-
Artigos Originais
Factors associated with women’s dyslipidemia in the post-menopause
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):594-601
02-06-2008
Summary
Artigos OriginaisFactors associated with women’s dyslipidemia in the post-menopause
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):594-601
02-06-2008DOI 10.1590/S0100-72032008001200002
Views61See morePURPOSE: to evaluate factors associated with women's dyslipidemia during menopause. METHODS: case-control study of prevalent cases and controls selected from a dedicated outpatient clinic. From recent biochemical parameters found in patients' files, women have been grouped in 'case' and 'control'. Women who presented any alteration in the blood levels of total cholesterol, LDL-cholesterol, triglycerides and/or HDL-cholesterol were considered as case, and the ones who presented normal levels of them, as control. Data concerning socioeconomic situation, physical activity, etilism and tabagism, anthropometric measurements and food ingestion have been collected and then compared between the groups. Ratios have been compared by the χ2, Fisher's exact test and/or t-Student test, depending on the distribution type. The crude relationship between each factor and the presence of dyslipidemia has been estimated by logistic regression. RESULTS: data have been collected from 84 women aged from 42 to 59 years, as 45 of them were grouped as case (dyslipidemic) and 39 as control (non-dyslipidemic). Age average of cases and controls was 52.1±4.2 and 52.2±4.7 years old, respectively. The sample showed to be homogeneous for the socioeconomic characteristics (income, occupation and schooling), physical activity practice, etilism and tabagism, and food ingestion, with no significant correlation with dyslipidemia. The groups presented an income up to two minimal wages, low schooling level (up to the fourth grade of lower school), and the housewife occupation. Smoking and drinking alcohol was not very frequent. Practicing physical activity was non-existent, thus characterizing a sedentary population. Food ingestion was adequate for carbohydrates, protein, lipids, but not for cholesterol (excessive) and fibers (insufficient), in both groups. Concerning the anthropometric evaluation, there has been an association with dyslipidemia, as the body mass index (BMI) and the waist circumference (WC) were significantly larger in case than in control. The waist-hip ratio has been similar in both groups. Weight excess has been found in most of the cases (73.3%) as almost half of them (44%) presented WC >88 cm, which represents a very increased risk. CONCLUSIONS: it is possible to conclude that, in the studied sample, only the anthropometric measurements have been considered as risk factors associated with dyslipidemia, during post-menopause.
Views61
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
Artigos OriginaisFactors associated with women’s dyslipidemia in the post-menopause
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):594-601
02-06-2008DOI 10.1590/S0100-72032008001200002
Views61See morePURPOSE: to evaluate factors associated with women's dyslipidemia during menopause. METHODS: case-control study of prevalent cases and controls selected from a dedicated outpatient clinic. From recent biochemical parameters found in patients' files, women have been grouped in 'case' and 'control'. Women who presented any alteration in the blood levels of total cholesterol, LDL-cholesterol, triglycerides and/or HDL-cholesterol were considered as case, and the ones who presented normal levels of them, as control. Data concerning socioeconomic situation, physical activity, etilism and tabagism, anthropometric measurements and food ingestion have been collected and then compared between the groups. Ratios have been compared by the χ2, Fisher's exact test and/or t-Student test, depending on the distribution type. The crude relationship between each factor and the presence of dyslipidemia has been estimated by logistic regression. RESULTS: data have been collected from 84 women aged from 42 to 59 years, as 45 of them were grouped as case (dyslipidemic) and 39 as control (non-dyslipidemic). Age average of cases and controls was 52.1±4.2 and 52.2±4.7 years old, respectively. The sample showed to be homogeneous for the socioeconomic characteristics (income, occupation and schooling), physical activity practice, etilism and tabagism, and food ingestion, with no significant correlation with dyslipidemia. The groups presented an income up to two minimal wages, low schooling level (up to the fourth grade of lower school), and the housewife occupation. Smoking and drinking alcohol was not very frequent. Practicing physical activity was non-existent, thus characterizing a sedentary population. Food ingestion was adequate for carbohydrates, protein, lipids, but not for cholesterol (excessive) and fibers (insufficient), in both groups. Concerning the anthropometric evaluation, there has been an association with dyslipidemia, as the body mass index (BMI) and the waist circumference (WC) were significantly larger in case than in control. The waist-hip ratio has been similar in both groups. Weight excess has been found in most of the cases (73.3%) as almost half of them (44%) presented WC >88 cm, which represents a very increased risk. CONCLUSIONS: it is possible to conclude that, in the studied sample, only the anthropometric measurements have been considered as risk factors associated with dyslipidemia, during post-menopause.
