Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 1999;21(4):187-192
DOI 10.1590/S0100-72031999000400002
Purpose: 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.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):187-192
DOI 10.1590/S0100-72031999000400002
Purpose: 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.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):193-200
DOI 10.1590/S0100-72031999000400003
Purpose: to evaluate the efficacy of cytology and colposcopy-directed biopsy to distinguish preclinical invasive cervical carcinoma from intraepithelial lesions. Patients and Methods: 441 patients submitted to conization, hysterectomy and Wertheim-Meigs operation from 1978 to 1995 in the University Hospital "Clementino Fraga Filho", Federal University of Rio de Janeiro, Cervical Pathology Outpatient Clinic. We estimated sensitivity, specificity, predictive values, likelihood ratio and confidence intervals of each study, which were divided into four classes: 1) normal and inflammatory; 2) mild and moderate dysplasias; 3) severe dysplasia and carcinoma in situ; 4) microcarcinoma and invasive carcinoma. Biopsies were analyzed as a whole and separated in accordance with the type of the colposcopic result (satisfactory and unsatisfactory). Results: cytology has shown sensitivity of 50%, specificity of 89%, positive predictive value of 63% and negative predictive value of 82%. The likelihood ratios were 4.4 for stromal invasion diagnosis, 0.7 for severe dysplasia and carcinoma in situ, 0.1 for mild and moderate dysplasia, 2.2 for normal and inflammatory report and 0.6 for the negative results for invasion as a whole. Satisfactory colposcopic guided biopsy white a visible lesion showed sensitivity of 59%, specificity of 100% positive predictive value of 100% and negative predictive value of 83%. Likelyohood ratios were: tending to infinity for invasion, 0.5 for severe dysplasia and carcinoma in situ, zero for mild and moderate dysplasia, zero for negative and inflammatory and 0.4 for all negative results for invasion.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):193-200
DOI 10.1590/S0100-72031999000400003
Purpose: to evaluate the efficacy of cytology and colposcopy-directed biopsy to distinguish preclinical invasive cervical carcinoma from intraepithelial lesions. Patients and Methods: 441 patients submitted to conization, hysterectomy and Wertheim-Meigs operation from 1978 to 1995 in the University Hospital "Clementino Fraga Filho", Federal University of Rio de Janeiro, Cervical Pathology Outpatient Clinic. We estimated sensitivity, specificity, predictive values, likelihood ratio and confidence intervals of each study, which were divided into four classes: 1) normal and inflammatory; 2) mild and moderate dysplasias; 3) severe dysplasia and carcinoma in situ; 4) microcarcinoma and invasive carcinoma. Biopsies were analyzed as a whole and separated in accordance with the type of the colposcopic result (satisfactory and unsatisfactory). Results: cytology has shown sensitivity of 50%, specificity of 89%, positive predictive value of 63% and negative predictive value of 82%. The likelihood ratios were 4.4 for stromal invasion diagnosis, 0.7 for severe dysplasia and carcinoma in situ, 0.1 for mild and moderate dysplasia, 2.2 for normal and inflammatory report and 0.6 for the negative results for invasion as a whole. Satisfactory colposcopic guided biopsy white a visible lesion showed sensitivity of 59%, specificity of 100% positive predictive value of 100% and negative predictive value of 83%. Likelyohood ratios were: tending to infinity for invasion, 0.5 for severe dysplasia and carcinoma in situ, zero for mild and moderate dysplasia, zero for negative and inflammatory and 0.4 for all negative results for invasion.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):201-205
DOI 10.1590/S0100-72031999000400004
Purpose: evaluation of the risk factors [lesion grade, seropositivity for type 1 acquired immunodeficiency virus (HIV-1) and association with pregnancy ] for relapse of human papillomavirus (HPV) induced lesions of the female genital tract. Patients and Methods: seventy patients with a clinical, colposcopic and cytologic diagnosis of HPV infection were studied. Clinical follow-up lasted at least 6 months after the initial treatment, thus permitting the evaluation of the therapeutic results. Twenty-seven of these patients were pregnant and 12 were seropositive for HIV-1. The remaining 44 patients were not in the pregnancy-puerperium cycle and 14 of them were HIV-1 positive. According to cytologic criteria, the cervical lesions were classified as changes associated with HPV or grade I cervical intraepithelial neoplasia (CIN I) (low grade lesions) or CIN II/III (high grade lesions). Data were analyzed statistically by the exact Fisher test, with the level of significance set at p<0.05. The therapeutic scheme for lesions limited to the uterine cervix was cryo- or electrocautery (EC), whereas topical 5-fluorouracil was used for the diffused lesions through the vaginal wall. For the lesions in the vulvoperineal region, 80% trichloroacetic acid was used, and when they were voluminous, EC was applied. Among the pregnant