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Artigos Originais
Sexuality evaluation in women submitted to hysterectomy for the treatment of uterine leiomyoma
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(10):503-507
11-19-2009
Summary
Artigos OriginaisSexuality evaluation in women submitted to hysterectomy for the treatment of uterine leiomyoma
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(10):503-507
11-19-2009DOI 10.1590/S0100-72032009001000006
Views101See morePURPOSE: to evaluate the impact of hysterectomy on the sexuality of women with uterine leiomyoma. METHODS: prospective study including 33 sexually active women, with ages from 35 to 50 years old, with orgasmic experience and with a fit stable partner. All the women were submitted to two instruments for the evaluation or their sexuality: Sexual Quotient - Female Version (SQF) and Sexual Satisfaction Inventory - Female Version (SSIF). Both instruments were applied by the same examiner, before and six months after the hysterectomy. RESULTS: the SQF has shown that 39.4% of the patients presented deterioration in the sexual intercourse, even though there has not been found an association between the SQF results before and after hysterectomy (χ2= 0.6; degree of freedom=12; p=0.05). The mean scores obtained after the application of the SSIF have shown significant deterioration in the following parameters: sexual satisfaction (p=0.03); expression of feminine sensuality (p=0.01); vaginismus/dyspareunia (p=0.02) and anorgasmia (p=0.04). CONCLUSIONS: it seems that hysterectomy has a negative impact on women's sexual life, with reports of decreased libido, arousal and orgasmic capacity.
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Relato de Caso
Benign metastasizing uterine leiomyoma: case reports
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(8):411-414
10-09-2009
Summary
Relato de CasoBenign metastasizing uterine leiomyoma: case reports
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(8):411-414
10-09-2009DOI 10.1590/S0100-72032009000800007
Views74Benign metastazing leiomyomatosis (BML) is a rare disease in which the lung is the most affected extra-uterine organ. The BML histology is compatible with benignity and similar to that found in the myometrial leiomyoma. A history of surgically treated uterine myomatosis is reported by most of the patients with metastatic disease. We report the cases of two patients with uterine metastazing leiomyomatosis. In the first case, a 55-year-old patient presented lung nodes over 20 years after being submitted to hysterectomy due to uterine leiomyoma. The histological and immunohistochemical studies from the lung node revealed that it was an implant of benign leiomyoma. The second patient, a 65-years-old woman, presented lung and retroperitoneal nodes 20 years after being submitted to a hysterectomy due to uterine leiomyoma.
Key-words Case reportsHysterectomyLeiomyomaLeiomyomatosisLung neoplasmsRetroperitoneal neoplasmsUterine neoplasmsSee more -
Artigos Originais
Tinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):544-549
01-12-2008
Summary
Artigos OriginaisTinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):544-549
01-12-2008DOI 10.1590/S0100-72032008001100003
Views135See morePURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy. The high ratio of BV at the immediate pre-surgery period among the women submitted to vaginal hysterectomy suggests that this infection must be better investigated and properly treated before the surgery.
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Artigo de Revisão
Current treatment of leiomyomas
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(6):324-328
10-08-2007
Summary
Artigo de RevisãoCurrent treatment of leiomyomas
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(6):324-328
10-08-2007DOI 10.1590/S0100-72032007000600008
Views64Leiomyomas are benign tumors. They appear in the myometrium and present a variable amount of fibrous conjunctive tissue. About 75% of the cases are not symptomatic and are usually found during abdominal, bimanual pelvic examination or during ultrasonography. The symptoms are directly related to the size, number and localization of the myomas. In the present review, the current clinical therapeutic procedures (oral anti-conceptive drugs, progestins and anti-progestins, analogues of the gonadothrophins’ releasing hormone (GnRH), and non-steroid anti-inflammatory drugs), and also the surgical procedures (hysterectomy, myomectomy, embolization) are presented for the treatment of leiomyomas.
