Você pesquisou por y?yr=2005 - Revista Brasileira de Ginecologia e Obstetrícia
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Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):509-514
DOI 10.1590/S0100-72032005000900002
PURPOSE: to evaluate the luteal function in adolescents with regular menstrual cycles. METHODS: this prospective cohort study included 55 adolescents, aged 14-19 years, with menarche at 12.2 years. Ovulation was identified by ultrasound, starting on the second or fifth day of the cycle. The corpus luteum vascularization and the resistence index of the ovarian vessels were measured by Doppler on the tenth postovulatory day. Progesterone was measured by chemoluminescence on days 6, 9 and 12 of the luteal phase. The endometrial biopsy was performed 8 to 10 days after ovulation. The results were analyzed using the SPSS software and were considered significant when p<0.05. RESULTS: on average ovulation was on day 17. Progesterone levels were 11.4, 10.9 and 3.9 ng/mL on days 6, 9, and 12 after ovulation, respectively; the progesterone mean during the whole luteal phase was 10.3 ng/ml. Luteal vascularization was scarce in 34.6%, mild in 23.6% and exuberant in 41.8%. The resistance index was 0.441. On the tenth day post-ovulation the endometrium was normal in 85.5% and out-of-phase in 14.5%. There was no correlation between the ovulation day and endometrial dating (p=0.294), levels of progesterone and endometrial dating (p=0.454), progesterone and corpus luteum vascularization (p=0.994), or resistance index (p=0.237). There also was no association between endometrium development and degree of vascularization (p=0.611). CONCLUSION: abnormal luteal function in adolescents with regular menstrual cycles was found in 14.5%. Degree of vascularization, resistance index, and serum progesterone were not related to endometrium development.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):509-514
DOI 10.1590/S0100-72032005000900002
PURPOSE: to evaluate the luteal function in adolescents with regular menstrual cycles. METHODS: this prospective cohort study included 55 adolescents, aged 14-19 years, with menarche at 12.2 years. Ovulation was identified by ultrasound, starting on the second or fifth day of the cycle. The corpus luteum vascularization and the resistence index of the ovarian vessels were measured by Doppler on the tenth postovulatory day. Progesterone was measured by chemoluminescence on days 6, 9 and 12 of the luteal phase. The endometrial biopsy was performed 8 to 10 days after ovulation. The results were analyzed using the SPSS software and were considered significant when p<0.05. RESULTS: on average ovulation was on day 17. Progesterone levels were 11.4, 10.9 and 3.9 ng/mL on days 6, 9, and 12 after ovulation, respectively; the progesterone mean during the whole luteal phase was 10.3 ng/ml. Luteal vascularization was scarce in 34.6%, mild in 23.6% and exuberant in 41.8%. The resistance index was 0.441. On the tenth day post-ovulation the endometrium was normal in 85.5% and out-of-phase in 14.5%. There was no correlation between the ovulation day and endometrial dating (p=0.294), levels of progesterone and endometrial dating (p=0.454), progesterone and corpus luteum vascularization (p=0.994), or resistance index (p=0.237). There also was no association between endometrium development and degree of vascularization (p=0.611). CONCLUSION: abnormal luteal function in adolescents with regular menstrual cycles was found in 14.5%. Degree of vascularization, resistance index, and serum progesterone were not related to endometrium development.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):515-523
DOI 10.1590/S0100-72032005000900003
