César Eduardo Fernandes

Breast arterial calcification is a predictive factor of cardiovascular disease in Brazilian postmenopausal women.

Objective The objectives of this study were to evaluate the association between cardiovascular disease (CVD) and breast arterial calcification (BAC), as well as the prevalence rates of these conditions in Brazilian postmenopausal women. Methods A cross-sectional study was performed in 307 women over 40 years of age who were receiving care at the gynecology clinic of the Center for Womens Integrated Healthcare (CAISM), ABC School of Medicine. All these women had been amenorrheic for at least 12 months and had undergone mammography in the preceding 12 months. Cardiovascular disease and its subtypes were evaluated, as well as its association with BAC. Means and standard deviations, absolute frequencies and percentages were calculated, and univariate analysis and multiple logistic regression were performed. Results The mean age of the patients was 55.2 ± 6.8 years; age at menopause was 48.5 ± 4 years. Time since menopause was 80.2 ± 75.4 months; 96.1% of the patients were non-smokers and 46.3% were using hormone therapy. Of the patients, 33.6% had systemic arterial hypertension, 4.9% had diabetes mellitus and 5.2% had hypercholesterolemia. The mean body mass index was 27.3 ± 4.3 kg/m2. CVD was found in 6.8% and BAC in 8.5% of the women. Significantly more women with BAC had CVD compared to the women who did not have this condition (23.1% vs. 5.3%, p = 0.0006). BAC was associated with an odds ratio of 8.13 (95% confidence interval 2.68–24.64) for predicting CVD. Conclusions In postmenopausal women, breast arterial calcification may represent a higher likelihood of cardiovascular disease.

Câncer de Mama Associado à Gravidez: Um Estudo Caso/Controle

Purpose: to report 15 breast cancer cases associated with pregnancy and to compare to a control group with breast ductal infiltrating carcinoma, evaluating clinical staging, metastatic axillary lymph node involvement, histopathologic aspects related to nuclear grade, histology grade and estrogen and progesterone hormonal receptors. Method: a retrospective study of 15 cases of patients with breast cancer associated with pregnancy, attended at Mastology Department in the Woman Health Reference Center, Perola Byington Hospital, Sao Paulo, was done between September 1996 and April 2001. The evaluation of clinical staging, time of diagnosis and involved axillary lymph nodes was the main study basis. Also age, parity, histologic type, applied treatment, histologic characteristics regarding nuclear grade and histologic grade and the presence of hormonal receptors in the tumors were analyzed. Results: we observed that 7 patients (46.7%) presented a locally advanced breast cancer (clinical stage IIIA and IIIB) and that 3 patients (20%) presented a disseminated disease at the moment of diagnosis. The patients presented on average 2.4 involved axillary lymph nodes and in only one patient the lymph nodes were free of disease (6.6%). Regarding time of diagnosis, 40% of the tumors were diagnosed during the lactational period, 46.7% during the second trimester and 13.3% during the third trimester. The pregnant patients were compared to a control group of non-pregnant patients in the same age range, all of them with infiltrating breast carcinoma, and clinical staging, axillary lymph node involvement, nuclear grade, histologic grade and estrogen and progesterone hormonal receptors were evaluated. There was a statistically significant difference (p=0.0022) regarding clinical staging and axillary lymph node involvement (p=0.0017), and no statistically significant difference as concerns the remaining parameters. Conclusion: breast cancer associated with pregnancy is a neoplasia with a bad prognosis. There is no difference when comparing pregnant patients with non-pregnant patients in the same age range, the advanced clinical staging at the moment of diagnosis being the determinant factor for survival.

Effects of estrogen and estrogen-progestogen therapy on homocysteine levels and their correlation with carotid vascular resistance.

Objective. To evaluate the correlation between homocysteine levels and carotid vascular resistance in menopausal women submitted to estrogen and estrogen–progestogen therapy. Methods. Eighty-six women with a mean age of 52 years were enrolled in a prospective, randomized, double-blind, 6-month study. Patients were allocated to use one of three oral therapies: placebo (n = 26), micronized estradiol 2 mg/day (n = 30) or micronized estradiol 2 mg/day plus norethisterone acetate 1 mg/day (n = 30). Evaluation of homocysteine levels and Doppler sonography of the common carotid artery, used to calculate pulsatility index (PI), were carried out prior to initiating therapy and at the end of the study. The correlation between these two parameters was evaluated using Pearsons coefficient of correlation. Results. There was a significant reduction in homocysteine levels in the groups treated with estrogen alone or estrogen combined with norethisterone. PI was significantly lower only in users of estrogen alone; however, no significant correlation was found between homocysteine measurements and PI. Conclusion. No significant correlation was found between homocysteine levels and carotid vascular resistance following hormone therapy.

