Luciana Schmidt Kirschnick

Antibody Anti-p16INK4a in Cervical Cytology

Objective To evaluate sensitivity, specificity and positive and negative predictive values (PPV, NPV) of anti-p16 INK4a in cervical cytology. Study Design A case-control study was conducted in a reference center for cervical pathology. Cytology slides were collected in a standard way with Ayre spatula and Cytobrush. The slides were interpreted by 2 independent pathologists (P1, P2). The cases (n = 61) represented all cervical examinations that had resulted in a biopsy with the diagnosis of CIN 1, 2 or 3 or squamous cell carcinoma. Controls (n = 87) included all examinations with negative cytology (Papanicolaou) and negative colposcopy. Results The sensitivity for the histologic diagnosis of CIN 2, 3 (n = 23) was 100% and 95.7% (P1, P2), respectively. The NPV for CIN 2 or worse was 100% (P1) and 98.9% (P2). The sensitivity for the diagnosis of CIN 1 was 77.8% (PI) and 58.3 % (P2). The NPV for CIN 1 or worse was 90.6% (PI) and 82 % (P2). The κ index between the 2 pathologists was 0.74. Conclusions Our results suggest that the antibody anti-p16 INK4a could contribute as an adjuvant tool in the follow-up of cervical intraepithelial lesions when the cytology sample is collected in the standard way.

Does serum ferritin correlate with coronary angiography findings

BACKGROUND A number of epidemiological studies have described a positive relationship between serum ferritin levels and coronary heart disease. In this prospective study, we evaluated the association between serum ferritin levels and the angiographic extent of coronary atherosclerosis. METHOD We studied 307 consecutive patients (60.9% male, age 60.1+/-11.0 years) referred for diagnostic coronary angiography. Risk factors for coronary artery disease, lipids and ferritin levels, as well clinical characteristics were recorded from all patients. Two experienced cardiologists blinded for clinical and laboratory data reviewed the cinefilms. Angiographic significant coronary artery disease (CAD) was defined as any more than a 50% diameter stenosis. RESULTS From the 307 patients, 196 (63.8%) were found to have angiographic significant CAD. The presence of significant CAD was associated with ferritin levels (P=0.015) as well as patient age (P<0.001), male sex (P<0.001), smoking (P<0.002), and cholesterol levels (P=0.028). By multivariate analysis, however, ferritin level was not an independent risk factor for CAD (P=0.27), while the association with all the other factors remained significant. CONCLUSION In patients referred for coronary angiography no independent relationship was found between angiographic significant coronary artery disease and serum ferritin levels.

Evaluation of morbidity of suction drains after retroperitoneal lymphadenectomy in gynecological tumors: a systematic literature review.

Introduction: The prophylactic use of closed suction drains after retroperitoneal lymphadenectomy in the management of gynecologic tumors has been widely used to prevent collections of clots or lymph and to avoid infections and postoperative fistulas. The improvement of newer surgical techniques, the use of antibiotic prophylaxis, and the nonclosure of the peritoneum led to the need to reevaluate the use of drains. Retrospective, prospective, and randomized studies did not find differences in the postoperative morbidity between the use and nonuse of drains. Some studies even suggested worse morbidity with the use of drains. Objectives: To assess the morbidity of the use of drains compared with no drains in a systematic literature review with aggregate effect measure (meta-analysis). Materials and Methods: Between 1966 and August 2007, 3 independent reviewers analyzed all studies that assessed the use of drains or no drains through a comprehensive literature search of the MEDLINE, EMBASE, and Cochrane Central Databases. Statistical analysis was carried out through the RevMan software. Results: Of the 285 studies initially reviewed, 11 were selected. Only 4 were considered adequate for group analysis, totaling 571 patients. When assessing outcomes altogether, namely, fever morbidity, symptomatic lymphocysts, deep vein thrombosis, pelvic infection, and fistulas, the relative risk was 1.76 (95% confidence interval, 1.04-3.01) and number necessary to harm was 12.2 referring to the use of drains. Conclusions: The prophylactic use of continuous suction drains after retroperitoneal lymphadenectomy in the management of gynecologic tumors should be avoided.

