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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):433-438
DOI 10.1590/S0100-72032002000700002
Purpose: to analyze the correlation between Valsalva leak point pressure and maximum urethral closure pressure and clinical symptoms in women with stress urinary incontinence. Methods: we analyzed retrospectively 164 patients with urodynamic diagnosis of stress and mixed urinary incontinence established by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM. All patients were submmited to medical interview, physical examination and urodynamic study. Patients were divided into groups according to the subjective degree of stress urinary incontinence. Valsalva leak point pressure (VLPP) was measured with a vesical volume of 200 mL. Urethral profile was determined using a flow catheter number 8 with measurement of maximum urethral closure pressure (MUCP). Data were compared by chi², ANOVA and Tukey tests. Results: mean age was 51.2 years (19-82), 76 women (47.2%) were in menacme and 85 (52.8%) in postmenopausal status. Mean parity was 3.9 (0-18). The exact test for trend demonstrated a statistically significant (p<0.0001) correlation between the number of patients with VLPP of 60 cmH2O or less and clinical complaints. The group with severe leakage had mean VLPP of 69.1 cmH2O. The group with moderated leakage had mean VLPP of 84.6 cmH2O and the group with mild leakage had mean VLPP of 90.6 cmH2O. Conclusions: VLPP correlated with the subjective degree of stress urinary incontinence. Higher grades of stress urinary incontinence had a higher likelyhood of a low VLPP. MUCP did not correlate with clinical complaints.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):433-438
DOI 10.1590/S0100-72032002000700002
Purpose: to analyze the correlation between Valsalva leak point pressure and maximum urethral closure pressure and clinical symptoms in women with stress urinary incontinence. Methods: we analyzed retrospectively 164 patients with urodynamic diagnosis of stress and mixed urinary incontinence established by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM. All patients were submmited to medical interview, physical examination and urodynamic study. Patients were divided into groups according to the subjective degree of stress urinary incontinence. Valsalva leak point pressure (VLPP) was measured with a vesical volume of 200 mL. Urethral profile was determined using a flow catheter number 8 with measurement of maximum urethral closure pressure (MUCP). Data were compared by chi², ANOVA and Tukey tests. Results: mean age was 51.2 years (19-82), 76 women (47.2%) were in menacme and 85 (52.8%) in postmenopausal status. Mean parity was 3.9 (0-18). The exact test for trend demonstrated a statistically significant (p<0.0001) correlation between the number of patients with VLPP of 60 cmH2O or less and clinical complaints. The group with severe leakage had mean VLPP of 69.1 cmH2O. The group with moderated leakage had mean VLPP of 84.6 cmH2O and the group with mild leakage had mean VLPP of 90.6 cmH2O. Conclusions: VLPP correlated with the subjective degree of stress urinary incontinence. Higher grades of stress urinary incontinence had a higher likelyhood of a low VLPP. MUCP did not correlate with clinical complaints.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):441-446
DOI 10.1590/S0100-72032002000700003
Purpose: to evaluate the reproductive aspects in climacteric women of the Family Health Program in Cuiabá. Methods: it was a cross-sectional study including 354 women, with ages between 40 and 65 years, attended at the Central-Western District Family Health Program of Cuiabá. A pretested questionnaire with specific questions regarding the present study was used. Data were analyzed using the Z test and chi² test for trend. The mean age of the 354 women was 49.7±7 years and the median 48 years. A total of 243 (68.6%) were born in Mato Grosso, and the others were migrants from different states. Most were married (65.8%), white (48.0%), catholic (73.4%), and had low schooling: 62.4% did not finish the elementary school and 19.2% were illiterate. About 84% were occupied only in domestic activities, and more than a half (58.2%) belonged to a lower social class. Results: the average number of pregnancies was 5.4±3.3. Nearly 5% were nulliparous and 7% had more than ten children. Almost 50% had the first pregnancy in adolescence and 14% after the age of 40 years. A total of 229 women (65%) were submitted to pelvic surgery: 78% to tubal sterilization, 20% to hysterectomy, and 7% to bilateral oophorectomy. Menopause was due to hysterectomy/oophorectomy in 25% of the women. Conclusion: almost 65% of the women were submitted to a pelvic surgery. The most frequent surgery was tubal sterilization followed by total hysterectomy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):441-446