women, a cryocautery was used for lesions limited to the cervix and EC for diffuse lesions. Results: among the HIV-1-negative pregnant women there was an 87.5% rate of recurrence when the lesions were in the cervix-vagina, and no recurrence when the lesions were vulvoperineal. In contrast, seropositive pregnant women presented 100% recurrence regardless of the site of the lesion. Among nonpregnant HIV negative women, 20 and 24% recurrence was observed in the cervix-vagina and in the vulvoperineal region, respectively, as opposed to 87.5 and 100% recurrence, respectively, for the same regions among HIV positive women. The lesions associated with CIN showed a higher frequency of recurrence with increasing CIN grade and a synergistic effect with the association of HIV-1 and pregnancy. Conclusions: the recurrence rate for women treated for HPV-induced lesions is high and the association with pregnancy, HIV and increased grade of the intraepithelial lesions are synergistic factors in the determination of therapeutic failure. The site of implantation of HPV-induced lesions is of prognostic significance only when the infection is not associated with HIV.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):201-205
DOI 10.1590/S0100-72031999000400004
Purpose: evaluation of the risk factors [lesion grade, seropositivity for type 1 acquired immunodeficiency virus (HIV-1) and association with pregnancy ] for relapse of human papillomavirus (HPV) induced lesions of the female genital tract. Patients and Methods: seventy patients with a clinical, colposcopic and cytologic diagnosis of HPV infection were studied. Clinical follow-up lasted at least 6 months after the initial treatment, thus permitting the evaluation of the therapeutic results. Twenty-seven of these patients were pregnant and 12 were seropositive for HIV-1. The remaining 44 patients were not in the pregnancy-puerperium cycle and 14 of them were HIV-1 positive. According to cytologic criteria, the cervical lesions were classified as changes associated with HPV or grade I cervical intraepithelial neoplasia (CIN I) (low grade lesions) or CIN II/III (high grade lesions). Data were analyzed statistically by the exact Fisher test, with the level of significance set at p<0.05. The therapeutic scheme for lesions limited to the uterine cervix was cryo- or electrocautery (EC), whereas topical 5-fluorouracil was used for the diffused lesions through the vaginal wall. For the lesions in the vulvoperineal region, 80% trichloroacetic acid was used, and when they were voluminous, EC was applied. Among the pregnant women, a cryocautery was used for lesions limited to the cervix and EC for diffuse lesions. Results: among the HIV-1-negative pregnant women there was an 87.5% rate of recurrence when the lesions were in the cervix-vagina, and no recurrence when the lesions were vulvoperineal. In contrast, seropositive pregnant women presented 100% recurrence regardless of the site of the lesion. Among nonpregnant HIV negative women, 20 and 24% recurrence was observed in the cervix-vagina and in the vulvoperineal region, respectively, as opposed to 87.5 and 100% recurrence, respectively, for the same regions among HIV positive women. The lesions associated with CIN showed a higher frequency of recurrence with increasing CIN grade and a synergistic effect with the association of HIV-1 and pregnancy. Conclusions: the recurrence rate for women treated for HPV-induced lesions is high and the association with pregnancy, HIV and increased grade of the intraepithelial lesions are synergistic factors in the determination of therapeutic failure. The site of implantation of HPV-induced lesions is of prognostic significance only when the infection is not associated with HIV.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):209-214
DOI 10.1590/S0100-72031999000400005
Purpose: to develop an experimental model in rats to study the interaction between hypertension and pregnancy. Methods: the present experiment was divided into 5 periods: adaptation (2 weeks), surgical procedures (1 week), hypertension development (6 weeks), mating and blood pressure stabilization (6 weeks), and gestational period (3 weeks). A total of 82 animals in reproductive age, weighing from 180 to 240 g, were used. They were randomly assigned to the 4 different groups (control, handled, nephrectomy and hypertension) and renal hypertension was produced by a controlled constriction of the main left renal artery, according to the technique described by Goldblatt, and contralateral nephrectomy (Goldblatt I - one kidney, one clip hypertension). They were studied at 15 precise moments. Afterwards, periodic blood pressure determinations were made by the tail plethysmographic method. Results: pregnancy caused a fall in blood pressure levels in the rat. Conclusion: the experimental model was adequate for the purposes of the study, since it proved to be efficient in producing hypertension.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):209-214
DOI 10.1590/S0100-72031999000400005
