Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):257-259
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):257-259
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):260-266
DOI 10.1590/S0100-72032010000600002
PURPOSE: to describe the maternal complications due to therapeutic endoscopic procedures in fetal Medicine performed at an university center in Brazil. METHODS: retrospective observational study including patients treated from April 2007 to May 2010 who underwent laser ablation of placental vessels (LAPV) for severe twin-twin transfusion syndrome (TTTS); fetal tracheal occlusion (FETO) and endoscopic removal of tracheal balloon in cases of severe congenital diaphragmatic hernia (CDH); LAPV with or without bipolar coagulation of the umbilical cord in cases of twin reversed arterial perfusion (TRAP) sequence. The main variables described for each disease/type of surgery were maternal complications and neonatal survival (discharge from nursery). RESULTS: fifty-six patients underwent 70 procedures: Severe TTTS (34 patients; 34 surgeries); severe CDH (16 patients; 30 surgeries), and TRAP sequence (6 patients; 6 surgeries). Among 34 women who underwent LAPV for TTTS, two (2/34=5.9%) experienced amniotic fluid leakage to the peritoneal cavity and seven (7/34=20.6%) miscarried after the procedure. Survival of at least one twin was 64.7% (22/34). Among 30 interventions performed in cases of CDH, there was amniotic fluid leakage into the maternal peritoneal cavity in one patient (1/30=3.3%) and premature preterm rupture of membranes after three (3/30=30%) fetoscopies for removal of the tracheal balloon. Infant survival with discharge from nursery was 43.8% (7/16). Among six cases of TRAP sequence, there was bleeding into the peritoneal cavity after surgery in one patient (1/6=16.7%) and neonatal survival with discharge from nursery was 50% (3/6). CONCLUSIONS: in agreement with the available data in literature, at our center, the benefits related to therapeutic endoscopic interventions for TTTS, CDH and TRAP sequence seem to overcome the risks of maternal complications, which were rarely considered severe.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):260-266
DOI 10.1590/S0100-72032010000600002
PURPOSE: to describe the maternal complications due to therapeutic endoscopic procedures in fetal Medicine performed at an university center in Brazil. METHODS: retrospective observational study including patients treated from April 2007 to May 2010 who underwent laser ablation of placental vessels (LAPV) for severe twin-twin transfusion syndrome (TTTS); fetal tracheal occlusion (FETO) and endoscopic removal of tracheal balloon in cases of severe congenital diaphragmatic hernia (CDH); LAPV with or without bipolar coagulation of the umbilical cord in cases of twin reversed arterial perfusion (TRAP) sequence. The main variables described for each disease/type of surgery were maternal complications and neonatal survival (discharge from nursery). RESULTS: fifty-six patients underwent 70 procedures: Severe TTTS (34 patients; 34 surgeries); severe CDH (16 patients; 30 surgeries), and TRAP sequence (6 patients; 6 surgeries). Among 34 women who underwent LAPV for TTTS, two (2/34=5.9%) experienced amniotic fluid leakage to the peritoneal cavity and seven (7/34=20.6%) miscarried after the procedure. Survival of at least one twin was 64.7% (22/34). Among 30 interventions performed in cases of CDH, there was amniotic fluid leakage into the maternal peritoneal cavity in one patient (1/30=3.3%) and premature preterm rupture of membranes after three (3/30=30%) fetoscopies for removal of the tracheal balloon. Infant survival with discharge from nursery was 43.8% (7/16). Among six cases of TRAP sequence, there was bleeding into the peritoneal cavity after surgery in one patient (1/6=16.7%) and neonatal survival with discharge from nursery was 50% (3/6). CONCLUSIONS: in agreement with the available data in literature, at our center, the benefits related to therapeutic endoscopic interventions for TTTS, CDH and TRAP sequence seem to overcome the risks of maternal complications, which were rarely considered severe.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):267-272
DOI 10.1590/S0100-72032010000600003
