Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):107-111
DOI 10.1590/S0100-72032000000200008
Purpose: the aim of the present work was to study the chronic action of the antiemetic domperidone on the pregnancy of albino rats. Methods: fifty albino, pregnant Wistar rats were randomly allocated to five groups: GI (control I) = intact rats; GII (control II) = rats receiving the drug vehicle (distilled water) by gavage at the same schedule of the experimental groups; rats in groups GIII, GIV and GV were treated with domperidone by gavage, 2, 6 and 12 mg/kg per day, respectively, divided into 4 daily doses, always in 1 ml of distilled water, from time zero up to the 20th day of pregnancy. The evolution of body weight gain was followed throughout and the animals were sacrificed at term (20th day) by deep ether anesthesia. Number of fetuses, placenta and implantation sites, placenta and fetus weight, fetal malformations and maternal and fetal mortality were evaluated. Results: we observed only intrauterine fetal mortality with 14, 26 and 32 in 74, 60 and 57 newborns of the groups III, IV and V, respectively. Conclusion: though the results of animal experimentation cannot directly be transposed to human conditions, this paper calls attention to the need for a safe judgement when prescribing domperidone to a first-trimester pregnant patient in order to reduce her emetic crises.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):107-111
DOI 10.1590/S0100-72032000000200008
Purpose: the aim of the present work was to study the chronic action of the antiemetic domperidone on the pregnancy of albino rats. Methods: fifty albino, pregnant Wistar rats were randomly allocated to five groups: GI (control I) = intact rats; GII (control II) = rats receiving the drug vehicle (distilled water) by gavage at the same schedule of the experimental groups; rats in groups GIII, GIV and GV were treated with domperidone by gavage, 2, 6 and 12 mg/kg per day, respectively, divided into 4 daily doses, always in 1 ml of distilled water, from time zero up to the 20th day of pregnancy. The evolution of body weight gain was followed throughout and the animals were sacrificed at term (20th day) by deep ether anesthesia. Number of fetuses, placenta and implantation sites, placenta and fetus weight, fetal malformations and maternal and fetal mortality were evaluated. Results: we observed only intrauterine fetal mortality with 14, 26 and 32 in 74, 60 and 57 newborns of the groups III, IV and V, respectively. Conclusion: though the results of animal experimentation cannot directly be transposed to human conditions, this paper calls attention to the need for a safe judgement when prescribing domperidone to a first-trimester pregnant patient in order to reduce her emetic crises.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):65-70
DOI 10.1590/S0100-72032000000200002
Purpose: to evaluate conization by the loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of cervical intraepithelial neoplasms (CIN), the importance of the margins and follow-up of these women. Methods: 95 women who underwent conization by LEEP for CIN and microinvasive carcinoma from January 1996 to December 1997 were evaluated. For statistical analysis, we used the kappa agreement coefficient and the tendency test of Cochran Armitage. Results: among 63 cases who underwent colposcopically directed biopsy before the conization, the cone presented the same grade of lesion in 20 and no residual disease in 8. The cone lesion presented a higher grade in 24 cases and one of them was a microinvasive carcinoma. Among the 25 women who underwent the cone biopsy with a previous biopsy suggestive of cervicitis or CIN 1, 56% had CIN 2 or 3 in the cone. Among the 32 women without previous biopsy, 15 had CIN 2 or 3, and four had microinvasive carcinoma in the cone. Regarding the margins of the cone, 25 cases presented some grade of CIN in the endocervical margins and 2/10 who underwent a second procedure presented residual disease on histological analysis. Among the 70 women with free cone margins, 2/4 who underwent a second procedure had residual disease on histological analysis. Conclusion: conization by LEEP without previous directed biopsy depends on the experience of the colposcopist. The second resection after LEEP for the diagnosis and treatment of CIN depends not only on the presence of disease in the cone margins but also on the follow-up. A second histological analysis is recommended in cases with microinvasive carcinoma and glandular lesion and affected margins.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):65-70
DOI 10.1590/S0100-72032000000200002