DOI 10.1590/S0100-72032002000700003
Purpose: to evaluate the reproductive aspects in climacteric women of the Family Health Program in Cuiabá. Methods: it was a cross-sectional study including 354 women, with ages between 40 and 65 years, attended at the Central-Western District Family Health Program of Cuiabá. A pretested questionnaire with specific questions regarding the present study was used. Data were analyzed using the Z test and chi² test for trend. The mean age of the 354 women was 49.7±7 years and the median 48 years. A total of 243 (68.6%) were born in Mato Grosso, and the others were migrants from different states. Most were married (65.8%), white (48.0%), catholic (73.4%), and had low schooling: 62.4% did not finish the elementary school and 19.2% were illiterate. About 84% were occupied only in domestic activities, and more than a half (58.2%) belonged to a lower social class. Results: the average number of pregnancies was 5.4±3.3. Nearly 5% were nulliparous and 7% had more than ten children. Almost 50% had the first pregnancy in adolescence and 14% after the age of 40 years. A total of 229 women (65%) were submitted to pelvic surgery: 78% to tubal sterilization, 20% to hysterectomy, and 7% to bilateral oophorectomy. Menopause was due to hysterectomy/oophorectomy in 25% of the women. Conclusion: almost 65% of the women were submitted to a pelvic surgery. The most frequent surgery was tubal sterilization followed by total hysterectomy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):447-452
DOI 10.1590/S0100-72032002000700004
Purpose: to compare the size of locally advanced breast tumors through clinical examination, mammography, and ultrasound, and describe the parameters of color Doppler ultrasound evaluated before and after primary chemotherapy. Methods: it was a prospective and descriptive clinical study. Eighteen women with the diagnosis of breast carcinoma, with clinical primary tumors of 50 mm or larger, were submitted to palpation, mammography, ultrasound and color Doppler ultrasound at the moment of diagnosis and after 3 cycles of chemotherapy. The response was considered present when there was a clinical decrease of 50% or more and an ultrasonographic decrease of 25% or more, and absent when there was a clinical decrease less than 50% and ultrasonographic decrease less than 25%. A descriptive statistical analysis and Wilcoxon test were used. Results: regarding the size of the tumors, the method whose results were closer to pathological examination was the clinical examination after chemotherapy, when compared with sizes on ultrasound and mammography. The mammography helped to evaluate 44% of the cases before chemotherapy (8/18). In the cases where the response was absent, the Doppler showed a significant increase of the flow and a decrease of resistance and pulsatility index. In the cases where the response was present (9 cases), the Doppler did not show any significant change regarding the studied parameters. Conclusion: clinical examination was the most efficient method to evaluate the decrease of the volume of tumors submitted to neoadjuvant chemotherapy when compared with ultrasound and mammographic examinations. Doppler showed increase of the flow in the cases of absent response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):447-452
DOI 10.1590/S0100-72032002000700004
Purpose: to compare the size of locally advanced breast tumors through clinical examination, mammography, and ultrasound, and describe the parameters of color Doppler ultrasound evaluated before and after primary chemotherapy. Methods: it was a prospective and descriptive clinical study. Eighteen women with the diagnosis of breast carcinoma, with clinical primary tumors of 50 mm or larger, were submitted to palpation, mammography, ultrasound and color Doppler ultrasound at the moment of diagnosis and after 3 cycles of chemotherapy. The response was considered present when there was a clinical decrease of 50% or more and an ultrasonographic decrease of 25% or more, and absent when there was a clinical decrease less than 50% and ultrasonographic decrease less than 25%. A descriptive statistical analysis and Wilcoxon test were used. Results: regarding the size of the tumors, the method whose results were closer to pathological examination was the clinical examination after chemotherapy, when compared with sizes on ultrasound and mammography. The mammography helped to evaluate 44% of the cases before chemotherapy (8/18). In the cases where the response was absent, the Doppler showed a significant increase of the flow and a decrease of resistance and pulsatility index. In the cases where the response was present (9 cases), the Doppler did not show any significant change regarding the studied parameters. Conclusion: clinical examination was the most efficient method to evaluate the decrease of the volume of tumors submitted to neoadjuvant chemotherapy when compared with ultrasound and mammographic examinations. Doppler showed increase of the flow in the cases of absent response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):455-462
