Applicability and safety of autologous fat for reconstruction of the breast.

BACKGROUND: Autologous fat grafting to the breast for cosmetic and reconstructive purposes is still controversial with respect to its safety and efficacy. The objective of this study was to conduct a systematic review of the clinical applicability and safety of the technique. METHODS: An online search of the Cochrane Library, MEDLINE, Embase and SciELO was conducted from July 1986 to June 2011. Studies included in the review were original articles of autologous liposuctioned fat grafting to the female breast, with description of clinical complications and/or radiographic changes and/or local breast cancer recurrence. RESULTS: This review included 60 articles with 4601 patients. Thirty studies used fat grafting for augmentation and 41 for reconstructive procedures. The incidence of clinical complications, identified in 21 studies, was 3·9 per cent (117 of 3015); the majority were induration and/or palpable nodularity. Radiographic abnormalities occurred in 332 (13·0 per cent) of 2560 women (17 studies); more than half were consistent with cysts. Local recurrence of breast cancer (14 of 616, 2·3 per cent) was evaluated in three studies, of which only one was prospective. CONCLUSION: There is broad clinical applicability of autologous fat grafting for breast reconstruction. Complications were few and there was no evidence of interference with follow-up after treatment for breast cancer. Oncological safety remains unclear.

Decrease in bone mass in women after liver transplantation: associated factors.

BACKGROUND: In the future, an increasing number of female liver transplant recipients will reach the climacteric with osteoporosis as a common complication. We evaluated the factors associated with decreased bone mass among women after liver transplantation. METHODS: A prospective, cross-sectional study of 23 outpatient transplant recipients followed from February 2009 to March 2010 included women of age ≥35 years after liver transplantations ≥1 year prior. We recorded patient histories, liver enzyme levels, as well as bone mineral densities measured at the lumbar spine and femur. Statistical analysis used Fisher's exact test, simple odds ratio (OR), and Spearman's rank correlation coefficient. RESULTS: The mean patient age was 52.5 ± 11 years with 30.4% premenopausal, and 69.6% perimenopausal or postmenopausal. Approximately 21% showed osteoporosis and 35%, a low bone mass. Postmenopausal women: OR 69.0 (95% CI 2.89-1647.18; P<.0001), aged ≥49 years: OR 13.33 (95% CI 1.78-100.15; P=.0123) and receiving a transplant after 44 years of age: OR 49.50 (95% CI 3.84-638.43; P<.0001) were associated with a lower bone mass. Having undergone transplantation for more than 5.8 years lowered the risk of bone mass change: OR 0.11 (95% CI 0.02-0.78; P=.0361). Clinical and laboratory variables, including corticosteroid use, were not associated with decreased bone mass. CONCLUSION: Understanding the prevalence and factors associated with osteoporosis among female liver transplant recipients is important to enhance the strategies to diagnose and treat these women, seeking to improve their quality of life.

Endometrial polyps in pre- and postmenopausal women: factors associated with malignancy.

OBJECTIVE: To evaluate the prevalence of premalignant and malignant polyps and their association with menopausal status, hormone therapy and clinical characteristics in perimenopausal and postmenopausal women. METHODS: A surgical database was used to select pre- and postmenopausal women >or=40 years of age, submitted to hysteroscopic resection of endometrial polyps. The medical records of 475 women were reviewed and clinical characteristics and histological diagnosis of resected polyps were assessed. RESULTS: The majority of women had benign endometrial lesions, 78.53% of which were endometrial polyps and 13.47% polyps with simple or complex endometrial hyperplasia without atypia. Polyps with endometrial hyperplasia with atypia comprised 1.05% of cases, while 2.74% were carcinomatous polyps. Analysis using prevalence ratios showed that premalignant and malignant lesions were associated with age and postmenopausal bleeding. Women >60 years of age had a prevalence ratio 3.28 times greater (95%CI: 1.19-9.07) of premalignant or malignant polyps. When only postmenopausal women were evaluated for the effect of age, those over 60 years of age had a prevalence 5.31 times greater (95%CI: 1.22-23.09), while those with postmenopausal bleeding had an age-adjusted prevalence ratio of 3.71 (95%CI: 1.21-11.34) compared to asymptomatic women. No significant association was found between arterial hypertension, diabetes mellitus, obesity, use of hormone therapy or tamoxifen and premalignancy or malignancy. CONCLUSIONS: There was a low prevalence of premalignant and malignant lesions in endometrial polyps. Older women and those with postmenopausal bleeding had a greater prevalence of malignancy and in these cases hysteroscopic resection of endometrial polyps is mandatory.

