Características clínicas, diagnóstico e tratamento de mulher com síndrome de Meigs: relato de caso e revisão narrativa / Clinical characteristics, diagnosis and treatment of a woman with Meigs syndrome: case report and narrative review

O objetivo deste estudo é descrever o caso de mulher com síndrome de Meigs e apresentar a revisão narrativa sobre o tema. Paciente do sexo feminino, 30 anos, nulípara, encaminhada ao hospital por massa anexial e história prévia de drenagem de derrame pleural. Evoluiu com instabilidade hemodinâmica por derrame pleural hipertensivo à direita, sendo submetida a drenagem torácica, com citologia do líquido negativa. Após, foi submetida a laparotomia: realizada salpingo-ooforectomia esquerda. A congelação e a análise histopatológica diagnosticaram fibroma ovariano. A citologia ascítica foi negativa. CA-125 elevado, presença de derrames cavitários e exame de imagem suspeito podem mimetizar um cenário de neoplasia maligna de ovário em estágio avançado. Entretanto, na síndrome de Meigs clássica, o tratamento é cirúrgico, sendo o diagnóstico obtido por meio da análise histopatológica do tumor ovariano. O manejo da síndrome de Meigs clássica é cirúrgico e, após a remoção do tumor, o derrame pleural e a ascite desaparecem.

To describe a case of Meigs syndrome and present a narrative review of the condition. Female patient, 30 years old, nulliparous, referred to the hospital due to an adnexal mass and a previous drainage of pleural effusion. She developed hemodynamic instability due to a hypertensive right pleural effusion being submitted to chest drainage, with negative cytology of the fluid. She underwent laparotomy: Left salpingo-oophorectomy was performed and frozen section and histopathological analysis diagnosed an ovarian fibroma. Ascites cytology was negative. Elevated CA-125, presence of cavitary effusions, suspicious imaging exam can mimic a scenario of ovarian cancer at an advanced stage. However, in classical Meigs syndrome, treatment is surgical, and the diagnosis is obtained through histopathological analysis of the ovarian tumor. Classical Meigs syndrome' management is surgical. After tumor removal, pleural effusion and ascites resolve.

Microdeleciones del gen AZF en varones azoospérmicos-oligozoospérmicos / AZF gene microdeletions in azoospermic–oligozoospermic males

Antecedentes y objetivo: La presencia de microdeleciones en las regiones del factor de azoospermia (AZF) del cromosoma Y (YCM) se considera la causa genética más frecuente de infertilidad masculina junto con el síndrome de Klinefelter. El objetivo del estudio fue investigar las frecuencias y tipo de YCM en hombres infértiles en Aragón y analizar la relación entre las hormonas sexuales, la concentración espermática y las microdeleciones en ellos.Pacientes y métodosEstudio descriptivo retrospectivo de 644 varones, durante el periodo 2006-2019, a los que se les realizo el cribado para YCM mediante YChromStrip (Operón, España) por PCR+hibridación reversa, espermiograma, cariotipo y medición de las hormonas sexuales.ResultadosLa frecuencia de YCM fue del 3,88% (25/644), no detectándose en ningún paciente con oligozoospermia leve ni normospérmico, es decir, en recuentos espermáticos superiores a 5×106/ml. El grupo de pacientes azoospérmicos fue el que presentó una frecuencia de YCM más elevada (14,58%, 14/96). Las deleciones en la región AZFc fueron las más frecuentes (68%). El 20% (5/25) de pacientes con YCM presentó además algún tipo de anomalía en el cariotipo que incluyeron aneuploidías, deleciones, duplicaciones o translocaciones. La concentración espermática fue significativamente menor y las concentraciones de FSH y LH significativamente mayores en el grupo de pacientes con YCM.ConclusionesEl cribado de YCM es una prueba clave en el abordaje diagnóstico de la infertilidad masculina. La obtención de un resultado genético adecuado permite elegir técnicas de reproducción asistida idóneas, prevenir tratamientos innecesarios y la transmisión de defectos genéticos a la descendencia. (AU)

