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Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(3):123-127
DOI 10.1590/S0100-72032011000300004
PURPOSE: to evaluate the frequency and clinical picture of patients with incisional endometriosis. METHODS: retrospective descriptive study performed from the medical records of patients that underwent nodules resection in the surgical scar at Faculdade de Medicina do ABC, from November 1990 to September 2003. The age, parity, number of cesarean sections, symptoms, tumor location, initial diagnosis, treatment, and recurrences were surveyed and analyzed. The results were reported as percentage, mean, and standard deviation. RESULTS: we found 42 patients that were diagnosed with scar endometriosis. From these 42 cases, 37 were of endometriosis on cesarean section scar; 3 cases of episiotomies and 2 cases on bladder in scar of hysterography. The mean age of the patients was 32.4 years old, standard deviation of ±6.2 years. All of them had previous obstetric surgery, and the main complaint was nodulation with perimenstrual pain in 40% of the cases. In 57% of the patients, the clinical evaluation was confirmed by pelvic or transvaginal ultrasonography. Patients were treated with total resection, and recurrence occurred in only two cases. CONCLUSION: scar surgical endometriosis is uncommon; however, the clinical diagnosis is easy when the signs and symptoms are known. The effective treatment is surgical resection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(3):123-127
DOI 10.1590/S0100-72032011000300004
PURPOSE: to evaluate the frequency and clinical picture of patients with incisional endometriosis. METHODS: retrospective descriptive study performed from the medical records of patients that underwent nodules resection in the surgical scar at Faculdade de Medicina do ABC, from November 1990 to September 2003. The age, parity, number of cesarean sections, symptoms, tumor location, initial diagnosis, treatment, and recurrences were surveyed and analyzed. The results were reported as percentage, mean, and standard deviation. RESULTS: we found 42 patients that were diagnosed with scar endometriosis. From these 42 cases, 37 were of endometriosis on cesarean section scar; 3 cases of episiotomies and 2 cases on bladder in scar of hysterography. The mean age of the patients was 32.4 years old, standard deviation of ±6.2 years. All of them had previous obstetric surgery, and the main complaint was nodulation with perimenstrual pain in 40% of the cases. In 57% of the patients, the clinical evaluation was confirmed by pelvic or transvaginal ultrasonography. Patients were treated with total resection, and recurrence occurred in only two cases. CONCLUSION: scar surgical endometriosis is uncommon; however, the clinical diagnosis is easy when the signs and symptoms are known. The effective treatment is surgical resection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(2):65-69
DOI 10.1590/S0100-72032011000200002
PURPOSE: to evaluate the frequency of VDR gene polymorphism Fok1 in infertile women with endometriosis and Control and its relation to the disease. METHODS: a case-control study that included 147 infertile women with endometriosis and 154 fertile women without endometriosis as Control. Fok1 polymorphism (rs10735810, T2C), which promotes a T/C exchange in exon 2 of the VDR gene, was identified by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), that involves the combination of amplification by PCR and digestion with restriction endonuclease. The χ2 test was used to compare allele and genotype frequencies between groups. All p-values were two-tailed and a p-value < 0.05 was considered statistically significant. RESULTS: the TT, TC and CC genotype frequencies of VDR Fok1 polymorphism were 44.2%, 46.9% and 8.9% in infertile women with endometriosis and 41.6%, 50% and 8.4% in the Control Group. No significant difference was found (p=0.8), even when the patients were subdivided according to the stage of endometriosis (p=0.3 for minimal and mild endometriosis and p=0.2 for moderate and severe endometriosis). Alleles T and C were present, respectively, in 67.6% and 32.3% of infertile women with endometriosis (p=0.8), in 63.5% and 36.5% of women with minimal/mild endometriosis (p=0.5), in 72.5% and 27.5% of women with moderate/severe endometriosis (p=0.2), and in 66.6% and 33.4% of the Control Group. No statistically significant difference was found among any groups and the Control. CONCLUSION: the results suggest that VDR gene polymorphism Fok1 does not confer genetic susceptibility to endometriosis-associated infertility in the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(2):65-69
DOI 10.1590/S0100-72032011000200002
