RESUMO
OBJECTIVE: Chronic endometritis (CE) is an inflammatory condition with several different risk factors. We aimed to examine whether intrauterine abnormalities, such as endometrial polyps, submucosal myomas, intrauterine adhesions, or a septate uterus, were associated with an increased likelihood of developing chronic endometritis. METHODS: A cross-sectional study was conducted on 335 infertile women who underwent hysteroscopy surgery at the Ayatollah Taleghani Hospital Infertility Center, affiliated by Shahid Beheshti University of Medical Sciences, in 2022. All participants in the study underwent hysteroscopic surgery, which allowed for direct visualization of the intrauterine cavity, and endometrial biopsies were taken for further analysis. To characterize endometritis, plasma cell infiltration was assessed. Patients with ≥5 plasma cells observed in 10 high-power fields were defined as having chronic endometritis. RESULTS: Endometritis was observed in 51.3% of the patients, totaling 172 individuals. Logistic regression analysis revealed that patients with endometrial polyps had 5.2 times higher odds of developing endometritis compared to patients without polyps (95% CI = 2.9, 9.2) (p-value <0.001). Similarly, patients with intrauterine adhesions had a significant increase in the odds of endometritis (OR = 4.6, 95% CI = 2.1, 10.1) (p-value <0.001). CONCLUSIONS: Treatment or removal of endometrial abnormalities through hysteroscopic procedures may help to reduce the risk of chronic endometritis and improve fertility outcomes. Further research is necessary.
Assuntos
Endometrite , Histeroscopia , Infertilidade Feminina , Humanos , Feminino , Estudos Transversais , Endometrite/epidemiologia , Adulto , Infertilidade Feminina/epidemiologia , Prevalência , Útero/patologia , Útero/cirurgia , Útero/anormalidades , Doenças Uterinas/epidemiologia , Doenças Uterinas/complicações , Doenças Uterinas/cirurgia , Doenças Uterinas/patologia , Doença Crônica , Pólipos/epidemiologia , Pólipos/cirurgia , Pólipos/patologia , Pólipos/complicações , Anormalidades Urogenitais/epidemiologia , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/cirurgia , Aderências Teciduais/epidemiologia , Aderências Teciduais/complicações , Fatores de RiscoRESUMO
Objetivo: Descrever dimensões e prevalência da Aderência Intertalâmica (AI) em cadáveres do Serviço de Verificação de Óbitos da Capital - USP, considerando idade, sexo, peso, altura e histórico pessoal de doença de Alzheimer (DA). Métodos: Cinquenta e sete cadáveres (31H/26M) foram incluídos no estudo, com média de idade de 66,2 anos (variando entre 15 e 91 anos). A análise da AI foi feita após secção transversal da calota craniana e incisão axial no limite inferior do tronco encefálico seguida de retirada do encéfalo de sua cavidade. Cinquenta e quatro encéfalos foram submetidos a incisão sagital mediana, dois encéfalos foram submetidos a cortes axiais, e um encéfalo a secção coronal. Dados quantitativos foram comparadas pelo teste t de student, e dados qualitativos pelo teste de Qui Quadrado. A análise idade vs área foi feita por regressão linear. Resultados: A prevalência de AI foi de 79%, não havendo diferença significativa entre os sexos (p=0,68). Observou-se associação entre menores áreas de secção sagital e idades mais avançadas (p=0,02). Não houve diferença significativa na prevalência de AI nem na área de secção transversal em pacientes com DA. Discussão: Ao contrário de estudos prévios, que associaram maior prevalência e tamanho de AI com sexo feminino, isso não foi observado em nossa casuística. Apesar de não ser estatisticamente significativa nota-se uma diferença importante nas áreas médias de secção sagital dos grupos com e sem DA, o que aponta para a necessidade de estudos subsequentes com amostras maiores
