José Aristodemo Pinotti

Inhibin B response to EFORT is associated with the outcome of oocyte retrieval in the subsequent in vitro fertilization cycle.

OBJECTIVEnTo examine whether the magnitude of the rise in inhibin B levels after gonadotropin challenge is associated with subsequent response to ovarian stimulation during IVF.nnnDESIGNnInhibin B serum levels after EFORT (exogenous follicle-stimulating hormone ovarian reserve test).nnnSETTINGnAcademic clinical practice.nnnPATIENT(S)nSerum samples from women who had undergone ovarian reserve screening with FSH in preparation for IVF. Thirteen of these women had a poor response in IVF (canceled cycle for low estradiol and/or no oocytes retrieved), and 19 had a good response (> or =10 oocytes retrieved).nnnINTERVENTION(S)nEFORT test.nnnMAIN OUTCOME MEASURE(S)nBaseline (day 3) serum E(2) (bE(2)), FSH (bFSH), and inhibin B (bInhB) levels and inhibin B and E(2) levels 24 hours after EFORT (DeltaInhB and DeltaE(2)).nnnRESULT(S)nThe mean bInhB and DeltaInhB levels were significantly higher in good vs. poor responders. The odds ratio of having a good response for women with a DeltaInhB of 202 pg/mL was 51.8 times (95% CI = 6.1-1,244) the corresponding odds for women with a DeltaInhB of 49 pg/mL. As expected, DeltaE(2) was also significantly higher in good vs. poor responders; however, combination of DeltaE(2) plus DeltaInhB did not improve the odds for predicting IVF response.nnnCONCLUSION(S)nOur data suggest that DeltaInhB after EFORT may provide a method for predicting ovarian response to hyperstimulation in a subsequent IVF cycle.

The insulin-like growth factor-I system and hormone replacement therapy.

OBJECTIVEnTo determine the effects of hormone replacement therapy on plasma concentrations of free and total insulin-like growth factor (IGF)-I, IGF binding protein (BP)-1, and IGFBP-3.nnnDESIGNnClinical study.nnnSETTINGnGynecologic clinic at a university hospital.nnnPATIENT(S)nSeventy-one postmenopausal women.nnnINTERVENTION(S)nSix cycles of four different hormonal replacement therapy regimens: oral conjugated estrogens, transdermal estradiol, oral conjugated estrogens and norethisterone, and transdermal estradiol and norethisterone acetate.nnnMAIN OUTCOME MEASURE(S)nBlood samples were collected before and after treatment for measurement of free and total IGF-I, IGFBP-1, and IGFBP-3.nnnRESULT(S)nConjugated estrogen replacement therapy is associated with a decrease in plasma concentration of total IGF-I and increase in concentrations of free IGF-I and IGFBP-1. Transdermal estrogens have no effect on total and free IGF-I and IGFBP-1 concentrations. Oral norethisterone plus conjugated estrogens increased free IGF-I and IGFBP-1 concentrations but did not change IGF-I concentrations. Transdermal conjugated estrogens plus norethisterone acetate increased free IGF-I concentrations but not total IGF-I or IGFBP-1 concentrations. The plasma concentration of IGFBP-3 did not change in any group.nnnCONCLUSION(S)nAlterations in total IGF-I concentration can occur depending on the route of hormone replacement therapy administration. Free IGF-I concentrations were elevated in all study groups except that treated with transdermal estrogens.

Induction of experimental mammary carcinogenesis in rats with 7,12-dimethylbenz(a)anthracene

PURPOSEnTo test an experimental model of chemical mammary carcinogenesis induction in rats.nnnMETHODSnTwenty young virgin Sprague-Dawley female rats, aged 47 days, received 20 mg of 7,12-dimethylbenz(a)anthracene (DMBA) intragastrically by gavage. Afterwards, at 8 and 13 weeks, their mammary glands were examined. At the end of the experiment, the animals were sacrificed, and the mammary tumors were measured and weighed. Tumor fragments were analyzed using light microscopy.nnnRESULTSnEight weeks after DMBA injection, 16 rats presented at least 1 breast tumor (80%). After 13 weeks, all of them (100%) developed breast carcinomas that were confirmed by histopathological analysis.nnnCONCLUSIONnThis experimental animal model of chemical mammary induced carcinogenesis is feasible and can be used in further experiments on the role of tumorigenic biomodulator substances.