Background and objective: The presence of microdeletions in the Y-chromosome azoospermia factor (AZF) region (YCMs) is considered the most frequent genetic cause of male infertility along with Klinefelter syndrome. The objective of this study was to investigate the frequencies and type of YCMs in infertile men in Aragon and to analyze the relationship between sex hormones, sperm count and microdeletions in them.Patients and methodsRetrospective descriptive study of 644 men who during 2006–2019 were screened for YCMs using YChromStrip (Operón, Spain) by PCR+reverse hybridization, spermiogram, karyotype and quantification of sex hormones.ResultsThe frequency of YCMs was 3.88% (25/644), not being detected in any patient with mild or normospermic oligozoospermia, that is, in sperm counts higher than 5×106/mL. The group of azoospermic patients was the one that presented a higher frequency of YCMs (14.58%, 14/96). Deletions in the AZFc region were the most frequent (68%). 20% (5/25) of patients with YCMs also presented some type of karyotype abnormality that included aneuploidies, deletions, duplications and/or translocations. Sperm count was significantly lower and FSH and LH concentrations significantly higher in the group of patients with YCMs.ConclusionsYCMs screening is a key test in the diagnostic approach to male infertility. Obtaining an adequate result allows choosing suitable assisted reproduction techniques, preventing unnecessary treatments and the transmission of genetic defects to offspring. (AU)

[AZF gene microdeletions in azoospermic-oligozoospermic males]. / Microdeleciones del gen AZF en varones azoospérmicos-oligozoospérmicos.

BACKGROUND AND OBJECTIVE: The presence of microdeletions in the Y-chromosome azoospermia factor (AZF) region (YCMs) is considered the most frequent genetic cause of male infertility along with Klinefelter syndrome. The objective of this study was to investigate the frequencies and type of YCMs in infertile men in Aragon and to analyze the relationship between sex hormones, sperm count and microdeletions in them. PATIENTS AND METHODS: Retrospective descriptive study of 644 men who during 2006-2019 were screened for YCMs using YChromStrip (Operón, Spain) by PCR+reverse hybridization, spermiogram, karyotype and quantification of sex hormones. RESULTS: The frequency of YCMs was 3.88% (25/644), not being detected in any patient with mild or normospermic oligozoospermia, that is, in sperm counts higher than 5×106/mL. The group of azoospermic patients was the one that presented a higher frequency of YCMs (14.58%, 14/96). Deletions in the AZFc region were the most frequent (68%). 20% (5/25) of patients with YCMs also presented some type of karyotype abnormality that included aneuploidies, deletions, duplications and/or translocations. Sperm count was significantly lower and FSH and LH concentrations significantly higher in the group of patients with YCMs. CONCLUSIONS: YCMs screening is a key test in the diagnostic approach to male infertility. Obtaining an adequate result allows choosing suitable assisted reproduction techniques, preventing unnecessary treatments and the transmission of genetic defects to offspring.

Post-radiotherapy hysterectomy does not benefit females with cervical adenocarcinoma.

