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Trabalhos Originais
Biophysical triple test: a new ultrasonographic parameter for prognostic evaluation in early pregnancies
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):18-24
03-15-1999
Summary
Trabalhos OriginaisBiophysical triple test: a new ultrasonographic parameter for prognostic evaluation in early pregnancies
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):18-24
03-15-1999DOI 10.1590/S0100-72031999000100004
Views103See morePurpose: it has been demonstrated that delays in gestational sac development, in crown-rump length and low embryonic heart rate could be indicators of poor pregnancy outcome. The purpose was to evaluate the use of these three parameters together, which we named Biophysical Triple Test (BTT). Method: thirty-five singleton pregnancies following IVF treatment with intracytoplasmatic sperm injection (ICSI) were studied. All ultrasonographic scans were performed by the same examiner, 4-5 weeks after embryo transference (6-7 week gestation), using a Diasonics equipment, model Synergy, with a 7.0-MHz transvaginal transducer. The gestational sac (GS) was measured at the longest transverse diameter; the crown-rump length (CRL) was measured at the sagittal plan and the embryonic heart rate (EHR) was calculated from frozen B and M-mode and Doppler. The statistical test used was Fisher's test. Results: the following parameters were considered abnormal: GS < 15.4 mm, CRL < 3.9 mm, EHR < 100 bpm. The parameters were calculated from the means less one standard deviation for the ongoing pregnancies. The patients with a positive BTT, i.e., with a high risk of miscarriage, were those with at least 2 altered parameters. In 35 pregnancies, a positive BTT was found in 5, all of those who miscarrided and 2 of those who had no miscarriage. The difference between the two groups was highly significant (p = 0.0015; t-Fisher). The sensitivity of the method was is 100%, with a specificity of 93.75 %, which resulted in a 96.87% efficacy. Conclusion: the BTT is an ultrasonographic noninvasive method that presents high efficacy as an indicator of poor pregnancy outcome.
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Trabalhos Originais
Women’s health evaluation by a family health program in a municipal health center in Rio Grande do Sul State
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):25-31
03-15-1999
Summary
Trabalhos OriginaisWomen’s health evaluation by a family health program in a municipal health center in Rio Grande do Sul State
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):25-31
03-15-1999DOI 10.1590/S0100-72031999000100005
Views98See morePurpose: This epidemiological census on health conditions of women ranging from 20 to 49 years of age was carried out at Vila Santos Dumont, Pelotas, RS, in order to quantify actions to reorganize the service developed at the local health center. Methods: Information was collected regarding age, level of education, if living with a partner, health service utilization, antenatal care characteristics, cervical cancer screening, physical breast examination and contraceptive methods used. Results: Among the 411 women, 343 (83.5%) had a medical visit during the last year. There were 18 (4.4%) pregnant women. Eighty percent of the women had a cervical smear in the past three years. We found that 47.4% of the women had their breast examined in the last year. Among the 279 women currently using some contraceptive method, 62.4% used the pill, 14.0% had performed surgical sterilization and 7.9% used IUD. Conclusions: This study was women's health diagnosis. It became possible to incorporate the epidemiological method in the health center care planning. We discuss some health actions developed to improve the community care.
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Trabalhos Originais
Ultrasonographic and urodynamic evaluation of patients with urinary incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):33-37
03-15-1999
Summary
Trabalhos OriginaisUltrasonographic and urodynamic evaluation of patients with urinary incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):33-37
03-15-1999DOI 10.1590/S0100-72031999000100006
Views126See morePurpose: to evaluate the agreement between the urodynamic and ultrasonography diagnoses of urinary incontinence, as well as to correlate the variables of both examinations. Methodology: three hundred eighty-one patients with urine loss were selected, from the Sectior of Urogynecology and Vaginal Surgery of the Division of Gynecology, Escola Paulista de Medicina - Federal University of São Paulo. All of them were submitted to urodynamic study, according to the standardization of the International Society of Continence, and to ultrasonography of the bladder neck, with a 6 MHz trasvaginal transducer. We analyzed the maximum closing urethral pressure (MCUP) and the etiological diagnosis of the urine loss. In the ultrasonography, the position of the bladder neck was evaluated in relation to the inferior border of the pubic symphysis, and its mobility as well as the diameter of the urethra and bladder neck. The women were categoriaed according to the urodynamic study in to stress urinary incontinence, detrusor instability and mixed urinary incontinence. Results: 1) the bladder neck, at rest was most frequently above the inferior border of the pubic symphysis and, during effort, below or at the height of the bony reference, in the three groups; 2) the mobility of the bladder neck was similar in the groups; 3) there was no significant correlation between MCUP and the diameter of the urethra and of the bladder neck. Conclusion: we deem that ultrasonography of the bladder neck is always a complement to the clinical evaluation and the urodymanic study.
