Assessment of the relationship between metabolic syndrome and breast cancer

Introduction: Metabolic syndrome (MS) affects approximately 30% of women aged over 50 years. It is known to have a direct relationship with carcinogenesis and, therefore, with breast neoplasia. Methods: Retrospective longitudinal observational cohort study carried out at the Gynecology and Obstetrics Service of the São Paulo State Public Servant Hospital. The rates of local recurrence, distant metastases and overall survival of patients with malignant breast neoplasia in each group were evaluated. Results: Between 2017 and 2020, 375 patients underwent surgical treatment for breast cancer, of which 335 were eligible for the study, with an average age of 63.4 years old. MS is present in 32.5% of patients. Regarding the prognostic factor, patients with MS have a very similar distribution. The molecular profile in patients with MS is 39.4% of Luminal A patients, while in those without MS it is 42.5% of Luminal B. Regarding clinical staging, patients with MS have initial clinical stage I and IIA in 54 .1% of cases, while patients without MS present an initial clinical stage in 65% of cases. The average overall survival of the sample was 37.3 years, with a CI of 1.1 years; disease-free survival was 35.9 years, with CI 1.2 years; and invasive disease-free survival was 36.9 years, with CI 1.3 years. Conclusions: The presence of MS at diagnosis does not worsen survival. (AU)

Amniotic Sludge and Prematurity: Systematic Review and Meta-analysis / Sludge amniótico e prematuridade: revisão sistemática e metanálise

Abstract Objective To perform a systematic review and meta-analysis of studies on maternal, fetal, and neonatal outcomes of women with singleton pregnancies, after spontaneous conception, and with the diagnosis of amniotic sludge before 37 weeks of gestational age. Data Sources We conducted a search on the PubMed, Cochrane, Bireme, and Theses databases until June 2022. Selection of Studies Using the keywords intra-amniotic sludge or fluid sludge or echogenic particles, we found 263 articles, 132 of which were duplicates, and 70 were discarded because they did not meet the inclusion criteria. Data Collection The articles retrieved were analyzed by 2 reviewers; 61 were selected for full-text analysis, 18 were included for a qualitative analysis, and 14, for a quantitative analysis. Data Synthesis Among the maternal outcomes analyzed, there was an increased risk of preterm labor (95% confidence interval [95%CI]: 1.45-2.03), premature rupture of ovular membranes (95%CI: 1.99-3.79), and clinical (95%CI: 1.41-6.19) and histological chorioamnionitis (95%CI: 1.75-3.12). Regarding the fetal outcomes, there was a significant increase in the risk of morbidity (95%CI: 1.80-3.17), mortality (95%CI: 1.14-18.57), admission to the Neonatal Intensive Care Unit (NICU; 95%CI: 1.17-1.95), and neonatal sepsis (95%CI: 2.29-7.55). Conclusion The results of the present study indicate that the presence of amniotic sludge is a risk marker for preterm delivery. Despite the heterogeneity of the studies analyzed, even in patients with other risk factors for prematurity, such as short cervix and previous preterm delivery, the presence of amniotic sludge increases the risk of premature labor. Moreover, antibiotic therapy seems to be a treatment for amniotic sludge, and it may prolong pregnancy.

Resumo Objetivo Realizar revisão sistemática e metanálise de estudos que avaliaram os desfechos maternos, fetais e neonatais em gestantes de gravidez única, após concepção espontânea, e com o diagnóstico de sludge amniótico antes de 37 semanas de idade gestacional. Fontes dos dados Realizou-se uma pesquisa nas bases de dados PubMed, Cochrane, Bireme e Teses até junho de 2022. Seleção dos estudos Usando as palavras-chave intra-amniotic sludge ou fluid sludge ou echogenic particles, foram encontrados 263 artigos, 132 dos quais eram duplicatas, e 70 foram descartados por não corresponderem aos critérios de inclusão. Coleta de dados Os artigos encontrados foram analisados por 2 revisores; 61 foram selecionados para análise de texto completo, 18 foram incluídos em uma análise qualitativa e 14, em uma análise quantitativa. Síntese dos dados Entre os desfechos maternos analisados, houve aumento do risco de trabalho de parto prematuro (intervalo de confiança de 95% [IC95%]: 1.45-2.03), rotura prematura de membranas ovulares (IC95%: 1.99-3.79), e corioamnionite clínica (IC95%: 1.41-6.19) e histológica (IC95%: 1.75-3.12). Em relação aos desfechos fetais, houve aumento significativo do risco de morbidade (IC95%: 1.80-3.17), mortalidade (IC95%: 1.14-18.57), admissão em Unidade de Tratamento Intensivo (UTI) neonatal (IC95%: 1.17-1.95) e sepse neonatal (IC95%: 2.29-7.55). Conclusão Os resultados do presente estudo indicam que a presença de sludge amniótico é um marcador de risco para parto prematuro. Apesar da heterogeneidade dos estudos analisados, até mesmo em pacientes com outros fatores de risco para prematuridade, como colo curto e trabalho de parto prematuro anterior, a presença de sludge amniótico aumenta o risco de trabalho de parto prematuro na gestação. Além do mais, a antibioticoterapia parece ser um tratamento para o sludge amniótico, e pode ser capaz de prolongar a gravidez.