Purpose: to develop an experimental model in rats to study the interaction between hypertension and pregnancy. Methods: the present experiment was divided into 5 periods: adaptation (2 weeks), surgical procedures (1 week), hypertension development (6 weeks), mating and blood pressure stabilization (6 weeks), and gestational period (3 weeks). A total of 82 animals in reproductive age, weighing from 180 to 240 g, were used. They were randomly assigned to the 4 different groups (control, handled, nephrectomy and hypertension) and renal hypertension was produced by a controlled constriction of the main left renal artery, according to the technique described by Goldblatt, and contralateral nephrectomy (Goldblatt I - one kidney, one clip hypertension). They were studied at 15 precise moments. Afterwards, periodic blood pressure determinations were made by the tail plethysmographic method. Results: pregnancy caused a fall in blood pressure levels in the rat. Conclusion: the experimental model was adequate for the purposes of the study, since it proved to be efficient in producing hypertension.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):215-221
DOI 10.1590/S0100-72031999000400006
Purpose: to determine the effectiveness and the safety of treatment with heparin and low-dose aspirin in pregnant women with antiphospholipid syndrome, and to determine possible deteriorating factors for this syndrome. Methods: 17 patients with antiphospholipid syndrome were submitted to a rigorous antenatal care. Patients were treated with a fixed dose of heparin (10,000 IU/day) associated with low-dose aspirin (100 mg/day). We analyzed perinatal and maternal results, using chi² test and Fischer's exact test. Results: the overall live birth rate was 88.2% in treated pregnancies of these patients versus 13.3% of their previous nontreated pregnancies. The incidence of adverse pregnancy outcomes was very significant: oligohydramnios (40%), fetal distress (33.3%), fetal growth retardation (33.3%), gestational diabetes (29.4%), preeclampsia(23.5%), and preterm delivery (60%). The presence of systemic lupus erythematosus was an indication of poor prognosis. No significant side effects were observed during the treatment. Conclusions: this treatment was effective to improve live birth rate, safe, but it was not able to avoid adverse pregnancy outcomes associated with antiphospholipid syndrome. Systemic lupus erythematosus was a deteriorating factor for this syndrome.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):215-221
DOI 10.1590/S0100-72031999000400006
Purpose: to determine the effectiveness and the safety of treatment with heparin and low-dose aspirin in pregnant women with antiphospholipid syndrome, and to determine possible deteriorating factors for this syndrome. Methods: 17 patients with antiphospholipid syndrome were submitted to a rigorous antenatal care. Patients were treated with a fixed dose of heparin (10,000 IU/day) associated with low-dose aspirin (100 mg/day). We analyzed perinatal and maternal results, using chi² test and Fischer's exact test. Results: the overall live birth rate was 88.2% in treated pregnancies of these patients versus 13.3% of their previous nontreated pregnancies. The incidence of adverse pregnancy outcomes was very significant: oligohydramnios (40%), fetal distress (33.3%), fetal growth retardation (33.3%), gestational diabetes (29.4%), preeclampsia(23.5%), and preterm delivery (60%). The presence of systemic lupus erythematosus was an indication of poor prognosis. No significant side effects were observed during the treatment. Conclusions: this treatment was effective to improve live birth rate, safe, but it was not able to avoid adverse pregnancy outcomes associated with antiphospholipid syndrome. Systemic lupus erythematosus was a deteriorating factor for this syndrome.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):223-226
DOI 10.1590/S0100-72031999000400007
Purpose: to evaluate retrospectively the obstetrical and perinatal aspects of multiple pregnancies with the death of one fetus. Methods: a retrospective study on 26 pregnant women with multiple pregnancies and death of one twin. A conservative approach was followed and the patients were followed-up clinically with blood clotting tests. Results: in 50% of the cases fetal death occurred between 20 and 32 weeks of pregnancy. The time between death and resolution of pregnancy ranged from 6 to 148 h. Death of the other twin occurred in two cases. In 15 cases, the surviving twin had a good course, with two of them presenting slight neurological sequelae. In the other nine cases the other twin died after birth. No pregnant woman developed coagulation disorders.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):223-226
DOI 10.1590/S0100-72031999000400007
Purpose: to evaluate retrospectively the obstetrical and perinatal aspects of multiple pregnancies with the death of one fetus. Methods: a retrospective study on 26 pregnant women with multiple pregnancies and death of one twin. A conservative approach was followed and the patients were followed-up clinically with blood clotting tests. Results: in 50% of the cases fetal death occurred between 20 and 32 weeks of pregnancy. The time between death and resolution of pregnancy ranged from 6 to 148 h. Death of the other twin occurred in two cases. In 15 cases, the surviving twin had a good course, with two of them presenting slight neurological sequelae. In the other nine cases the other twin died after birth. No pregnant woman developed coagulation disorders.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):227-232
