Use of radioguided surgery in abdominal wall endometriosis: An innovative approach.

Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity. The occurrence of endometriosis in the anterior abdominal wall is often associated with previous cesarean section, once the spread of endometrial cells during the surgical procedure is a biologically fact possible. A 43-year-old patient, with cesarean section history and pelvic endometriosis diagnosed for over 10 years, presented with progressive abdominal pain. Tests showed cystic image with 1.6 cm of diameter and debris, located in mid-lower portion of the rectus abdominis left, suggesting abdominal wall endometriosis. This abdominal wall lesion was not identifiable in the clinical examination (impalpable), which is why we opted for the use of preoperative marking technique with radioisotope called Radioguided Occult Lesion Localization (ROLL™). The use of ROLL™ in this case allowed rapid surgical identification of endometriotic lesion and its complete excision.

Fibroadenoma in axillary accessory breast: a case report

The mass are among the possible alterations observed in the axilla. When found, the most frequent differential diagnosis are lymphadenopathy, metastatic lymphadenomegaly, lymphoma, lipoma or tumors in the apocrine glands. Besides that, the presence of accessory breast tissue must also be considered and, as the topical breast tissue, can be the target of breast diseases, either benign or malignant. Female patient, 23 years old, with the presence of hardened palpable node in the right axilla. At the ultrasound, it presented characteristics that classified it as Bi-Rads® 4. An aspiration biopsy of the node was performed with fine-needle, which resulted in unsatisfying material. After the explanation of the therapeutic choices, the patient opted for the excision of the axillary node. The anatomical pathological result showed a nodular formation compatible with fibroadenoma. The occurrence of a node in the axillary region is common. However, in the vast majority of times, it is merely an inflammatory response, manifested as a lymphadenomegaly. In case of chronic mass with suspicious characteristics, it is convenient to suspect the presence of lymphoid neoplasms, locoregional metastasis of breast cancer or melanoma and alterations in accessory breast tissue. In young patients, it is important to evaluate the existence of accessory breast tissue with the presence of suspicious axillary node, because, although controversial, some authors believe that such alterations occur more frequently in these patients. Additionally, in cases of inconclusive imaging, an excision of the lesion must be performed for a definite diagnosis.

A história obstétrica de gestantes com trombofilias hereditárias / Obstetric history of pregnant women with hereditary thrombophilias

Introdução: A doença tromboembólica venosa e as complicações obstétricas resultantes do tromboembolismo placentário são as principais causas de morbidade e mortalidade materna e fetal. Pode-se dizer que a gravidez é um fator independente para o desenvolvimento de trombose, já que seu risco é de 5 a 6 vezes maior em mulheres grávidas quando comparadas a não grávidas, sendo mais elevado após o parto. Métodos: Trata-se de uma coorte histórica, onde foram estudadas pacientes atendidas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora (expostos=n=70 pacientes) e na Faculdade de Medicina de Barbacena (não expostos=n=74 pacientes). As pacientes foram divididas em dois grupos: Grupo 1 = pacientes com alguma trombofilia identificada (expostos) através das dosagens de proteína S, proteína C, homocisteína, antitrombina III, mutação da MTHFR, mutação da protrombina e do fator V de Leiden; e Grupo 2 = pacientes do serviço de baixo risco obstétrico. Resultados: Houve associação entre trombofilia e aborto prévio, bem como trombofilia e morte fetal prévia (p<0,05). O tipo de trombofilia que foi associada a abortamento prévio foi o déficit da proteína S. A mutação da MTHFR foi associada aos antecedentes de HELLP síndrome (p=0,03; x2 =4,2) e de pré-eclâmpsia (p=0,03; X2 =4,5) quando em homozigotia mutante. A homozigotia para a MTHFR foi também associada às médias de homocisteína, de forma que as homozigotas eram aquelas que apresentavam a maior dosagem de homocisteína (p=0,01; X2 =5,8; X= 27,2 ± 41,2 vs. 12,62 ± 19,0). Conclusão: As trombofilias hereditárias podem estar associadas a mau desfecho obstétrico e devem ser valorizadas na clínica obstétrica. (AU)

