Relation between naked eye Swede score and the outcomes of atypias of undetermined significance.

INTRODUCTION: Cervical cancer precursor lesions occur due to persistent infection caused by human papillomavirus (HPV). One of the challenges of the Pap test is detecting lesions at a high risk of evolving into cancer. In this context, differentiating patients at low and high risk of developing cervical cancer becomes necessary. The Swede score, a standardized point system assigned based on colposcopy, is the most commonly used method to evaluate suspicious lesions. However, access to colposcopy is limited in low-income countries. It is, therefore, important to assess the applicability of less costly diagnostic methods in these situations to avoid a late diagnosis of cervical cancer. OBJECTIVE: To analyze histological outcomes of cytology tests with atypical squamous cells of undetermined significance (ASC-US and ASC-H) and to compare the performance of the Swede score with and without colposcopy. METHODS: The study was approved by the Ethics Committee via Plataforma Brasil (CAAE no. 41958320.6.0000.5259) and conducted by applying colposcopy score and naked eye score to patients with cytology alterations (ASC-US and ASC-H), with posterior analysis of cytological and histological results and comparison between the scores. RESULTS: A total of 34 women aged ranging from 24 to 65 years, with results of atypia with undetermined significance (ASC-US and ASC-H), were included in the study. The receiver operating characteristic curve was calculated for the naked eye inspection Swede score. The cut-off of 6 was considered to indicate the best sensitivity and specificity (55.56% and 93.75%, respectively). Then, the positive and negative predictive values were 90.91% and 65.22%, respectively. By increasing the cut-off to 7, specificity increased to 100%. For the colposcopic inspection, a cut-off of 6 indicates better specificity and positive predictive value (both 100%), whereas the negative predictive value was 57.14%. CONCLUSION: The correlation between the colposcopic and naked-eye Swede scores was statistically significant (0.82). Further studies with larger samples are important to establish the actual applicability of the naked eye method; however, in the absence of colposcopy, this appears to be an effective and very helpful method to make diagnostic decisions regarding HPV-induced lesions.

Maternity in prison: influence on physical and emotional health / Maternidade no cárcere: influência na saúde física e emocional

Abstract Objectives: to evaluate the repercussions of motherhood on patients deprived of their liberty. Methods: integrative review based on research in electronic databases: Medline (PubMed), LILACS, SciELO and Nursing Database (BDENF), using the following search strategy: ("Prisons" [Majr] AND "Pregnancy" [ Mesh]), as of 2016. Results: the research ended with 33 bibliographic references, being the highest level of evidence from cohort studies, which demonstrate the precariousness of health care offered to these pregnant women. Three main groups of results were identified: low quality prenatal care, negative maternal and neonatal health indicators in relation to the general population and the emotional issues involved in prison reality during the period of pregnancy and puerperium. Conclusions: prenatal care has flaws that influence, in some way, the maternal and neonatal health indicators. In addition, the precarious structure of prison system directly interferes with the emotional health of these women.

Resumo Objetivos: avaliar as repercussões da maternidade em pacientes privadas da liberdade. Métodos: revisão integrativa a partir de pesquisa nas bases de dados eletrônicas: Medline (PubMed), LILACS, SciELO e Base de Dados de Enfermagem (BDENF), sendo usada como estratégia de busca: ("Prisons"[Majr] AND "Pregnancy"[Mesh]), a partir de 2016. Resultados: a pesquisa finalizou com 33 referências bibliográficas, sendo o maior nível de evidência de estudos de coorte, que demonstram a precarização na assistência de saúde ofertada a essas gestantes. Foram identificados três grupos principais de resultados: pré-natal de baixa qualidade, indicadores de saúde maternos e neonatais negativos e as questões emocionais envolvidas na realidade carcerária durante o período de gestação e puerpério. Conclusões: a assistência pré-natal apresenta falhas que influenciam nos indicadores de saúde maternos e neonatais. Além disso, a estrutura precária do sistema prisional interfere diretamente na saúde emocional dessas mulheres

The Effect of Neuromodulatory Drugs on the Intensity of Chronic Pelvic Pain in Women: A Systematic Review / Efeito de neuromoduladores na intensidade da dor pélvica crônica em mulheres: Revisão sistemática

