Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):655-659
DOI 10.1590/S0100-72032003000900006
PURPOSE: to assess the simultaneous approach of radioguided occult lesion localization and sentinel lymph node biopsy in women with breast cancer. METHOD: forty-five patients with nonpalpable breast cancer were enrolled in a prospective study. The employed radiocolloid was 99mTc-labelled dextran. The injection was performed peritumorally under sonographic or stereotactic guidance using a 18 gauge needle. Lymphoscintigraph images for the visualization of both the site of injection and sentinel lymph node were obtained in a conventional gamma-camera, with the ipsilateral arm positioned in a 90º angle. Excision biopsy of the tumor and sentinel lymph node were performed with a gamma-detecting probe. RESULTS: the procedure was always successful in permitting the localization of occult breast lesions. It was necessary to enlarge surgical margins in five cases. Concerning the sentinel lymph node we achieved localization in 93% of the cases. No complications were observed. CONCLUSION: the results seems to demonstrate that a combined radioguided occult lesion localization and sentinel lymph node biopsy using the same radiopharmaceutical represents a useful and practicable strategy in the management of early breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):655-659
DOI 10.1590/S0100-72032003000900006
PURPOSE: to assess the simultaneous approach of radioguided occult lesion localization and sentinel lymph node biopsy in women with breast cancer. METHOD: forty-five patients with nonpalpable breast cancer were enrolled in a prospective study. The employed radiocolloid was 99mTc-labelled dextran. The injection was performed peritumorally under sonographic or stereotactic guidance using a 18 gauge needle. Lymphoscintigraph images for the visualization of both the site of injection and sentinel lymph node were obtained in a conventional gamma-camera, with the ipsilateral arm positioned in a 90º angle. Excision biopsy of the tumor and sentinel lymph node were performed with a gamma-detecting probe. RESULTS: the procedure was always successful in permitting the localization of occult breast lesions. It was necessary to enlarge surgical margins in five cases. Concerning the sentinel lymph node we achieved localization in 93% of the cases. No complications were observed. CONCLUSION: the results seems to demonstrate that a combined radioguided occult lesion localization and sentinel lymph node biopsy using the same radiopharmaceutical represents a useful and practicable strategy in the management of early breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):661-666
DOI 10.1590/S0100-72032003000900007
PURPOSE: to present the most frequent gynecologic results in a cohort of 300 outpatient HIV-infected women. METHODS: this is a prospective and descriptive study of HIV-infected women that have been followed up at the gynecological clinic from November 1996 to December 2002. These patients were subjected to a specific protocol which included an interview, a gynecological evaluation and a collecting cervical sample for Pap smear, research of HPV (PCR) and colposcopy. Cervical biopsy was performed when necessary. Data were stored and analyzed by Epi-Info, version 6.0. RESULTS: the mean age was 34.5 years. The small number of sexual partners, average of three partners, and the predominance of heterosexual contagion should be mentioned: 271 (90.6%) patients were contaminated through sexual contact with their partners. There was a high prevalence of cervical intraepithelial neoplasia (CIN) representing 21.7% of the total group. Of 109 patients subjected to PCR, 89 (81.7%) were found to have some HPV genotype. An inflammatory smear was present in 69% of the patients. CONCLUSIONS: there is a high frequency of CIN and genital infectious diseases among HIV-infected women, mainly HPV.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):661-666
DOI 10.1590/S0100-72032003000900007
PURPOSE: to present the most frequent gynecologic results in a cohort of 300 outpatient HIV-infected women. METHODS: this is a prospective and descriptive study of HIV-infected women that have been followed up at the gynecological clinic from November 1996 to December 2002. These patients were subjected to a specific protocol which included an interview, a gynecological evaluation and a collecting cervical sample for Pap smear, research of HPV (PCR) and colposcopy. Cervical biopsy was performed when necessary. Data were stored and analyzed by Epi-Info, version 6.0. RESULTS: the mean age was 34.5 years. The small number of sexual partners, average of three partners, and the predominance of heterosexual contagion should be mentioned: 271 (90.6%) patients were contaminated through sexual contact with their partners. There was a high prevalence of cervical intraepithelial neoplasia (CIN) representing 21.7% of the total group. Of 109 patients subjected to PCR, 89 (81.7%) were found to have some HPV genotype. An inflammatory smear was present in 69% of the patients. CONCLUSIONS: there is a high frequency of CIN and genital infectious diseases among HIV-infected women, mainly HPV.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):667-672
