Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2000;22(2):101-106
DOI 10.1590/S0100-72032000000200007
Purpose: to evaluate the prevalence of anticardiolipin antibody in women with stillbirth. Patients and Methods: this was a cross-sectional study performed from May 1998 to September 1999 at the Maternity of the University of Campinas and at the Hospital and Maternity Leonor Mendes de Barros, in Brazil, which evaluated 109 pregnant women hospitalized with the diagnosis of intrauterine fetal death and gestational age of 20 or more weeks. These women underwent some laboratory examinations to identify the cause of fetal death, including anticardiolipin antibody evaluation performed through the determination of IgG and IgM serum levels. IgG and IgM results are expressed as GPL and MPL units, respectively, and, in both cases, results above 10 units are considered positive. The statistical procedures used were the mean and standard deviation estimates, Student's t test, Fisher test and chi². Results: the prevalence of anticardiolipin positivity was 18.3%. The women were predominantly young, with a mean age around 27 years. The main identified causes of fetal death were: hypertension (26.1%), hemorrhage during the third trimester (9.9%) and fetal malformation (8.1%). One third of the cases had no identified causes of fetal death. However, considering the 20 positive cases for anticardiolipin antibody, the proportion of unidentified causes decreased to 29%. Conclusions: it is important to investigate the presence of anticardiolipin antibodies among women with intrauterine fetal death with the purpose of clarifying the causes of stillbirth. If the diagnosis of antiphospholipid syndrome is confirmed, it is necessary to counsel and treat these women regarding future pregnancies.
Summary
Rev Bras Ginecol Obstet. 2000;22(2):101-106
DOI 10.1590/S0100-72032000000200007
Purpose: to evaluate the prevalence of anticardiolipin antibody in women with stillbirth. Patients and Methods: this was a cross-sectional study performed from May 1998 to September 1999 at the Maternity of the University of Campinas and at the Hospital and Maternity Leonor Mendes de Barros, in Brazil, which evaluated 109 pregnant women hospitalized with the diagnosis of intrauterine fetal death and gestational age of 20 or more weeks. These women underwent some laboratory examinations to identify the cause of fetal death, including anticardiolipin antibody evaluation performed through the determination of IgG and IgM serum levels. IgG and IgM results are expressed as GPL and MPL units, respectively, and, in both cases, results above 10 units are considered positive. The statistical procedures used were the mean and standard deviation estimates, Student's t test, Fisher test and chi². Results: the prevalence of anticardiolipin positivity was 18.3%. The women were predominantly young, with a mean age around 27 years. The main identified causes of fetal death were: hypertension (26.1%), hemorrhage during the third trimester (9.9%) and fetal malformation (8.1%). One third of the cases had no identified causes of fetal death. However, considering the 20 positive cases for anticardiolipin antibody, the proportion of unidentified causes decreased to 29%. Conclusions: it is important to investigate the presence of anticardiolipin antibodies among women with intrauterine fetal death with the purpose of clarifying the causes of stillbirth. If the diagnosis of antiphospholipid syndrome is confirmed, it is necessary to counsel and treat these women regarding future pregnancies.
Summary
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 2000;22(2):113-116
DOI 10.1590/S0100-72032000000200009
Takayasu's arteritis is an idiopathic occlusive inflammation of the aorta and its major branches. The disease shows a striking predilection for young women and thus is occasionally associated with pregnancy. The authors describe a case of a pregnant patient with Takayasu's arteritis. The pregnancy was accompanied by a multidisciplinary group in a satisfactory way. There was only one hospitalization due to an exacerbation of the symptoms during the 32nd week of gestation, controlled by medical treatment. A vaginal delivery occurred at 37 weeks. A live infant weighing 2,750 g was delivered and the patient had an uncomplicated course.
Summary
Rev Bras Ginecol Obstet. 2000;22(2):113-116
DOI 10.1590/S0100-72032000000200009
Takayasu's arteritis is an idiopathic occlusive inflammation of the aorta and its major branches. The disease shows a striking predilection for young women and thus is occasionally associated with pregnancy. The authors describe a case of a pregnant patient with Takayasu's arteritis. The pregnancy was accompanied by a multidisciplinary group in a satisfactory way. There was only one hospitalization due to an exacerbation of the symptoms during the 32nd week of gestation, controlled by medical treatment. A vaginal delivery occurred at 37 weeks. A live infant weighing 2,750 g was delivered and the patient had an uncomplicated course.
Summary
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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
Rev Bras Ginecol Obstet. 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.
