Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2000;22(10):609-613
DOI 10.1590/S0100-72032000001000002
Purpose: the effects of corticosteroids on the female urinary tract are not well understood, specially in climacteric women with or without estrogen replacement therapy. We studied the effects of corticosteroids on the blood vessels and epithelium of the bladder and urethra of female rats. Method: fifty-four female rats were used, divided into five groups. Group I - ten castrated female rats; Group II - eleven castrated female rats which receivedintraperitoneally 15 mg/kg weight prednisolone, for 26 days; Group III - twelve castrated female rats which received the same amount of corticosteroid, during the same time, and subcutaneously 10 mg/kg 17 beta-estradiol, in the last five days before they were sacrificed; Group IV - eleven castrated rats which received placebo for 26 days; and Group V - no castrated female rats which received the same dose of corticosteroid during the same time as in Group II. Results: we observed an average of 1.8 vessels in the bladder of the castrated group which received corticosteroid, a similar number to that of those which received corticosteroid and estrogen, compared with 0.8 vessel in the placebo group. Regarding the urethra, 0.7 vessel was observed in the group which received corticosteroid, as compared with 0.9 vessel in the group treated with corticosteroid associated with estrogen and 0.4 in the placebo group. Regarding the mucous membrane, the vesical epithelium thickness of 14.1 mm in the placebo group increased to 20.6 mm in that with corticosteroid and to 22.6 mm in that with corticosteroid plus estrogen. The urethral epithelium thickness of 12.4 mm in the placebo group increased to 15.1 mm in the group with corticosteroid and to 16.7 mm in that with corticosteroid plus estrogen. Conclusion: corticosteroids significantly increased the vascularization and the thickness of the vesical and urethral epithelia of castrated female rats.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):609-613
DOI 10.1590/S0100-72032000001000002
Purpose: the effects of corticosteroids on the female urinary tract are not well understood, specially in climacteric women with or without estrogen replacement therapy. We studied the effects of corticosteroids on the blood vessels and epithelium of the bladder and urethra of female rats. Method: fifty-four female rats were used, divided into five groups. Group I - ten castrated female rats; Group II - eleven castrated female rats which receivedintraperitoneally 15 mg/kg weight prednisolone, for 26 days; Group III - twelve castrated female rats which received the same amount of corticosteroid, during the same time, and subcutaneously 10 mg/kg 17 beta-estradiol, in the last five days before they were sacrificed; Group IV - eleven castrated rats which received placebo for 26 days; and Group V - no castrated female rats which received the same dose of corticosteroid during the same time as in Group II. Results: we observed an average of 1.8 vessels in the bladder of the castrated group which received corticosteroid, a similar number to that of those which received corticosteroid and estrogen, compared with 0.8 vessel in the placebo group. Regarding the urethra, 0.7 vessel was observed in the group which received corticosteroid, as compared with 0.9 vessel in the group treated with corticosteroid associated with estrogen and 0.4 in the placebo group. Regarding the mucous membrane, the vesical epithelium thickness of 14.1 mm in the placebo group increased to 20.6 mm in that with corticosteroid and to 22.6 mm in that with corticosteroid plus estrogen. The urethral epithelium thickness of 12.4 mm in the placebo group increased to 15.1 mm in the group with corticosteroid and to 16.7 mm in that with corticosteroid plus estrogen. Conclusion: corticosteroids significantly increased the vascularization and the thickness of the vesical and urethral epithelia of castrated female rats.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):615-618
DOI 10.1590/S0100-72032000001000003