Abstract Objective: To evaluate the effect of neuromodulatory drugs on the intensity of chronic pelvic pain (CPP) in women. Data sources: Searches were carried out in the PubMed, Cochrane Central, Embase, Lilacs, OpenGrey, and Clinical Trials databases. Selection of studies: The searches were carried out by two of the authors, not delimiting publication date or original language. The following descriptors were used: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors, and tricyclic antidepressants, with the Boolean operator OR. Case reports and systematic reviews were excluded. Data collection: The following data were extracted: author, year of publication, setting, type of study, sample size, intervention details, follow-up time, and results. Data synthesis: A total of 218 articles were found, with 79 being excluded because they were repeated, leaving 139 articles for analysis: 90 were excluded in the analysis of the titles, 37 after reading the abstract, and 4 after reading the articles in full, and 1 could not be found, therefore, leaving 7 articles that were included in the review. Conclusion: Most of the studies analyzed have shown pain improvement with the help of neuromodulators for chronic pain. However, no improvement was found in the study with the highest statistical power. There is still not enough evidence that neuromodulatory drugs reduce the intensity of pain in women with CPP.

Resumo Objetivo: Avaliar o efeito de drogas neuromoduladoras na intensidade da dor pélvica crônica em mulheres. Fontes de dados: As buscas foram realizadas nas bases de dados PubMed, Cochrane Central, Embase, Lilacs, OpenGrey e Clinical Trials. Seleção dos estudos: As buscas foram realizadas por dois dos autores, não delimitando data de publicação ou idioma de publicação. Foram usados os seguintes descritores: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors e tricyclic antidepressants, com o operador booleano OR. Relatos de caso e revisões sistemáticas foram excluídos. Coleta de dados: Foram extraídos os seguintes dados: autor, ano de publicação, local de origem, tipo de estudo, tamanho da amostra, detalhes da intervenção, tempo de seguimento e resultados. Síntese dos dados: Foram encontrados 218 artigos, sendo 79 deles excluídos por serem repetidos, restando 139 artigos para análise, dos quais 90 foram excluídos na análise dos títulos, 37 após a leitura do resumo e 4 após a leitura dos artigos na íntegra, e 1 não foi encontrado, restando, então, 7 artigos que foram incluídos na revisão. Conclusão: A maioria dos estudos analisados mostrou melhora da dor crônica com auxílio de neuromoduladores. No entanto, nenhuma melhora foi encontrada no artigo com maior poder estatístico. Ainda não há evidências suficientes de que drogas neuromoduladoras reduzam a intensidade da dor pélvica crônica em mulheres.

The Effect of Neuromodulatory Drugs on the Intensity of Chronic Pelvic Pain in Women: A Systematic Review.

OBJECTIVE: To evaluate the effect of neuromodulatory drugs on the intensity of chronic pelvic pain (CPP) in women. DATA SOURCES: Searches were carried out in the PubMed, Cochrane Central, Embase, Lilacs, OpenGrey, and Clinical Trials databases. SELECTION OF STUDIES: The searches were carried out by two of the authors, not delimiting publication date or original language. The following descriptors were used: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors, and tricyclic antidepressants, with the Boolean operator OR. Case reports and systematic reviews were excluded. DATA COLLECTION: The following data were extracted: author, year of publication, setting, type of study, sample size, intervention details, follow-up time, and results. DATA SYNTHESIS: A total of 218 articles were found, with 79 being excluded because they were repeated, leaving 139 articles for analysis: 90 were excluded in the analysis of the titles, 37 after reading the abstract, and 4 after reading the articles in full, and 1 could not be found, therefore, leaving 7 articles that were included in the review. CONCLUSION: Most of the studies analyzed have shown pain improvement with the help of neuromodulators for chronic pain. However, no improvement was found in the study with the highest statistical power. There is still not enough evidence that neuromodulatory drugs reduce the intensity of pain in women with CPP.

