Artigos Originais Archives - Page 2 of 81 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):525-531
DOI 10.1590/S0100-72032007001000006
PURPOSE: to evaluate changes in mammographic breast density in postmenopausal women using raloxifene. METHODS: in this clinical trial, 80 women (mean age=61.1 years) were studied prospectively. Forty patients received 60 mg/day raloxifene, and 40 women comprised the non-treated group (control), paired by age and time of menopause. The treated group was composed of patients with osteoporosis of the lumbar spine. Those with history of breast surgery and users of hormone therapy up to six months prior to the study were excluded. The breast density was assessed qualitatively (subjective) and quantitatively (objective) in two moments, initial and final, after a 6-month follow-up. The 320 mammograms (craniocaudal and oblique) were interpreted qualitatively by the Breast Imaging Reporting and Data System (BI-RADS) classification and quantitatively by digital scanning and computer-assisted segmentation. For statistical analysis t-test, Wilcoxon Mann-Whitney, Spearman correlation and the kappa index were used. RESULTS: on the initial statistical comparison, the groups were considered homogenous for the variables: analyzed age, time of menopause, parity, breast feeding, previous hormonal therapy and body mass index. Baseline breast density, by qualitative and quantitative methods, correlated negatively with the age in both groups (p<0.05). Concerning the other variables, there was no correlation. After six months, no alteration was observed in the mammographic breast density in 38 women of raloxifene group and 38 of the control group, by qualitative method. However, by quantitative method, no alteration was observed in 30 women of the raloxifene group and 27 controls (p>0.05). It was observed a weak agreement rate (kappa=0.25) between the BI-RADS classification and digital scanning/computer-assisted segmentation. CONCLUSIONS: in post-menopausal women with osteoporosis, submitted to raloxifene treatment for six months, no alterations were observed on the mammographic breast density.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):525-531
DOI 10.1590/S0100-72032007001000006
PURPOSE: to evaluate changes in mammographic breast density in postmenopausal women using raloxifene. METHODS: in this clinical trial, 80 women (mean age=61.1 years) were studied prospectively. Forty patients received 60 mg/day raloxifene, and 40 women comprised the non-treated group (control), paired by age and time of menopause. The treated group was composed of patients with osteoporosis of the lumbar spine. Those with history of breast surgery and users of hormone therapy up to six months prior to the study were excluded. The breast density was assessed qualitatively (subjective) and quantitatively (objective) in two moments, initial and final, after a 6-month follow-up. The 320 mammograms (craniocaudal and oblique) were interpreted qualitatively by the Breast Imaging Reporting and Data System (BI-RADS) classification and quantitatively by digital scanning and computer-assisted segmentation. For statistical analysis t-test, Wilcoxon Mann-Whitney, Spearman correlation and the kappa index were used. RESULTS: on the initial statistical comparison, the groups were considered homogenous for the variables: analyzed age, time of menopause, parity, breast feeding, previous hormonal therapy and body mass index. Baseline breast density, by qualitative and quantitative methods, correlated negatively with the age in both groups (p<0.05). Concerning the other variables, there was no correlation. After six months, no alteration was observed in the mammographic breast density in 38 women of raloxifene group and 38 of the control group, by qualitative method. However, by quantitative method, no alteration was observed in 30 women of the raloxifene group and 27 controls (p>0.05). It was observed a weak agreement rate (kappa=0.25) between the BI-RADS classification and digital scanning/computer-assisted segmentation. CONCLUSIONS: in post-menopausal women with osteoporosis, submitted to raloxifene treatment for six months, no alterations were observed on the mammographic breast density.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):538-547
DOI 10.1590/S0100-72032007001000008
