[Immediate breast reconstruction with the use of a microsurgical flap of the rectus abdominis muscle]. / Reconstrução mamária imediata com o uso do retalho microcirúrgico do músculo reto abdominal.

Breast cancer in advanced stages is a condition still frequently diagnosed in the female patients of this hospital. The surgical treatment proposed tends to be radical and mutilating. The importance of the breast for the female self-image is recognized, as well as the sameness of the prognosis of the disease after breast reconstruction, for which different techniques may be proposed to the patients. Among them is the use of the m. rectus abdominis as musculo-cutaneous free flap. This paper reports our experience in regard to the indication, tactics, results and complications of this technique.

Tissue carcinoembryonic antigen in the prognosis of early invasive breast cancer.

Twenty-five patients with stage II ductal breast carcinoma followed up for ten years were studied for the presence of tissue carcinoembryonic antigen (CEA). Overall expression of CEA was 60%. The ten year survival rate was significantly higher for patients with CEA-negative tumours (70%) than for patients with CEA-positive tumours (27%), while the difference between the survival rate of patients with (30%) or without (53%) lymph node involvement did not reach significance. Among the 10 patients with lymph node involvement, CEA-negative patients had a better outcome. These results suggest that there is a correlation between the presence of tissue CEA and the prognosis of the disease, and that CEA status might possibly be more important than lymph node involvement, at least within stage II breast carcinomas.

[Sexually transmitted agents in gynecology: incidence and importance]. / Agentes sexualmente transmitidos em ginecologia: incidencia e importancia.

PIP: The study comprised the analysis of 77 patients between May 1985 and May 1986 in the emergency clinic of the Gynecological Clinic of the Faculty of Medicine of the University of Sao Paulo. Three different groups constituted the cases: A) 15 women devoid of infectious symptoms, aged 18-52 with an average of 31.5 years; B) 25 patients who were carriers of mucous purulent cervicitis, aged 16-42 with an average age of 27.6 years; and C) 37 carriers of acute salpingitis, aged 16-48 with an average age of 25 years. All patients had been sexually active, and none of them had used any local or systemic anti-infection medication for 30 days preceding the study. Pap smears were carried out in all patients. Laparoscopy indicated light salpingitis in 17 patients, moderate in 12, and grave in 8 patients. Neisseria gonorrhea was isolated from the endocervix of 14 women (37.8%) with acute salpingitis, and from none of the other 2 groups. Chlamydia trachomatis was found in 1 (6.7%), 3 (12%), and 14 (37.8%) patients in the Groups A, B, and C. Ureaplasma urealyticum was identified in 3 (20%), 9 (36%), and 21 (56.8%) in the respective groups. Mycoplasma hominis was isolated in 1 (6.7%), 1 (4%), and 2 (5.4%) patients in the respective groups. Cervical-vaginal cytology in the different groups broke down in this fashion; in Group A, 4 were normal (26.7%) and 11 were infectious (64.7%); in Group B, 3 were normal (12%) and 21 were infectious (84%), while 1 (4%) was suspected of dysplasia; and in Group C, 2 were normal (5.4%) and 31 were infectious (83%), while 4 (10.8%) were suspected of dysplasia. It is well known that colpocytological alterations are intimately related to sexual activity. These alterations may also have to do with cancer of the cervix. In view of the fact that the analyzed groups had been promiscuous, a high percentage of colpocytological alterations could be expected. Indeed, clear increases of inflammatory alterations and cervical displasias were found in the cervicitis and salpingitis groups.^ieng

Endometrial damage in acute salpingitis.

Histologic and bacteriologic analyses of endometrium were performed before and on day 15 after minocycline treatment of 20 patients with acute salpingitis. Endometritis was diagnosed in 15 patients before and in nine after treatment. Neisseria gonorrhoeae was recovered from the cervix and endometrium of seven patients but was not isolated after treatment. Chlamydia trachomatis was recovered from the cervix of eight, and from the endometrium of three patients, two of whom had negative cervical cultures. After treatment C. trachomatis was recovered from the cervix of three patients, although two of them had taken aluminum hydroxide for gastric symptomatology during minocycline treatment. Culture of an endometrial specimen revealed no growth of C. trachomatis. The histologic study revealed plasma cell infiltrates in specimens from patients who had cultures positive for C. trachomatis. The results showed that although endometritis is an important manifestation of acute salpingitis, there is no correlation between severity of endometritis and degree of tubal damage.

Surgical treatment of congenital uterovaginal agenesis: Mayer-Rokitansky-Küster-Hauser syndrome.

Twenty-five patients with congenital uterovaginal agenesis underwent neovaginoplasty according to the McIndoe and Banister technique. In 17 (68.0%) cases the congenital agensis was also associated with renal and bone malformations. The postoperative results, based on the length of the neovagina, were considered to be satisfactory in 16 (64.0%) cases, moderate in five (20.0%) and fair in four (16.0%). Dehiscences, fistulae and retention cysts were observed in six (24.0%) cases but had no statistically significant correlation with the final length of the neovagina. On the other hand, a statistically significant relationship between the length of the neovagina and dyspareunia was observed.