Pattern of prolactin secretion after administration of gonadotropin-releasing hormone agonist at the preovulatory phase of intrauterine insemination cycles.

CONTEXT AND OBJECTIVE: Administration of a gonadotropin-releasing hormone (GnRH) agonist at the preovulatory phase is an option for triggering ovulation in assisted reproductive technology cycles. The aim of this work was to investigate the pattern of prolactin secretion after the administration of a single dose of GnRH-agonist at the preovulatory phase. DESIGN AND SETTING: Descriptive study at a tertiary referral center. PARTICIPANTS: Fifteen normally ovulating patients undergoing ovarian stimulation for intrauterine insemination were studied. METHODS: Ovarian stimulation was carried out using human menopausal gonadotropin (intramuscular 75 IU daily). When at least one follicle reached 17 mm (observed echographically), 0.5 mg of buserelin acetate was administered. Blood samples were taken to determine prolactin concentrations, at the time of agonist injection and 4, 8, 12, 24 and 48 hours later. RESULTS: A statistically significant increase in serum levels of prolactin was observed 4, 8 and 12 hours after GnRH-agonist administration, with a peak at 8 hours. CONCLUSION: The administration of a single dose of GnRH-agonist at the preovulatory phase in patients undergoing ovarian stimulation performed with human menopausal gonadotropin causes a significant increase in serum prolactin levels.

Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study.

AIMS: Sentinel lymph node biopsy (SLN) seems to represent a reliable method for early breast cancer staging, offering an alternative to complete axillary dissection. METHODS: The identification of sentinel node(s), their localization and the predictive capacity of SLN were analysed in 42 patients who had neoadjuvant chemotherapy for breast cancer. Dextran labelled with (99m)Tc was injected close to the tumor. The radioactive uptake in the axilla was detected by scintigraphic images and by a hand-held probe guided the SLN. RESULTS: One or more sentinel nodes were identified in 41 patients (97.6%). We could accurately predict axillary lymph nodes status in 93% of the cases. CONCLUSIONS: SLN can predict the status of the axilla in patients who have received primary chemotherapy.

Reassurance in the Treatment of Mastalgia.

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.

Outcome analysis of patients with early infiltrating breast carcinoma treated by surgery with intraoperative evaluation of surgical margins.

AIM: The purpose of this study was to determine the effect of intraoperative evaluation of surgical margins (IESM) on the local recurrence rate, the occurrence of distant metastases and survival in invasive breast carcinoma (T1-2). METHODS: Two groups of patients were compared: a control group of 149 patients treated by classical quadrantectomy without IESM, and an IESM study group of 102 patients submitted to surgical treatment guided by this procedure. In the IESM group 64 quandrantectomies, 33 enlarged quadrantectomies and five mastectomies were performed. RESULTS: In the control group 17 local recurrences (11.4%), 49 distant metastases (39.2%) and 43 deaths (31.5%) occurred; in the IESM group there were no local recurrences, nine distant metastases occurred (8.8%) and three patients died (2%). Adjuvant treatment was the same in both groups. The survival curves were estimated by the Kaplan-Meier method and compared with the log-rank test. The curves were censored at 99 months of follow-up for adequate comparison because the follow-up period was different in the two groups. Significant differences in local recurrence-free survival and distant metastasis-free survival curves (P = 0.001) in favor of the study group were observed. The overall survival curve of the IESM group was also superior, but statistical analysis revealed only a strong tendency without significance (P = 0.06). CONCLUSION: Treatment of early infiltrating breast carcinoma guided by IESM results in a better prognosis.

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.

Prognostic effects of local recurrence after conservative treatment for early infiltrating breast carcinoma.

AIM: A study was carried out to determine whether local recurrence after quadrantectomy, axillary dissection and radiotherapy (QUART) affects the oncologic prognosis of patients with early infiltrating breast carcinoma. METHODS: A total of 149 patients were submitted to QUART between 1981 and 1990 and followed by an average period of 120.9 months (range, 16-213). Local recurrence was not observed in 132 cases (group 1) but was detected in 17 patients (group 2). RESULTS: In group 1, 39 cases (29.5%) presented distant metastases and 34 (25.8%) evolved to death. In group 2, 10 (51.8%) distant metastases and 9 deaths (52.9%) were verified. The survival curves estimated by the Kaplan-Meier method and analyzed by the logrank test were statistically different for distant metastases-free survival (P = 0.03) and for overall survival (P = 0.01). The relative risk in patients with post-QUART local recurrence for distant metastases was 2.09 and for death 2.34. CONCLUSIONS: It was concluded that post-QUART local recurrences are a poor prognostic factor in patients with early infiltrating breast carcinoma.

