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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):323-323
DOI 10.1590/S0100-72032000000600001
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):323-323
DOI 10.1590/S0100-72032000000600001
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):325-331
DOI 10.1590/S0100-72032000000600002
Purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. Patients and Methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. These patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. Patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. Those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. The length of treatment ranged from 3 to 18 months. Control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. Results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. The mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. Medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. Despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. No progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. During follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. Histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. Conclusions: the treatment of endometrial hyperplasia with medroxyprogesterone acetate and megestrol acetate can be a safe alternative for women who refuse to have their uterus removed or those at high risk for surgery. However, a careful monitoring of the endometrium is needed. This can be achieved with periodical endometrial biopsy, transvaginal ultrasonography, and evaluation of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):325-331
DOI 10.1590/S0100-72032000000600002
Purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. Patients and Methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. These patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. Patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. Those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. The length of treatment ranged from 3 to 18 months. Control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. Results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. The mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. Medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. Despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. No progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. During follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. Histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. Conclusions: the treatment of endometrial hyperplasia with medroxyprogesterone acetate and megestrol acetate can be a safe alternative for women who refuse to have their uterus removed or those at high risk for surgery. However, a careful monitoring of the endometrium is needed. This can be achieved with periodical endometrial biopsy, transvaginal ultrasonography, and evaluation of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):333-337
DOI 10.1590/S0100-72032000000600003
Purpose: to evaluate the efficacy of conservative axillary dissection (levels I and II) in the surgical treatment of stage I breast cancer. Methods: the results of 142 mastectomies performed from January/93 to December/98 in patients with clinical stage I breast cancer (T1NO) were evaluated. Removing the axillary lymph nodes present at levels I and II, with the preservation of the pectoralis muscles, the axillary lymph nodes were dissected by the author (LAGB), and subsequently one section of each lymph node was histopathologically evaluated. Quadrantectomy was performed in 138 cases and modified mastectomy (Patey), in 4 cases. The predominance of the T1c (130 cases) was observed. Results: a total of 3,282 lymph nodes were removed (2,456 at level I and 826 at level II), with an average of 23.1 nodes per axilla. Only 68 were histologically involved (2%). "Skip" metastasis was present only in one case (0.7%). Thirty-five false negative cases were observed (24.6%), with involvement of level I in 34 cases (97.1%) and of level II in 2 cases (5.7%). We observed 107 cases with negative axillary lymph nodes (75.4%). Conclusion: the axillary dissection of levels I and II is sufficient to treat the axilla in clinical stage I breast cancer. In clinical stage II and III of the disease, the complete axillary dissection including levels I, II and III is indicated. The interpectoral Rotter group will be removed if surgically suspicious.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):333-337
DOI 10.1590/S0100-72032000000600003
Purpose: to evaluate the efficacy of conservative axillary dissection (levels I and II) in the surgical treatment of stage I breast cancer. Methods: the results of 142 mastectomies performed from January/93 to December/98 in patients with clinical stage I breast cancer (T1NO) were evaluated. Removing the axillary lymph nodes present at levels I and II, with the preservation of the pectoralis muscles, the axillary lymph nodes were dissected by the author (LAGB), and subsequently one section of each lymph node was histopathologically evaluated. Quadrantectomy was performed in 138 cases and modified mastectomy (Patey), in 4 cases. The predominance of the T1c (130 cases) was observed. Results: a total of 3,282 lymph nodes were removed (2,456 at level I and 826 at level II), with an average of 23.1 nodes per axilla. Only 68 were histologically involved (2%). "Skip" metastasis was present only in one case (0.7%). Thirty-five false negative cases were observed (24.6%), with involvement of level I in 34 cases (97.1%) and of level II in 2 cases (5.7%). We observed 107 cases with negative axillary lymph nodes (75.4%). Conclusion: the axillary dissection of levels I and II is sufficient to treat the axilla in clinical stage I breast cancer. In clinical stage II and III of the disease, the complete axillary dissection including levels I, II and III is indicated. The interpectoral Rotter group will be removed if surgically suspicious.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):339-345
