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9 articles
  • Editorial

    How the gynecologist can guide women with a family history of cancer?

    Rev Bras Ginecol Obstet. 2014;36(8):335-339

    Summary

    Editorial

    How the gynecologist can guide women with a family history of cancer?

    Rev Bras Ginecol Obstet. 2014;36(8):335-339

    DOI 10.1590/SO100-720320140005104

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    How the gynecologist can guide women with a family history of cancer?
  • Artigos Originais

    Loss of PTEN expression and AKT activation in HER2-positive breast carcinomas

    Rev Bras Ginecol Obstet. 2014;36(8):340-346

    Summary

    Artigos Originais

    Loss of PTEN expression and AKT activation in HER2-positive breast carcinomas

    Rev Bras Ginecol Obstet. 2014;36(8):340-346

    DOI 10.1509/SO100-720320140005034

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    PURPOSE:

    To examine the expression of AKT and PTEN in a series of HER2-positive primary invasive breast tumors using immunohistochemistry, and to associate these expression profiles with classic pathologic features such as tumor grade, hormone receptor expression, lymphatic vascular invasion, and proliferation.

    METHODS:

    A total of 104 HER2-positive breast carcinoma specimens were prepared in tissue microarrays blocks for immunohistochemical detection of PTEN and phosphorylated AKT (pAKT). Original histologic sections were reviewed to assess pathological features, including HER2 status and Ki-67 index values. The associations between categorical and numeric variables were identified using Pearson's chi-square test and the Mann-Whitney, respectively.

    RESULTS:

    Co-expression of pAKT and PTEN was presented in 59 (56.7%) cases. Reduced levels of PTEN expression were detected in 20 (19.2%) cases, and these 20 tumors had a lower Ki-67 index value. In contrast, tumors positive for pAKT expression [71 (68.3%)] were associated with a higher Ki-67 index value.

    CONCLUSION:

    A role for AKT in the proliferation of HER2-positive breast cancers was confirmed. However, immunohistochemical detection of PTEN expression did not correlate with an inhibition of cellular proliferation or control of AKT phosphorylation, suggesting other pathways in these mechanisms of control.

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    Loss of PTEN expression and AKT activation in HER2-positive breast carcinomas
  • Original Article

    Validity of cervicovaginal cytology in a Brazilian State with high incidence rate of cervical cancer

    Rev Bras Ginecol Obstet. 2014;36(8):347-352

    Summary

    Original Article

    Validity of cervicovaginal cytology in a Brazilian State with high incidence rate of cervical cancer

    Rev Bras Ginecol Obstet. 2014;36(8):347-352

    DOI 10.1590/SO100-720320140005061

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    PURPOSE:

    To evaluate the validity of cervicovaginal cytology performed at LAPER, the main Laboratory of Pathology of the State of Roraima, Brazil, by interrater agreement (external monitoring) and agreement with histopathologic results.

    METHODS:

    One hundred women were included, a population-based convenience sample. Their cervical cytological exams were evaluated by the laboratory staff and reviewed by expert medical pathologists, external to the laboratory. Cohen's Kappa index, sensitivity and specificity were evaluated. The study was approved by LAPER coordination and Federal University of Roraima Research Ethics Commitee.

    RESULTS:

    Regarding the prevalence of human papillomavirus-related atypical, there was no concordance between the results issued by LAPER and by the external pathologists (k=0.21). A low sensitivity (28.5%) and specificity (89,2%) was detected for the diagnostic performance of LAPER, with a high proportion of false positive and false negative results. The cytological reports of the external pathologists showed higher sensitivity and specificity (71.4 and 98.9%, respectively), ruling out the possibility that errors related to collection methods and staining would explain the low performance of the laboratory.

    CONCLUSION:

    A low diagnostic accuracy of cervicovaginal cytology can be a barrier against the control of cervical cancer in Roraima. We emphasize the need for professional training and internal and external monitoring in Brazilian states with a high incidence of cervical cancer.

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  • Original Article

    Chlamydia trachomatis and Neisseria gonorrhoeae infection: factors associated with infertility in women treated at a human reproduction public service

    Rev Bras Ginecol Obstet. 2014;36(8):353-358

    Summary

    Original Article

    Chlamydia trachomatis and Neisseria gonorrhoeae infection: factors associated with infertility in women treated at a human reproduction public service

    Rev Bras Ginecol Obstet. 2014;36(8):353-358

    DOI 10.1590/SO100-720320140005009

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    PURPOSE:

    To evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women undergoing assisted reproduction in a public reference service in the midwestern region of Brazil.