Exogenous female hormones used for contraception or postmenopausal hormonal replacement therapy are associated with an increase of venous thromboembolism (VTE) risk, mainly because they cause a hypercoagulable state. The risk is highest during the first year of use and it is not cumulative. The dose of estrogen, the type of estrogen and progestogen, the route of administration of female sex steroid hormones, and the hereditary risk factors for VTE of each patient can interfere on the final risk for VTE. The knowledge of their effect on hemostasis is essential for a correct prescription.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):538-547
DOI 10.1590/S0100-72032007001000008
Exogenous female hormones used for contraception or postmenopausal hormonal replacement therapy are associated with an increase of venous thromboembolism (VTE) risk, mainly because they cause a hypercoagulable state. The risk is highest during the first year of use and it is not cumulative. The dose of estrogen, the type of estrogen and progestogen, the route of administration of female sex steroid hormones, and the hereditary risk factors for VTE of each patient can interfere on the final risk for VTE. The knowledge of their effect on hemostasis is essential for a correct prescription.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):506-510
DOI 10.1590/S0100-72032007001000003
PURPOSE: to evaluate the usefulness of the normal human chorionic gonadotropin (hCG) regression curve in the early diagnosis of post-molar trophoblastic neoplasia (GTN). METHODS: a longitudinal study including 105 patients with complete hydatidiform mole (CHM) followed up at the Botucatu Center of Trophoblastic Diseases from 1998 to 2005. Serial serum hCG titers were measured fortnightly in all patients. Individual curves of the 105 patients were built. Comparison between the normal regression curve established at our center with individual hCG curves was used to screen and diagnose (plateau/rise) GTN. The number of weeks postevacuation when hCG levels exceeded the normal limits was compared with the number of weeks when hCG reached plateau/rise. RESULTS: among the 105 patients with CHM, 80 reached spontaneous remission (SR) and 25 developed GTN. Among the 80 SR patients, 7 (8.7%) initially showed hCG concentrations above normal but eventually achieved remission. All the 25 GTN patients showed deviation from the normal hCG curve at 3.84±2.57 weeks and reached plateau or rise at 8.40±2.94 weeks (p<0.001). CONCLUSIONS: the normal regression curve of post-molar hCG is useful in the early diagnosis of GTN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):506-510
DOI 10.1590/S0100-72032007001000003
PURPOSE: to evaluate the usefulness of the normal human chorionic gonadotropin (hCG) regression curve in the early diagnosis of post-molar trophoblastic neoplasia (GTN). METHODS: a longitudinal study including 105 patients with complete hydatidiform mole (CHM) followed up at the Botucatu Center of Trophoblastic Diseases from 1998 to 2005. Serial serum hCG titers were measured fortnightly in all patients. Individual curves of the 105 patients were built. Comparison between the normal regression curve established at our center with individual hCG curves was used to screen and diagnose (plateau/rise) GTN. The number of weeks postevacuation when hCG levels exceeded the normal limits was compared with the number of weeks when hCG reached plateau/rise. RESULTS: among the 105 patients with CHM, 80 reached spontaneous remission (SR) and 25 developed GTN. Among the 80 SR patients, 7 (8.7%) initially showed hCG concentrations above normal but eventually achieved remission. All the 25 GTN patients showed deviation from the normal hCG curve at 3.84±2.57 weeks and reached plateau or rise at 8.40±2.94 weeks (p<0.001). CONCLUSIONS: the normal regression curve of post-molar hCG is useful in the early diagnosis of GTN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):519-524
DOI 10.1590/S0100-72032007001000005