DOI 10.1590/S0100-72032003000900008
PURPOSE: to compare the results of hysterosonography with those of hysteroscopy and the histopathologic study in postmenopausal women. METHODS: hysterosonography, hysteroscopy and endometrial biopsy were performed in 59 women who had an endometrial echo over 4 mm, age above 40 years and amenorrhea over one year, and whose follicle-stimulating hormone levels were over 35 mIU/mL. Patients using hormones were excluded, as well those in whom it was impossible to perform histerosonography, histeroscopy or endometrial biopsy. The statistical analysis was performed using the nonparametric "G"-Cochran and McNemar tests. In addition, sensitivity and specificity, as well as positive and negative predictive values were determined. The value of 0.05 or 5% for rejection level of the null hypothesis was applied. RESULTS: the agreement rates of hysterosonographic results compared to hysteroscopy and histopatology were 94.8 ande 77.6%, respectively. Sensitivity and specificity of hysterosonographic evaluation of the abnormal endometrial cavity were 98 and 75%, respectively, when compared to hysteroscopy. In addittion, positive and negative predictive values of hysterosonography were 96 and 86%, respectively. When the histopathologic study was used as the gold standard, sensitivity and specificity were 98 and 33%, with positive predictive value of 76% and negative predictive value of 86%, for the detection of the endometrial cavitary changes. One great concern were the histopathologic results of two patients with uterine synechia who showed endometrial hyperplasia. Also, one patient was diagnosed as normal using histerosonography and the histopatological result showed simple hyperplasia. CONCLUSIONS: our data suggest that hysterosonography presented good sensitivity as compared with hysteroscopy. However, uterine synechia is the great limitation of this method as compared with histopathology.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):667-672
DOI 10.1590/S0100-72032003000900008
PURPOSE: to compare the results of hysterosonography with those of hysteroscopy and the histopathologic study in postmenopausal women. METHODS: hysterosonography, hysteroscopy and endometrial biopsy were performed in 59 women who had an endometrial echo over 4 mm, age above 40 years and amenorrhea over one year, and whose follicle-stimulating hormone levels were over 35 mIU/mL. Patients using hormones were excluded, as well those in whom it was impossible to perform histerosonography, histeroscopy or endometrial biopsy. The statistical analysis was performed using the nonparametric "G"-Cochran and McNemar tests. In addition, sensitivity and specificity, as well as positive and negative predictive values were determined. The value of 0.05 or 5% for rejection level of the null hypothesis was applied. RESULTS: the agreement rates of hysterosonographic results compared to hysteroscopy and histopatology were 94.8 ande 77.6%, respectively. Sensitivity and specificity of hysterosonographic evaluation of the abnormal endometrial cavity were 98 and 75%, respectively, when compared to hysteroscopy. In addittion, positive and negative predictive values of hysterosonography were 96 and 86%, respectively. When the histopathologic study was used as the gold standard, sensitivity and specificity were 98 and 33%, with positive predictive value of 76% and negative predictive value of 86%, for the detection of the endometrial cavitary changes. One great concern were the histopathologic results of two patients with uterine synechia who showed endometrial hyperplasia. Also, one patient was diagnosed as normal using histerosonography and the histopatological result showed simple hyperplasia. CONCLUSIONS: our data suggest that hysterosonography presented good sensitivity as compared with hysteroscopy. However, uterine synechia is the great limitation of this method as compared with histopathology.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):673-678
DOI 10.1590/S0100-72032003000900009
PURPOSE: to evaluate the uterine volume in women between 10 and 40 years in order to observe if the uterine volume in adolescents is smaller than the uterine volume in women between 20 and 40 years. We intend to emphasize the differences between the uterine volume of adolescents and that of adult women and to correlate with the immaturity of the genital tract of adolescents regarding gestation and delivery. METHOD: a cross-sectional study, which included 828 patients between 10 and 40 years old divided into two groups and examined using abdominal ultrasound to obtain the uterine volume measure. The first group consisted of 477 (57.7%) adolescents, and the second group of 351 (42.3%) adult women between 20 and 40 years old. In the adolescent group, ultrasound examination was performed by a single