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. -
Artigos Originais
Importance of a second opinion in breast surgical pathology and therapeutic implications
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):602-608
02-04-2008
Summary
Artigos OriginaisImportance of a second opinion in breast surgical pathology and therapeutic implications
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):602-608
02-04-2008DOI 10.1590/S0100-72032008001200003
Views91See morePURPOSE: to evaluate the agreement between histopathologic diagnoses of breast lesions made by general pathologists and by a specialist in breast pathology. METHODS: a cohort retrospective study comparing histopathologic diagnoses of 329 cases of breast lesions received in consultation for a second opinion was carried out. The material received for consultation included slides (152 cases), paraffin blocks (59 cases) or slides and blocks (118 cases). Cases were reviewed and the original diagnoses and diagnoses from a specialist in breast pathology were compared. The main diagnoses, nuclear grade of ductal carcinoma in situ, and the histopathologic grade of invasive mammary carcinomas were evaluated. The kappa index and percentual concordance were used in the statistical analyses. RESULTS: a moderate agreement was observed between the original histopathologic diagnoses and the second opinion (kappa index=0.48; percentual concordance=59.9%). The diagnosis of malignancy was confirmed in 185/225 cases (82.2%) and diagnosis of benign lesions was confirmed in 89/104 cases (85.6%). The highest agreement was observed in the diagnosis of invasive mammary carcinomas (81%) and the highest disagreement was observed among diagnoses of ductal carcinoma in situ with microinvasion (74%), lobular carcinoma in situ (70%), and atypical epithelial hyperplasias (61%). There was a moderate agreement in the nuclear grade of ductal carcinoma in situ (kappa index=0.52; percentual concordance=68.8%), and good concordance in the histologic grade of invasive carcinomas (kappa index=0.61; percentual concordance=74.3). CONCLUSIONS: the results show higher concordance rate in the diagnosis of invasive carcinomas and lower concordance in the diagnosis of ductal carcinoma in situ with microinvasion and premalignant breast lesions, especially lobular neoplasia in situ, and atypical epithelial hyperplasias.
Views91This 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
Artigos OriginaisImportance of a second opinion in breast surgical pathology and therapeutic implications
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):602-608
02-04-2008DOI 10.1590/S0100-72032008001200003
Views91See morePURPOSE: to evaluate the agreement between histopathologic diagnoses of breast lesions made by general pathologists and by a specialist in breast pathology. METHODS: a cohort retrospective study comparing histopathologic diagnoses of 329 cases of breast lesions received in consultation for a second opinion was carried out. The material received for consultation included slides (152 cases), paraffin blocks (59 cases) or slides and blocks (118 cases). Cases were reviewed and the original diagnoses and diagnoses from a specialist in breast pathology were compared. The main diagnoses, nuclear grade of ductal carcinoma in situ, and the histopathologic grade of invasive mammary carcinomas were evaluated. The kappa index and percentual concordance were used in the statistical analyses. RESULTS: a moderate agreement was observed between the original histopathologic diagnoses and the second opinion (kappa index=0.48; percentual concordance=59.9%). The diagnosis of malignancy was confirmed in 185/225 cases (82.2%) and diagnosis of benign lesions was confirmed in 89/104 cases (85.6%). The highest agreement was observed in the diagnosis of invasive mammary carcinomas (81%) and the highest disagreement was observed among diagnoses of ductal carcinoma in situ with microinvasion (74%), lobular carcinoma in situ (70%), and atypical epithelial hyperplasias (61%). There was a moderate agreement in the nuclear grade of ductal carcinoma in situ (kappa index=0.52; percentual concordance=68.8%), and good concordance in the histologic grade of invasive carcinomas (kappa index=0.61; percentual concordance=74.3). CONCLUSIONS: the results show higher concordance rate in the diagnosis of invasive carcinomas and lower concordance in the diagnosis of ductal carcinoma in situ with microinvasion and premalignant breast lesions, especially lobular neoplasia in situ, and atypical epithelial hyperplasias.