Introduction: Venous thromboembolic disease and obstetric complications resulting from placental thromboembolism are the main causes of maternal and fetal morbidity and mortality. Pregnancy is considered an independent factor for the development of thrombosis, as its risk is 5 to 6 times greater in pregnant women when compared to non-pregnant women, being even higher after childbirth. Methods: This historical cohort included patients seen at the Obstetrics Service of Federal University of Juiz de Fora (exposed patients, n = 70) and at the School of Medicine of Barbacena (unexposed patients, n = 74). The patients were divided into two groups: Group 1 consisted of patients with some thrombophilia identified through measurement of protein S, protein C, homocysteine, antithrombin III, MTHFR mutation, prothrombin and factor V Leiden mutations; and Group 2 consisted of patients from the low obstetric risk service. Results: There was an association between thrombophilia and previous abortion, as well as thrombophilia and previous fetal death (p < 0.05). MTHFR mutation was associated with history of HELLP syndrome (p = 0.03; x2 = 4.2) and preeclampsia (p = 0.03; x2 = 4.5) when in homozygous mutation. Homozygous MTHFR was also associated with mean homocysteine levels, so that homozygotes were those with highest homocysteine levels (p = 0.01; x2 = 5.8; x = 27.2 ± 41.2 vs. 12.62 ± 19.0). Conclusions: Hereditary thrombophilias may be associated with poor obstetric outcome and should be valued at clinical obstetrics. (AU)

Perfil socioeconômico de 820 mulheres atendidas no Hospital Universitário da Universidade Federal de Juiz de Fora / Socioeconomic profile of 820 women attended at the University Hospital of the Universidade Federal de Juiz de Fora

Introdução: A manutenção da boa saúde da mulher envolve atitudes preventivas e cuidados específicos através de políticas de saúde, as quais demandam uma avaliação abrangente da história socioeconômica das pacientes para serem efetivas. Objetivos: Caracterizar o perfil socioeconômico das usuárias do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF) e compará-lo aos dados do IBGE e do PNAD, de forma a avaliar a representatividade amostral perante a população brasileira. Métodos: Estudo transversal, observacional e descritivo realizado com 820 usuárias do HU-UFJF mediante entrevista estruturada. Para análise, foi aplicado o Teste Quiquadrado, p-valor ≤0,05 e intervalo de confiança de 95%. Resultados: A idade média das pacientes foi de 42,7 anos (+/- 12,8); 70,7% residiam em Juiz de Fora, sendo as demais provenientes de outras 73 cidades do Sudeste brasileiro; 92,9% relataram morar em área urbana; 45,9% afirmaram ter cursado o ensino fundamental; 55,3% declararam viver em união conjugal; e 37,4% relataram ter renda familiar entre 2,0 e 4,0 salários mínimos. Conclusões: A amostra estudada apresentou características que se aproximaram às da população do Censo de 2010 do IBGE, logo, pode ser entendida como representativa da realidade de populações de unidades públicas de saúde, podendo servir de base para outros estudos.

Introduction: The support of women's health requires preventive measures and specific care, which demands a comprehensive evaluation of the socioeconomic history of the patients to be effective. Objectives: To characterize the population of women attended at the University Hospital of Universidade Federal de Juiz de Fora (HU-UFJF) and compare the sample data with the data from the IBGE and IPEA in order to evaluate the sample representativeness before the Brazilian population. Methods: Cross-sectional, observational and descriptive study of 820 women, patients at the HU-UFJF, through structured interviews. The association between the variables was performed using the chi-square test, p-value ≤0,05 and a confidence interval of 95%. Results: The mean age of patients was 42.7 years (+/- 12.8); 70.7% lived in Juiz de Fora, while the remaining patients were from 73 other cities in southeastern of Brazil; 92.9% reported living in an urban area; 45.9% claimed to have completed primary education; 55.3% live in marital union and 37.4% reported having a family income between 2 and 4 times the minimum wage. Conclusions: The sample presented similar characteristics of IBGE's 2010 Census. Therefore, women users of the HU-UFJF are representatives of the reality of populations assisted in public health units and can serve as a basis for further studies.