Cervical adenocarcinoma is associated with a poor prognosis, which may be caused by the infiltrative growth pattern and metastasis of tumor cells. There is a lack of consensus on hysterectomy after radiotherapy for the improvement of selected cases. The present study aimed to assess the oncological outcome of post-radiotherapy hysterectomy in females with cervical adenocarcinoma. A total of 39 females with cervical adenocarcinoma at stages IB1 to IIIB, managed primarily with radiotherapy with complete response, and underwent extrafascial hysterectomy as consolidation therapy between 1988 to 2015 were studied. Surgery complications and residual disease were evaluated. A comparison group was constructed, comprising 41 females with cervical adenocarcinoma managed with exclusive radiotherapy or chemoradiotherapy demonstrating complete response, without surgery. Descriptive and survival analysis was performed. The groups were comparable in terms of age, cancer stage, radiotherapy (dose and duration) and follow-up, although 67% of hysterectomies were performed prior to 2002 and 46% of the radiotherapy group received chemoradiation. Late complications were similar. There were nine recurrences (23%) in the case series and 10 recurrences (24%) in the radiotherapy group. Residual disease was detected in 56% (22/39) of uterine specimens, of which 12 were up to 10 mm. Residual disease was associated with recurrence (31% vs. 6%, P=0.028). The overall survival rate was 75% for the case series vs. 88% for the radiotherapy group (P=0.579), and the disease-free survival rate was 79-80% for both. Removal of residual disease by hysterectomy did not improve the overall survival rate (P=0.283) and disease-free survival rate (P=0.072). Post-radiotherapy hysterectomy in cervical adenocarcinoma is a feasible procedure with acceptable complications, however, it did not bring relevant benefits in recurrences, disease-free survival, and overall survival rates.

Effectiveness of a multicomponent intervention to reduce social isolation and loneliness in community-dwelling elders: A randomized clinical trial. Study protocol.

AIMS: This study aims to evaluate the effectiveness of a multicomponent intervention in non-institutionalized older people. This effectiveness will be assessed in terms of reducing social isolation and loneliness and improving Health-Related Quality of Life. BACKGROUND: The concern for social isolation and loneliness in non-institutionalized older adults has increased in recent decades. In addition, their relationship with numerous negative health outcomes is amply demonstrated. DESIGN: A mixed-method design including a cluster randomized controlled clinical trial and an exploratory qualitative study with focus groups was used. METHOD: Each study group consists of 57 subjects. The experimental group will be subjected to a multicomponent intervention comprising six domiciliary face-to-face sessions and five telephone calls that will be interspersed. Interventions will be conducted by healthcare professionals and volunteers. The control group will not be subjected to any systematized intervention. We are going to consider social isolation, loneliness, and Quality of Life as the primary outcomes. However, the factors that influence both primary outcomes and the feasibility of the intervention in clinical practice will also be assessed. DISCUSSION: Despite the negative influence of social isolation and loneliness on clinical outcomes is widely evidenced, few early detection programs are available, especially interventions at the community setting. This study will examine the effectiveness of the intervention in the Spanish community setting. At the same time, this study will identify the feasibility of this intervention in Primary Care clinical practice. IMPACT: Substantial evidence indicates the detrimental health impact of social isolation and loneliness, particularly on mental wellness. Knowing that mental disorders are associated with high economic cost, this project would have strong clinical implication to inform nursing practice on managing social isolation and loneliness. The findings may also inform primary health policy setting in Spain and the wider European countries.

Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome.

OBJECTIVE: To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival. STUDY DESIGN: 194 women underwent hysterectomies by laparotomy, with SL (n = 95) or without SL (n = 99) between 1990 and 2014 was evaluated. Diagnosis period, age, BMI, comorbidities, stage, and adjuvant radiotherapy were analyzed. DFS and cancer-specific survival were analyzed by Kaplan-Meier and log-rank test, and recurrences by Cox regression. RESULTS: SL was performed in 93% (41/44) of women managed before 1998 and decreasing after that (p < 0.001). SL was also more frequent if BMI under 35.0 kg/m2 (p < 0.001) and in women without comorbidities (p = 0.017). Distribution of age, stage and postoperative radiotherapy were not different between groups. There were 14 recurrences (7.4%), concentrated in the SL group (12 cases) and associated with Stage IAG3 (35.7%, p = 0.009). Longitudinal evaluation exhibited 95% of 5-year cancer-specific survival rate for non-SL group vs. 88% for the SL group (p = 0.039), and DFS rate was 97% for the non-SL group vs. 85% for the SL group (p = 0.004). Cox regression analyses exhibited Stage IAG3 (HR 6.48, IC95% 1.88-22.39; p = 0.003) associated with less DFS. CONCLUSION: SL in surgical staging of EEC at intermediate risk presented no benefits regarding recurrences, DFS, and cancer-specific survival rate when compared to patients not submitted to complete surgical staging. Stage IAG3 had poor prognosis regardless treatment modality. Our results provide further evidence to support the current trend to avoid SL in the surgical approach to selected women.

