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A tendência à queda da maioria das alterações citológicas, principalmente nas de maior gravidade (LIEAG/ Ca), reforça a importância dos três pilares do Programa: educação permanente dos profissionais do nível primário e secundário, integração das UBSs com os serviços de Colposcopia, monitoramento e tratamento dos casos com alterações (AU)

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Objetivo: Analisar o controle do câncer do colo uterino a partir do enfoque do acesso a serviços de saúde. Método: Estudo transversal utilizando-se consulta documental e inquérito domiciliar com análise do cálculo de frequências de varáveis selecionadas. Resultados: Os resultados do último exame citológico mostraram maior frequência de metaplasia escamosa imatura; lesão intraepitelial de baixo grau (LSIL); lesão intraepitelial de alto grau (HSIL) e células escamosas atípicas de significado indeterminado (ASC-US), predominantemente em mulheres na faixa etária de 25 a 64, pardas, casadas/convivência marital e donas de casa, com queixas clínicas de corrimento, sangramento e ocorrência de DSTs (inclusive HPV). Conclusão: Não há acompanhamento longitudinal das mulheres na área geográfica de adscrição 47 da USF Nova Natal II desde a coleta do exame citológico até a liberação da mulher, pela alta, do programa de controle do câncer de colo uterino

Objective: To analyze the control of cancer of the cervix from the focus of access to health services. Method: A crosssectional study using consultation documentary and household survey with analysis of calculation of frequencies of selected variables. Results: The results of the last cytological examination showed higher frequency of squamous metaplasia immature; intraepithelial lesion of low grade (LSIL); Intraepithelial Lesion high grade (HSIL) and atypical squamous cells of undetermined significance (ASC-US), predominantly in women In the age group 25 to 64, brown, married/marital harmony and housewives, with clinical complaints of vaginal discharge, bleeding and the occurrence of stds (including HPV). Conclusion: There is no longitudinal follow-up of women in the geographical area of enrollment 47 of USF Nova Natal II from the collection of cytological examination until the discharge by cure

Objetivo: Analizar la lucha contra el cáncer del cuello del útero con el enfoque de acceso a los servicios de salud. Método: Estudio transversal mediante consulta documental y una encuesta de hogares con análisis de cálculo de frecuencias de variables seleccionadas. Resultados: Los resultados del último examen citológico mostraron una mayor frecuencia de metaplasia escamosa inmadura; lesión intraepitelial de baixo grado (ILSA); lesión escamosa intraepitelial de alto grado (NIEA) y células escamosas atípicas de significado indeterminado (ASC-US), principalmente en las mujeres en el grupo de edad de 25 a 64, de piele morena, casadas/armonía conyugal y amas de casa, con quejas clínicas de la secreción vaginal y sangrado, y la aparición de las ETS (incluyendo el VPH). Conclusión: No hay un seguimiento longitudinal de las mujeres en el área geográfica de inscripción 47 de USF Nova Natal II a partir de la colección de examen citológico hasta la liberación de la mujer, por la alta del programa de control de cáncer del cuello uterino

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OBJECTIVE: To evaluate 2 different predicting scores of submucous myoma removal, fluid balance, and operative time in woman undergoing hysteroscopic myomectomy. DESIGN: A multicenter and prospective study (Canadian Task Force classification II-2). SETTING: Six hysteroscopy centers in Brazil. PATIENTS: A total of 191 women who underwent hysteroscopic resection of 205 submucous myomas. INTERVENTION: Resection of submucous myomas (hysteroscopic myomectomy). Myomas were scored according to the European Society for Gynaecological Endoscopy (ESGE) and STEPW (size, topography, extension, penetration, and wall) classifications. The validation of the 2 classifications was assessed with sensitivity and specificity of each classification, with their best cutoff point. MAIN OUTCOME MEASURES: To correlate ESGE and STEPW classifications with complete or incomplete removal of submucous myoma, length of surgery, surgical complications, and fluid balance. RESULTS: Removal of the myoma was complete in 190 (92.7%) of 205 myomectomies, and incomplete in 15 (7.3%). All 140 (100%) of 140 myomas with a score ≤ 4 in the STEPW classification were completely removed, and 50 (76.9%) of 65 myomas with a score >4 were removed. All 15 (100%) cases of incomplete hysteroscopic myomectomy had a STEPW score >4. With the ESGE classification, 156/164 (95.1%) cases of type 0 and type 1 myomas, and 34/41 (82.9%) of type 2 were completely resected. STEPW scores >4 were statistically associated with longer duration of surgery, surgical complications, higher levels of fluid balance, and use of gonadotropin releasing hormone analogue if compared with lower scores. The ESGE scores were not associated with any of these variables. CONCLUSION: Classifying submucous myomas with the STEPW classification allows better prediction of myoma removal, fluid balance, length of surgery and surgical complications in hysteroscopic myomectomy than ESGE classification.

