Aspectos técnicos dos tratamentos endodônticos realizados por cirurgiões-dentistas da PMESP: avaliação por meio de questionário / Technical aspects of endodontic treatments performed by PMESP dentists: evaluation by means of a questionnaire

Introdução: De todas as especialidades na Odontologia, uma das mais favorecidas nos últimos anos com o desenvolvimento de novas tecnologias tem sido a Endodontia. Objetivo: O presente estudo visou obter informações sobre os aspectos técnicos dos tratamentos endodônticos realizados por cirurgiões-dentistas da Polícia Militar do Estado de São Paulo (PMESP), dando ênfase aos materiais, técnicas e equipamentos empregados. Métodos: Um questionário com 25 questões de múltipla escolha foi enviado aos 147 dentistas da PMESP, e o critério de inclusão foi que os profissionais realizassem tratamentos endodônticos. Resultados: A análise estatística foi feita por meio do teste qui-quadrado, com p<0,05. Entre os 42 profissionais avaliados, 59,5% eram do sexo masculino, o dique de borracha foi utilizado em 54,8% dos casos, o comprimento de trabalho foi obtido por meio de radiografias em 71,4%, o sensor digital foi utilizado em 28,6%, a magnificação visual foi utilizada em 23,8% e a técnica de condensação lateral foi a mais utilizada, com 90,2%. Outra análise foi realizada com 10 especialistas do Centro Odontológico da PMESP que efetuavam unicamente tratamento endodôntico, sendo que 50% eram do sexo masculino e tratavam mais de 15 casos/mês: o dique de borracha foi utilizado em 80% dos casos; o comprimento de trabalho foi obtido com localizador foraminal em 50% dos casos; o sensor digital foi utilizado em 90%, assim como o motor elétrico; a técnica de condensação lateral foi utilizada em 60% dos casos e o ultrassom, em 20%. Conclusões: Conclui-se que os especialistas utilizaram mais as novas tecnologias, e que o ultrassom e a magnificação visual foram pouco utilizados em ambos os grupos (AU).

Introduction: Of all the specialties in dentistry, one of the most favored in recent years with the development of new technologies has been endodontics. Objective: This study aimed to obtain information on the technical aspects of endodontic treatments performed by dentists from the Military Police of the State of São Paulo, emphasizing the materials, equipment, and techniques used. Methods: A questionnaire with 25 multiple choice questions was sent to 147 dentists from PMESP and the inclusion criterion was professionals who performed endodontic treatment. Results: The statistical analysis was done through the chi-square test, with p< 0.05. The professionals evaluated 59.5% were male, the rubber dam was used in 54.8% of the cases, the working length by means of radiographs was obtained in 71.4%, the digital sensor was used in 28.6%, the visual magnification was used in 23.8% and the lateral condensation technique was the most used with 90.2%. Another analysis was performed with 10 specialists of the Dental Center who performed only endodontic treatment, 50% were male, treated more than 15 cases/month, the rubber dike was used in 80% of the cases, the working length was performed in 50% of the cases by foraminal locator, the digital sensor was used in 90%, as well as the electric motor, the technique of lateral condensation was used in 60% of the cases and ultrasound 20%. Conclusion: It was concluded that the specialists used more new technologies and that the use of ultrasound and visual magnification was little used in both groups (AU).

The use of biologics for autoimmune rheumatic diseases in fertility and pregnancy.

In an age where autoimmune rheumatic diseases are successfully managed with biologics, their discontinuation in pregnancy is inadvisable without careful forethought; maternal disease activity is associated with adverse pregnancy outcomes, which has long-term implications for both mother and offspring. We aim to provide clinicians with the necessary tools to facilitate decision-making - when a biologic should be used, when it can be discontinued in pregnancy if appropriate. The pathophysiology of these biologic molecules and their effect on fertility, pregnancy and parturition are discussed. A summary of the 2016 international guidelines (European League Against Rheumatism and British Society in Rheumatology) on biologics in pregnancy has been tabulated; more recent publications are discussed in depth. Data on transplacental-transfer ratios and breastmilk excretion rates are also included. Biologic effects on organogenesis, their implications for the exposed infant in terms of infection risks and vaccination requirements are included, and future directions for research proposed.