Purpose: to evaluate conization by the loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of cervical intraepithelial neoplasms (CIN), the importance of the margins and follow-up of these women. Methods: 95 women who underwent conization by LEEP for CIN and microinvasive carcinoma from January 1996 to December 1997 were evaluated. For statistical analysis, we used the kappa agreement coefficient and the tendency test of Cochran Armitage. Results: among 63 cases who underwent colposcopically directed biopsy before the conization, the cone presented the same grade of lesion in 20 and no residual disease in 8. The cone lesion presented a higher grade in 24 cases and one of them was a microinvasive carcinoma. Among the 25 women who underwent the cone biopsy with a previous biopsy suggestive of cervicitis or CIN 1, 56% had CIN 2 or 3 in the cone. Among the 32 women without previous biopsy, 15 had CIN 2 or 3, and four had microinvasive carcinoma in the cone. Regarding the margins of the cone, 25 cases presented some grade of CIN in the endocervical margins and 2/10 who underwent a second procedure presented residual disease on histological analysis. Among the 70 women with free cone margins, 2/4 who underwent a second procedure had residual disease on histological analysis. Conclusion: conization by LEEP without previous directed biopsy depends on the experience of the colposcopist. The second resection after LEEP for the diagnosis and treatment of CIN depends not only on the presence of disease in the cone margins but also on the follow-up. A second histological analysis is recommended in cases with microinvasive carcinoma and glandular lesion and affected margins.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):71-77
DOI 10.1590/S0100-72032000000200003
Purpose: to compare hospital costs between laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH), reporting the initial experience with the new approach in a communitary general hospital. Patients and Methods: eleven cases of LAVH and 23 of TAH, carried out from September 1998 to July 1999, were compared. Each patient's records and hospital charges were reviewed to collect the analyzed variables. Results: there was no statistical difference between the groups in relation to age, parity, and previous abdominal surgery. The main surgical indication for both groups was uterine leiomyomatosis. The LAVH group presented a shorter hospital stay with a median of one day, and the TAH group, of two days (p<0.01). LAVH showed to be 40.2% more expensive than TAH (p<0.01). Operating room charges contributed to the major part of hospital costs for both groups, corresponding to 79.8 and 57.9% of the total, for LAVH and TAH, respectively. LAVH infirmary charges were smaller than for TAH, with a statistically significant difference (p = 0.002). Conclusion: with shorter hospital stay and smaller infirmary costs, we demonstrated that LAVH provides better postoperative conditions and faster recovery than TAH. When done in a community general hospital, despite being more expensive, LAVH is an excellent option for uterine removal, and should be part of the therapeutical arsenal of gynecologic surgeons.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):71-77
DOI 10.1590/S0100-72032000000200003
Purpose: to compare hospital costs between laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH), reporting the initial experience with the new approach in a communitary general hospital. Patients and Methods: eleven cases of LAVH and 23 of TAH, carried out from September 1998 to July 1999, were compared. Each patient's records and hospital charges were reviewed to collect the analyzed variables. Results: there was no statistical difference between the groups in relation to age, parity, and previous abdominal surgery. The main surgical indication for both groups was uterine leiomyomatosis. The LAVH group presented a shorter hospital stay with a median of one day, and the TAH group, of two days (p<0.01). LAVH showed to be 40.2% more expensive than TAH (p<0.01). Operating room charges contributed to the major part of hospital costs for both groups, corresponding to 79.8 and 57.9% of the total, for LAVH and TAH, respectively. LAVH infirmary charges were smaller than for TAH, with a statistically significant difference (p = 0.002). Conclusion: with shorter hospital stay and smaller infirmary costs, we demonstrated that LAVH provides better postoperative conditions and faster recovery than TAH. When done in a community general hospital, despite being more expensive, LAVH is an excellent option for uterine removal, and should be part of the therapeutical arsenal of gynecologic surgeons.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):79-87