    METHODS:

    A cross-sectional study was conducted on 340 women aged from 20 to 47 years with a history of infertility, undergoing assisted reproduction techniques. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae identified in urine specimens by PCR, and the profile of infertility were analyzed. We used the χtest or Fisher's exact test to evaluate the association between infection and variables.

    RESULTS:

    The prevalence of Chlamydia trachomatis infection was 10.9%, and Neisseria gonorrhoeae co-infection was observed in 2 cases. Women infected with Chlamydia trachomatis had more than 10 years of infertility (54.1%; p<0.0001). The tubal factor was the main cause in infected cases (56.8%; p=0.047). Tubal occlusion was found in 67.6% of cases with positive infection (p=0.004).

    CONCLUSION:

    There was an association of tubal obstruction with infection by Chlamydia trachomatis and Neisseria gonorrhoeae, reinforcing the need for effective strategies for an early detection of sexually transmitted diseases, especially in asymptomatic women of childbearing age.

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  • Artigos Originais

    Effects of hyperprolactinemia and ovariectomy on the tibial epiphyseal growth plate and bone formation in mice

    Rev Bras Ginecol Obstet. 2014;36(8):359-366

    Summary

    Artigos Originais

    Effects of hyperprolactinemia and ovariectomy on the tibial epiphyseal growth plate and bone formation in mice

    Rev Bras Ginecol Obstet. 2014;36(8):359-366

    DOI 10.1590/SO100-720320140005065

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    PURPOSE:

    To evaluate the effects of ovariectomy and the hyperprolactinemia procedure in the tibial epiphyseal growth plate of female mice.

    METHODS:

    In this study, the epiphyseal growth plate of ovariectomized (OVX) and/or rendered hyperprolactinemic female mice by 50 days of treatment with 200 μg metoclopramide (M) was evaluated morphologically, morphometrically and immuno-histochemically. Forty female and adult mice were divided into four groups according to treatment: V group - animals treated with saline solution; H group - hyperprolactinemic animals; Ovx/V group - ovariectomized animals and treated with saline solution; Ovx/H group - hyperprolactinemic and ovariectomized animals. After the treatment period, the animals were sacrificed, tibia was removed and fixed in 10% buffered formalin and decalcified in 10% formic acid. The material was immersed in paraffin and subjected to histological processing in paraffin. The sections were stained with Masson's trichrome and immunohistochemistry was carried out for the pro-apoptotic protein BCL-2. The images for the morphological and morphometric study were analyzed with the imaging program AxioVision 4.8 (Carl-Zeiss(r), Germany).

    RESULTS:

    The combination of hyperprolactinemia and the ovariectomy procedure decreased the number of resting chondrocytes 1.5-fold, the number of proliferative chondrocytes 1.8-fold; the percentage of resting cartilage 2.4-fold and the percentage of trabecular bone 2.1-fold, compared with respective control animals.

    CONCLUSION:

    The procedure of ovariectomy combined with the metoclopramide-induced hyperprolactinemia in female mice has showed marked bone degeneration due to significant decrease of cell proliferation in the epiphyseal growth plate and bone formation.

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    Effects of hyperprolactinemia and ovariectomy on the tibial epiphyseal growth plate and bone formation in mice
  • Original Article

    Breast and cervical cancer in patients with systemic lupus erythematosus

    Rev Bras Ginecol Obstet. 2014;36(8):367-371

    Summary

    Original Article

    Breast and cervical cancer in patients with systemic lupus erythematosus

    Rev Bras Ginecol Obstet. 2014;36(8):367-371

    DOI 10.1590/SO100-720320140005052

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    PURPOSE:

    To study the incidence of tumors in a Brazilian sample of women with systemic lupus erythematosus.

    METHODS:

    This is a retrospective study of 395 medical charts from women with systemic lupus erythematosus diagnosed by the presence of at least 4 of the American College of Rheumatology classification criteria for the diagnosis of this disease and followed for the last 10 years in a rheumatology outpatient clinic. Demographic data (age and ethnicity of patients), data on disease duration, use of immunomodulators and on the presence of neoplasms were listed. Results are presented in frequency and contingency tables. The incidence rate of malignancies in women with lupus was compared with that of the general population for the same demographic region for the past ten years, using data published by the Brazilian National Cancer Institute (INCA). Association studies were carried out by the Fisher and χ tests, when the data were nominal, and by Mann-Whitney test, when numeric. The level of significance was set at 5%.