Neumatosis intestinal y gas portal secundarios a obstrucción de origen adherencial / Intestinal pneumatosis and portal gas secondary to adhesional obstruction

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[Clinically undetectable lymph node invasion in vulvar cancer]. / Invasão linfática clinicamente não detectável do câncer vulvar.

OBJECTIVE: To assess the neoplastic invasion of superficial and deep inguinal lymph nodes of women with invasive vulvar squamous carcinoma smaller than 5 centimeters with a clinically normal inguinal region. METHODS: the medical records of 59 women cared at the State University of Campinas with invasive vulvar squamous carcinoma T1 and T2 and who presented clinically normal inguinal regions (N0) were reviewed. Clinical characteristics of both tumor and patients were evaluated as well as the follow-up data. Odds ratios and Fisher's Exact Test were used to assess the correlations between the invasion of inguinal lymph nodes and tumor size, grade, relapses and clinical complications. Confidence limits of 95% were used. RESULTS: Age of the patients ranged from 34 to 91 years (mean 67 years), and follow-up time ranged from 3 days (peri-operatory death) to 252 months (mean 27 months). Clinically, 22 (37%) women had lesions T1 lesions and 37 (63%) T2. Histological analysis showed unilateral lymphatic invasion in six (10%) women and bilateral in three (5%). There was no significant association between tumor size and lymph node invasion. Also, pathologic tumor size and grade were not associated with lymph node neoplastic involvement. Relapses and late complications were not correlated with lymph node neoplastic invasion. CONCLUSIONS: Superficial and deep inguinal dissection disclosed clinically undetectable lymph node neoplastic invasion, although tumor size and histological grade, relapses and late complications were not associated with node involvement.

Invasão linfática clinicamente não detectável do câncer vulvar / Clinically undetectable lymph node invasion in vulvar cancer

OBJETIVO: Avaliar em mulheres com carcinoma escamoso da vulva menor que 5 cm e clinicamente sem comprometimento inguinal a invasão por neoplasia nos linfonodos inguinais superficiais e profundos. MÉTODOS: Foram avaliados os dados de 59 mulheres atendidas entre outubro de 1982 e janeiro de 2004 na Universidade Estadual de Campinas, em decorrência de carcinoma escamoso invasivo da vulva T1 ou T2 e com linfonodos inguinais clinicamente livres de invasão neoplásica (N0). Foram levantadas características clínicas do tumor e das pacientes e os dados do seguimento. Foram calculados os odds ratio e teste exato de Fisher para as associacões entre a invasão dos linfonodos inguinais com o tamanho do tumor, grau histológico, recidivas e complicacões. A confianca estatística foi de 95 por cento. RESULTADOS: A idade das mulheres variou de 34 a 91 anos (média de 67 anos), com tempo de seguimento entre três dias (óbito perioperatório) e 252 meses (média de 27 meses). Clinicamente, 22 (37 por cento) mulheres apresentavam tumores T1 e 37 (63 por cento) T2. Após análise histológica, seis (10 por cento) mulheres apresentavam invasão unilateral e três (5 por cento) bilateral, não havendo associacão entre o tamanho do tumor e a invasão dos linfáticos inguinais. Também o tamanho do tumor à avaliacão patológica e seu grau histológico não se mostraram associados à invasão nos linfonodos inguinais. Recidivas e complicacões tardias não se correlacionaram com a invasão neoplásica inguinal. CONCLUSÕES: A disseccão inguinal superficial e profunda revelou invasão neoplásica clinicamente não detectável em 15 por cento das mulheres estudadas, apesar de que tamanho e grau histológico do tumor, recidivas e complicacões tardias não estiveram associadas com a invasão nos linfonodos.