The association of pregnancy history with areal and volumetric bone mineral density in adolescence.

INTRODUCTION: Studies demonstrate that pregnancy may interfere with bone mineral density. Adolescence is a crucial time of life for bone mass acquisition and there are some questions as to the influence of pregnancy on bone mass at this age. OBJECTIVE: To evaluate the association between pregnancy history and areal (BMD) and volumetric (vBMD) bone mineral density in adolescence. SUBJECTS AND METHODS: A cross-sectional study of 119 adolescents ranging from 12-20 years of age was conducted; 30 of these girls had a history of full-term pregnancy. The adolescents were selected during a routine visit to the Adolescent Gynecology Outpatient Facility, completed a questionnaire, and had a physical examination to evaluate weight, height and Tanner stage. Bone mineral densitometry of the lumbar spine (L(1)-L(4)) and total body (TB) was performed to measure bone mineral density and body composition. RESULTS: The mean measurements of the area, bone mineral content (BMC), BMD and vBMD of L(1)-L(4) and the area, BMC and BMD of TB were not significantly different between adolescents with and without a pregnancy history, stratified by chronologic and gynecologic age. The percentage of adolescents with altered Z-scores was similar in both groups, and the prevalence ratio showed no association between pregnancy history and low bone mass (PR=0.52; CI 0.04-6.07). Upon multiple regression analysis, body mass index (BMI) and lean body mass (LBM) were the main factors associated with lumbar spine and total body measurements. Pregnancy history was inversely associated with areal BMD of L(1)-L(4) (R (2)=0.04) and vBMD of L(1)-L(4) (R (2)=0.04), accounting for only 4% variation in the lumbar spine. CONCLUSION: These data suggest that adolescent pregnancy seems to exert no significant influence on the acquisition of bone mass and does not appear to represent a risk factor for osteoporosis in the future.

Association between habitual physical activity and parameters of physical fitness in postmenopausal women.

OBJECTIVE: To evaluate the association between physical activity and the morphological, functional and physiological components of physical fitness in postmenopausal women. METHODS: A cross-sectional study of 162 postmenopausal women, 40-65 years of age, who verbally responded to the International Physical Activity Questionnaire applied to evaluate their level of physical activity. Physical fitness was evaluated by measuring body mass index, waist circumference, body fat percentage, maximum oxygen consumption, plasma levels of total and fractional cholesterol, triglycerides and fasting glucose, as well as blood pressure. RESULTS: Approximately 83.5% of the women were active, principal physical activities being household chores and transportation walking. Approximately 80% of the women were overweight or obese and presented a waist circumference indicative of high or very high risk for cardiovascular disease, and fat percentage above 33%. Over 50% were found to have low oxygen consumption. There were no significant differences between the groups of active and inactive women with respect to mean body mass index (p = 0.43), percentage of body fat (p = 0.60), hip-to-waist ratio (p = 0.93), waist circumference (p = 0.44), maximum VO2 (p = 0.32), total cholesterol (p = 0.43), fasting glucose (p = 0.73), and systolic (p = 0.79) or diastolic blood pressure (p = 0.48). Adjusted prevalence ratios also showed no significant differences between the groups. CONCLUSIONS: Habitual physical activity is not associated with variations in the components that are used to describe physical fitness. It is important to encourage physical activity and provide guidelines to ensure that it is carried out in the quantity, duration and intensity required for improving physical fitness level and obtaining health benefits.

