Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):163-166
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):163-166
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):167-170
DOI 10.1590/S0100-72032008000400002
PURPOSE: to present a series of cases of umbilical endometriosis in patients in reproductive age, with no previous pelvic surgery. METHODS: four patients aged between 33 and 43 years were included in the study. They all presented umbilical bleeding associated or not with pelvic pain, and medical history varied from two months to four years. Abdominal wall ultrasound was performed for diagnosis support before surgical excision of the umbilical lesions, and histological examination was also performed. RESULTS: the ultrasonographic evaluation of the four patients showed hypoechogenic umbilical lesion suggestive of endometriosis. All patients were submitted to surgical excision and histological examination of the lesions. CA-125 serum levels were measured in three of the patients, but they were within normal ranges (from 6.8 to 10.1 U/mL). In addition to umbilical surgery, laparoscopy was performed in all patients, but only one presented concomitant pelvic endometriosis. In a one-year follow-up, patients maintained asymptomatic and there was no recurrence of the lesions. CONCLUSIONS: umbilical endometriosis is a rare entity, but it may be remembered as a possibility in cases of umbilical nodulations or bleeding, even if there is no previous history of pelvic surgery with endometrial manipulation. Its treatment is always surgical and, in general, it is enough to promote complete elimination of the lesion and of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):167-170
DOI 10.1590/S0100-72032008000400002
PURPOSE: to present a series of cases of umbilical endometriosis in patients in reproductive age, with no previous pelvic surgery. METHODS: four patients aged between 33 and 43 years were included in the study. They all presented umbilical bleeding associated or not with pelvic pain, and medical history varied from two months to four years. Abdominal wall ultrasound was performed for diagnosis support before surgical excision of the umbilical lesions, and histological examination was also performed. RESULTS: the ultrasonographic evaluation of the four patients showed hypoechogenic umbilical lesion suggestive of endometriosis. All patients were submitted to surgical excision and histological examination of the lesions. CA-125 serum levels were measured in three of the patients, but they were within normal ranges (from 6.8 to 10.1 U/mL). In addition to umbilical surgery, laparoscopy was performed in all patients, but only one presented concomitant pelvic endometriosis. In a one-year follow-up, patients maintained asymptomatic and there was no recurrence of the lesions. CONCLUSIONS: umbilical endometriosis is a rare entity, but it may be remembered as a possibility in cases of umbilical nodulations or bleeding, even if there is no previous history of pelvic surgery with endometrial manipulation. Its treatment is always surgical and, in general, it is enough to promote complete elimination of the lesion and of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):171-176
DOI 10.1590/S0100-72032008000400003
PURPOSE: the propose of this study was to analyze the clinical and laboratorial parameters of patients submitted to human assisted reproduction techniques with association of sperm processing techniques, in order to remove virus particles from semen samples of couples in which men was infected by human immunodeficiency virus (HIV). METHODS: it was assessed 11 intracytoplasmatic sperm injection (ICSI) cycles from couples whose men were HIV seropositive (HIV Group), and 35 cycles in which semen donors' samples were used in ICSI procedures (Control Group). Semen samples from Control Group were submitted to routine semen analysis, sperm wash and cryopreservation. The man from HIV Group received previous antibiotic therapy; the semen samples were analyzed routinely and prepared by sperm wash and density gradient method before cryopreservation. Those samples were evaluated to viral load and ICSI was performed when no HIV was detected. RESULTS: regards to semen analysis the groups were similar to sperm concentration and progressive motility. Nevertheless, the percentage of sperm with normal morphology