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Efeitos da Histerectomia Total Abdominal sobre o Fluxo Sangüíneo Ovariano
Nahás Eliana Aguiar Petri,Pontes Anaglória,Traiman Paulo,Nahás Neto Jorge
Revista Brasileira de Ginecologia e Obstetrícia , 2002,
Abstract: Objetivo: avaliar os efeitos da histerectomia total abdominal (HTA) sobre o fluxo sangüíneo ovariano, em mulheres no menacme, por meio da dopplervelocimetria e ultra-sonografia transvaginal. Métodos: estudo prospectivo no qual foram incluídas 61 mulheres, com idade igual ou inferior a 40 anos. As pacientes foram divididas em dois grupos: G1, com 31 pacientes submetidas à HTA, e G2, com 30 mulheres normais n o submetidas à cirurgia. Somente foram incluídas pacientes eumenorréicas, ovulatórias, n o-obesas ou fumantes, sem cirurgias ou doen as ovarianas prévias. Avaliou-se o fluxo sangüíneo das artérias ovarianas, inicialmente e aos 6 e 12 meses, pelo índice de pulsatilidade (IP) na dopplervelocimetria, e o volume ovariano pela ultra-sonografia transvaginal (US). Para análise estatística empregou-se teste t pareado, análise de perfil, teste de Friedman e teste de Mann-Whitney. Resultados: na compara o estatística inicial os grupos foram homogêneos quanto às características epidemiológicas e quanto aos demais parametros avaliados neste estudo. Nas pacientes submetidas à histerectomia, observaram-se aos 6 e 12 meses aumento do volume ovariano ao US e diminui o do IP avaliado pela dopplervelocimetria (p<0,05), quando confrontadas ao controle. Aos 12 meses, em 8 das 31 pacientes pós-HTA (25,5%) verificou-se ocorrência de cistos ovarianos de aspecto benigno. No grupo controle n o houve altera o de nenhum desses parametros. Conclus o: a redu o do IP na dopplervelocimetria das artérias ovarianas sugere aumento do fluxo sangüíneo ovariano pós-histerectomia total abdominal em mulheres no menacme.
Tratamento Clínico e Seguimento das Hiperplasias de Endométrio
Pontes Anaglória,Traiman Paulo,Franco Marcello,Nahás Eliana Aguiar Petri
Revista Brasileira de Ginecologia e Obstetrícia , 2000,
Abstract: Objetivos: avaliar a eficácia do acetato de medroxiprogesterona e do acetato de megestrol nas hiperplasias de endométrio. Métodos: foram incluídas, retrospectivamente 47 pacientes com sangramento uterino anormal, submetidas a curetagem uterina diagnóstica e/ou biópsia de endométrio, cujo achado histopatológico foi de hiperplasia de endométrio. Nas pacientes com hiperplasia sem atipia foi iniciado a terapêutica com acetato de medroxiprogesterona por via oral, na dose de 10 mg/dia durante 10-12 dias por mês. Nas com atipia, era utilizado o acetato de megestrol por via oral, dose de 160 mg/dia, uso contínuo. O período de tratamento variou de 3 a 18 meses. Biópsia de endométrio e/ou curetagem uterina de controle foram realizadas entre três e seis meses do início do tratamento e periodicamente para avaliar a resposta terapêutica. Resultados: foram analisadas 42 pacientes com hiperplasia endometrial sem atipia e cinco com atipia. A média de idade das pacientes foi de 49,5 ± 10,6 anos, sendo 70,2% com idade superior a 45 anos. O acetato de medroxiprogesterona foi eficaz em fazer regredir as hiperplasias sem atipias em 83,2% (35/42) e o acetato de megestrol em 80% (4/5) das hiperplasias com atipia. Em 16,8% (7 casos) das hiperplasias sem atipia e em 20% (1 caso) das com atipia, ocorreu persistência das les es, apesar do tratamento. Em nenhum caso ocorreu progress o para cancer de endométrio, durante o período de seguimento que foi de 3 meses a 9 anos. No acompanhamento dessas pacientes, verificamos que 18 (38,3%) apresentaram amenorréia, em 12 (25,5%) ocorreu regulariza o do ciclo menstrual e 17 (36,2%) permaneceram com sangramento uterino anormal, sendo submetidas a histerectomia total abdominal. O exame anatomopatológico mostrou a persistência da les o hiperplásica em oito casos, leiomioma em quatro, adenomiose em três, mio-hipertrofia uterina difusa em um caso e útero normal em outro, tendo havido regress o das les es hiperplásicas nesses últimos nove casos. Conclus es: o tratamento das hiperplasias de endométrio com acetato de medroxiprogesterona e/ou acetato de megestrol, representa uma alternativa satisfatória para mulheres que desejam preservar o útero ou que tenham risco cirúrgico elevado. Entretanto, é necessário monitoriza o cuidadosa do endométrio, o que deve ser realizado pela avalia o dos sintomas, ultra-sonografia transvaginal e biópsia periódica.