DOI 10.1590/S0100-72032000000600004
Purpose: to quantify the vessels and epithelial proliferation, applying immunohistochemical staining with anti-CD34 as well as anti-PCNA markers, in intra-epithelial neoplasia of the uterine cervix. Methods: in the present study, 16 patients with CIN III, 16 with CIN II, 21 with CIN I and 11 with normal cervix (control group) were investigated. Slide analysis was performed at the same time by two observers, in 10 consecutive sites using 100X and 400X magnification, both in the highest vascularization (CD34) and proliferative activity sites (PCNA). Results: the means obtained with the use of anti-PCNA in intraepithelial neoplasias were: 78.2% (CIN III), 52.1% (CIN II), 33.3% (CIN I) and 4.6% (control group), while 199.1 vessels (CIN III), 162.0 vessels (CIN II), 111.7 vessels (CIN I) and 124.4 vessels (control group) were quantified using anti-CD34 as a vascular marker. Conclusion: the results showed that both markers, anti-PCNA and anti-CD34, are useful for investigating proliferative and angiogenic activity, respectively. However, anti-PCNA showed better and more accurate results than anti-CD34 in differentiating intraepithelial neoplasias.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):339-345
DOI 10.1590/S0100-72032000000600004
Purpose: to quantify the vessels and epithelial proliferation, applying immunohistochemical staining with anti-CD34 as well as anti-PCNA markers, in intra-epithelial neoplasia of the uterine cervix. Methods: in the present study, 16 patients with CIN III, 16 with CIN II, 21 with CIN I and 11 with normal cervix (control group) were investigated. Slide analysis was performed at the same time by two observers, in 10 consecutive sites using 100X and 400X magnification, both in the highest vascularization (CD34) and proliferative activity sites (PCNA). Results: the means obtained with the use of anti-PCNA in intraepithelial neoplasias were: 78.2% (CIN III), 52.1% (CIN II), 33.3% (CIN I) and 4.6% (control group), while 199.1 vessels (CIN III), 162.0 vessels (CIN II), 111.7 vessels (CIN I) and 124.4 vessels (control group) were quantified using anti-CD34 as a vascular marker. Conclusion: the results showed that both markers, anti-PCNA and anti-CD34, are useful for investigating proliferative and angiogenic activity, respectively. However, anti-PCNA showed better and more accurate results than anti-CD34 in differentiating intraepithelial neoplasias.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):347-351
DOI 10.1590/S0100-72032000000600005
Purpose: to analyze the symptoms of premenstrual syndrome (PMS), its duration, time of presentation and pathogenesis. Methods: a questionnaire was applied to 254 women aged 20 to 44 years, without gynecological or clinical conditions affecting their general state or physical well-being, excluding those with amenorreha for more than six months, hysterectomized or pregnant. Results: one hundred and ten women (43.3%) describing at least one intense symptom causing harm to their life, were considered as having PMS. Irritability was presented by 86.4%, tiredness by 70.9%, depression by 61.8%, headache by 61.8%, breast tenderness by 59.1% and abdominal pain by 54.5%. Almost all (94.5%) had more that one symptom, 89.1% presented psychological complaints, and 76.4% associated physical and psychological complaints. Most declared that duration of the symptoms was three to four days (32.4%) or five to seven days (31.4%). Conclusions: the clinical picture of PMS is generally composed of irritability and/or depression, associated with tiredness and headache or breast pain, there being association of physical and psychological symptoms, for 3 to 7 days, and it is difficult to attribute a single etiology to it at this stage of knowledge.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):347-351
DOI 10.1590/S0100-72032000000600005
Purpose: to analyze the symptoms of premenstrual syndrome (PMS), its duration, time of presentation and pathogenesis. Methods: a questionnaire was applied to 254 women aged 20 to 44 years, without gynecological or clinical conditions affecting their general state or physical well-being, excluding those with amenorreha for more than six months, hysterectomized or pregnant. Results: one hundred and ten women (43.3%) describing at least one intense symptom causing harm to their life, were considered as having PMS. Irritability was presented by 86.4%, tiredness by 70.9%, depression by 61.8%, headache by 61.8%, breast tenderness by 59.1% and abdominal pain by 54.5%. Almost all (94.5%) had more that one symptom, 89.1% presented psychological complaints, and 76.4% associated physical and psychological complaints. Most declared that duration of the symptoms was three to four days (32.4%) or five to seven days (31.4%). Conclusions: the clinical picture of PMS is generally composed of irritability and/or depression, associated with tiredness and headache or breast pain, there being association of physical and psychological symptoms, for 3 to 7 days, and it is difficult to attribute a single etiology to it at this stage of knowledge.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):353-363
DOI 10.1590/S0100-72032000000600006