PURPOSE: to assess the alpha-tocopherol concentration in the serum and colostrum of adolescent and adult mothers and to determine the nutritional adequacy of vitamin E in the colostrum offered to infants. METHODS: in total, 72 pregnant women participated in the study, 25 adolescents and 47 adults. An amount of 5 mL of blood and 2 mL of colostrum were collected under fasting conditions for the analysis of alpha-tocopherol levels. The samples were analyzed by means of high performance liquid chromatography. Nutritional adequacy of colostrum for vitamin E was calculated as the product of the estimated volume of milk intake by the concentration of alpha-tocopherol in colostrum and by direct comparison of this product with the reference value for nutrient intake (4 mg/day). RESULTS: the levels of alpha-tocopherol in the serum of adolescents and adults were 30.8±9.8 and 34.1±9.5 µmol/L (mean±SD), respectively, and in colostrum, the adolescents showed a concentration of 32.9±15.8 µmol/L and the adults, a concentration of 30.4±18.0 µmol/L. No significant difference was found between concentrations of alpha-tocopherol in serum or in colostrum between adolescents and adults. CONCLUSIONS: Both adolescents and adult women had a satisfactory vitamin E nutritional status reflected in the colostrum, whose values were able to meet the nutritional requirements of infants, suggesting that the maternal age does not influence the levels of alpha-tocopherol in human colostrum.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):267-272
DOI 10.1590/S0100-72032010000600003
PURPOSE: to assess the alpha-tocopherol concentration in the serum and colostrum of adolescent and adult mothers and to determine the nutritional adequacy of vitamin E in the colostrum offered to infants. METHODS: in total, 72 pregnant women participated in the study, 25 adolescents and 47 adults. An amount of 5 mL of blood and 2 mL of colostrum were collected under fasting conditions for the analysis of alpha-tocopherol levels. The samples were analyzed by means of high performance liquid chromatography. Nutritional adequacy of colostrum for vitamin E was calculated as the product of the estimated volume of milk intake by the concentration of alpha-tocopherol in colostrum and by direct comparison of this product with the reference value for nutrient intake (4 mg/day). RESULTS: the levels of alpha-tocopherol in the serum of adolescents and adults were 30.8±9.8 and 34.1±9.5 µmol/L (mean±SD), respectively, and in colostrum, the adolescents showed a concentration of 32.9±15.8 µmol/L and the adults, a concentration of 30.4±18.0 µmol/L. No significant difference was found between concentrations of alpha-tocopherol in serum or in colostrum between adolescents and adults. CONCLUSIONS: Both adolescents and adult women had a satisfactory vitamin E nutritional status reflected in the colostrum, whose values were able to meet the nutritional requirements of infants, suggesting that the maternal age does not influence the levels of alpha-tocopherol in human colostrum.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):273-278
DOI 10.1590/S0100-72032010000600004
PURPOSE: to translate, culturally adapt and validate the questionnaire "International Consultation on Incontinence Questionnaire Overactive Bladder" (ICIQ-OAB) for the Portuguese Language. METHODS: two Brazilian translators acquainted with the objectives of this research translated the ICIQ-OAB into Portuguese and both translations were back-translated by two other native English speaking translators. The differences between the versions were brought to agreement and pre-tested in a pilot study. The final version of the ICIQ-OAB was applied together with the previously translated and tested version of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) in 142 male and female patients with irritative urinary symptoms. For the validation of the ICIQ-OAB the following psychometric features were evaluated: reliability (internal consistency and test-retest) and validity of the survey. The retest was performed four weeks after the first interview. RESULTS: the reliability of the instrument was demonstrated through the Cronbach α Coefficient, with a general result of 0.7. The test-retest corroborated the stability of the instrument through the intraclass correlation coefficient and presented a result of 0.91 and 0.95 when compared to both the ICIQ-OAB and ICIQ-SF, respectively. When the instruments were compared by the Pearson correlation coefficient the result was 0.7 (p=0.0001), that confirms the validity of the study criterion. The concurrent validity was evaluated by the correlation between some clinical and sociodemographic variants and the ICIQ-OAB score. CONCLUSION: the culturally adapted version of the ICIQ-OAB translated into Brazilian Portuguese presented satisfactory reliability and survey validity and was considered valid for the evaluation of irritative urinary symptoms of Brazilian patients of both genders.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):273-278
DOI 10.1590/S0100-72032010000600004
