Artigos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(9):441-446
DOI 10.1590/S0100-72032010000900005
PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95%CI). RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4%), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3%), and 16 cases of pelvic inflammatory disease (18.6%). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53%), revealed unilateral obstruction in 21 cases (25.3%) and bilateral obstruction in 17 cases (20.5%). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7%). HSG sensitivity was 0.79 (95%CI=0.62-0.9) and its specificity was 0.58 (95%CI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, wheter this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95%CI=0.24-0.71) and 0.77 (95%CI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3%) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2%) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion. CONCLUSIONS: the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(9):441-446
DOI 10.1590/S0100-72032010000900005
PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95%CI). RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4%), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3%), and 16 cases of pelvic inflammatory disease (18.6%). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53%), revealed unilateral obstruction in 21 cases (25.3%) and bilateral obstruction in 17 cases (20.5%). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7%). HSG sensitivity was 0.79 (95%CI=0.62-0.9) and its specificity was 0.58 (95%CI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, wheter this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95%CI=0.24-0.71) and 0.77 (95%CI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3%) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2%) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion. CONCLUSIONS: the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(9):433-440
DOI 10.1590/S0100-72032010000900004
PURPOSE: to evaluate the level of physical activity, quality of life and associated factors in women aged 60 or older. METHODS: a cross-sectional study was conducted on 271 women who go to a Leisure Center and women attended at a menopause ambulatory in Campinas (SP). The women were invited to take part in the research, carried out through interviews. The instruments used were the version 8 of the International Physical Activity Questionnaire (IPAQ) modified for the elderly population in order to evaluate their physical activity, and the World Health Organization Questionnaire of Quality of Life specific for this group (WHOQOL-OLD) to evaluate their quality of life. IPAQ results were assessed using tertiles. The association between the WHOQOL-OLD and the IPAQ results and subject characteristics was assessed by the Student's t test, Mann-Whitney test and multiple analyses. RESULTS: the average age of women was 67.4±5.3 years. Among these women, 33% were classified as being less active. Analysis of each physical activity domain showed that 60.8% of the time was spent in sitting activities (1,701.6±986.1 minutes/week). Multiple analyses indicated that attending a leisure center in Campinas (SP) and being 70 years old or older increased the chances of engaging in moderate-intensity or vigorous-intensity physical activity by 11.4 and 2.8 times, respectively. The average quality of life score was 66.9±11.7. The highest value was observed in the domain related to sensory abilities (72.0±18.8) and the lowest value was related to autonomy (60.3±16.2). Linear regression showed that a good self-perception of health increased the quality of life score by 7.3 points, the use of a bigger amount of medication decreased it by 4.4 points and the performance of moderate or vigorous physical exercise increased the score by 4.8 points. CONCLUSION: women spend prolonged periods of time in sitting activities. The importance of engaging in moderate/vigorous-intensity physical activity is evident for obtaining a good quality of life.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(9):433-440
DOI 10.1590/S0100-72032010000900004