Evaluation of tibolone effect on arterial resistance in postmenopausal women.

Objective: The aim of this study was to evaluate the effect of tibolone on peripheral vascular resistance in postmenopausal women, by determination of the pulsatility index (PI) of the common carotid, radial and popliteal arteries using Doppler ultrasonography. Methods: Twenty-nine patients were studied in a longitudinal, prospective, before and after study, for 7 months. The patients did not suffer from cardiovascular disease or any other conditions that would interfere with vascular resistance, and had no contraindications for hormone replacement therapy (HRT). Tibolone was used in a dose of 2.5 mg, orally, continuously for 6 months. Color duplex Doppler ultrasonography of the right and left common carotid, radial and popliteal arteries was carried out to determine PI, using the average value found in both sides at baseline (before administration of the drug), 3 and 6 months after initiating medication and 1 month after discontinuation of the drug. PI was determined by means of spectral analysis of the best arterial blood flow waveform, and pretreatment values (baseline) were used as control. Results: In the common carotid artery, no significant differences in PI were observed at 3 and 6 months, in comparison with baseline. A significant decrease in PI was noted in the radial artery at 6 months as compared with baseline (decrease of 51.5%). PI in the popliteal artery also presented a significant decrease at 6 months in relation to baseline (decrease of 28.6%). The results were statistically assessed by ANOVA (analysis of variance). Conclusion: There was no significant variance in PI in the common carotid artery; however, in the radial and popliteal arteries there was significant variance, and their resistance decreased after use of tibolone for 6 months but returned to the pretreatment values 1 month after discontinuation of the drug.

Transvaginal ultrasonography assessment of ovarian volumes in postmenopausal women

The authors evaluated ovarian volumes by transvaginal ultrasonography at different periods after menopause. Ninety-eight postmenopausal women with an average age of 51.9 years and a one- to eight-year postmenopausal period were studied. The control group consisted of 40 women during menacme with an average age of 31.8 years, who were also submitted to transvaginal ultrasonography to evaluate ovarian volume. There was no significant difference between right and left ovarian volumes in the study groups. There was a significant decrease in measure and standard deviations of the volumes after the first year of menopause (mean volume--2.2 +/- 0.9 cm3) when compared to the control group (mean volume--6.3 +/- 2.0 cm3), followed by a slow and gradual shrinking after this phase. Decrease in ovarian volume became significant after the fourth postmenopausal year. Transvaginal ultrasonography demonstrated great importance as an investigative method of ovarian diseases in postmenopausal women.

Association of breast vascular calcifications with low bone mass in postmenopausal women.

Abstract Background In developing countries, there is a deficiency of densitometers with which to screen the population for osteoporosis. Thus, strategies with which to select patients for a bone density test are desirable. Objective To determine whether breast vascular calcifications (BVCs) may be employed to identify postmenopausal women with osteoporosis/osteopenia. Methods This was a cross-sectional study of postmenopausal women subjected to bilateral mammography and bone densitometry (DXA) of the spine and hip. A medical interview registered possible confounding factors, such as age, length of menopause, previous use of postmenopausal hormone therapy, family history of osteoporosis, smoking, alcoholism, hypertension, diabetes, cardiovascular diseases, and medication use. Results The study included 211 postmenopausal women aged 62.1 ± 9.3 years, 38 of whom (18.0%) exhibited BVC. Osteoporosis was detected in 36 (17.1%), and a T-score < 21.0 for any site was found in 164 (77.7%). No statistically significant difference was found between the groups without BVC (n = 173) and with BVC (n = 38) for the prevalence of ‘osteoporosis’ or ‘moderate/severe osteopenia or osteoporosis’ at the spine or at any other site. There was a difference between the groups in terms of age (59.0 ± 7.8 vs. 71.9 ± 8.9 years, respectively; p < 0.001), sedentary lifestyle (57.8% vs. 84.2%, respectively; p = 0.002), smoking (27.7% vs. 7.9%, respectively; p = 0.009), and high blood pressure (65.3% vs. 92.1%, respectively; p = 0.001). Logistic regression analysis confirmed the lack of statistical significance for BVC as a predictor of an osteoporosis diagnosis. Sensitivity values of BVCs to detect osteoporosis or osteopenia ranged from 17.9% to 25.0%. Conclusion BVCs have been shown to be inadequate to identify postmenopausal women with osteoporosis or osteopenia.