were higher on Control Group (14.3%) than HIV (5.8%; p=0.002). On embryo parameters assessment, the normal fertilization (CT: 74.7% and HIV: 71.7; p=0.838, respectively) and good embryos rate (CT: 42.4% and HIV: 65.1%; p=0.312, respectively) were comparable. On the other hand, the Control Group presented better clinic results than HIV Group (ongoing pregnancy rate: 52.9% versus 12.5%; p=0.054, and implantation rate: 42.6 versus 10.4%; p=0.059, respectively), however the differences were not statistically significant. After delivery, no seroconversion was observed on mother and child. CONCLUSIONS: the association of sperm processing techniques in order to remove HIV from semen samples does not influence in laboratorial parameters of assisted reproduction techniques cycles. On the other hand, it has been demonstrated excellent results getting safety gametes to serodiscordant couples.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):171-176
DOI 10.1590/S0100-72032008000400003
PURPOSE: the propose of this study was to analyze the clinical and laboratorial parameters of patients submitted to human assisted reproduction techniques with association of sperm processing techniques, in order to remove virus particles from semen samples of couples in which men was infected by human immunodeficiency virus (HIV). METHODS: it was assessed 11 intracytoplasmatic sperm injection (ICSI) cycles from couples whose men were HIV seropositive (HIV Group), and 35 cycles in which semen donors' samples were used in ICSI procedures (Control Group). Semen samples from Control Group were submitted to routine semen analysis, sperm wash and cryopreservation. The man from HIV Group received previous antibiotic therapy; the semen samples were analyzed routinely and prepared by sperm wash and density gradient method before cryopreservation. Those samples were evaluated to viral load and ICSI was performed when no HIV was detected. RESULTS: regards to semen analysis the groups were similar to sperm concentration and progressive motility. Nevertheless, the percentage of sperm with normal morphology were higher on Control Group (14.3%) than HIV (5.8%; p=0.002). On embryo parameters assessment, the normal fertilization (CT: 74.7% and HIV: 71.7; p=0.838, respectively) and good embryos rate (CT: 42.4% and HIV: 65.1%; p=0.312, respectively) were comparable. On the other hand, the Control Group presented better clinic results than HIV Group (ongoing pregnancy rate: 52.9% versus 12.5%; p=0.054, and implantation rate: 42.6 versus 10.4%; p=0.059, respectively), however the differences were not statistically significant. After delivery, no seroconversion was observed on mother and child. CONCLUSIONS: the association of sperm processing techniques in order to remove HIV from semen samples does not influence in laboratorial parameters of assisted reproduction techniques cycles. On the other hand, it has been demonstrated excellent results getting safety gametes to serodiscordant couples.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):177-181
DOI 10.1590/S0100-72032008000400004
PURPOSE: to evaluate the expression of Bax antigen in the normal mammary epithelium of premenopausal women treated with raloxifene. METHODS: a randomized double-blind study was conducted in 33 ovulatory premenopausal women with fibroadenoma. Patients were divided into two groups: Placebo, (n=18) and Raloxifene 60 mg, (n=15). The medication was used for 22 days, beginning on the first day of the menstrual cycle. An excisional biopsy was carried out on the 23rd day of the menstrual cycle and a sample of normal breast tissue adjacent to the fibroadenoma was collected and submitted to immunohistochemical study using anti-Bax polyclonal antibody to evaluate the expression of Bax protein. Immunoreaction for Bax was evaluated taking into consideration intensity and fraction of stained cells, whose combination resulted in a final score ranging from 0 to 6. Cases with a final score >3 were classified as positive for Bax. The c2 test was used for statistical analysis (p<0.05). RESULTS: the percentage of positivity of Bax protein expression was 66.7 and 73.3% in Groups A and B, respectively. There was no significant difference in Bax expression between the two groups (p=0.678). CONCLUSIONS: raloxifene, administered for 22 days in the dose of 60 mg/day, did not alter the expression of Bax protein in the breast normal tissue of premenopausal women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):177-181