DOI 10.1590/S0100-72032002000700005
Purpose: to determine the Maternal Mortality Ratio (MMR) among women living in the city of Recife, Brazil through the analysis of all death certificates of women aged 10-49 years from 1994 to 2000. To determine the underreporting rate and to study the main characteristics, basic causes, classification and avoidance of maternal deaths. Methods: a descriptive population-based study was conducted and all death certificates of women aged 10-49 years were analyzed and classified as declared or presumed (Laurenti criteria). Clinical records and autopsy data, when available, were studied and basic cause and underreporting rate were determined. Maternal Mortality Ratio was calculated using information on live births from SINASC ("Sistema de Informações dos Nascidos Vivos"). Results: a total of 144 maternal deaths were identified (declared=104; presumed and confirmed after investigation=44). The Maternal Mortality Ratio was 75.5 per 100,000 live births. The underreporting rate was 27.8%. A predominance of direct causes was observed (about 69%) and the most frequent causes of death were hypertension (19%), hemorrhage (16%) and infection (11%). About 82% of the deaths were considered avoidable by adequate antenatal, delivery and post-partum care. Conclusions: Maternal Mortality Ratio is high in the city of Recife, Brazil and the underreporting rate is still high. Direct obstetric causes and avoidable deaths are predominant. There is a lack of adequate antenatal, delivery and post-partum care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):455-462
DOI 10.1590/S0100-72032002000700005
Purpose: to determine the Maternal Mortality Ratio (MMR) among women living in the city of Recife, Brazil through the analysis of all death certificates of women aged 10-49 years from 1994 to 2000. To determine the underreporting rate and to study the main characteristics, basic causes, classification and avoidance of maternal deaths. Methods: a descriptive population-based study was conducted and all death certificates of women aged 10-49 years were analyzed and classified as declared or presumed (Laurenti criteria). Clinical records and autopsy data, when available, were studied and basic cause and underreporting rate were determined. Maternal Mortality Ratio was calculated using information on live births from SINASC ("Sistema de Informações dos Nascidos Vivos"). Results: a total of 144 maternal deaths were identified (declared=104; presumed and confirmed after investigation=44). The Maternal Mortality Ratio was 75.5 per 100,000 live births. The underreporting rate was 27.8%. A predominance of direct causes was observed (about 69%) and the most frequent causes of death were hypertension (19%), hemorrhage (16%) and infection (11%). About 82% of the deaths were considered avoidable by adequate antenatal, delivery and post-partum care. Conclusions: Maternal Mortality Ratio is high in the city of Recife, Brazil and the underreporting rate is still high. Direct obstetric causes and avoidable deaths are predominant. There is a lack of adequate antenatal, delivery and post-partum care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):463-468
DOI 10.1590/S0100-72032002000700006
Purpose: to evaluate, in the first and second trimesters of pregnancy, the correlation between cervical length and spontaneous preterm delivery. Methods: cervical length was evaluated in 641 pregnant women between 11-16 weeks' and 23-24 weeks' gestation. Cervical assessment was performed by a transvaginal scan with the patient with empty bladder in a gynecological position. Cervical length was measured from the internal to the external os. The gestational age at delivery was correlated with the length of the cervix. To compare the means in groups of pregnant women who had a term or preterm delivery, we used Student's t test. Sensitivity, specificity, false-positive and false-negative rates, and accuracy were calculated for cervical length of 20 mm or less, 25 mm or less and 30 mm or less in the prediction of preterm delivery. Results: the measurement of cervical length, between 11 and 16 weeks of pregnancy, did not show any statistically significant difference on comparing women who had preterm and term delivery (40.6 mm and 42.7 mm, respectively, p=0.2459). However, the difference between the two groups at 23 to 24 weeks was significant (37.3 mm in the group who delivered prematurely and 26.7 mm in the term group, p=0.0001, Student's t test). Conclusion: there was no significant difference in cervical length, at 11 to 16 weeks, between pregnant women who had a preterm and term delivery. However, at 23 to 24 weeks, cervical length was significantly different between the two groups, and this measurement might be used as a predictor for prematurity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):463-468