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. -
Artigos Originais
Predictive factors for height gain in idiopathic central precocious puberty treated with GnRH analogues
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):609-613
02-04-2008
Summary
Artigos OriginaisPredictive factors for height gain in idiopathic central precocious puberty treated with GnRH analogues
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):609-613
02-04-2008DOI 10.1590/S0100-72032008001200004
Views123PURPOSE: to evaluate predictive factors of response to GnRHa treatment in girls with idiopathic central precocious puberty. METHODS: a retrospective cohort study was conducted involving 33 girls diagnosed with idiopathic central precocious puberty and treated with GnRHa. The following independent variables were assessed: age at the beginning of therapy and at the onset of symptoms, time elapsed since the appearance of pubertal characteristics and the beginning of treatment, bone age, bone age advance, duration of GnRHa treatment, actual height and Z-score, predicted height and Z-score and hormone measurements of FSH and LH after GnRH stimulation, which were correlated with gain in height as a dependent variable at treatment discontinuation, calculated by the difference between the predicted height at the end and beginning of treatment. For statistical analysis, Pearson's linear correlation was used, in addition to multiple linear regression analysis. RESULTS: the mean age at the beginning of treatment was 7.8±1.3 years, with a mean bone age of 10.1±1.6 years. Bone age advance was 2.3±1.1 years and was controlled during the treatment period. Gain in predicted height was 2.5±1.3cm. It was positively correlated with time elapsed since the beginning of symptoms and the beginning of treatment and with bone age advance, while negatively correlated with the Z-score of height at the beginning of treatment and predicted height at the beginning of treatment, and the latter was the main factor determining gain from treatment. CONCLUSIONS: girls who had the most significant compromise of predicted adult height, as detected by a larger deviation from the population (Z-score) and the most considerable advance in bone age, received benefit from GnRHa therapy, and they must not be excluded from the group to be treated.
Key-words Age determination by skeletonBody heightBone developmentGonadotropin-releasing, hormonePuberty, precociousSee moreViews123This 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
Artigos OriginaisPredictive factors for height gain in idiopathic central precocious puberty treated with GnRH analogues
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):609-613
02-04-2008DOI 10.1590/S0100-72032008001200004
Views123PURPOSE: to evaluate predictive factors of response to GnRHa treatment in girls with idiopathic central precocious puberty. METHODS: a retrospective cohort study was conducted involving 33 girls diagnosed with idiopathic central precocious puberty and treated with GnRHa. The following independent variables were assessed: age at the beginning of therapy and at the onset of symptoms, time elapsed since the appearance of pubertal characteristics and the beginning of treatment, bone age, bone age advance, duration of GnRHa treatment, actual height and Z-score, predicted height and Z-score and hormone measurements of FSH and LH after GnRH stimulation, which were correlated with gain in height as a dependent variable at treatment discontinuation, calculated by the difference between the predicted height at the end and beginning of treatment. For statistical analysis, Pearson's linear correlation was used, in addition to multiple linear regression analysis. RESULTS: the mean age at the beginning of treatment was 7.8±1.3 years, with a mean bone age of 10.1±1.6 years. Bone age advance was 2.3±1.1 years and was controlled during the treatment period. Gain in predicted height was 2.5±1.3cm. It was positively correlated with time elapsed since the beginning of symptoms and the beginning of treatment and with bone age advance, while negatively correlated with the Z-score of height at the beginning of treatment and predicted height at the beginning of treatment, and the latter was the main factor determining gain from treatment. CONCLUSIONS: girls who had the most significant compromise of predicted adult height, as detected by a larger deviation from the population (Z-score) and the most considerable advance in bone age, received benefit from GnRHa therapy, and they must not be excluded from the group to be treated.