PURPOSE: to evaluate the frequency of VDR gene polymorphism Fok1 in infertile women with endometriosis and Control and its relation to the disease. METHODS: a case-control study that included 147 infertile women with endometriosis and 154 fertile women without endometriosis as Control. Fok1 polymorphism (rs10735810, T2C), which promotes a T/C exchange in exon 2 of the VDR gene, was identified by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), that involves the combination of amplification by PCR and digestion with restriction endonuclease. The χ2 test was used to compare allele and genotype frequencies between groups. All p-values were two-tailed and a p-value < 0.05 was considered statistically significant. RESULTS: the TT, TC and CC genotype frequencies of VDR Fok1 polymorphism were 44.2%, 46.9% and 8.9% in infertile women with endometriosis and 41.6%, 50% and 8.4% in the Control Group. No significant difference was found (p=0.8), even when the patients were subdivided according to the stage of endometriosis (p=0.3 for minimal and mild endometriosis and p=0.2 for moderate and severe endometriosis). Alleles T and C were present, respectively, in 67.6% and 32.3% of infertile women with endometriosis (p=0.8), in 63.5% and 36.5% of women with minimal/mild endometriosis (p=0.5), in 72.5% and 27.5% of women with moderate/severe endometriosis (p=0.2), and in 66.6% and 33.4% of the Control Group. No statistically significant difference was found among any groups and the Control. CONCLUSION: the results suggest that VDR gene polymorphism Fok1 does not confer genetic susceptibility to endometriosis-associated infertility in the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):37-42
DOI 10.1590/S0100-72032011000100006
PURPOSE: to evaluate the frequency of TP53 codon 72 polymorphism in infertile women with endometriosis, women with idiopathic infertility, controls and its relation to the disease. METHODS: a case-control study that included 198 infertile women with endometriosis, 70 women with idiopathic infertility and 169 fertile women without endometriosis as control. Detection of TP53 codon 72 gene polymorphism (rs1042522, Arg/C:Pro/G), that promotes a C/G exchange in the coding region of the gene, was performed by real time Polymerase Chain Reaction (PCR), using the TaqMan system of primers, that flank the implicated region and probes labeled with different fluorescent dyes, one for allele C and other for allele G. When two dyes were observed, the patient was considered to be heterozygous CG. In the presence of only one dye, the individual was considered to be homozygous CC or GG. The χ2 test was used to compare allele and genotype frequencies between groups. All p-values were two-tailed and a p-value <0.05 was considered to be statistically significant. RESULTS: we found no statistically significant difference in the distribution of TP53 codon 72 polymorphism genotypes CC, CG or GG (p=0.7) and alleles C or G (p=0.4) between infertile patients with endometriosis and controls (p=0.4), regardless of the stage of the disease. In relation to infertility, no statistically significant difference in the genotype or allele distribution (p=1.0 and p=0.9, respectively) was observed between idiopathic infertile women and controls. Considering the dominant inheritance model, again, no statistically significant difference was found even in the endometriosis (p=0.5) or the idiopathic infertility group (p=0.9) when compared to controls. Regarding the recessive inheritance model no statistically significant difference was found, with p=0.6 and p=1.0, respectively, for the endometriosis and idiopathic infertility groups. CONCLUSION: the results suggest that the TP53 codon 72 polymorphism does not confer genetic susceptibility to endometriosis and/or infertility in the Brazilian population, not even the severe form of the disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):37-42
DOI 10.1590/S0100-72032011000100006
PURPOSE: to evaluate the frequency of TP53 codon 72 polymorphism in infertile women with endometriosis, women with idiopathic infertility, controls and its relation to the disease. METHODS: a case-control study that included 198 infertile women with endometriosis, 70 women with idiopathic infertility and 169 fertile women without endometriosis as control. Detection of TP53 codon 72 gene polymorphism (rs1042522, Arg/C:Pro/G), that promotes a C/G exchange in the coding region of the gene, was performed by real time Polymerase Chain Reaction (PCR), using the TaqMan system of primers, that flank the implicated region and probes labeled with different fluorescent dyes, one for allele C and other for allele G. When two dyes were observed, the patient was considered to be heterozygous CG. In the presence of only one dye, the individual was considered to be homozygous CC or GG. The χ2 test was used to compare allele and genotype frequencies between groups. All p-values