PURPOSE: the technological improvements in image quality have increased the importance of ultrasound as an imaging method in the study of breast pathologies. The need for a standardized method for lesion characterization, description and reporting in image analysis motivated the development of a breast sonographic report classification system. METHODS: the classification grouped the breast sonographic images in five classes: I - normal; II - benign; III - indeterminate, IV - suspect, and V - highly suspect. The used morphologic ultrasound features were shape, border, contour, echogenicity, echotexture, sound transmission, orientation, and secondary signals. The gold standard test, in the study of 450 lesions, considered sonographic follow-up of the lesions for a period from 6 to 24 months and the histopathology of surgical cases. RESULTS: breast sonographic classification for the diagnosis of breast cancer showed a sensitivity of 90.2% (CI: 82.8-94.9%), a specificity of 96.2% (CI: 94.0-97.6%), a positive predictive value of 84.1% (CI: 76.0-89.9%), and a negative predictive value of 97.8% (CI: 95.9-98.9%), obtaining an accuracy of 95.1%. CONCLUSIONS: the adoption of a sonographic classification system results in the standardization and optimization of the reports. It also aids the comparison with clinical findings, histopathological tests and breast images, avoiding unnecessary procedures and therefore leading to more adequate therapeutical management.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):515-523
DOI 10.1590/S0100-72032005000900003
PURPOSE: the technological improvements in image quality have increased the importance of ultrasound as an imaging method in the study of breast pathologies. The need for a standardized method for lesion characterization, description and reporting in image analysis motivated the development of a breast sonographic report classification system. METHODS: the classification grouped the breast sonographic images in five classes: I - normal; II - benign; III - indeterminate, IV - suspect, and V - highly suspect. The used morphologic ultrasound features were shape, border, contour, echogenicity, echotexture, sound transmission, orientation, and secondary signals. The gold standard test, in the study of 450 lesions, considered sonographic follow-up of the lesions for a period from 6 to 24 months and the histopathology of surgical cases. RESULTS: breast sonographic classification for the diagnosis of breast cancer showed a sensitivity of 90.2% (CI: 82.8-94.9%), a specificity of 96.2% (CI: 94.0-97.6%), a positive predictive value of 84.1% (CI: 76.0-89.9%), and a negative predictive value of 97.8% (CI: 95.9-98.9%), obtaining an accuracy of 95.1%. CONCLUSIONS: the adoption of a sonographic classification system results in the standardization and optimization of the reports. It also aids the comparison with clinical findings, histopathological tests and breast images, avoiding unnecessary procedures and therefore leading to more adequate therapeutical management.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):524-528
DOI 10.1590/S0100-72032005000900004
PURPOSE: to evaluate the morphological changes in murine lacrimal glands by metoclopramide-induced hyperprolactinemia during the proestrus phase or pregnancy. METHODS: forty adult mice were divided into two groups: CTR1 (control) and MET1 (treated with metoclopramide). After fifty days, half of the mice were sacrificed. The remaining animals were mated, and then labeled as pregnant controls (CTR2). Part of these animals were treated with metoclopramide and constituted the metoclopramide-treated pregnant (MET2) group. The CTR2 and MET2 groups were sacrificed on the 6th day of pregnancy. The blood was collected for determination of the hormonal levels of estradiol and progesterone by a chemoluminescent method. The lacrimal glands were then removed, fixed in 10% formaldehyde and stained with HE. The morphometric analysis was performed using the Axion Vision program (Carl Zeiss) to measure acinar nuclear and cellular volumes. RESULTS: the nuclear and cellular volumes of the lacrimal glands in the MET1-(152.2±8.7; 6.3±1.6 µm³) and MET2-(278.3±7.9; 27.5±0.9 µm³) treated groups were lower than those in CTR1 (204.2±7.4; 21.9±1.3 µm³) and CTR2 (329.4±2.2; 35.5±2.0 µm³), respectively. There was a significant hormonal level reduction in the animals that received metoclopramide compared to controls (CTR1: estradiol = 156.6±42.2 pg/ml; progesterone = 39.4±5.1 ng/ml; MET1: estradiol = 108.0±33.1 pg/ml; progesterone = 28.0±6.4 ng/ml; CTR2: estradiol = 354.0±56.0 pg/ml; progesterone = 251.0±56.0 ng/ml; MET2: estradiol = 293.0±43.0 pg/ml, progesterone = 184.0±33.0 ng/ml). CONCLUSION: metoclopramide-induced hyperprolactinemia produced morphological signs of reduction of cellular activity in lacrimal glands during the proestrus phase and pregnancy. It is hypothesized that this effect might be related to the hyperprolactinemia-induced decrease in the hormonal production of estrogen and progesterone.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):524-528