Comparison of bone remodeling indicators in climacteric women.

OBJECTIVE: The objective was to study the polymorphism of collagen type 1 alpha 1 (COL1 A1) gene as a genetic marker, the biochemical markers of formation (osteocalcin) and bone reabsorption (cross-links of pyridinoline-CTx), bone mineral density and bone ultrasonometry compared to bone densitometry (DEXA). METHOD: The study included 82 women ranging in age from 45 to 60 years, menopausal from 1 to 10 years. Polymorphism of COL1 A1 was assessed by PCR (polymerase chain reaction), by the specific allele technique. Bone formation markers were studied using an ELISA (Novocalcin and Active Crosslaps). A Hologic 4500 A QDR (DEXA) densitometer and DBM Sonic 1200 IGEA ultrasonograph were employed. RESULTS: The bone reabsorption marker (cross-links of pyridinoline-CTx) demonstrated statistically significant negative correlation with bone mineral density (lumbar and femoral neck), while the bone formation marker (osteocalcin) did not display a correlation with bone mineral density. Bone ultrasonometry yielded a statistically significant positive correlation with bone densitometry. Collagen type 1 alpha 1 polymorphism was not identified by the technique employed. CONCLUSION: The bone reabsorption marker (cross-links of pyridinoline) and bone ultrasonometry and densitometry are measurements enabling evaluation of bone remodeling.

[Assessment of orgasmic capacity of postmenopausal women]. / Avaliação da capacidade orgástica em mulheres na pós-menopausa.

OBJECTIVE: To correlate the capacity of healthy postmenopausal women to have orgasms (during intercourse or by solitary masturbation) with psychosocial, behavioral, climacteric, hormonal and interpersonal factors. METHODS: Nine hundred and ninety-nine women (aged from 41 to 60 years) underwent physical and supplementary tests and answered questionnaires regarding sexual behaviour. Sixty healthy women, sexually active, with one or more years of amenorrhea, without hormone therapy and with a partner capable of intercourse were chosen from this group. A Logistic Regression Model with one dependent variable -- orgasmic capacity -- and seventeen independent variables -- psychosocial, behavioral, interpersonal, climacteric and hormonal factors -- was developed. RESULTS: The orgasmic capacity correlated significantly with the practice of masturbation (p=0.000), with pleasure in embracing and caressing the partner's body (p=0.036) and with the presence of vaginal dryness (p=0.021). CONCLUSIONS: This study shows that the most important factors were interpersonal and behavioral and that the other parameters considered were not statistically significant. Women with vaginal dryness, who however engage in masturbation and maintain an affective relationship with their partner, obtain an equal or a greater number of orgasms when compared to the frequency of sexual intercourse.

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

OBJECTIVE: To 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. METHODS: This 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). RESULTS: A 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. CONCLUSION: The 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.

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

OBJECTIVE: To investigate the sexual behavior and knowledge about sexually transmitted infections (STIs) among undergraduate students in Sao Paulo, Brazil. METHODS: Self-reported questionnaires were used. RESULTS: Most of the 447 students in the study were single (97.3%), in their first year of university (87.7%), and the mean ages were 20.4 years (males) and 19.8 years (females). Vaginal intercourse was practiced by 69.7% of males and 48.4% of females, oral sex by 64.5% of males and 43.7% of females, and anal sex by 18.4% of males and 14.1% of females. Use of a condom during vaginal sex was practiced by 80.4% of males and 74.8% of females and during anal sex by 47.8% of males and 30.0% of females. Knowledge of transmission of STIs was greater than 90% for HIV, syphilis, genital herpes, and gonorrhea; 63%-76% for HPV and genital warts; 30%-34% for Trichomonas and only 16% for Chlamydia. Only 25%-34% knew that HIV was transmitted by breastfeeding; 56%-60% knew that HIV was transmitted by anal sex. CONCLUSION: Many students engage in high-risk sexual behavior with multiple partners and use condoms inconsistently. Knowledge of the acquisition and modes of sexual and vertical transmission of HIV are strikingly deficient.

Analysis of the concordance rates between core needle biopsy and surgical excision in patients with breast cancer / Análise das taxas de concordância entre a biópsia com agulha grossa e a excisão cirúrgica em pacientes com câncer de mama

OBJECTIVE: To 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. METHODS: This 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 gowth 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). RESULTS: A 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. CONCLUSION: The 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.

