Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
You searched for:"José Geraldo Lopes Ramos"
We found (19) results for your search.Summary
. 2017;39(9):496-512
The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most important clinical disease in Brazilian pregnant women, may have its incidence reduced with prevention through the use of calcium and aspirin in pregnant women at risk. Previously, it was a disease that presented with hypertension with proteinuria, but it has now been classified with new clinical parameters besides proteinuria. Morbidity and mortality should be reduced in a continental country such as Brazil using protocols for the early treatment of complications by calculating severe outcomes in preeclampsia. The early treatment of acute hypertension, use of magnesium sulfate and early hospitalization in cases of preeclampsia are concepts to pursue the reduction of our pregnant women’s mortality.
Summary
. 2017;39(9):496-512
The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most important clinical disease in Brazilian pregnant women, may have its incidence reduced with prevention through the use of calcium and aspirin in pregnant women at risk. Previously, it was a disease that presented with hypertension with proteinuria, but it has now been classified with new clinical parameters besides proteinuria. Morbidity and mortality should be reduced in a continental country such as Brazil using protocols for the early treatment of complications by calculating severe outcomes in preeclampsia. The early treatment of acute hypertension, use of magnesium sulfate and early hospitalization in cases of preeclampsia are concepts to pursue the reduction of our pregnant women’s mortality.
Summary
. 2016;38(9):450-455
To demonstrate the initial experience of robotic hysterectomy to treat benign uterine disease at a university hospital in Brazil.
A cross-sectional study was conducted to review data from the first twenty patients undergoing robotic hysterectomy at our hospital. The surgeries were performed from November 2013 to August 2014, all of them by the same surgeon. The patients were reviewed for preoperative characteristics, including age, body mass index (BMI), indications for the hysterectomy and previous surgeries. Data of operative times, complications, postoperative pain and length of hospital stay were also collected.
The total operating room time was 252.9 minutes, while the operative time was 180.7 minutes and the console time was 136.6 minutes. Docking time was 4.2 minutes, and the average undocking time was 1.9 minutes. There was a strong correlation between the operative time and the patient's BMI (r = 0.670 ; p = 0.001). The console time had significant correlation with the uterine weight and the patient's BMI (r = 0.468; p = 0.037). A learning curve was observed during docking and undocking times.
Despite its high cost, the robotic surgery is gaining more space in gynecological surgery. By the results obtained in our hospital, this surgical proposal proved to be feasible and safe. Our initial experience demonstrated a learning curve in some ways.
Summary
. 2016;38(9):450-455
To demonstrate the initial experience of robotic hysterectomy to treat benign uterine disease at a university hospital in Brazil.
A cross-sectional study was conducted to review data from the first twenty patients undergoing robotic hysterectomy at our hospital. The surgeries were performed from November 2013 to August 2014, all of them by the same surgeon. The patients were reviewed for preoperative characteristics, including age, body mass index (BMI), indications for the hysterectomy and previous surgeries. Data of operative times, complications, postoperative pain and length of hospital stay were also collected.
The total operating room time was 252.9 minutes, while the operative time was 180.7 minutes and the console time was 136.6 minutes. Docking time was 4.2 minutes, and the average undocking time was 1.9 minutes. There was a strong correlation between the operative time and the patient's BMI (r = 0.670 ; p = 0.001). The console time had significant correlation with the uterine weight and the patient's BMI (r = 0.468; p = 0.037). A learning curve was observed during docking and undocking times.
Despite its high cost, the robotic surgery is gaining more space in gynecological surgery. By the results obtained in our hospital, this surgical proposal proved to be feasible and safe. Our initial experience demonstrated a learning curve in some ways.