DOI 10.1590/S0100-72032000000200004
Purpose: to assess the esthetic results and personal satisfaction of patients submitted to conservative surgery for cancer of the breast. The study was conducted on 44 patients with breast cancer diagnosed at the mastology outpatient clinic of HCFMRP-USP from January 1990 to December 1994, who fulfilled inclusion criteria according to a previously established protocol. The study consisted of analysis of the esthetic results after conservative treatment of breast cancer and analysis of the degree of patient satisfaction, with a comparison of the morphometry of the treated breast to that of the normal breast. The results were obtained on the basis of five previously established parameters using the esthetic evaluation score proposed by Westreich¹. Methods: of the 44 patients studied, 10 had been submitted to neoadjuvant chemotherapy (CT) because they presented locally advanced tumors, and 2 because of an unfavorable tumor/breast ratio for conservative treatment. Mean follow-up time was 65 months. All 27 patients followed-up at the outpatient clinic received a convocation letter. An evaluation questionnaire was applied to the 20 patients who came to the clinic, followed by breast measurement. Fifteen of these patients had been submitted to surgery with separate incisions and 5 to surgery with a single incision. Results: according to morphometry, the results were classified as excellent in 17 cases (85%), as good in two (10%), and as poor in only one case (5%), an evaluation comparable to the subjective evaluation made by the patients themselves. Considered separately, both measurement "A" (distance from the manubrium of the sternum to the nipple) and measurement "B" (distance from the cranial articulation of the xyphoid appendix to the nipple) showed a greater discriminative power than the measurements as a whole, since with these measurements the cases classified as poor by the patients would have also been classified as poor according to these same criteria separately (A and/or B). Conclusion: there was a significant difference in esthetic results between surgical treatment with a single incision or separate incisions, with the separate incision providing better results. There was high agreement between the classification made by the patients and the morphometric results obtained by us.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):79-87
DOI 10.1590/S0100-72032000000200004
Purpose: to assess the esthetic results and personal satisfaction of patients submitted to conservative surgery for cancer of the breast. The study was conducted on 44 patients with breast cancer diagnosed at the mastology outpatient clinic of HCFMRP-USP from January 1990 to December 1994, who fulfilled inclusion criteria according to a previously established protocol. The study consisted of analysis of the esthetic results after conservative treatment of breast cancer and analysis of the degree of patient satisfaction, with a comparison of the morphometry of the treated breast to that of the normal breast. The results were obtained on the basis of five previously established parameters using the esthetic evaluation score proposed by Westreich¹. Methods: of the 44 patients studied, 10 had been submitted to neoadjuvant chemotherapy (CT) because they presented locally advanced tumors, and 2 because of an unfavorable tumor/breast ratio for conservative treatment. Mean follow-up time was 65 months. All 27 patients followed-up at the outpatient clinic received a convocation letter. An evaluation questionnaire was applied to the 20 patients who came to the clinic, followed by breast measurement. Fifteen of these patients had been submitted to surgery with separate incisions and 5 to surgery with a single incision. Results: according to morphometry, the results were classified as excellent in 17 cases (85%), as good in two (10%), and as poor in only one case (5%), an evaluation comparable to the subjective evaluation made by the patients themselves. Considered separately, both measurement "A" (distance from the manubrium of the sternum to the nipple) and measurement "B" (distance from the cranial articulation of the xyphoid appendix to the nipple) showed a greater discriminative power than the measurements as a whole, since with these measurements the cases classified as poor by the patients would have also been classified as poor according to these same criteria separately (A and/or B). Conclusion: there was a significant difference in esthetic results between surgical treatment with a single incision or separate incisions, with the separate incision providing better results. There was high agreement between the classification made by the patients and the morphometric results obtained by us.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):89-94