Objective: Identifying the prevalence and dimensions of the Interthalamic Adhesion (ITA) in corpses from the "Serviço de Verificação de Óbitos da Capital - USP", considering factors as age, sex, weight, height, and diagnosis of Alzheimer's disease (AD). Methods: Fifty-seven corpses (31M/26F) were included in the study. The mean age was 66.2 (varying between 15 and 91). The analysis of the ITA was made after the encephalon's removal from its cavity, which occurred by the transversal section of the skullcap, and, next, an axial incision in the inferior limit of the pons to separate the encephalon from the spinal cord. Fifty-four encephalons were submitted to medial sagittal incisions, two encephalons were submitted to axial cuts and one to a coronal section. Quantitative data were compared by the Student's T Test, and qualitative data by the Chi-squared test. The Age vs Area analysis was made by linear regression. Results: the prevalence of the ITA was 79%, not having differences in prevalence between sexes (p=0.68). Advanced ages presented lower areas in sagittal sections (p= 0.02). It does not appear to have a significant alteration in prevalence of the ITA and transversal section aerea in patients with AD. Discussion: Unlike previous studies which observed higher prevalence and size of the ITA in females, differences in this parameters were not obtained in this study. Evidence of correlation between AD and lower sagittal section of the ITA, even without statistic significance, points to the need of further studies.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tálamo , Encéfalo , Aderências Teciduais/epidemiologia , Prevalência , Doença de Alzheimer , CadáverRESUMO
BACKGROUND: Bariatric surgery is considered a safe therapy to treat obesity. Postoperative complications are well known; however, there is a lack of data describing intraoperative complications and/or unexpected findings, and if there is further impact on outcomes. METHODS: Retrospective study with patients operated between 2013 and 2016 at a single institution. All operative information was collected prospectively and aimed to analyze the incidence and causes of unexpected intraoperative findings, complications, change in surgical plan, extra surgeries, and procedure interruption in patients submitted to bariatric surgery. Secondarily, a morbidity analysis was performed, correlating intraoperative complications with postoperative complications and length of stay. RESULTS: Four-hundred and five patients were included. Female sex comprised 82% of cases, and a median age of 38 years old was observed; almost 90% were gastric bypass. In 29.3% of cases, there were intraoperative findings, mainly adhesions, abdominal wall hernias, positive methylene blue test, hiatal hernias, and gastrointestinal stromal tumors. Associated surgeries were performed in 8.6% cases, and intraoperative adverse events reported in 7.1%, where organ injury and anastomosis problems were the most frequent. A change in the operative plan was done in 0.9% and surgery interruption in 1.2% of the cases. Early complications were observed in 6.6%. There was no correlation between intraoperative complications and length of stay or early complications. CONCLUSION: Unexpected intraoperative findings/complications are common in bariatric surgery, but without increasing morbidity or length of stay. Surgery suspension, change in the planned technique, or adding extra (non-bariatric) procedures may occur.
Assuntos
Achados Incidentais , Complicações Intraoperatórias , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Feminino , Hérnia Hiatal/epidemiologia , Hérnia Hiatal/cirurgia , Hérnia Ventral/epidemiologia , Hérnia Ventral/cirurgia , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Aderências Teciduais/epidemiologia , Aderências Teciduais/cirurgiaRESUMO
BACKGROUND: Obesity surgery includes various gastrointestinal procedures. Roux-en-Y gastric bypass is the prototype of mixed procedures being the most practiced worldwide. A similar and novel technique has been adopted by Dr. Almino Cardoso Ramos and Dr. Manoel Galvao called "simplified bypass," which has been accepted due to the greater ease and very similar results to the conventional technique. The aim of this study is to describe the results of the simplified gastric bypass for treatment of morbid obesity in our institution. METHODS: We performed a descriptive, retrospective study of all patients undergoing simplified gastric bypass from January 2008 to July 2012 in the obesity clinic of a private hospital in Mexico City. RESULTS: A total of 90 patients diagnosed with morbid obesity underwent simplified gastric bypass. Complications occurred in 10% of patients; these were more frequent bleeding and internal hernia. Mortality in the study period was 0%. The average weight loss at 12 months was 72.7%. CONCLUSION: Simplified gastric bypass surgery is safe with good mid-term results and a loss of adequate weight in 71% of cases.