Sexual behavior and knowledge of sexually transmitted infections among university students in Sao Paulo, Brazil

To investigate the sexual behavior and knowledge about sexually transmitted infections (STIs) among undergraduate students in Sao Paulo, Brazil.

Reassurance in the Treatment of Mastalgia

▪u2002Abstract: The purpose of the study was to evaluate the results of the application of a nonpharmacologic treatment based on explanations and reassurance to women with mastalgia. A total of 121 women were studied. They received reassurance and underwent follow up with a questionnaire 2–3 months later. An original methodology to evaluate the efficiency of mastalgia treatment was employed, which consisted of comparing pain parameters of the patients before and after treatment. The authors verified a success rate of 70.2% (n = 85) with reassurance. When evaluating the intensity of the symptom, reassurance was effective in 85.7% of the patients with a mild form of mastalgia, in 70.8% with a moderate form, and in 52.3% with a severe form. It was concluded that reassurance should be the first‐line treatment for women with mastalgia. Drug prescriptions are indicated only in patients refractory to this form of management.u2003▪

Effects of treatment with gonadotropin releasing hormone agonist on the uterine leiomyomata structure.

Objective. Our aim was to study the effects of the gonadotropin releasing hormone agonist on the uterine leiomyoma of infertile women.

Adequação do uso de pílula anticoncepcional entre mulheres unidas

A total of 2,364 women in marital union, 15 to 49 years of age, were interviewed at home. They lived in poor neighbourhoods in the metropolitan area and in the interior of S. Paulo State, Brazil. The prevalence of contraceptive pill use and the association between socio-demographic characteristics of users and the presence or not of risk factors for pill use were studied. One fourth (25.8 percent) of the women interviewed were using contraceptive pills. Prevalence was higher among younger women, those with no more than one live child and those who had completed between three and eight grades of schooling. Over 40 percent of the users referred having risk factors for pill use at the time they initiated the method. No association was found between age and the percentage of women with risk factors. This percentage increased with number of children and decreased with womens schooling. The fact that pills were prescribed or obtained through the health system was not associated with the proportion of users with risk factors. The percentage of users with risk factors was similar when comparing women who did not consult any health service before initiating use with those who had consulted a public service. The prevalence of use observed in this study is similar to that described by other authors. Results show that the health system in the State of S. Paulo played no role in the improvement in the prescription of hormonal contraceptive pills. Central policy seemed not to have filtered down to the peripheral areas of the system.Foram entrevistadas em seus domicilios 2.364 mulheres unidas de 15 a 49 anos de idade, que moravam em bairros de baixa renda, na area metropolitana e no interior do Estado de Sao Paulo, Brasil. Estudou-se a prevalencia de uso da pilula contraceptiva, a associacao entre algumas caracteristicas socio-demograficas das usuarias e a presenca ou nao de fatores de risco para seu uso. Verificou-se que 25,8% das mulheres usavam pilula anticoncepcional. A prevalencia de uso foi maior entre as mais jovens, entre as com ate um filho vivo e nas com 5a a 8a series de escolaridade. Mais de 40% das usuarias referiram apresentar fatores de risco ao iniciar o uso. Nao se verificou associacao entre a idade e a percentagem de mulheres com fatores de risco. Essa percentagem aumentou com o numero de filhos e diminuiu com a escolaridade da mulher. A presenca de fatores de risco foi igualmente frequente entre as mulheres que nao consultaram nenhum servico de saude para iniciar o uso como entre aquelas que consultaram em servicos publicos. As politicas do nivel central nao parecem ter atingido a periferia do sistema.A total of 2,364 women in marital union, 15 to 49 years of age, were interviewed at home. They lived in poor neighbourhoods in the metropolitan area and in the interior of S. Paulo State, Brazil. The prevalence of contraceptive pill use and the association between socio-demographic characteristics of users and the presence or not of risk factors for pill use were studied. One fourth (25.8 percent) of the women interviewed were using contraceptive pills. Prevalence was higher among younger women, those with no more than one live child and those who had completed between three and eight grades of schooling. Over 40 percent of the users referred having risk factors for pill use at the time they initiated the method. No association was found between age and the percentage of women with risk factors. This percentage increased with number of children and decreased with womens schooling. The fact that pills were prescribed or obtained through the health system was not associated with the proportion of users with risk factors. The percentage of users with risk factors was similar when comparing women who did not consult any health service before initiating use with those who had consulted a public service. The prevalence of use observed in this study is similar to that described by other authors. Results show that the health system in the State of S. Paulo played no role in the improvement in the prescription of hormonal contraceptive pills. Central policy seemed not to have filtered down to the peripheral areas of the system.

