safety and the additional costs of the procedure. Patients and Methods: cases: 9 patients submitted to Laparoscopically Assisted Vaginal Hysterectomy (LAVH) associated with adnexectomy. Controls:18 patients submitted to Abdominal Hysterectomy (AH) associated with adnexectomy. Both groups were compared regarding preoperative characteristics and the results of the procedure. The patients submitted to LAVH and AH are similar concerning age, parity, cesarean deliveries, previous surgeries and body mass index. Results: the average surgery time was 163.9 minutes for patients submitted to LAVH and 142.8 minutes for patients submitted to AH. No patient in the LAVH group presented postoperative complications, while in the AH group 2 patients presented suture deiscence and there was 1 case of incisional hernia. The median of hospital stay was 1 day in the LAVH group and 2 days in the AH group, those of convalescence periods were 2 and 4 weeks, respectively. 55.6% of the patients in the LAVH group and 100% in the AH group needed analgesics in the postoperative period. Conclusions: LAVH was shown to be advantageous in relation to AH in terms of better recovery and lower incidence of complications in the postoperative period. The procedure is feasible and safe in a University Hospital, and without additional costs.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(12):733-740
DOI 10.1590/S0100-72032006001200008
Chronic pelvic pain is a debilitating and highly prevalent disease with a major impact on quality of life and work productivity, beyond significant costs to health services. The dilemma of managing patients with chronic pelvic pain continues to frustrate physicians confronted with these complaints, in part because its pathophysiology is poorly understood. Consequently, its treatment is often unsatisfactory and limited to temporary symptom relief. In the present revision, we discuss the adequate management of chronic pelvic pain. We point out that a comprehensive medical history and physical examination should include special attention to gastrointestinal, urological, gynecological, muscle-skeletal, neurological, psychiatric, and endocrine systems. Thus, a multidisciplinary approach is recommended. Additionally, we emphasize that, although useful, specific surgical procedures, such as laparoscopy, should be indicated only to selected patients, mainly after excluding irritable bowel syndrome and pain of myofascial origin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(12):733-740
DOI 10.1590/S0100-72032006001200008
Chronic pelvic pain is a debilitating and highly prevalent disease with a major impact on quality of life and work productivity, beyond significant costs to health services. The dilemma of managing patients with chronic pelvic pain continues to frustrate physicians confronted with these complaints, in part because its pathophysiology is poorly understood. Consequently, its treatment is often unsatisfactory and limited to temporary symptom relief. In the present revision, we discuss the adequate management of chronic pelvic pain. We point out that a comprehensive medical history and physical examination should include special attention to gastrointestinal, urological, gynecological, muscle-skeletal, neurological, psychiatric, and endocrine systems. Thus, a multidisciplinary approach is recommended. Additionally, we emphasize that, although useful, specific surgical procedures, such as laparoscopy, should be indicated only to selected patients, mainly after excluding irritable bowel syndrome and pain of myofascial origin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):47-54
DOI 10.1590/S0100-72031999000100008
Purpose: to evaluate clinical and ultrasonic findings in patients with pelvic tumors at postmenopause and to correlate them with the final diagnosis. Patients and Methods: thirty-six postmenopausal women with pelvic tumor diagnosis were prospectively evaluated through clinical examination and endovaginal ultrasonography. Clinical follow-up with no surgical procedures was indicated for anechoic cystic tumors with or without thin unique septation and volume under 50 cm³. Needle aspiration was indicated for tumors with the same aspect, and volume of 50 to 100 cm³, whereas exploratory laparotomy was performed in the remaining patients. Diagnosis defined two groups of patients: benign (28) and malignant (8) pathologies. Results: anechoic cystic tumor with or without a thin septum indicates benignity (p = 0.0091). Tumors with solid areas indicate malignancy (p = 0.0024). Ascites correlates with malignancy (p = 0.0278). Heterogeneity, thick capsule, thick septa, and papillary projections predominated in malignancies but without no statistical significance (p > 0,05). Tumor volume indicates malignancy, with a median of 85.2 cm³ in benign tumors and 452.5 cm³ in malignancies (p = 0.0048), with a cutoff at 295 cm³ (sensitivity = 83.3% and specificity = 85.2%). Following this protocol, all malignancies were submitted to surgery and 11 benign tumor patients were treated with a conservative protocol (39.3% of all benign patients). Conclusion: conservative management is an adequate protocol for women with anechoic pelvic tumors with low volume, with or without single thin septum and without ascites. Differentiation between benign and malignant of complex and/or high volume tumors requires complementary investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):47-54
DOI 10.1590/S0100-72031999000100008
Purpose: to evaluate clinical and ultrasonic findings in patients with pelvic tumors at postmenopause and to correlate them with the final diagnosis. Patients and Methods: thirty-six postmenopausal women with pelvic tumor diagnosis were prospectively evaluated through clinical examination and endovaginal ultrasonography. Clinical follow-up with no surgical procedures was indicated for anechoic cystic tumors with or without thin unique septation and volume under 50 cm³. Needle aspiration was indicated for tumors with the same aspect, and volume of 50 to 100 cm³, whereas exploratory laparotomy was performed in the remaining patients. Diagnosis defined two groups of patients: benign (28) and malignant (8) pathologies. Results: anechoic cystic tumor with or without a thin septum indicates benignity (p = 0.0091). Tumors with solid areas indicate malignancy (p = 0.0024). Ascites correlates with malignancy (p = 0.0278). Heterogeneity, thick capsule, thick septa, and papillary projections predominated in malignancies but without no statistical significance (p > 0,05). Tumor volume indicates malignancy, with a median of 85.2 cm³ in benign tumors and 452.5 cm³ in malignancies (p = 0.0048), with a cutoff at 295 cm³ (sensitivity = 83.3% and specificity = 85.2%). Following this protocol, all malignancies were submitted to surgery and 11 benign tumor patients were treated with a conservative protocol (39.3% of all benign patients). Conclusion: conservative management is an adequate protocol for women with anechoic pelvic tumors with low volume, with or without single thin septum and without ascites. Differentiation between benign and malignant of complex and/or high volume tumors requires complementary investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):415-418
DOI 10.1590/S0100-72031999000700008
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):415-418
DOI 10.1590/S0100-72031999000700008
