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You searched for:"Hélio de Lima Ferreira Fernandes Costa"
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Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(8):391-396
DOI 10.1590/S0100-72032009000800004
PURPOSE: to study the changes in the urethrovesical junction (UVJ) and in the proximal urethra (PU) caused by the Marshall-Marchetti-Krantz-Burch (MMK-B) combined surgery through perineal ultrasonography. METHODS: an interventional, longitudinal and prospective study has been conducted. Thirty-two women with stress urinary incontinence were submitted to perineal ultrasonography before and 30 days after surgery to evaluate the pubo-urethral distance (PUD), the proximal urethra length, the UVJ horizontal distance (UVJHD) and the UVJ vertical distance (UVJVD), the patient being at rest, and in effort during the Valsava manoeuvre. Results have been expressed in mean and standard deviation. The Student's t-test has been used to compare pre and postoperative results whenever the variables fulfilled the normality test criterion; otherwise, the Wilcoxon's paired test has been used. RESULTS: as compared with the preoperative measures, the Marshall-Marchetti-Krantz-Burch surgery has reduced the PUD at rest (14 mm x 4.3 mm) and during effort (20.8 mm x 6.4 mm); has reduced the UVJHD at rest (14 mm x 4.3 mm) and during effort (20.8 mm x 6.4 mm); has increased the PU length at rest (16.7 mm x 19.7 mm) and during effort (1.6 mm x 15.4 mm); and has increased UVJVD during effort (-5.4 mm x 14.8 mm), but has not changed it at rest (16.2 mm x 18.7 mm, p = 0.085). CONCLUSIONS: the Marshall-Marchetti-Krantz-Burch surgery has significantly reduced the urethrovesical junction vertical and horizontal mobility without raising the urethrovesical junction.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(8):391-396
DOI 10.1590/S0100-72032009000800004
PURPOSE: to study the changes in the urethrovesical junction (UVJ) and in the proximal urethra (PU) caused by the Marshall-Marchetti-Krantz-Burch (MMK-B) combined surgery through perineal ultrasonography. METHODS: an interventional, longitudinal and prospective study has been conducted. Thirty-two women with stress urinary incontinence were submitted to perineal ultrasonography before and 30 days after surgery to evaluate the pubo-urethral distance (PUD), the proximal urethra length, the UVJ horizontal distance (UVJHD) and the UVJ vertical distance (UVJVD), the patient being at rest, and in effort during the Valsava manoeuvre. Results have been expressed in mean and standard deviation. The Student's t-test has been used to compare pre and postoperative results whenever the variables fulfilled the normality test criterion; otherwise, the Wilcoxon's paired test has been used. RESULTS: as compared with the preoperative measures, the Marshall-Marchetti-Krantz-Burch surgery has reduced the PUD at rest (14 mm x 4.3 mm) and during effort (20.8 mm x 6.4 mm); has reduced the UVJHD at rest (14 mm x 4.3 mm) and during effort (20.8 mm x 6.4 mm); has increased the PU length at rest (16.7 mm x 19.7 mm) and during effort (1.6 mm x 15.4 mm); and has increased UVJVD during effort (-5.4 mm x 14.8 mm), but has not changed it at rest (16.2 mm x 18.7 mm, p = 0.085). CONCLUSIONS: the Marshall-Marchetti-Krantz-Burch surgery has significantly reduced the urethrovesical junction vertical and horizontal mobility without raising the urethrovesical junction.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(10):524-530
DOI 10.1590/S0100-72032008001000008
Detection of endometrial cancer in asymptomatic women has not proved to be a cost-effective procedure. Studies on this matter have shown that ultrasonography as a detecting method presents a high ratio of false-positive results and a negligible effect on the mortality rate. This way, the assistance strategy should be based on earlier diagnosis and appropriate treatment in women who present postmenopause bleeding. Being a non-invasive method, largely available and with high sensitivity, the transvaginal ultrasonography should be the initial investigative method. Though there is no consensus about the echographical endometrial thickness, above which the investigation is to proceed, diagnostic hysteroscopy should be the next step. The risk of neoplasia in endometriums with thickness under or equal to 3 mm is low enough to limit hysteroscopy to exceptional cases. Biopsy must be a necessary part of the hysteroscopy, because the diagnosis, made on visual basis, alone may lead to false results. Outpatient hysteroscopy can be done in more than 95% of the cases, even in menopausal women, rarely with severe complications. The adoption of "non-contact" examination techniques and the progressive reduction of the hysteroscope diameter have decreased the discomfort associated to small outpatient procedures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(10):524-530