SUMMARY Purpose: to evaluate the videolaparoscopic surgical mana-gement of 32 patients with ovarian endometrioma. Method: retrospective study of thirty-two patients admitted to the Gynecologic Endoscopy Section - Gynecology and Obstetrics Department of the Hospital do Servidor Público Estadual "Francisco Morato de Oliveira" - São Paulo - Brazil with clinical and ultrasonographic diagnosis of ovarian endometrioma, who have been submitted to videolaparoscopic surgery. Eleven of them had endometriomas less than 3 cm and had the tumor emptied and the capsule excised at the first laparoscopy. Twenty-one patients with endometriomas larger than 3 cm were submitted to emptying and washing of the cyst at the first laparoscopy. These women used GnRH analogues for four months (1 dose each month) and were then submitted to a second laparoscopy when the capsule was excised. Histopathologic study was performed in the surgical tissues of all cases. The early results of the procedure and the recurrence rate were evaluated. Results: there were no surgical intercurrent episodes or postsurgical complications. The problem was solved in all but three patients among the 21 with endometriomas larger than 3 cm. These patients presented recurrence of the disease within a period of 6 to 12 months. Conclusion: the videolaparoscopic surgical management of ovarian endometriomas, with capsule excision, showed good results and small number of recurrences.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):615-618
DOI 10.1590/S0100-72032000001000003
SUMMARY Purpose: to evaluate the videolaparoscopic surgical mana-gement of 32 patients with ovarian endometrioma. Method: retrospective study of thirty-two patients admitted to the Gynecologic Endoscopy Section - Gynecology and Obstetrics Department of the Hospital do Servidor Público Estadual "Francisco Morato de Oliveira" - São Paulo - Brazil with clinical and ultrasonographic diagnosis of ovarian endometrioma, who have been submitted to videolaparoscopic surgery. Eleven of them had endometriomas less than 3 cm and had the tumor emptied and the capsule excised at the first laparoscopy. Twenty-one patients with endometriomas larger than 3 cm were submitted to emptying and washing of the cyst at the first laparoscopy. These women used GnRH analogues for four months (1 dose each month) and were then submitted to a second laparoscopy when the capsule was excised. Histopathologic study was performed in the surgical tissues of all cases. The early results of the procedure and the recurrence rate were evaluated. Results: there were no surgical intercurrent episodes or postsurgical complications. The problem was solved in all but three patients among the 21 with endometriomas larger than 3 cm. These patients presented recurrence of the disease within a period of 6 to 12 months. Conclusion: the videolaparoscopic surgical management of ovarian endometriomas, with capsule excision, showed good results and small number of recurrences.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):619-625
DOI 10.1590/S0100-72032000001000004
Purpose: to compare the methods used to investigate the endouterine cavity by testing the sensitivity and specificity of X-ray hysterography and sonohysterography compared with hysteroscopy (gold standard). Methods: we carried out a prospective study with 18 patients who, due to symptoms such as irregular menstrual cycles, unexplained postmenopausal uterine bleeding and ultrasound disturbance, were candidates for uterine cavity investigation by X-ray hysterography, sonohysterography and hysteroscopy. Results: sonohysterography sensitivity and specificity were 90 and 87.5%, respectively. Positive and negative predictive values were 90 and 87.5%. For X-ray hysterography, sensitivity, specificity, positive and negative predictive values were 70, 75, 77.7 and 75%, respectively. Conclusion: the use of saline instilation into the endometrial cavity in order to enhance the acuracy of the vaginal ultrasonography seems reliable as a mean to distinguish lesions in the uterine cavity, thereby facilitating the identification of candidates for diagnostic or operative hysteroscopy. X-ray hysterography produces results inferior to hysterosonography.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):619-625
DOI 10.1590/S0100-72032000001000004
Purpose: to compare the methods used to investigate the endouterine cavity by testing the sensitivity and specificity of X-ray hysterography and sonohysterography compared with hysteroscopy (gold standard). Methods: we carried out a prospective study with 18 patients who, due to symptoms such as irregular menstrual cycles, unexplained postmenopausal uterine bleeding and ultrasound disturbance, were candidates for uterine cavity investigation by X-ray hysterography, sonohysterography and hysteroscopy. Results: sonohysterography sensitivity and specificity were 90 and 87.5%, respectively. Positive and negative predictive values were 90 and 87.5%. For X-ray hysterography, sensitivity, specificity, positive and negative predictive values were 70, 75, 77.7 and 75%, respectively. Conclusion: the use of saline instilation into the endometrial cavity in order to enhance the acuracy of the vaginal ultrasonography seems reliable as a mean to distinguish lesions in the uterine cavity, thereby facilitating the identification of candidates for diagnostic or operative hysteroscopy. X-ray hysterography produces results inferior to hysterosonography.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):627-632
