Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):281-286
DOI 10.1590/S0100-72032000000500005
Purpose: to evaluate the effectiveness of the transverse cerebellar diameter (TCD), by ultrasonography, in the evolution of the fetal growth, and to relate it to gestational age, biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Method: a prospective and longitudinal study was performed on 254 pregnant women considered of low risk, with a gestational age from 20 to 40 weeks. Only 55 pregnant women were included in the study, according to inclusion and exclusion criteria. All the examinations, 217 ultrasonographic evaluations, were done by the author (LN), at least three and at most six examinations for each pregnant woman being accomplished at an interval of one to five weeks. Normality patterns were established between the 10 and 90 percentiles for each gestational age and confirmed postnatally. Results: the transverse cerebellar diameter presented a good correlation with the gestational age either as a dependent variable (R² = 0.90) or as an independent variable (R² = 0.92). A significant relationship was found in the evaluation of the fetal growth between the TCD and the several fetal parameters: BPD and HC (R² = 0.92), FL (R² = 0.90) and AC (R² = 0.89). Conclusions: the transverse cerebellar diameter is a parameter that should be used in the follow-up of development and of fetal growth because of the ascending pattern of its growth curve. Any up- or downward alteration in the growth curve can be useful for the detection of deviations of fetal growth.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):287-292
DOI 10.1590/S0100-72032000000500006
Purpose: to evaluate the effects of hormone replacement therapy (HRT) on the systolic and diastolic blood pressure of postmenopausal women. Methods: a total of 166 users and 136 non-users of hormone replacement were evaluated retrospectively during a period of three years. All women were assisted at the Menopause Outpatient Clinic of CAISM -- Unicamp, where the variations of these parameters were evaluated at the end of each year in relation to the initial parameters. The data analysis was performed through Student's t test, Mann-Whitney test, and the Wilcoxon nonparametric test. Results: we observed that the systolic blood pressure of HRT users was statistically lower at the end of the third year of use, compared to the initial values (p = 0.01). There was no significant difference in the diastolic blood pressure between users and non-users. Conclusion: hormone replacement therapy did not produce changes in the parameters studied in women properly assisted during the use of HRT.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):293-299
DOI 10.1590/S0100-72032000000500007
Purpose: to determine the role of sonohysterography in the evaluation of abnormalities in the uterine cavity in patients presenting abnormal uterine bleeding, who had previously been selected by transvaginal ultrasonography. Methods: forty-eight patients presenting abnormal uterine bleeding and changes in the uterine cavity seen by transvaginal ultrasonography were selected, and they were in the menacme or postmenopause period. All patients underwent a sonohysterography, and later a hysteroscopy and/or a hysterectomy. The sonohysterographies were evaluated by two different physicians, and the diagnoses were compared. Results: the sonohysterography method showed high sensitivity and specificity for the diagnosis of benign pathologies in the uterine cavity. First, in the presence of polyps the sensitivity and specificity rates were 100 and 97%, respectively, second, in the presence of submucous myoma, they were 83 and 100%, and finally, concerning endometrial hyperplasia and normal endometrium, they were 100%. We diagnosed thirty-three cases of polyps, thirteen cases of submucous myoma, four cases of endometrial hyperplasia and three normal cases. The correlation between the diagnoses provided by the two physicians was high. Conclusions: sonohysterography is a safe and fast method which is very well tolerated by the patient, and has low levels of complications. Its high sensitivity and specificity allow this method to be used for routine diagnosis concerning benign pathologies in the uterine cavity of patients presenting abnormal uterine bleeding.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):301-305
DOI 10.1590/S0100-72032000000500008