DOI 10.1590/S0100-72032008001000008
Detection of endometrial cancer in asymptomatic women has not proved to be a cost-effective procedure. Studies on this matter have shown that ultrasonography as a detecting method presents a high ratio of false-positive results and a negligible effect on the mortality rate. This way, the assistance strategy should be based on earlier diagnosis and appropriate treatment in women who present postmenopause bleeding. Being a non-invasive method, largely available and with high sensitivity, the transvaginal ultrasonography should be the initial investigative method. Though there is no consensus about the echographical endometrial thickness, above which the investigation is to proceed, diagnostic hysteroscopy should be the next step. The risk of neoplasia in endometriums with thickness under or equal to 3 mm is low enough to limit hysteroscopy to exceptional cases. Biopsy must be a necessary part of the hysteroscopy, because the diagnosis, made on visual basis, alone may lead to false results. Outpatient hysteroscopy can be done in more than 95% of the cases, even in menopausal women, rarely with severe complications. The adoption of "non-contact" examination techniques and the progressive reduction of the hysteroscope diameter have decreased the discomfort associated to small outpatient procedures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):25-30
DOI 10.1590/S0100-72032008000100005
PURPOSE: to compare diagnostic hysteroscopy through vaginoscopy, using warm saline solution, with traditional technique, regarding to pain, patient satisfaction and feasibility of the procedure. METHODS: randomized clinical trial, involving 184 women, referred for diagnostic hysteroscopy, between May and December of 2006. Participants were randomized to be submitted to hysteroscopy by the proposed technique, which consisted of access through vaginoscopy using normal saline at 36ºC as distension medium, no speculum or cervical grasping, or by the traditional technique with CO2. In both techniques, a 2.7 mm hysteroscope was used. Pain was assessed by the analogical visual scale, during the procedure and every five minutes after it. RESULTS: the mean pain score was 1.60 in the proposed technique and 3.39 in the traditional technique (p<0.01). Lower pain scores were also observed after 5, 10 and 15 minutes (p<0,01) as well as after 20 minutes (p=0.056). In the proposed technique, 82.4% of the procedures were feasible, while, in the traditional technique, 84.9% were so (p=0.64). Satisfaction with the procedure was referred by 88.7% of women submitted to the proposed technique and by 76.3% of women submitted to the traditional technique (p<0.05). CONCLUSIONS: diagnostic hysteroscopy by the proposed technique resulted in less pain, same feasibility and greater satisfaction of patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):25-30
DOI 10.1590/S0100-72032008000100005
PURPOSE: to compare diagnostic hysteroscopy through vaginoscopy, using warm saline solution, with traditional technique, regarding to pain, patient satisfaction and feasibility of the procedure. METHODS: randomized clinical trial, involving 184 women, referred for diagnostic hysteroscopy, between May and December of 2006. Participants were randomized to be submitted to hysteroscopy by the proposed technique, which consisted of access through vaginoscopy using normal saline at 36ºC as distension medium, no speculum or cervical grasping, or by the traditional technique with CO2. In both techniques, a 2.7 mm hysteroscope was used. Pain was assessed by the analogical visual scale, during the procedure and every five minutes after it. RESULTS: the mean pain score was 1.60 in the proposed technique and 3.39 in the traditional technique (p<0.01). Lower pain scores were also observed after 5, 10 and 15 minutes (p<0,01) as well as after 20 minutes (p=0.056). In the proposed technique, 82.4% of the procedures were feasible, while, in the traditional technique, 84.9% were so (p=0.64). Satisfaction with the procedure was referred by 88.7% of women submitted to the proposed technique and by 76.3% of women submitted to the traditional technique (p<0.05). CONCLUSIONS: diagnostic hysteroscopy by the proposed technique resulted in less pain, same feasibility and greater satisfaction of patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):532-537
DOI 10.1590/S0100-72032007001000007