OBJETIVO: Avaliar o efeito de drogas neuromoduladoras na intensidade da dor pélvica crônica em mulheres. FONTES DE DADOS: As buscas foram realizadas nas bases de dados PubMed, Cochrane Central, Embase, Lilacs, OpenGrey e Clinical Trials. SELEçãO DOS ESTUDOS:: As buscas foram realizadas por dois dos autores, não delimitando data de publicação ou idioma de publicação. Foram usados os seguintes descritores: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine , nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors e tricyclic antidepressants, com o operador booleano OR. Relatos de caso e revisões sistemáticas foram excluídos. COLETA DE DADOS: Foram extraídos os seguintes dados: autor, ano de publicação, local de origem, tipo de estudo, tamanho da amostra, detalhes da intervenção, tempo de seguimento e resultados. SíNTESE DOS DADOS:: Foram encontrados 218 artigos, sendo 79 deles excluídos por serem repetidos, restando 139 artigos para análise, dos quais 90 foram excluídos na análise dos títulos, 37 após a leitura do resumo e 4 após a leitura dos artigos na íntegra, e 1 não foi encontrado, restando, então, 7 artigos que foram incluídos na revisão. CONCLUSãO:: A maioria dos estudos analisados mostrou melhora da dor crônica com auxílio de neuromoduladores. No entanto, nenhuma melhora foi encontrada no artigo com maior poder estatístico. Ainda não há evidências suficientes de que drogas neuromoduladoras reduzam a intensidade da dor pélvica crônica em mulheres.

Differences in HPV infection and HPV-related lesions between the cervix and anus in hiv-positive women / Diferenças na infecção por HPV e lesões HPV-relacionadas entre colo uterino e ânus em mulheres hiv positivas

Introduction: the prevalence of cervical and anal human papillomavirus (HPV) infection in women infected with human immunodeficiency virus (HIV) is high. However, little is known about the differences in the susceptibility of these infections and related lesions. The aim of this study was to describe the association between the prevalence of cervical and anal HPV infection and HPV-related lesions in HIV-positive women. Methods: this study included 88 HIV-positive women attending an outpatient clinic in a university hospital. Ectocervical, endocervical, and anal samples were collected for colpocytology and anal cytology. A polymerase chain reaction-based technique was used to detect HPV deoxyribonucleic acid in endocervical and anal swab samples. Results: the cervical and anal HPV positivity rates were 35.21% and 78.8%, respectively. The presence of HPV-related lesions on colpocytology was associated with anal HPV positivity (P = 0.027). The ratio between cervical HPV infection and cervical HPV-related lesions was 2.5. The ratio between anal HPV infection and anal HPV-related lesions was 4.3. Overall, 30% had concomitant HPV DNA in the cervix and anus. Conclusion: there are differences in the susceptibility of infections and related lesions between the cervix and anus. Despite a higher incidence of anal HPV, the progression to HPV-related lesion does not occur via the same manner in the cervix and anus. Moreover, cervical HPV-related lesions in HIV-positive women may serve as a cue for anal preventive strategies, and further investigations in these women may be useful.

Introdução: as infecções cervicais e anais pelo papilomavírus humano (HPV) em mulheres infectadas com o vírus da imunodeficiência umana (HIV) são muito prevalentes. Entretanto, pouco se sabe sobre as diferenças na suscetibilidade entre essas infecções e as lesões HPV-relacionadas. Objetivo: descrever a associação entre as prevalências de infecção cervical e anal pelo HPV e lesões relacionadas em mulheres HIV-positivas. Metodologia: este estudo incluiu 88 mulheres HIV-positivas atendidas em ambulatório de hospital universitário. Amostras ectocervicais, endocervicais e anais foram coletadas para colpocitologia e citologia anal. Uma técnica baseada na reação em cadeia da polimerase foi usada para detectar o ácido desoxirribonucléico (DNA) do HPV em amostras de swabs endocervical e anal. Resultado: as taxas de positividade do HPV cervical e anal foram de 35,21% e 78,8%, respectivamente. As lesões relacionadas ao HPV na colpocitologia foram associadas à positividade anal para o HPV (P = 0,027). A proporção entre infecção cervical por HPV e lesões cervicais relacionadas foi de 2,5. A proporção entre a infecção anal por HPV e as lesões anais relacionadas foi de 4,3. 30% tinham DNA-HPV concomitante no colo do útero e ânus. Conclusão: existem diferenças na suscetibilidade de infecções e de lesões relacionadas entre o colo e o ânus. Apesar de maior incidência de HPV anal, a progressão para lesões relacionadas não ocorre da mesma forma no colo e no ânus. Além disso, lesões cervicais relacionadas ao HPV em mulheres HIV positivas podem servir como pista para estratégias preventivas anais. Investigações adicionais podem ser úteis.

