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Trabalhos Originais
Index for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):127-135
04-10-1998
Views50
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisIndex for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):127-135
04-10-1998DOI 10.1590/S0100-72031998000300002
Views50See moreA prospective study was performed with 42 patients with unruptured ectopic pregnancy, which intended to elaborate an index to orient the systemic treatment with the administration of a single intramuscular dose of methotrexate (50 mg/m²). Patients were monitored with beta-hCG titers on days 1, 4 and 7 after the methotrexate. When the titers of beta-hCG declined more than 15%, between days 4 and 7 after methotrexate, the patients were discharged and had an outpatient follow-up monitored with beta-hCG titers weekly until the titers were less than 5 mIU/ml, which represents success of the treatment. We prepared an index for the systemic treatment with methotrexate, with five parameters: (1) initial titers of beta-hCG; (2) aspects of the image at ultrasound (hematosalpinx, gestational sac, live embryo); (3) size of the mass; (4) free fluid in cul-de-sac; (5) collor doppler. Each parameter received a grade from 0 to 2. Grade 0 represented bad prognosis, favorable parameters received grade 2 and borderline parameters received grade one. The success rate with a single dose of methotrexate was 69.0% (29/42). The color doppler was performed in 20 of the 42 patients; in this group of 20 patients the success rate was 75.0% (15/20). In the 22 patients who were not submitted to the color doppler, the average grade of the score in the successful cases was 6.6, and in the unsuccessful it was 3.1. In the group who underwent the doppler (20 patients) the average was 7.9 in the successful cases and 4.2 in the cases that failed. In the present study the cut-off grade was 5, for most of the patients with grades above 5 had a successful treatment (15/16 – 93.75%), while grades equal or below 5 failed. The score will help to indicate the best cases for the medical treatment. We do not advise the treatment when the grade is equal or below 5. Therefore, we can predict a good evolution of the treatment when the grade is above five.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Editorial
A coordenação necessária
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):125-125
04-10-1998
Views41This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
EditorialA coordenação necessária
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):125-125
04-10-1998This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Resumos de Teses
Estudo do teste de angiotensina ii em gestantes hipertensas crônicas na predição da pré-eclâmpsia superajuntada
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
04-09-1998
Views27This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Resumos de TesesEstudo do teste de angiotensina ii em gestantes hipertensas crônicas na predição da pré-eclâmpsia superajuntada
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
04-09-1998DOI 10.1590/S0100-72031998000900011
Views27Estudo do Teste de Angiotensina II em Gestantes Hipertensas Crônicas na Predição da Pré-Eclâmpsia Superajuntada. […]See moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Resumos de Teses
Índice proteinúria/creatininúria em gestantes com hipertensão arterial sistêmica
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
04-09-1998
Views43This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Resumos de TesesÍndice proteinúria/creatininúria em gestantes com hipertensão arterial sistêmica
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
04-09-1998This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Resumos de Teses
Valor da histerossonografia na avaliação da cavidade endometrial na mulher com sangramento uterino anormal
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):541-542
04-09-1998
Views34This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Resumos de TesesValor da histerossonografia na avaliação da cavidade endometrial na mulher com sangramento uterino anormal
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):541-542
04-09-1998DOI 10.1590/S0100-72031998000900010
Views34Valor da Histerossonografia na Avaliação da Cavidade Endometrial na Mulher com Sangramento Uterino Anormal […]See moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Resumos de Teses
Freqüência de mutação no códon 12 do gene K-ras no carcinoma ductal invasivo de mama, através da técnica da reação em cadeia da polimerase
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):541-541
04-09-1998
Views41This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Resumos de TesesFreqüência de mutação no códon 12 do gene K-ras no carcinoma ductal invasivo de mama, através da técnica da reação em cadeia da polimerase
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):541-541
04-09-1998DOI 10.1590/S0100-72031998000900009
Views41Freqüência de Mutação no Códon 12 do Gene K-ras no Carcinoma Ductal Invasivo de Mama, Através da Técnica da Reação em Cadeia da Polimerase[…]See moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Vaginal hysterectomy: is the laparoscope necessary?
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):537-540
04-09-1998
Views58This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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
Views58See 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.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Ultrasound screening for Down syndrome using a multiparameter score
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):525-531
04-09-1998
Views100This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisUltrasound screening for Down syndrome using a multiparameter score
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):525-531
04-09-1998DOI 10.1590/S0100-72031998000900006
Views100See morePurpose: to calculate sensitivity, specificity and positive and negative predictive values for multiparameter ultrasound scores for Down’s syndrome. Patients and Methods: sensitivity and specificity for Down syndrome were calculated for ultrasound scores in a prospective study of ultrasound signs from 16 to 24 weeks in a high-risk population who denied invasive procedures after genetic counselling. The signs and scores were: femur/foot length < 0,9 (1), nuchal fold > 5 mm (2), pyelocaliceal diameter > 5 mm (1), nasal bones < 6 mm (1), absent or hypoplastic fifth median phalanx (1) and major structural malformations (2). Complete follow-up was obtained in each case. Genetic amniocentesis was proposed in the case of score 2 or more. Results: a total of 963 patients were examined from October 93 to December 97 at a mean gestational age of 19.6 (range 16 -24) weeks. Women's age ranged from 35 to 47 years (mean 38.8) and 18 Down syndrome cases were observed (1.8%). Sensitivity was 94.5% (17/18) for score 1 and 73% (13/18) for score 2 (false positive rate of 9.8% for score 1 and 4.1% for score 2). Individual sign sensitivity and specificity were: femur/foot = 16.7% (3/18) and 96.8% (915/945); nasal bones = 22.2% (4/18) and 92.1% (870/945); nuchal fold = 44.4% (8/18) and 96.5% (912/945); pyelic diameter = 38.9% (7/18) and 94.3% (891/945); absent phalanx = 22.2% (4/18) and 98.5% (912/945); malformation = 22.2% (4/18) and 98.2% (928/945). Conclusions: the overall sensitivity for score 1 was high but false positive rates were also high. For score 2, sensibility was still good (73%) and false positive rate was acceptable (4.1%). Positive and negative predictive values can be calculated for each prevalence (women's age). More cases are needed to reach final conclusions about this screening method (specially in a low-risk population) although this system has been useful for high-risk patients who deny invasive procedures.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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