Risk-of-malignancy index in preoperative evaluation of clinically restricted ovarian cancer.

CONTEXT: There is no adequate preoperative method for differentiating between benign and malignant pelvic masses. Evaluations of CA 125 serum levels, ultrasonography findings and menstrual state have been tested in isolation as diagnostic methods. The evaluation of these three methods in association with each other could improve diagnostic performance. OBJECTIVE: To evaluate the risk-of-malignancy index by combining serum CA 125 levels, ultrasound score and menopausal status in preoperative diagnoses for women with pelvic masses clinically restricted to the ovaries and without clear evidence of malignancy. DESIGN: Cross-sectional study. SETTING: Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. PARTICIPANTS: 158 women admitted between January 1996 and March 1998 for surgical exploration of pelvic masses. PROCEDURES: The risk-of-malignancy index was calculated as US x M x CA 125, performed preoperatively. Ultrasound findings were classified according to the shape, size, multiplicity, presence of wall expansion involvement or ascites, using a score system (US). Menopausal status was considered as 1 for premenopausal and 3 for postmenopausal (M), and CA 125 serum levels were considered in absolute values. STATISTICAL ANALYSIS: Most relevant variables were included in a logistic multiple regression model, fitted using the ultrasound score, the serum CA 125 level and the menopausal status. The model was used for evaluating the performance of each individual predictor in determining the malignancy of these tumors and identifying the risk-of-malignancy index. RESULTS: The best individual performance was found in CA 125 levels (sensitivity of 78%, specificity of 75%), followed by ultrasound score (sensitivity of 75%, specificity of 73%) and menopausal status (sensitivity of 73%, specificity of 69%). The performance obtained for the risk-of-malignancy index at the cut-off point of 150 was a sensitivity and specificity of 79%. The area under the ROC curve for the risk-of-malignancy index was 0.90, which was greater than the area for CA 125 levels (0.83) or ultrasound score (0.79). CONCLUSION: The risk-of-malignancy index using ultrasound morphological score, serum CA 125 levels and menopausal status might be of value in the preoperative assessment of ovarian carcinomas.

Presence and physiologic regulation of alcohol oxidase activity in an indigenous fungus isolated from petroleum-contaminated soils.

A soluble alcohol oxidase (AO) activity was detected in the mycelium of a filamentous fungus strain named YR-1, isolated from petroleum-contaminated soils. AO activity from aerobically grown mycelium was detected in growth media containing the hydrocarbons decane or hexadecane; the enzyme activity exhibited optimum pH for the oxidation of different alcohols (methanol, ethanol, and hexadecanol) similar to that of the corresponding aldehyde. Zymogram analysis conducted with purified fractions from aerobic mycelium of YR-1 strain extracts indicated the existence of two AO enzymes (AO-1 and AO-2). Purified samples of both enzymes analyzed by sodium dodecylsulfate-polyacrylamide gel electrophoresis indicated the presence of three protein bands with molecular sizes 20,38, and 46 kDa that could be part of the native enzyme. In samples of both enzymes, the 46-kDa protein gave a positive reaction in immunodetection experiments with antibodies directed against AO from Hansenula polymorpha. The purified AO-2 enzyme oxidized different alcohols, although higher activity was displayed with hexadecanol. Km values obtained for methanol and hexa-decanol indicated a higher affinity for the latter. Analysis of the aminoter-minal sequence of the 46-kDa protein of AO-2 enzyme indicated significant similarity to enzymes involved in the metabolism of biphenyl polychloride compounds.