DOI 10.1590/S0100-72032008000400004
PURPOSE: to evaluate the expression of Bax antigen in the normal mammary epithelium of premenopausal women treated with raloxifene. METHODS: a randomized double-blind study was conducted in 33 ovulatory premenopausal women with fibroadenoma. Patients were divided into two groups: Placebo, (n=18) and Raloxifene 60 mg, (n=15). The medication was used for 22 days, beginning on the first day of the menstrual cycle. An excisional biopsy was carried out on the 23rd day of the menstrual cycle and a sample of normal breast tissue adjacent to the fibroadenoma was collected and submitted to immunohistochemical study using anti-Bax polyclonal antibody to evaluate the expression of Bax protein. Immunoreaction for Bax was evaluated taking into consideration intensity and fraction of stained cells, whose combination resulted in a final score ranging from 0 to 6. Cases with a final score >3 were classified as positive for Bax. The c2 test was used for statistical analysis (p<0.05). RESULTS: the percentage of positivity of Bax protein expression was 66.7 and 73.3% in Groups A and B, respectively. There was no significant difference in Bax expression between the two groups (p=0.678). CONCLUSIONS: raloxifene, administered for 22 days in the dose of 60 mg/day, did not alter the expression of Bax protein in the breast normal tissue of premenopausal women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):182-189
DOI 10.1590/S0100-72032008000400005
PURPOSE: to evaluate the anthropometric measures as predictors of cardiovascular and metabolic risk in non-transmissible chronic diseases in postmenopausal women. METHODS: a clinical and sectional study enrolling 120 sedentary postmenopausal women (amenorrhea for at least 12 months, age 45 to 70 years was conducted). Exclusion criteria included insulin-dependent diabetes and use of statins or hormone therapy within the preceding six months. Anthropometric indicators included: weight, height, body mass index (BMI=weight/height²), and waist circumference (WC). Metabolic profiles as total cholesterol (TC), HDL, LDL, triglycerides (TG), glycemia, and insulin were measured and the atherogenic index of plasma (AIP) and Homeostasis model assessment-insulin resistance (HOMA-IR) were calculated. One-way analysis of variance (ANOVA) and Odds Ratio (OR) were used in the statistical analysis. RESULTS: subjects were classified on average as overweight and showed central fat distribution. Overweight and obesity were observed in 76% and abdominal obesity in 87.3% of the patients. On average, TC, LDL and TG levels were higher than recommended in 67.8, 55.9 and 45.8% of the women, respectively, and HDL was low in 40.7%. Values of WC >88 cm were observed in 14.8% of women with normal weight, 62.5% overweight and 100% obesity p>0.05). On average, the values of AIP, TG, and HOMA-IR increased significantly along with values of BMI and WC, while decreased HDL (p<0.05). Among women with WC >88 cm, a risk association was observed with low HDL (OR=5.86; 95%CI=2.31-14.82), with higher TG (OR=2.61; 95%CI=1.18-5.78), with higher AIP (OR=3.42; 95%CI=1.19-9.78) and with IR (OR=3.63; 95%CI=1.27-10.36). There was a risk of low HDL (OR=3.1; 95%CI=1.44-6.85) with increased obesity (BMI>30 kg/m²). CONCLUSIONS: in the postmenopausal women, the simple measure of WC can predict cardiovascular and metabolic risk of non-transmissible chronic diseases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):182-189
DOI 10.1590/S0100-72032008000400005
PURPOSE: to evaluate the anthropometric measures as predictors of cardiovascular and metabolic risk in non-transmissible chronic diseases in postmenopausal women. METHODS: a clinical and sectional study enrolling 120 sedentary postmenopausal women (amenorrhea for at least 12 months, age 45 to 70 years was conducted). Exclusion criteria included insulin-dependent diabetes and use of statins or hormone therapy within the preceding six months. Anthropometric indicators included: weight, height, body mass index (BMI=weight/height²), and waist circumference (WC). Metabolic profiles as total cholesterol (TC), HDL, LDL, triglycerides (TG), glycemia, and insulin were measured and the atherogenic index of plasma (AIP) and Homeostasis