PURPOSE: to evaluate the level of physical activity, quality of life and associated factors in women aged 60 or older. METHODS: a cross-sectional study was conducted on 271 women who go to a Leisure Center and women attended at a menopause ambulatory in Campinas (SP). The women were invited to take part in the research, carried out through interviews. The instruments used were the version 8 of the International Physical Activity Questionnaire (IPAQ) modified for the elderly population in order to evaluate their physical activity, and the World Health Organization Questionnaire of Quality of Life specific for this group (WHOQOL-OLD) to evaluate their quality of life. IPAQ results were assessed using tertiles. The association between the WHOQOL-OLD and the IPAQ results and subject characteristics was assessed by the Student's t test, Mann-Whitney test and multiple analyses. RESULTS: the average age of women was 67.4±5.3 years. Among these women, 33% were classified as being less active. Analysis of each physical activity domain showed that 60.8% of the time was spent in sitting activities (1,701.6±986.1 minutes/week). Multiple analyses indicated that attending a leisure center in Campinas (SP) and being 70 years old or older increased the chances of engaging in moderate-intensity or vigorous-intensity physical activity by 11.4 and 2.8 times, respectively. The average quality of life score was 66.9±11.7. The highest value was observed in the domain related to sensory abilities (72.0±18.8) and the lowest value was related to autonomy (60.3±16.2). Linear regression showed that a good self-perception of health increased the quality of life score by 7.3 points, the use of a bigger amount of medication decreased it by 4.4 points and the performance of moderate or vigorous physical exercise increased the score by 4.8 points. CONCLUSION: women spend prolonged periods of time in sitting activities. The importance of engaging in moderate/vigorous-intensity physical activity is evident for obtaining a good quality of life.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):398-404
DOI 10.1590/S0100-72032010000800007
PURPOSE: to evaluate the characteristics regarding care of Bolivian pregnant women and their outcomes in Hospital Municipal Vereador José Storopolli. METHODS: a cross-sectional retrospective case-control study comparing two groups of pregnant women from 2003 to 2007. The Study Group included 312 Bolivian pregnant women and the Control Group, 314 Brazilian women. The groups were compared with respect to demographic variables, the presence of maternal complications and perinatal outcomes. Statistical analysis was performed by χ2 test and, when necessary, by applying Yates' correction. RESULTS: compared to Brazilian mothers, a smaller number of Bolivian women received prenatal care (16.4 versus 5.1%, p<0.001) and among those that did, the percentage of those who had less than five visits was higher (50 versus 19.3%, p<0.001). Compared to the Brazilian group, the Bolivian group had fewer unwed mothers (12.1 versus 25.4%, p<0.001) and a lower number of nulliparous women (34.1 versus 43.6%, p=0.017). Congenital syphilis had a higher incidence in the Bolivian group (2.9 versus 0.5%, p<0.05), as well as a higher number of newborns classified as large for gestational age (14.6 versus 5.8%, p <0.001). CONCLUSIONS: the failure to attend prenatal care or its completion with an inadequate number of consultations, and the higher number of cases of congenital syphilis observed among the Bolivian women show the great vulnerability of this ethnic minority group to health problems. Consequently, it is necessary a strategic planning of the sectors responsible for coordinating assistance in our country, in order to reduce this disparity, either through socio-economic improvements or by the implementation of health care tailored to the needs of this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):398-404
DOI 10.1590/S0100-72032010000800007
PURPOSE: to evaluate the characteristics regarding care of Bolivian pregnant women and their outcomes in Hospital Municipal Vereador José Storopolli. METHODS: a cross-sectional retrospective case-control study comparing two groups of pregnant women from 2003 to 2007. The Study Group included 312 Bolivian pregnant women and the Control Group, 314 Brazilian women. The groups were compared with respect to demographic variables, the presence of maternal complications and perinatal outcomes. Statistical analysis was performed by χ2 test and, when necessary, by applying Yates' correction. RESULTS: compared to Brazilian mothers, a smaller number of Bolivian women received prenatal care (16.4 versus 5.1%, p<0.001) and among those that did, the percentage of those who had less than five visits was higher (50 versus 19.3%, p<0.001). Compared to the Brazilian group, the Bolivian group had fewer unwed mothers (12.1 versus 25.4%, p<0.001) and a lower number of nulliparous women (34.1 versus 43.6%, p=0.017). Congenital syphilis had a higher incidence in the Bolivian group (2.9 versus 0.5%, p<0.05), as well as a higher number of newborns classified as large for gestational age (14.6 versus 5.8%, p <0.001). CONCLUSIONS: the failure to attend prenatal care or its completion with an inadequate number of consultations, and the higher number of cases of congenital syphilis observed among the Bolivian women show the great vulnerability of this ethnic minority group to health problems. Consequently, it is necessary a strategic planning of the sectors responsible for coordinating assistance in our country, in order to reduce this disparity, either through socio-economic improvements or by the implementation of health care tailored to the needs of this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):393-397
DOI 10.1590/S0100-72032010000800006
PURPOSE: to describe hysteroscopy findings in infertile patients. METHODS: this was a retrospective series of 953 patients with diagnosis of infertility evaluated by hysteroscopy. A total of 957 patients investigated for infertility were subjected to hysteroscopy, preferentially during the first phase of the menstrual cycle. When necessary, directed biopsies (under direct visualization during the exam) or guided biopsies were obtained using a Novak curette after defining the site to be biopsied during the hysteroscopic examination. Outcome frequencies were determined as percentages, and the χ2 test was used for the correlations. The statistical software EpiInfo 2000 (CDC) was used for data analysis. RESULTS: a normal uterine cavity was detected in 436 cases (45.8%). This was the most frequent diagnosis for women with primary infertility and for women with one or no abortion (p<0.05). Abnormal findings were obtained in 517 of 953 cases (54.2%), including intrauterine synechiae in 185 patients (19.4%), endometrial polyps in 115 (12.1%), endocervical polyps in 66 (6.0%), submucosal myomas in 47 (4.9%), endometrial hyperplasia in 39 (4.1%), adenomyosis in five (0.5%), endometritis (with histopathological confirmation) in four (0.4%), endometrial bone metaplasia in two (0.4%), and cancer of the endometrium in one case (0.1%). Morphological and functional changes of the uterus were detected in 5.6% of the cases, including uterine malformations in 32 (3.4%) and isthmus-cervical incompetence in 21 (2.2%). CONCLUSIONS: intrauterine synechiae were the most frequent abnormal findings in patients evaluated for infertility. Patients with a history of abortion and infertility should be submitted to hysteroscopy in order to rule out intrauterine synechiae as a possible cause of infertility.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):393-397
DOI 10.1590/S0100-72032010000800006
PURPOSE: to describe hysteroscopy findings in infertile patients. METHODS: this was a retrospective series of 953 patients with diagnosis of infertility evaluated by hysteroscopy. A total of 957 patients investigated for infertility were subjected to hysteroscopy, preferentially during the first phase of the menstrual cycle. When necessary, directed biopsies (under direct visualization during the exam) or guided biopsies were obtained using a Novak curette after defining the site to be biopsied during the hysteroscopic examination. Outcome frequencies were determined as percentages, and the χ2 test was used for the correlations. The statistical software EpiInfo 2000 (CDC) was used for data analysis. RESULTS: a normal uterine cavity was detected in 436 cases (45.8%). This was the most frequent diagnosis for women with primary infertility and for women with one or no abortion (p<0.05). Abnormal findings were obtained in 517 of 953 cases (54.2%), including intrauterine synechiae in 185 patients (19.4%), endometrial polyps in 115 (12.1%), endocervical polyps in 66 (6.0%), submucosal myomas in 47 (4.9%), endometrial hyperplasia in 39 (4.1%), adenomyosis in five (0.5%), endometritis (with histopathological confirmation) in four (0.4%), endometrial bone metaplasia in two (0.4%), and cancer of the endometrium in one case (0.1%). Morphological and functional changes of the uterus were detected in 5.6% of the cases, including uterine malformations in 32 (3.4%) and isthmus-cervical incompetence in 21 (2.2%). CONCLUSIONS: intrauterine synechiae were the most frequent abnormal findings in patients evaluated for infertility. Patients with a history of abortion and infertility should be submitted to hysteroscopy in order to rule out intrauterine synechiae as a possible cause of infertility.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):386-392
DOI 10.1590/S0100-72032010000800005