PURPOSE: to identify the impact of pelvic reconstructive surgery on female sexual function, as well as the changes in vaginal anatomy, and to detect possible correlations between them. METHODS: a prospective, descriptive study, including 43 sexually active women with genital dystopy, undergoing surgery for pelvic organ prolapse, conducted between October 2004 and September 2006. The women completed the same multiple-choice questionnaire regarding sexual function, and analogic scales to quantify the degree of desire, arousal and satisfaction, and were clinically assessed using the pelvic organ prolapse quantification (POP-Q) staging system, before the surgery and three and six months after it. Statistical analysis was performed through the Bowker test for symmetry, Wilcoxon test, Student t test, chi2 and analysis of variance (ANOVA) as appropriate, with statistical significance set at 5% (p<0.05). RESULTS: all 43 women completed the follow-up at three and six months after the surgery, but two of them lost their partners after the surgery. Quality of sexual life improved significantly (p=0.03). Symptoms such as dyspareunia (25.6% before versus 17.1% after surgery), discomfort (27.9 versus 0%), embarrassment (20.9% versus 0%) and fear (2.3% versus 0%) significantly improved (p<0.001). Analogical scales scores regarding desire (5 versus 7, p=0.001), arousal (6 versus 8, p<0.001) and satisfaction with sexual life (5 versus 7, p<0.001) also improved. There was a statistically significant improvement (p<0.001) of the POP-Q stages after the surgery. However, there was no statistically significant correlation between changes in vaginal dimensions and changes in sexual function. CONCLUSIONS: after pelvic reconstructive surgery, there was a significant improvement in the quality of sexual life and of the POP-Q stages. However, there was no correlation between them.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):519-524
DOI 10.1590/S0100-72032007001000005
PURPOSE: to identify the impact of pelvic reconstructive surgery on female sexual function, as well as the changes in vaginal anatomy, and to detect possible correlations between them. METHODS: a prospective, descriptive study, including 43 sexually active women with genital dystopy, undergoing surgery for pelvic organ prolapse, conducted between October 2004 and September 2006. The women completed the same multiple-choice questionnaire regarding sexual function, and analogic scales to quantify the degree of desire, arousal and satisfaction, and were clinically assessed using the pelvic organ prolapse quantification (POP-Q) staging system, before the surgery and three and six months after it. Statistical analysis was performed through the Bowker test for symmetry, Wilcoxon test, Student t test, chi2 and analysis of variance (ANOVA) as appropriate, with statistical significance set at 5% (p<0.05). RESULTS: all 43 women completed the follow-up at three and six months after the surgery, but two of them lost their partners after the surgery. Quality of sexual life improved significantly (p=0.03). Symptoms such as dyspareunia (25.6% before versus 17.1% after surgery), discomfort (27.9 versus 0%), embarrassment (20.9% versus 0%) and fear (2.3% versus 0%) significantly improved (p<0.001). Analogical scales scores regarding desire (5 versus 7, p=0.001), arousal (6 versus 8, p<0.001) and satisfaction with sexual life (5 versus 7, p<0.001) also improved. There was a statistically significant improvement (p<0.001) of the POP-Q stages after the surgery. However, there was no statistically significant correlation between changes in vaginal dimensions and changes in sexual function. CONCLUSIONS: after pelvic reconstructive surgery, there was a significant improvement in the quality of sexual life and of the POP-Q stages. However, there was no correlation between them.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):532-537
DOI 10.1590/S0100-72032007001000007
PURPOSE: to determine the effects of soy-derived isoflavone on hot flashes, menopausal symptoms, and endometrial thickness in postmenopausal women. METHODS: this double-blind, placebo-controlled, randomized study involved 90 postmenopausal patients aged 45-60 years old attended at the Outpatient Menopause Clinic. All patients had been experiencing hot flashes accompanied or not by other hypo-estrogenic symptoms. Patients were randomized to receive either two soy capsules containing 50 mg of soy-derived isoflavone or two identical placebo capsules, twice a day for 12 weeks in a double-blind fashion. Each patient was observed for 12 weeks, with two evaluations being made, one at baseline and the other at the end of the study. At each time point, the patients were given a diary to record the severity of the climacteric symptoms experienced, assessed with a modified Kupperman index, using a 100 mm Visual Analogue Scale (VAS). The intensity of hot flashes was also assessed