Effect of abrupt discontinuation versus gradual dose reduction of postmenopausal hormone therapy on hot flushes

Objectiveu2003To compare the effects of the abrupt discontinuation of postmenopausal hormone therapy (HT) and reduction of the daily dosage of the hormone on climacteric symptoms. Methodsu2003The study included Brazilian postmenopausal women who were using estrogen–progestogen hormone therapy in full doses previously prescribed for vasomotor symptoms. The patients were randomized to receive one of three treatments: placebo for 6 months; estradiol (E2) 1u2009mg/dayu2009+u2009norethisterone acetate (NETA) 0.5u2009mg/day for 2 months, followed by placebo for 4 months; or E2 1u2009mg/dayu2009+u2009NETA 0.5u2009mg/day for 4 months, followed by placebo for 2 months. The climacteric symptoms were assessed by the Blatt–Kupperman Menopausal Index at baseline and at 2, 4 and 6 months. Statistical evaluation was performed using the χ2 or Fishers test for categorical data, the Kruskal–Wallis test for numerical data, and ANOVA for time and group relationship with the Blatt–Kupperman Menopausal Index. Resultsu2003We randomized 60 women (20 in each group), and 54 completed the study. It was observed that both the full Blatt–Kupperman Menopausal Index and the hot flush score did not change significantly in the HT group during low-dose therapy compared with baseline; however, the evaluation performed at 2 months after low-dose-HT cessation showed that the full Blatt–Kupperman Menopausal Index and the hot flush score were similar to those of the group who stopped HT abruptly and significantly higher than at baseline (hot flush scores: pu2009<u20090.001 for all three groups at months 2, 4 and 6, respectively, vs. baseline). Conclusionu2003Discontinuation of HT by reducing the daily dose of estrogen for a period of 2 or 4 months did not differ in its effect from that of abrupt cessation with regard to vasomotor symptoms.

Estados hiperprolactinêmicos: inter-relações com o psiquismo

Hyperprolactinemia is the most frequent endocrine disorder of the hypothalamus-hypophysis axis observed in women of reproductive age. It is characterized by elevated serum prolactin levels. Prolactin production is regulated by the inhibitory action of a neurotransmitter, dopamine. Clinical manifestations include irregular menstrual cycle, amenorrhea, galactorrhea, infertility and libido decrease, but psychological symptoms, especially anxiety and depression, have also been associated with hyperprolactinemia. Nonetheless, few studies about this condition are available. In the pathogenesis of psychiatric disorders, prolactin may have either a direct action on the central nerve system or an indirect effect via gonadal hormones or function as independent factors as a result of dopamine depletion. Thus, since the prevalence of psychiatric disorders in patients with hyperprolactinemia was detected, it was concluded that further studies are necessary to investigate the basis of a potential relationship between both hyperprolactinemic and psychiatric conditions.

Irregularidades menstruais: inter-relações com o psiquismo

Data from both animal and human research indicate that psychological stress is associated with altered menstrual function. A number of studies have examined the relationship between more common stressors (job strain, financial worries, daily hassles) and menstrual cycle characteristics, such as cycle length and quality of bleeding, as well as amenorrhea. Numerous investigators have suggested that functional reproductive deficits result primarily from direct actions of the hypothalamic-pituitary-adrenocortical, probably modulated by a CRH-stimulated increase in the opioid beta-endorphin. The characterization of the psychic envolvement in these conditions represents basic element for the adequate therapeutical approach.

Hyperandrogenic chronic anovulation and psychologic disturbances

Os autores fazem uma revisao da sindrome dos ovarios policisticos (SOP) com relacao aos seus aspectos etiopatogenicos, clinicos, diagnosticos e terapeuticos, dando enfase aos transtornos de ordem psiquica que frequentemente acompanham esse disturbiio. Tecem consideracoes sobre a importância nao so de um efetivo tratamento medico, mas tambem de uma abordagem e um apoio psicologico, no sentido de melhorar ainda mais o bem-estar e a qualidade de vida dessas mulheres.