Tratamento Clínico e Seguimento das Hiperplasias de Endométrio
Pontes, Anaglória;Traiman, Paulo;Franco, Marcello;Nahás, Eliana Aguiar Petri;Dias, Rogério;De Luca, Laurival Antonio;
Revista Brasileira de Ginecologia e Obstetrícia , 2000, DOI: 10.1590/S0100-72032000000600002
Abstract: purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. patients and methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. these patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. the length of treatment ranged from 3 to 18 months. control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. the mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. no progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. during follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. conclusions: the treatment of endometrial hyperplasia with
Efeitos da isoflavona sobre os sintomas climatéricos e o perfil lipídico na mulher em menopausa
Nahás, Eliana Aguiar Petri;Nahás Neto, Jorge;De Luca, Laurival A.;Traiman, Paulo;Pontes, Anaglória;Dalben, Ivete;
Revista Brasileira de Ginecologia e Obstetrícia , 2003, DOI: 10.1590/S0100-72032003000500006
Abstract: purpose: to evaluate the effects of soy germ isoflavone on menopausal symptoms and blood lipids in postmenopausal women. methods: a prospective study was performed on 50 women, randomly divided into two groups: 25 women on soy germ isoflavones (60 mg/day, capsules) (g1) and 25 women on placebo (g2). inclusion criteria: women with hot flushes and fsh >40 miu/ml, non-vegetarian, non-smoker, non-asiatic, not in use of hormone replacement therapy and without disease of the gastrointestinal tract. for six months, the menopausal kupperman index (mki) and hormonal and lipid profiles were assessed. for statistical analysis, anova, t test and the non-parametric kruskal-wallis and mann-whitney tests were used. results: the median mki values, initially similar in both groups, decreased in g1 at two and four months (mki = 14 and 9, respectively), and in g2 at two months (mki = 15) (p<0.01). at six months, isoflavone was significantly superior to placebo in reducing hot flushes (44 versus 12%, respectively). at the end of the study, in the isoflavone group, an increase in estradiol levels (from 16,8±7.3 to 18,0±6.7 ng/dl) (p<0.05) was observed, with no alteration in fsh, lh and vaginal cytology; there was also a reduction of 11.8% in ldl (from 151.5±39.2 for 133,6±26.4 mg/dl) and a hdl increase of 27.3% (from 44.0±11.3 to 56.0±11.9 mg/dl) (p<0.05). conclusions: soy germ isoflavone induced favorable effects on menopausal symptoms and lipid profile, showing to be an interesting option for alternative therapy in postmenopausal women.
Efeitos da Histerectomia Total Abdominal sobre o Fluxo Sangüíneo Ovariano
Nahás, Eliana Aguiar Petri;Pontes, Anaglória;Traiman, Paulo;Nahás Neto, Jorge;De Luca, Laurival A.;Borges, Vera Therezinha Medeiros;Carvalho, Lídia Raquel de;
Revista Brasileira de Ginecologia e Obstetrícia , 2002, DOI: 10.1590/S0100-72032002000500007
Abstract: purpose: to evaluate the effect of total abdominal hysterectomy on ovarian blood supply in women in reproductive age, using transvaginal color doppler. methods: a prospective study was carried out on 61 40-year-old or younger women. they were divided into two groups: g1, 31 patients submitted to hysterectomy, and g2, 30 normal women. criteria of inclusion: normal ovarian function at baseline, normal body weight, without expasure to tobacco, no history of laparotomy or ovarian pathology. the pulsatility index (pi) of ovarian arteries determined by doppler and the transvaginal ultrasonographic measurement of the ovarian volume were performed at three moments: baseline, 6 and 12 months. results: at baseline the groups were homogeneous. in the hysterectomized group, with 6 and 12 months, increase of the volume of the ovaries and decrease of pi (p<0,05) were observed. at the end of the study, 25.5% (8/31) of the hysterectomized patients presented benign ovarian cysts. in the control group no alteration of the parameters was observed. conclusion: the decrease of pi by doppler of ovarian arteries suggests increased ovarian blood supply after total abdominal hysterectomy in women in reproductive age.