DOI 10.1590/S0100-72032000001000005
Purpose: to investigate clinical and bacteriological aspects, follow-up and treatment of mastitis in our clinic. Methods: this study was performed at Cleriston Andrade General Hospital. Patients were interviewed regarding personal data, prenatal care, care received during delivery and puerperium and clinical aspects. Their mastitides were classified by Vinha's criteria. The patients with abscesses had them drained for bacteriological study. Culture medium Tryptone Soya Broth was used. Results: seventy nursing mothers were interviewed; 57% of them had given birth for the first time, 57% were between 20 and 29 years old, 51% had not finished elementary school, 63% had income less than the minimum wage, 66% of them had nobody to help with the housework. Out of the seventy females, 50% had not had their breasts examined. Approximately half of them had not been told how to breastfeed (50%) or how to express breast milk (58%). Sixty-three percent had not delivered in institutions designated by WHO as "Children's Friends Hospitals". Engorgement occurred in 46% of the cases and nipple fissures in 47%. According to Vinha's criteria, 44% had lobar, 39% ampular and 17% glandular locations. Presence of Staphylococcus aureus was detected in 55% of the cases. Conclusion: factors such as low schooling, low incomes, no assistance in housework, giving birth for the first time and lack of professional help contributed to occurrence of mastitis.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):627-632
DOI 10.1590/S0100-72032000001000005
Purpose: to investigate clinical and bacteriological aspects, follow-up and treatment of mastitis in our clinic. Methods: this study was performed at Cleriston Andrade General Hospital. Patients were interviewed regarding personal data, prenatal care, care received during delivery and puerperium and clinical aspects. Their mastitides were classified by Vinha's criteria. The patients with abscesses had them drained for bacteriological study. Culture medium Tryptone Soya Broth was used. Results: seventy nursing mothers were interviewed; 57% of them had given birth for the first time, 57% were between 20 and 29 years old, 51% had not finished elementary school, 63% had income less than the minimum wage, 66% of them had nobody to help with the housework. Out of the seventy females, 50% had not had their breasts examined. Approximately half of them had not been told how to breastfeed (50%) or how to express breast milk (58%). Sixty-three percent had not delivered in institutions designated by WHO as "Children's Friends Hospitals". Engorgement occurred in 46% of the cases and nipple fissures in 47%. According to Vinha's criteria, 44% had lobar, 39% ampular and 17% glandular locations. Presence of Staphylococcus aureus was detected in 55% of the cases. Conclusion: factors such as low schooling, low incomes, no assistance in housework, giving birth for the first time and lack of professional help contributed to occurrence of mastitis.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):633-639
DOI 10.1590/S0100-72032000001000006
Purpose: to evaluate the risk of preterm delivery using the fetal fibronectin test and the measurement of the cervix by transvaginal ultrasonography in pregnant women with previous preterm delivery. Methods: one hundred and seven women were enrolled in the study at 24th, 28thand 32ndweek to detect the presence of fetal fibronectin by immediate-reading membrane test and to perform vaginal ultrasonography to measure the length of the cervix between the internal and external cervical os. The cervix was considered to be short when the cervical length was at or below the cutoff set by the receiver-operating characteristic (ROC) curve for prediction of preterm delivery. Sonographic cervical length and fetal fibronectin were compared to assess the risk of preterm birth before 34 and 37 weeks. Results: the spontaneous preterm delivery rate was 37.4% (40/107). The analysis made by the ROC curve indicated 30 mm as the best cutoff to maximize sensitivity and specificity at 24 and 28 weeks and 25 mm at 32 weeks of gestation. The positive test of fetal fibronectin had a significant relative risk (RR: 1.77; 95% confidence interval (IC): 1.10-2.84) to predict delivery before 37 weeks, when compared with a negative test, only at 28 weeks. The presence of short cervix at 24, 28 and 32 weeks showed a significative RR for birth before 37 weeks. The highest RR occurred with a short cervix at 24 weeks (RR: 4.42; 95% CI: 1.25-15.56). Conclusion: we concluded that the measurement of uterine cervix by vaginal ultrasonography is better than the fetal fibronectin test for evaluating the risk of preterm delivery in women with previous preterm delivery.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):633-639