OBJETIVO: Avaliar se a análise dos marcadores imunoistoquímicos obtidos por meio de espécimes de core biopsy (CB) refletem com precisão o perfil dos marcadores tumorais obtidos por biópsia cirúrgica excisional (BCE). MÉTODOS: Estudo retrospectivo usando dados da Divisão de Mastologia do Hospital das Clínicas de São Paulo. Sessenta e nove pacientes submetidas à CB guiada por ultrassom com diagnóstico de câncer de mama foram analisadas retrospectivamente. O exame imunoistoquímico dos espécimes de CB foram comparados com aquele obtido a partir da BCE em relação ao receptor de estrogênio (RE), receptor de progesterona (RP), human epidermal gowth factor receptor 2 gene (HER2), p53 e Ki-67. A análise de concordância entre a CB e a BCE foram realizados usando o coeficiente de kappa (k) (IC 95%). RESULTADOS: A concordância perfeita entre a BCE e a CB do p53 (k = 1,0; IC 95%: 0,76-1,0) foi identificada. A concordância foi quase perfeita para o RE (k = 0,89; IC 95%: 0,65-1,0) e concordância substancial foi identificada para o RP (= 0,70; IC 95%: 0,46-0,93). O HER2 (k = 0,61; IC 95%: 0,38-0,84) e Ki-67 (k = 0,74; IC 95%: 0,58-0,98) obtiveram uma concordância substancial nesta análise. CONCLUSÃO: os resultados deste estudo indicam que a análise imunoistoquímica do RE, RP, Ki-67 e p53 a partir dos espécimes de CB fornecem resultados que refletem com precisão o perfil dos marcadores do tumor. O HER2 foi menos consistente, porque apesar de ter produzido uma concordância substancial, os valores foram muito próximos da concordância moderada.

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.

Saúde no Brasil: provocações e reflexões / Health in Brazil: provocations and reflections

O Conselho Nacional de Secretários de Saúde (Conass) foi criado, em 1982, por Adib Jatene, notável médico e gestor público. Sua intenção era que os posicionamentos técnicos e políticos dos gestores estaduais fossem fortalecidos a partir da agregação dos diferentes saberes e da troca de experiências. A estratégia mostrou-se adequada, levando o Conass a integrar o que viria a ser o Sistema Único de Saúde (SUS), na representação da gestão estadual do sistema público de saúde.Nas mais de três décadas de sua existência, o Conass coleciona a participação de gestores de memorável formulação técnica e compromisso com o sistema público de saúde, revelados pelos esforços contínuos em tornar o SUS técnica e financeiramente sustentável, além de socialmente compreendido e defendido. Nessa esteira é que nos foi desvelada a oportunidade de apresentar o livro escrito pelo ex-secretário de saúde do estado de São Paulo, Dr. José Aristodemo Pinotti, médico, gestor e professor universitário, falecido em 2009. É um livro em primeira pessoa, cuja narrativa desperta diferentes emoções e para o qual o adjetivo 'visceral' aplica-se muito bem. Neste livro, o Dr. Pinotti revela suas impressões sobre o sistema de saúde em sua (in)completude. Discorre sobre a organização do SUS desde seu nascedouro, expõe as agruras vividas pelos gestores públicos, reforça a necessária interface com o sistema de ensino, distingue as especificidades da saúde da mulher e, principalmente, apresenta as relações do SUS com o Congresso Nacional, do qual foi integrante e viveu os bastidores. O livro chegou ao Conass pelas mãos do ex-presidente José Sarney, que, conhecendo seu conteúdo e sua inegável relação com os interesses da gestão estadual do SUS, sugeriu-nos avaliar a possibilidade de publicação. É um livro que, segundo Marianne Pinotti, foi motivador para seu pai: Ele escreveu e publicou sobre saúde pública desde que foi secretário de saúde de estado, entre 1987-1991. Mas a construção dos programas e dos textos, imagino, levou quase 30 anos. Ele viveu intensamente organizando o livro em seu último ano, de julho de 2008, até seu falecimento, em julho 2009. Com a permissão da família Pinotti, a quem de pronto agradecemos, foram tomadas as iniciativas de adequação do livro aos formatos que ora apresenta. Nossa pretensão é que a leitura seja capaz de influenciar o leitor a perceber que a escrita do 'Professor Pinotti' apresenta a doutrina e a prática, seus estudos e sua experiência, em uma relação responsável entre as melhores evidências e o 'fazer'. Pretendemos que o leitor compreenda o presente o livro como uma obra iniciada pelo Dr. Pinotti e que, propositadamente, não foi encerrada, de modo a imbricar a todos nós na construção ininterrupta do SUS. Sugerimos que seja entendido como um relato sobre um sistema público de saúde em formação e em constante luta para sobreviver e se aperfeiçoar. O livro é uma conversa entre o autor e cada um de seus leitores. É um convite para rememorar o passado e fundamentar a avaliação dos progressos e dos desafios que o SUS nos impõe.