Prevalência do hipotiroidismo subclínico e repercuss?es sobre o perfil lipídico e massa óssea em mulheres na pós-menopausa
Nahas, Eliana Aguiar Petri;Nahas-Neto, Jorge;Santos, Paulo Eduardo Mattos Ferreira;Mazeto, Gláucia Maria Ferreira da Silva;Dalben, Ivete;Pontes, Anaglória;Traiman, Paulo;
Revista Brasileira de Ginecologia e Obstetrícia , 2005, DOI: 10.1590/S0100-72032005000800006
Abstract: purpose: to evaluate the prevalence of subclinical hypothyroidism and its effects on lipidic profile and bone mineral density (bmd) in postmenopausal women. methods: a cross-sectional study with survey of data from medical records of patients attended at a climacteric outpatient clinic. inclusion criteria: postmenopausal women with measured thyroid-stimulating hormone (tsh) and free thyroxin (t4-l). exclusion criteria: hyperthyroidism and thyroid cancer. values of tsh >5.0 miu/ml and normal t4-l were considered to be subclinical hypothyroidism. the 329 selected women (55.2±6.4 years) were divided into three groups: normal thyroid function (control) (n=208), subclinical hypothyroidism (n=53) and clinical hypothyroidism under treatment (n=59). clinical data, hormonal therapy use, body mass index (bmi=kg/m2), lipid profile (total cholesterol, hdl, ldl, triglycerides) and bmd of lumbar column and femur were obtained. results: subclinical hypothyroidism was diagnosed in 16.1% of the cases. the groups were homogeneous regarding clinical features, bmi or lipidic profile. bmd in lumbar column and femur was lower in subclinical and clinical hypothyroidism than in euthyroidism (p<0.001). there was a negative correlation between values of tsh and bmd of lumbar column and femur (p<0.001). there was no correlation between tsh values and age, menopause time, bmi, and lipid profile. the total of hormonal therapy users was 65.1%, mean duration of 3.43±2.42 years, not differing between the groups. conclusion: subclinical hypothyroidism with prevalence of 16.1% in postmenopausal women was associated with lower bmd, with no effects on lipid profile.
Screenning of Chlamydia trachomatis Infection among Women Attending Outpatient Clinic of Infertility  [PDF]
Heloisa Lopes Lavorato, Natália Prearo Mo?o, Laura Fernandes Martin, Ana Gabriela Pontes Santos, Anaglória Pontes, Marli Teresinha Cassamassimo Duarte, Márcia Guimar?es da Silva
Open Journal of Obstetrics and Gynecology (OJOG) , 2015, DOI: 10.4236/ojog.2015.511085
Abstract: Objective: The goal of this study was to determine the prevalence of C. trachomatis in women diagnosed with infertility attending the Outpatient Clinic of Infertility from Botucatu Medical School, UNESP, Brazil. Patients and Methods: This molecular study enrolled a total of 112 women. Among these patients, 62 presented primary infertility while 50 presented secondary infertility. The criteria for eligibility included women who were: reproductive-aged; no prior report of seroconversion for HIV; no antibiotic or vaginal cream used in the preceding 30 days; and abstinence from sexual intercourse for 72 hours before the visit. The women were submitted to a gynecological examination and cervical samples were collected with an endocervical cytobrush for molecular analysis of C. trachomatis. Results: The prevalence of chlamydial infection was 8% with similar prevalence between primary (8.1%) and secondary (8.0%) infertility. Conclusion: Considering the asymptomatic nature of chlamydial infection and its association with tubal factor infertility, there is a pressing need to incorporate the screening of C. trachomatis infection as part of the routine investigation for infertility. The early diagnostic by screening can minimize complications and reduce Public Health costs with Assisted Reproductive Technology.