separately. The patients were also submitted to a transvaginal echography for the measurement of endometrial thickness. Yates chi2, ANOVA or t de Student and Mann-Whitney were used for statistical analysis. RESULTS: no significant difference was detected in the Kupperman index (64 versus 82, p>0,05) or in the hot flashes (20 versus 20, p>0,05) between the isoflavone and placebo groups. No significant difference was either detected concerning the Kupperman index and hot flashes before and after treatment, when the two groups were analyzed separately. No difference was detected in the endometrial thickness either in the isoflavone or the placebo group (0.28 versus 0.26 mm, respectively, p>0.05). CONCLUSIONS: our results indicate that 100 mg of isoflavone are not more effective than placebo in reducing hot flashes and hypo-estrogenic symptoms in postmenopausal women and present no effect on the endometrium thickness.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):532-537
DOI 10.1590/S0100-72032007001000007
PURPOSE: to determine the effects of soy-derived isoflavone on hot flashes, menopausal symptoms, and endometrial thickness in postmenopausal women. METHODS: this double-blind, placebo-controlled, randomized study involved 90 postmenopausal patients aged 45-60 years old attended at the Outpatient Menopause Clinic. All patients had been experiencing hot flashes accompanied or not by other hypo-estrogenic symptoms. Patients were randomized to receive either two soy capsules containing 50 mg of soy-derived isoflavone or two identical placebo capsules, twice a day for 12 weeks in a double-blind fashion. Each patient was observed for 12 weeks, with two evaluations being made, one at baseline and the other at the end of the study. At each time point, the patients were given a diary to record the severity of the climacteric symptoms experienced, assessed with a modified Kupperman index, using a 100 mm Visual Analogue Scale (VAS). The intensity of hot flashes was also assessed separately. The patients were also submitted to a transvaginal echography for the measurement of endometrial thickness. Yates chi2, ANOVA or t de Student and Mann-Whitney were used for statistical analysis. RESULTS: no significant difference was detected in the Kupperman index (64 versus 82, p>0,05) or in the hot flashes (20 versus 20, p>0,05) between the isoflavone and placebo groups. No significant difference was either detected concerning the Kupperman index and hot flashes before and after treatment, when the two groups were analyzed separately. No difference was detected in the endometrial thickness either in the isoflavone or the placebo group (0.28 versus 0.26 mm, respectively, p>0.05). CONCLUSIONS: our results indicate that 100 mg of isoflavone are not more effective than placebo in reducing hot flashes and hypo-estrogenic symptoms in postmenopausal women and present no effect on the endometrium thickness.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):446-451
DOI 10.1590/S0100-72032007000900002
PURPOSE: to evaluate the clinical and epidemiological characteristics of patients with the diagnosis of phantom breast syndrome or with phantom phenomena lonely. METHODS: it was conducted an observational, descriptive and sectional study enrolling 98 patients treated for breast cancer at Hospital São Marcos, Teresina (PI), Brazil. A standardized questionnaire was applied. RESULTS: the phantom breast syndrome was observed in 11.2% of the patients and phantom sensation alone was observed in 30% of the patients. The mean age of the patients was 54 years. Fifty-nine patients were married (60%) and 79.5% were analphabetic or had not concluded the high school. Emotional alterations were present in 67.4%, even though in 66.7% the libido was not changed after surgical procedure. As a relief factor of phantom pain, resting was cited by 90.9% of the patients, while physical exercises were mentioned to exacerbate the symptoms in 63.6% of the cases. The mean grade attributed to the pain in a 0 to 10 scale was 3, ranging from 1 to 7. Only 3% of the patients knew about the existence of this syndrome before the interviews. CONCLUSIONS: phantom phenomena are frequent in mastectomized patients, being necessary more studies to know about its characteristics and effects in these women's quality of life.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):446-451
DOI 10.1590/S0100-72032007000900002