Key-words Age determination by skeletonBody heightBone developmentGonadotropin-releasing, hormonePuberty, precociousSee 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. -
Artigos Originais
First polar body morphology and fertilization rate, cleavage rate, and embryo quality
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(7):360-365
02-03-2008
Summary
Artigos OriginaisFirst polar body morphology and fertilization rate, cleavage rate, and embryo quality
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(7):360-365
02-03-2008DOI 10.1590/S0100-72032008000700007
Views138PURPOSE: to determine the relationship between the morphology of the first spindle pole of human oocytes and rates of fertilization, fragmentation and embryo quality in procedures of Intracytoplasmic Sperm Injection (ICSI). METHODS: retrospective study of 582 consecutive ICSI cycles, from July 2003 to July 2005. The morphology of the first spindle pole (SP) was assessed through the analysis of 3,177 oocytes in metaphase II, immediately before the ICSI procedure, always by the same observer. SP has been classified in the following categories: normal size intact, fragmented or augmented SP. Fertilization rate and fragmentation, and the number and rate of good quality embryos in each one of the three groups studied have been evaluated, 48 hours after ICSI (D2). Embryos with four cells, without fragmentation and with symmetric blastomeres in D2 were considered as of good quality. RESULTS: rates of fertilization, fragmentation and of good quality embryo formation, resulting from oocyte insemination, with augmented SP (20.7, 16.7 and 5% respectively) were significantly lower than the ones from intact and normal size SP (70.8, 62.5 and 19%, respectively) or from fragmented SP oocytes (69.7, 60.5 and 17.1%, respectively). CONCLUSIONS: it has been observed that the presence of augmented first spindle pole is related to worse rates of fertilization, fragmentation and bad quality embryo formation. Nevertheless, fragmentation in the first spindle pole of the oocyte does not seem to affect ICSI results.
Key-words Embryo implantationFertilizationFertilization in vitroOcytesOocytesQuality controlSperm injections, intracytoplasmicSee moreViews138This 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
Artigos OriginaisFirst polar body morphology and fertilization rate, cleavage rate, and embryo quality
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(7):360-365
02-03-2008DOI 10.1590/S0100-72032008000700007
Views138PURPOSE: to determine the relationship between the morphology of the first spindle pole of human oocytes and rates of fertilization, fragmentation and embryo quality in procedures of Intracytoplasmic Sperm Injection (ICSI). METHODS: retrospective study of 582 consecutive ICSI cycles, from July 2003 to July 2005. The morphology of the first spindle pole (SP) was assessed through the analysis of 3,177 oocytes in metaphase II, immediately before the ICSI procedure, always by the same observer. SP has been classified in the following categories: normal size intact, fragmented or augmented SP. Fertilization rate and fragmentation, and the number and rate of good quality embryos in each one of the three groups studied have been evaluated, 48 hours after ICSI (D2). Embryos with four cells, without fragmentation and with symmetric blastomeres in D2 were considered as of good quality. RESULTS: rates of fertilization, fragmentation and of good quality embryo formation, resulting from oocyte insemination, with augmented SP (20.7, 16.7 and 5% respectively) were significantly lower than the ones from intact and normal size SP (70.8, 62.5 and 19%, respectively) or from fragmented SP oocytes (69.7, 60.5 and 17.1%, respectively). CONCLUSIONS: it has been observed that the presence of augmented first spindle pole is related to worse rates of fertilization, fragmentation and bad quality embryo formation. Nevertheless, fragmentation in the first spindle pole of the oocyte does not seem to affect ICSI results.