Antecedentes: la cirugía de la obesidad comprende diversos procedimientos gastrointestinales. El bypass gástrico en Y de Roux es el prototipo de los procedimientos mixtos y el más practicado en el mundo en sus diversas variedades. Una técnica similar y novedosa es la adoptada por Cardoso-Ramos y Galvao denominada "bypass simplificado" que rápidamente se aceptó por la mayor facilidad y resultados muy parecidos a la técnica convencional. Objetivo: describir los resultados a un año del bypass gástrico simplificado para el tratamiento de la obesidad mórbida. Material y métodos: estudio retrospectivo y descriptivo de todos los pacientes a quienes se realizó bypass gástrico de enero de 2008 a julio de 2012, en la clínica de obesidad de un hospital privado de la Ciudad de México. Resultados: se estudiaron 90 pacientes con diagnóstico de obesidad mórbida, con límites de edad de 18 y 65 años, operados para bypass gástrico simplificado. En 10% de los pacientes hubo complicaciones, las más frecuentes fueron: hemorragia y hernia interna. Durante el periodo de estudio la mortalidad fue de 0%. La pérdida de peso promedio a los 12 meses fue de 72.7%. Conclusión: el bypass gástrico simplificado laparoscópico es una cirugía segura, con buenos resultados a mediano plazo, y con una pérdida del exceso de peso adecuada en 71% de los casos.
Assuntos
Derivação Gástrica/métodos , Laparoscopia/métodos , Adolescente , Adulto , Anastomose em-Y de Roux/métodos , Comorbidade , Feminino , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Aderências Teciduais/epidemiologia , Aderências Teciduais/etiologia , Resultado do Tratamento , Veias Cavas , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Redução de Peso , Adulto JovemRESUMO
CONTEXT AND OBJECTIVE: Intrauterine adhesion (IUA) is a possible complication of uterine curettage following abortion. Because IUA is an important cause of infertility, some investigators have been advocating its inclusion in the routine investigational workup after every abortion curettage procedure. The aim of this study was to evaluate the uterine cavity of patients subjected to abortion curettage, in order to ascertain the prevalence of IUA and its association with social and clinical factors. DESIGN AND SETTING: This was a cross-sectional study at the Human Reproduction Unit, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). METHODS: A total of 109 women were enrolled. The investigators searched the records of Unicamp's hospital for patients who had been subjected to uterine curettage following abortion. The hysteroscopy was performed 3 to 12 months after the curettage. The correlations between patients' characteristics and the prevalence of IUA were assessed by means of chi-squared and Fisher's exact test calculations. RESULTS: The prevalence of IUA was 37.6%. The number of previous abortions and curettage procedures did not correlate with the presence of IUA. Most of the women (56.1%) presented IUA grade I. CONCLUSIONS: In the present study, 37.6% of the women subjected to curettage following abortion had IUA, which was mostly mucous and grade I. None of the demographic and clinic characteristics evaluated were found to be associated with IUA. From this study, there is no firm evidence to justify carrying out routine diagnostic hysteroscopy following abortion evacuation.