DOI 10.1590/S0100-72032000000200005
Purpose: to evaluate the lipid profile (cholesterol, triglycerides, HDL and LDL) of women with polycystic ovary syndrome (PCO) and compare it to that of women with ovulatory menstrual cycles. Methods: the patients were divided into two groups, obese and nonobese, based on body mass index, so that it would be possible to determine the joint effect of PCO and obesity on the lipid metabolism of the studied women. We studied 117 women divided into 4 groups: group I (PCO--obese), n = 33; group II (PCO--nonobese), n = 27; group III (control--obese), n = 28; group IV (control--nonobese), n = 29. Results: cholesterol levels were elevated (179 mg/dl) in obese patients with ovulatory cycles (group III) compared to group I (147 mg/dl) and group II (149 mg/dl), as also were triglyceride levels (117 mg/dl) compared to group IV (77 mg/dl) and LDL levels (117 mg/dl) compared to group I (82 mg/dl). Conclusion: these data suggest that alterations in lipid profile are related to obesity only.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):89-94
DOI 10.1590/S0100-72032000000200005
Purpose: to evaluate the lipid profile (cholesterol, triglycerides, HDL and LDL) of women with polycystic ovary syndrome (PCO) and compare it to that of women with ovulatory menstrual cycles. Methods: the patients were divided into two groups, obese and nonobese, based on body mass index, so that it would be possible to determine the joint effect of PCO and obesity on the lipid metabolism of the studied women. We studied 117 women divided into 4 groups: group I (PCO--obese), n = 33; group II (PCO--nonobese), n = 27; group III (control--obese), n = 28; group IV (control--nonobese), n = 29. Results: cholesterol levels were elevated (179 mg/dl) in obese patients with ovulatory cycles (group III) compared to group I (147 mg/dl) and group II (149 mg/dl), as also were triglyceride levels (117 mg/dl) compared to group IV (77 mg/dl) and LDL levels (117 mg/dl) compared to group I (82 mg/dl). Conclusion: these data suggest that alterations in lipid profile are related to obesity only.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):95-100
DOI 10.1590/S0100-72032000000200006
SUMMARY Purpose: to study the usefulness of minilaparoscopy in diagnosing the cause of pelvic pain. Methods: women with pelvic pain were prospectively analyzed and underwent an office video-microlaparoscopy. We analyzed the data regarding procedure time, stay in the recovery room, acceptance of anesthesia, and morbidity. Results: the average procedure time of the office video-microlaparoscopy was 19 min, the average stay for recovery was 43 min, and the technical quality of the image was excellent or good in 100% of the selected patients. The following laparoscopic findings were reported: 34.4% endometriosis, 28.1% pelvic adhesion, 12.5% pelvic varices, and 25% normal. Based on Bordhal et al.'s¹ criteria, a low frequency of pain manifestation during local anesthesia (12.5%) and discomfort on pneumoperitoneum (46.9%) were noticed. It could also be observed that, according to Milki and Tazuke's² criteria, the tolerance to the method was excellent and good (96.9%). Twenty-four hours after the procedure the morbidity rate was in accordance with Chung et al.'s³ criteria, showing a high frequency of pain at the incision area (59.4%) and sleepiness (43.8%). Only 3.1% reported they felt pain during the procedure, which shows the acceptance of the method by the patients. Conclusions: the acceptance of anesthesia and of the surgical procedure and the low morbidity allow the use of minilaparoscopy as a very important method in investigating patients with pelvic pain.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(2):95-100
DOI 10.1590/S0100-72032000000200006
SUMMARY Purpose: to study the usefulness of minilaparoscopy in diagnosing the cause of pelvic pain. Methods: women with pelvic pain were prospectively analyzed and underwent an office video-microlaparoscopy. We analyzed the data regarding procedure time, stay in the recovery room, acceptance of anesthesia, and morbidity. Results: the average procedure time of the office video-microlaparoscopy was 19 min, the average stay for recovery was 43 min, and the technical quality of the image was excellent or good in 100% of the selected patients. The following laparoscopic findings were reported: 34.4% endometriosis, 28.1% pelvic adhesion, 12.5% pelvic varices, and 25% normal. Based on Bordhal et al.'s¹ criteria, a low frequency of pain manifestation during local