Comparative study of the levonorgestrel intrauterine system and laparoscopic hysterectomy for the treatment of heavy menstrual bleeding in enlarged uteri

ABSTRACT Objective To evaluate the effectiveness of the levonorgestrel intrauterine system in the treatment of patients with heavy menstrual bleeding and an enlarged uterus and to compare satisfaction and its complications with hysterectomy. Methods This was a comparative cross-sectional observational study of women with heavy menstrual bleeding and an enlarged uterus. Sixty-two women were treated and followed up for four years. Insertion of the levonorgestrel intrauterine system was performed in Group 1, and laparoscopic hysterectomy was performed in Group 2. Results In Group 1 (n=31), 21 patients (67.7%) showed improvement in the bleeding pattern, and 11 patients (35.5%) had amenorrhea. Five patients (16.1%) remained with heavy bleeding and were considered to have experienced treatment failure. There were seven expulsions (22.6%); in five patients, bleeding remained heavy, but in two patients the bleeding returned to that of normal menstruation. No relationship was found between treatment failure and greater hysterometries (p=0.40) or greater uterine volumes (p=0.50), whereas expulsion was greater in uteri with smaller hysterometries (p=0.04). There were 13 (21%) complications, seven (53.8%) in the group that underwent insertion of the levonorgestrel intrauterine system (all were device expulsions), and six (46.2%) in the surgical group, which were the most severe ones (p=0.76). Regarding satisfaction, 12 patients (38.7%) were dissatisfied with the levonorgestrel intrauterine system and one (3.23%) was dissatisfied with the surgical treatment (p=0.00). Conclusion Treatment with the levonorgestrel intrauterine system in patients with heavy menstrual bleeding and an enlarged uterus was effective, and when compared with laparoscopic hysterectomy, it had a lower rate of satisfaction and the same rate of complications, although less severe.

Impact of neoadjuvant chemotherapy in the surgical treatment of breast cancer

Introduction: Neoadjuvant chemotherapy is an increasingly frequent option in the treatment of breast cancer. One of the goals of neoadjuvant chemotherapy is to change the indication for a mastectomy to a conservative surgery, and for axillary lymphadenectomy to sentinel lymph node assessment. Methods: This was an observational, cross-sectional, retrospective study that evaluated response to neoadjuvant chemotherapy in breast cancer patients undergoing surgical treatment. Patients were divided into three groups when the surgery indication was changed after neoadjuvant chemotherapy: downgrade, unchanged, upgrade. Results: During the study period, 355 patients were included with a mean age of 55 years. Neoadjuvant chemotherapy promoted a downgrade in 38.7% of patients with indication for mastectomy and an upgrade in 36.8% of patients with indication for conservative surgery; in the total group, the maintenance of indication for surgery was 62,2%. In the axillary approach, lymphadenectomy downgrade was 6.9% and sentinel lymph node biopsy upgrade was 34% with 27% being due to positivity and 7% due to disease progression. Multivariate analysis found a significant difference between clinical staging and change in surgical indication for both breast and axilla (p<0.0001). In the multivariate analysis of pathologic complete response and change of indication for breast and axilla surgery, triple negative and HER-2-positive tumors showed a significant difference (p<0.0001). Conclusions: Neoadjuvant chemotherapy was able to perform a downgrade of breast and axilla surgery in few patients and there was no relationship between the change of indication and pathologic complete response. (AU)

Antibiotic prophylaxis in pregnant with premature rupture of ovular membranes: systematic review and meta-analysis

ABSTRACT Objective To perform a systematic review and meta-analysis of randomized clinical trials that compared the use of antibiotics versus placebo in premature rupture of membranes preterm and evaluated maternal, fetal and neonatal outcomes in pregnant women with premature rupture of ovular membranes at a gestational age between 24 and 37 weeks. Methods A search was conducted using keywords in PubMed, Cochrane, Biblioteca Virtual em Saúde and Biblioteca Digital de Teses e Dissertações da USP between August 2018 and December 2021. A total of 926 articles were found. Those included were randomized clinical trials that compared the use of antibiotics versus placebo in the premature rupture of preterm membranes. Articles referring to antibiotics only for streptococcus agalactiae prophylaxis were excluded. The retrieved articles were independently and blindly analyzed by two reviewers. A total of 24 manuscripts met the inclusion criteria and 21 articles were included for quantitative analysis. Results Among the maternal outcomes analyzed, there was a prolongation of the latency period that was ≥7 days. In addition, we observed a reduction in chorioamnionitis in the group of pregnant women who used antibiotics. As for endometritis and other maternal outcomes, there was no statistically significant difference between the groups. Regarding fetal outcomes, antibiotic prophylaxis worked as a protective factor for neonatal sepsis. Necrotizing enterocolitis and respiratory distress syndrome showed no statistically significant differences. Conclusion The study showed positive results in relation to antibiotic prophylaxis to prolong the latency period, new randomized clinical trials are needed to ensure its beneficial effect. Prospero database registration (www.crd.york.ac.uk/prospero) under number CRD42020155315.

Comparative analysis between screening mammography performed in patients at usual risk and at high risk for breast cancer

Breast cancer is currently considered as a public health issue. To avoid late diagnosis, there is an attempt to use appropriate screening programs addressed to the early detection by testing the asymptomatic population in order to identify preclinical stage lesions. Methods: This is a retrospective, analytical, cross-sectional study of the notifications available in the cancer information system. The incidence of notifications from the reports of the BI-RADS™ notification system (Breast Imaging Reporting Data System) was compared between women at high and usual risk for breast cancer. Results: In the analyzed period, from 2013 to 2021, 16,065,383 screening mammographies were performed and notified in Brazil. Of these, 13,167,259 were performed in usualrisk women, whereas 2,898,124 were performed in high-risk women. To analyze the difference between reports of women at usual and high risk, the relative risk between them was calculated, as well as the necessary number to causa damage; the relative risk we found was of 0.5412 (95%CI 0.5341­0.5483) in B4 and relative risk of 0,433 (95%CI 0.4203­0.4462). As to the necessary number to cause damage, we observed 203 (95%CI 198­209) for B4 and 788 (95%CI 754­825) for B5. Despite the well-established need for breast cancer screening programs to reduce mortality, some aspects of screening do not have such a consensus. In this study, the incidence of reports that are suggestive of malignant breast lesions was higher among women at high risk.