observer and in the group of adult women ultrasound examination was performed by a group of observers who used the same methodology as that of group 1. Image Point HX (Hewlett Packard) and Hitachi 525 ultrasound equipment were used with a multiple frequency probe. For the calculation of the uterine volume we used the longitudinal diameter (LD), anteroposterior diameter (APD) and transverse diameter (TD) with the (LD x APD x TD) x 0.45 formula. RESULTS: adolescents aged 10 to 17 years had a smaller uterine volume than women aged 20 to 40 years (p<0.05). Adolescents who delivered twice had a uterine volume similar to that of the patients between 20 and 40 years old with respective mean values of 62.6 ± 20.6 and 69.0±22.9 (p>0.05). CONCLUSION: adolescents less than 18 years old or primiparous have a smaller uterine volume than women between 20 to 40 years old. However, adolescents aged 18 years or older, or secundipara, have a uterine volume similar to that of women aged 20 to 40 years.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):673-678
DOI 10.1590/S0100-72032003000900009
PURPOSE: to evaluate the uterine volume in women between 10 and 40 years in order to observe if the uterine volume in adolescents is smaller than the uterine volume in women between 20 and 40 years. We intend to emphasize the differences between the uterine volume of adolescents and that of adult women and to correlate with the immaturity of the genital tract of adolescents regarding gestation and delivery. METHOD: a cross-sectional study, which included 828 patients between 10 and 40 years old divided into two groups and examined using abdominal ultrasound to obtain the uterine volume measure. The first group consisted of 477 (57.7%) adolescents, and the second group of 351 (42.3%) adult women between 20 and 40 years old. In the adolescent group, ultrasound examination was performed by a single observer and in the group of adult women ultrasound examination was performed by a group of observers who used the same methodology as that of group 1. Image Point HX (Hewlett Packard) and Hitachi 525 ultrasound equipment were used with a multiple frequency probe. For the calculation of the uterine volume we used the longitudinal diameter (LD), anteroposterior diameter (APD) and transverse diameter (TD) with the (LD x APD x TD) x 0.45 formula. RESULTS: adolescents aged 10 to 17 years had a smaller uterine volume than women aged 20 to 40 years (p<0.05). Adolescents who delivered twice had a uterine volume similar to that of the patients between 20 and 40 years old with respective mean values of 62.6 ± 20.6 and 69.0±22.9 (p>0.05). CONCLUSION: adolescents less than 18 years old or primiparous have a smaller uterine volume than women between 20 to 40 years old. However, adolescents aged 18 years or older, or secundipara, have a uterine volume similar to that of women aged 20 to 40 years.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):679-686
DOI 10.1590/S0100-72032003000900010
PURPOSE: to evaluate the first in vitro fertilization results at a medical university using low-cost programmed cycles. METHODS: from May to December 2002, 66 programmed cycles of in vitro fertilization were carried out using norethisterone acetate, clomiphene citrate and human chorionic gonadotrophin (hCG). The ovarian follicle aspiration was guided by ultrasonography, 34 to 36 h after the administration of hCG, and the embryo transfer, 48 h after puncturing. The diagnosis of clinical pregnancy was defined when a pulsating heart was detected by transvaginal ultrasonography. RESULTS: the cycle cancelation rate was 21.2%. An average of 2.8 follicles and 1.7 oocytes were obtained per puncture. In 79.6% of the punctured cycles it was possible to retrieve oocytes and 69% of them were fertilized. The number of embryos per transfer was 1.5. Some level of difficulty occurred in 10.2% of the aspiration procedures and 32.4% in the embryo transfer. The obtained pregnancy rate was 10,8% per transfer; however, the drug cost per transferred embryo was only R$ 96,00. CONCLUSION: the difficulty to begin an in vitro fertilization program in a medical school, not aiming at profits and to help a population without financial possibilities, became evident. After progressive experience, the cumulative pregnancy rate tends to be similar to that of reference centers, but with significantly lower costs and incidence of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):679-686
DOI 10.1590/S0100-72032003000900010