Protective Effect of Fluoride Varnish Containing Trimetaphosphate against Dentin Erosion and Erosion/Abrasion: An in vitro Study.

This in vitro study evaluated the protective effect of fluoride varnishes containing sodium trimetaphosphate (TMP) against dentin erosion and abrasion. Specimens of coronal dentin were divided into: placebo, 2.5% NaF, 5% NaF, 2.5% NaF + 5% TMP, and 5% NaF + 5% TMP groups (n =24/group). After single application of the varnishes, the samples were immersed in citric acid (0.05 mol/L, pH = 3.2, 5 min) followed or not by brushing, and the dentin wear was assessed after 5 days. Varnishes containing fluoride + TMP led to the lowest wear. TMP varnishes showed a superior effect against dentin erosive wear.

Clinical and epidemiological characteristics and factors associated with mortality in adult patients admitted by COVID -19 in intensive care / Características clínicas, epidemiológicas e fatores associados à mortalidade em pacientes adultos internados por COVID -19 em unidade de terapia intensiva

Objectives: We conducted a retrospective, observational, case-control type study to define the clinical and epidemiological characteristics and factors associated with death in the intensive care of these patients. Methodology: We reviewed the medical records and examinations of 72 patients with confirmed diagnosis of SARS-CoV-2 infection in our intensive care unit (ICU). Results: In the review, 20 patients died during hospitalization, and 52 were discharged from the ICU. Associated with mortality, we verified, after analysis, that age, male gender, smoking, tropononin levels, creatinine, lymphocytes, bilirubin, and respiratory compliance were statistically significant. SOFA, APACHE 2, and SAPS 2 scores were good predictors of ICU mortality in this population. Conclusion: Despite several limitations, our study was able to demonstrate a series of clinical and laboratory factors associated with ICU death by COVID-19, compatible with international and multicenter case series.

Objetivo: Realizamos um estudo retrospectivo, observacional, tipo caso-controle com o objetivo de definir as características clínicas, epidemiológicas e fatores associados à morte em terapia intensiva desses pacientes. Metodologia: Revisamos os prontuários e exames de 72 pacientes com diagnóstico confirmado de infecção por SARS-CoV-2 em nossa unidade de terapia intensiva (UTI), realizando uma análise de fatores associados a óbito em terapia intensiva em nossa população. Resultados: Em nosso centro, 20 pacientes morreram durante o internamento, e 52 tiveram alta da UTI. Associado à mortalidade, verificamos, após análise, que idade, sexo masculino, tabagismo, níveis de tropononina, creatinina, linfócitos, bilirrubinas e complacência respiratória tiveram significância estatística. Os escores SOFA, APACHE 3 e SAPS 2 foram bons preditores de mortalidade em UTI nessa população em nosso meio. Conclusão: Apesar das várias limitações, nosso estudo conseguiu demostrar uma série de fatores clínicos e laboratoriais associados a óbito em UTI por COVID-19, compatível com séries de casos internacionais e multicêntricas.

The Effect of Mucin in Artificial Saliva on Erosive Rehardening and Demineralization.

The effect of mucin in artificial saliva on rehardening (RE-experiment) and inhibition (DE-experiment) of erosion was evaluated. The treatment groups were: artificial saliva with mucin, artificial saliva without mucin, human saliva, and water. For the RE-experiment, after immersion of enamel blocks in citric acid (4 min), hardness was measured and blocks were subjected to treatment for 2 h. For the DE-experiment, sound blocks were subjected to treatment for 2 h and immersed in citric acid (4 min). Percentages of hardness recovery (RE) and loss (DE) were analyzed (ANOVA/Tukey's test). The salivas promoted similar rehardening, but only the saliva with mucin was similar to human saliva with regard to enamel protection against erosion.

Penetration of resin-based materials into initial erosion lesion: A confocal microscopic study.