Key-words Embolization, therapeuticGonadotropin-releasing, hormoneHysterectomyLeiomyomaMyomaReceptors, progesteroneSee more -
Artigos Originais
The control of postpartum hemorrhage with the B-Lynch suture technique: a case series
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):120-125
06-21-2007
Summary
Artigos OriginaisThe control of postpartum hemorrhage with the B-Lynch suture technique: a case series
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):120-125
06-21-2007DOI 10.1590/S0100-72032007000300002
Views115PURPOSE: to present a surgical technique for patients submitted to caesarean section, which evolves to medicine refractory hemorrhage. METHODS: a case report study, of which the including criteria were failure in the pharmacological treatment to control post-partum hemorrhage, and the patients' request to preserve their uterus. Four patients submitted to caesarean section which evolved to immediate post-partum hemorrhage, refractory to the use of ocytocin, ergometrine and misoprostol, were treated with the suture technique described by B-Lynch, without modification. The uterus was transfixed in six points according to the standard procedure, with chrome catgut-2 or polyglactine-1thread. After the assistant's manual compression of the uterus, the thread was pulled by its extremities by the surgeon, and a double knot followed by two simple knots were applied before performing the hysterorraphy. RESULTS: needled chrome catgut-2 thread was used in three cases and needled poluglactine-1 in one case. In the four cases there was immediate discontinuity of the vaginal bleeding, after the suture. The four patients did not present any complication during the procedure or along the immediate and late puerperal period. CONCLUSION: this technique represents a surgical alternative to deal with post-partum hemorrhage and may represent a reduction in the maternal morbidity and mortality in our country.
Key-words Gynecologic surgical proceduresHysterectomyMaternal mortalityOxytocinPostpartum hemorrhageUterine inertiaSee more -
Artigos Originais
Hysterectomy and benign gynecological diseases: what has been performed in Medical Residency in Brazil?
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(2):67-73
05-02-2007
Summary
Artigos OriginaisHysterectomy and benign gynecological diseases: what has been performed in Medical Residency in Brazil?
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(2):67-73
05-02-2007DOI 10.1590/S0100-72032007000200002
Views64See morePURPOSE: to evaluate the teaching and the practice of hysterectomy in the Brazilian regions and to compare them with data of international literature. METHODS: questionnaires about nine issues on benign hysterectomy indications, surgical procedures, use of antibiotic prophylaxis, suture of the vaginal vault and complications were sent to the 132 Gynecological and Obstetrics Residency Services of Brazil, registered by the Ministry of the Education and Culture in 2003. Data were computed and statically analyzed, with the use of the Friedman's, Kruskal-Wallis's and chi2 tests, according to the characteristics of the variables. RESULTS: 48.5% of the questionnaires were answered or justified when there were no answers, mainly in the Southeastern region (62%). The main surgical hysterectomy procedure was the abdominal, varying from 60 to 100% (p<0.001), followed by the vaginal (10 to 40%) and the laparoscopy (6%). In 94% of the cases, laparoscopy was not employed. The main indication for hysterectomy was myomatosis (60.4%; p<0.001), followed by adenomiosis (8.3%) and abnormal uterine bleeding (7.5%). First generation cephalosporin was used for antibiotic prophylaxis in 94% of the cases. There was no significant statistical difference among the threads (simple Catgut®, chrome Catgut® or Vicryl®) used for the suture of the vaginal vault and the development of granuloma in this region, which was the main complication of the procedure (p=0,002). CONCLUSIONS: the surgical procedures, the hysterectomy indications, the threads used to suture the vaginal vault and the complications were similar in the different regions of Brazil and they agreed with the evidence reported in the international literature.
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Trabalhos Originais
Vaginal hysterectomy: is the laparoscope necessary?
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):537-540
04-09-1998
Summary
Trabalhos OriginaisVaginal hysterectomy: is the laparoscope necessary?
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):537-540
04-09-1998DOI 10.1590/S0100-72031998000900008
Views53See morePurpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2%) were nulliparous, and 104 (26.0%) had never delivered vaginally. Three hundred and three patients (75.7%) had a history of previous pelvic surgery, the most common being cesarean section (48.7%). The most frequent indication was leiomyoma (61.2%), and the mean uterine volume was 239.9 cm³ (30-1228 cm³). Vaginal hysterectomy was successfully performed in 396 patients (99.0%), and 73 surgeries (18.2%) were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%). Intraoperative complications included 6 cystotomies (1.5%) and one rectal laceration (0.2%). There were four conversions (1.0%) to the abdominal route. Postoperative complications occurred in 24 patients (6.0%). Two hundred and eighty-one patients (70.2%) were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.
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Trabalhos Originais
Laparoscopically Assisted Vaginal Histerectomy in Patients Requiring Adnexectomy
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(10):571-576
04-04-1998
Summary
Trabalhos OriginaisLaparoscopically Assisted Vaginal Histerectomy in Patients Requiring Adnexectomy
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(10):571-576
04-04-1998DOI 10.1590/S0100-72031998001000005
Views97See morePurpose: 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.