PURPOSE: to evaluate the incidence and direct economic impact of cervical cancer (CC) in Roraima, in 2009, and to analyze the epidemiological profile of patients with this disease. METHODS: the histopathologic reports issued in Roraima in 2009 were reviewed, as were hospital records of female patients under treatment for cancer. Clinical data and medical procedures related to CC were recorded. CC carriers were treated under expenses of the public Brazilian health system (SUS) in Roraima underwent an interview dealing with socio-economic topics. RESULTS: we registered 90 cases of CC and high grade pre-invasive lesions. Roraima has the highest incidence of CC of Brazil (46.21 cases/100,000 women), which is 3 times higher than that of breast cancer, comparable to low-income developing countries. The epidemiological profile shows patients with economic deprivation, social disadvantage, low education, early first intercourse (mean age is 13.8 years), and high parity (medium of 5.5 gestations). Among the patients included in this report, 71.7% had never been submited to a Pap smear, and ignorance about it was the main reported reason (47.4%). As a public health problem, the management of CC generates direct annual expenditures of more than R$ 600,000, with an average cost per patient of R$ 8,711. CONCLUSIONS: CC is the most common cancer among women from Roraima, and represents a serious public health problem in Roraima. Its high economic impact favors the implementation of preventive strategies from the standpoint of cost-effectiveness. The profile of patients reveals the ineffectiveness of preventive services in reaching patients with a socio-economic exclusion profile at high risk for cervical cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):386-392
DOI 10.1590/S0100-72032010000800005
PURPOSE: to evaluate the incidence and direct economic impact of cervical cancer (CC) in Roraima, in 2009, and to analyze the epidemiological profile of patients with this disease. METHODS: the histopathologic reports issued in Roraima in 2009 were reviewed, as were hospital records of female patients under treatment for cancer. Clinical data and medical procedures related to CC were recorded. CC carriers were treated under expenses of the public Brazilian health system (SUS) in Roraima underwent an interview dealing with socio-economic topics. RESULTS: we registered 90 cases of CC and high grade pre-invasive lesions. Roraima has the highest incidence of CC of Brazil (46.21 cases/100,000 women), which is 3 times higher than that of breast cancer, comparable to low-income developing countries. The epidemiological profile shows patients with economic deprivation, social disadvantage, low education, early first intercourse (mean age is 13.8 years), and high parity (medium of 5.5 gestations). Among the patients included in this report, 71.7% had never been submited to a Pap smear, and ignorance about it was the main reported reason (47.4%). As a public health problem, the management of CC generates direct annual expenditures of more than R$ 600,000, with an average cost per patient of R$ 8,711. CONCLUSIONS: CC is the most common cancer among women from Roraima, and represents a serious public health problem in Roraima. Its high economic impact favors the implementation of preventive strategies from the standpoint of cost-effectiveness. The profile of patients reveals the ineffectiveness of preventive services in reaching patients with a socio-economic exclusion profile at high risk for cervical cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):381-385
DOI 10.1590/S0100-72032010000800004
PURPOSE: to examine the association between cytogenetic characteristics and clinical and epidemiological changes in patients with Turner syndrome (TS). METHODS: Forty-two patients were included. Data were collected using a standardized questionnaire in interviews conducted with the responsible person and, when possible, with the patient. A detailed physical examination was performed. The association between karyotype, stigmata and clinical disorders were examined using the χ2 test. RESULTS: Sixty-four percent of TS patients were 45,X; 26,2% 45,X/46,X;7% 45,X/46Xi(Xq), and 2,3% 45,X/46,X,Del(Xq). Regardless of the karyotype, all patients had short stature. Low hair implantation was more frequent in patients with 45,X (p=0.03). Cardiovascular abnormalities (45%), otitis (43%), thyroid dysfunction (33%) and hypertension (26.6%) were the most frequent clinical disorders, but without correlation with the karyotype. Anthropometric measurements revealed a positive linear correlation of waist and hip circumference with age (r=0.9, p=0.01). Thirty-one patients (74%) were using or had previously used growth hormone (43%), sex steroids (30%), thyroxine (11.9%) or oxandrolone (9.5%). Comparison between gestational age at birth and learning difficulties showed a prevalence ratio of 1.71 (p>0.05). CONCLUSION: Low hair implantation is the most prevalent stigma in patients with a 45,X karyotype and the most common clinical changes were cardiovascular problems, otitis, thyroid dysfunction and hypertension; however, they did not show any correlation with the karyotype.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):381-385