Acurácia da histerossonografia versus ultrassonografia transvaginal em mulheres inférteis candidatas às técnicas de reprodu??o assistida
Vilela, Jo?o Rocha;Cardoso, Maria Teresinha de Oliveira;Franco Júnior, José Gon?alves;Pontes, Anaglória;
Revista Brasileira de Ginecologia e Obstetrícia , 2012, DOI: 10.1590/S0100-72032012000300006
Abstract: purpose: to compare the diagnostic accuracy of sonohysterography (hsn) and conventional transvaginal ultrasound (usg) in assessing the uterine cavity of infertile women candidate to assisted reproduction techniques (art). methods: comparative cross-sectional study with 120 infertile women candidate to art, assisted at centro de reprodu??o assistida (cra) of hospital regional da asa sul (hras), brasília - df, from august 2009 to november 2010. sonohysterography was performed with saline solution infusion in a close system. the sonohysterography finding was compared to previous usg results. the uterine cavity was considered abnormal when the endometrium was found to be thicker than expected during the menstrual cycle and when an endometrial polyp, a submucous myoma and an abnormal shape of the uterine cavity were observed. the statistical analysis was done using absolute frequencies, percentage values and the χ2, with the level of significance set at 5%. results: hsn revealed that 92 (76.7%) infertile women candidate to art had a normal uterine cavity, while 28 (23.3%) had the following abnormalities: 15 polyps (12.5%), 9 cases of abnormal shape of the uterine cavity (7.5%), 6 submucous myomas (5%), 4 cases of inadequate endometrial thickness for the menstrual cycle phase (3.3%), and 2 cases of uterine septum (1.7%); 5 women presented more than one abnormality (4.2%). while usg showed alteration in the cavity only in 5 (4.2%) women, the sonohysterography confirmed 4 out of the 5 abnormalities shown by usg and detected an abnormal uterine cavity in 24 other women, who had not been detected by usg. this means that sonohysterography was able to detect more abnormalities in the uterine cavity than usg, with a statistically significant difference (p=0.002). conclusion: the sonohysterography was more accurate than usg in the assessment of the uterine cavity of this cohort of infertile women candidate to art. the sonohysterography can be easily incorporated into the investig
Estados hiperprolactinêmicos: inter-rela??es com o psiquismo
Nahas, Eliana Aguiar Petri;Nahás-Neto, Jorge;Pontes, Anaglória;Dias, Rogério;Fernandes, César Eduardo;
Revista de Psiquiatria Clínica , 2006, DOI: 10.1590/S0101-60832006000200006
Abstract: 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.
Miomas submucosos: classifica??o pré-operatória para avalia??o da viabilidade da cirurgia histeroscópica
Lasmar, Ricardo Bassil;Barrozo, Paulo Roberto Mussel;Dias, Rogério;Oliveira, Marco Aurélio Pinho de;Pontes, Anaglória;Dias, Daniel Spadoto;
Revista Brasileira de Ginecologia e Obstetrícia , 2004, DOI: 10.1590/S0100-72032004000400007
Abstract: objective: to develop a new preoperative classification of submucous myomas to evaluate the viability and the degree of difficulty of hysteroscopic myomectomy. methods: forty-four patients were submitted to hysteroscopic resection of submucous myomas. the possibility of total resection of the myoma, the surgery duration, the fluid deficit, and the incidence of complications were evaluated. the myomas were classified by the classification of the european society of endoscopic surgery (ceses) and by the classification proposed (cp) by our group, that besides the degree of penetration of the myoma in the myometrium, adds the parameters: extent of the base of the myoma as related to the uterine wall, the size of the myoma in centimeters and its topography at the uterine cavity. for statistical analysis the fisher test, the student t test and the analysis of variance were used. statistic significance was considered when the p-value was smaller than 0.05 in the bicaudal test. results: in 47 myomas the hysteroscopic surgery was considered complete. there was no significant difference among the three levels (0, 1 and 2) by ceses. by cp, the difference among the number of complete surgeries was significant (p=0.001) between the two levels (groups i and ii). the difference between the surgery duration was significant when the two classifications were compared. in relation to the fluid deficit, just cp presented significant differences among the levels (p=0,02). conclusions: the proposed classification includes more clues about the difficulties of the hysteroscopic myomectomy than the standard classification. it should be noted that the number of hysteroscopic myomectomies used for that analysis was modest, being interesting to evaluate the performance of the proposed classification in larger series of cases.
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