anesthesia (12.5%) and discomfort on pneumoperitoneum (46.9%) were noticed. It could also be observed that, according to Milki and Tazuke's² criteria, the tolerance to the method was excellent and good (96.9%). Twenty-four hours after the procedure the morbidity rate was in accordance with Chung et al.'s³ criteria, showing a high frequency of pain at the incision area (59.4%) and sleepiness (43.8%). Only 3.1% reported they felt pain during the procedure, which shows the acceptance of the method by the patients. Conclusions: the acceptance of anesthesia and of the surgical procedure and the low morbidity allow the use of minilaparoscopy as a very important method in investigating patients with pelvic pain.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(10):757-764
DOI 10.1590/S0100-72032004001000002
PURPOSE: to analyze the results of a technical alternative to perform sacrospinous colpopexy for the treatment of vault prolapse after hysterectomy, and also as an additional facilitating procedure in cases of total uterovaginal prolapse. METHODS: forty-six patients underwent hysterectomy and were followed-up for 12 to 44 months, with an average of 32 months. Twenty-three of them presented vaginal vault prolapse (GVault), and 23 had total uterovaginal prolapse (GUterus). The inclusion criterion was the presence of symptomatic prolapse grade III or IV according to the classification proposed by the International Continence Society. Patients presenting lower grade prolapse were excluded. The average age of the patients was similar: 67.0 years in GVault and 67.5 years in GUterus. Average body mass index was also similar: 27.4 kg/m² in GVault and 25.6 kg/m² in GUterus. Deliveries varied from 0 to 13 in GVault (average: 4.4 deliveries), and from 1 to 13 in GUterus (average: 6.2 deliveries). Among the 23 patients in GVault, eight had undergone previous surgical repair without success. The results obtained in both groups were analyzed and compared. The used method takes into account well-known anatomical principles, and differs from the original technique by using a curved needle holder oriented upside down to place sutures through the right sacrospinous ligament under direct vision, approximately 2 cm medially to the ischial spine, thus minimizing the risk of injury to the pudendal vessels and nerve. RESULTS: average duration of the surgery was 90.0 min in GVault and 119.5 min in GUterus, a statistically significant difference (p<0.05). Three blood transfusions were needed, one in GVault and two in GUterus. There was no bladder, rectal or ureteral injury nor death in any of the groups. The incidence and type of postoperative complications were similar in the two groups, and included urinary infection, granuloma, urinary retention, transient neuropathy, buttock pain and blood transfusion. Average vaginal length after the operation was 7.6 cm in GVault and 7.3 cm in GUterus (p>0.05). The anatomical result of the apical, anterior and posterior vaginal compartments was satisfactory in more than 90% of the patients of both groups. The functional result was also similar in both groups, and among the sexually active patients, only one (7.7%) in GVault and two (13.3%) in GUterus complained of dyspareunia after the surgery. There was no association between age, parity, obesity, and the anatomical and functional results. CONCLUSION: analysis of the obtained data demonstrates that this modification of sacrospinous colpopexy is technically simple, safe and effective, providing similar results in both groups of the studied patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(10):757-764
DOI 10.1590/S0100-72032004001000002
PURPOSE: to analyze the results of a technical alternative to perform sacrospinous colpopexy for the treatment of vault prolapse after hysterectomy, and also as an additional facilitating procedure in cases of total uterovaginal prolapse. METHODS: forty-six patients underwent hysterectomy and were followed-up for 12 to 44 months, with an average of 32 months. Twenty-three of them presented vaginal vault prolapse (GVault), and 23 had total uterovaginal prolapse (GUterus). The inclusion criterion was the presence of symptomatic prolapse grade III or IV according to the classification proposed by the International Continence Society. Patients presenting lower grade prolapse were excluded. The average age of the patients was similar: 67.0 years in GVault and 67.5 years in GUterus. Average body mass index was also similar: 27.4 kg/m² in GVault and 25.6 kg/m² in GUterus. Deliveries varied from 0 to 13 in GVault (average: 4.4 deliveries), and from 1 to 13 in GUterus (average: 6.2 deliveries). Among the 23 patients in GVault, eight