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. MATERIAL AND METHODS: Sixty-seven nulliparous women (aged 24-39 years) with uterine leiomyomas, underwent ultrasonographic study of leiomyoma volume, and were divided in two groups. Thirty-one had nodes greater than 300 cm3 and were treated with goserelin 3.6 mg every 28 days for 6 months (group I); the other 36 patients did not receive medication (group II or control group). Sixteen patients from group I had < or = 36% (median) reduction of the leiomyoma volume (subgroup Ia) and the other 15 women had reduction > 36% (subgroup Ib). All women underwent myomectomy. RESULTS: The group with the greater leiomyoma reduction after treatment with goserelin (group Ib) showed a significantly lower percentage of ER+ when compared with group Ia and the control group. Group Ib had a significantly higher percentage of PR+ in relation to the control group, but not to group Ia. The number of blood vessels, AgNOR dots, and cells, and the amount of collagen were not different between the three groups studied. Leiomyomata reduction correlated negatively with the percentage ER+ cells, but positively with the PR+ cells, amount of collagen and number of blood vessels. No correlation was found between the number of AgNOR dots and cellularity. CONCLUSION: Our data strengthen the hypothesis that the uterine leiomyoma response to steroid hormones results from the presence of specific hormone receptors, and progesterone receptors may also play a role in the development of leiomyoma.

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

PURPOSE: To test an experimental model of chemical mammary carcinogenesis induction in rats. METHODS: Twenty 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. RESULTS: Eight 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. CONCLUSION: This experimental animal model of chemical mammary induced carcinogenesis is feasible and can be used in further experiments on the role of tumorigenic biomodulator substances.

Color Doppler sonography with contrast in the differentiation of ovarian tumors.

UNLABELLED: The objective of this study was to differentiate benign ovarian tumors from malignant ones before surgery using color and pulsed Doppler sonography, and to compare results obtained before and after use of contrast medium, thereby verifying whether contrast results in an improvement in the diagnostic sensitivity. METHODS: Sixty two women (mean age 49.9 years) with ovarian tumors were studied, 45 with benign and 17 with malignant tumors. All women underwent a transvaginal color Doppler ultrasonographic exam. A study of the arterial vascular flow was made in all tumor areas, as well as an impedance evaluation of arterial vascular flow using the resistance index. RESULT: Localization of the vessels in the tumor revealed a greater proportion of malignant tumors with detectable internal vascular flows (64%) than benign tumors with such flows (22%). There was a considerable overlap of these findings. The use of contrast identified a greater number of vessels with confirmation in the totality of tumors, but did not improve the Doppler capacity in tumoral differentiation. Malignant tumors presented lower values of resistance index than the benign ones, whether or not contrast was used. The cutoff value for resistance index that better maximized the Doppler sensitivity and specificity was 0.55. Through this value, an increase of the sensitivity after contrast use was obtained, varying from 47% to 82%, while specificity remained statistically unchanged. CONCLUSION: Although the injection of a microbubble agent improved the sensitivity of the method detecting vascularization of tumors, a positive finding for vascularization by this method was not clinically useful in the differentiation of benign and malignant ovarian tumors.

Pattern of prolactin secretion after administration of gonadotropin-releasing hormone agonist at the preovulatory phase of intrauterine insemination cycles

CONTEXTO E OBJETIVO: A administração de um agonista do hormônio liberador das gonadotropinas no momento pré-ovulatório é uma opção para desencadear a ovulação nos ciclos de reprodução assistida. O objetivo deste trabalho é investigar o padrão da secreção de prolactina após a administração de dose única de agonista no momento pré-ovulatório. TIPO DE ESTUDO E LOCAL: Estudo descritivo realizado em um centro de referência terciário. PARTICIPANTES: 15 pacientes normo-ovulatórias submetidas a indução da ovulação para inseminação intra-uterina. MÉTODOS: A estimulação ovariana foi realizada com gonadotropinas da mulher menopausada (75 UI por via intramuscular diariamente). Na presença de pelo menos um folículo de 17 mm (observado por ultra-sonografia), administrou-se 0,5 mg de acetato de buserelina. Foram colhidas amostras de sangue para determinação dos níveis de prolactina no momento da injeção do agonista e 4, 8, 12, 24 e 48 horas depois. RESULTADOS: Observou-se aumento significante nas concentrações séricas de prolactina 4, 8 e 12 horas após a administração do análogo, com um pico após 8 horas. CONCLUSÃO: A administração de uma dose única de análogo agonista no momento pré-ovulatório de pacientes estimuladas com gonadotropinas da mulher menopausada promove aumento significante nas concentrações séricas de prolactina.