Urodynamics in climacteric women with urinary incontinence: correlation with route of delivery.

The aim of this study was to compare the urodynamic findings among climacteric women complaining of urinary incontinence who had only vaginal deliveries with those who had only cesarean sections. The study group comprised 30 climacteric women with complaints of urinary incontinence consulting at the Menopause Outpatient Clinic, State University of Campinas, submitted to anamneses and complete urodynamic testing. Nineteen women had had only vaginal deliveries and 11 were delivered only by cesarean section. Vaginal delivery was significantly associated with a reduced normal and strong desire to void and maximum cystometric capacity compared to women who delivered only by Cesarean section. Detrusor instability was four to five times more frequent among women who had had only vaginal deliveries. There was no difference between the two groups concerning uroflowmetry parameters. Climacteric women with urinary incontinence who had had only vaginal deliveries are at a higher risk of urodynamic abnormalities.

[Urinary incontinence among climateric Brazilian women: household survey]. / Incontinência urinária entre mulheres climatéricas brasileiras: inquérito domiciliar.

OBJECTIVE: To investigate the prevalence of stress urinary incontinence and its associated factors in perimenopause women using a population-based household survey. METHODS: A descriptive, exploratory cross-sectional population-based study with secondary analysis of a population-based household survey on perimenopause and menopause was conducted among women living in the city of Campinas, Brazil. Through a sampling process, 456 women between 45 and 60 years old were selected. Complaints of urinary incontinence and related risk factors, such as age, socioeconomic status, education level, race, parity, smoking habits, body mass index, previous gynecological surgeries, menopausal status, and hormonal replacement therapy were explored. Data were collected through home interviews using an adapted version of the structured pre-tested questionnaire elaborated by the International Health Foundation, International Menopause Society and the American Menopause Society. Statistical analysis were performed using prevalence rates (CI 95%). RESULTS: Thirty-five percent of the interviewees referred stress urinary incontinence. None of the sociodemographic factors studied was associated to the risk of urinary incontinence. In addition, parity did not significantly change the risk of urinary incontinence. Other factors, such as previous gynecological surgeries, body mass index, and smoking habits, were not associated with the prevalence of stress urinary incontinence. Also, menopausal status and hormonal replacement therapy did not change the risk of stress urinary incontinence. CONCLUSION: Though there was a high prevalence of stress urinary incontinence among perimenopause women, there was not found any associations with sociodemographic and reproductive factors.

The risk of urinary incontinence of parous women who delivered only by cesarean section.

OBJECTIVES: To evaluate the association of route of delivery with prevalence of urinary incontinence. METHODS: Women with menopause who consulted at the Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, were interviewed and examined to detect urinary incontinence. Obstetrics history and other possible factors that could influence incontinence were also recorded. RESULTS: Urinary incontinence was diagnosed in 98 women (cases) while 91 were free of this problem. The risk of urinary incontinence was approximately five times higher among women with one or more pregnancies than among nulligravida, and 3.5 times higher among women who had had only cesarean sections than among nullipara. CONCLUSIONS: Women cannot prevent urinary incontinence by delivering exclusively by cesarean section.

[An exploratory study of the association between lipid profile and bone mineral density in menopausal women in a Campinas reference hospital]. / Estudo exploratório da associação entre o perfil lipídico e a densidade mineral óssea em mulheres menopausada, em hospital de referência de Campinas.

A total of 72 postmenopausal patients presenting no risk factors for cardiovascular disease nor osteoporosis, were studied. The study evaluated total serum cholesterol and fractions and bone mass by densitometry of the lumbar spine and femur using a Lunar-DPX. There was no association between lipid profile variables and bone mineral density, except for high density lipoprotein (HDL), which showed an inverse correlation (p=0.001). Multiple regression showed that total cholesterol levels higher than 240 mg% had a positive association with BMD (p=0.026). In addition, the ratio between LDL and HDL (Castelli 2 index) showed a negative association with BMD (p=0.002). The diagnostic validation test showed that all lipid profile variables had low sensitivity and specificity as indicators for osteoporosis. The conclusions were that lipid profile variables did not show a significant association with bone mass and could not be used as indicators for bone mineral density.