PURPOSE: to translate, culturally adapt and validate the questionnaire "International Consultation on Incontinence Questionnaire Overactive Bladder" (ICIQ-OAB) for the Portuguese Language. METHODS: two Brazilian translators acquainted with the objectives of this research translated the ICIQ-OAB into Portuguese and both translations were back-translated by two other native English speaking translators. The differences between the versions were brought to agreement and pre-tested in a pilot study. The final version of the ICIQ-OAB was applied together with the previously translated and tested version of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) in 142 male and female patients with irritative urinary symptoms. For the validation of the ICIQ-OAB the following psychometric features were evaluated: reliability (internal consistency and test-retest) and validity of the survey. The retest was performed four weeks after the first interview. RESULTS: the reliability of the instrument was demonstrated through the Cronbach α Coefficient, with a general result of 0.7. The test-retest corroborated the stability of the instrument through the intraclass correlation coefficient and presented a result of 0.91 and 0.95 when compared to both the ICIQ-OAB and ICIQ-SF, respectively. When the instruments were compared by the Pearson correlation coefficient the result was 0.7 (p=0.0001), that confirms the validity of the study criterion. The concurrent validity was evaluated by the correlation between some clinical and sociodemographic variants and the ICIQ-OAB score. CONCLUSION: the culturally adapted version of the ICIQ-OAB translated into Brazilian Portuguese presented satisfactory reliability and survey validity and was considered valid for the evaluation of irritative urinary symptoms of Brazilian patients of both genders.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):279-285
DOI 10.1590/S0100-72032010000600005
PURPOSE: to compare serum markers of oxidative stress between infertile patients with and without endometriosis and to assess the association of these markers with disease staging. METHODS: this was a prospective study conducted on 112 consecutive infertile, non-obese patients younger than 39 years, divided into two groups: Endometriosis (n=48, 26 with minimal and mild endometriosis - Stage I/II, and 22 with moderate and severe endometriosis - Stage III/IV) and Control (n=64, with tubal and/or male factor infertility). Blood samples were collected during the early follicular phase of the menstrual cycle for the analysis of serum malondialdehyde, glutathione and total hydroxyperoxide levels by spectrophotometry and of vitamin E by high performance liquid chromatography. The results were compared between the endometriosis and control groups, stage I/II endometriosis and control, stage III/IV endometriosis and control, and between the two endometriosis subgroups. The level of significance was set at 5% (p<0.05) in all analyses. RESULTS: vitamin E and glutathione levels were lower in the serum of infertile women with moderate/severe endometriosis (21.7±6.0 mMol/L and 159.6±77.2 nMol/g protein, respectively) compared to women with minimal and mild endometriosis (28.3±14.4 mMol/L and 199.6±56.1 nMol/g protein, respectively). Total hydroxyperoxide levels were significantly higher in the endometriosis group (8.9±1.8 µMol/g protein) than in the Control Group (8.0±2 µMol/g protein) and among patients with stage III/IV disease (9.7±2.3 µMol/g protein) compared to patients with stage I/II disease (8.2±1.0 µMol/g protein). No significant differences in serum malondialdehyde levels were observed between groups. CONCLUSIONS: we demonstrated a positive association between infertility related to endometriosis, advanced disease stage and increased serum hydroxyperoxide levels, suggesting an increased production of reactive species in women with endometriosis. These data, taken together with the reduction of serum vitamin E and glutathione levels, suggest the occurrence of systemic oxidative stress in women with infertility associated with endometriosis. The reproductive and metabolic implications of oxidative stress should be assessed in future studies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):279-285
DOI 10.1590/S0100-72032010000600005