Evolution of Nutritional Status after Early Nutritional Management in COVID-19 Hospitalized Patients.

Background & Aims: SARS-CoV2 infection is associated with an increased risk of malnutrition. Although there are numerous screening and nutritional management protocols for malnutrition, only few studies have reported nutritional evolution after COVID-19. The objectives of this study were to describe the evolution of nutritional parameters between admission and 30 days after hospital discharge, and to determine predictive factors of poor nutritional outcome after recovery in adult COVID-19 patients. Methods: In this observational longitudinal study, we report findings after discharge in 91 out of 114 patients initially admitted for COVID-19 who received early nutritional management. Nutritional status was defined using GLIM criteria and compared between admission and day 30 after discharge. Baseline predictors of nutritional status at day 30 were assessed using logistic regression. Results: Thirty days after discharge, 28.6% of patients hospitalized for COVID-19 were malnourished, compared to 42.3% at admission. Half of malnourished patients (53%) at admission recovered a normal nutritional status after discharge. Weight trajectories were heterogeneous and differed if patients had been transferred to an intensive care unit (ICU) during hospitalization (p = 0.025). High oxygen requirement during hospitalization (invasive ventilation p = 0.016 (OR 8.3 [1.6-61.2]) and/or oxygen therapy over 5 L/min p = 0.021 (OR 3.2 [1.2-8.9]) were strong predictors of malnutrition one month after discharge. Conclusions: With early nutritional management, most patients hospitalized for COVID-19 improved nutritional parameters after discharge. These findings emphasize the importance of nutritional care in COVID-19 patients hospitalized in medicine departments, especially in those transferred from ICU.

Medical confidentiality in underage consent sex in Brazil.

This paper is a theoretical discussion that explores medical confidentiality within the context of Brazilian law about underage consent sex. Brazilian law determines that the age of consent for sexual intercourse is 14 years. Before this limit, physicians should report the sexual activity of adolescents, breaking the confidentiality of the consultation. The medical code of ethics prohibits the breach of professional confidentiality of a minor patient, including their parents or legal representatives, unless a lack of disclosure may cause harm to the patient. The legal issue seems to go beyond the ethical issue; however, the breach of confidentiality can cause more risks than benefits by removing these adolescents from health services. The law aims to protect the sexual dignity of teenagers under 14 years old, but the particularities of each case must be considered, and flexibility concerning medical confidentiality should be included.

Tendências da mortalidade por câncer de colo no Brasil em 5 anos (2012-2016) / Trends in cervical cancer mortality in Brazil in 5 years (2012-2016)

RESUMO O câncer do colo uterino é uma importante causa de morte no Brasil. O objetivo deste estudo é avaliar a mortalidade por esse câncer na população brasileira, entre 2012 e 2016, conhecendo a mortalidade nos grupos etários e nas diferentes regiões. Foi realizado um estudo de corte transversal descritivo. Os dados foram obtidos pelo Sistema de Informações sobre Mortalidade. Entre 2012 e 2016, o total de óbitos por câncer do colo do útero foi de 27.716 casos. A taxa de mortalidade específica para o Brasil passou de 6,86 para 7,18. O crescimento do coeficiente de mortalidade foi de 4,6%. Nas mulheres abaixo de 25 anos, observaram-se 189 mortes, o que equivale a 0,68% do total. Entre 25 e 64 anos, houve 18.574 óbitos (67,02%), e 8.950 mortes no grupo acima de 64 anos (32,29%). O maior percentual de óbitos ocorreu na faixa etária de 50-54 anos. A região Norte apresentou os maiores índices de óbitos e taxas de mortalidade, e o Sul o maior índice de crescimento. A mortalidade por câncer do colo uterino no Brasil apresentou crescimento durante os anos observados, com mais óbitos entre 50-54 anos. A região Sul apresentou o maior crescimento nas taxas de mortalidade.