DOI 10.1590/S0100-72032005000900004
PURPOSE: to evaluate the morphological changes in murine lacrimal glands by metoclopramide-induced hyperprolactinemia during the proestrus phase or pregnancy. METHODS: forty adult mice were divided into two groups: CTR1 (control) and MET1 (treated with metoclopramide). After fifty days, half of the mice were sacrificed. The remaining animals were mated, and then labeled as pregnant controls (CTR2). Part of these animals were treated with metoclopramide and constituted the metoclopramide-treated pregnant (MET2) group. The CTR2 and MET2 groups were sacrificed on the 6th day of pregnancy. The blood was collected for determination of the hormonal levels of estradiol and progesterone by a chemoluminescent method. The lacrimal glands were then removed, fixed in 10% formaldehyde and stained with HE. The morphometric analysis was performed using the Axion Vision program (Carl Zeiss) to measure acinar nuclear and cellular volumes. RESULTS: the nuclear and cellular volumes of the lacrimal glands in the MET1-(152.2±8.7; 6.3±1.6 µm³) and MET2-(278.3±7.9; 27.5±0.9 µm³) treated groups were lower than those in CTR1 (204.2±7.4; 21.9±1.3 µm³) and CTR2 (329.4±2.2; 35.5±2.0 µm³), respectively. There was a significant hormonal level reduction in the animals that received metoclopramide compared to controls (CTR1: estradiol = 156.6±42.2 pg/ml; progesterone = 39.4±5.1 ng/ml; MET1: estradiol = 108.0±33.1 pg/ml; progesterone = 28.0±6.4 ng/ml; CTR2: estradiol = 354.0±56.0 pg/ml; progesterone = 251.0±56.0 ng/ml; MET2: estradiol = 293.0±43.0 pg/ml, progesterone = 184.0±33.0 ng/ml). CONCLUSION: metoclopramide-induced hyperprolactinemia produced morphological signs of reduction of cellular activity in lacrimal glands during the proestrus phase and pregnancy. It is hypothesized that this effect might be related to the hyperprolactinemia-induced decrease in the hormonal production of estrogen and progesterone.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):529-533
DOI 10.1590/S0100-72032005000900005
PURPOSE: to study the histological modifications that occur in the endometrium of women before and six months after tubal ligation (TL) and to correlate these findings with progesterone (P4) levels. METHODS: the study was conducted on 16 women with normal menstrual cycles who were evaluated before and in the sixth cycle after TL. P4 levels were determined from the 8th day at 2-day intervals until ovulation and on the 8th, 10th and 12th day after ovulation or on the 24th day of the cycle. An endometrial biopsy was obtained between the 10th and 12th day after ovulation or on the 24th day of the cycle and a correlation with P4 was determined. Data were analyzed statistically by the nonparametric McNemar test for the evaluation of hormonal determination and by the exact Fisher test for the histological evaluation of the endometrium, with the level of significance set at p<0.05. RESULTS: mean age was 34.1±1.3 years. The intermenstrual interval was 27.1±2.6 days and the duration of bleeding was 3 to 5 days, with no difference between the studied periods. Before TL, 8/16 (50.0%) of the cases had a secretory endometrium according to the cycle, 3/16 (18.8%) had a secretory endometrium not according to the cycle and 3/16 (18.8%) had a dysfunctional endometrium, suggesting a defect in the luteal phase in 6/16 (37.5%). After TL, 7/16 (43.8%) had a secretory endometrium according to the cycle, 3/16 (18.8%) a secretory endometrium not according to the cycle and 4/16 (25.0%) had a dysfunctional endometrium, suggesting a defect in the luteal phase in 7/16 (43.8%). In 2/16 (12.5%) of the cases before TL and in 2/16 (12.5%) other cases after TL it was not possible to perform histological evaluation due to insufficient material or unspecfiic endometritis. In the luteal phase after TL, mean P4 levels were significantly lower on days +8, +10 and +12 than before TL, being 15.1, 18.0 and 20.7 ng/ml, respectively, before TL and 10.6, 8.0 and 5.4 ng/ml after TL (p<0.05). Before TL, 5/8 (62.5%) of the cases with a secretory endometrium according to the cycle had P4 >10 ng/ml and 3/8 (37.5%) had P4 <10 ng/ml. After TL, when the endometrium was secretory according to the cycle, P4 was >10 ng/ml in 4/7 (57.1%) and <10 ng/ml in 3/7 (42.9%). These differences were nonsignificant (p>0.05). CONCLUSION: six months after TL, the intermenstrual interval and the duration of bleeding were unchanged. P4 levels decreased during the luteal phase although this did not interfere in the endometrial response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):529-533