DOI 10.1590/S0100-72032002000700006
Purpose: to evaluate, in the first and second trimesters of pregnancy, the correlation between cervical length and spontaneous preterm delivery. Methods: cervical length was evaluated in 641 pregnant women between 11-16 weeks' and 23-24 weeks' gestation. Cervical assessment was performed by a transvaginal scan with the patient with empty bladder in a gynecological position. Cervical length was measured from the internal to the external os. The gestational age at delivery was correlated with the length of the cervix. To compare the means in groups of pregnant women who had a term or preterm delivery, we used Student's t test. Sensitivity, specificity, false-positive and false-negative rates, and accuracy were calculated for cervical length of 20 mm or less, 25 mm or less and 30 mm or less in the prediction of preterm delivery. Results: the measurement of cervical length, between 11 and 16 weeks of pregnancy, did not show any statistically significant difference on comparing women who had preterm and term delivery (40.6 mm and 42.7 mm, respectively, p=0.2459). However, the difference between the two groups at 23 to 24 weeks was significant (37.3 mm in the group who delivered prematurely and 26.7 mm in the term group, p=0.0001, Student's t test). Conclusion: there was no significant difference in cervical length, at 11 to 16 weeks, between pregnant women who had a preterm and term delivery. However, at 23 to 24 weeks, cervical length was significantly different between the two groups, and this measurement might be used as a predictor for prematurity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):471-477
DOI 10.1590/S0100-72032002000700007
Purpose: to assess the diagnostic and therapeutic aspects and the complications of symptomatic urinary tract infections (UTI) during pregnancy of patients who were hospitalized. Methods: a total of 136 pregnant women with a clinical diagnosis of pyelonephritis were studied. The studied parameters were: age and parity of patients, gestational age of diagnosis, epidemiologic aspects, laboratory evaluation for UTI, treatment and clinic evolution, prophylaxis and complications. Results: pyelonephritis was diagnosed at the same proportions at all gestational ages. The incidence of UTI was higher among primigravidae. Only 29.3% of the pregnant women had a previous history of UTI; 57.0% were anemic and 93.0% had altered urinalysis. Escherichia coli was the most prevalent uropathogen (75.8% of cases), with low percentages of sensitivity to ampicillin (60.6%) and high percentages of sensitivity to cefuroxime (95,5%). The highest rate of clinical improvement was obtained for the pregnant women treated with cefuroxime (95.7%). Prophylaxis was needed in 11.0% of the patients. Preterm labor occurred in 33.3% of the pregnant women who delivered in our service and preterm delivery occurred in 18.9%. Conclusions: the present results support the need for an early diagnosis and effective treatment of UTI in pregnant women in order to prevent the frequent occurrence of perinatal complications such as premature labor and delivery. We emphasize the need of a periodical evaluation of the pattern of sensitivity of the etiologic agents to the antimicrobials allowed for use during pregnancy, with cefuroxime being adopted as the antibiotic of choice for the treatment of UTI during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):471-477
DOI 10.1590/S0100-72032002000700007
Purpose: to assess the diagnostic and therapeutic aspects and the complications of symptomatic urinary tract infections (UTI) during pregnancy of patients who were hospitalized. Methods: a total of 136 pregnant women with a clinical diagnosis of pyelonephritis were studied. The studied parameters were: age and parity of patients, gestational age of diagnosis, epidemiologic aspects, laboratory evaluation for UTI, treatment and clinic evolution, prophylaxis and complications. Results: pyelonephritis was diagnosed at the same proportions at all gestational ages. The incidence of UTI was higher among primigravidae. Only 29.3% of the pregnant women had a previous history of UTI; 57.0% were anemic and 93.0% had altered urinalysis. Escherichia coli was the most prevalent uropathogen (75.8% of cases), with low percentages of sensitivity to ampicillin (60.6%) and high percentages of sensitivity to cefuroxime (95,5%). The highest rate of clinical improvement was obtained for the pregnant women treated with cefuroxime (95.7%). Prophylaxis was needed in 11.0% of the patients. Preterm labor occurred in 33.3% of the pregnant women who delivered in our service and preterm delivery occurred in 18.9%. Conclusions: the present results support the need for an early diagnosis and effective treatment of UTI in pregnant women in order to prevent the frequent occurrence of perinatal complications such as premature labor and delivery. We emphasize the need of a periodical evaluation of the pattern of sensitivity of the etiologic agents to the antimicrobials allowed for use during pregnancy, with cefuroxime being adopted as the antibiotic of choice for the treatment of UTI during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):479-484
