[Immediate breast reconstruction with the use of a microsurgical flap of the rectus abdominis muscle]. / Reconstrução mamária imediata com o uso do retalho microcirúrgico do músculo reto abdominal.

Breast cancer in advanced stages is a condition still frequently diagnosed in the female patients of this hospital. The surgical treatment proposed tends to be radical and mutilating. The importance of the breast for the female self-image is recognized, as well as the sameness of the prognosis of the disease after breast reconstruction, for which different techniques may be proposed to the patients. Among them is the use of the m. rectus abdominis as musculo-cutaneous free flap. This paper reports our experience in regard to the indication, tactics, results and complications of this technique.

Tissue carcinoembryonic antigen in the prognosis of early invasive breast cancer.

Twenty-five patients with stage II ductal breast carcinoma followed up for ten years were studied for the presence of tissue carcinoembryonic antigen (CEA). Overall expression of CEA was 60%. The ten year survival rate was significantly higher for patients with CEA-negative tumours (70%) than for patients with CEA-positive tumours (27%), while the difference between the survival rate of patients with (30%) or without (53%) lymph node involvement did not reach significance. Among the 10 patients with lymph node involvement, CEA-negative patients had a better outcome. These results suggest that there is a correlation between the presence of tissue CEA and the prognosis of the disease, and that CEA status might possibly be more important than lymph node involvement, at least within stage II breast carcinomas.

Endometrial damage in acute salpingitis.

Histologic and bacteriologic analyses of endometrium were performed before and on day 15 after minocycline treatment of 20 patients with acute salpingitis. Endometritis was diagnosed in 15 patients before and in nine after treatment. Neisseria gonorrhoeae was recovered from the cervix and endometrium of seven patients but was not isolated after treatment. Chlamydia trachomatis was recovered from the cervix of eight, and from the endometrium of three patients, two of whom had negative cervical cultures. After treatment C. trachomatis was recovered from the cervix of three patients, although two of them had taken aluminum hydroxide for gastric symptomatology during minocycline treatment. Culture of an endometrial specimen revealed no growth of C. trachomatis. The histologic study revealed plasma cell infiltrates in specimens from patients who had cultures positive for C. trachomatis. The results showed that although endometritis is an important manifestation of acute salpingitis, there is no correlation between severity of endometritis and degree of tubal damage.

[Sexually transmitted agents in gynecology: incidence and importance]. / Agentes sexualmente transmitidos em ginecologia: incidencia e importancia.

PIP: The study comprised the analysis of 77 patients between May 1985 and May 1986 in the emergency clinic of the Gynecological Clinic of the Faculty of Medicine of the University of Sao Paulo. Three different groups constituted the cases: A) 15 women devoid of infectious symptoms, aged 18-52 with an average of 31.5 years; B) 25 patients who were carriers of mucous purulent cervicitis, aged 16-42 with an average age of 27.6 years; and C) 37 carriers of acute salpingitis, aged 16-48 with an average age of 25 years. All patients had been sexually active, and none of them had used any local or systemic anti-infection medication for 30 days preceding the study. Pap smears were carried out in all patients. Laparoscopy indicated light salpingitis in 17 patients, moderate in 12, and grave in 8 patients. Neisseria gonorrhea was isolated from the endocervix of 14 women (37.8%) with acute salpingitis, and from none of the other 2 groups. Chlamydia trachomatis was found in 1 (6.7%), 3 (12%), and 14 (37.8%) patients in the Groups A, B, and C. Ureaplasma urealyticum was identified in 3 (20%), 9 (36%), and 21 (56.8%) in the respective groups. Mycoplasma hominis was isolated in 1 (6.7%), 1 (4%), and 2 (5.4%) patients in the respective groups. Cervical-vaginal cytology in the different groups broke down in this fashion; in Group A, 4 were normal (26.7%) and 11 were infectious (64.7%); in Group B, 3 were normal (12%) and 21 were infectious (84%), while 1 (4%) was suspected of dysplasia; and in Group C, 2 were normal (5.4%) and 31 were infectious (83%), while 4 (10.8%) were suspected of dysplasia. It is well known that colpocytological alterations are intimately related to sexual activity. These alterations may also have to do with cancer of the cervix. In view of the fact that the analyzed groups had been promiscuous, a high percentage of colpocytological alterations could be expected. Indeed, clear increases of inflammatory alterations and cervical displasias were found in the cervicitis and salpingitis groups.^ieng

Surgical treatment of congenital uterovaginal agenesis: Mayer-Rokitansky-Küster-Hauser syndrome.

Twenty-five patients with congenital uterovaginal agenesis underwent neovaginoplasty according to the McIndoe and Banister technique. In 17 (68.0%) cases the congenital agensis was also associated with renal and bone malformations. The postoperative results, based on the length of the neovagina, were considered to be satisfactory in 16 (64.0%) cases, moderate in five (20.0%) and fair in four (16.0%). Dehiscences, fistulae and retention cysts were observed in six (24.0%) cases but had no statistically significant correlation with the final length of the neovagina. On the other hand, a statistically significant relationship between the length of the neovagina and dyspareunia was observed.

Ovarian histology and function after total abdominal hysterectomy.

Ovarian histology and function were assessed before and after total abdominal hysterectomy in 25 patients with symptomatic uterine myomata. Immediately before hysterectomy, bilateral ovarian biopsies were performed, and, 12 months later, all patients underwent a second ovarian biopsy through laparoscopy. Histologic study of the ovaries one year after total abdominal hysterectomy showed stromal cell hyperplasia, thickening of the tunica albuginea, and a significant decrease of follicular reserve, follicular cysts, and corpora albicantia. There was no significant difference in the number of atretic follicles and corpora lutea. The serum levels of all hormones studied were unchanged 12 months after the surgical procedures.