DOI 10.1590/S0100-72032010000800004
PURPOSE: to examine the association between cytogenetic characteristics and clinical and epidemiological changes in patients with Turner syndrome (TS). METHODS: Forty-two patients were included. Data were collected using a standardized questionnaire in interviews conducted with the responsible person and, when possible, with the patient. A detailed physical examination was performed. The association between karyotype, stigmata and clinical disorders were examined using the χ2 test. RESULTS: Sixty-four percent of TS patients were 45,X; 26,2% 45,X/46,X;7% 45,X/46Xi(Xq), and 2,3% 45,X/46,X,Del(Xq). Regardless of the karyotype, all patients had short stature. Low hair implantation was more frequent in patients with 45,X (p=0.03). Cardiovascular abnormalities (45%), otitis (43%), thyroid dysfunction (33%) and hypertension (26.6%) were the most frequent clinical disorders, but without correlation with the karyotype. Anthropometric measurements revealed a positive linear correlation of waist and hip circumference with age (r=0.9, p=0.01). Thirty-one patients (74%) were using or had previously used growth hormone (43%), sex steroids (30%), thyroxine (11.9%) or oxandrolone (9.5%). Comparison between gestational age at birth and learning difficulties showed a prevalence ratio of 1.71 (p>0.05). CONCLUSION: Low hair implantation is the most prevalent stigma in patients with a 45,X karyotype and the most common clinical changes were cardiovascular problems, otitis, thyroid dysfunction and hypertension; however, they did not show any correlation with the karyotype.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):374-380
DOI 10.1590/S0100-72032010000800003
PURPOSE: to evaluate the reactivity of VEGF-A and cleaved caspase-3 in the adrenal gland cortex of female pinealectomized rats treated with melatonin. METHODS: forty adult female rats were divided into 4 groups (G) of 10 animals: GI - no surgical intervention, with vehicle administration; GII - sham pinealectomized with vehicle administration; GIII - pinealectomized with vehicle administration; GIV - pinealectomized with melatonin administration (10 µg/animal) during the night. After 60 days of treatment, all animals were anesthetized, and the adrenal glands were removed and fixed in 10% formaldehyde (phosphate buffered) for histological processing and paraffin embedding. Sections (5 µm thick) were collected on silanized slides and submitted to imunnohistochemical methods for the detection of cleaved caspase-3 (apoptosis) and of vascular endothelial growth factor (VEGF-A) in the adrenal cortex. The data obtained were submitted to analysis of variance (ANOVA) complemented by the Tukey-Kramer test (p<0.05). RESULTS: reactivity to cleaved Caspase-3 was noted in the zona glomerulosa of the adrenal glands in all studied groups. There were no significant differences in the zona glomerulosa; however, the zona fasciculata (15.51±3.12*, p<0.05) and the zona reticularis (8.11±1.90*, p<0.05) presented the smallest percentage of apoptosis in the pinealectomized group (GIII). The reactivity to the VEGF-A was stronger in the zona glomerulosa and weaker in the zona reticularis in all groups. We found a stronger VEGF-A reactivity in the zona fasciculata in the pinealectomized group (GIII). CONCLUSIONS: the pineal gland affects the arrangement of the zona glomerulosa and reticularis of the adrenal glands, which are related to the production of sex hormones.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):374-380
DOI 10.1590/S0100-72032010000800003