PURPOSE: to evaluate the clinical and epidemiological characteristics of patients with the diagnosis of phantom breast syndrome or with phantom phenomena lonely. METHODS: it was conducted an observational, descriptive and sectional study enrolling 98 patients treated for breast cancer at Hospital São Marcos, Teresina (PI), Brazil. A standardized questionnaire was applied. RESULTS: the phantom breast syndrome was observed in 11.2% of the patients and phantom sensation alone was observed in 30% of the patients. The mean age of the patients was 54 years. Fifty-nine patients were married (60%) and 79.5% were analphabetic or had not concluded the high school. Emotional alterations were present in 67.4%, even though in 66.7% the libido was not changed after surgical procedure. As a relief factor of phantom pain, resting was cited by 90.9% of the patients, while physical exercises were mentioned to exacerbate the symptoms in 63.6% of the cases. The mean grade attributed to the pain in a 0 to 10 scale was 3, ranging from 1 to 7. Only 3% of the patients knew about the existence of this syndrome before the interviews. CONCLUSIONS: phantom phenomena are frequent in mastectomized patients, being necessary more studies to know about its characteristics and effects in these women's quality of life.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):452-458
DOI 10.1590/S0100-72032007000900003
PURPOSE: to evaluate and to compare the effectiveness of oxybutynin, electrostimulation (ES) and pelvic floor training (PFT) in the management of women with detrusor overactivity. METHODS: a total of 64 women, 35 to 80 years old, were enrolled in this randomized prospective trial. Patients were randomized in three groups: Oxybutynin (n=22), ES (n=21) and PFT (n=21). There were no statistical differences between the three groups with regards to race (p=0.948), age (p=0.747), hormonal status (p=0.813), time of symptomatology (p=0.789), previous surgery for urinary incontinence (p=0.993), or body mass index (p=0.897). Patients were assessed before and after treatment by urodynamic test, a seven-day voiding diary, and subjective response. The duration of the treatment was twelve weeks. For statistical analyses, the Pearson chi2, analysis of variance (ANOVA) and the paired t-test were used. RESULTS: there was a decrease in the urge-incontinence episodes and in the number of pads required in all groups (p<0.05). There was reduction in the frequency of micturition in the Oxybutynin Group (p=0.014). Oxybutynin and ES Groups had reduction in nocturia episodes (p=0.003 and p=0.036, respectively). There were no significant differences in improvement between the three groups (p>0.05). Urgency was resolved in 14 (63.6%), 11 (52.4%) and 12 (57.1%) patients of the Oxybutynin, ES and PFT Groups, respectively, without differences among the groups (p=0.754). Subjectively, 17 (77.3%), 11 (52.4%) and 16 (76.2%) women who had accomplished oxybutynin, ES and PFT, respectively, were satisfied, without differences among the groups (p = 0.142). Urodynamic was normal in 8 (36.4%), 12 (57.1%) and 11 (52.4%) patients of the Oxybutynin, ES and PFT Groups, respectively. This urodynamic analysis revealed no differences between the three groups (p=0.358). The reduction of urge-incontinence correlated with patient satisfaction (p<0.05). CONCLUSIONS: treatments were equally effective; reduction of urge-incontinence was correlated with patient satisfaction.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):452-458
DOI 10.1590/S0100-72032007000900003
PURPOSE: to evaluate and to compare the effectiveness of oxybutynin, electrostimulation (ES) and pelvic floor training (PFT) in the management of women with detrusor overactivity. METHODS: a total of 64 women, 35 to 80 years old, were enrolled in this randomized prospective trial. Patients were randomized in three groups: Oxybutynin (n=22), ES (n=21) and PFT (n=21). There were no statistical differences between the three groups with regards to race (p=0.948), age (p=0.747), hormonal status (p=0.813), time of symptomatology (p=0.789), previous surgery for urinary incontinence (p=0.993), or body mass index (p=0.897). Patients were assessed before and after treatment by urodynamic test, a seven-day voiding diary, and subjective response. The duration of the treatment was twelve weeks. For statistical analyses, the Pearson chi2, analysis of variance (ANOVA) and the paired t-test were