Key-words Embryo implantationFertilizationFertilization in vitroOcytesOocytesQuality controlSperm injections, intracytoplasmicSee 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. -
Artigos Originais
Tibolone’s effect on retinal and ophthalmic arteries flowmetry
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):537-543
01-12-2008
Summary
Artigos OriginaisTibolone’s effect on retinal and ophthalmic arteries flowmetry
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):537-543
01-12-2008DOI 10.1590/S0100-72032008001100002
Views106PURPOSE: to evaluate the effect of tibolone use on dopplervelocimetric parameters of ophthalmic and retinal arteries. METHODS: clinical, prospective, longitudinal, randomized, placebo-controlled, triple-blind study, in which among 100 menopausal women, 50 have used 2.5 mg of the active principle tibolone (Tib Group) and 50, placebo as a means to form the control-group (Plac Group). In the Tib Group, 44 of the 50 women returned after 84 days to finish the exams, and in the Plac Group, 47. The ophthalmic and retinal arteries were studied to determine the resistance index (RI), the pulsatility index (PI) and the systole/diastole ratio (S/D). Assessments have been done before and 84 days after medication. The t-Student test has been used for the comparison of means between the groups in independent samples, as well as for within-group comparisons in dependent samples. RESULTS: in both groups, the women's characteristics were similar in age, menopause duration, body mass index, arterial blood pressure, deliveries and cardiac rate. The Tib Group presented the following values in the ophthalmic artery: RI(pre)=0.71±0.05, RI(post)0.72±0.08 (p=0.43); PI(pre)=1.29±0.22, PI(post)=1.30±0.25 (p=0.4) and S/D(pre)=3.49±0.77, SD(post)=3.65±0.94 (p=0.32). In the retinal artery, the following values have been found: RI(pre)=0.67±0.09, RI(post)=0.69±0.10 (p=0.7); PI(pre)=1.20±0.29, PI(post)=1.22±0.3 (p=0.2) and SD(pre)=3.29±0.95, SD(post)=3.30±1.07 (p=0.3). Also, the tibolone and control groups did not show any significant difference in regard to the above indexes in the end of the study. CONCLUSIONS: the 2.5 mg dose of tibolone had no effect on the Doppler velocimetry indexes of the ophthalmic and retinal arteries.
Key-words Laser-doppler flowmetryNorpregnanesOphthalmic arteryPlacebosRandomized controlled trialsRetinal arteryUltrasonographySee moreViews106This 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
Artigos OriginaisTibolone’s effect on retinal and ophthalmic arteries flowmetry
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):537-543
01-12-2008DOI 10.1590/S0100-72032008001100002
Views106PURPOSE: to evaluate the effect of tibolone use on dopplervelocimetric parameters of ophthalmic and retinal arteries. METHODS: clinical, prospective, longitudinal, randomized, placebo-controlled, triple-blind study, in which among 100 menopausal women, 50 have used 2.5 mg of the active principle tibolone (Tib Group) and 50, placebo as a means to form the control-group (Plac Group). In the Tib Group, 44 of the 50 women returned after 84 days to finish the exams, and in the Plac Group, 47. The ophthalmic and retinal arteries were studied to determine the resistance index (RI), the pulsatility index (PI) and the systole/diastole ratio (S/D). Assessments have been done before and 84 days after medication. The t-Student test has been used for the comparison of means between the groups in independent samples, as well as for within-group comparisons in dependent samples. RESULTS: in both groups, the women's characteristics were similar in age, menopause duration, body mass index, arterial blood pressure, deliveries and cardiac rate. The Tib Group presented the following values in the ophthalmic artery: RI(pre)=0.71±0.05, RI(post)0.72±0.08 (p=0.43); PI(pre)=1.29±0.22, PI(post)=1.30±0.25 (p=0.4) and S/D(pre)=3.49±0.77, SD(post)=3.65±0.94 (p=0.32). In the retinal artery, the following values have been found: RI(pre)=0.67±0.09, RI(post)=0.69±0.10 (p=0.7); PI(pre)=1.20±0.29, PI(post)=1.22±0.3 (p=0.2) and SD(pre)=3.29±0.95, SD(post)=3.30±1.07 (p=0.3). Also, the tibolone and control groups did not show any significant difference in regard to the above indexes in the end of the study. CONCLUSIONS: the 2.5 mg dose of tibolone had no effect on the Doppler velocimetry indexes of the ophthalmic and retinal arteries.