Assuntos
Aborto Incompleto/cirurgia , Curetagem/efeitos adversos , Doenças Uterinas/epidemiologia , Adolescente , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Gravidez , Aderências Teciduais/diagnóstico , Aderências Teciduais/epidemiologia , Aderências Teciduais/etiologia , Doenças Uterinas/diagnóstico , Doenças Uterinas/etiologiaRESUMO
BACKGROUND: The aim of this study was to determine the prevalence of uterine synechiae in patients with recurrent miscarriages and to evaluate the diagnostic accuracy of transvaginal ultrasound and of hysterosonography. METHODS: Sixty non-pregnant patients with a history of at least three previous consecutive miscarriages were evaluated by transvaginal ultrasound, hysterosonography and hysteroscopy to detect uterine synechiae. Hysteroscopy was considered the gold standard. Agreement of findings disclosed by transvaginal ultrasound and by the hysterosonography were evaluated according to the Kappa coefficient and their significance was tested. Significance was established at < 0. 05 (Alpha error = 5%). Sensitivity, specificity, positive and negative predictive values were determined for each method. RESULTS: Uterine synechiae were identified in 16 patients (26.7%). The accuracy of the transvaginal ultrasound and of the hysterosonography was 78.9% and 92.7%, respectively. When compared to the transvaginal ultrasound, hysterosonography had a much greater sensitivity (78. % vs. 20.0%) and a higher degree of agreement with hysteroscopy (Kappa = 80% vs. Kappa = 27%). CONCLUSION: For diagnosis of uterine synechiae, hysterosonography had a higher level of agreement with hysteroscopy than the transvaginal ultrasound. In patients with recurrent miscarriages transvaginal ultrasound is not recommended for the investigation of uterine synechiae because of its low sensitivity. Hysterosonography, on the other hand, seems to offer an important contribution especially because it is a simple, low-cost and accurate method for diagnosis of uterine synechiae.
Assuntos
Aborto Habitual/diagnóstico por imagem , Histeroscopia/métodos , Ultrassonografia/métodos , Doenças Uterinas/diagnóstico por imagem , Aborto Habitual/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Histeroscopia/economia , Histeroscopia/normas , Valor Preditivo dos Testes , Prevalência , Recidiva , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/epidemiologia , Ultrassonografia/economia , Ultrassonografia/normas , Doenças Uterinas/epidemiologia , VaginaRESUMO
OBJECTIVE: To determinate the frequency of Chlamydia trachomatis infection in male partners of infertile couples who attend to the infertility clinic at Instituto Nacional de Perinatología, as well as to compare the clinical data and lifestyle between C. trachomatis-infected and uninfected men to establish a possible association with gynecological damage in their sexual female partners. METHODS: An open prospective study was performed in infertile couples, whose follow up was carried out at Instituto Nacional de Perinatología between June 2000 and April 2001. Urethral and cervical swabs were obtained from each couple and the specimens were subjected to a C. trachomatis-specific liquid-phase hybridization test (PACE-2) and routine microbiological analysis. Semen analysis were also included. A relative risk (RR) test was done to analyze variables and square chi test was used to analyze clinical and gynecological data from female partners and data from semen examination. Statistical differences were considered as significant when the p value was below 0.05. RESULTS: C. trachomatis active infection was found in 14 out of 384 urethral swabs (3.6%). No significant alterations were observed in semen samples of C. trachomatis-infected men, as compared to non-infected individuals. Microbiological analyses of semen showed a significant isolation of Mycoplasma sp (RR = 5.87, IC95% 1.4-24.7). Eight out of fourteen female partners of C. trachomatis-infected men were also infected with C. trachomatis (RR = 10.57, IC95% 5.67-19.7), Candida albicans was other pathogen isolated from 8/14 of those women (RR = 1.89, IC95% 1.17-3.05). Gynecological and obstetrical associations found among female partners of C. trachomatis-infected men were as follows: tubal adhesions in 10/14 (RR = 1.54, IC95% 1.08-2.18), salpingitis in 2/14 (RR = 2.2), history of ectopic pregnancies in 11/14 (RR = 2.94, IC95% 1.01-8.53) and abnormal pregnancy loss in 9/14 (RR = 1.5). CONCLUSION: A low prevalence of C. trachomatis infection was observed among male partners of infertile couples as compared with other reports, but this discrepancy could be attributable to the specimen collection and diagnostic assay used. Otherwise, this data suggests that a chronic pathogen's antigenic stimulation may result in an increased formation of tubal adhesions and/or in ectopic pregnancies among female partners of C. trachomatis-infected individuals. Thus, preventive and control measures must be introduced into men's healthcare services, through laboratory and clinical examination, since these subjects are the main reservoirs of C. trachomatis.