Effects of clinical heterogeneity on Pregnancy-Associated Breast Cancer survival: a systematic review with meta-analysis

Pregnancy-associated breast cancer is defined as a diagnosis of breast cancer during pregnancy or within 1 year of childbirth. Current evidence shows that Pregnancy-associated breast cancer is associated with poor prognosis; however, no systematic review has summarized and explored how baseline characteristics could impact survival. We aimed to explore the impact of breast cancer characteristics on death and disease relapse. A systematic review with meta-analyses was conducted by searching articles in the main databases (Medline, Embase, and Cochrane) and congress abstracts. Summarized death and disease-free survival hazard ratios were recalculated, and all meta-analyses used a random-effects model. Heterogeneity was reported using the I2 method. A total of 7143 studies were identified and only 30 studies were included. Pregnancy-associated breast cancer is associated with a 96% (HR 1.96; 95%CI 1.58­2.35) higher risk of death and 82% (HR 1.82; 95%CI 1.45­2.20) risk of death or disease relapse in comparison to a population of non-pregnancy-associated breast cancer or nulliparous breast cancer. Through sensitivity analyses, we identified that clinical outcomes were impacted, possibly due to Ki-67 levels, poorly differentiated tumors, and triple-negative breast cancer frequency in the study. As relevant sources of inconsistencies, such clinical cancer-related characteristics should be better investigated as potential confounders for upcoming Pregnancy-associated breast cancer therapeutic strategies.

Relação do Índice de Massa Corporal e Linfedema Secundário a tratamento cirúrgico do Câncer de Mama: estudo retrospectivo / Relationship of Body Mass Index and Secondary Lymphedema to Surgical Treatment of Breast Cancer: a retrospective study

INTRODUÇÃO: O câncer de mama é a neoplasia mais incidente na população feminina brasileira, sendo o linfedema uma de suas principais complicações cirúrgicas. OBJETIVO: Verificar a relação do índice de massa corpóreo e o desenvolvimento do linfedema no pós-operatório de câncer de mama, sua relação com o tipo de tratamento e ao tempo pós-cirúrgico. MATERIAIS E MÉTODOS: Foram levantados prontuários de 59 mulheres no período de maio de 2008 a fevereiro de 2009 utilizando dados da anamnese; exame físico; perimetria, volume estimado; relatos, sintomas e dados em prontuário. A análise foi feita por meio de médias e desvios padrões para as variáveis quantitativas e qualitativas (absoluta e relativa) e para verificação dos fatores de risco foi utilizado o Teste t de Student e Teste Qui-quadrado de Pearson com nível de significância de 5%. RESULTADOS: A frequência de linfedema foi de 47,5%, sendo que 40,7% eram obesas. Observou-se diferença significativa entre os grupos de linfedema e IMC (p=0,002). Nota-se ainda diferença significativa entre linfedema no grupo sem radioterapia de axila (p=0,003) e associação entre o tempo pós-cirúrgico e linfedema (p=0,006), sendo maior após 6 meses de cirurgia. CONCLUSÃO: Existe correlação entre obesidade e desenvolvimento do linfedema. Os tipos de tratamento parecem não ter influenciado o seu desenvolvimento e quanto mais tempo decorrido pós- cirurgia, maior o risco do seu aparecimento.

INTRODUCTION: Breast cancer is the most common neoplasm in the Brazilian female population, with lymphedema being one of its main surgical complications. OBJECTIVE: To verify the relationship between the body mass index and the development of lymphedema in the postoperative period of breast cancer, its relationship with the type of treatment received and the time elapsed from the surgery. MATERIALS AND METHODS: Medical records of 59 women were collected from May 2008 to February 2009 using data from anamnesis, physical exam; perimetry, estimated volume; reports, symptoms, and notes in medical records. The analysis was performed using means and standard deviations for the quantitative and qualitative variables (absolute and relative) and to verify the risk factors used, the Student's t-test and Pearson's chi-square test with a 5% significance level (0.05). RESULTS: The frequency of lymphedema was 47.5%, with 40.7% being obese. There was a significant difference between the groups of lymphedema and BMI (p=0.002). There is also a significant difference between lymphedema in the group without axillary radiotherapy (p=0.003) and an association between post-surgical time and lymphedema (p=0.006), being greater after six months of surgery. CONCLUSION: There is a correlation between obesity and the development of lymphedema. The types of treatment do not seem to have influenced their development, and the longer the surgery has elapsed, the greater the risk of their appearance.

Epidemiology of artherial hypertension in pregnants / Epidemiologia da hipertensão arterial em gestantes

ABSTRACT Objective To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events. Methods Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used. Results Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed). Conclusion After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.

RESUMO Objetivo Pesquisar os dados epidemiológicos da hipertensão arterial em gestantes, bem como identificar seus possíveis eventos associados. Métodos A coleta de dados foi realizada no ambulatório do pré-natal de alto risco e na enfermaria da maternidade em hospital público da cidade de São Paulo, nos períodos matutino e vespertino, de outubro de 2015 a julho de 2016. Foi aplicado um questionário com 22 perguntas elaborado pelos pesquisadores. A margem de erro foi de 5% e o nível de confiança, de 95%. Para o cálculo, foram usados o teste de igualdade de duas proporções, a correlação de Pearson e o teste de ANOVA. Resultados Dentre as entrevistadas, 43% tinham hipertensão crônica, 33,3% se apresentaram com até 20 semanas de gestação, 23,7% se apresentaram após a 20ª semana da gestação, 62,3% tinham idade entre 18 e 35 anos, 78,1% tinham antecedente familiar com hipertensão arterial, 11,4% com idade entre 36 a 45 anos estavam na primeira gestação, e 26,3% com a mesma idade estavam a partir da segunda gestação. Dentre as afecções associadas, prevaleceu o diabetes com 50%; 22,2% se tratavam de obesidade, e dos alimentos mais escolhidos para consumo entre as gestantes, 47,5% possuíam alto teor energético (processados/ultraprocessados). Conclusão Após análise epidemiológica no resultado da prevalência da hipertensão arterial, foram encontradas gestantes com hipertensão arterial crônica, hipertensão arterial preexistente descoberta durante a gestação e doença hipertensiva específica da gestação. Em relação aos possíveis fatores associados à hipertensão arterial, foram encontrados: idade mais elevada, antecedentes familiares de hipertensão, preexistência de hipertensão, gestações tardias, diabetes, obesidade e frequente consumo de alimentos processados/ultraprocessados.