used. RESULTS: there was a decrease in the urge-incontinence episodes and in the number of pads required in all groups (p<0.05). There was reduction in the frequency of micturition in the Oxybutynin Group (p=0.014). Oxybutynin and ES Groups had reduction in nocturia episodes (p=0.003 and p=0.036, respectively). There were no significant differences in improvement between the three groups (p>0.05). Urgency was resolved in 14 (63.6%), 11 (52.4%) and 12 (57.1%) patients of the Oxybutynin, ES and PFT Groups, respectively, without differences among the groups (p=0.754). Subjectively, 17 (77.3%), 11 (52.4%) and 16 (76.2%) women who had accomplished oxybutynin, ES and PFT, respectively, were satisfied, without differences among the groups (p = 0.142). Urodynamic was normal in 8 (36.4%), 12 (57.1%) and 11 (52.4%) patients of the Oxybutynin, ES and PFT Groups, respectively. This urodynamic analysis revealed no differences between the three groups (p=0.358). The reduction of urge-incontinence correlated with patient satisfaction (p<0.05). CONCLUSIONS: treatments were equally effective; reduction of urge-incontinence was correlated with patient satisfaction.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):459-464
DOI 10.1590/S0100-72032007000900004
PURPOSE: describe epidemiologic profile of patients enrolled in the oocyte reception program at Hospital Regional da Asa Sul (HRAS) in Brasília, Distrito Federal, Brazil, and its main indications. METHODS: prospective descriptive study, in which 330 patients enrolled in the waiting list program were studied. Sixty-seven women, irrespective of their infertility factor and that had not been contemplated by the treatment were included. Thirty women who lived in other cities, 50 patients over 50 years old, 24 patients that didn't want to take part in the study, nine patients that asked to be left out of the program and 150 women that couldn't be found by phone calls were excluded. The 67 patients included were interviewed in order to answer a questionnaire. Their medical handbook was recovered to confirm that the investigation required to establish the cause of infertility had been done. The data was registered and analyzed by SPSS version 12.0 software. RESULTS: the patients' epidemiologic profile is age range 40 to 49 years old (82%), non-white skinned (77,6%), catholic (71,6%), married (59,7%), in high school (76,1%), secondary infertility (53,6%) from which due to tubal sterilization (40,3%) and those ones who started trying to conceive before 35 years old (91%). The main indication to enroll in this oocyte reception program was age and low ovarian reserve. CONCLUSION: the results demonstrated the indiscriminate tubal sterilization. The oocyte reception program benefits women with reserved reproductive prognostic.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):459-464
DOI 10.1590/S0100-72032007000900004
PURPOSE: describe epidemiologic profile of patients enrolled in the oocyte reception program at Hospital Regional da Asa Sul (HRAS) in Brasília, Distrito Federal, Brazil, and its main indications. METHODS: prospective descriptive study, in which 330 patients enrolled in the waiting list program were studied. Sixty-seven women, irrespective of their infertility factor and that had not been contemplated by the treatment were included. Thirty women who lived in other cities, 50 patients over 50 years old, 24 patients that didn't want to take part in the study, nine patients that asked to be left out of the program and 150 women that couldn't be found by phone calls were excluded. The 67 patients included were interviewed in order to answer a questionnaire. Their medical handbook was recovered to confirm that the investigation required to establish the cause of infertility had been done. The data was registered and analyzed by SPSS version 12.0 software. RESULTS: the patients' epidemiologic profile is age range 40 to 49 years old (82%), non-white skinned (77,6%), catholic (71,6%), married (59,7%), in high school (76,1%), secondary infertility (53,6%) from which due to tubal sterilization (40,3%) and those ones who started trying to conceive before 35 years old (91%). The main indication to enroll in this oocyte reception program was age and low ovarian reserve. CONCLUSION: the results demonstrated the indiscriminate tubal sterilization. The oocyte reception program benefits women with reserved reproductive prognostic.