were two-tailed and a p-value <0.05 was considered to be statistically significant. RESULTS: we found no statistically significant difference in the distribution of TP53 codon 72 polymorphism genotypes CC, CG or GG (p=0.7) and alleles C or G (p=0.4) between infertile patients with endometriosis and controls (p=0.4), regardless of the stage of the disease. In relation to infertility, no statistically significant difference in the genotype or allele distribution (p=1.0 and p=0.9, respectively) was observed between idiopathic infertile women and controls. Considering the dominant inheritance model, again, no statistically significant difference was found even in the endometriosis (p=0.5) or the idiopathic infertility group (p=0.9) when compared to controls. Regarding the recessive inheritance model no statistically significant difference was found, with p=0.6 and p=1.0, respectively, for the endometriosis and idiopathic infertility groups. CONCLUSION: the results suggest that the TP53 codon 72 polymorphism does not confer genetic susceptibility to endometriosis and/or infertility in the Brazilian population, not even the severe form of the disease.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(11):536-540
DOI 10.1590/S0100-72032010001100004
PURPOSE: to evaluate the impact of body mass index (BMI) on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes performed at the Human Reproduction Center of Faculdade de Medicina do ABC. METHODS: retrospective data from 488 IVF cycles of 385 patients. Patients were classified into two groups according to BMI: normal weight (18.5-24.9 kg/m²) and overweight/obesity (>25 kg/m²). We evaluated the dose of recombinant follicle stimulating hormone (FSHr), the cancellation rates for ovarian cycle response, and the results of the assisted reproduction laboratory such as number of oocytes, number of good quality embryos, number of embryos transferred, and pregnancy rates, chemical pregnancy rates, miscarriage rate and live birth rate. The t test was used for comparison of quantitative variables between groups, and the χ2 test for comparison between qualitative variables. P values <0.05 were considered significant. RESULTS: considering ovulation induction characteristics, there was no statistically significant difference between groups regarding the FSHr dose administered or the cancellation rates, p=0.47 and p=0.85, respectively. Regarding laboratory findings, the number of oocytes retrieved per cycle was similar for both groups (p=0.09), as also was the number of good quality embryos obtained and transferred (p=0.7 and p=0.6). The pregnancy rate per embryo transfer was 27.6% for the group of normal weight and 29.6% for the overweight/obese group (p=0.76). Miscarriage rates and birth rates were similar for both groups, p=0.54 and p=0.94. CONCLUSION: BMI did not influence IVF/ICSI outcomes evaluated.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(11):536-540
DOI 10.1590/S0100-72032010001100004
PURPOSE: to evaluate the impact of body mass index (BMI) on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes performed at the Human Reproduction Center of Faculdade de Medicina do ABC. METHODS: retrospective data from 488 IVF cycles of 385 patients. Patients were classified into two groups according to BMI: normal weight (18.5-24.9 kg/m²) and overweight/obesity (>25 kg/m²). We evaluated the dose of recombinant follicle stimulating hormone (FSHr), the cancellation rates for ovarian cycle response, and the results of the assisted reproduction laboratory such as number of oocytes, number of good quality embryos, number of embryos transferred, and pregnancy rates, chemical pregnancy rates, miscarriage rate and live birth rate. The t test was used for comparison of quantitative variables between groups, and the χ2 test for comparison between qualitative variables. P values <0.05 were considered significant. RESULTS: considering ovulation induction characteristics, there was no statistically significant difference between groups regarding the FSHr dose administered or the cancellation rates, p=0.47 and p=0.85, respectively. Regarding laboratory findings, the number of oocytes retrieved per cycle was similar for both groups (p=0.09), as also was the number of good quality embryos obtained and transferred (p=0.7 and p=0.6). The pregnancy rate per embryo transfer was 27.6% for the group of normal weight and 29.6% for the overweight/obese group (p=0.76). Miscarriage rates and birth rates were similar for both groups, p=0.54 and p=0.94. CONCLUSION: BMI did not influence IVF/ICSI outcomes evaluated.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(9):454-458
DOI 10.1590/S0100-72032010000900007
