ABSTRACT
OBJECTIVE: To determine the influence of depot medroxyprogesterone acetate (MPA) on bone mineral density when used as a contraceptive method. DESIGN: Cross-sectional study. SETTING: Academic tertiary-care hospital. PATIENT(S): Fifty premenopausal women who had used depot MPA as a contraceptive method for > or =1 year and 50 women who had never used hormonal contraceptive methods. INTERVENTION(S): Bone mineral density was evaluated at the midshaft and at the distal radius of the nondominant forearm using single x-ray absorptiometry. MAIN OUTCOME MEASURE(S): Bone mineral density. RESULT(S): Bone mineral density at the midshaft of the forearm was lower in depot MPA users than in women who had never used hormonal contraceptive methods, but the difference was not statistically significant. At the distal portion, bone mineral density was significantly lower in the study group. The duration of depot MPA use was not related to bone mineral density. CONCLUSION(S): Women > or =35 years of age presented with a lower bone mineral density only at the distal portion of the forearm after the use of depot MPA for > or =1 year. However, this decrease was not related to the duration of depot MPA use. It is not possible to conclude that women who use depot MPA are at risk of osteoporosis.
PIP: The impact of depot medroxyprogesterone acetate use on bone mineral density was assessed in a cross-sectional study of 100 women recruited from a teaching hospital in Campinas, Brazil, during 1996-98. Bone mineral density, as evaluated at the midshaft and distal radius of the nondominant forearm by single x-ray absorptiometry, was compared in 50 women 35-45 years of age who had been using Depo-Provera for contraception for 1 year or more (mean duration, 46.4 +or- 38.6 months) but had never used any other hormonal method and 50 age- and weight-matched women who had never used any form of hormonal contraception. Although mean bone mineral density at the midshaft of the forearm was lower in Depo-Provera users than nonusers of hormonal contraception (0.459 +or- 0.042 vs. 0.474 +or- 0.049 g/sq. cm), the difference was not statistically significant. At the distal portion, bone mineral density was significantly lower in Depo-Provera users than nonusers of hormonal methods (0.362 +or- 0.040 vs. 0.392 +or- 0.049 g/sq. cm, p 0.001). The duration of Depo-Provera use was not related to bone mineral density, even when women had used the method for more than 5 years. Multiple regression analysis indicated that 4 pregnancies, White race, and Depo-Provera use were significantly associated with lower bone mineral density at the midshaft section of the forearm; at the distal section of the forearm, these variables were Depo-Provera use, more than 4 pregnancies, White race, older age at menarche, and habitual coffee drinking. These findings do not provide sufficient evidence to conclude that Depo-Provera users are at increased risk of osteoporosis.
Subject(s)
Bone Density/drug effects , Contraceptive Agents, Female/pharmacology , Forearm , Medroxyprogesterone Acetate/pharmacology , Radius/drug effects , Ulna/drug effects , Adult , Cross-Sectional Studies , Female , Humans , Linear Models , Middle Aged , Premenopause , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: In order to evaluate the puberal development of girls treated by Acute Lymphocytic Leukaemia (ALL) a retrospective study was done at Campinas-SP, Brazil. MATERIAL AND METHODS: Forty two girls were treated by ALL with either 18 or 24 Grays of cranial irradiation. All patients were treated with chemotherapy including intrathecal methotrexate in similar dose regimens in either groups. RESULTS: The results showed lower mean ages at telarche, pubarche and menarche in the treated group, mainly in the group treated before five years old. No differences were observed in the 18 Grays or 24 Grays group. CONCLUSIONS: Our data suggest that girls treated by ALL have a precocious puberal development.
Subject(s)
Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/radiotherapy , Puberty/drug effects , Puberty/radiation effects , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Linear Models , Retrospective StudiesABSTRACT
Objetivo. Com o objetivo de avaliar o desenvolvimento puberal após o tratamento de leucemia linfóide aguda (LLA) na infância, foi realizado um estudo retrospectivo, em meninas tratadas de janeiro de 1980 a janeiro de 1991, no Centro de Investigaçoes Hematológicas "Dr. Domingos A. Boldrini", em Campinas-SP. Casuística e Método. Foram selecionadas 42 meninas, tratadas antes da puberdade com quimioterapia sistêmica e intratecal e radioterapia cranial, utilizando doses de 18 a 24 Grays (Gy). Resultados. As idades médias da telarca, pubarca e menarca foram inferiores às do grupo-controle, embora com significância estatística apenas para a idade da telarca. Nao houve diferenças entre os grupos tratados com 18 ou 24Gy. As meninas tratadas antes dos cinco anos de idade apresentaram idade média da menarca estatisticamente inferior àquelas tratadas após cinco anos e em relaçao ao grupo-controle. Conclusao. Os resultados mostraram que o desenvolvimento puberbal em meninas tratadas de LLA na infância foi mais precoce que o de mininas saudáveis.
Subject(s)
Child, Preschool , Child , Female , Humans , Adolescent , Puberty/drug effects , Puberty/radiation effects , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/radiotherapy , Linear Models , Retrospective Studies , Age FactorsABSTRACT
BACKGROUND: The treatment of the acute lymphocytic leukaemia can determine impaired growth. SUBJECTS AND METHOD: All the patients had length measurements at the time of the beginning of the treatment and, at least, one year after the end of it. CONCLUSIONS: There was impaired growth after the treatment according to the dose regimens (18 or 24 Grays). No relation was observed related to the age at the diagnosis.