Risk-of-Malignancy Index in preoperative evaluation of clinically restricted ovarian cancer

CONTEXT: There is no adequate preoperative method for differentiating between benign and malignant pelvic masses. Evaluations of CA 125 serum levels, ultrasonography findings and menstrual state have been tested in isolation as diagnostic methods. The evaluation of these three methods in association with each other could improve diagnostic performance. OBJECTIVE: To evaluate the risk-of-malignancy index by combining serum CA 125 levels, ultrasound score and menopausal status in preoperative diagnoses for women with pelvic masses clinically restricted to the ovaries and without clear evidence of malignancy. DESIGN: Cross-sectional study. SETTING: Centro de Atençäo Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, Säo Paulo, Brazil. PARTICIPANTS: 158 women admitted between January 1996 and March 1998 for surgical exploration of pelvic masses. PROCEDURES: The risk-of-malignancy index was calculated as US x M x CA 125, performed preoperatively. Ultrasound findings were classified according to the shape, size, multiplicity, presence of wall expansion involvement or ascites, using a score system (US). Menopausal status was considered as 1 for premenopausal and 3 for postmenopausal (M), and CA 125 serum levels were considered in absolute values. STATISTICAL ANALYSIS: Most relevant variables were included in a logistic multiple regression model, fitted using the ultrasound score, the serum CA 125 level and the menopausal status. The model was used for evaluating the performance of each individual predictor in determining the malignancy of these tumors and identifying the risk-of-malignancy index. RESULTS: The best individual performance was found in CA 125 levels (sensitivity of 78 percent, specificity of 75 percent), followed by ultrasound score (sensitivity of 75 percent, specificity of 73 percent) and menopausal status (sensitivity of 73 percent, specificity of 69 percent). The performance obtained for the risk-of-malignancy index at the cut-off point of 150 was a sensitivity and specificity of 79 percent. The area under the ROC curve for the risk-of-malignancy index was 0.90, which was greater than the area for CA 125 levels (0.83) or ultrasound score (0.79). CONCLUSION: The risk-of-malignancy index using ultrasound morphological score, serum CA 125 levels and menopausal status might be of value in the preoperative assessment of ovarian carcinomas

Relaçäo entre tumores ovarianos epiteliais borderline e francamente invasores: epidemiologia, histologia e prognóstico / The relationship between broderline and invasive epithelial ovarian tumors: epidemiology, histology and prognosis

Objetivo: avaliar alguns aspectos epidemiológicos, do diagnóstico e do prognóstico em mulheres com tumores epiteliais ovarianos borderline e francamente invasores. Métodos: foram revisados os prontuários de 198 pacientes tratadas no CAISM/UNICAMP de 1986 a 1996. Para análise estatística foram utilizados os testes X², exato de Fisher, t de Student e curvas de sobrevida pelo método de Kaplan-Meyer comparadas pelo teste log-rank. O seguimento médio das pacientes foi de 50 meses (de 11 a 168). Dos 198 casos, 24 eram tumores borderline (12 por cento) e 174 (88 por cento) carcinomas francamente invasores. Resultados: a média de idade das pacientes com tumores borderline foi significativamente menor que a das mulheres com carcinoma francamente invasor: 43 ñ 14,8 anos vs 52 ñ 12,6 anos (p<0,002). Os tipos histológicos mais freqüentes foram serosos (81 casos - 41 por cento) e diagnosticada em estádios mais precoces (p<0,0001). A biópsia de congelaçäo, realizada em 77 pacientes, mostrou uma boa concordância com a biópsia de parafina nos casos de carcinoma francamente invasor. Entretanto, nos tumores borderline a taxa de erro foi alta (13 por cento), sendo que a maioria das falhas diagnósticas da congelaçäo ocorreu entre os tumores mucosos. Em relaçäo ao prognóstico, a taxa de sobrevida foi significativamente maior nas pacientes com tumores borderline (p<0,001). Conclusöes: as pacientes com tumores apiteliais ovarianos borderline foram mais jovens que aquelas com tumores francamente invasores, apresentaram a doença em estádios iniciais e tiveram melhor prognóstico quando comparadas àquelas com carcinoma francamente invasor.