PURPOSE: to evaluate the first in vitro fertilization results at a medical university using low-cost programmed cycles. METHODS: from May to December 2002, 66 programmed cycles of in vitro fertilization were carried out using norethisterone acetate, clomiphene citrate and human chorionic gonadotrophin (hCG). The ovarian follicle aspiration was guided by ultrasonography, 34 to 36 h after the administration of hCG, and the embryo transfer, 48 h after puncturing. The diagnosis of clinical pregnancy was defined when a pulsating heart was detected by transvaginal ultrasonography. RESULTS: the cycle cancelation rate was 21.2%. An average of 2.8 follicles and 1.7 oocytes were obtained per puncture. In 79.6% of the punctured cycles it was possible to retrieve oocytes and 69% of them were fertilized. The number of embryos per transfer was 1.5. Some level of difficulty occurred in 10.2% of the aspiration procedures and 32.4% in the embryo transfer. The obtained pregnancy rate was 10,8% per transfer; however, the drug cost per transferred embryo was only R$ 96,00. CONCLUSION: the difficulty to begin an in vitro fertilization program in a medical school, not aiming at profits and to help a population without financial possibilities, became evident. After progressive experience, the cumulative pregnancy rate tends to be similar to that of reference centers, but with significantly lower costs and incidence of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):571-576
DOI 10.1590/S0100-72032003000800005
PURPOSE: to estimate the prevalence of the hepatitis B surface antigen (HBsAg) in parturients admitted to the "Instituto Materno-Infantil de Pernambuco (IMIP)", Recife-PE, and to determine the serologic profile of the positive ones. METHODS: this is a prospective cross-sectional study where the VIDAS and VIDAS HBs systems were used for detection and confirmation of HBsAg, respectively. The parturients were randomly selected. In HBsAg+ patients, the other serologic markers were tested by the use of the AxSYM automated system. The newborn babies of HBsAg+ mothers were vaccinated with the Engerix B vaccine. RESULTS: among 1584 parturients, there were 9 (0.6%) HBsAg positive. None of them had anti-HBc IgM, thus they were all prevalent cases. In 1/9 (11.1%) of the HBsAg+ mothers, HBeAg was isolated and in 4/9 (44.4%), this antigen circulated along with its antibody, hence the importance of establishing the different magnitudes of risk of vertical transmission. Except for two newborn babies from a twin pregnancy (one with low birth weight), all presented seroconversion to anti-HBs with 3 doses of the vaccine. The premature twin babies showed seroconvertion only after the fourth dose of the vaccine. CONCLUSIONS: the prevalence of hepatitis B among parturients at IMIP is relatively low and all patients diagnosed had the chronic form of the infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):571-576
DOI 10.1590/S0100-72032003000800005
PURPOSE: to estimate the prevalence of the hepatitis B surface antigen (HBsAg) in parturients admitted to the "Instituto Materno-Infantil de Pernambuco (IMIP)", Recife-PE, and to determine the serologic profile of the positive ones. METHODS: this is a prospective cross-sectional study where the VIDAS and VIDAS HBs systems were used for detection and confirmation of HBsAg, respectively. The parturients were randomly selected. In HBsAg+ patients, the other serologic markers were tested by the use of the AxSYM automated system. The newborn babies of HBsAg+ mothers were vaccinated with the Engerix B vaccine. RESULTS: among 1584 parturients, there were 9 (0.6%) HBsAg positive. None of them had anti-HBc IgM, thus they were all prevalent cases. In 1/9 (11.1%) of the HBsAg+ mothers, HBeAg was isolated and in 4/9 (44.4%), this antigen circulated along with its antibody, hence the importance of establishing the different magnitudes of risk of vertical transmission. Except for two newborn babies from a twin pregnancy (one with low birth weight), all presented seroconversion to anti-HBs with 3 doses of the vaccine. The premature twin babies showed seroconvertion only after the fourth dose of the vaccine. CONCLUSIONS: the prevalence of hepatitis B among parturients at IMIP is relatively low and all patients diagnosed had the chronic form of the infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):585-591
DOI 10.1590/S0100-72032003000800007
PURPOSE: to analyze the histopathological patterns of the placental bed arteries in pregnancies complicated by abruptio placentae (AP) and compare them with the normal vascular histology of the placental bed. METHODS: placental bed biopsy was performed in 23 pregnant women with a diagnosis of abruptio placentae associated with high blood pressure (G/HBP) disorders, with gestational age of 28 weeks or more, submitted to cesarean section. The control group (CG) consisted of 30 patients without disease, submitted to cesarean section for obstetric reasons. The selected histological variables were: unaltered pattern, physiological changes, medial layer disorganization, hyperplastic changes, acute necrosis and atherosis. RESULTS: in patients with AP associated with HBP there was a significant predominance of medial layer disorganization and hyperplastic changes, compared to CG, while physiological changes in spiral arteries were statistically more common in CG. Findings of acute necrosis and atherosis were observed in a low number of G/HBP, with no statistical significance. CONCLUSIONS: in pregnant women with AP associated with HBP the predominant vascular histological findings were medial layer disorganization and hyperplastic changes. The presence of histopathological features was significantly higher in G/HBP, with prevalence of medial layer disorganization. Normal histological pattern, i.e., physiological changes, were more prevalent in CG.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):585-591
