Revista Brasileira de Ginecologia e Obstetricia最新文献

{"title":"Grau de subestimação histopatológica por core biopsy de lesões não palpáveis da mama","authors":"Aline Valadão Britto Gonçalves, Luiz Claudio Santos Thuler, Fabíola Procaci Kestelman, Pedro Carmo, C.F.F Lima, R. Cipolotti","doi":"10.1590/S0100-72032011000700002","DOIUrl":"https://doi.org/10.1590/S0100-72032011000700002","url":null,"abstract":"OBJETIVO: Determinar o grau de subestimacao de core biopsy, guiada por imagem, de lesoes impalpaveis da mama subsequentemente submetidas a exerese cirurgica. METODOS: Foram revisados retrospectivamente 352 casos com biopsias de fragmento que foram submetidos a cirurgia entre fevereiro de 2000 e dezembro de 2005, cujo laudo histopatologico estava registrado no sistema interno de informacao. Os resultados foram comparados com os da cirurgia e a taxa de subestimacao foi calculada dividindo-se o numero de carcinoma in situ e/ou invasivo a cirurgia pelo numero de lesoes de alto risco ou carcinoma in situ que foram submetidas a cirurgia. O grau de concordância entre os resultados foi obtido pelo percentual de concordância e pelo coeficiente kappa de Cohen. A associacao das variaveis estudadas com a subestimacao do diagnostico foi verificada pelos testes do c2 exato de Fisher, ANOVA e Mann-Whitney U. O risco de subestimacao foi medido por meio do risco relativo acompanhado dos respectivos intervalos com 95% de confianca (IC95%). RESULTADOS: Core biopsy foi inconclusiva em 15,6%. O laudo histopatologico foi benigno em 26,4%, sugestivo de lesao de alto risco em 12,8% e maligno em 45,2%. A concordância entre a core biopsy e a cirurgia foi de 82,1% (kappa=0,75). A taxa de falso negativo foi de 5,4% e a lesao foi completamente removida em 3,4%. A taxa de subestimacao foi de 9,1% e esteve associada com BI-RADS® categoria 5 (p=0,01), microcalcificacoes (p < 0,001) e estereotaxia (p= 0,002). Todos os casos subestimados apresentavam diâmetro menor que 20 mm e em todos foram retirados pelo menos cinco fragmentos. A taxa de subestimacao para lesoes de alto risco foi de 31,1%, 41,2%, para hiperplasia ductal atipica, 31,2% para lesoes papiliferas, 16,7% para tumor filoides e 41,9% para carcinoma ductal in situ. CONCLUSOES: Core biopsy guiada por imagem e um procedimento confiavel, contudo permanece a recomendacao de resseccao cirurgica de lesoes de alto risco detectadas a biopsia de fragmento ja que nao foi possivel estabelecer caracteristicas clinicas, imaginologicas, do procedimento e patologicas que pudessem predizer subestimacao e evitar a cirurgia. Amostras representativas da lesao sao mais importantes que o numero de fragmentos.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desenvolvimento das fissuras cerebrais fetais: avaliação com ultrassonografia tridimensional","authors":"C. Alves, Edward Araújo Júnior, L. M. M. Nardozza, P. S. Oliveira, Suzan Menasce Goldman, S. Ajzen, A. F. Moron","doi":"10.1590/S0100-72032011000300002","DOIUrl":"https://doi.org/10.1590/S0100-72032011000300002","url":null,"abstract":"OBJETIVO: avaliar a distância das fissuras cerebrais fetais a borda interna da calota craniana por meio da ultrassonografia tridimensional (US3D). METODOS: realizou-se um estudo de corte transversal em 80 gestantes normais entre a 21a e 34a semanas de gestacao. Avaliou-se a distância entre a tabua ossea interna da calota craniana fetal e as fissuras de Sylvius, parieto-occipital, hipocampo e calcarina. Para a obtencao desta distância para as tres primeiras fissuras, realizou-se uma varredura tridimensional atraves do plano axial (nivel dos ventriculos laterais). Para a obtencao da distância da fissura calcarina utilizou-se uma varredura coronal (nivel dos lobos occiptais). Para avaliar a correlacao entre as fissuras e a idade gestacional foram realizadas regressoes de primeiro grau, sendo os ajustes calculados pelo coeficiente de determinacao (R2). Foram determinados percentis 5, 50 e 95 para cada fissura. Avaliou-se ainda a correlacao entre a distância destas fissuras com os diâmetros biparietal (DBP) e circunferencia craniana (CC) utilizando o coeficiente de correlacao de Pearson (r). RESULTADOS: todas as medidas das fissuras apresentaram correlacao linear com a idade gestacional (Sylvius: R2=0,5; parieto-occipital: R2=0,7; hipocampo: R2=0,3 e calcarina: R2=0,3). A media da distância das fissuras variou de 7,0 a 14,0 mm, 15,9 a 28,7 mm, 15,4 a 25,4 mm e 15,7 a 24,8 mm para as fissuras de Sylvius, parieto-occipital, hipocampo e calcarina, respectivamente. As fissuras de Sylvius e parieto-occipital apresentaram as maiores correlacoes com o DBP (r=0,8 e 0,7, respectivamente) e a CC (r=0,7 e 0,8, respectivamente). CONCLUSOES: a distância das fissuras cerebrais fetais a borda interna da calota craniana por meio da US3D apresentou correlacao positiva com a idade gestacional.