Influence of breast cancer subtype on pathological complete response

Objective: To compare the rates of pathological complete response (pCR) after treatment with neoadjuvant chemotherapy, in the different subtypes of breast cancer in patients followed at the Mastology Service of Hospital do Servidor Público Estadual. Methods: Descriptive and retrospective study, in which medical records of 213 patients diagnosed with breast cancer and submitted to neoadjuvant chemotherapy were reviewed, from February 2011 through January 2018. Histological data collected were: hormone receptors, hyperexpression of HER-2, grade, histological type and clinical data: age of the patient at diagnosis, tumor size and clinical stage at diagnosis and after chemotherapy, and rate of pCR. Results: The mean age of patients at diagnosis was 53.97 years. Forty-six patients (21,6%) had pCR, 77 (36.1%) were grade 2 and 136 (63.9%) were grade 3. Regarding cancer subtype, 29 patients (13.6%) were reported to have pure HER2 subtype, 48 patients (22.5%) corresponded to Luminal A subtype, 51 (23.9%) to Luminal B, and 66 patients (31.0%) were characterized as Triple Negative, while only 17 patients (7.9%) had Luminal B HER. Conclusion: The subtypes Pure HER 2 and Luminal B had the highest pCR rates.

Surgical treatment of intestinal endometriosis: outcomes of three different techniques / Tratamento cirúrgico de endometriose intestinal: resultados de três técnicas operatórias

Abstract Objective To outline the demographic and clinical characteristics of patients with deep intestinal endometriosis submitted to surgical treatment at a tertiary referral center with a multidisciplinary team, and correlate those characteristics with the surgical procedures performed and operative complications. Methods A prospective cohort from February 2012 to November 2016 of 32 women with deep intestinal endometriosis operations. The variables analyzed were: age; obesity; preoperative symptoms (dysmenorrhea, dyspareunia, acyclic pain, dyschezia, infertility, urinary symptoms, constipation and intestinal bleeding); previous surgery for endometriosis; Enzian classification; size of the intestinal lesion; and surgical complications. Results Themean age was 37.75 (±5.72) years. A total of 7 patients (22%) had a prior history of endometriosis. The mean of the largest diameter of the intestinal lesions identified intraoperatively was of 28.12 mm (±14.29 mm). In the Enzian classification, there was a predominance of lesions of the rectum and sigmoid, comprising 30 cases (94%). There were no statistically significant associations between the predictor variables and the outcome complications, even after the multiple logistic regression analysis. Regarding the size of the lesion, there was also no significant correlation with the outcome complications (p = 0.18; 95% confidence interval [95%CI]:0.94-1.44); however, there was a positive association between grade 3 of the Enzia classification and the more extensive surgical techniques: segmental intestinal resection and rectosigmoidectomy, with a prevalence risk of 4.4 (p < 0.001; 95%CI:1.60-12.09). Conclusion The studied sample consisted of highly symptomatic women. A high prevalence of deep infiltrative endometriosis lesions was found located in the rectum and sigmoid region, and their size correlated directly with the extent of the surgical resection performed.

Resumo Objetivo Delinear as características das pacientes portadoras de endometriose profunda intestinal submetidas a tratamento cirúrgico em centro de referência com equipe multidisciplinar, e correlacionar tais achados com a extensão de doença e com os procedimentos cirúrgicos realizados. Métodos Tratamento cirúrgico no período de fevereiro de 2012 a novembro de 2016 em 32 mulheres portadoras de endometriose profunda intestinal. Variáveis analisadas: idade; obesidade; queixas pré-operatórias: dismenorreia, dispareunia, dor acíclica, disquezia, sangramento uterino anormal, infertilidade, sintomas urinários, constipação, e sangramento intestinal; cirurgia prévia para tratamento de endometriose profunda; classificação de Enzian; técnica cirúrgica aplicada; tamanho da lesão intestinal; e complicações operatórias. Resultados A média de idade foi de 37,75 (±5,72) anos. Um total de 7 (22%) pacientes tinha histórico de abordagem prévia da endometriose. A média do maior diâmetro das lesões intestinais foi de 28,12 mm (±14,29 mm). Na classificação de Enzian, houve predomínio das lesões da região de reto ou retossigmoide no compartimento posterior, num total de 30 casos (94%). Não foi observada associação estatística significativa entre as variáveis preditivas e o desfecho da complicação, mesmo após análise de regressão logística múltipla. Quanto ao tamanho da lesão, também não houve correlação significativa com o desfecho complicação (p = 0,18; intervalo de confiança de 95% [IC95%]: 0,94-1,44). No entanto, Houve associação positiva entre o grau 3 da classificação de Enzian e a técnica cirúrgicamais extensa: ressecção intestinal segmentar e retossigmoidectomia, com risco de prevalência de 4,4 (p = 0,00003; IC95%: 1,60-12,09). Conclusão A amostra populacional estudada foi constituída de mulheres muito sintomáticas. Foi encontrada prevalência alta de lesões de endometriose infiltrativa profunda localizadas em região de retossigmoide, e seu tamanho correlacionou-se diretamente com a extensão da ressecção cirúrgica realizada.