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Trabalhos Originais
Laparascopic approach to endometrial cancer
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):41-45
03-15-1999
Summary
Trabalhos OriginaisLaparascopic approach to endometrial cancer
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):41-45
03-15-1999DOI 10.1590/S0100-72031999000100007
Views62See morePurpose: to demonstrate a new approach to treatment of endometrial cancer. Methods: Between February, 1996 and February, 1998, twelve patients with endometrial cancer, diagnosed by hysteroscopy and biopsy, were submitted to pelvic lymphadenectomy and hysterectomy with salpingo-oophorectomy by laparoscopy. The mean age was 58.1 years, the mean number of gestations was 2.3 and the mean body mass index was 28.6. Results: the mean length of anesthesia was 4.8 hours. The mean time of hospital stay was 3.3 days. The total of lymph nodes obtained was 176, 104 (59.1%) being from the right side and 72 (40.9%) from the left side. The mean of lymph nodes per patient was 18.5. We observed two complications: in one case the laparoscopic procedure had to be abandoned because the patient presented a dangerous increase in intratracheal pressure and in the other case a granuloma in the vagina was observed. Conclusions: the initial evaluation of the laparoscopic hysterectomy and laparoscopy shows that we achieved good results regarding the accuracy of staging, the number of nodes and a small number (3) of complications.
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Trabalhos Originais
Pelvic tumors in postmenopausal women
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):47-54
03-15-1999
Summary
Trabalhos OriginaisPelvic tumors in postmenopausal women
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):47-54
03-15-1999DOI 10.1590/S0100-72031999000100008
Views128See morePurpose: to evaluate clinical and ultrasonic findings in patients with pelvic tumors at postmenopause and to correlate them with the final diagnosis. Patients and Methods: thirty-six postmenopausal women with pelvic tumor diagnosis were prospectively evaluated through clinical examination and endovaginal ultrasonography. Clinical follow-up with no surgical procedures was indicated for anechoic cystic tumors with or without thin unique septation and volume under 50 cm³. Needle aspiration was indicated for tumors with the same aspect, and volume of 50 to 100 cm³, whereas exploratory laparotomy was performed in the remaining patients. Diagnosis defined two groups of patients: benign (28) and malignant (8) pathologies. Results: anechoic cystic tumor with or without a thin septum indicates benignity (p = 0.0091). Tumors with solid areas indicate malignancy (p = 0.0024). Ascites correlates with malignancy (p = 0.0278). Heterogeneity, thick capsule, thick septa, and papillary projections predominated in malignancies but without no statistical significance (p > 0,05). Tumor volume indicates malignancy, with a median of 85.2 cm³ in benign tumors and 452.5 cm³ in malignancies (p = 0.0048), with a cutoff at 295 cm³ (sensitivity = 83.3% and specificity = 85.2%). Following this protocol, all malignancies were submitted to surgery and 11 benign tumor patients were treated with a conservative protocol (39.3% of all benign patients). Conclusion: conservative management is an adequate protocol for women with anechoic pelvic tumors with low volume, with or without single thin septum and without ascites. Differentiation between benign and malignant of complex and/or high volume tumors requires complementary investigation.