The application of resin-based materials is an alternative of treatment for eroded lesions. Nevertheless, there are no studies about the penetration of these materials into eroded lesion, which might affect its adhesion. Therefore, this study evaluated the penetration of four resin-based materials, with and without enamel etching. By using an in vitro protocol, types of treatment were studied at five levels (AdheSE(®) , Tetric N-Bond(®) , Single Bond 2(®) , Helioseal Clear(®) , Icon(®) ) and types of enamel etching in two levels (with and without). Materials were stained with 0.02 mg/mL ethanolic solution of tetramethylrhodamine isothiocyanate. Bovine enamel samples (4 × 4 mm) were immersed in 0.01 M HCl, pH 2.3, for 30 seconds to produce initial eroded lesions. Afterward, the materials were applied on half of sample enamel surface following the manufacturer's instructions. On the other half of sample, the materials were applied without etching the enamel. Materials penetration into the enamel was assessed by Confocal Laser Scanning Microscopy on reflection and fluorescence modes. The penetration depth (PD) was measured using ImageJ software. Data were analyzed by two-way ANOVA and Tukey test (P < 0.05). Regardless of the material, etched enamel resulted in higher PD than non-etched (P < 0.05). Icon(®) showed the highest PD in enamel followed by Helioseal Clear(®) (P < 0.05), with significant difference between them (P < 0.05) and no difference was found among AdheSE(®) , Tetric N-Bond(®) , and Single Bond 2(®) (P > 0.05). It can be concluded that prior enamel etching increased the materials penetration into eroded enamel and the Icon(®) -infiltrant presented highest penetration.

Resin infiltration of early carious lesion in early childhood: a case report.

The treatment of white-spot lesions in infants and young children with early childhood caries is a challenge. The ideal management of the disease and subsequent remineralization of the lesions depend on the family's commitment to dietary behavior modifications to address the causes of the disease. If this proves ineffective or unlikely, resin infiltration has been developed to slow or arrest progression of white-spot lesions. In resin infiltration, the porous lesion body is penetrated by a special low-viscosity resin, blocking the diffusion of cariogenic acids into the lesion. This case report describes the use of a resin infiltrant to treat white-spot lesions in a 24-month-old boy with early childhood caries.

Effect of fluoride varnish supplemented with sodium trimetaphosphate on enamel erosion and abrasion.

PURPOSE: To assess in vitro the effect on enamel erosion (ERO) and erosion followed by abrasion (ERO+ABR) of varnishes with different fluoride concentrations, supplemented or not with sodium trimetaphosphate (TMP). METHODS: Bovine enamel blocks were randomly divided into six groups according to the type of varnish used: placebo (no F), NaF 5%, NaF 2.5%, NaF 2.5% plus TMP 3.5%, NaF 2.5% plus TMP 5%, NaF 2.5% plus TMP 10%. Varnishes were tested for ERO and ERO+ABR, separately for 3 and 5 days. ERO was done by immersion in Sprite Zero (5 minutes, 4x/day), while ERO+ABR was performed by brushing for 15 seconds after each erosive challenge. Enamel wear (microm) and cross-sectional hardness (AKHN) were assessed after the experimental periods. Data were analyzed by ANOVA, Tukey's test and Pearson's correlation coefficient (P< 0.05). RESULTS: Varnishes supplemented with TMP promoted significantly lower wear and hardness loss when compared to the other treatments in all conditions studied (P< 0.05). Similar wear rates were observed for the placebo, NaF 2.5% and NaF 5% varnishes (P> 0.05). Greater wear was observed after 5 days of ERO and ERO+ABR when compared with 3 days (P< 0.05). Positive and significant correlations were found between enamel wear and AKHN. No dose-response relationship was found between TMP concentration and wear and hardness. It was concluded that fluoride varnishes supplemented with TMP had a higher protective effect against ERO and ERO+ABR, which was associated with a reduction in enamel softening.