Female Sexual Function in Women with Suspected Deep Infiltrating Endometriosis / Função sexual feminina em mulheres com suspeita de endometriose infiltrativa profunda

Abstract Objective To evaluate the quality of the sexual function of women with suspected deep infiltrating endometriosis. Methods A cross-sectional, observational and prospective study was conducted between May 2015 and August 2016, in which 67 patients with deep infiltrating endometriosis, suspected or diagnosed, were assessed for epidemiological and clinical characteristics, such as pain level through a visual analog scale (VAS), features of deep infiltrating endometriosis lesions and score on the Female Sexual Function Index (FSFI) before the onset of treatment. The statistical analysis was performed using the software STATA version 12.0 (StataCorp LLC, College Station, TX, USA) to compare the variables through multiple regression analysis. Results The average age of the patients was 39.2 years old; most patients were symptomatic (92.5%); and the predominant location of the deep infiltrating lesions was on the rectosigmoid colon (50%), closely followed by the retrocervical region (48.3%). The medianoverallscoreontheFSFIwas23.4;in67.2%of thecasesthescorewas26.5(cutoff point for sexualdysfunction). Deepdyspareunia(p = 0.000,confidenceinterval [CI]:0.64- 0.83) and rectosigmoid endometriosis lesions (p = 0.008, CI: 0.72-0.95) showed significant correlation with lower FSFI scores, adjusted by bladder lesion, patients' ageand size of lesions. Deep dyspareunia (p = 0.003, CI: 0.49-0.86) also exhibited significant correlation with FSFI pain domain, adjusted by cyclic bowel pain, vaginal lesion and use of gonadotropin-releasing hormone (GnRH) analog. These results reflect the influence of deep dyspareunia on the sexual dysfunction of the analyzed population. Conclusion Most patients exhibited sexual dysfunction, and deep dyspareunia was the pelvic painful symptom that showed correlation with sexual dysfunction.

Resumo Objetivo Avaliar a qualidade da função sexual em pacientes com suspeita de endometriose profunda infiltrativa. Métodos Foi realizado um estudo observacional transversal prospectivo entre maio de 2015 e agosto de 2016, no qual foram analisados os dados clínicos e epidemiológicos de 67 pacientes com endometriose profunda presuntiva ou diagnosticada, níveis de dor através de escala visual analógica (EVA) e Índice de Função Sexual Feminina (questionário IFSF) antes do início do tratamento. A análise estatística foi realizada utilizando o programa estatístico STATA, na versão 12.0 (StataCorp LLC, College Station, TX, USA), para comparar as variáveis por meio de regressão múltipla. Resultados A idade média foi de 39,2 anos; houve predominância de mulheres sintomáticas (92,5%) e da localização de lesões de endometriose profunda em retossigmoide (50%) seguida pela topografia retrocervical (48,3%). A pontuação total no IFSF mostrou uma mediana de 23,4, e em 67,2% das mulheres a pontuação foi 26,55 (cut-off que indica disfunção sexual). Dispareunia (p = 0.000, intervalo de confiança [IC]: 0.64-0.83) e lesão endometriótica em retossigmoide (p = 0.008, IC: 0.72-0.95) exibiram uma relação estatisticamente significante com valores baixos de pontuação no IFSF, ajustados por lesão em bexiga, idade da paciente e tamanho da lesão. A dispareunia de profundidade também mostrou correlação significante com o domínio dor do IFSFajustado por dor cíclica intestinal, lesão vaginal e uso de análogo de hormônio liberador de gonadotrofina (GnRH). Os resultados refletem a influência da dispareunia de profundidade na disfunção sexual da população do estudo. Conclusão A maioria das pacientes apresentava disfunção sexual e o sintoma mais relacionado a esta disfunção foi dispareunia de profundidade.

PHYLLODES TUMORS OF THE BREAST: A RETROSPECTIVE EVALUATION OF CASES FROM THE HOSPITAL DO SERVIDOR PÚBLICO ESTADUAL DE SÃO PAULO / Tumor filoides de mama: avaliação retrospectiva de casos do Hospital do Servidor Público Estadual de São Paulo

Objective: To evaluate the clinical and pathological characteristics of phyllodes tumors, and to identify possible associated risk factors for relapses among patients from the Breast Surgery Department of the Hospital do Servidor Público Estadual of São Paulo (HSPE-SP). Methods: Retrospective, descriptive study of data from 52 patients, between 1976 and 2013. The following data were collected: age, tumor size, histological type, surgical margins, type of surgery performed, relapses and amount of time before relapse. Results: The mean age of the patients was 45.7 years old, the mean size of the tumor was 7.8 cm. A mastectomy was performed on 12 patients, and the others underwent a wide excision. Benign phyllodes tumors were found in 30 patients, and the others were found as follows: 11 with borderline tumors and 11 with malign phyllodes tumors. There was no statistical relevance with regard to the relapses and the characteristics evaluated. Conclusion: The sample studied has similar clinical and pathological characteristics as described in the scientific literature, with the mean age at diagnosis being 45 years old, the mean tumor size, 7.8 cm. The majority found were benign phyllodes tumors and 33% were from relapses. There was no statistical significance between the evaluated variables and the risk for relapse.

Objetivo: Avaliar as características clínicas e patológicas do tumor filoides e identificar fatores relacionados com risco de recidivas em pacientes acompanhadas no ambulatório de Mastologia do Hospital do Servidor Público Estadual de São Paulo (HSPE-SP). Método: Estudo retrospectivo descritivo de dados de 52 pacientes, entre 1976 e 2013, dentre os quais: idade, tamanho do tumor, tipo histológico, margens cirúrgicas, tipo de cirurgia, recidivas e tempo para recidiva. Resultados: A idade média das pacientes foi 45,7 anos. O tamanho médio do tumor foi de 7,8 cm. O tratamento em 12 pacientes foi a mastectomia, e as demais 40 a excisão ampla. O tipo histológico encontrado em 30 pacientes foi tumores benignos, 11 malignos e 11 de variedade borderline. Após o seguimento médio de 53,93 meses, observaram-se 17 recidivas. Não houve relevância estatística entre a recorrência local e as variáveis avaliadas. Conclusões: A amostra avaliada tem características clínicas e patológicas condizentes com a literatura, com média de idade de 45 anos, tamanho do tumor de 7,8 cm, sendo encontrados na maioria tumor filoides benigno e 33% de recidivas. Não houve significância estatística entre características avaliadas e o risco de recidiva.