PURPOSE: to evaluate and compare the effects of body mass index (BMI) on the severity of female urinary incontinence (UI) using the quality of life questionnaire King's Health Questionnaire (KHQ), variables of urodynamic studies and the medical history taken. METHODS: cross-sectional clinical study. We selected 65 patients with stress urinary incontinence (SUI) who were divided into three groups: Group I (BMI: 18-25 kg/m²), Group II (BMI: 25-30 kg/m²) and Group III (BMI>30 kg/m²). The KHQ domains were compared between these groups. In addition, some clinical history urodynamic data (presence of nocturia, enuresis, urgency and urge incontinence) were also related to BMI by calculating the Odds Ratio (OR). The BMI in the presence and absence of non-inhibited detrusor contractions and Valsalva leak point pressure (VLPP) <60 or > 60 cmH2O were evaluated. Finally, the correlation between BMI and the nine KHQ domains has been tested in order to detect some association. RESULTS: the KHQ did not record deterioration of quality of life in women with UI with increasing BMI in any of its areas. The OR for the presence of enuresis in relation to a BMI was 1.003 [CI: 0.897-1.121], p=0.962. The OR for nocturia was 1.049 [CI: 0.933-1.18], p=.425. The OR for urgency was 0.975 [CI: 0.826-1.151], p=0.762, and the OR for incontinence was 0.978 [CI: 0.85-1.126], p=0.76. We studied the BMI in patients with and without non-inhibited detrusor contractions and detected medians of 26.4±4.8 and 28.3±5.7 kg/m², respectively (p=0.6). Similarly, the median BMI values for the groups with VLPP <60 and >60 cmH2O were 29.6±4.1 and 27.7±5.7 kg/m², respectively (p=0.2). Finally, we failed to demonstrate an association between BMI and any of the nine KHQ domains by means of the Spearman correlation. CONCLUSION: there was no association of KHQ scores with BMI. There was also no correlation between the parameters of clinical history and of the urodynamic study with BMI.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(9):454-458
DOI 10.1590/S0100-72032010000900007
PURPOSE: to evaluate and compare the effects of body mass index (BMI) on the severity of female urinary incontinence (UI) using the quality of life questionnaire King's Health Questionnaire (KHQ), variables of urodynamic studies and the medical history taken. METHODS: cross-sectional clinical study. We selected 65 patients with stress urinary incontinence (SUI) who were divided into three groups: Group I (BMI: 18-25 kg/m²), Group II (BMI: 25-30 kg/m²) and Group III (BMI>30 kg/m²). The KHQ domains were compared between these groups. In addition, some clinical history urodynamic data (presence of nocturia, enuresis, urgency and urge incontinence) were also related to BMI by calculating the Odds Ratio (OR). The BMI in the presence and absence of non-inhibited detrusor contractions and Valsalva leak point pressure (VLPP) <60 or > 60 cmH2O were evaluated. Finally, the correlation between BMI and the nine KHQ domains has been tested in order to detect some association. RESULTS: the KHQ did not record deterioration of quality of life in women with UI with increasing BMI in any of its areas. The OR for the presence of enuresis in relation to a BMI was 1.003 [CI: 0.897-1.121], p=0.962. The OR for nocturia was 1.049 [CI: 0.933-1.18], p=.425. The OR for urgency was 0.975 [CI: 0.826-1.151], p=0.762, and the OR for incontinence was 0.978 [CI: 0.85-1.126], p=0.76. We studied the BMI in patients with and without non-inhibited detrusor contractions and detected medians of 26.4±4.8 and 28.3±5.7 kg/m², respectively (p=0.6). Similarly, the median BMI values for the groups with VLPP <60 and >60 cmH2O were 29.6±4.1 and 27.7±5.7 kg/m², respectively (p=0.2). Finally, we failed to demonstrate an association between BMI and any of the nine KHQ domains by means of the Spearman correlation. CONCLUSION: there was no association of KHQ scores with BMI. There was also no correlation between the parameters of clinical history and of the urodynamic study with BMI.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):349-352
DOI 10.1590/S0100-72032009000700005
PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed, through the basal (U/L) follicle stimulating hormone (FSH), between the third and fifth days of the cycle, 12 months after the surgery. The body mass index (BMI) was calculated according to Quetelet's formula [weight (kg)/height(cm²)]. The Mann-Whitney non-parametric U test was used to compare the variables "age", "BMI" and "basal SFH" between the groups. RESULTS: there was no significant difference between the groups about age and BMI. Concerning basal FSH, in the group of patients with severe endometriosis, the average value was 7.0 U/L, while in the Control Group, it was 5.6 U/L (p=0.3), what demonstrates that the difference between the two groups was not significant. CONCLUSIONS: the surgery did not affect the ovarian reserve of patients with severe ovarian endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):349-352