    RESULTS:

    Twenty-two cases of malignant tumors were identified during these 10 years of follow-up (22 cases/395 or 5.5% of the sample), being the most common those of the uterine cervix (10 cases/395 or 2.5% of the sample) and breast cancer (9 cases/395 or 2.2% of the sample). The presence of tumors was associated with disease duration (p=0.006) and was not influenced by treatment with methotrexate (p=0.1), azathioprine (p=0.9), cyclophosphamide (p=0.6) and glucocorticoids (p=0.3). Breast and uterine cervix tumors were more common in systemic lupus erythematosus women than in the general population (p<0.0001 for both).

    CONCLUSION:

    A high prevalence of malignant tumors was found in this sample, with tumors being more common in patients with longer disease duration. The most frequent tumors affected the breast and uterus at a higher incidence than in the general population. The presence of tumors was not influenced by the use of glucocorticoids or immunosuppressors.

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    Breast and cervical cancer in patients with systemic lupus erythematosus
  • Original Article

    Comparison between the serum concentration of alpha-tocopherol in puerperal women assisted in public and private maternities in Northeastern Brazil

    Rev Bras Ginecol Obstet. 2014;36(8):372-376

    Summary

    Original Article

    Comparison between the serum concentration of alpha-tocopherol in puerperal women assisted in public and private maternities in Northeastern Brazil

    Rev Bras Ginecol Obstet. 2014;36(8):372-376

    DOI 10.1590/SO100-720320140005006

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    PURPOSE:

    To compare the concentration of serum alpha-tocopherol during the postpartum period in women admitted to public and private hospitals in Natal (RN), Brazil.

    METHODS:

    The study included 209 women in the postpartum period, 96 of them from private hospitals and 113 from public hospitals, studied between 24 and 48 hours postpartum. Inclusion criteria were: mothers aged 12 years or more, without diseases associated with pregnancy, who had given birth to a singleton with no malformations. Clinically decompensated women with multiple fetuses were excluded. A 5 mL blood sample was obtained from each participant under fasting conditions, before the first meal of the day. The concentration of alpha-tocopherol in serum (µg/dL) was determined by high performance liquid chromatography (HPLC). The statistical difference between means was tested by the Student's t-test.

    RESULTS:

    The mean concentration of alpha-tocopherol was 1.115.7 µg/dL in puerperae from the public network and 1.355.7±397.6 µg/dL in puerperae from the privte network , with a significant difference between groups (p=0.000687). Vitamin E concentration was determined individually and an alpha-tocopherol level <11.6 µmol/L or <499.6 µg/dL was considered to indicate deficiency. Vitamin E deficiency was detected in 5.3% of puerperae from the public network (n=6), whereas no deficiency was detected among women from the private network. However, low concentrations of alpha-tocopherol (11.6 to 16.2 µmol/L or 499.6 to 697.7 µg/dL) was detected in both groups, i.e., in 9.7% of the women from the public network (n=11) and in 4.2% for the women from the private network (n=4).

    CONCLUSION:

    These results highlight that women assisted in the public sector were more vulnerable to developing low concentrations of alpha-tocopherol than women assisted in the private sector.

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  • Case Report

    Spontaneous rupture of renal angiomyolipoma during pregnancy

    Rev Bras Ginecol Obstet. 2014;36(8):377-380

    Summary

    Case Report

    Spontaneous rupture of renal angiomyolipoma during pregnancy

    Rev Bras Ginecol Obstet. 2014;36(8):377-380

    DOI 10.1590/SO100-720320140005019

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    Renal angiomyolipoma is a benign tumor, composed of adipocytes, smooth muscle cells and blood vessels. The association with pregnancy is rare and related with an increased risk of complications, including rupture with massive retroperitoneal hemorrhage. The follow-up is controversial because of the lack of known cases, but the priorities are: timely diagnosis in urgent cases and a conservative treatment when possible. The mode of delivery is not consensual and should be individualized to each case. We report a case of a pregnant woman with 18 weeks of gestation admitted in the emergency room with an acute right low back pain with no other symptoms. The diagnosis of rupture of renal angiomyolipoma was established by ultrasound and, due to hemodinamically stability, conservative treatment with imaging and clinical monitoring was chosen. At 35 weeks of gestation, it was performed elective cesarean section without complications for both mother and fetus.

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    Spontaneous rupture of renal angiomyolipoma during pregnancy

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