ABSTRACT Cervical cancer is an important cause of death in Brazil. The aim of this study is to find out the mortality rate due to this cancer in the female population, between 2012 and 2016, knowing the mortality in the age groups and in the different regions. A descriptive cross-sectional study was carried out. Data were obtained using the Mortality Information System. Between 2012 and 2016, the total number of deaths due to cervical cancer was 27.716 cases. The specific mortality rate for Brazil went from 6,86 to 7,18. The growth of the mortality coefficient was 4.6%. In women under 25 years of age, 189 deaths were observed, equivalent to 0.68% of the total. Between 25 and 64 years, there were 18.574 deaths (67.02%) and 8.950 deaths in the group over 64 years (32.29%). The highest percentage of deaths occurred in the 50-54 age group. The North region had the highest death rates, and the South, the highest growth rate. Cervical cancer mortality in Brazil increased during the years observed, with more deaths between 50-54 years. The South region showed the highest growth in mortality rates.

Protease inhibitor effects on prevalence of bacterial vaginosis and human papillomavirus-related lesions.

AIM: Antiretrovirals of the protease inhibitor (PI) class tend to achieve low concentrations in biological fluids. This study aimed to analyze possible changes in the vaginal microbiome and frequency of cervical human papillomavirus (HPV)-DNA and HPV-related lesions associated with the use of PI in antiretroviral therapy (ART). METHODS: Eighty-eight women with human immunodeficiency virus infection were divided in two groups: ART with PI and without PI. All the participants underwent anamnesis with demographic data collection. The total DNA, used as the template in the polymerase chain reaction-based assays for the detection of HPV-DNA, was extracted from cervical samples during cervical cytopathology. RESULTS: There were no differences between the groups with respect to HPV-related lesions. Despite the higher prevalence of bacterial vaginosis (BV) in the PI group (33.96% vs 17.14%), the difference was insignificant when considering all women (P = 0.066). When women with a detectable viral load and a CD4+ T-cell count <200 were excluded in both groups, BV was found to be more prevalent in the PI group (odds ratio, 3.349; 95% confidence interval, 1.113-11.41, P = 0.049). No associations were found between BV and age, condom use, cervical HPV, time with current ART regimen, unprotected receptive anal intercourse and cervical HPV-related lesions. CONCLUSION: The use of PI did not alter the frequencies of HPV-DNA and HPV-related lesions. However, an increased frequency of BV was found in women using PI after excluding women with a detectable viral load and a CD4+ T-cell count of <200.

Association of Sexually Transmitted Diseases With Cervical Ectopy: A Systematic Review.

OBJECTIVE: The aim of this study was to review the available literature to explore evidence indicating an association between cervical ectopy and sexually transmitted diseases, which could help in the decision to treat or not to treat this condition. METHODS: A review of the literature was conducted using the PubMed, EMBASE and clinicaltrials.gov databases on ectopy of the cervix using the terms "ectopy OR ectropium AND cervix" filtered only by language, without limit of date. A total of 71 studies were found in the initial selection, of which 56 were deleted by title, abstract, or full text. The remaining 15 articles were analyzed in this study. RESULTS: Cervical ectopy showed a positive association with human papillomavirus, human immunodeficiency virus, bacterial vaginosis, cervical epithelial atypia, postcoital bleeding, and desquamative inflammatory vaginitis. High-quality studies reported no association between ectopy and chlamydia infection. It was also not associated with gonococcal infection and herpes simplex. CONCLUSIONS: Cervical ectopy shows a probable association with increased acquisition of some sexually transmitted diseases. Additional studies are required to confirm the possible beneficial effects of treatment and to evaluate the possible complications of these treatments.

How to Use CA-125 More Effectively in the Diagnosis of Deep Endometriosis.