Purpose: to analyze the surgical results after slings with vaginal wall, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, for the treatment of incontinent women with hypermobility of the bladder neck, who show great risk of surgery failure with other techniques or in those with intrinsic sphincteric deficiency (ISD) and, also, surgery recurrence. Methods: we studied 21 patients submitted to surgery in order to correct urinary incontinence by the vaginal wall sling technique, in the period from December 1997 to February 1999, with postoperative follow-up which varied between 1 and 14 months (average 8.2). The mean age of patients was 56 years (39 to 77 years), 15 (71.4%) were in menopause and 6 (28.6%) in menacme. All patients were evaluated before the surgery through medical interview, physical examination, ultrasound and urodynamic study, the grade of urinary loss being high in 66.7% and moderate in 33.3% of the patients. All patients showed hypermobility of the bladder neck (more than 10 mm) and 12 patients had previous surgery to correct the urinary incontinence. Regarding the urodinamic study, the patients manifested urinary loss with maximum pressure of urethral closure (MPUC) varying from 20 to 124 cmH2O (average 55.2) and Valsalva leak point pressure (VLPP) varying from 18 to 128 cmH2O (average 60.3). The indications of surgery were: ISD (11 patients -- 52.4%), obesity (5 patients -- 23.8%), ISD and obesity (2 patients -- 9.5%), surgery recurrence (2 patients -- 9.5) and ISD and first grade womb prolapse (1 patient -- 4.8%). Results: as complications, 6 patients (28.6%) showed temporary urinary retention after surgery, 1 patient (4.8%) infection in the urinary tract, 1 patient (4.8%) presence of polypropylene suture in the vagina, 1 patient (4.8%) infection of the surgery wound, 4 patients (19%) developed urgency/incontinence, 1 (4.8%) urgency and 1 (4.8%) difficulty in urinating (high postvoiding residue). The grade of the patients' satisfaction was satisfactory, with 15 patients (71.4%) referring cure, 3 patients (14.3%) improvement, in 2 patients (9.5%) the urinary loss remained unchanged and in 1 patient (4.8%) the urinary loss got worse. Conclusions: the vaginal wall sling surgery is efficient for the treatment of specific cases of stress urinary incontinence, emphasizing intrinsic urethral sphincteric incompetence, surgery recurrence and predisposing factors to failure of other techniques.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):605-610
DOI 10.1590/S0100-72032004000800003
OBJECTIVE: to evaluate staging, surgical procedures and outcome of ovarian granulosa cell tumors (GCT), with emphasis in the possibility of conservative surgery (unilateral ooforectomy). METHODS: this is a retrospective cohort study in which 24 patients treated with GCT during the period of January 1994 to January 2004 were included. Variables of interest such as patient's age, symptoms, tumor size on physical examination, staging, treatment modalities (types of surgery and of adjuvant chemotherapy and/or radiotherapy) and prognosis have been analyzed. The chi-square test was used to check the association between variables, and the level of significance was set at p < 0.05, always describing the two-tailed Fisher exact test. RESULTS: the patients' age varied from 30 to 82 (mean 51.7) years old. The most frequently referred symptom was pelvic pain (n = 10; 41.7%). Fourteen patients (58.3%) presented clinical stage (CS) Ic, 5 (20.8%) CS IIIc and 5 (20.8%) CS Ia. More advanced clinical stages were significantly associated with palpable pelvic masses (p < 0.04). Endometrial hyperplasias were found in 3 (25%) of the 12 hysterectomy specimens. The follow-up period varied from 2 to 114 (mean 42.5) months. Among the 16 (66.7%) surviving and disease-free patients, 4 had CS Ia (25%), 11 CS Ib (68.8%) and 1 CS Ic (6.3%), whereas all patients who died had CS IIIc (p = 0.0008). All 6 patients (25%) that underwent conservative surgery were alive and without recurrence. CONCLUSION: although GCT usually present low aggressiveness, the clinical staging continues to be the main prognostic factor and hence it determines the option for conservative surgery and the use of adjuvant therapy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):595-602
DOI 10.1590/S0100-72032004000800002