Influência da preservação de pele em cirurgia conservadora por câncer de mama sobre as taxas de recorrência local e a distância / Influence of skin sparing in conservative surgery for breast cancer on the rates of local and distant recurrence

OBJETIVO: avaliar a taxa de recorrência local, regional e a distância de nova técnica cirúrgica para tratamento conservador do câncer de mama de estádio inicial. A técnica é baseada na ressecção segmentar com dissecção axilar e preservação de pele por incisão periareolar única. MÉTODOS: cento e dezenove pacientes com câncer de mama de estádio I e II foram incluídas neste estudo. O grupo estudo foi constituído por 57 pacientes que se submeteram à cirurgia pela técnica proposta e 62 pacientes submetidas a quadrantectomia clássica constituíram o grupo controle. A radioterapia pós-operatória e o boost foram realizados em ambos os grupos. A média de seguimento foi de 50,1 meses para o grupo estudo e 51,2 para o grupo controle. As taxas de recidiva, sobrevida global e sobrevida livre de doença foram analisadas e comparadas entre os dois grupos. RESULTADOS: a taxa de recidiva local no período foi de 3,5 por cento para o grupo estudo e 4,8 por cento para o grupo controle. Não houve diferença significativa entre os grupos nas taxas de sobrevida livre de doença e sobrevida global. CONCLUSÕES: a técnica de ressecção segmentar com dissecção axilar por incisão única periareolar, preservando pele, näo mostrou diferença, em relação à quadrantectomia clássica, nas taxas de recidiva, sobrevida global e sobrevida livre de doença

Avaliação da capacidade orgástica em mulheres na pós-menopausa / Assessment of orgasmic capacity of postmenopausal women

OBJETIVO: Correlacionar a capacidade orgástica (durante a relação sexual e/ou a masturbação solitária) de mulheres pós-menopausadas, saudáveis e sem tratamento hormonal com fatores climatéricos, psicossociais, comportamentais, hormonais e interpessoais. MÉTODOS: De um total de 999 mulheres avaliadas com idade entre 41 e 60 anos, selecionaram-se 60 mulheres saudáveis, sexualmente ativas, com pelo menos um ano de amenorréia, útero íntegro, relacionamento estável com parceiro capacitado ao coito e não usuárias de terapia hormonal. Elaborou-se um modelo estatístico de regressão logística que avaliou a capacidade de orgasmo (variável dependente) em função de 17 variáveis independentes, que representavam fatores psicossociais, comportamentais, interpessoais, climatéricos e hormonais. RESULTADOS: A capacidade orgástica está significativamente correlacionada à prática da masturbação (p=0,000), ao gostar de abraçar e acariciar o corpo do parceiro (p= 0,036) e à presença de secura vaginal (p=0,021). CONCLUSÕES: Nas mulheres pós-menopausadas avaliadas, a capacidade orgástica relacionou-se positivamente com o relacionamento mais afetivo com o companheiro e com a prática da masturbação. Mulheres que apresentam secura vaginal, mas que praticam a masturbação e mantêm relacionamento afetivo com o parceiro, conseguem obter o mesmo número ou um número maior de orgasmos se comparados à freqüência do coito.

Microlaparoscopy in gynecology: analysis of 16 cases and review of literature

Microlaparoscopy represents the development of endoscopic surgery towards a minimally invasive surgical procedure. The advantages include fewer surgical complications, faster return to daily activities, more comfortable postoperative recovery, and satisfactory aesthetic results. The possibility of performing surgery under sedation may result in shorter hospitalization, lower hospital costs, and easier anesthetic procedures. The authors report their preliminary experience with the use of microlaparoscopy, using optics and 2mm instruments, as well as a review of the literature since the introduction of this new technique. The report of these 16 cases demonstrates that microlaparoscopy is a feasible technique with satisfactory results. On the other hand, this new technique requires precise indications and a training period for the development of the skills necessary for performing these surgeries