DOI 10.1590/S0100-72032009000700005
PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed, through the basal (U/L) follicle stimulating hormone (FSH), between the third and fifth days of the cycle, 12 months after the surgery. The body mass index (BMI) was calculated according to Quetelet's formula [weight (kg)/height(cm²)]. The Mann-Whitney non-parametric U test was used to compare the variables "age", "BMI" and "basal SFH" between the groups. RESULTS: there was no significant difference between the groups about age and BMI. Concerning basal FSH, in the group of patients with severe endometriosis, the average value was 7.0 U/L, while in the Control Group, it was 5.6 U/L (p=0.3), what demonstrates that the difference between the two groups was not significant. CONCLUSIONS: the surgery did not affect the ovarian reserve of patients with severe ovarian endometriosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):405-410
DOI 10.1590/S0100-72031998000700006
Objective: to demonstrate the effectiveness of video-hysteroscopic endometrial resection in the treatment of abnormal uterine bleeding. Patients and method: The authors studied 60 records of patients with abnormal uterine bleeding who did not respond to clinical treatment. Results: eighty-eight percent of the patients had adequate response to the treatment (53% oligomenorrhea and 35% amenorrhea). The complication rate was 8.3% (5 uterine perforations). Conclusion: video-hysteroscopic endometrial resection is an effective technique to treat abnormal uterine bleeding which failed to respond to clinical management. The intra and postoperative complication rates are low.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):405-410
DOI 10.1590/S0100-72031998000700006
Objective: to demonstrate the effectiveness of video-hysteroscopic endometrial resection in the treatment of abnormal uterine bleeding. Patients and method: The authors studied 60 records of patients with abnormal uterine bleeding who did not respond to clinical treatment. Results: eighty-eight percent of the patients had adequate response to the treatment (53% oligomenorrhea and 35% amenorrhea). The complication rate was 8.3% (5 uterine perforations). Conclusion: video-hysteroscopic endometrial resection is an effective technique to treat abnormal uterine bleeding which failed to respond to clinical management. The intra and postoperative complication rates are low.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):41-45
DOI 10.1590/S0100-72031999000100007
Purpose: to demonstrate a new approach to treatment of endometrial cancer. Methods: Between February, 1996 and February, 1998, twelve patients with endometrial cancer, diagnosed by hysteroscopy and biopsy, were submitted to pelvic lymphadenectomy and hysterectomy with salpingo-oophorectomy by laparoscopy. The mean age was 58.1 years, the mean number of gestations was 2.3 and the mean body mass index was 28.6. Results: the mean length of anesthesia was 4.8 hours. The mean time of hospital stay was 3.3 days. The total of lymph nodes obtained was 176, 104 (59.1%) being from the right side and 72 (40.9%) from the left side. The mean of lymph nodes per patient was 18.5. We observed two complications: in one case the laparoscopic procedure had to be abandoned because the patient presented a dangerous increase in intratracheal pressure and in the other case a granuloma in the vagina was observed. Conclusions: the initial evaluation of the laparoscopic hysterectomy and laparoscopy shows that we achieved good results regarding the accuracy of staging, the number of nodes and a small number (3) of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):41-45
DOI 10.1590/S0100-72031999000100007
Purpose: to demonstrate a new approach to treatment of endometrial cancer. Methods: Between February, 1996 and February, 1998, twelve patients with endometrial cancer, diagnosed by hysteroscopy and biopsy, were submitted to pelvic lymphadenectomy and hysterectomy with salpingo-oophorectomy by laparoscopy. The mean age was 58.1 years, the mean number of gestations was 2.3 and the mean body mass index was 28.6. Results: the mean length of anesthesia was 4.8 hours. The mean time of hospital stay was 3.3 days. The total of lymph nodes obtained was 176, 104 (59.1%) being from the right side and 72 (40.9%) from the left side. The mean of lymph nodes per patient was 18.5. We observed two complications: in one case the laparoscopic procedure had to be abandoned because the patient presented a dangerous increase in intratracheal pressure and in the other case a granuloma in the vagina was observed. Conclusions: the initial evaluation of the laparoscopic hysterectomy and laparoscopy shows that we achieved good results regarding the accuracy of staging, the number of nodes and a small number (3) of complications.