Initial experience with hysteroscopic tubal occlusion (Essure®) / Experiência inicial com a oclusão tubária por via histeroscópica (Essure®)

ABSTRACT Objective To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). Methods This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Results Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method. Conclusions Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied.

RESUMO Objetivo Avaliar os resultados das primeiras oclusões tubárias realizadas pela via histeroscópica (Essure®). Métodos Estudo prospectivo com 38 pacientes, sendo 73,7% caucasianas, com média de idade de 34,5 anos, e com 3 gestações e 2,7 partos em média. Do total, 86,8% das pacientes fizeram preparo prévio do endométrio. Todos os procedimentos foram ambulatoriais e sem anestesia. Resultados A taxa de inserção do dispositivo foi de 100%, com tempo médio de 4 minutos e 50 segundos. Segundo a Escala Visual Analógica, a dor média obtida foi de três, e 55,3% das mulheres não referiram qualquer dor após o método. Ocorreu um caso de reflexo vagal e 89,5% das pacientes retornaram às atividades normais no mesmo dia. Após 3 meses, 89,5% das pacientes encontravam-se muito satisfeitas com o método. A radiografia simples da pelve evidenciou 92,1% de dispositivos tópicos, ocorrendo um caso de expulsão unilateral. Após 4 anos de seguimento, não houve falha do método. Conclusão A oclusão tubária por via histeroscópica em regime ambulatorial e sem anestesia foi um procedimento rápido, bem tolerado, isento de complicações graves e com alta taxa de sucesso e satisfação das pacientes.

Perinatal outcomes in women over 40 years of age compared to those of other gestations / Resultados perinatais em gestantes acima de 40 anos comparados aos das demais gestações / Resultados perinatais em gestantes acima de 40 anos comparados aos das demais gestações

Objective To clarify if older pregnant women were more likely to have adverse perinatal outcomes when compared to women at an ideal age to have a child. Methods The groups were divided according to age groups: under 20 years, ≥20 to <40 years, and ≥40 years. Results During the period from January 1st, 2008, to December 31st, 2008, there were 76 births from patients younger than 20 years and 91 births from patients aged 40 years or over. To form a third group with intermediate age, the data of 92 patients aged 20 to 40 years were obtained, totaling 259 patients. Patients aged 40 or older had a statistically greater number of cesarean sections and less use of forceps or normal deliveries (p<0.001). The use of spinal anesthesia was statistically higher among those aged 40 years or more (p<0.001). The frequency of male newborns was statistically higher in older patients, a group with statistically fewer first pregnancies (p<0.001). The frequency of premature newborns was statistically higher in patients aged 40 years or more (p=0.004). Conclusion It is crucial to give priority to aged women, so that prenatal care will be appropriate, minimizing maternal complications and improving perinatal outcomes in this unique group. .

Objetivo Esclarecer se as gestantes em idade avançada estiveram mais propensas a terem resultados perinatais adversos quando comparadas àquelas em idade reprodutiva ideal. Métodos Os grupos foram divididos segundo grupos etários: idade menor que 20 anos; idade maior ou igual a 20 anos e menor que 40 anos; e idade maior ou igual a 40 anos. Resultados No período compreendido entre 1o de janeiro de 2008 a 31 de dezembro de 2008, ocorreram 76 partos de pacientes com idade menor que 20 anos e 91 partos de pacientes com idade maior ou igual a 40 anos. Para a formação de um terceiro grupo de faixa etária intermediária, foram coletados os dados de 92 pacientes com idade maior ou igual a 20 anos e menor que 40 anos, totalizando 259 pacientes. As pacientes com 40 anos ou mais apresentaram estatisticamente maior quantidade de partos cesárea e menos parto a fórcipe ou normais (p<0,001). A aplicação de raquianestesia foi estatisticamente maior nas gestantes com 40 anos ou mais (p<0,001). A frequência de recém-nascido do sexo masculino foi estatisticamente maior nas pacientes mais velhas, que também eram estatisticamente menos primigestas (p<0,001). A frequência de recém-nascido pré-termo foi estatisticamente maior em pacientes com 40 anos ou mais (p=0,004). Conclusão A priorização no atendimento das gestantes em idade avançada é imprescindível para que o pré-natal seja realizado com segurança, minimizando as complicações maternas e melhorando os resultados perinatais deste grupo tão particular. .

Achados histeroscópicos na cavidade endometrial após ablação endometrial / Hysteroscopic appearance of the endometrial cavity after endometrial ablation

OBJETIVO: Verificar o aspecto da cavidade uterina após a ablação endometrial histeroscópica, a prevalência de sinéquias após o procedimento e, com isso, avaliar a importância da histeroscopia realizada no pós-operatório dessas pacientes. MÉTODOS: Foram avaliados, retrospectivamente, os laudos dos exames de 153 pacientes que haviam sido submetidas à histeroscopia ambulatorial após ablação do endométrio devido a sangramento uterino anormal de causa benigna, no período entre janeiro de 2006 e julho de 2011. As pacientes foram divididas em dois grupos: HIST≤60 (n=90), com pacientes submetidas ao exame no período de 40 a 60 dias após o procedimento, e grupo HIST>60 (n=63), das que foram examinadas entre 61 dias e 12 meses. RESULTADOS: No grupo HIST≤60, 30% das pacientes apresentavam algum grau de sinéquia; aderências grau I foram descritas em 4,4%; grau II em 6,7%; grau IIa em 4,4%; grau III em 7,8%; e 2,2% apresentavam grau IV. No HIST>60, sinéquias foram descritas em 53,9% dos casos, 3,2% tinham sinéquias grau I; 11,1%, grau II; 7,9%, grau IIa; 15,9%, grau III; e 4,8%, grau IV. Hematometra foi descrito em 2,2% dos casos do HIST≤60 e em 6,3% no HIST>60. CONCLUSÕES: A cavidade uterina de pacientes submetidas à histeroscopia ambulatorial até 60 dias após a ablação endometrial mostrou menor número de sinéquias quando comparada com as cavidades uterinas de pacientes que foram submetidas ao exame após 60 dias. Acompanhamento em longo prazo é necessário para avaliar plenamente o impacto da histeroscopia ambulatorial após a ablação endometrial. .