Summary
. ;:182-188
DOI 10.1590/S0100-72032009000400005
PURPOSE: to observe the impact of obesity and other risk factors on the rate of failure in patients submitted to Burch's surgery for the treatment of urinary incontinence. METHODS: cases study of patients submitted to Burch's surgery, from 1992 to 2003. Patients were evaluated at the second post-surgery appointment (average 66 days) and after one-year follow-up, and classified in two groups: Continent and Non-continent. Variables analyzed were: age, parity, body mass index (BMI), menopause duration, duration of hormonal therapy, urodynamic evaluation, history of urinary tract infection, previous urinary incontinence surgery, diabetes, cystocele and uterine prolapse, time spent in hospital, necessity of self-probing, post-surgical spontaneous micturition, and surgical wound. Data were analyzed with the Statistical Package for Social Sciences 14.0 statistical package. For the comparison of continuous variables, Student's t-test or Mann-Whitney test were used, and Fisher exact and χ2 tests, for the categorical variables (p<0.05). RESULTS: at the second post-surgical evaluation, there was no significant difference between the two groups, concerning the variables analyzed. After one-year follow-up, from a total of 97 patients, 81 were continent and 16, non-continent, BMI and height being different between the groups. In the continent group, average BMI was 27.1 and height, 1.57 m, and, among the non-continent, 30.8 (p=0.02) and 1.52 m (p=0.01). The BMI>30 Odds Ratio was 3.7 (CI95%=1.2-11.5). CONCLUSIONS: obesity has shown to be an important risk factor for the surgery failure in the first follow-up year. Results show that patients with BMI>30 have 3.7 times more chance of being non-continent one-year after Burch's surgery than non-obese patients.
Summary
. ;:182-188
DOI 10.1590/S0100-72032009000400005
PURPOSE: to observe the impact of obesity and other risk factors on the rate of failure in patients submitted to Burch's surgery for the treatment of urinary incontinence. METHODS: cases study of patients submitted to Burch's surgery, from 1992 to 2003. Patients were evaluated at the second post-surgery appointment (average 66 days) and after one-year follow-up, and classified in two groups: Continent and Non-continent. Variables analyzed were: age, parity, body mass index (BMI), menopause duration, duration of hormonal therapy, urodynamic evaluation, history of urinary tract infection, previous urinary incontinence surgery, diabetes, cystocele and uterine prolapse, time spent in hospital, necessity of self-probing, post-surgical spontaneous micturition, and surgical wound. Data were analyzed with the Statistical Package for Social Sciences 14.0 statistical package. For the comparison of continuous variables, Student's t-test or Mann-Whitney test were used, and Fisher exact and χ2 tests, for the categorical variables (p<0.05). RESULTS: at the second post-surgical evaluation, there was no significant difference between the two groups, concerning the variables analyzed. After one-year follow-up, from a total of 97 patients, 81 were continent and 16, non-continent, BMI and height being different between the groups. In the continent group, average BMI was 27.1 and height, 1.57 m, and, among the non-continent, 30.8 (p=0.02) and 1.52 m (p=0.01). The BMI>30 Odds Ratio was 3.7 (CI95%=1.2-11.5). CONCLUSIONS: obesity has shown to be an important risk factor for the surgery failure in the first follow-up year. Results show that patients with BMI>30 have 3.7 times more chance of being non-continent one-year after Burch's surgery than non-obese patients.
Summary
. ;:542-542
Summary
. ;:542-542
Summary
. ;:513-522
DOI 10.1590/S0100-72032006000900003
PURPOSE: to describe, in participants of the Brazilian Study of Gestational Diabetes (EBDG), the percentile distribution of uterine height by gestational age and to validate the use of percentiles of the chart derived by the "Centro Latino-Americano de Perinatologia" (CLAP), used as reference in predicting abnormal fetal growth. METHODS: the EBDG is a cohort study of 5564 pregnant women older than 19 years, followed through and after delivery. Interviews and standardized anthropometry were performed at baseline between 20-28 weeks. Medical records covering prenatal and delivery periods were then reviewed following a standardized approach. Analyses pertain to 3539 women with gestational age confirmed by ultrasound. Diagnostic properties of the 10th and the 90th percentiles of both charts (EBDG and CLAP) as predictors of abnormal neonatal weight were determined. RESULTS: uterine height was higher in EBDG than in the CLAP chart at every gestational week, being 1-4 and 2-6 cm greater, at the 10th and 90th percentiles respectively. The CLAP 10th percentile classified as small the uterine heights of only 0.3 to 1.7% of Brazilian women, while the 90th percentile classified as large the uterine heights of 42 to 57% of the sample. The sensitivity of CLAP percentile 10 in the prediction of small for gestational age varied from 0.8 to 6% and the specificity of CLAP percentile 90 in the prediction of large for gestational age, from 46 to 61%. CONCLUSIONS: the CLAP uterine height reference chart does not reflect the current uterine growth pattern of pregnant Brazilians, limiting its clinical applicability in the detection of abnormal fetal growth, especially intrauterine growth restriction.