Analysis of the concordance rates between core needle biopsy and surgical excision in patients with breast cancer

OBJECTIVEnTo evaluate whether immunohistochemical marker studies performed on core needle biopsy (CNB) specimens accurately reflect the marker status of the tumor obtained from final surgical specimen.nnnMETHODSnThis was a retrospective study that used the database of the Division of Mastology of the Hospital das Clínicas, São Paulo, Brazil. Sixty-nine patients submitted to ultrasound-guided CNB diagnosed with breast cancer were retrospectively analyzed. Immunohistochemistry (IHC) on core biopsy specimens was compared to that of excisional biopsy regarding estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 gene (HER2), p53, and Ki67. The analysis of the concordance between CNB and surgical biopsy was performed using the kappa (k) coefficient (95% CI).nnnRESULTSnA perfect concordance between the labeling in the surgical specimens and the preoperative biopsies in p53 (k = 1.0; 95% CI: 0.76-1.0) was identified. There was an almost perfect concordance for ER (k = 0.89; 95% CI: 0.65-1.0) and a substantial concordance for PR (k = 0.70; 95% CI: 0.46-0.93). HER2 (k = 0.61; 95% CI: 0.38-0.84) and Ki-67 (k = 0.74; 95% CI: 0.58-0.98) obtained a substantial concordance this analysis.nnnCONCLUSIONnThe results of this study indicate that the immunohistochemical analysis of ER, PR, Ki-67, and p53 from core biopsy specimens provided results that accurately reflect the marker status of the tumor. The concordance rate of HER2 was less consistent; although it produced substantial concordance, values were very close to moderate concordance.

Immediate effects of intraoperative evaluation of surgical margins over the treatment of early infiltrating breast carcinoma

Aims and Background Local recurrences in patients submitted to conservative breast treatment for early infiltrating breast carcinomas occur in 5–10% of the cases and are caused mainly by inadequate local resection and remaining residual malignant tissue. The present study was carried out to analyze the effect of intraoperative evaluation of surgical margins and its influence on the immediate surgical management of patients with early breast carcinomas (T1–T2) scheduled to undergo quadrantectomy. Methods A total of 102 cases were studied. After a classical quadrantectomy, intraoperative evaluation of surgical margins was done by means of macroscopic, cytological and histopathologic analysis. The margins of the resected tissue were examined to assure they were clear or to orient a wider resection. Results In 64 cases (62.7%), the extent of the quadrant resection was considered adequate and the margins were clear. In 38 cases (37.3%), surgical margins were considered inadequate. An enlarged quadrantectomy was immediately performed in 33 patients (32.4%) and mastectomies in 5 (4.9%). Conclusions Intraoperative evaluation of surgical margins frequently modifies the surgical management of patients who were initially prepared to be submitted to a quadrantectomy, indicating the need for further resection in the form of an enlarged quadrantectomy or mastectomy.

The influence of reduction mammaplasty techniques in synchronous breast cancer diagnosis and metachronous breast cancer prevention.

Background:Although reduction mammaplasty (RM) is a well-described technique for cosmetic objectives, there are few reports regarding its bilateral application combined with oncologic breast surgery in patients with breast cancer. The purpose of this study is to analyze the role of RM in the contralateral breast (CB) synchronous cancer (SBC) incidence, the impact in risk reduction for metachronous breast cancer (MBC), the disease-free period, and overall survival Methods:Patients were divided into 2 groups; group I: 114 pts submitted to oncologic surgery associated with immediate CB RM. Group II: 135 pts without CB RM. Mean time of follow-up was 51.5 months for both groups. Data regarding age, tumor size, histologic type and grade, clinical stage, and adjuvant therapy were collected Results:Except for the CB RM, no differences were observed between the groups. In group I, the diagnosis of an occult, synchronic, and invasive carcinoma was noted in 1.8%, in situ in 2.6%, and MBC in 1.8%. In group II, MBC was observed in 6.7%. No difference was observed between the 2 groups (P = 0.062). The initiation of adjuvant therapy, the disease-free period, and overall survival were not influenced by the CB RM. Conclusion:CB RM is a reliable technique providing an opportunity for diagnosis of an occult SBC. There is evidence of reduction of MBC; however, a larger number of patients are necessary for significant conclusions. The technique should be considered in combination with immediate breast reconstruction. Success depends on patient selection and careful intraoperative management.