Efeito de agentes fluoretados e suplementados com trimetafosfato de sódio sobre a erosão e abrasão do esmalte dentário bovino: estudos in situ e ex vivo / Effect of fluoridated agents supplemented with sodium trimetaphosphate on erosion and abrasion of bovine dental enamel: studies in situ and ex vivo

O presente estudo teve como objetivo avaliar in situ/ex vivo a ação de agentes fluoretados e suplementados com trimetafosfato de sódio (TMP) sobre a erosão (ERO) associada ou não a abrasão (ERO+ABR) de esmalte dentário bovino. O 1º capitulo abordou o efeito de dentifrícios de diferentes concentrações de fluoreto (F) suplementados com TMP sobre a ERO e ERO+ABR do esmalte. Os voluntários (n=15) foram aleatoriamente divididos em 5 grupos de acordo com os dentifrícios: placebo, 1100 μg F/g, 1100 μg F/g + 3% TMP, 500 μg F/g + 3%TMP e 5000 μg F/g. Os voluntários utilizaram dispositivos palatinos contendo 4 blocos de esmalte organizados em duas fileiras que correspondiam a ERO e ERO+ABR. Os blocos foram submetidos a desafio ácido com Coca-Cola® (pH 2,6) por 5 minutos 4x/dia, por 7 dias. Em metade dos blocos (ERO) foi aplicada uma suspensão do dentifrício utilizado em cada etapa, durante 15 segundos, enquanto a outra metade (ERO+ABR) dos blocos foi submetida à abrasão (escovação por 15 segundos). Foram verificados o desgaste (μm) e a dureza final (SHf). Os dados foram analisados por ANOVA a 2 critérios seguido pelo teste de Student-Newman-Keuls (p<0,05). Foi observado desgaste significativamente menor para os grupos 500 μgF /g + TMP3% e 5000 ug F/g em comparação aos demais grupos em ERO e ERO+ABR (p<0,05). Quanto à SHf, valores significativamente maiores foram observados para o grupo 5000 ugF/g, não havendo diferenças significativas entre os demais grupos, com exceção do placebo, em ERO e ERO+ABR (p<0,05). No 2º capítulo foram utilizados vernizes fluoretados e um verniz com concentração reduzida de F suplementado com TMP. Os voluntários (n=10) foram aleatoriamente divididos em 4 grupos de acordo com os vernizes: placebo, NaF 5%, NaF 2,5%, NaF 2,5% + TMP 3%. Os voluntários utilizaram dispositivos palatinos semelhantes aos descritos para o Capítulo 1. Os blocos foram imersos em ácido cítrico (0,05 M, pH 3,2) por 5 minutos 4x/dia, por 5 dias, sendo os blocos tratados...

The aim of the present study was to evaluate in situ/ex vivo fluoridated agents supplemented with sodium trimetaphosphate (TMP) on bovine enamel erosion (ERO) with or without abrasion (ERO+ABR). The 1st chapter addressed the effect of dentifrices with different fluoride (F) concentrations supplemented with TMP on ERO and ERO+ABR. Subjects (n=15) were randomly assigned into 5 groups according to the dentifrices: placebo, 1100 μg F/g, 1100 μg F/g + 3% TMP, 500 μg F/g + 3% TMP and 5000 μg F/g. The volunteers wore palatal appliances containing four enamel blocks arranged in two rows corresponding to ERO and ERO+ABR. All blocks were subjected to acid challenge with Coca-Cola® (pH 2.6) for 5 minutes 4x/ day, for 7 days. Half of the blocks (ERO) was exposed to a slurry of the dentifrice used in each phase for 15 seconds, while the other half of the blocks (ERO+ABR) was subjected to abrasion (brushing for 15 seconds) using the same slurry. Enamel wear (μm) and final surface hardness (SHf) were assessed after the experimental periods. Data were analyzed by 2-way ANOVA followed by Student-Newman-Keuls test (p<0.05). Significantly lower wear values were observed for groups 500 μg F/g + 3 %TMP and 5000 μg F/g in comparison to other groups for ERO and ERO+ABR (p<0.05). Concerning SHf, significantly higher values were observed for the group 5000 μg F/g, with no significant differences among the other groups except the placebo for both ERO and ERO+ABR (p <0.05). In the 2nd chapter the protective effect of varnishes with different F concentrationns as well as a F varnish supplemented with TMP were assessed. Volunteers (n=10) were randomly divided into four groups according to the varnishes: placebo, 5% NaF, 2.5% NaF, 2.5% NaF + 3% TMP. The volunteers wore palatal appliances similar to those described for Chapter 1. The blocks were immersed in citric acid (0.05 M, pH 3.2) for 5 minutes 4x/ day for 5 days, being treated with F-free dentifrice slurry as described in Chapter 1...