DOI 10.1590/S0100-72032005000900005
PURPOSE: to study the histological modifications that occur in the endometrium of women before and six months after tubal ligation (TL) and to correlate these findings with progesterone (P4) levels. METHODS: the study was conducted on 16 women with normal menstrual cycles who were evaluated before and in the sixth cycle after TL. P4 levels were determined from the 8th day at 2-day intervals until ovulation and on the 8th, 10th and 12th day after ovulation or on the 24th day of the cycle. An endometrial biopsy was obtained between the 10th and 12th day after ovulation or on the 24th day of the cycle and a correlation with P4 was determined. Data were analyzed statistically by the nonparametric McNemar test for the evaluation of hormonal determination and by the exact Fisher test for the histological evaluation of the endometrium, with the level of significance set at p<0.05. RESULTS: mean age was 34.1±1.3 years. The intermenstrual interval was 27.1±2.6 days and the duration of bleeding was 3 to 5 days, with no difference between the studied periods. Before TL, 8/16 (50.0%) of the cases had a secretory endometrium according to the cycle, 3/16 (18.8%) had a secretory endometrium not according to the cycle and 3/16 (18.8%) had a dysfunctional endometrium, suggesting a defect in the luteal phase in 6/16 (37.5%). After TL, 7/16 (43.8%) had a secretory endometrium according to the cycle, 3/16 (18.8%) a secretory endometrium not according to the cycle and 4/16 (25.0%) had a dysfunctional endometrium, suggesting a defect in the luteal phase in 7/16 (43.8%). In 2/16 (12.5%) of the cases before TL and in 2/16 (12.5%) other cases after TL it was not possible to perform histological evaluation due to insufficient material or unspecfiic endometritis. In the luteal phase after TL, mean P4 levels were significantly lower on days +8, +10 and +12 than before TL, being 15.1, 18.0 and 20.7 ng/ml, respectively, before TL and 10.6, 8.0 and 5.4 ng/ml after TL (p<0.05). Before TL, 5/8 (62.5%) of the cases with a secretory endometrium according to the cycle had P4 >10 ng/ml and 3/8 (37.5%) had P4 <10 ng/ml. After TL, when the endometrium was secretory according to the cycle, P4 was >10 ng/ml in 4/7 (57.1%) and <10 ng/ml in 3/7 (42.9%). These differences were nonsignificant (p>0.05). CONCLUSION: six months after TL, the intermenstrual interval and the duration of bleeding were unchanged. P4 levels decreased during the luteal phase although this did not interfere in the endometrial response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):534-540
DOI 10.1590/S0100-72032005000900006
PURPOSE: to evaluate the role of morphological (12) and Doppler velocimetry (17) ultrasonographic features, in the detection of lymph node metastases in breast cancer patients. METHODS: 179 women (181 axillary cavities) were included in the study from January to December 2004. The ultrasonographic examinations were performed with a real-time linear probe (Toshiba-Power Vision-6000 (model SSA-370A)). The morphological parameters were studied with a frequency of 7.5-12 MHz. A frequency of 5 MHz was used for the Doppler velocimetry parameters. Subsequently, the women were submitted to level I, II and III axillary dissection (158), or to the sentinel lymph node technique (23). Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. The decision tree test was used for parameter association. The cutoff points were established by the ROC curve. RESULTS: at least one lymph node was detected in 173 (96%) of the women by the ultrasonographic examinations. Histological examination detected lymph node metastases in 87 women (48%). The best sensitivity among the morphological paramenters was found with the volume (62%), the antero-posterior diameter (62%) and the fatty hilum placement (56%). Though the specificity of the extracapsular invasion (100%), border regularity (92%) and cortex echogenicity (99%) were high, the sensitivity of these features was too low. None of the Doppler velocimetry parameters reached 50% sensitivity. The decision tree test selected the ultrasonographic parametners: fatty hilum placement, border regularity and cortex echogenicity, as the best parameter association. CONCLUSION: the detection of axillary cavity lymph node stage by a noninvasive method still remains an unfulfilled goal in the treatment of patients with breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):534-540
DOI 10.1590/S0100-72032005000900006
PURPOSE: to evaluate the role of morphological (12) and Doppler velocimetry (17) ultrasonographic features, in the detection of lymph node metastases in breast cancer patients. METHODS: 179 women (181 axillary cavities) were included in the study from January to December 2004. The ultrasonographic examinations were performed with a real-time linear probe (Toshiba-Power Vision-6000 (model SSA-370A)). The morphological parameters were studied with a frequency of 7.5-12 MHz. A frequency of 5 MHz was used for the Doppler velocimetry parameters. Subsequently, the women were submitted to level I, II and III axillary dissection (158), or to the sentinel lymph node technique (23). Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. The decision tree test was used for parameter association. The cutoff points were established by the ROC curve. RESULTS: at least one lymph node was detected in 173 (96%) of the women by the ultrasonographic examinations. Histological examination detected lymph node metastases in 87 women (48%). The best sensitivity among the morphological paramenters was found with the volume (62%), the antero-posterior diameter (62%) and the fatty hilum placement (56%). Though the specificity of the extracapsular invasion (100%), border regularity (92%) and cortex echogenicity (99%) were high, the sensitivity of these features was too low. None of the Doppler velocimetry parameters reached 50% sensitivity. The decision tree test selected the ultrasonographic parametners: fatty hilum placement, border regularity and cortex echogenicity, as the best parameter association. CONCLUSION: the detection of axillary cavity lymph node stage by a noninvasive method still remains an unfulfilled goal in the treatment of patients with breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):541-547
DOI 10.1590/S0100-72032005000900007
PURPOSE: to evaluate the predictors (clinical findings and physiological and anatomical scores) of the maternal and fetal outcomes among pregnant women victims of abdominal trauma who were submitted to laparotomy and to discuss particularities of assessment in this situation. METHODS: retrospective analysis of the medical records of 245 women with abdominal trauma and surgical treatment, from 1990 to 2002. Thirteen pregnant women with abdominal injury were identified. All cases were registered in the Epi-Info 6.04 protocol and data were analyzed statistically by the Fisher exact test, with confidence interval of 95%. RESULTS: ages ranged from 13 to 34 years (mean of 22.5). Six women (46.2%) were in the third trimester of pregnancy. Penetrating trauma accounted for 53.8% of injuries and in six of these patients the mechanism of trauma was gunshot wounds. Three patients had uterine injuries associated with fetal death. There were no maternal deaths and fetal mortality was 30.7%. The use of trauma scores was not associated with maternal and fetal mortality. Uterine injury was the only predictive risk factor for fetal loss (p=0.014). CONCLUSIONS: this is a retrospective study analyzing a small number of pregnant women victims of severe trauma. However, the results show that there are no predictive accuracy scores to evaluate maternal and fetal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):541-547
DOI 10.1590/S0100-72032005000900007