had undergone previous surgical repair without success. The results obtained in both groups were analyzed and compared. The used method takes into account well-known anatomical principles, and differs from the original technique by using a curved needle holder oriented upside down to place sutures through the right sacrospinous ligament under direct vision, approximately 2 cm medially to the ischial spine, thus minimizing the risk of injury to the pudendal vessels and nerve. RESULTS: average duration of the surgery was 90.0 min in GVault and 119.5 min in GUterus, a statistically significant difference (p<0.05). Three blood transfusions were needed, one in GVault and two in GUterus. There was no bladder, rectal or ureteral injury nor death in any of the groups. The incidence and type of postoperative complications were similar in the two groups, and included urinary infection, granuloma, urinary retention, transient neuropathy, buttock pain and blood transfusion. Average vaginal length after the operation was 7.6 cm in GVault and 7.3 cm in GUterus (p>0.05). The anatomical result of the apical, anterior and posterior vaginal compartments was satisfactory in more than 90% of the patients of both groups. The functional result was also similar in both groups, and among the sexually active patients, only one (7.7%) in GVault and two (13.3%) in GUterus complained of dyspareunia after the surgery. There was no association between age, parity, obesity, and the anatomical and functional results. CONCLUSION: analysis of the obtained data demonstrates that this modification of sacrospinous colpopexy is technically simple, safe and effective, providing similar results in both groups of the studied patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(10):765-771
DOI 10.1590/S0100-72032004001000003
PURPOSE: to identify factors associated with the occurrence of hot flashes in climacteric women living in Campinas, São Paulo. METHODS: data bank secondary analysis of a cross-sectional descriptive population-based study. The selection of 456 women aged 45-60 years was done through area cluster sampling. Data were collected via home interviews using structured, pre-tested questionnaires provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society and adapted by the authors. The analyzed variables were age, race, use of contraceptive methods and hormonal therapy, tubal ligation, body mass index, menopausal status, time since menopause, hysterectomy, and cigarette smoking. Statistical analysis was performed using the mean, median and the prevalence ratio (PR). Multiple logistic regression was performed using the stepwise selection process with a 95% confidence interval (95% CI). RESULTS: bivariate analysis showed that postmenopausal women (PR: 1.42, CI 95%: 1.06-1.90) and those who were submitted to hysterectomy (PR: 1.50, CI 95%: 1.05-2.14) had a significantly greater chance of presenting hot flashes. After applying multiple regression analysis, there was no significant association between hot flashes and any of the evaluated variables. CONCLUSION: results were consistent with previous studies. Many doubts still exist about which factors are associated with hot flashes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(10):765-771
DOI 10.1590/S0100-72032004001000003
PURPOSE: to identify factors associated with the occurrence of hot flashes in climacteric women living in Campinas, São Paulo. METHODS: data bank secondary analysis of a cross-sectional descriptive population-based study. The selection of 456 women aged 45-60 years was done through area cluster sampling. Data were collected via home interviews using structured, pre-tested questionnaires provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society and adapted by the authors. The analyzed variables were age, race, use of contraceptive methods and hormonal therapy, tubal ligation, body mass index, menopausal status, time since menopause, hysterectomy, and cigarette smoking. Statistical analysis was performed using the mean, median and the prevalence ratio (PR). Multiple logistic regression was performed using the stepwise selection process with a 95% confidence interval (95% CI). RESULTS: bivariate analysis showed that postmenopausal women (PR: 1.42, CI 95%: 1.06-1.90) and those who were submitted to hysterectomy (PR: 1.50, CI 95%: 1.05-2.14) had a significantly greater chance of presenting hot flashes. After applying multiple regression analysis, there was no significant association between hot flashes and any of the evaluated variables. CONCLUSION: results were consistent with previous studies. Many doubts still exist about which factors are associated with hot flashes.