Efeito de agentes fluoretados e suplementados com trimetafosfato de sódio sobre a erosão e abrasão do esmalte dentário bovino: estudos in situ e ex vivo / Effect of fluoridated agents supplemented with sodium trimetaphosphate on erosion and abrasion of bovine dental enamel: studies in situ and ex vivo

O presente estudo teve como objetivo avaliar in situ/ex vivo a ação de agentes fluoretados e suplementados com trimetafosfato de sódio (TMP) sobre a erosão (ERO) associada ou não a abrasão (ERO+ABR) de esmalte dentário bovino. O 1º capitulo abordou o efeito de dentifrícios de diferentes concentrações de fluoreto (F) suplementados com TMP sobre a ERO e ERO+ABR do esmalte. Os voluntários (n=15) foram aleatoriamente divididos em 5 grupos de acordo com os dentifrícios: placebo, 1100 μg F/g, 1100 μg F/g + 3% TMP, 500 μg F/g + 3%TMP e 5000 μg F/g. Os voluntários utilizaram dispositivos palatinos contendo 4 blocos de esmalte organizados em duas fileiras que correspondiam a ERO e ERO+ABR. Os blocos foram submetidos a desafio ácido com Coca-Cola® (pH 2,6) por 5 minutos 4x/dia, por 7 dias. Em metade dos blocos (ERO) foi aplicada uma suspensão do dentifrício utilizado em cada etapa, durante 15 segundos, enquanto a outra metade (ERO+ABR) dos blocos foi submetida à abrasão (escovação por 15 segundos). Foram verificados o desgaste (μm) e a dureza final (SHf). Os dados foram analisados por ANOVA a 2 critérios seguido pelo teste de Student-Newman-Keuls (p<0,05). Foi observado desgaste significativamente menor para os grupos 500 μgF /g + TMP3% e 5000 ug F/g em comparação aos demais grupos em ERO e ERO+ABR (p<0,05). Quanto à SHf, valores significativamente maiores foram observados para o grupo 5000 ugF/g, não havendo diferenças significativas entre os demais grupos, com exceção do placebo, em ERO e ERO+ABR (p<0,05). No 2º capítulo foram utilizados vernizes fluoretados e um verniz com concentração reduzida de F suplementado com TMP. Os voluntários (n=10) foram aleatoriamente divididos em 4 grupos de acordo com os vernizes: placebo, NaF 5%, NaF 2,5%, NaF 2,5% + TMP 3%. Os voluntários utilizaram dispositivos palatinos semelhantes aos descritos para o Capítulo 1. Os blocos foram imersos em ácido cítrico (0,05 M, pH 3,2) por 5 minutos 4x/dia, por 5 dias, sendo os blocos tratados...