PURPOSE: to compare serum markers of oxidative stress between infertile patients with and without endometriosis and to assess the association of these markers with disease staging. METHODS: this was a prospective study conducted on 112 consecutive infertile, non-obese patients younger than 39 years, divided into two groups: Endometriosis (n=48, 26 with minimal and mild endometriosis - Stage I/II, and 22 with moderate and severe endometriosis - Stage III/IV) and Control (n=64, with tubal and/or male factor infertility). Blood samples were collected during the early follicular phase of the menstrual cycle for the analysis of serum malondialdehyde, glutathione and total hydroxyperoxide levels by spectrophotometry and of vitamin E by high performance liquid chromatography. The results were compared between the endometriosis and control groups, stage I/II endometriosis and control, stage III/IV endometriosis and control, and between the two endometriosis subgroups. The level of significance was set at 5% (p<0.05) in all analyses. RESULTS: vitamin E and glutathione levels were lower in the serum of infertile women with moderate/severe endometriosis (21.7±6.0 mMol/L and 159.6±77.2 nMol/g protein, respectively) compared to women with minimal and mild endometriosis (28.3±14.4 mMol/L and 199.6±56.1 nMol/g protein, respectively). Total hydroxyperoxide levels were significantly higher in the endometriosis group (8.9±1.8 µMol/g protein) than in the Control Group (8.0±2 µMol/g protein) and among patients with stage III/IV disease (9.7±2.3 µMol/g protein) compared to patients with stage I/II disease (8.2±1.0 µMol/g protein). No significant differences in serum malondialdehyde levels were observed between groups. CONCLUSIONS: we demonstrated a positive association between infertility related to endometriosis, advanced disease stage and increased serum hydroxyperoxide levels, suggesting an increased production of reactive species in women with endometriosis. These data, taken together with the reduction of serum vitamin E and glutathione levels, suggest the occurrence of systemic oxidative stress in women with infertility associated with endometriosis. The reproductive and metabolic implications of oxidative stress should be assessed in future studies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):286-292
DOI 10.1590/S0100-72032010000600006
PURPOSE: to evaluate the expression of E-cadherin in cervical lesions of patients suffering from HIV infection. METHODS: we conducted a study with 77 patients with cervical HPV infection, 40 of them were HIV seropositive and 37 HIV seronegative who underwent colposcopy and a biopsy of the cervix. The material obtained by biopsy of the cervix was sent for histopathologic and immunohistochemical study. Sections were obtained and mounted on silanized slides and examined by an observer who was blind to patient serology. E-cadherin antibody, clone NHC-38 diluted 1:400 (DAKO) and the Novolink polymer system (Novocastra) were used. The expression of E-cadherin was determined on the epithelial cell membrane based on the extent of the stained area. The χ2 test with Yates correction or the Fisher's Exact test was used for comparison of the proportion in univariate analysis. All the variables with p<0.25 were included in the logistic regression model, called initial model. The analyses were carried out using the SPSS software, with the level of significance set at 5%. RESULTS: the expression of E-cadherin was observed in up to the internal 1/3 of the epithelium in 59.3% of cases and in up to 2/3 of the epithelium in 11.1% of cases, but in 29.6% of cases the expression was identified throughout the thickness of the epithelium in HIV-seronegative patients. In contrast, in HIV-seropositive patients, 45.9% showed expression up to 1/3 of the epithelium, 13.5% showed expression in up to 2/3 of the epithelium, and 40.5% showed expression throughout the thickness of the epithelium. E-cadherin expression did not differ between groups (p=0.5). However, the multivariate analysis identified a significant association between high-grade cervical injury and E-cadherin expression in 2/3 and 3/3 of the epithelium (p=0.001; χ2=36.9). CONCLUSIONS: the expression of E-cadherin in the epithelial cell membrane is not associated with infection by the human immunodeficiency virus, but with the degree of intraepithelial cervical injury.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):286-292
DOI 10.1590/S0100-72032010000600006
PURPOSE: to evaluate the expression of E-cadherin in cervical lesions of patients suffering from HIV infection. METHODS: we conducted a study with 77 patients with cervical HPV infection, 40 of them were HIV seropositive and 37 HIV seronegative who underwent colposcopy and a biopsy of the cervix. The material obtained by biopsy of the cervix was sent for histopathologic and immunohistochemical study. Sections were obtained and mounted on silanized slides and examined by an observer who was blind to patient serology. E-cadherin antibody, clone NHC-38 diluted 1:400 (DAKO) and the Novolink polymer system (Novocastra) were used. The expression of E-cadherin was determined on the epithelial cell membrane based on the extent of the stained area. The χ2 test with Yates