Reproductive outcome after discharge of patients with high-risk hydatidiform mole with or without use of one bolus dose of actinomycin D, as prophylactic chemotherapy, during the uterine evacuation of molar pregnancy.

OBJECTIVE: To evaluate whether prophylactic chemotherapy (P-chem) with one bolus dose of actinomycin D (Act-D) during the uterine evacuation of patients with high-risk hydatidiform mole (Hr-HM) affects reproductive outcomes in subsequent pregnancies. METHODS: From 1987 to 2006, 1090 patients with gestational trophoblastic disease (GTD) were evaluated at a Trophoblastic Disease Center in southern Brazil; 265 with Hr-HM were selected and retrospectively analyzed. From 1996 to 2006, 163 received one bolus dose of Act-D at the time of uterine evacuation (Hr-HM-chem group); 102 with the same risk factors did not get P-chem (Hr-HM-control group). In March 2009, the number of pregnancies, progression of first pregnancy, and association of low age and low parity with subsequent pregnancy were evaluated. RESULTS: The percentage of patients that became pregnant was similar in both groups (Hr-HM-control: 59.5%; Hr-HM-chem group: 45.7%; p=0.069) and independent of HM progression. Percentages of no pregnancies because of age (> or =40 years) or hysterectomy were also similar. Type of subsequent pregnancy was not statistically different between groups, and the rate of live births associated with pregnancies for which US showed a live fetus was high. Frequency of repeat GTD was unexpectedly high in both groups (4.2% and 6.3%; p=1.00). CONCLUSIONS: P-chem did not affect reproductive outcomes for patients with Hr-HM. Patients allowed to become pregnant again in both groups had high rates of live births associated with normal pregnancies. Chances of a subsequent pregnancy were higher in the low age and low parity subgroups.

Algoritmo classificatorio para as cefaleias / Using algorithm to classify headaches

Os autores fazem uma breve revisao sobre as classificacoes internacionais propostas para as cefaleias, com enfase na ultima classificacao desenvolvida pela International Headache Society em 1988. Apresentam uma analise critica desta classificacao, bem como algumas das recomendacoes para o seu futuro aperfeicoamento. Os autores propoem um algoritmo para auxiliar o clinico no diagnostico das cefaleias primarias mais frequentes, enxaqueca com aura e sem aura e cefaleia tensional episodica e cronica, incluindo tambem a cefaleia em salvas

Diagnóstico operacional e manejo básico da enxaqueca / Diagnostic criteria and therapeutic management of migraine

Os autores fazem uma revisäo sobre a classificaçäo e o tratamento da enxaqueca. Säo apresentados os critérios diagnósticos para as enxaquecas da atual classificaçäo de cefaléias e o seu manejo terapêutico básico

O estudante de Medicina frente a seus pacientes / Medical students and their patients

Os autores revisam a bibliografia sobre a relaçäo do estudante de medicina com o paciente, descrevendo as dificuldades mais frequentes nos primórdios da relaçäo médico-paciente

Tratamento da candidíase oro-esofagiana em pacientes portadores de HIV / Therapeutic management of oral-esophageal candidiasis in HIV patients

Os autores revisam a literatura sobre a candidíase oroesofagiana em pacientes portadores do vírus da imunodeficiência adquirida. Apresentam aspectos da fisiopatogenia, quadro clínico, diagnóstico e, em especial, do manejo terapêutico