Subject(s)
Cranial Irradiation/adverse effects , Growth/radiation effects , Precursor Cell Lymphoblastic Leukemia-Lymphoma/radiotherapy , Age Factors , Body Height/radiation effects , Child , Child, Preschool , Female , Humans , Infant , Retrospective StudiesABSTRACT
Objetivo. Determinar alteraçoes no crescimento após o tratamento de leucemia linfóide aguda em meninas. Pacientes e Métodos. Realizou-se estudo restrospectivo com 59 meninas que apresentavam medidas de estatura antes e com no mínimo um ano do tratamento, subdivididas de acordo com a dose de radioterapia cranial utilizada [18 ou 24 Grays Gy] e com a idade no início do tratamento (antes e após os cinco anos de idade). Resultados. Observou-se deficiência do crescimento com um, dois e mais de dois anos do tratamento. O crescimento foi mais afetado no grupo tratado com 24Gy, quando comparado com 18Gy. Nao houve diferenças com relaçao à idade no início do tratamento. Conclusoes. Houve retardo no crescimento após o tratamento, independentemente da idade em que foi realizado, mas dependente da dose de radioterapia cranial utilizada.
Subject(s)
Child , Child, Preschool , Infant , Female , Humans , Cranial Irradiation/adverse effects , Precursor Cell Lymphoblastic Leukemia-Lymphoma/radiotherapy , Growth/radiation effects , Body Height/radiation effects , Retrospective Studies , Age FactorsABSTRACT
O carcinoma do colo uterino é, ainda hoje, uma das neoplasias de maior incidência e prevalência entre a populaçäo feminina brasileira, sendo a quarta causa de óbito por câncer entre as mulheres do Estado de Säo Paulo. O carcinoma microinvasor ou estádio la da FIGO, corresponde à fase em que säo detectados os sinais mais precoces de invasäo do estroma cervical e têm-se observado, na literatura, muitas controvérsias quanto aos critérios de definiçäo da doença. Após revisäo da literatura nacional e internacional sobre o assunto, os autores discorrem acerca dos aspectos epidemiológicos de maior relevância sobre o carcinoma microinvasor do colo uterino
Subject(s)
Humans , Female , Adult , Carcinoma , Uterine Cervical Neoplasms/epidemiology , UterusABSTRACT
The treatment of cervical microinvasive carcinoma is controversial. Hysterectomy is performed in almost all cases, associated or not with more radical procedures. Currently, there is a tendency to adopt conservative management to treat patients with early invasion, as long as it can be assured that the whole lesion has been removed. The aim of this study was to establish which histological information should be obtained from the cones that would give the best possible assurance of absence of residual neoplasia in the patient. This was done by comparing cone and hysterectomy specimens from each patient. One hundred sixty-three cases, treated from 1967 to 1994, underwent simple or radical hysterectomy following cone biopsy. We evaluated the following histological features in the cones: (i) invasion depth, (ii) lateral extension of the lesion, (iii) unifocal or extensive lesion, (iv) vascular invasion, (v) morphological signs of HPV infection, and (vi) free or involved cone surgical margins. Residual neoplasia in the hysterectomy was more frequent when the margins of the cone were involved by atypical epithelium, and in cases with signs of HPV infection. However, according to statistical analysis, these two variables were not mutually independent, and the only important parameter to predict residual neoplasia in the hysterectomy specimens was involved surgical margins in the cone.
Subject(s)
Hysterectomy , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgery , Adult , Aged , Conization , Female , Humans , Middle Aged , Neoplasm Invasiveness , Neoplasm, Residual , Papillomaviridae , Papillomavirus Infections/pathology , Retrospective Studies , Tumor Virus Infections/pathologyABSTRACT
OBJECTIVE: To analyze the follow-up of a cohort of women who requested reversal of surgical sterilization. METHODS: This retrospective study was carried out at the State University of Campinas, Brazil. A cohort of 394 women who requested sterilization reversal was followed up for one year after reversal surgery. The analysis includes the percentage of women who completed the steps between the initial consultation up to one year after reversal surgery. RESULTS: After an initial consultation, 55.1% of the patients decided not to continue with the procedures. Of the patients who did undergo laparoscopy (n = 177), 48.6% had no possibility of a successful surgical reversal because the Fallopian tubes were in very poor condition. Only 17.5% of the initial patients requesting reversal ultimately underwent surgery and 3.3% became pregnant. CONCLUSIONS: The analysis of regret about surgical sterilization should include not only women who undergo surgery but also women requesting surgery. Better patient selection and counseling prior to sterilization are necessary in order to prevent increasing rates of sterilization regret in Brazil.
Subject(s)
Sterilization Reversal/psychology , Sterilization Reversal/standards , Adult , Brazil , Cohort Studies , Decision Making , Fallopian Tubes/anatomy & histology , Fallopian Tubes/physiology , Female , Follow-Up Studies , Humans , Laparoscopy , Patient Selection , Pregnancy , Pregnancy Rate , Retrospective Studies , Sex CounselingABSTRACT
Os autores reveem a literatura sobre a associacao de cancer de mama e gravidez. Embora a incidencia nao seja alta, entendem que uma maior atencao deve ser dada ao problema. Alem de entenderem que se deve examinar mais adequadamente as mamas durante o ciclo gravidopuerperal, propoem a ecografia como um metodo diagnostico auxiliar importante