PURPOSE: to determine the effects of soy-derived isoflavone on hot flashes, menopausal symptoms, and endometrial thickness in postmenopausal women. METHODS: this double-blind, placebo-controlled, randomized study involved 90 postmenopausal patients aged 45-60 years old attended at the Outpatient Menopause Clinic. All patients had been experiencing hot flashes accompanied or not by other hypo-estrogenic symptoms. Patients were randomized to receive either two soy capsules containing 50 mg of soy-derived isoflavone or two identical placebo capsules, twice a day for 12 weeks in a double-blind fashion. Each patient was observed for 12 weeks, with two evaluations being made, one at baseline and the other at the end of the study. At each time point, the patients were given a diary to record the severity of the climacteric symptoms experienced, assessed with a modified Kupperman index, using a 100 mm Visual Analogue Scale (VAS). The intensity of hot flashes was also assessed separately. The patients were also submitted to a transvaginal echography for the measurement of endometrial thickness. Yates chi2, ANOVA or t de Student and Mann-Whitney were used for statistical analysis. RESULTS: no significant difference was detected in the Kupperman index (64 versus 82, p>0,05) or in the hot flashes (20 versus 20, p>0,05) between the isoflavone and placebo groups. No significant difference was either detected concerning the Kupperman index and hot flashes before and after treatment, when the two groups were analyzed separately. No difference was detected in the endometrial thickness either in the isoflavone or the placebo group (0.28 versus 0.26 mm, respectively, p>0.05). CONCLUSIONS: our results indicate that 100 mg of isoflavone are not more effective than placebo in reducing hot flashes and hypo-estrogenic symptoms in postmenopausal women and present no effect on the endometrium thickness.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):532-537
DOI 10.1590/S0100-72032007001000007
PURPOSE: to determine the effects of soy-derived isoflavone on hot flashes, menopausal symptoms, and endometrial thickness in postmenopausal women. METHODS: this double-blind, placebo-controlled, randomized study involved 90 postmenopausal patients aged 45-60 years old attended at the Outpatient Menopause Clinic. All patients had been experiencing hot flashes accompanied or not by other hypo-estrogenic symptoms. Patients were randomized to receive either two soy capsules containing 50 mg of soy-derived isoflavone or two identical placebo capsules, twice a day for 12 weeks in a double-blind fashion. Each patient was observed for 12 weeks, with two evaluations being made, one at baseline and the other at the end of the study. At each time point, the patients were given a diary to record the severity of the climacteric symptoms experienced, assessed with a modified Kupperman index, using a 100 mm Visual Analogue Scale (VAS). The intensity of hot flashes was also assessed separately. The patients were also submitted to a transvaginal echography for the measurement of endometrial thickness. Yates chi2, ANOVA or t de Student and Mann-Whitney were used for statistical analysis. RESULTS: no significant difference was detected in the Kupperman index (64 versus 82, p>0,05) or in the hot flashes (20 versus 20, p>0,05) between the isoflavone and placebo groups. No significant difference was either detected concerning the Kupperman index and hot flashes before and after treatment, when the two groups were analyzed separately. No difference was detected in the endometrial thickness either in the isoflavone or the placebo group (0.28 versus 0.26 mm, respectively, p>0.05). CONCLUSIONS: our results indicate that 100 mg of isoflavone are not more effective than placebo in reducing hot flashes and hypo-estrogenic symptoms in postmenopausal women and present no effect on the endometrium thickness.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):631-635
DOI 10.1590/S0100-72032003000900003
PURPOSE: to evaluate maternal age of 40 and older as an independent risk factor for pregnancy-induced hypertension (PIH). METHOD: we conducted a retrospective cohort study involving analysis of medical records of 2047 women in labor, divided into groups of 298 aged 40 and older and 1749 aged under 40. A multiple logistic regression was done to evaluate the association of maternal age with the occurrence of PIH adjusted by parity, chronic arterial hypertension, diabetes and twin pregnancy. RESULTS: the incidence of PIH in patients aged 40 and over was 22.1% (66/298), higher than in patients aged under 40 (16%, 286/1463). PIH was diagnosed in 27.2% of primiparous (174/640), 47.6% of chronic hypertensive (30/66) and 27.1% of diabetic patients (13/48). Advancing maternal age, primiparity and chronic arterial hypertension were associated with the occurrence of PIH in univariate analysis (OR = 1.46, 2.58 and 4.69, respectively). There was no significant association with diabetes. After the adjustment we observed an increase in the strength of the association between maternal age and PIH (adjusted OR = 1.69), as well as parity and chronic arterial hypertension. CONCLUSION: maternal age of 40 and older was a risk factor for the occurrence of PIH independent of parity, chronic arterial hypertension and diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):631-635