PURPOSE: to evaluate the predictors (clinical findings and physiological and anatomical scores) of the maternal and fetal outcomes among pregnant women victims of abdominal trauma who were submitted to laparotomy and to discuss particularities of assessment in this situation. METHODS: retrospective analysis of the medical records of 245 women with abdominal trauma and surgical treatment, from 1990 to 2002. Thirteen pregnant women with abdominal injury were identified. All cases were registered in the Epi-Info 6.04 protocol and data were analyzed statistically by the Fisher exact test, with confidence interval of 95%. RESULTS: ages ranged from 13 to 34 years (mean of 22.5). Six women (46.2%) were in the third trimester of pregnancy. Penetrating trauma accounted for 53.8% of injuries and in six of these patients the mechanism of trauma was gunshot wounds. Three patients had uterine injuries associated with fetal death. There were no maternal deaths and fetal mortality was 30.7%. The use of trauma scores was not associated with maternal and fetal mortality. Uterine injury was the only predictive risk factor for fetal loss (p=0.014). CONCLUSIONS: this is a retrospective study analyzing a small number of pregnant women victims of severe trauma. However, the results show that there are no predictive accuracy scores to evaluate maternal and fetal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):548-553
DOI 10.1590/S0100-72032005000900008
PURPOSE: to study maternal mortality caused by hypertension during pregnancy, determining the mortality rate and the profile of those patients. METHODS: a retrospective study of maternal mortality caused by hypertension at the Maternidade Escola Assis Chateaubriand of the Universidade Federal do Ceará, from 1981 to 2003. General maternal mortality rate (MMR) and specific maternal mortality rate due to hypertension were evaluated, as well as these patients' epidemiological and clinical data. RESULTS: two hundred and ninety six cases of maternal death and 184,672 of live births were recorded, with a MMR of 160.28/100.000 live births. The most frequent cause of death was hypertension (41.2%); with 122 cases and an annual average of 5.3 deaths, and hypertension MMR of 60.10/100,000 live births. The women's age range varied from 13 to 42 years with an average of 26 years. Most of the patients came from the interior of the state. Deaths occurred predominantly in the first 24 hours after admission to the hospital (50.9%). Deaths were predominant in the first pregnancy (40.3%) and in women with 31 to 38 weeks gestational age (48.2%). Eclampsia occurred in 73 patients (64.1%) and was predominant along the gestational period (53.4%). There were 101 deaths in the puerperium. Cesarean section (62.3%) and general anesthesia (45.1%) prevailed. A high percentage of patients (61.4%) had no prenatal care. CONCLUSIONS: General MMR and hypertension MMR were high, the latter being the main cause of death in our maternity hospital.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):548-553
DOI 10.1590/S0100-72032005000900008
PURPOSE: to study maternal mortality caused by hypertension during pregnancy, determining the mortality rate and the profile of those patients. METHODS: a retrospective study of maternal mortality caused by hypertension at the Maternidade Escola Assis Chateaubriand of the Universidade Federal do Ceará, from 1981 to 2003. General maternal mortality rate (MMR) and specific maternal mortality rate due to hypertension were evaluated, as well as these patients' epidemiological and clinical data. RESULTS: two hundred and ninety six cases of maternal death and 184,672 of live births were recorded, with a MMR of 160.28/100.000 live births. The most frequent cause of death was hypertension (41.2%); with 122 cases and an annual average of 5.3 deaths, and hypertension MMR of 60.10/100,000 live births. The women's age range varied from 13 to 42 years with an average of 26 years. Most of the patients came from the interior of the state. Deaths occurred predominantly in the first 24 hours after admission to the hospital (50.9%). Deaths were predominant in the first pregnancy (40.3%) and in women with 31 to 38 weeks gestational age (48.2%). Eclampsia occurred in 73 patients (64.1%) and was predominant along the gestational period (53.4%). There were 101 deaths in the puerperium. Cesarean section (62.3%) and general anesthesia (45.1%) prevailed. A high percentage of patients (61.4%) had no prenatal care. CONCLUSIONS: General MMR and hypertension MMR were high, the latter being the main cause of death in our maternity hospital.