DOI 10.1590/S0100-72032000001000006
Purpose: to evaluate the risk of preterm delivery using the fetal fibronectin test and the measurement of the cervix by transvaginal ultrasonography in pregnant women with previous preterm delivery. Methods: one hundred and seven women were enrolled in the study at 24th, 28thand 32ndweek to detect the presence of fetal fibronectin by immediate-reading membrane test and to perform vaginal ultrasonography to measure the length of the cervix between the internal and external cervical os. The cervix was considered to be short when the cervical length was at or below the cutoff set by the receiver-operating characteristic (ROC) curve for prediction of preterm delivery. Sonographic cervical length and fetal fibronectin were compared to assess the risk of preterm birth before 34 and 37 weeks. Results: the spontaneous preterm delivery rate was 37.4% (40/107). The analysis made by the ROC curve indicated 30 mm as the best cutoff to maximize sensitivity and specificity at 24 and 28 weeks and 25 mm at 32 weeks of gestation. The positive test of fetal fibronectin had a significant relative risk (RR: 1.77; 95% confidence interval (IC): 1.10-2.84) to predict delivery before 37 weeks, when compared with a negative test, only at 28 weeks. The presence of short cervix at 24, 28 and 32 weeks showed a significative RR for birth before 37 weeks. The highest RR occurred with a short cervix at 24 weeks (RR: 4.42; 95% CI: 1.25-15.56). Conclusion: we concluded that the measurement of uterine cervix by vaginal ultrasonography is better than the fetal fibronectin test for evaluating the risk of preterm delivery in women with previous preterm delivery.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):641-646
DOI 10.1590/S0100-72032000001000007
Purpose: to evaluate the influence of cigarette smoking on uteroplacental, fetoplacental and fetal blood flow by obstetric Doppler velocimetry of the uterine, umbilical and middle cerebral arteries. Method: a prospective study with 42 healthy pregnant women, 20 of whom were smokers and 24 nonsmokers. Ultrasound was performed initially to determine the gestation time. The pregnant women next underwent pulsed and color Doppler velocimetry of the uterine, umbilical and middle cerebral arteries at the 24th, 28th, 32nd, 36th, and 40th week. The smokers were instructed not to smoke for at least two hours before the test. Results: the mean resistance index (RI) of the right and left uterine arteries was greatest in the smoking group at the 36th week [mean (SD) = 0.501 (0.034)], (p = 0.002). The pulsatility index (PI) of the umbilical artery was greatest in the smoking group at the 28th week [mean (SD) = 1.135 (0.182)], (p = 0.008). No difference in the PI of the middle cerebral artery (MCA) was detected between the two groups. However, the MCA/umbilical PI ratio was lower in the smoking group at the 32nd [mean (SD) = 1.977 (0.291)], (p = 0.027), and 36th week [mean (SD) = 1.850 (0.465)], (p = 0.014). Conclusion: it was concluded that smoking increases resistance in the uteroplacental and fetoplacental circulation while simultaneously reducing resistance in the MCA, imitating a "brain-sparing" effect, most likely due to chronic hypoxia.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):641-646
DOI 10.1590/S0100-72032000001000007
Purpose: to evaluate the influence of cigarette smoking on uteroplacental, fetoplacental and fetal blood flow by obstetric Doppler velocimetry of the uterine, umbilical and middle cerebral arteries. Method: a prospective study with 42 healthy pregnant women, 20 of whom were smokers and 24 nonsmokers. Ultrasound was performed initially to determine the gestation time. The pregnant women next underwent pulsed and color Doppler velocimetry of the uterine, umbilical and middle cerebral arteries at the 24th, 28th, 32nd, 36th, and 40th week. The smokers were instructed not to smoke for at least two hours before the test. Results: the mean resistance index (RI) of the right and left uterine arteries was greatest in the smoking group at the 36th week [mean (SD) = 0.501 (0.034)], (p = 0.002). The pulsatility index (PI) of the umbilical artery was greatest in the smoking group at the 28th week [mean (SD) = 1.135 (0.182)], (p = 0.008). No difference in the PI of the middle cerebral artery (MCA) was detected between the two groups. However, the MCA/umbilical PI ratio was lower in the smoking group at the 32nd [mean (SD) = 1.977 (0.291)], (p = 0.027), and 36th week [mean (SD) = 1.850 (0.465)], (p = 0.014). Conclusion: it was concluded that smoking increases resistance in the uteroplacental and fetoplacental circulation while simultaneously reducing resistance in the MCA, imitating a "brain-sparing" effect, most likely due to chronic hypoxia.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):647-651