Lack of a relationship between serum ferritin levels and coronary atherosclerosis evaluated by coronary arteriography

Many clinical and epidemiological studies have demonstrated the relationship between serum ferritin and ischemic heart disease. In the present study we evaluated the relationship between coronary heart disease (CHD) and serum ferritin levels in patients submitted to coronary arteriography. We evaluated 307 patients (210 (68.7%) males; median age: 60 years) who were submitted to coronary angiography, measurement of serum ferritin and identification of clinical events of ischemic heart disease. Serum ferritin is reported as quartiles. Ninety-six patients (31.27%) had normal coronary angiography (group 1) and 211 (68.73%) had coronary heart disease (group 2). Of the patients with CHD, 61 (28.9%) had serum ferritin levels higher than 194 ng/ml (4th quartile), as opposed to only 14 (14.58%) of those without CHD (P = 0.0067). In the 2nd quartile, 39 patients (18.48%) had CHD, while 35 patients (36.46%) had normal coronary arteries (P = 0.00064). Multivariate analysis of the data showed that the difference between groups was not statistically significant (P = 0.33). We conclude that there is no independent relationship between coronary heart disease and increased levels of serum ferritin.

Comparação da aterosclerose coronária em pacientes com infarto do miocárdio e angina do peito

Objetivo - Comparar a gravidade da doenca coronaria e a presenca de fatores de risco cardiovasculares entre pacientes com angina e infarto do miocardio (IM). Metodos - Estudaram-se 62 pacientes com IM e 129 com angina, atraves de cineangiocoronariografia, avaliando-se a oclusao (lesao de 99% ou 100%), a severidade (escore de 0 a 5 de acordo com o numero de vasos afetados) e a extensao (3 grupos com diferentes graus de estenose). Dois observadores experientes interpretaram cegamente os angiogramas. Resultados - Os pacientes com IM tiveram maior oclusao (50% vs 13,2% [p<0,01]), maior severidade (79% vs 54,3% com mais de 90% de estenose [p<0,02]) e maior extensao (2,0 vs 0,87 [p<0,001]), mesmo quando controlados para os fatores de risco coronarios classicos e para o tempo de doenca. O tabagismo foi o unico fator de risco independente correlacionado com IM (P<0,01). Conclusao - Entre os pacientes estudados, a doenca coronaria foi maior no grupo IM, bem como a prevalencia de tabagismo.Objetivo - Comparar a gravidade da doenca coronaria e a presenca de fatores de risco cardiovasculares entre pacientes com angina e infarto do miocardio (IM). Metodos - Estudaram-se 62 pacientes com IM e 129 com angina, atraves de cineangiocoronariografia, avaliando-se a oclusao (lesao de 99% ou 100%), a severidade (escore de 0 a 5 de acordo com o numero de vasos afetados) e a extensao (3 grupos com diferentes graus de estenose). Dois observadores experientes interpretaram cegamente os angiogramas. Resultados - Os pacientes com IM tiveram maior oclusao (50% vs 13,2% [p<0,01]), maior severidade (79% vs 54,3% com mais de 90% de estenose [p<0,02]) e maior extensao (2,0 vs 0,87 [p<0,001]), mesmo quando controlados para os fatores de risco coronarios classicos e para o tempo de doenca. O tabagismo foi o unico fator de risco independente correlacionado com IM (P<0,01). Conclusao - Entre os pacientes estudados, a doenca coronaria foi maior no grupo IM, bem como a prevalencia de tabagismo.

Are apolipoproteins A and B better than lipoproteins for assessing risk of obstructive coronary heart disease

OBJECTIVE To evaluate whether apolipoproteins A-I (Apo A-I) and B (Apo B) have, higher ensitivity (SN), specificity (SP) and positive predictive value (PPV) than lipoproteins (LP), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), and triglycerides (TGL) in assessing the risk of coronary heart disease (CHD). METHODS This is a transversal case-control study of 241 patients, who were divided into two groups: 1) 145 patients with CHD, and 2) 96 patients without coronary disease. A model of logistic regression to evaluate the relation between the LPs and CHD was developed in which variables with a p-alpha < 0.1 were included. RESULTS Apo A-I levels were higher in the patients without CHD, (OR 2.08, CI 1.20-3.57). There were no statistical differences between the values of Apo A-I and the remaining lipid fractions (Apo A-I: 67%; Apo B: 100%; PPV: TC = 71%; TGC = 71%; HDL = 71%; LDL = 71%). The costs of the tests in Reais were as follows: Apo A-I: R

Comparative study for the identification of myocardial ischemia by contrast ventriculography under the effect of isosorbide mononitrate and by perfusional myocardial scintigraphy in patients with ischemic heart disease

56.60; Apo B-100: R

Seriam as apolipoproteinas A e B mais eficientes do que as lipoproteinas na investigacao de risco de doenca arterial coronariana obstrutiva

56.60; TC: R

Comparao da aterosclerose coronria em pacientes com infarto do miocrdio e angina do peito

9.94; HDL: R

Associação da aterosclerose coronária entre pacientes portadores de cardiopatia isquêmica com e sem infarto do miocárdio

21.30; LDL: R