Assuntos
Aborto Espontâneo/epidemiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Infertilidade Feminina/epidemiologia , Infertilidade Masculina/epidemiologia , Infecções por Mycoplasma/epidemiologia , Doença Inflamatória Pélvica/epidemiologia , Gravidez Ectópica/epidemiologia , Salpingite/epidemiologia , Parceiros Sexuais , Uretrite/epidemiologia , Aborto Espontâneo/etiologia , Adulto , Candidíase Vulvovaginal/epidemiologia , Colo do Útero/microbiologia , Infecções por Chlamydia/complicações , Comorbidade , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Masculina/etiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Mycoplasma/isolamento & purificação , Infecções por Mycoplasma/complicações , Ocupações , Doença Inflamatória Pélvica/etiologia , Gravidez , Gravidez Ectópica/etiologia , Prevalência , Estudos Prospectivos , Salpingite/etiologia , Sêmen/microbiologia , Aderências Teciduais/epidemiologia , Aderências Teciduais/etiologia , Uretra/microbiologia , Uretrite/complicações , Uretrite/microbiologia , Vaginose Bacteriana/epidemiologiaRESUMO
Objective.To determinate the frequency of Chlamydia trachomatis infection in male partners of infertile couples who attend to the infertility clinic at Instituto Nacional de Perinatologia, as well as to compare the clinical data and lifestyle between C. trachomatis-inifected and uninfected men to establish a possible association with gynecological damage in their sexual female partners. Methods. An open prospective study was performed in infertile couples, whose follow up was carried out at Instituto Nacional de Perinatologia between June 2000 and April 2001. Urethral and cervical swabs were obtained from each couple and the specimens were subjected to a C. trachomatis-specific liquid-phase hibridization test (PACE-2) and routine microbiological analysis. Semen analysis were also included. A relative risk (RR) test was done to analyze variables and square chi test was used to analize clinical and gynecological data from female partners and data from semen examination. Statistical differences were considered as significant when the p value was below 0.05. Results. C. trachomatis active infection was found in 14 out of 384 urethral swabs (3.6%). No significant alterations were observed in semen samples of C. trachomatis-infected men, as compared to non-infected individuals. Microbiological analyses of semen showed a significant isolation o/Mycoplasma sp (RR = 5.87, IC95% 1.4-24.7). Eight out of fourteen female partners of C. trachomatis-infected men were also infected with C. trachomatis (RR= 10.57, IC95% 5.67-19.7), Candida albicans was other pathogen isolated from 8/14 of those women (RR = 1.89, IC95% 1.17-3.05). Gynecological and obstetrical associations found among female partners of C. trachomatis-infected men were as follows: tubal adhesions in 10/14 (RR = 1.54, IC95% 1.08-2.18), salpingitis in 2/14 (RR = 2.2), history of ectopic pregnancies in 11/14 (RR =2.94, IC95% 1.01-8.53) and abnormal pregnancy loss in 9/14 (RR = 1.5). Conclusion. A low prevalence of C. trachomatis infection was observed among male partners of infertile couples as compared with other reports, but this discrepancy could be attributable to the specimen collection and diagnostic assay used. Otherwise, this data suggests that a chronic pathogen's antigenic stimulation may result in an increased formation of tubal adhesions and/or in ectopic pregnancies among female partners of C. trachomatis-infected individuals. Thus, preventive and control measures must be introduced into men's healthcare services, through laboratory and clinical examination, since these subjects are the main reservoirs of C trachomatis.