DOI 10.1590/S0100-72032000001000008
Purpose: to study the effects of ciprofloxacin on abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number, weight and neurological reflexes. Methods: we used 30 Wistar rats, divided into three groups: D50-treated (ciprofloxacin, 50 mg/kg); D100-treated (ciprofloxacin 100 mg/kg) and control group which received physiological saline per os, from the 1st to the 7th day after mating. We studied abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number and weight at 1st, 3rd, 5th and 10th day of life and newborn neurological reflexes at 1st, 3rd, 5th and 10th day of life. Results: there was no difference between groups in the number of rats that became pregnant. The same was found for maternal weight gain and newborn number. There was a difference in newborn mean weight on day 3rd, 5th and 10th (p = 0.006, 0.01 and 0.03, respectively). The D100 newborn group was the one with less weight gain up to the 10th day of life. We found a significant difference (p = 0.002) in the newborn orientation reflex on the 1st day of life, that disappeared afterwards. No abortion or gross malformation was found in this study. Conclusions: ciprofloxacin modified the newborn weight and reflex on the first days of life. In conclusion, we consider that the use of ciprofloxacin should be restricted during the pregnancy.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):647-651
DOI 10.1590/S0100-72032000001000008
Purpose: to study the effects of ciprofloxacin on abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number, weight and neurological reflexes. Methods: we used 30 Wistar rats, divided into three groups: D50-treated (ciprofloxacin, 50 mg/kg); D100-treated (ciprofloxacin 100 mg/kg) and control group which received physiological saline per os, from the 1st to the 7th day after mating. We studied abortion percentage, maternal weight gain during pregnancy, fetal and maternal death, gross fetal malformation, newborn number and weight at 1st, 3rd, 5th and 10th day of life and newborn neurological reflexes at 1st, 3rd, 5th and 10th day of life. Results: there was no difference between groups in the number of rats that became pregnant. The same was found for maternal weight gain and newborn number. There was a difference in newborn mean weight on day 3rd, 5th and 10th (p = 0.006, 0.01 and 0.03, respectively). The D100 newborn group was the one with less weight gain up to the 10th day of life. We found a significant difference (p = 0.002) in the newborn orientation reflex on the 1st day of life, that disappeared afterwards. No abortion or gross malformation was found in this study. Conclusions: ciprofloxacin modified the newborn weight and reflex on the first days of life. In conclusion, we consider that the use of ciprofloxacin should be restricted during the pregnancy.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):653-656
DOI 10.1590/S0100-72032000001000009
Chronic appendicitis might simulate several diseases, making clinical management difficult. We report the case of a 9-year-old girl with an abdominal pain for 13 months. Ultrasound and tomography showed an expansive mass in the lower abdomen. It was extremely difficult to establish the diagnosis because the symptoms, laboratory results and images were inconclusive. The definitive diagnosis occurred only after laparotomy. We discuss in the present article several differential diagnoses for chronic appendicitis, mainly gynecological malformations, endometriosis, neoplasias and pseudotumors.
Summary
Rev Bras Ginecol Obstet. 2000;22(10):653-656
DOI 10.1590/S0100-72032000001000009
Chronic appendicitis might simulate several diseases, making clinical management difficult. We report the case of a 9-year-old girl with an abdominal pain for 13 months. Ultrasound and tomography showed an expansive mass in the lower abdomen. It was extremely difficult to establish the diagnosis because the symptoms, laboratory results and images were inconclusive. The definitive diagnosis occurred only after laparotomy. We discuss in the present article several differential diagnoses for chronic appendicitis, mainly gynecological malformations, endometriosis, neoplasias and pseudotumors.