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comportamento do médico residente diante das questões sobre função sexual no ciclo gravídico-puerperal: comparação entre três especialidades - Ginecologia/Obstetrícia, Psiquiatria e Clínica Médica","authors":"T. C. Vieira","doi":"10.1590/S0100-72032011000300009","DOIUrl":"https://doi.org/10.1590/S0100-72032011000300009","url":null,"abstract":"ObjetivO: comparar o comportamento do médico residente de Ginecologia e Obstetrícia (GO) com o de Clínica Médica (CM) e Psiquiatria (Psiq), perante as questões da função sexual, enfocando sua conduta profissional. MetOdOlOgia: estudo observacional,transversal, usando questionário adaptado, autorresponsivo e anônimo. ResultadOs: 154 questionários (92,5%) foram considerados válidos (74CM, 33 Psiq e 47GO). Somente 19,5 % dos médicos investigam queixas sexuais espontaneamente, apesar de que 68,2% concordam que estas questões devem fazer parte de todas as anamneses. Somente 22,7%, das 3 especialidades, afirmam ter segurança total para responder a questões sexuais; entretanto diante destas, 76% ouvem e orientam e 70,8% admitem faltar conhecimento específico sobre sexualidade. O GO foi o profissional mais indicado para tratar disfunções sexuais femininas (89%).Entretanto, o GO não conhece o ciclo de resposta sexual feminina (74,5%), além de que, ele se considera menos apto a tratar desejo hipoativo (25,5%) e anorgasmia (17%) comparado com o de psiquiatria (respectivamente, 69,7% e 57,6%). A maioria achou o estudo instigante e educativo: Clínica Médica (47,3%), Psiquiatria (69,7%) e Ginecologia/Obstetrícia (74,5%). A participação,neste trabalho aumentou o interesse pelo tema em todas as especialidades (60,4%). COnClusões: residentes de Psiquiatria investigaram espontaneamente e com maior frequência as queixas sexuais de suas pacientes, além de relatarem maior aptidão em tratar desejo hipoativo e anorgasmia, enquanto os GO sentiram maior habilidade para: lubrificação deficiente, sinussorragia e hipotonia e/ou rotura do assoalho pélvico. Os residentes de Clínica Médica, por seu lado, foram os que menos indagaram, menos atenderam e não se consideraram aptos a tratar queixas sexuais. Os médicos das 3 áreas de residência afirmaram não possuírem segurança, nem conhecimento específico suficiente para responder às questões sobre função sexual. A maioria dos residentes considerou este estudo instigante e educativo. Somente responder ao questionário despertou interesse em ampliar o conhecimento na área de Sexualidade.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sexuality in women undergoing total and subtotal hysterectomy","authors":"Nayara de Paula Faleiros","doi":"10.1590/S0100-72032011000300012","DOIUrl":"https://doi.org/10.1590/S0100-72032011000300012","url":null,"abstract":"","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eficácia de dinoprostone e misoprostol para indução do trabalho de parto em nulíparas","authors":"Tenilson Amaral Oliveira, Elisane Melo, Márcia Maria Auxiliadora de Aquino, Corintio Mariani Neto","doi":"10.1590/S0100-72032011000300003","DOIUrl":"https://doi.org/10.1590/S0100-72032011000300003","url":null,"abstract":"PURPOSE: to determine the efficacy and safety of dinoprostone and misoprostol for the induction of vaginal childbirth, with or without the use of oxytocin in nulliparous women. METHODS: in this retrospective observational study, 238 patients were subjected to the induction of delivery from January 2008 to February 2010 with the use of misoprostol 25 mcg by the vaginal route or a pessary containing 10 mg of dinoprostone. A total of 184 patients were selected, with the following characteristics: nulliparous, gestational age of 37-42 weeks, singleton pregnancies, cephalic presentation, intact membranes, and Bishop score < 3. Obstetric and neonatal data were analyzed and compared between groups. The Student t-test, chi-square test and Fisher's exact test were used for statistical analysis, with the level of significance set at p<0.05. RESULTS: the rate of vaginal childbirth did not differ significantly in patients who used misoprostol and dinoprostone (43.2% versus 50%; p = 0.35, respectively). The ripening of cervix was higher in the group treated with misoprostol (87.3% versus 75.6%, p=0.04). The use of oxytocin was necessary in 58.8% of the misoprostol group and 57.3% in the dinoprostone group after the ripening of cervix. Failed induction was the primary indication of caesarean section delivery in both groups, with no significant difference between them. Fetal and maternal adverse events, such as tachysystole and Apgar scores were similar. CONCLUSION: dinoprostone and misoprostol are both effective for vaginal childbirth induction, although they need to be combined with oxytocin. They showed a similar safety profile, with misoprostol being more efficient regarding cervical ripening.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometriose em cicatriz cirúrgica: uma série de 42 pacientes","authors":"F. Vilarino, Bianca Bianco, A. Martins, Denise Maria Christofolini, C. Barbosa","doi":"10.1590/S0100-72032011000300004","DOIUrl":"https://doi.org/10.1590/S0100-72032011000300004","url":null,"abstract":"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.