The aim of the present study was to evaluate in situ/ex vivo fluoridated agents supplemented with sodium trimetaphosphate (TMP) on bovine enamel erosion (ERO) with or without abrasion (ERO+ABR). The 1st chapter addressed the effect of dentifrices with different fluoride (F) concentrations supplemented with TMP on ERO and ERO+ABR. Subjects (n=15) were randomly assigned into 5 groups according to the dentifrices: placebo, 1100 μg F/g, 1100 μg F/g + 3% TMP, 500 μg F/g + 3% TMP and 5000 μg F/g. The volunteers wore palatal appliances containing four enamel blocks arranged in two rows corresponding to ERO and ERO+ABR. All blocks were subjected to acid challenge with Coca-Cola® (pH 2.6) for 5 minutes 4x/ day, for 7 days. Half of the blocks (ERO) was exposed to a slurry of the dentifrice used in each phase for 15 seconds, while the other half of the blocks (ERO+ABR) was subjected to abrasion (brushing for 15 seconds) using the same slurry. Enamel wear (μm) and final surface hardness (SHf) were assessed after the experimental periods. Data were analyzed by 2-way ANOVA followed by Student-Newman-Keuls test (p<0.05). Significantly lower wear values were observed for groups 500 μg F/g + 3 %TMP and 5000 μg F/g in comparison to other groups for ERO and ERO+ABR (p<0.05). Concerning SHf, significantly higher values were observed for the group 5000 μg F/g, with no significant differences among the other groups except the placebo for both ERO and ERO+ABR (p <0.05). In the 2nd chapter the protective effect of varnishes with different F concentrationns as well as a F varnish supplemented with TMP were assessed. Volunteers (n=10) were randomly divided into four groups according to the varnishes: placebo, 5% NaF, 2.5% NaF, 2.5% NaF + 3% TMP. The volunteers wore palatal appliances similar to those described for Chapter 1. The blocks were immersed in citric acid (0.05 M, pH 3.2) for 5 minutes 4x/ day for 5 days, being treated with F-free dentifrice slurry as described in Chapter 1...

Histologic evaluation of the use of membrane, bone graft, and MTA in apical surgery.

The aim of this study was to evaluate the periapical healing after the use of membrane, bone graft, and mineral trioxide aggregate (MTA) in apical surgery of dogs' teeth. Apical lesions were induced in 48 roots of 6 dogs after coronal access and pulpal removal. Apical surgery consisted of osteotomy with trephine bur for the standardization of the critical surgical cavities, followed by apicoectomy, curettage, preparation of the root-end cavities with the aid of the ultrasonic device, and retrofilling with MTA. The surgical sites were divided into: group 1-filled with blood; group 2-filled with blood and recovered with membrane; group 3-filled with bone graft; and group 4-filled with bone graft and recovered with membrane. The results showed that the inflammatory infiltrate, the periapical healing process, and the behavior of MTA was the same in all groups, including the mineralization stimulation. It was concluded that the use of membranes and bone graft materials isolated or associated in apical surgery did not alter the periapical healing process after the root-end filling with MTA.

Immediate ureterovaginal fistula secondary to oocyte retrieval--a case report.

OBJECTIVE: To report a case of ureterovaginal fistula secondary to transvaginal oocyte retrieval (TVOR). DESIGN: Case report. SETTING: IVF Center IN a private hospital. PATIENT(S): A 31-year-old woman presented immediately after TVOR with right lower abdominal pain with irradiation to the suprapubic area and vaginal discharge. INTERVENTION(S): Vaginal examination, creatinine dosage in plasma and vaginal discharge, excretory urography. A double-J catheter was inserted under general anesthesia. MAIN OUTCOME MEASURE(S): Clinical follow-up. RESULT(S): Vaginal leakage ceased a few hours after catheter insertion. Transfer of two embryos was performed 3 days after TVOR, but no pregnancy occurred. The double-J catheter was removed 21 days after its placement. Imaging studies done 6 weeks later demonstrated a normal urinary tract morphology. CONCLUSION(S): Given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureterovaginal fistula.

[Premature ovarian failure: present aspects]. / Falência ovariana prematura: aspectos atuais.

Premature ovarian failure occurs in approximately 1:1000 women before 30 years, 1:250 by 35 years and 1:100 by the age of 40. It is characterized by primary or secondary amenorrhea and cannot be considered as definitive because spontaneous conception may occur in 5 to 10% of cases. In 95% of cases, premature ovarian failure is sporadic. The known causes of premature ovarian failure include chromosomal defects, autoimmune diseases, exposure to radiation or chemotherapy, surgical procedures, and certain drugs. Frequently, however, the etiology is not clear and these cases are considered to be idiopathic. Premature ovarian failure is defined by gonadal failure and high serum follicle-stimulating hormone (FSH) levels. Clinical approach includes emotional support, hormonal therapy with estrogens and progesterone or progestogens, infertility treatment, and prevention of osteoporosis and potential cardiovascular risk.