Bone density among long-term users of medroxyprogesterone acetate as a contraceptive.

The bone density (BD) of 72 women using depot-medroxyprogesterone acetate (DMPA) for at least 1 year was compared with that of 64 women who were not users of hormonal contraceptives. The BD of lumbar spine, femoral neck, Ward's triangle, and trochanter was measured by dual energy X-ray absorptiometry (DEXA-LUNAR DPX). Estradiol (E2) concentrations were measured by radioimmunoassay (RIA). The mean age of DMPA users and nonusers was 31.8 and 31.1 years, respectively. Mean E, was 55.7 pg/mL for users and 149.9 pg/mL for controls (p < 0.001). The BD was significantly lower for DMPA users than for controls in all sites (p < 0.01). In addition, young adult T-scores in the lumbar spine were significantly lower among DMPA users than in controls (p < 0.01). Differences were maintained in a subsample of 47 women per group paired by age and body mass index (BMI). Multiple regression analysis showed that older age, lower BMI, and longer amenorrhea were associated with lower BD in the femoral neck, whereas lower BMI and use of DMPA were associated with lower BD in the lumbar spine.

PIP: Family planning programs that offer depot medroxyprogesterone acetate (DMPA) cannot be indifferent to the risk of lowered bone density. A study conducted at the Family Planning Clinic of the State University of Campinas (Sao Paulo, Brazil) compared bone densities in 72 women who had been using DMPA for at least 1 year (mean duration, 42 months) and 64 regularly menstruating nonusers. Mean age was 31 years in both groups; there were no significant differences between the 2 groups in terms of ethnicity, body mass index (BMI), or smoking. Mean serum estradiol concentrations were 55.7 +or- 40.5 pg/ml for DMPA users and 149.9 +or- 88.2 pg/ml for nonusers (p 0.001). The mean length of amenorrhea was 26.5 +or- 23.8 months among DMPA users. The mean bone density in DMPA users was significantly lower than that of controls at all sites evaluated (i.e., lumbar spine, femoral neck, Ward's triangle, and trochanter). 38 DMPA users, compared with only 17 controls, had a T-score in the lumbar spine lower than -1 standard deviation (p = 0.014). Multiple regression analysis identified BMI and DMPA use as variables significantly associated with bone density in the lumbar spine; in the femoral neck, these variables were BMI, age, and length of amenorrhea. Periodic bone densitometry should be considered for women over 40 years of age with low BMI who have more than 2 years of continuous amenorrhea.

Infection by the human papillomavirus in teenagers sexually active: clinic and subclinic manifestations.

This research studies the association of the cervical condyloma with the intraepithelial neoplasia, during sex activity, pregnancy, diagnose methods, cytology and colposcopy in teenagers. The objective of this research is to study the propaedeutics for the uterine coli condyloma diagnose in a group of teenagers. For this purpose, we have studied 131 teenagers sexually active with ages between 14 and 19 years and presenting histologically confirmed uterine coli condyloma. Association with intraepithelial neoplasia, sexual activity duration, method of diagnose, pregnancy analysis, cytology and colposcopy results and association with vulva and vagina injuries were evaluated. The high association rate with condyloma and intraepithelial neoplasia after a short time of sexual activity and the none presence of macroscopic warts in the genital organs in 80% of cases presenting cervical condyloma, demonstrate that: a more careful investigation with colposcopy and biopsy of the inferior genitals of the women-teenagers sexually active is needed, when presenting modified cervical cytology.