Key-words Laser-doppler flowmetryNorpregnanesOphthalmic arteryPlacebosRandomized controlled trialsRetinal arteryUltrasonographySee 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. -
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
Views174See 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.
Views174This 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
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
Views174See 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.
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. -
Artigos Originais
Training and standardized criteria improve the diagnosis of premalignant breast lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):550-555
01-12-2008
Summary
Artigos OriginaisTraining and standardized criteria improve the diagnosis of premalignant breast lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):550-555
01-12-2008DOI 10.1590/S0100-72032008001100004
Views125PURPOSE: to analyze interobserver variability in the histopathological diagnosis of premalignant breast lesions before and after training with diagnostic standardized criteria. METHODS: Slides containing histological sections representative of three kinds of breast lesions (atypical ductal hyperplasia, ductal carcinoma in situ and ductal carcinoma in situ with microinvasion), revised by an international specialist in breast pathology whose diagnoses were considered as golden standard, have been used. The same slides have been evaluated at two different times by five pathologists from the community according to a specific protocol for classifying the lesions. In the first evaluation, the cases were analyzed and classified according to the specific criteria adopted in each service. At the second time, the pathologists were given a tutorial containing diagnostic criteria and representative images, and the lesions were classified again, employing the standardized criteria. Interobserver analysis using percent agreement and weighted Kappa index has been performed. RESULTS: There has been a large diagnostic variation among the pathologists in the initial analysis without the use of standardized diagnostic criteria concerning the diagnostic, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis varied from 0.15 to 0.40). In the second evaluation using standardized criteria, there has been a significant improvement in the diagnostic concordance among the five pathologists concerning the diagnosis, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis have varied from 0.42 to 0.80). CONCLUSIONS: interobserver concordance related to diagnosis and classification of breast premalignant lesions may be improved with specific training and the use of standardized histopathological criteria.
Key-words BreastBreast diseasesCarcinomaductalHyperplasiaintraductalNeoplasm invasivenessnoninfiltratingSee moreViews125This 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
Artigos OriginaisTraining and standardized criteria improve the diagnosis of premalignant breast lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):550-555
01-12-2008DOI 10.1590/S0100-72032008001100004
Views125PURPOSE: to analyze interobserver variability in the histopathological diagnosis of premalignant breast lesions before and after training with diagnostic standardized criteria. METHODS: Slides containing histological sections representative of three kinds of breast lesions (atypical ductal hyperplasia, ductal carcinoma in situ and ductal carcinoma in situ with microinvasion), revised by an international specialist in breast pathology whose diagnoses were considered as golden standard, have been used. The same slides have been evaluated at two different times by five pathologists from the community according to a specific protocol for classifying the lesions. In the first evaluation, the cases were analyzed and classified according to the specific criteria adopted in each service. At the second time, the pathologists were given a tutorial containing diagnostic criteria and representative images, and the lesions were classified again, employing the standardized criteria. Interobserver analysis using percent agreement and weighted Kappa index has been performed. RESULTS: There has been a large diagnostic variation among the pathologists in the initial analysis without the use of standardized diagnostic criteria concerning the diagnostic, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis varied from 0.15 to 0.40). In the second evaluation using standardized criteria, there has been a significant improvement in the diagnostic concordance among the five pathologists concerning the diagnosis, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis have varied from 0.42 to 0.80). CONCLUSIONS: interobserver concordance related to diagnosis and classification of breast premalignant lesions may be improved with specific training and the use of standardized histopathological criteria.