Falência ovariana prematura: aspectos atuais / Premature ovarian failure: present aspects

A falência ovariana prematura (FOP) acomete aproximadamente 1:1000 mulheres antes dos 30 anos, 1:250 em torno dos 35 anos e de 1:100 aos 40 anos. Manifesta-se como amenorréia primária ou amenorréia secundária, não podendo ser considerada definitiva em todas as pacientes, uma vez que a concepção espontânea pode ocorrer em até 5-10 por cento das FOP. Na maioria dos casos apresenta-se na forma esporádica, pois apenas 5 por cento apresentam história familial. Entre as causas conhecidas estão as alterações cromossômicas, dos genes ligados ao cromossomo X e cromossomos autossômicos, doenças autoimunes, alterações tóxicas e iatrogênicas. Com relativa freqüência, a causa etiológica não é obtida, sendo então denominada de idiopática. O diagnóstico da FOP é feito baseado na história clínica e níveis elevados do hormônio folículo estimulante (FSH), sendo posteriormente investigadas as causas mais específicas. O manejo clínico visa o suporte emocional, o tratamento hormonal com estrogênios e progestogênios, a abordagem da infertilidade e a prevenção de co-morbidades como a osteoporose e potencial maior risco cardiovascular.

Premature ovarian failure occurs in approximately 1:1000 women before 30 years, 1:250 by 35 years and 1:100 by the age of 40. It is characterized by primary or secondary amenorrhea and cannot be considered as definitive because spontaneous conception may occur in 5 to 10 percent of cases. In 95 percent of cases, premature ovarian failure is sporadic. The known causes of premature ovarian failure include chromosomal defects, autoimmune diseases, exposure to radiation or chemotherapy, surgical procedures, and certain drugs. Frequently, however, the etiology is not clear and these cases are considered to be idiopathic. Premature ovarian failure is defined by gonadal failure and high serum follicle-stimulating hormone (FSH) levels. Clinical approach includes emotional support, hormonal therapy with estrogens and progesterone or progestogens, infertility treatment, and prevention of osteoporosis and potential cardiovascular risk.

Análise da coagulação sangüínea em pacientes submetidas à hiperestimulação ovariana para fertilização in vitro / Analysis of coagulation parameters in patients undergoing controlled ovarian hyperstimulation for in vitro fertilization

OBJETIVO: Identificar alteraçöes na coagulaçäo sangüínea em mulheres submetidas à fertilizaçäo in vitro (FIV). MÉTODOS: Trata-se de um estudo prospectivo onde foram incluídas 15 pacientes submetidas à FIV. No período pré-ovulatório imediato, do ciclo menstrual precedente à FIV, foi coletada amostra sangüínea para coagulograma, com dosagem de Estradiol, Hemograma, Fibrinogênio, Tempo de Protrombina, Tempo de Tromboplastina Parcial Ativada, Tempo de Coagulaçäo e Plaquetas. Durante a hiperestimulaçäo ovariana para FIV, nova amostra para coagulograma foi coletada no dia da aplicaçäo da Gonadotrofina Coriônica Humana. Os dados referentes à análise das duas amostras foram avaliados usando teste estatístico Paired T-Test. RESULTADOS: O estudo comparativo das médias das amostras identificou aumento significativo nos níveis de fibrinogênio, 304,9 pg/ml na primeira amostra e 383,1 pg/ml na segunda (p=0,01), já os níveis de hematócrito tiveram um decréscimo significativo, com valores de 40,5 por cento e 38,4 por cento, respectivamente (p=0,0001). As demais provas de coagulaçäo näo apresentaram diferença significativa. As médias do estradiol foram significativamente diferentes, sendo 167pg/ml na primeira amostra e 1435pg/ml na segunda (p=0,0001). CONCLUSÖES: Os Dados refletem uma tendência a um estado de hipercoagüabilidade sangüínea, o que é esperado nas situaçöes de hiperestrogenismo. Apesar da significância estatística nos níveis de fibrinogênio e hematócrito, esses resultados têm pouca expressäo clínica, visto que os valores máximos das duas amostras permaneceram dentro dos limites da normalidade. A pesquisa sugere que, apesar do grande aumento nos níveis de estradiol e mudanças nas provas de coagulaçäo, os programas de FIV mostram-se seguros quanto aos riscos tromboembólicos

Ovarian and uterine findings in pelvic sonography: comparison between prepubertal girls, girls with isolated thelarche, and girls with central precocious puberty.