DOI 10.1590/S0100-72032002000700008
Purpose: to evaluate the lymphoscintigraphy, the hand-held probe and the vital blue dye to identify the sentinel lymph node (SLN) in breast carcinoma and to establish sensitivity, negative predictive value (NPV) and overall accuracy of the SLN detection. Methods: eighty-eight consecutive attended patients, with clinically negative axillary lymph nodes were enrolled for this study using the technique of mapping with 99m technetium dextran for scintigraphic images before surgery. In the operating room, five minutes before axillary incision, we injected 2 mL of 2.5% Bleu Patente V Sodique around the tumor and intradermally. Then the gamma probe helped to find out the hot spot where the SLN was supposed to be. The pathologic results of SLN were obtained by the standard technique with hematoxylin and eosin staining in seventy-seven patients. Results: scintigraphy was conclusive for lymphatic basins in 62.1% of 58 cases, concerning SLN identification. In these conclusive patients, there were 9 in which 2 nodes appeared simultaneously without lymph vessel delineation. Using the gamma probe, at least one axillary SLN site could be found preoperatively in 45 cases (84.9%), and intraoperatively, associated with blue dye, in all 53 patients. In 32 of 35 patients only vital blue dye was used with success. Concerning the groups "day" and "other day" (when biopsy was performed on the same day or the other day, after the radiolabeled injection), therefore different regarding time and gamma counts, both achieved the same results regarding SLN detection. Forty-one patients had positive axillary lymph nodes and only two had false negative SLN, giving sensitivity of 95.3%, a NPV of 95.5% and overall accuracy of 97.7%. Conclusions: the lymph node mapping with the use of technetium and patent blue V, alone or associated, is feasible. The time since the injection of technetium up to surgery varied from 3 to 17 h. The pathologic findings confirmed that the biopsied lymph node was the true sentinel node in 97.6% of the cases and validated the SLN mapping, and this should lead to an avoidance of complete axillary dissection as a routine procedure in patients with negative SLN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):479-484
DOI 10.1590/S0100-72032002000700008
Purpose: to evaluate the lymphoscintigraphy, the hand-held probe and the vital blue dye to identify the sentinel lymph node (SLN) in breast carcinoma and to establish sensitivity, negative predictive value (NPV) and overall accuracy of the SLN detection. Methods: eighty-eight consecutive attended patients, with clinically negative axillary lymph nodes were enrolled for this study using the technique of mapping with 99m technetium dextran for scintigraphic images before surgery. In the operating room, five minutes before axillary incision, we injected 2 mL of 2.5% Bleu Patente V Sodique around the tumor and intradermally. Then the gamma probe helped to find out the hot spot where the SLN was supposed to be. The pathologic results of SLN were obtained by the standard technique with hematoxylin and eosin staining in seventy-seven patients. Results: scintigraphy was conclusive for lymphatic basins in 62.1% of 58 cases, concerning SLN identification. In these conclusive patients, there were 9 in which 2 nodes appeared simultaneously without lymph vessel delineation. Using the gamma probe, at least one axillary SLN site could be found preoperatively in 45 cases (84.9%), and intraoperatively, associated with blue dye, in all 53 patients. In 32 of 35 patients only vital blue dye was used with success. Concerning the groups "day" and "other day" (when biopsy was performed on the same day or the other day, after the radiolabeled injection), therefore different regarding time and gamma counts, both achieved the same results regarding SLN detection. Forty-one patients had positive axillary lymph nodes and only two had false negative SLN, giving sensitivity of 95.3%, a NPV of 95.5% and overall accuracy of 97.7%. Conclusions: the lymph node mapping with the use of technetium and patent blue V, alone or associated, is feasible. The time since the injection of technetium up to surgery varied from 3 to 17 h. The pathologic findings confirmed that the biopsied lymph node was the true sentinel node in 97.6% of the cases and validated the SLN mapping, and this should lead to an avoidance of complete axillary dissection as a routine procedure in patients with negative SLN.