Key-words BreastBreast diseasesCarcinomaductalHyperplasiaintraductalNeoplasm invasivenessnoninfiltratingSee 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. -
Artigos Originais
Influence of adequacy of the sample on detection of the precursor lesions of the cervical cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):556-560
01-12-2008
Summary
Artigos OriginaisInfluence of adequacy of the sample on detection of the precursor lesions of the cervical cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):556-560
01-12-2008DOI 10.1590/S0100-72032008001100005
Views155See morePURPOSE: to evaluate whether the sample adequacy influences the detection of precursor cervical cancer lesions. METHODS: a transversal study from January 2004 to December 2005. A number of 10,951 results of cervical cytotopathological exams from users of the National Health System (Sistema Único de Saúde, SUS) in Goiânia, Goiás , Brazil, was studied. These women had spontaneously looked for the services from the Family Health Program or from the Basic Units of Health. Samples were collected by medical doctors and nurses, through the conventional technique to detect cervical cancer. The analyzed smears were classified by the Bethesda System, the sample adequacy being defined along the routine screening and categorized as: satisfactory, satisfactory but presenting factors that might partially jeopardize the analysis, and unsatisfactory. Results were stored in the Epi-Info 3.3.2 program. The χ2 test was used to compare altered results with the adequacy of the samples from cytopathological smears. Differences with probability of rejection of the null hypothesis lower than 5% (p<0.05) were considered as significant. RESULTS: From 10,951 smears, 51.1% were classified as having satisfactory adequacy for analysis, 46.6% as satisfactory, but presenting some limiting factors, and 2.3%, as unsatisfactory. The main factors which have partially jeopardized the analysis were: lack of endocervical cells (52.2%), dried smears (22.8%), purulence (14.9%), or smears with some thick areas (9.5%). There was a higher rate of altered smears when the sample had been classified as satisfactory for analysis and with representation of endocervical cells ASC-US (2.3%), ASC-H (0.6%), LSIL (3.2%), HSIL (1.7%) and 0.3% of AGC. Differences were significant when p=0.001. The rate of low and high grade lesions was higher when the smears were satisfactory for analysis. CONCLUSIONS: the rate of precursor uterine cervix cancer lesions varies according to the sample adequacy, and the main adequacy limitations of the sample are mainly related to the collection condition.
Views155This 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
Artigos OriginaisInfluence of adequacy of the sample on detection of the precursor lesions of the cervical cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):556-560
01-12-2008DOI 10.1590/S0100-72032008001100005
Views155See morePURPOSE: to evaluate whether the sample adequacy influences the detection of precursor cervical cancer lesions. METHODS: a transversal study from January 2004 to December 2005. A number of 10,951 results of cervical cytotopathological exams from users of the National Health System (Sistema Único de Saúde, SUS) in Goiânia, Goiás , Brazil, was studied. These women had spontaneously looked for the services from the Family Health Program or from the Basic Units of Health. Samples were collected by medical doctors and nurses, through the conventional technique to detect cervical cancer. The analyzed smears were classified by the Bethesda System, the sample adequacy being defined along the routine screening and categorized as: satisfactory, satisfactory but presenting factors that might partially jeopardize the analysis, and unsatisfactory. Results were stored in the Epi-Info 3.3.2 program. The χ2 test was used to compare altered results with the adequacy of the samples from cytopathological smears. Differences with probability of rejection of the null hypothesis lower than 5% (p<0.05) were considered as significant. RESULTS: From 10,951 smears, 51.1% were classified as having satisfactory adequacy for analysis, 46.6% as satisfactory, but presenting some limiting factors, and 2.3%, as unsatisfactory. The main factors which have partially jeopardized the analysis were: lack of endocervical cells (52.2%), dried smears (22.8%), purulence (14.9%), or smears with some thick areas (9.5%). There was a higher rate of altered smears when the sample had been classified as satisfactory for analysis and with representation of endocervical cells ASC-US (2.3%), ASC-H (0.6%), LSIL (3.2%), HSIL (1.7%) and 0.3% of AGC. Differences were significant when p=0.001. The rate of low and high grade lesions was higher when the smears were satisfactory for analysis. CONCLUSIONS: the rate of precursor uterine cervix cancer lesions varies according to the sample adequacy, and the main adequacy limitations of the sample are mainly related to the collection condition.
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.
Artigos Originais Archives - Page 6 of 81 - Revista Brasileira de Ginecologia e Obstetrícia