correction or the Fisher's Exact test was used for comparison of the proportion in univariate analysis. All the variables with p<0.25 were included in the logistic regression model, called initial model. The analyses were carried out using the SPSS software, with the level of significance set at 5%. RESULTS: the expression of E-cadherin was observed in up to the internal 1/3 of the epithelium in 59.3% of cases and in up to 2/3 of the epithelium in 11.1% of cases, but in 29.6% of cases the expression was identified throughout the thickness of the epithelium in HIV-seronegative patients. In contrast, in HIV-seropositive patients, 45.9% showed expression up to 1/3 of the epithelium, 13.5% showed expression in up to 2/3 of the epithelium, and 40.5% showed expression throughout the thickness of the epithelium. E-cadherin expression did not differ between groups (p=0.5). However, the multivariate analysis identified a significant association between high-grade cervical injury and E-cadherin expression in 2/3 and 3/3 of the epithelium (p=0.001; χ2=36.9). CONCLUSIONS: the expression of E-cadherin in the epithelial cell membrane is not associated with infection by the human immunodeficiency virus, but with the degree of intraepithelial cervical injury.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):293-297
DOI 10.1590/S0100-72032010000600007
The symptoms of ovarian tumor are not specific and a rare presentation of the tumor is as the content of an inguinal hernia. We reported a case of an 82-year-old woman, diagnosed with breast cancer and with a concomitant hypoecoic adnexal mass at the ecographic exam. The patient was treated with conservative breast surgery and laparotomy. A cystic-solid ovarian lesion was found inside the right inguinal canal. Frozen-section examination was negative for malignancy, and the anatomopathological analysis revealed a borderline ovarian tumor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):293-297
DOI 10.1590/S0100-72032010000600007
The symptoms of ovarian tumor are not specific and a rare presentation of the tumor is as the content of an inguinal hernia. We reported a case of an 82-year-old woman, diagnosed with breast cancer and with a concomitant hypoecoic adnexal mass at the ecographic exam. The patient was treated with conservative breast surgery and laparotomy. A cystic-solid ovarian lesion was found inside the right inguinal canal. Frozen-section examination was negative for malignancy, and the anatomopathological analysis revealed a borderline ovarian tumor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):298-307
DOI 10.1590/S0100-72032010000600008
Endometriosis is characterized by the presence of endometrial tissue, localized outside the uterine cavity, such as peritoneal surface, ovaries, and rectum-vaginal septum. The prevalence is about 6 to 10%. Concerning the etiopathogenesis, the retrograde menstruation theory is accepted, although disruption in endometrial molecular biology seems to be fundamental to the development of endometriosis ectopic focuses. Women with endometriosis may be asymptomatic or may present complaints of dysmenorrhea, dispareunia, chronic pelvic pain and/or infertility. Although the definitive diagnosis of endometriosis needs a surgical intervention, mainly by laparoscopy, many findings obtained by physicalexamination and imaging and laboratory tests can predict, with a high degree of reliability, that the patient has endometriosis. The most common current treatments include surgery, ovarian suppression therapy or both. Pharmacological treatments that do not inhibit ovarian function are under investigation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(6):298-307
DOI 10.1590/S0100-72032010000600008
Endometriosis is characterized by the presence of endometrial tissue, localized outside the uterine cavity, such as peritoneal surface, ovaries, and rectum-vaginal septum. The prevalence is about 6 to 10%. Concerning the etiopathogenesis, the retrograde menstruation theory is accepted, although disruption in endometrial molecular biology seems to be fundamental to the development of endometriosis ectopic focuses. Women with endometriosis may be asymptomatic or may present complaints of dysmenorrhea, dispareunia, chronic pelvic pain and/or infertility. Although the definitive diagnosis of endometriosis needs a surgical intervention, mainly by laparoscopy, many findings obtained by physicalexamination and imaging and laboratory tests can predict, with a high degree of reliability, that the patient has endometriosis. The most common current treatments include surgery, ovarian suppression therapy or both. Pharmacological treatments that do not inhibit ovarian function are under investigation.