model assessment-insulin resistance (HOMA-IR) were calculated. One-way analysis of variance (ANOVA) and Odds Ratio (OR) were used in the statistical analysis. RESULTS: subjects were classified on average as overweight and showed central fat distribution. Overweight and obesity were observed in 76% and abdominal obesity in 87.3% of the patients. On average, TC, LDL and TG levels were higher than recommended in 67.8, 55.9 and 45.8% of the women, respectively, and HDL was low in 40.7%. Values of WC >88 cm were observed in 14.8% of women with normal weight, 62.5% overweight and 100% obesity p>0.05). On average, the values of AIP, TG, and HOMA-IR increased significantly along with values of BMI and WC, while decreased HDL (p<0.05). Among women with WC >88 cm, a risk association was observed with low HDL (OR=5.86; 95%CI=2.31-14.82), with higher TG (OR=2.61; 95%CI=1.18-5.78), with higher AIP (OR=3.42; 95%CI=1.19-9.78) and with IR (OR=3.63; 95%CI=1.27-10.36). There was a risk of low HDL (OR=3.1; 95%CI=1.44-6.85) with increased obesity (BMI>30 kg/m²). CONCLUSIONS: in the postmenopausal women, the simple measure of WC can predict cardiovascular and metabolic risk of non-transmissible chronic diseases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):190-195
DOI 10.1590/S0100-72032008000400006
PURPOSE: to evaluate the accuracy of fetal upper arm volume, using three-dimensional ultrasound (3DUS), in the prediction of birth weight. METHODS: this prospective cross-sectional study involved 25 pregnancies without structural or chromosomal anomalies. Bidimensional parameters (biparietal diameter, abdominal circumference and femur length) and the 3DUS fetal upper arm volume were obtained in the last 48 hours before delivery. The multiplanar method, using multiple sequential planes with 5.0-mm intervals, was used to calculate fetal upper arm volume. Polynomial regressions were used to determine the best equation in the prediction of fetal weight. The accuracy of this new formula was compared with Shepard's and Hadlock's formulas. RESULTS: fetal upper arm volume was strongly correlated to birth weight (r=0.83; p<0.005). Linear regression was the best equation [birth weight=681.59 + 43.23 x fetal upper arm volume]. The fetal upper arm volume mean error (0 g), mean absolute error (196.6 g) and mean percent absolute error (6.5%) were lower than using Shepard's formula; however, the difference did not reach significance (p>0.05). Birth weight predicted by fetal upper arm volume had a mean error lower than Hadlock's formula, but this difference was not statistically significant (p>0.05). CONCLUSIONS: the accuracy of fetal upper arm volume obtained through 3DUS is similar to the accuracy of bidimensional ultrasound in the prediction of birth weight. These findings need to be confirmed by larger studies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):190-195
DOI 10.1590/S0100-72032008000400006
PURPOSE: to evaluate the accuracy of fetal upper arm volume, using three-dimensional ultrasound (3DUS), in the prediction of birth weight. METHODS: this prospective cross-sectional study involved 25 pregnancies without structural or chromosomal anomalies. Bidimensional parameters (biparietal diameter, abdominal circumference and femur length) and the 3DUS fetal upper arm volume were obtained in the last 48 hours before delivery. The multiplanar method, using multiple sequential planes with 5.0-mm intervals, was used to calculate fetal upper arm volume. Polynomial regressions were used to determine the best equation in the prediction of fetal weight. The accuracy of this new formula was compared with Shepard's and Hadlock's formulas. RESULTS: fetal upper arm volume was strongly correlated to birth weight (r=0.83; p<0.005). Linear regression was the best equation [birth weight=681.59 + 43.23 x fetal upper arm volume]. The fetal upper arm volume mean error (0 g), mean absolute error (196.6 g) and mean percent absolute error (6.5%) were lower than using Shepard's formula; however, the difference did not reach significance (p>0.05). Birth weight predicted by fetal upper arm volume had a mean error lower than Hadlock's formula, but this difference was not statistically significant (p>0.05). CONCLUSIONS: the accuracy of fetal upper arm volume obtained through 3DUS is similar to the accuracy of bidimensional ultrasound in the prediction of birth weight. These findings need to be confirmed by larger studies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):196-200