Estudo clinico e laboratorial de pacientes climatericas (fase pos-menopausica) submetidas ao LIR-1660. / Clinical and laboratorial study of climacteric patients (post-menopausal phase) submitted to LIR 1660

Trinta pacientes na pos-menopausa fisiologica foram tratadas com LIR-1660 na dosagem de 100 mg/dia durante 20 dias. Atraves do indice menopausal de Kupperman, da dosagem de FSH, LH prolactina, estradiol e da colpocitologia hormonal observaram-se as modificacoes apos o tratamento. Pode-se concluir ser a droga eficaz no controle dos sintomas neurovegetativos, mas nao determina alteracoes nas concentracoes sanguineas dos hormonios estudados e na colpocitologia hormonal. Em nenhum caso foi observado efeitos colaterais e galactorreia

Estudo clinico de nova medicacao (LIR-1660) na sindrome climaterica (fase pos-menopausica) / Clinical study of a new drug (LTR-1660) in the climateric syndrome (post-menopausal phase)

Os autores estudaram 20 pacientes climatericas na fase pos-menopausica fisiologica, pertencentes a Secao de Climaterio da Clinica Ginecologica da FMUSP (Hospital das Clinicas - Servico do Prof. Carlos Alberto Salvatore), cujas idades oscilaram de 44 a 60 anos. A estas pacientes foi administrado LIR-1660 na dosagem de 100 mg por dia, via oral, por 20 dias consecutivos. Os resultados relacionados aos sintomas vasomotores foram satisfatorios em 80% dos casos e regulares em 20%; em nenhum caso observou-se efeito colateral a droga. Concluem os autores da eficacia desta substancia, e que a mesma representa uma boa alternativa terapeutica nas pacientes climatericas

O acido pipemidico no tratamento da infeccao urinaria. / Pipemidic acid in the urinary tract infection treatment

Vinte e quatro pacientes de sexo feminino, acometidas por infeccoes do trato urinario que procuraram o Pronto-Socorro de Ginecologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, foram tratadas com acido pipemidico, 400 mg 2 vezes ao dia por via oral, por um periodo de sete dias. Do estudo foram excluidas pacientes com molestia imflamatoria pelvica, vulvovaginites ou gestantes.Exame de urina tipo I, cultura e teste de sensibilidade bacteriana foram realizados antes e 10 dias apos o tratamento. O agente mais frequente encontrado foi o E. coli seguido por Staphylococcus saprophyticus, alem de Proteus mirabilis e Citrobacter sp O acido pipemidico mostrou-se altamente eficaz, proporcionando cura bacteriologica e desaparecimento ou melhora da sintomatologia em 87,5% dos casos. A tolerabilidade do medicamento foi muito boa, tendo sido observado apenas um caso de desconforto abdominal e um outro de sensacao de plenitude epigastrica com prurido cutaneo generalizado, anbos transitorios e de leve intensidade

Efeito do danazol na endometriose pelvica. Analise de 20 casos com seguimento de cinco anos. / Effect of danazol on pelvic endometriosis. Analysis of 20 cases with follow-up for 5 years

Os autores analisaram a eficacia do danazol, administrado por via oral nas doses de 400 mg e 600 mg/dia em pacientes inferteis com endometriose pelvica. Os sintomas mais comuns foram dismenorreia (55,0%) algia pelvica cronica (40,0%) e tumor anexial (30,0%). A amenorreia farmacologica e de importante valor prognostico, traduzindo a eficacia do tratamento. No esquema de 400 mg/dia, o indice global de resposta sintomatologica foi de 87,5%; de 600 mg/ dia, de 75.0%. Obteve-se gestacao em 9 (47,4%) das 19 enfermas desejosas de engravidar e o intervalo de tempo medio entre o termino da terapeutica e a gravidez foi de 2,9 meses. Por fim, a ocorrencia de gestacao em pacientes com endometriose pelvica, nesta casuistica, nao guardou relacao com o tempo de esterilidade previa.O periodo de seguimento foi de cinco anos em todos os casos

Medida vascular no carcinoma da mama.Estudo mamografico quantitativo. / Vascular measurement in brest cancer Quantitative mammographic study

O padrao vascular das mamas apreciado pela mamografia foi estudado quantitativamente entre 1978 e 1982. Assim, a vascularizacao mamaria em 10 portadoras de carcinoma (Grupo A) foi comparada com a existente em 10 pacientes com displasia (Grupo B). A idade media foi de 47,1 e 45 anos para os grupos A e B, respectivamente. O total de mensuracoes nas 40 mamas foi de 4.000, escolhidas ao acaso. O diametro medio dos vasos nas mamas carcinomatosas foi de 1,60 +/- 0,11 milimetros, ao passo que o da glandula contralateral foi de 0,72 +/- 0, 12 milimetros, dados estatisticamente diferentes. O diametro medio dos vasos nas pacientes com displasia apresentou-se estatisticamente igual nas glandulas direita a esquerda, isto e, 0,71 +/- 0,08 e 0,68 +/- 0,10 milimetros, respectivamente. Comparou-se o diametro medio dos vasos nas mamas das enfermas com displasia (0,69 +/- 0,09 milimetros) com o correspondente das 10 glandulas normais em portadoras de carcinoma (0,73 +/- 0,11 milimetros).Nao houve diferenca estatistica nos dados encontrados, sugerindo que o aumento da vascularizacao em mamas carcinomatosas resulta de fator local