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Trabalhos Originais
Evaluation of fetal well-being through color doppler velocimetry
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):7-12
03-15-1999
Summary
Trabalhos OriginaisEvaluation of fetal well-being through color doppler velocimetry
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):7-12
03-15-1999DOI 10.1590/S0100-72031999000100002
Views52See morePurpose: to evaluate the accuracy of Doppler velocimetry in the diagnosis of fetal well-being. Methods: a total of 130 pregnant women assisted at the Ultrasound Unit of the Center for Integral Assistance of Women's Health, UNICAMP, between the 28th and 42nd gestational weeks was analyzed. The correlation between fetal umbilical and middle cerebral arteries, abdominal aorta, and the adverse perinatal results was established. The pregnant women selected for this study were submitted electively to cesarean sections, at the utmost four hours after the color Doppler examination. We considered as adverse perinatal results: Apgar score lower than seven at the 5th minute, neonatal intensive care unit hospitalization, intrauterine growth retardation, acute fetal distress, perinatal mortality, hypoglycemia, polycythemia, necrotizing enterocolitis, and cerebral hemorrhage. The indexes for the umbilical and middle cerebral arteries and the abdominal aorta were related, in each case, to the adverse perinatal results. Results: the systole/diastole umbilical artery ratio presented a higher sensitivity than the pulsatile and tolerance indexes. The Doppler study of the umbilical artery presented greater sensitivity than the middle cerebral artery and the abdominal aorta in detecting adverse perinatal results. Conclusion: the Doppler velocimetry of the umbilical and middle cerebral arteries presented good diagnostic capacity in evaluating fetal well-being, and a significant association with the adverse perinatal results.
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Trabalhos Originais
Frequency of mutations at codon 12 of the K–ras gene in invasive ductal breast cancer
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):127-131
03-14-1999
Summary
Trabalhos OriginaisFrequency of mutations at codon 12 of the K–ras gene in invasive ductal breast cancer
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):127-131
03-14-1999DOI 10.1590/S0100-72031999000300002
Views92See morePurpose: the frequency of point mutation at codon 12 of the K¾ras gene was determined in paraffin blocks of surgical specimens from patients who had ductal invasive breast cancer. Material and Methods: Fifty surgical specimens blocked in paraffin from patients with ductal invasive breast cancer, with histological degree II and III, were used. The polymerase chain reaction (PCR) was used for amplification of DNA fragments studied. The material cleavage was obtained with restriction fragment length polymorphisms (RFLP). The electrophoresis in agarose gel, with Ladder 123 (GIBCO-BRL) marker, was employed to verify if some mutation had occurred. The results were shown using ultraviolet beam and recorded by photos. Results: mutations at codon 12 of K-ras gene were found in five samples (10%) and all of them were polymorphic for this caracter. The five patients whose tumors expressed mutation were in the postmenopausal period. Four patientes had tumors of histological degree II and one, III.
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Trabalhos Originais
Residual tumor after neoadjuvant chemotherapy for breast cancer: impact on conservative surgical treatment
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(4):187-192
03-14-1999
Summary
Trabalhos OriginaisResidual tumor after neoadjuvant chemotherapy for breast cancer: impact on conservative surgical treatment
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(4):187-192
03-14-1999DOI 10.1590/S0100-72031999000400002
Views104See morePurpose: analysis of histopathologic alterations caused by neoadjuvant chemotherapy (fluorouracil, epirubicine, cyclophosphamide; FEC - 4 cycles) at the tumor site, adjacent mammary tissue and homolateral lymph nodes, as observed in sections of patients with primary breast carcinomas. Method: histological studies performed on 30 surgical sections obtained from radical mastectomy (Patey) of patients with primary breast carcinomas, who underwent prior neoadjuvant systemic therapy. Results: all sections showed tumor regression with variable intensity. This regression occurred irregularly, several refractory tumor cells remaining at the primary tumor site. Resistant tumor cells, independent of the primary tumor, were found in mammary tissue. Other histopathological findings, resulting from chemotherapy in tumoral and mammary tissues, such as calcifications and fibrosis, and in axillary homolateral lymph nodes were obtained. Conclusion: the effect of neoadjuvant chemotherapy is not uniform, refratory tumor cells remaining not only at primary tumor site, but also in distant regions. Furthermore, we found no correlation between the regression of the tumor and the axillary metastatic lymph nodes. Thus, a conservative surgery after neoadjuvant chemotherapy (FEC) should be avoided.