Objetivo. Determinar la frecuencia de infección por Chlamydia trachomatis y comparar la información clínica y el estilo de vida de varones con y sin infección por este patógeno, así como su asociación con las alteraciones ginecológicas que presenta su compañera sexual en un grupo de parejas que asisten a la Clínica de Infertilidad del Instituto Nacional de Perinatologia de la Ciudad de México. Métodos. Se realizó un estudio abierto, longitudinal y prospectivo en un grupo de parejas con diagnóstico de infertilidad, que fueron tratadas en el Instituto Nacional de Perinatologia durante el periodo de junio del 2000 a abril del 2001. Se recolectaron muestras uretrales y cervicales de cada pareja para el diagnóstico de C. trachomatis mediante la prueba de hibridación en fase líquida (PACE-2). También se recolectaron muestras de semen para el análisis de espermatobioscopia y se hicieron cultivos microbiológicos de rutina a las muestras cervicales y de semen. Los datos microbiológicos, clínicos y ginecológicos de los participantes fueron comparados por %z, el análisis de tendencia para proporciones fue usado para establecer el nivel de riesgo en las variables (RR). Las diferencias fueron consideradas estadísticamente significativas si p < 0.05. Resultados. Se analizaron un total de 384 muestras uretrales de varones, 14 presentaron infección activa por C. trachomatis (3.6%), Los datos de espermatobioscopia de los individuos positivos a C. trachomatis no mostraron alteraciones significativas con respecto al de varones no infectados con esta bacteria. El análisis microbiológico del semen mostró un número de aislamientos significativos de infección por Mycoplasma sp. (RR = 5.87, IC95% 1.40-24.70). En cuanto a las muestras cervicovaginales de mujeres con compañero sexual infectado por C. trachomatis, los patógenos aislados con mayor frecuencia fueron: Candida albicans en ocho de 14 (RR = 1.89, IC95% 1.17-3.05) y C. trachomatis en ocho de 14 (RR = 10.57, IC95% 5.67-19.7). Las asociaciones ginecológicas y obstétricas de la compañera sexual de varones positivos a C. trachomatis fueron adherencias tubáricas en 10 de 14 (RR = 1.54, IC95% 1.08-2.18), salpingitis en dos de 14 (RR = 2.2), antecedentes de embarazos ectópicos en 11 de 14 casos (RR = 2.94, IC95% 1.01-8.53) y abortos previos en nueve de 14 (RR = 1.5). Conclusión. Se observó una baja prevalencia de infección por C. trachomatis en los varones de mujeres infértiles en comparación con lo reportado por otros autores, esta diferencia puede estar dada por el método de diagnóstico y la toma del producto. Estos resultados sugieren que el estímulo constante del patógeno produce un aumento de adherencias tubáricas y embarazos ectópicos en las compañeras sexuales de los varones infectados con C. trachomatis. Por lo que una evaluación diagnóstica y de laboratorio deberá ser llevada a cabo en el varón como una medida de prevención y control para la infección por este patógeno, ya que estos individuos actúan como reservónos importantes de infección.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Aborto Espontâneo/epidemiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Infertilidade Feminina/epidemiologia , Infertilidade Masculina/epidemiologia , Infecções por Mycoplasma/epidemiologia , Doença Inflamatória Pélvica/epidemiologia , Gravidez Ectópica/epidemiologia , Parceiros Sexuais , Salpingite/epidemiologia , Uretrite/epidemiologia , Aborto Espontâneo/etiologia , Comorbidade , Candidíase Vulvovaginal/epidemiologia , Colo do Útero/microbiologia , Infecções por Chlamydia/complicações , Infertilidade Feminina/etiologia , Infertilidade Masculina/etiologia , México/epidemiologia , Infecções por Mycoplasma/complicações , Mycoplasma/isolamento & purificação , Ocupações , Prevalência , Estudos Prospectivos , Doença Inflamatória Pélvica/etiologia , Gravidez Ectópica/etiologia , Salpingite/etiologia , Sêmen/microbiologia , Aderências Teciduais/epidemiologia , Aderências Teciduais/etiologia , Uretra/microbiologia , Uretrite/complicações , Uretrite/microbiologia , Vaginose Bacteriana/epidemiologiaRESUMO