DOI 10.1590/S0100-72031999000400008
Purpose: to identify and investigate the causes of maternal death that occurred in Campinas from 1992 to 1994. Methods: a total of 204 death certificates (DC) whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC's of 10 to 49 year-old women. A complementary investigation was performed consulting hospital records, Death Survey Units, and households. Results: a total of 20 maternal deaths were confirmed, corresponding to a maternal mortality ratio of 42.2 deaths per 100,000 live births. The direct obstetrical causes were responsible for 85% of the deaths (17 cases). Abortion complications were the main causes of death (7 cases), followed by hemorrhage (4 cases), preeclampsia (3 cases) and puerperal infection (3 cases). Conclusions: despite the apparent progress concerning the reduction in deaths due to hypertensive syndromes during pregnancy, that were the main causes in earlier periods, there was no improvement in the maternal mortality ratio for this studied period. Unfortunately, this lack of progress was due to abortion complications. A better coverage and efficiency of family planning programs, besides the need for implementation of a real epidemiological surveillance of maternal deaths, as well as a better social protection of the pregnant woman, the mother, and the newborns, could reduce their occurrence and specially those due to abortions.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):227-232
DOI 10.1590/S0100-72031999000400008
Purpose: to identify and investigate the causes of maternal death that occurred in Campinas from 1992 to 1994. Methods: a total of 204 death certificates (DC) whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC's of 10 to 49 year-old women. A complementary investigation was performed consulting hospital records, Death Survey Units, and households. Results: a total of 20 maternal deaths were confirmed, corresponding to a maternal mortality ratio of 42.2 deaths per 100,000 live births. The direct obstetrical causes were responsible for 85% of the deaths (17 cases). Abortion complications were the main causes of death (7 cases), followed by hemorrhage (4 cases), preeclampsia (3 cases) and puerperal infection (3 cases). Conclusions: despite the apparent progress concerning the reduction in deaths due to hypertensive syndromes during pregnancy, that were the main causes in earlier periods, there was no improvement in the maternal mortality ratio for this studied period. Unfortunately, this lack of progress was due to abortion complications. A better coverage and efficiency of family planning programs, besides the need for implementation of a real epidemiological surveillance of maternal deaths, as well as a better social protection of the pregnant woman, the mother, and the newborns, could reduce their occurrence and specially those due to abortions.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):235-238
DOI 10.1590/S0100-72031999000400009
We report a case of nonmolar fetal triploidy detected by fetal blood sampling at 20 weeks of gestation, performed as an investigation of intrauterine growth retardation and severe oligohydramnios found by ultrasound scan. At 19 weeks of gestation very low levels of maternal free serum beta-subunit of human chorionic gonadotropin and unconjugated estriol, and normal levels of alpha-fetoprotein were found, which were interpreted as a high risk of fetal Edwards syndrome. Fetal death supervened the day after fetal blood sampling, and the pregnancy was terminated by vaginal delivery induced by misoprostol and oxytocin, under epidural anesthesia. Chromosome study of the fetal blood cells showed a 69,XXX karyotype. The severe intrauterine growth retardation and macrocephaly noted on pathological review plus the very low levels of hCG and unconjugated estriol suggest a fetal gynoid triploidy case, caused by the fertilization of a diploid egg by a haploid sperm.
Summary
Rev Bras Ginecol Obstet. 1999;21(4):235-238
DOI 10.1590/S0100-72031999000400009
We report a case of nonmolar fetal triploidy detected by fetal blood sampling at 20 weeks of gestation, performed as an investigation of intrauterine growth retardation and severe oligohydramnios found by ultrasound scan. At 19 weeks of gestation very low levels of maternal free serum beta-subunit of human chorionic gonadotropin and unconjugated estriol, and normal levels of alpha-fetoprotein were found, which were interpreted as a high risk of fetal Edwards syndrome. Fetal death supervened the day after fetal blood sampling, and the pregnancy was terminated by vaginal delivery induced by misoprostol and oxytocin, under epidural anesthesia. Chromosome study of the fetal blood cells showed a 69,XXX karyotype. The severe intrauterine growth retardation and macrocephaly noted on pathological review plus the very low levels of hCG and unconjugated estriol suggest a fetal gynoid triploidy case, caused by the fertilization of a diploid egg by a haploid sperm.