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presença de células da junção escamo-colunar em esfregaços cérvico-vaginais de mulheres acima de 40 anos","authors":"G. A. Nai, Karen Karina Gusmão de Souza, Eliane Rissato Rodrigues, Ricardo Luís Barbosa","doi":"10.1590/S0100-72032011000300005","DOIUrl":"https://doi.org/10.1590/S0100-72032011000300005","url":null,"abstract":"PURPOSE: to evaluate the frequency of cells of the cervical transitional zone (CTZ) in cervicovaginal smears of women older than 40 years. METHODS: we conducted a retrospective study with review of 24,316 Pap smear reports during the period from January 2005 to December 2008, to evaluate the cases without material of the CTZ. Exclusion criteria were: total hysterectomy, smears with severe atrophy or unsatisfactory for analysis, cases without visualization of the cervix or the external orifice of the cervix closed during examination and records without the patient's age. A total of 21,866 cervical-vaginal cytology reports were included in this study. We evaluated the relationship between the presence of material of the CTZ and use of hormone replacement therapy (HRT) in patients aged 40 years or more and the relationship between presence of material of the CTZ and a moderate to intense inflammatory process in patients aged 39 years or less. Data were analyzed statistically by the χ2 test and Odds Ratio. RESULTS: only 11.2% of patients younger than 40 years had no material from the CTZ in their smears, while 47% patients older than 40 years had no material from the CTZ (p=0.0001). Most patients aged 40 years or more (92.1%) did not use HRT and this was not a predictor of incidence of CTZ material in these patients (p> 0.05). In contrast, most patients younger than 40 years without CTZ material (74.5%) had abundant inflammation in the smears (p=0.0001). CONCLUSION: patients aged 40 years or more had a lower incidence of material from the CTZ in cervicovaginal smears, and inflammation was a factor that contributed to the absence of CTZ material in the smears from patients younger than 40 years.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1590/S0100-72032011000300005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and epidemiological evaluation and quality of life in women with breast cancer","authors":"P. B. M. Soares","doi":"10.1590/S0100-72032011000300010","DOIUrl":"https://doi.org/10.1590/S0100-72032011000300010","url":null,"abstract":"","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlação entre as queixas de incontinência urinária de esforço e o pad test de uma hora em mulheres na pós-menopausa","authors":"Maria Thereza Aragão Albuquerque, Barbosa Cabral Micussi, Elvira Maria Mafaldo Soares, T. Lemos, Tereza Neuma Sousa Brito, João Batista da Silva, Técia Maria do Oliveira Maranhão","doi":"10.1590/S0100-72032011000200003","DOIUrl":"https://doi.org/10.1590/S0100-72032011000200003","url":null,"abstract":"OBJECTIVE: to correlate complaints of stress urinary incontinence and the results of a one-hour pad test in pre- and postmenopausal women. METHODS: cross-sectional study conducted on 60 postmenopausal volunteers divided into two groups: one consisting of 34 women with involuntary loss of urine due to stress incontinence and the other consisting of 26 women without involuntary loss of urine. A control group of 15 premenopausal women with normal menstrual cycles and no urinary complaints was also used. All women underwent clinical and laboratory analysis as well as the one-hour pad test. Patients were considered to be incontinent when sanitary pad weight post-test was more than 1 g. Data were submitted to descriptive statistics, parametric ANOVA, post-hoc Tukey test and Pearson's correlation. RESULTS: all postmenopausal women presented with stress urinary incontinence during the pad test, both those with urinary loss (4 g) and with no previous loss (3.5 g). A strong correlation was observed between urinary loss and time since menopause (r=0.8; p<0.01) and body mass index (r=0.7; p=0.01). Premenopausal women were continent during the pad test (0.4 g). CONCLUSIONS: the results of the one-hour pad test showed that all postmenopausal women exhibited stress urinary incontinence, including those without urine loss on effort. Urine loss was correlated with time since menopause and body mass index.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Análise do polimorfismo Fok1 do gene VDR em mulheres inférteis com endometriose","authors":"F. Vilarino, Bianca Bianco, Denise Maria Christofolini, T. G. Lerner, C. Barbosa","doi":"10.1590/S0100-72032011000200002","DOIUrl":"https://doi.org/10.1590/S0100-72032011000200002","url":null,"abstract":"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.","PeriodicalId":47257,"journal":{"name":"Revista Brasileira de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67234384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}