DOI 10.1590/S0100-72032003000900003
PURPOSE: to evaluate maternal age of 40 and older as an independent risk factor for pregnancy-induced hypertension (PIH). METHOD: we conducted a retrospective cohort study involving analysis of medical records of 2047 women in labor, divided into groups of 298 aged 40 and older and 1749 aged under 40. A multiple logistic regression was done to evaluate the association of maternal age with the occurrence of PIH adjusted by parity, chronic arterial hypertension, diabetes and twin pregnancy. RESULTS: the incidence of PIH in patients aged 40 and over was 22.1% (66/298), higher than in patients aged under 40 (16%, 286/1463). PIH was diagnosed in 27.2% of primiparous (174/640), 47.6% of chronic hypertensive (30/66) and 27.1% of diabetic patients (13/48). Advancing maternal age, primiparity and chronic arterial hypertension were associated with the occurrence of PIH in univariate analysis (OR = 1.46, 2.58 and 4.69, respectively). There was no significant association with diabetes. After the adjustment we observed an increase in the strength of the association between maternal age and PIH (adjusted OR = 1.69), as well as parity and chronic arterial hypertension. CONCLUSION: maternal age of 40 and older was a risk factor for the occurrence of PIH independent of parity, chronic arterial hypertension and diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):371-376
DOI 10.1590/S0100-72032001000600005
Purpose: to evaluate the results of the first 104 hysteroscopic polypectomies in a teaching hospital. Methods: a retrospective descriptive study was designed. Medical records of the first 136 operative hysteroscopies - 104 of which polypectomies - were reviewed. Patient characteristics such as age, parity, period of reproductive function and symptoms; number and size of polyps and results concerning complications and symptom relief were evaluated. Results: the average age of patients was 52.7 years. Three quarters of them were multiparous. Fifty-seven percent of the patients were menopaused. About half of the patients had symptoms related to polyps. Abnormal bleeding was the most frequent symptom (47.1%). In 16.3% of the patients more than 1 polyp were detected and 84% of the polyps were larger than 1 cm. The only immediate complication was a uterine perforation. Late complications were rare and mild. The follow-up period was 9 months on average. In 82% of teh patients the symptoms were controlled. Hysterectomy was necessary in 8.2% of the patients, all of them with other uterine diseases such as leiomyomas, adenomyosis and atypical endometrial hyperplasia in one patient). Conclusion: hysteroscopic polypectomy is a simple, safe and effective method for the treatment of endometrial polyps. Selection of patients must be rigorous to avoid further operative procedures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):371-376
DOI 10.1590/S0100-72032001000600005
Purpose: to evaluate the results of the first 104 hysteroscopic polypectomies in a teaching hospital. Methods: a retrospective descriptive study was designed. Medical records of the first 136 operative hysteroscopies - 104 of which polypectomies - were reviewed. Patient characteristics such as age, parity, period of reproductive function and symptoms; number and size of polyps and results concerning complications and symptom relief were evaluated. Results: the average age of patients was 52.7 years. Three quarters of them were multiparous. Fifty-seven percent of the patients were menopaused. About half of the patients had symptoms related to polyps. Abnormal bleeding was the most frequent symptom (47.1%). In 16.3% of the patients more than 1 polyp were detected and 84% of the polyps were larger than 1 cm. The only immediate complication was a uterine perforation. Late complications were rare and mild. The follow-up period was 9 months on average. In 82% of teh patients the symptoms were controlled. Hysterectomy was necessary in 8.2% of the patients, all of them with other uterine diseases such as leiomyomas, adenomyosis and atypical endometrial hyperplasia in one patient). Conclusion: hysteroscopic polypectomy is a simple, safe and effective method for the treatment of endometrial polyps. Selection of patients must be rigorous to avoid further operative procedures.