OBJECTIVE: To evaluate prepuce development and retractibility in a group of boys. To point out the value of circumcision and prepucial forced dilation during childhood. METHODS: Prepuce development and retractibility were evaluated in 400 boys ages between 0-16 year old. RESULTS: In boys under 1 year prepuce retractibility (assessed only in children who did not undergo forced dilation previously) was type I (non retractile) in 71.5% whereas type V (completely retractile) was only 5.5%. In adolescent boys type I prepuce was observed in 1 boy only, 1.6%, whereas type V was observed in 82.3%. Furthermore, it was observed that at the time of examination for the study 106 boys who had undergone forced dilation at an earlier age had balano-prepucial adhesions again, which demonstrates that prepuce adheres again to glans penis in many boys after a forced dilation is performed. Only 11 boys were considered in need for circumcision, three of them for prepucial orifice stenosis, which prevented normal micturition, causing a prepucial sac, one case due to a constrictive ring below the prepucial edge that would have prevented ulterior retractability, two cases with repetitive balanopostitis, and five cases secondary to xerosol balanitis, accounting for 2.7% of all examined boys. CONCLUSIONS: Incomplete separation between prepuce and glans penis is normal and common among new-borns, progressing until adolescence to spontaneous separation, at which time it is complete in the majority of boys. Accordingly to the criteria we have sustained for years and present study's findings, circumcision has few indications during childhood, as well as forced prepucial dilation.
Assuntos
Circuncisão Masculina , Fimose/cirurgia , Procedimentos Desnecessários , Adolescente , Fatores Etários , Pré-Escolar , Circuncisão Masculina/efeitos adversos , Circuncisão Masculina/psicologia , Dilatação/efeitos adversos , Humanos , Lactente , Masculino , Doenças do Pênis/epidemiologia , Pênis/crescimento & desenvolvimento , Fimose/epidemiologia , Aderências Teciduais/epidemiologiaRESUMO
Se presenta una técnica modificada de laparoscopia abierta, realizada en doscientos pacientes con indicación de laparoscopia o cirugía laparoscópica. No se presentaron complicaciones intraoperatorias o postoperatorias relacionadas con la técnica. Todas las pacientes fueron controladas una semana posterior a la cirugía, ninguna presentó infección o hernia. Las modificaciones a la técnica clásica de laparoscopia abierta descrita en el presente artículo, la transforman en un procedimiento simple y eficiente manteniendo la seguridad inherente a la técnica original
Assuntos
Humanos , Feminino , Doenças dos Genitais Femininos , Laparoscopia/estatística & dados numéricos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Aderências Teciduais/epidemiologiaRESUMO
Foi estudada a incidência de aderências intra-uterinas após curetagem para tratamento de abortamento espontâneo. A incidência do grupo em estudo foi de 14,8 por cento, sendo que o diagnóstico era estabelecido através de estudo radiográfico com histerossalpingografia. No grupo de abortamento retido, a incidência foi de 33,3 por cento, e no grupo de aborto nÒo retido, de 3,5 por cento. As médias etárias foram de 34 anos e 24 anos, respectivamente, para os grupos com aderência intra-uterina e sem aderências. Näo foram encontradas complicaçöes no estudo.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Aborto Espontâneo/cirurgia , Curetagem/efeitos adversos , Aderências Teciduais/epidemiologia , Útero/cirurgia , Incidência , Estudos ProspectivosRESUMO
Adhesions are the most common cause of intestinal obstruction. Medical treatment for those patients with no signs of vascular involvement has been successful in many cases. We reviewed the clinical records of 87 patients with intestinal obstruction due to adhesions, having a total of 122 episodes. Satisfactory follow up was obtained in 76% of patients for a mean of 29.6 months. 47% of episodes resolved without need for surgical intervention. Volume entrapment during the first hours was correlated with need for surgical treatment (p < 0.01). Recurrences were not different between medical and surgical patients (p = 0.28). Thus, medical treatment of this type of intestinal obstruction may be attempted in most patients, not only those who are poor surgical risks.