OBJECTIVE: To describe pelvic sonographic findings in girls as old as 7 years, to compare prepubertal girls with girls who had isolated thelarche or central precocious puberty, and to verify the accuracy of sonographic variables for distinguishing prepubertal girls from girls with central precocious puberty. METHODS: Ninety-six prepubertal girls and 2 reference groups (8 girls with isolated thelarche and 8 with idiopathic central precocious puberty) were included. Ovaries were classified morphologically as homogeneous, paucicystic, macrocystic, multicystic, and having isolated cysts. Receiver operating characteristic curves were used to choose the best cutoff points. RESULTS: Chronologic and bone age were correlated with uterine length, area, and volume and ovarian volume in prepubertal girls (P < .0001). Ovarian morphologic characteristics in prepubertal girls differed significantly from those of the reference groups (P < .0001). The best cutoff points were uterine length of 4.0 cm, uterine area of 4.5 cm2, uterine volume of 3.0 cm3, and ovarian volume of 1.0 cm3. CONCLUSIONS: Uterine and ovarian growth are proportional to age in prepubertal girls. Mean ovarian volume greater than 1 cm3 showed 100% sensitivity and specificity for discriminating between prepubertal girls and girls with central precocious puberty. Microcysts are common in prepubertal girls, but the presence of 6 or more follicles up to 10 mm in diameter may suggest central precocious puberty in girls younger than 8 years.

[Analysis of coagulation parameters in patients undergoing controlled ovarian hyperstimulation for in vitro fertilization]. / Análise da coagulação sangüínea em pacientes submetidas à hiperestimulação ovariana para fertilização in vitro.

BACKGROUND: Hyperestrogenic conditions have been related to alterations in the coagulation parameters. The objective of this study was to identify changes in coagulation parameters in women undergoing in vitro fertilization and embryo transfer (IVF-ET). METHODS: A group of 15 patients was studied prospectively, immediately before and during the course of an IVF-ET cycle. Blood was drawn in the preovulatory period of the cycle preceeding IVF-ET for complete blood count, fibrinogen, prothrombin time (TP), thromboplastin partial actived time (ATTP), coagulation time and estradiol. A another blood sample for the same tests was collected during controlled ovarian hyperstimulation, on the hCG day. Both samples were compared by a paired t-test. RESULTS: There was an increase in fibrinogen (340.9 pg/mL to 383.1 pg/mL, p = 0.01). On the other hand, hematocrit levels decreased (40.5% to 38.4 %, p = 0.0001). The other coagulation tests showed no difference. Estradiol levels increased (167 pg/mL to 1435 pg/ml, p=0.0001), as expected during such treatment. CONCLUSIONS: The data suggest a tendency towards an increase in coagulability, as expected in hyperestrogenic situations. However, even considering the statistical significance of the results, they might have limited clinical impact, since they were within the normal range. This study suggests that, despite the marked increase in estradiol and changes in coagulation parameters, IVF-ET is a safe procedure in terms of thromboembolic risks.

Hipertensäo arterial sistêmica / Sistemic arterial hypertension

O conceito, diagnóstico e achados clínico-laboratoriais da Hipertensäo Arterial Sistêmica säo descritos de maneira sumária. É dada ênfase a Hipertensäo Arterial em sua forma dita Essencial. As drogas anti-hipertensivas de uso corrente, säo também revisadas. A revisäo da literatura se destina a dar uma orientaçäo a Estudantes e Generalistas para o estudo desta importante e comum entidade