Deep infiltrative endometriosis (DIE) is a severe form of the disease. The median time interval from the onset of symptoms to diagnosis of endometriosis is around 8 years. In this prospective study patients were divided into two groups: cases (34 DIE patients) and control (20 tubal ligation patients). The main objective of this study was to evaluate the performance of CA-125 measurement in the menstrual and midcycle phases of the cycle, as well as the difference in its levels between the two phases, for the early diagnosis of DIE. Area Under the Curve (AUC) of CA-125 in menstrual phase and of the difference between menstrual and midcycle phases had the best performance (both with AUC = 0.96), followed by CA-125 in the midcycle (AUC = 0.89). The ratio between menstrual and midcycle phases had the worst performance. CA-125 may be useful for the diagnosis of deep endometriosis, especially when both are collected during menstruation and in midcycle. These may help to decrease the long interval until the definitive diagnosis of DIE. Multicentric studies with larger samples should be performed to better evaluate the cost-effectiveness of measuring CA-125 in two different phases of the menstrual cycle.

Histological outcomes in conventional cervical cytology for invasive carcinoma: not always cancer.

The value of cytology for the detection of invasive cancer remains unknown. We performed a retrospective cohort study with 884 patients diagnosed of premalignant lesions and invasive carcinoma in cytology. 382 (43.2%) of them had cytological results of high-grade squamous intraepithelial lesions (HSIL), 244 (27.6%) showed low-grade squamous intraepithelial lesions (LSIL), 120 (13.6%) patients had atypical squamous cells of undetermined significance (ASC-US), 67 (7.6%) patients with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), 38 (4.3%) had invasive carcinoma and 33 (3.7%) patients presented with atypical glandular cells (ACG). From 38 patients with cytological results of invasive carcinoma, 24 had confirmatory histological results (63.2%). The other 14 had 4 benign lesions and 10 HSIL. The predictive positive value (PPV) was 63.2%. Cytology results of carcinoma do not confer a definitive diagnosis of invasive lesion, but it is strongly an indication of, at least, a precancerous lesion.

Tratamento fisioterapêutico vascular para a doença venosa crônica: artigo de revisão / Vascular physiotherapy for treatment of chronic venous disease: review article

A fisioterapia tem papel importante no processo de prevenção e recuperação de danos causados pela doença venosa crônica (DVC), com técnicas adequadas e focadas no quadro clínico da doença, sendo então denominada de fisioterapia vascular. O tratamento fisioterapêutico vascular precoce pode aliviar os sintomas da doença, reduzir o risco de úlceras venosas e melhorar a qualidade de vida do portador de DVC. O objetivo desta revisão de literatura foi elaborar um protocolo de tratamento fisioterapêutico vascular, mostrando evidências e benefícios das técnicas da fisioterapia vascular e sugerindo como podem ser utilizadas no tratamento da DVC. Trata-se de um estudo de revisão de literatura através de referências sobre o tema, considerando os materiais disponíveis nas bases de dados bibliográficos LILACS e SciELO, publicados no período de 1990 a 2014. Esse protocolo constitui uma proposta de tratamento direcionada às necessidades dos indivíduos com DVC, a fim de proporcionar uma melhor qualidade de vida.

Physiotherapy has an important role to play in prevention of and recovery from the damage cause by chronic venous disease (CVD), employing techniques that are adapted to and focused on clinical disease status, in which form it is known as vascular physiotherapy. Early initiation of treatment with vascular physiotherapy can relieve symptoms of the disease, reduce the risk of venous ulcers and improve the quality of life of CVD patients. The objective of this literature review was to develop a protocol for treatment with vascular physiotherapy, compiling evidence of the benefits of each vascular physiotherapy technique and suggesting how they can be used for treatment of CVD. This is a review of literature investigating the subject that is listed on the LILACS and SciELO bibliographic databases and was published from 1990 to 2014. The resulting protocol is a proposal for treatment oriented towards the requirements of people with CVD, with the objective of achieving better quality of life.

Portal Hypertension Caused by Immature Teratoma in an Adolescent Female.

BACKGROUND: Tumor compression is a cause of portal hypertension. In adolescents, most tumors are germ cell tumors. CASE: We report the case of a 17-year-old female patient with progressive abdominal distention. Portal hypertension with ascites and esophageal varices were identified. A computed tomography scan showed a large ovarian mass that was consistent with a teratoma. After laparotomy, the portal hypertension was resolved. SUMMARY AND CONCLUSION: Venous compression by an immature teratoma should be considered a cause of portal hypertension in adolescents.