Fatores de risco para condiloma do colo uterino em mulheres adolescentes sexualmente ativas / Risk factors for uterine condyloma in sexually active adolescent women

Os fatores mais freqüentemente associados ao câncer do colo uterino säo o início precoce da atividade sexual e a infecçäo por papilomavírus humano. Objetivo. Avaliar alguns fatores de risco para o condiloma do colo uterino num grupo de adolescentes sexualmente ativas da regiäo de Campinas. Métodos. Foram estudadas 131 adolescentes com condiloma do colo uterino e 131 adolescentes sem condiloma, controladas por idade e estado gestacional, em relaçäo a algumas variáveis sociodemográficas, do comportamento sexual e dos antecedentes ginecológicos e obstétricos. Foi realizada uma avaliaçäo do risco relativo para cada variável e, a seguir, uma análise múltipla com regressäo logística para determinaçäo das variáveis confundidoras. Resultados. Foram identificados, como fatores de risco independentes para condiloma do colo uterino, o hábito de fumar e a nuliparidade. Mais de dois parceiros sexuais e uma baixa escolaridade da adolescente foram fatores de risco para condiloma na análise univariada, porém estiveram correlacionados com o hábito de fumar e a paridade. As outras variáveis foram semelhantes nos dois grupos. Conclusäo. Apesar do hábito de fumar e da nuliparidade serem fatores de risco para condiloma do colo uterino, é difícil caracterizar um grupo de adolescentes sexualmente ativas sem risco para a infecçäo

[Risk factors for uterine cervix condyloma in sexually active adolescent women]. / Fatores de risco para condiloma do colo uterino em mulheres adolescentes sexualmente ativas.

Factors most commonly associated with cervical cancer are early start of sexual activity and papillomavirus infection. PURPOSE--Studying risk factors for cervical condyloma in sexually active adolescents in the region of Campinas, SP, Brazil. METHOD--131 adolescents with condyloma and 131 without disease, controlled by age and pregnancy state, were compared according to social-demographical, sexual-behavioral and gynecological/obstetrical variables. Relative risk evaluation was performed for each variable and multivariate analysis with logistic regression was made to determine confunding factors. RESULTS--Tobacco smoking and nulliparity were identified as independent risk factors for cervical condyloma in this population. More than two sexual partners and low level of schooling were identified as risk factors in the univariate analysis, however, these factors were highly correlated with tobacco smoking and parity, respectively. All other variables were similar in both groups. CONCLUSION--Although tobacco smoking and nulliparity were identified as risk factors for cervical condyloma, it is very difficult to characterize a sexually active adolescent group without risk for infection.

Multidisciplinary experience in the selection of patients for tubal sterilization.

Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.

PIP: 27% of reproductive-age women in Brazil have chosen surgical sterilization as their contraceptive method. Most of these women who have undergone tubal sterilization opted for cesarean surgery. However, given the young ages of many of these women, many regret having been sterilized. This paper summarizes the experience of a multidisciplinary group in evaluating women who apply for surgical sterilization at the Department of Tocogynecology, Faculdade de Ciencas Medicas, Universidade Estadual de Campinas in Sao Paulo. Detailed descriptions are presented of the medical and social characteristics of cases seen between June 1988 and July 1989. The authors conclude that the use of the defined parameters of age, parity, marital union duration, number of living children, and the presence of maternal clinical pathology are useful in identifying the patients who are least likely to regret undergoing surgical sterilization.

Performance of the copper T 200 in parous adolescents: are copper IUDs suitable for these women?

The clinical performance of a cohort of 995 parous adolescents, first-time users of the T-Cu 200B was studied and compared with a cohort of paired controls 10 years older, of the same parity. Life-table analysis showed that pregnancy, expulsion rates, as well as removals for bleeding and/or pain were higher in adolescents but within ranges already reported in the literature on this device. Removals for infection were few and not significantly different. Although the clinical performance of the T-Cu 200B in adolescents is not as good as in older women, the performance is similar or better than that reported for other reversible methods in this age group. Our conclusion is that IUDs should not be contraindicated for parous adolescents as long as adequate counseling, screening of risk factors, skillful insertion and follow-up are provided.