DOI 10.1590/S0100-72032003000800007
PURPOSE: to analyze the histopathological patterns of the placental bed arteries in pregnancies complicated by abruptio placentae (AP) and compare them with the normal vascular histology of the placental bed. METHODS: placental bed biopsy was performed in 23 pregnant women with a diagnosis of abruptio placentae associated with high blood pressure (G/HBP) disorders, with gestational age of 28 weeks or more, submitted to cesarean section. The control group (CG) consisted of 30 patients without disease, submitted to cesarean section for obstetric reasons. The selected histological variables were: unaltered pattern, physiological changes, medial layer disorganization, hyperplastic changes, acute necrosis and atherosis. RESULTS: in patients with AP associated with HBP there was a significant predominance of medial layer disorganization and hyperplastic changes, compared to CG, while physiological changes in spiral arteries were statistically more common in CG. Findings of acute necrosis and atherosis were observed in a low number of G/HBP, with no statistical significance. CONCLUSIONS: in pregnant women with AP associated with HBP the predominant vascular histological findings were medial layer disorganization and hyperplastic changes. The presence of histopathological features was significantly higher in G/HBP, with prevalence of medial layer disorganization. Normal histological pattern, i.e., physiological changes, were more prevalent in CG.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):593-598
DOI 10.1590/S0100-72032003000800008
PURPOSE: to investigate the effect of antiretroviral drugs on the lipid metabolism in HIV-infected pregnant women. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, consisting of 20 HIV-infected women taking ZDV; TT group, consisting of 25 HIV-1-infected women on triple antiretroviral treatment (ZDV + 3TC + NFV), and control group, consisting of 12 pregnant women considered to be normal from a clinical and laboratory viewpoint. Demographic and anthropometric data were homogeneous. Patients with a personal and family history of hyperlipidemia were excluded. Blood samples were obtained for the determination of fasting lipids (total cholesterol, LDL and HDL, and triglycerides) at four periods during pregnancy (1st = 14-20 weeks; 2nd = 21-26 weeks; 3rd = 27-32 weeks and 4th = 33-38 weeks). Data were analyzed statistically using the nonparametric chi², Friedman and Kruskal-Wallis tests . RESULTS: the use of antiretroviral drugs during pregnancy induced no difference in total or HDL cholesterol but caused an increase from 76.5 and 84 mg/dL to 96 and 105 mg/dL in the concentration of the LDL fraction along gestation in ZDV and TT groups, respectively (p<0.01). A positive significant association was observed between triglycerides and viral burden in the ZDV group (r: 0.534; p=0.015). CONCLUSION: Antiretroviral agents during pregnancy increase serum LDL-colesterol levels. The risk of pregnancy regarding potentiation of long-term antiretroviral effects on lipid metabolism, remains to be established.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):593-598
DOI 10.1590/S0100-72032003000800008
PURPOSE: to investigate the effect of antiretroviral drugs on the lipid metabolism in HIV-infected pregnant women. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, consisting of 20 HIV-infected women taking ZDV; TT group, consisting of 25 HIV-1-infected women on triple antiretroviral treatment (ZDV + 3TC + NFV), and control group, consisting of 12 pregnant women considered to be normal from a clinical and laboratory viewpoint. Demographic and anthropometric data were homogeneous. Patients with a personal and family history of hyperlipidemia were excluded. Blood samples were obtained for the determination of fasting lipids (total cholesterol, LDL and HDL, and triglycerides) at four periods during pregnancy (1st = 14-20 weeks; 2nd = 21-26 weeks; 3rd = 27-32 weeks and 4th = 33-38 weeks). Data were analyzed statistically using the nonparametric chi², Friedman and Kruskal-Wallis tests . RESULTS: the use of antiretroviral drugs during pregnancy induced no difference in total or HDL cholesterol but caused an increase from 76.5 and 84 mg/dL to 96 and 105 mg/dL in the concentration of the LDL fraction along gestation in ZDV and TT groups, respectively (p<0.01). A positive significant association was observed between triglycerides and viral burden in the ZDV group (r: 0.534; p=0.015). CONCLUSION: Antiretroviral agents during pregnancy increase serum LDL-colesterol levels. The risk of pregnancy regarding potentiation of long-term antiretroviral effects on lipid metabolism, remains to be established.