Purpose: to study the prognostic parameters for perinatal death in pregnancies with absent or reversed end-diastolic flow velocity on umbilical artery dopplervelocimetry. Methods: two hundred and four pregnancies were retrospectively reviewed. The methods used were cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry of ductus venosus, fetal aorta, middle cerebral artery, umbilical arteries and uterine artery. The logistic regression model was applied to one hundred and seventy cases in order to determine the most accurate variable for predicting perinatal death. Results: the mortality rates were: 28 cases of intrauterine fetal death (13.7%) and 45 neonatal deaths (22.1%). A statistically significant correlation was found between death and the studied variables. The perinatal death rate in the group with birth weight below 1,000 g was 74.7%, and in the group with gestational age at delivery below 31 weeks it was 66.3%. By logistic regression, birth weight was the most accurate variable for predicting perinatal death, and a probability curve for death according to this variable was obtained. Conclusions: absent or reversed end-diastolic flow velocity in the umbilical arteries is a severe fetal condition, where the risk of perinatal death is mainly related to birth weight and a gestational age at delivery below 31 weeks.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):353-363
DOI 10.1590/S0100-72032000000600006
Purpose: to study the prognostic parameters for perinatal death in pregnancies with absent or reversed end-diastolic flow velocity on umbilical artery dopplervelocimetry. Methods: two hundred and four pregnancies were retrospectively reviewed. The methods used were cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry of ductus venosus, fetal aorta, middle cerebral artery, umbilical arteries and uterine artery. The logistic regression model was applied to one hundred and seventy cases in order to determine the most accurate variable for predicting perinatal death. Results: the mortality rates were: 28 cases of intrauterine fetal death (13.7%) and 45 neonatal deaths (22.1%). A statistically significant correlation was found between death and the studied variables. The perinatal death rate in the group with birth weight below 1,000 g was 74.7%, and in the group with gestational age at delivery below 31 weeks it was 66.3%. By logistic regression, birth weight was the most accurate variable for predicting perinatal death, and a probability curve for death according to this variable was obtained. Conclusions: absent or reversed end-diastolic flow velocity in the umbilical arteries is a severe fetal condition, where the risk of perinatal death is mainly related to birth weight and a gestational age at delivery below 31 weeks.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):365-371
DOI 10.1590/S0100-72032000000600007
Purpose: to evaluate the accuracy of prenatal ultrasound in the diagnosis of nephrouropathies. Methods: the authors followed-up 127 pregnancies referred to the Fetal Medicine Center of UFMG with suspicion of these anomalies. Fetal biometry, growth, vitality, and associated malformations were evaluated. Finally, a detailed description of the renal system was made to define the prenatal morphologic diagnosis of the malformations to be compared with the postnatal diagnosis. Results: based on the kappa index (statistical method that measures the concordance between different measurements, methods or measurement instruments: below 0.40, poor agreement; between 0.40 and 0.75, good agreement; above 0.75, excellent ageement), the authors found an excellent concordance (kappa index 0.95). Among the 127 cases, there were only 9 misdiagnoses, all of them of obstructive uropathies: 6 cases showed different obstruction levels after delivery and in three cases there were confounding diagnosis with multicystic kidney. Conclusions: the detailed ultrasonographic description of the renal system is a good method for prenatal diagnosis of the fetal nephropathies, allowing some options to modify the outcome of these fetuses, like to send them to specialized centers, to anticipate delivery and even to apply intrauterine therapy, in order to preserve the renal function. Serial echography and amnioinfusion can be used to improve the precision of prenatal diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):365-371
DOI 10.1590/S0100-72032000000600007
Purpose: to evaluate the accuracy of prenatal ultrasound in the diagnosis of nephrouropathies. Methods: the authors followed-up 127 pregnancies referred to the Fetal Medicine Center of UFMG with suspicion of these anomalies. Fetal biometry, growth, vitality, and associated malformations were evaluated. Finally, a detailed description of the renal system was made to define the prenatal morphologic diagnosis of the malformations to be compared with the postnatal diagnosis. Results: based on the kappa index (statistical method that measures the concordance between different measurements, methods or measurement instruments: below 0.40, poor agreement; between 0.40 and 0.75, good agreement; above 0.75, excellent ageement), the authors found an excellent concordance (kappa index 0.95). Among the 127 cases, there were only 9 misdiagnoses, all of them of obstructive uropathies: 6 cases showed different obstruction levels after delivery and in three cases there were confounding diagnosis with multicystic kidney. Conclusions: the detailed ultrasonographic description of the renal system is a good method for prenatal diagnosis of the fetal nephropathies, allowing some options to modify the outcome of these fetuses, like to send them to specialized centers, to anticipate delivery and even to apply intrauterine therapy, in order to preserve the renal function. Serial echography and amnioinfusion can be used to improve the precision of prenatal diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):373-380
DOI 10.1590/S0100-72032000000600008
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):373-380
DOI 10.1590/S0100-72032000000600008