PURPOSE: to evaluate the effects of estradiol benzoate associated with dexamethasone on the squamocolumnar junction (SCJ) of rats in permanent estrus (PE) and then ovariectomized (Ovx). METHODS: thirty female rats were divided into six groups of five animals each: PhEG rats in physiological estrus (PhE) treated with propylene glycol (vehicle); OVXG rats in PhE, Ovx and treated with vehicle; PEG - rats in PE treated with vehicle; PEOVXG rats in PE, Ovx and treated with vehicle; ESTRG rats in PE, Ovx and treated with 10 mg per day benzoate of estradiol, and DEXAG in PE, Ovx and treated with 10 mg per day estradiol benzoate associated with 0.8 mg dexamethasone. PE induction was performed with 1.25 mg testosterone propionate per animal per day after birth. After 90 days, rats in the OVXG, EPOVXG, ESTRG, and DEXAG groups were ovariectomized. After 21 days of castration, all animals received the corresponding treatment for five days. At the end of the experiment, all animals were sacrificed and the uteri removed for histological routine. RESULTS: the borders of the SCJ in the PEG were irregular and not clearly delineated, with many buds towards the direction of the lamina propria as well as a reduction in the leukocyte number compared to the PhEG. The SCJ of the OVXG and PEOVXG was not very visible, with cubical epithelium on the endometrial side and with reduction in the layers of squamous epithelium due to stromal atrophy. The SCJ in the ESTRG was more developed than in the OVXG and PEOVXG, but it was similar to that of the PEG, having unclear borders. In contrast, the SCJ of the DEXAG was well-delineated and similar to the PhEG. CONCLUSION: our data suggest that estrogen associated with dexamethasone may be important for remodeling SCJ morphology in female rats with previously induced permanent estrus and subsequent ovariectomy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):613-617
DOI 10.1590/S0100-72032004000800004
OBJECTIVE: the aim of the present study was to verify whether there is a correlation between the prevalence of the polymorphism in the progesterone receptor gene named PROGINS and pelvic endometriosis at different stages. METHODS: a case-control study carried out from November 2003 to May 2004. The genotypes of 104 women were analyzed 66 women had had surgically confirmed endometriosis (26 women at stages I-II and 40 at stages III-IV), and 38 were healthy women. The 306-base pair Alu insertion polymorphism in the intron G of the progesterone receptor gene was detected by polymerase chain reaction and analyzed on 2% agarose gel stained with ethidium bromide. ANOVA analysis was performed in order to make comparisons between among the studied groups. RESULTS: the groups of women with endometriosis stages I-II (EndoI group) and stages III-IV (EndoII group) showed statistically significant increased incidence of PROGINS polymorphic allele as compared with the control group: 27% in the EndoI group, 38% in EndoII and 18% in the control group (p < 0.001. In the analyses, a high frequency of the PROGINS insertion was observed in women with endometriosis as compared to healthy women, disregarding the clinical stage of the disease (p = 0.0385). CONCLUSION: there is a significant statistical association between the PROGINS polymorphism and pelvic endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):619-624
DOI 10.1590/S0100-72032004000800005
PURPOSE: to analyze the relationship of the imune system with preeclamptic pregnancies, comparing lymphocyte and lymphocyte subset analyses of normal pregnant women to pregnancy-induced hypertensive women. To evaluate this immunological function, 40 pregnant women were studied at the "Irmandade da Santa Casa Hospital" of São Paulo: 20 women with normal pregnancies and 20 women with pregnancy-induced hypertension. From all these pregnant women peripheral blood samples were obtained and submitted to the following tests: lymphocyte and lymphocyte subsets analyses (CD4+, CD8+, CD4+/CD8 +CD3+, CD19+). Statistical analysis was performed by the Mann-Whitney test. RESULTS: the serum lymphocyte counts were decreased in women with preeclampsia (preeclamptic group 2295.10±1328.16; control group 3892.80±1430.85, p<0,05); and so were CD4+ (preeclamptic group 1188.80±625.61, control group; 1742.25±628.40, p<0.05); CD8+ (preeclamptic group: 774.00±371.31, control group 1175.70±517.72, p<0,05) and CD3+ (preeclamptic group 1958.65±983.78, control group 2916.95±1117.88, p<0,05). The other tests showed no significant differences between groups. CONCLUSION: the findings indicated a decreased number of lymphocytes, CD4+, CD8+ and CD3+ in preeclampsia.