PURPOSE: To examine the aspect of the uterine cavity after hysteroscopic endometrial ablation, to determine the prevalence of synechiae after the procedure, and to analyze the importance of hysteroscopy during the postoperative period. METHODS: The results of the hysteroscopic exams of 153 patients who underwent outpatient hysteroscopy after endometrial ablation due to abnormal uterine bleeding of benign etiology during the period from January 2006 to July 2011 were retrospectively reviewed. The patients were divided into two groups: HIST≤60 (n=90) consisting of patients undergoing the exam 40-60 days after the ablation procedure, and the group HIST>60 (n=63) consisting of patients undergoing the exam between 61 days and 12 months after the procedure. RESULTS: In the HIST≤60 group, 30% of the patients presented some degree of synechiae: synechiae grade I in 4.4% of patients, grade II in 6.7% , grade IIa in 4.4%, grade III in 7.8%, and grade IV in 2.2%. In the HIST>60 group, 53.9% of all cases had synechiae, 3.2% were grade I, 11.1% grade II, 7.9% grade IIa, 15.9% grade III, and 4.8% grade IV. Hematometra was detected in 2.2 % of all cases in group HIST≤60 and in 6.3% of all cases in group HIST>60. CONCLUSIONS: The uterine cavity of the patients submitted to diagnostic hysteroscopy up to 60 days after endometrial ablation showed significantly fewer synechiae compared to the uterine cavity of patients who underwent the exam after 60 days. Long-term follow-up is necessary to fully evaluate the importance of outpatient hysteroscopy after endometrial ablation regarding menstrual patterns, risk of cancer and prevalence of treatment failure. .

Analysis of endometrial thickness measured by transvaginal ultrasonography in obese patients / Análise da medida da espessura endometrial pela ultrassonografia transvaginal em pacientes obesasAnalysis of endometrial thickness measured by transvaginal ultrasonography in obese patients

Objective To compare the endometrial echo values obtained by transvaginal ultrasonography with the body mass index of postmenopausal patients; to verify if there is higher prevalence of endometrial thickening in women with body mass index ≥30. Methods This is an analytical and cross-sectional study that evaluated 294 patients. Postmenopausal women were included, and those on hormone therapy were excluded. The variables evaluated were body mass index (considering obesity if >30), number of pregnancies, years since menopause, and age. These variables were correlated with endometrial echography. Results There was a statistically significant correlation between overweight and obese patients and increased endometrial thickness (p=0.0236). The correlation between age and endometrial echo was negative and statistically significant, that is, the older the woman, the lower the endometrial thickness (p=0.0478). Pregnancies and years since menopause showed no statistical significance in relation to endometrial echo, with p=0.0614 and p=0.115, respectively. Conclusion There was positive and significant correlation between body mass index ≥30 and endometrial thickeness. .

Objetivo Relacionar os valores do eco endometrial obtidos à ultrassonografia transvaginal com o índice de massa corporal de pacientes na pós-menopausa; verificar se existe maior prevalência de espessamento endometrial naquelas com índice de massa corporal ≥30. Métodos Trata-se de estudo analítico, transversal, que avaliou 294 pacientes. As pacientes incluídas estavam na pós-menopausa; foram excluídas aquelas que faziam uso de terapia hormonal. As variáveis avaliadas foram o índice de massa corporal, sendo considerado obesidade quando acima de 30, o número de gestações, o número de anos após a menopausa e a idade. Todas foram correlacionadas com os valores de eco endometrial. Resultados Houve correlação estatisticamente significante entre as pacientes com sobrepeso/obesas e o aumento do eco endometrial (p=0,0236). A correlação entre idade e valores de eco endometrial foi negativa e significante, isto é, quanto maior a idade, menor o eco (p=0,0478). Gestações e anos após a menopausa não demonstraram significância com relação ao eco endometrial, com p=0,0614 e p=0,115, respectivamente. Conclusão Houve correlação positiva e significante entre o aumento do eco endometrial e o índice de massa corporal ≥30. Objective To compare the endometrial echo values obtained by transvaginal ultrasonography with the body mass index of postmenopausal patients; to verify if there is higher prevalence of endometrial thickening in women with body mass index ≥30. Methods This is an analytical and cross-sectional study that evaluated 294 patients. Postmenopausal women were included, and those on hormone therapy were excluded. The variables evaluated were body mass index (considering obesity if >30), number of pregnancies, years since menopause, and age. These ...

Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy / Lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica / Lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica

Objective : To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy. Methods : The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm. Results : Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal. Conclusion : Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer. .

Objetivo : Avaliar a incidência de lesões precursoras e câncer em pólipos do endométrio de pacientes submetidas à polipectomia histeroscópica. Métodos : Análise dos resultados de 1.020 exames anatomopatológicos de pacientes submetidas, em hospital público, à polipectomia histeroscópica, e achados em suas histeroscopias diagnóstica e cirúrgica. Em termos de estado menstrual, 295 (28,9%) pacientes encontravam-se na menacme. Do total, 193 (65,4%) apresentavam sangramento uterino anormal e 102 (34,6%) eram assintomáticas, com alteração da medida do eco endometrial à ultrassonografia transvaginal. Das 725 (71,1%) pacientes na pós-menopausa, 171 (23,6%) eram sintomáticas (sangramento uterino anormal) e 554 (76,4%) assintomáticas, com eco endometrial >5,0mm. Resultados : Vinte e uma (2,0%) pacientes apresentaram lesões precursoras nos pólipos, 13 com hiperplasia glandular simples, das quais 5 sem atipias e 8 com atipias. Oito pólipos apresentavam área focal de hiperplasia complexa, quatro com atipias e quatro sem lesões. Câncer foi diagnosticado em cinco (0,5%) pólipos. Dos 21 pólipos que abrigavam lesões precursoras, 12 foram interpretados como benignos nas histeroscopias diagnóstica e cirúrgica. Quatro dos pólipos com câncer também foram interpretados histeroscopicamente como normais. Conclusão : Os pólipos sintomáticos na menacme, bem como todos na pós-menopausa, devem ser ressecados para realização de exame anatomopatológico, por poderem apresentar aspecto benigno, mesmo quando abrigam áreas de atipia celular ou câncer. .