Summary
. ;:513-522
DOI 10.1590/S0100-72032006000900003
PURPOSE: to describe, in participants of the Brazilian Study of Gestational Diabetes (EBDG), the percentile distribution of uterine height by gestational age and to validate the use of percentiles of the chart derived by the "Centro Latino-Americano de Perinatologia" (CLAP), used as reference in predicting abnormal fetal growth. METHODS: the EBDG is a cohort study of 5564 pregnant women older than 19 years, followed through and after delivery. Interviews and standardized anthropometry were performed at baseline between 20-28 weeks. Medical records covering prenatal and delivery periods were then reviewed following a standardized approach. Analyses pertain to 3539 women with gestational age confirmed by ultrasound. Diagnostic properties of the 10th and the 90th percentiles of both charts (EBDG and CLAP) as predictors of abnormal neonatal weight were determined. RESULTS: uterine height was higher in EBDG than in the CLAP chart at every gestational week, being 1-4 and 2-6 cm greater, at the 10th and 90th percentiles respectively. The CLAP 10th percentile classified as small the uterine heights of only 0.3 to 1.7% of Brazilian women, while the 90th percentile classified as large the uterine heights of 42 to 57% of the sample. The sensitivity of CLAP percentile 10 in the prediction of small for gestational age varied from 0.8 to 6% and the specificity of CLAP percentile 90 in the prediction of large for gestational age, from 46 to 61%. CONCLUSIONS: the CLAP uterine height reference chart does not reflect the current uterine growth pattern of pregnant Brazilians, limiting its clinical applicability in the detection of abnormal fetal growth, especially intrauterine growth restriction.
Summary
. ;:43-48
DOI 10.1590/S0100-72032000000100008
Purpose: to analyze the prevalence of genuine urinary incontinence (GUI) recurrence, after at least two years of follow-up, in different surgical techniques used for its correction. Patients and Methods: fifty-five patients with diagnosis of GUI, submitted to surgery for its repair at the Serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre from 1992 to 1996 and whose post-surgical follow-up was superior to 2 years were divided into three groups according to the surgical approach: Kelly-Kennedy (n = 24), Burch (n = 23) and Marshall-Marchetti-Krantz (n = 8). Results: there were no differences regarding recurrence rate, age at surgery and at recurrence time, estrogen therapy, number of pregnancies and vaginal delivery (p>0.05). Although posterior perineoplasty was more prevalent in the Kelly-Kennedy group, it did not influence the recurrence rate. The group submitted to the Burch approach had more years of menopause at the time of surgery. Conclusion: the recurrence rates of urinary incontinence comparing the three different techniques (Kelly-Kennedy, Burch and Marshall-Marchetti-Krantz) were, respectively, 29.2, 39.1 and 50%, which did not differ statistically. Considering the potential confusional bias for urinary stress incontinence, they did not differ among the groups. Nevertheless, we noticed that all women who had previous surgery presented recurrence of incontinence.
Summary
. ;:43-48
DOI 10.1590/S0100-72032000000100008
Purpose: to analyze the prevalence of genuine urinary incontinence (GUI) recurrence, after at least two years of follow-up, in different surgical techniques used for its correction. Patients and Methods: fifty-five patients with diagnosis of GUI, submitted to surgery for its repair at the Serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre from 1992 to 1996 and whose post-surgical follow-up was superior to 2 years were divided into three groups according to the surgical approach: Kelly-Kennedy (n = 24), Burch (n = 23) and Marshall-Marchetti-Krantz (n = 8). Results: there were no differences regarding recurrence rate, age at surgery and at recurrence time, estrogen therapy, number of pregnancies and vaginal delivery (p>0.05). Although posterior perineoplasty was more prevalent in the Kelly-Kennedy group, it did not influence the recurrence rate. The group submitted to the Burch approach had more years of menopause at the time of surgery. Conclusion: the recurrence rates of urinary incontinence comparing the three different techniques (Kelly-Kennedy, Burch and Marshall-Marchetti-Krantz) were, respectively, 29.2, 39.1 and 50%, which did not differ statistically. Considering the potential confusional bias for urinary stress incontinence, they did not differ among the groups. Nevertheless, we noticed that all women who had previous surgery presented recurrence of incontinence.