DOI 10.1590/S0100-72032008000400007
PURPOSE: to obtain an equation to estimate the volume of red blood cells concentrate to be infused to correct anemia in fetuses of pregnant women with Rh factor isoimmunization, based in parameters obtained along the cordocentesis previous to intrauterine transfusion. METHODS: a transversal study analyzing 89 intrauterine transfusions to correct anemia in 48 fetuses followed-up in the Centro de Medicina Fetal do Hospital das Clínicas da Universidade de Minas Gerais. The median gestational age at the cordocentesis was 29 weeks and the average number of procedures was 2.1. Fetal hemoglobin was assayed before and after cordocentesis, leading to the volume of transfused red blood cells concentrate. The determination of an equation to estimate the blood volume necessary to correct the fetal anemia was based in the blood volume necessary to raise the fetal hemoglobin in 1 g% (the difference between the final and the initial hemoglobin concentration divided by the transfused volume) and in the volume of the amount necessary to reach 14 g%, in the multiple regression analysis. RESULTS: the concentration of pre-transfusion hemoglobin varied between 2.3 and 15.7 g%. The prevalence of fetal anemia (Hb<10 g%) was 52%. The regression equation obtained in the determination of blood volume necessary to reach the concentration of 14 g% of Hb was: transfusion volume (mL)=18.2 - 13.4 x pre- intrauterine transfusion hemoglobin + 6.0 x gestational age in weeks. This equation was statistically significant (p<0.0001). CONCLUSIONS: the study has shown that it is possible to estimate the transfusion volume necessary to correct fetal anemia, based on easily obtainable parameters: gestational age and level of pre-transfusion hemoglobin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):196-200
DOI 10.1590/S0100-72032008000400007
PURPOSE: to obtain an equation to estimate the volume of red blood cells concentrate to be infused to correct anemia in fetuses of pregnant women with Rh factor isoimmunization, based in parameters obtained along the cordocentesis previous to intrauterine transfusion. METHODS: a transversal study analyzing 89 intrauterine transfusions to correct anemia in 48 fetuses followed-up in the Centro de Medicina Fetal do Hospital das Clínicas da Universidade de Minas Gerais. The median gestational age at the cordocentesis was 29 weeks and the average number of procedures was 2.1. Fetal hemoglobin was assayed before and after cordocentesis, leading to the volume of transfused red blood cells concentrate. The determination of an equation to estimate the blood volume necessary to correct the fetal anemia was based in the blood volume necessary to raise the fetal hemoglobin in 1 g% (the difference between the final and the initial hemoglobin concentration divided by the transfused volume) and in the volume of the amount necessary to reach 14 g%, in the multiple regression analysis. RESULTS: the concentration of pre-transfusion hemoglobin varied between 2.3 and 15.7 g%. The prevalence of fetal anemia (Hb<10 g%) was 52%. The regression equation obtained in the determination of blood volume necessary to reach the concentration of 14 g% of Hb was: transfusion volume (mL)=18.2 - 13.4 x pre- intrauterine transfusion hemoglobin + 6.0 x gestational age in weeks. This equation was statistically significant (p<0.0001). CONCLUSIONS: the study has shown that it is possible to estimate the transfusion volume necessary to correct fetal anemia, based on easily obtainable parameters: gestational age and level of pre-transfusion hemoglobin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):201-209
DOI 10.1590/S0100-72032008000400008
Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):201-209
DOI 10.1590/S0100-72032008000400008
Polycystic ovary syndrome (PCOS) occurs in 6 to 10% of women during the reproductive age. Insulin resistance and compensatory hyperinsulinemia are currently two of the main factors involved in the etiopathogenesis of PCOS. The objective of the present review was to discuss the controversies related to the treatment of infertile women with PCOS and during their pregnancy, focusing on the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) current consensus.