Evolução perinatal e pediátrica de crianças com translucência nucal aumentada e cariótipo normal / Perinatal and pediatric follow up of children with increased nuchal translucency and normal karyotype

OBJETIVOS: Analisar o desfecho perinatal e pediátrico de fetos que apresentaram translucência nucal (TN) acima do percentil 95 (P95) e cariótipo normal a fim de obter dados que permitam um melhor aconselhamento materno pré-natal. METÓDOS: Análise de fetos em um serviço terciário de obstetrícia apresentaram TN acima do P95 e cariótipo normal entre os anos 2005 e 2011. Analisamos o seguimento ultrassonográfico gestacional, ecocardiografia (ECO) fetal e pós-natal, peso, comprimento e escore de Apgar ao nascimento, além do desenvolvimento neuropsicomotor por meio do Ages and Stages Questionnaire (ASQ) até julho de 2012. RESULTADOS: Durante esse período, foram 116 casos de translucência nucal acima do P95, sendo que em 79 (68%) foi realizado cariótipo fetal. Das análises, 43 foram normais (54,4%) e 36, alteradas (45,6%). Nos fetos com cariótipo normal, houve um abortamento na 15ª semana gestacional com pentalogia de Cantrel, um óbito na 24ª semana com diversas anomalias estruturais, um óbito neonatal sem causa definida e dois casos de comunicação intraventricular (CIV) detectados no ECO fetal. Na avaliação ecocardiográfica pós-natal, persistiu um caso de CIV e foi diagnosticado um caso de comunicação interatrial (CIA) e persistência do canal arterial (PCA). Entre os 40 casos sobreviventes, apenas 1 criança apresentou atraso no desenvolvimento da fala e outra apresentou quadro de autismo. Os demais casos resultaram em desenvolvimento neuropsicomotor normal. CONCLUSÃO: No acompanhamento dos fetos com TN aumentada e cariótipo normal, os pais podem ser mais bem aconselhados de que, frente a um exame morfológico-ecocardiográfico do 2º trimestre sem alterações, a probabilidade de a criança nascer viva e bem é alta (93,5%).

PURPOSE: To analyze the perinatal and pediatric outcome of fetuses that showed nuchal translucency (NT) above the 95th percentile (P95) and a normal karyotype in order to obtain data allowing better maternal prenatal counseling. METHODS: fetuses from a tertiary obstetric service with an NT above P95 and a normal karyotype were analyzed between 2005 and 2011. We analyzed gestational ultrasound follow-up, fetal and postnatal echocardiography (ECHO), weight, length and Apgar score at birth, and neuropsychomotor development by the Ages and Stages Questionnaire (ASQ) up to July 2012. RESULTS: During this period, there were 116 cases of nuchal translucency above the 95th percentile, and the fetal karyotype was determined in 79 of them (68%). Forty-three analyses were normal (54.4%) and 36 were altered (45.6%). Among the fetuses with a normal karyotype, one was miscarried at 15 weeks of gestation with Cantrel pentalogy and one died at 24 weeks with several structural abnormalities. There was one neonatal death of unknown cause and two cases of intraventricular communication (IVC) detected by fetal ECHO. Postnatal echocardiography revealed the persistence of IVC in one case and one case of atrial septal defect (ASD) and patent ductus arteriosus (PDA). Of the 40 surviving children, only 1 showed delayed speech development and another presented autism. The remaining cases resulted in normal neurodevelopment. CONCLUSION: During the monitoring of fetuses with increased NT and a normal karyotype, parents can be best advised that when a 2nd trimester morphological-echocardiography ultrasound study is normal, the probability of the child being born alive and well is high (93.5%).

Esterilização histeroscópica de paciente com dispositivo intrauterino Mirena® / Hysteroscopic sterilization of patient with intrauterine device Mirena®

A esterilização tubária é o procedimento definitivo mais utilizado no mundo para controle da fecundidade. A ligadura laparoscópica é segura, porém invasiva e com possíveis riscos cirúrgicos e anestésicos. A via histeroscópica permite a oclusão tubária em ambiente ambulatorial, sem incisões ou anestesia. Um microdispositivo (Essure®) é inserido diretamente no interior das tubas e suas fibras internas de poliéster causam sua obstrução em até 3 meses. Durante esse período, deve ser mantido o método contraceptivo temporário utilizado pela paciente. Várias mulheres utilizam o sistema intrauterino liberador de levonorgestrel, denominado comercialmente Mirena®. O objetivo neste estudo foi de avaliar a possibilidade de inserção do Essure® sem a remoção do dispositivo intrauterino e a tolerância da paciente ao procedimento. O dispositivo foi colocado com sucesso em paciente portadora do Mirena® sem necessidade de retirada do mesmo. Após 3 meses o dispositivo intrauterino foi retirado sem intercorrências.

Tubal sterilization is the definitive procedure most often used worldwide to control fecundity. Laparoscopic ligature is safe, but invasive and with possible surgical and anesthetic risks. The hysteroscopic approach enables tubal occlusion at outpatient's setting without the need of incisions or anesthesia. A microdevice (Essure®) is inserted directly into the tubes and its polyethelene fibers cause obstruction of tubes in about three months. During this period, it is recommended that patients continue the use of a temporary birth control method. Several women use the levonorgestrel-releasing intrauterine system, which is called in the market as Mirena®. This report evaluated the possibility of inserting Essure® without remove the intrauterine device; patient tolerance to the procedure was also assessed. The tubal device was successfully placed in the patient without the need to remove Mirena®. After three months the intrauterine device was removed with no intercurrent events.