PURPOSE: to evaluate the reactivity of VEGF-A and cleaved caspase-3 in the adrenal gland cortex of female pinealectomized rats treated with melatonin. METHODS: forty adult female rats were divided into 4 groups (G) of 10 animals: GI - no surgical intervention, with vehicle administration; GII - sham pinealectomized with vehicle administration; GIII - pinealectomized with vehicle administration; GIV - pinealectomized with melatonin administration (10 µg/animal) during the night. After 60 days of treatment, all animals were anesthetized, and the adrenal glands were removed and fixed in 10% formaldehyde (phosphate buffered) for histological processing and paraffin embedding. Sections (5 µm thick) were collected on silanized slides and submitted to imunnohistochemical methods for the detection of cleaved caspase-3 (apoptosis) and of vascular endothelial growth factor (VEGF-A) in the adrenal cortex. The data obtained were submitted to analysis of variance (ANOVA) complemented by the Tukey-Kramer test (p<0.05). RESULTS: reactivity to cleaved Caspase-3 was noted in the zona glomerulosa of the adrenal glands in all studied groups. There were no significant differences in the zona glomerulosa; however, the zona fasciculata (15.51±3.12*, p<0.05) and the zona reticularis (8.11±1.90*, p<0.05) presented the smallest percentage of apoptosis in the pinealectomized group (GIII). The reactivity to the VEGF-A was stronger in the zona glomerulosa and weaker in the zona reticularis in all groups. We found a stronger VEGF-A reactivity in the zona fasciculata in the pinealectomized group (GIII). CONCLUSIONS: the pineal gland affects the arrangement of the zona glomerulosa and reticularis of the adrenal glands, which are related to the production of sex hormones.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):368-373
DOI 10.1590/S0100-72032010000800002
PURPOSE: to evaluate the agreement between conventional cytology using the Papanicolaou test, repeated at the time of colposcopy, with colposcopic and histopathological findings. METHODS: the study was carried out at the central public health laboratory of the state of Pernambuco between January and July, 2008, involving 397 women referred for colposcopic evaluation following an abnormal cervical smear test. Cytology was repeated at the time of colposcopy using conventional method, with particular attention being paid to the presence of abnormal colposcopic findings. The nomenclature used for cytology was the 2001 Bethesda system terminology, while that used for histology was the World Health Organization 1994 classification. Cytology performed at the time of colposcopy was compared with colposcopy and with histopathology obtained by colposcopy-directed biopsy. The Kappa coefficient was used to evaluate the agreement between methods, as well as the χ2 test, with the level of significance set at 5%. RESULTS: poor agreement was found between cytology performed at the time of colposcopy and colposcopic findings (K=0.33; 95%CI=0.21-0.45) and between colposcopy and histopathology (K=0.35; 95%CI=0.39-0.51). Cytology performed at the time of colposcopy compared with histopathology revealed a Kappa of 0.41 (95%CI=0.29-0.530), which was considered to reflect moderate agreement. CONCLUSIONS: agreement was better between cytology and histopathology than between colposcopy and cytology or between colposcopy and histopathology.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(8):368-373
DOI 10.1590/S0100-72032010000800002
PURPOSE: to evaluate the agreement between conventional cytology using the Papanicolaou test, repeated at the time of colposcopy, with colposcopic and histopathological findings. METHODS: the study was carried out at the central public health laboratory of the state of Pernambuco between January and July, 2008, involving 397 women referred for colposcopic evaluation following an abnormal cervical smear test. Cytology was repeated at the time of colposcopy using conventional method, with particular attention being paid to the presence of abnormal colposcopic findings. The nomenclature used for cytology was the 2001 Bethesda system terminology, while that used for histology was the World Health Organization 1994 classification. Cytology performed at the time of colposcopy was compared with colposcopy and with histopathology obtained by colposcopy-directed biopsy. The Kappa coefficient was used to evaluate the agreement between methods, as well as the χ2 test, with the level of significance set at 5%. RESULTS: poor agreement was found between cytology performed at the time of colposcopy and colposcopic findings (K=0.33; 95%CI=0.21-0.45) and between colposcopy and histopathology (K=0.35; 95%CI=0.39-0.51). Cytology performed at the time of colposcopy compared with histopathology revealed a Kappa of 0.41 (95%CI=0.29-0.530), which was considered to reflect moderate agreement. CONCLUSIONS: agreement was better between cytology and histopathology than between colposcopy and cytology or between colposcopy and histopathology.