Tumores de células da granulosa do ovário: estadiamento e tratamento / Granulosa cell tumors of the ovary: staging and treatment

O objetivo deste trabalho foi o de analisar a importância dos achados cirúrgicos e histólogicos para a definiçäo dos estadiamento e tratamento dos tumores de células da camada granulosa do ovário. Foram avaliados o estadiamento e os resultados do tratamento de 11 pacientes, atendidas entre janeiro de 1990 e dezembro de 1994, no Centro de Atençäo Integral + Saúde da Mulher, da Universidade Estadual de Campinas, no Estado de Säo Paulo. O seguimento foi atualizado em agosto de 1996. A idade das pacientes variou de 18 a 67 anos, com média de 46 anos. Duas pacientes foram submetidas à salpingo-ooforectomia bilateral, histerectomia total, apendicectomia e omentectomia e, em sete, acrescentou-se a linfadenectomia retroperitoneal. Em dois casos a doença era irressecável. Cinco pacientes encontravam-se com tumor em estádio IIIC; uma, em estádio IC; e cinco, em estádio IA. A revisäo histopatológica revelou 10 neoplasias do tipo adulto e uma do tipo juvenil. Em todos os casos encontrou-se mais de um tipo histopatológico de tumor de células granulosas, sendo dominante o tipo sólido (7/11 casos). O tratamento complementar com antiblásticos - seis ciclos de carboplatina (300 mg/m²) e ciclofosfamida (500 mg/m²) - foi aplicado nas pacientes com doença em estádios IC e IIIC. No último controle, com um seguimento variando de 20 a 71 meses, todas as pacientes com tumores no estádio inicial encomtravam-se sem doença; contudo, das cinco pacientes com neoplasia em estádio IIIC, três apresentavam progressäo da doença apesar do tratamento antiblástico.

Estudo radiológico ósseo de mulheres climatéricas e menopausadas / Bone radiology study on climacteric and menopausal women

Quinhentas e três mulheres admitidas no Ambulatório de Menopausa do Centro de Atençåo Integral à Saúde da Mulher da Universidade de Campinas em 1992 e 1993 foram submetidas a raios-X simples de tórax, fêmur, måos e punhos e coluna vertebral. Os dados para estudo foram obtidos através de revisåo retrospectiva dos laudos do exame radiológico fornecidos pelo Setor de Radiologia desta instituiçåo. A idade média das pacientes foi de 51,8 +-8,4 anos. O local mais freqüentemente acometido foi a coluna vertebral. Sinais sugestivos de osteoartrose e osteoporose foram mais prevalentes em coluna lombar. Também observou-se desvios acentuados da coluna vertebral em 53,3 por cento dos casos, a presença de ateromas aórticos calcificados em 26 por cento e lesöes radiodensas pulmonares em 9,6 por cento das pacientes. Concluiu-se que a avaliaçåo radiológica de pacientes menopausadas e climatéricas é de grande valor, sobretudo quando nåo existe a disponibilidade de procedimentos mais sofisticados para a avaliaçåo de massa óssea

Distúrbio hipertensivo na gravidez acompanhado por síndrome HELLP / Hypertensive disorder during pregnancy followed by HELLP syndrome

A Síndrome HELLP (SH) é uma complicaçao da pré-eclâmpsia e eclâmpsia associada com anemia hemolítica microangiopática, produzindo hemólise, elevaçao de enzimas hepáticas e plaquetopenia. Apresentamos uma série de dez casos, diagnosticados e seguidos na Maternidade do Centro de Assistência Integral à Saúde da Mulher (CAISM) da UNICAMP. Foram analisadas características pré-gestacionais como idade, paridade e antecedentes mórbidos, assim como a idade gestacional no início do quadro clínico, dados do parto, da puerpério e do recém-nascido. Nao houve morte materna e o resultado perinatal dependeu diretamente do peso do recém-nascido e da idade gestacional no momento do parto. Os autores discutem os aspectos diagnósticos e acreditam que a conduta intervencionista possa melhorar o prognóstico materno.