Hélio de Lima Ferreira Fernandes Costa

Idade materna como fator de risco para a hipertensão induzida pela gravidez: análise multivariada

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.

Inspeção visual do colo uterino após aplicação de ácido acético no rastreamento das neoplasias intra-epiteliais e lesões induzidas por HPV

OBJETIVO: estimar a validade da inspecao visual apos aplicacao de acido acetico (IVA) no rastreamento das neoplasias intra-epiteliais cervicais (NIC) e lesoes induzidas por HPV, comparando seu desempenho com o da colpocitologia e da colposcopia. METODOS: estudo de validacao de teste diagnostico realizado em 893 mulheres de 18 a 65 anos, rastreadas simultaneamente com colpocitologia, IVA e colposcopia, em unidade de saude publica de Recife, PE. A IVA foi realizada por embrocacao do colo com acido acetico a 5% e observacao a olho nu, com auxilio de foco clinico comum. Considerou-se como positividade o achado de qualquer lesao aceto-branca no colo. O padrao-ouro foi o histopatologico de biopsia cervical, realizado sempre que qualquer um dos tres testes resultasse anormal. Foram estimados e comparados os indicadores de validade de cada teste, com os respectivos intervalos de confianca a 95%. A concordância entre os resultados dos testes foi avaliada pelo coeficiente kappa (k). RESULTADOS: das 303 mulheres biopsiadas, o estudo histopatologico foi anormal em 24. Deste total, a IVA foi positiva em 22, conferindo-lhe sensibilidade estimada de 91,7%, especificidade de 68,9%, valor preditivo positivo de 7,5% e valor preditivo negativo de 99,7%. Comparando-se os intervalos de confianca a 95%, a IVA mostrou maior sensibilidade que a colpocitologia, mas com menores especificidade e valor preditivo positivo. Houve fraca concordância entre os resultados da IVA e da colpocitologia (k=0,02) e excelente concordância com os da colposcopia (k=0,93). CONCLUSAO: a IVA foi muito mais sensivel que a colpocitologia no rastreamento das NIC e lesoes HPV-induzidas e teve o mesmo desempenho da colposcopia. Sua baixa especificidade foi responsavel por um elevado numero de resultados falso-positivos.

Waist circumference and menopausal status are independent predictors of endothelial low-grade inflammation.

Abstract Background: The high-sensitivity C-reactive protein (hs-CRP) seems to be associated with the presence of atherosclerosis. The association between menopause-related changes in endogenous sex hormones and hs-CRP levels remains controversial. Objective: To compare the levels of hs-CRP in pre- and postmenopausal women and to evaluate the association of endogenous sex hormones, waist circumference (WC) and insulin resistance with the levels of hs-CRP. Methods: This cross-sectional study included 145 women (age range: 45–65 years), 56 premenopausal and 89 postmenopausal. Patients were evaluated for hormonal and lipid profile, HOMA-IR, hs-CRP and WC. Each variable was first assessed for correlation with log hs-CRP using a univariate model, and significant variables were then added to the multivariate regression model. A p value <0.05 was considered statistically significant. Results: The hs-CRP is higher in postmenopausal patients (3.6 ± 4.9 versus 2.6 ± 3.7, p = 0.004). The log hs-CRP was positively correlated with WC (r = 0.13, p = 0.005), HOMA-IR (r = 0.29, p = 0.001), and triglycerides (r = 0.50, p = 0.01). The menopausal status (p = 0.02) and WC (p = 0.00003) behaved as independent predictors of hs-CRP levels. No correlation was found between hs-CRP and the time since menopause (r = −0.1, p = 0.58). Conclusions: The hs-CRP is higher in postmenopausal patients. The menopausal status and WC were independently associated with hs-CRP levels in this sample of pre and postmenopausal women.

Histeroscopia cirúrgica com ressectoscópio para polipectomia endometrial: eficácia e segurança

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.

[Topographic modifications of the urethrovesical junction and proximal urethra after combined Marshall-Marchetti-Krantz and Burch surgery].

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 Students t-test has been used to compare pre and postoperative results whenever the variables fulfilled the normality test criterion; otherwise, the Wilcoxons 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.

Validade dos Métodos Clínico e Ecográfico para o Diagnóstico de Adenomiose

Objetivos: determinar a sensibilidade, especificidade, valores preditivos positivo e negativo de um metodo clinico e da ultra-sonografia no diagnostico da adenomiose. Metodos: foi realizado estudo transversal do tipo validacao de metodo diagnostico incluindo 95 mulheres no menacme submetidas a histerectomia por diversas indicacoes. O diagnostico clinico foi estabelecido em mulheres acima de 40 anos, dois ou mais filhos, com desvio menstrual para mais associado a dismenorreia. O diagnostico ecografico foi firmado pelo achado de, no minimo, uma area mal delimitada de textura miometrial anormal hiper ou hipoecoica, heterogenea ou cistica. O criterio histopatologico, considerado padrao-ouro, consistiu de achado de glândulas e estroma endometrial a 2,5 cm ou mais da juncao endomiometrial. Resultados: o metodo clinico apresentou sensibilidade de 68,2%, especificidade de 78,1%, valor preditivo positivo de 48,4% e valor preditivo negativo de 89,1%. Para o metodo ecografico esses valores foram de, respectivamente, 45,5%, 84,9%, 47,6% e 83,8%. A razao de verosimilhanca foi de 3,11 para o metodo clinico e 3,03 para o metodo ecografico. Considerando apenas os casos positivos para ambos os metodos concomitantemente, a sensibilidade nao ultrapassou 30%, mas a especificidade aproximou-se de 100%. Considerando-se os casos positivos em um dos dois metodos ou em ambos, a sensibilidade atingiu 86% e a especificidade a 60%. Conclusoes: o metodo ecografico nao foi superior ao metodo clinico no diagnostico de adenomiose.

É pior o prognóstico do segundo gemelar

Muito se discute sobre as desvantagens que sofre o gemeo que nasce por derradeiro, em relacao as condicoes de seu nascimento. Neste estudo foram revistos 90 casos de partos gemelares ocorridos na Maternidade da Encruzilhada (CISAM) em Recife, entre Janeiro de 1992 e Dezembro de 1993, com o objetivo de comparar variaveis perinatais entre o 1o e o 2o gemelar. Foram pesquisados a estatica fetal, a via de parto, o peso ao nascer, o Apgar do 1o e 5o minutos, a ocorrencia de complicacoes neonatais como a sindrome da membrana hialina, taquipneia transitoria e infeccao neonatal e, finalmente, o prognostico de cada um dos gemelares. Nao houve diferenca estatisticamente significativa na incidencia de apresentacoes nao cefalicas, operacao cesariana, baixo peso ao nascer, Apgar < 7 no 1o e 5o minutos ou das complicacoes neonatais acima referidas. Nao houve tambem diferenca na mortalidade perinatal entre os gemeos. Nossos resultados sugerem ser iguais as condicoes de nascimento dos gemelares de uma mesma gestacao, devendo ser prestada uma assistencia igualmente apurada a ambos pela equipe de perinatologia.