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OBJECTIVE: To evaluate the performance of the STEPW (size, topography, extension, penetration, wall) classification system in predicting partial or complete fibroid removal on hysteroscopic myomectomy. DESIGN: Multicenter, prospective study (Canadian Task Force classification II-2). SETTING: Four hysteroscopy centers in Brazil, China, Italy, and the United States. PATIENT(S): Four hundred forty-nine women who underwent hysteroscopic resection of 465 submucous fibroids. INTERVENTION(S): Resection of the submucous fibroids (hysteroscopic myomectomy). Fibroids were scored according to the European Society for Gynaecological Endoscopy (ESGE) and STEPW classifications. The validation of the two classifications was assessed using sensitivity and specificity of each classification, with their best cutoff point. A test of equality of the two areas under the receiver operating characteristic curves was performed for correlated samples. MAIN OUTCOME MEASURE(S): Correlation of ESGE and STEPW classifications with complete or incomplete removal of submucous fibroid. RESULT(S): Removal of the myoma was complete in 432 (92.9%) of 465 myomectomies and incomplete in 33 (7.1%). All 320 fibroids (100%) with a score≤4 in the STEPW classification were completely removed, and 112 of 145 fibroids (77.2%) with a score>4 were removed. All 33 cases of incomplete hysteroscopic myomectomy (100%) had a STEPW score>4. Using the ESGE classification, 85 of 86 cases (98.9%) of type 0 fibroids, 278 of 298 (93.3%) of type 1, and 69 of 81 (85.2%) of type 2 were completely resected. CONCLUSION(S): Classifying submucous fibroids using the STEPW classification permits greater correlation with complete or incomplete removal of the myoma by hysteroscopic myomectomy.

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Se realizó un estudio descriptivo de corte transversal contando con una población de 753 pacientes con cáncer en el período de enero - diciembre 2005. Los principales resultados encontrados fueron: un 48.4 por ciento tiene algún grado de escolaridad primaria, se encontró que la mayoría de pacientes con un 55.3 por ciento procedían de Managua y sus alrededores, el grupo etáreo más afectado fue el grupo de 30 - 39 años: El cáncer de cervix fue el más frecuente encontrado con un 63.7 por ciento, seguido por el cáncer de mama con un 50 por ciento. Con relación al número de gesta se encontró que la mayoría de ellas con un 58.4 por ciento son multigesta, con respecto a la menarca el 76.2 por ciento corresponde al grupo de 11- 14 años, un 88.6 por ciento tuvieron entre 1-3 compañero, el 49.3 por ciento tuvo su primer hijo antes de los 19 años de edad. En relación a la edad de primera relación sexual el 66.3 por ciento lo tuvo entre los 16- 30 años, se encontró que el 30.1 por ciento presentaron alguna patología asociada, el 11.8 por ciento tienen hábitos tóxicos, el 14.6 por ciento tenian antecedentes familiares de cáncer. En los resultados histológicos el más feecuente fue el tipo escamoso con 47.1 por ciento, siguiéndole el ductal con 16 por ciento

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STUDY OBJECTIVE: To develop a new preoperative classification of submucous myomas for evaluating the viability and the degree of difficulty of hysteroscopic myomectomy. DESIGN: Retrospective study (Canadian Task Force classification II-3) SETTING: University teaching hospitals. PATIENTS: Fifty-five patients who underwent hysteroscopic resection of submucous myomas. INTERVENTION: The possibility of total resection of the myoma, the operating time, the fluid deficit, and the frequency of any complications were considered. The myomas were classified according to the Classification of the European Society for Gynaecological Endoscopy (ESGE) and by our group's new classification (NC), which considers not only the degree of penetration of the myoma into the myometrium, but also adds in such parameters as the distance of the base of the myoma from the uterine wall, the size of the nodule (cm), and the topography of the uterine cavity. The Fisher's exact test, the Student's t test, and the analysis of variance test were used in the statistical analysis. A p value less than .05 in the two-tailed test was considered significant. MEASUREMENTS AND MAIN RESULTS: In 57 myomas, hysteroscopic surgery was considered complete. There was no significant difference among the three ESGE levels (0, 1, and 2). Using the NC, the difference between the numbers of complete surgeries was significant (p <.001) for the two levels (groups I and II). The difference between the operating times was significant for the two classifications. With respect to the fluid deficit, only the NC showed significant differences between the levels (p = .02). CONCLUSIONS: We believe that the NC gives more clues as to the difficulties of a hysteroscopic myomectomy than the standard ESGE classification. It should be stressed that the number of hysteroscopic myomectomies used in this analysis was low, and it would be interesting to evaluate the performance of the classification in a larger number of patients.

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Se realizó estudio de tipo descriptivo, de corte transversal, realizado en el servicio de Gineco-Obstetricia del Hospital Escuela "Dr. Oscar Danilo Rosales A" en el período comprendido de julio 1998- junio19 99 a todas las pacientes con diagnostico de masa anexial ingresadas en el servicio de Gineco-Obstetricia. Se estudiarón un total de 39 pacientes que ingresarón al departamento de gineco-obstetricia con diagnóstico de Masa Anexial, el promedio de edad de las mujeres fue de 20-29 años 46.2 porciento, seguido del grupo de 30-39 años con 20.5 porciento y de 15-19 años 12.8 los sintomas más frecuentes fueron: dolor abdominal y sensación de peso en el 97.4 porciento, dismenorrea y dispareunía 82 porciento y malestar general y disuría. En la totalidad de las pacientes se encontró masa pélvica, sangrado transvaginal, fiebre y amenorrea, anemía, hirsutismo, perdida de peso. El medio diagnóstico utilizado fue el USG pelvico, radiografía de abdomen, pielografía intravenosa y colon por enema pero cabe destacar que el diagnóstico definitivo se obtiene con el apoyo del laboratorio anatomopatológico. Los quistes de ovario y embarazo ectópico fuerón los diagnosticos clínicos más frecuentes al igual que los principales hallazgos transoperatorios: La salpingo-oxforectomía

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Una mujer de 56 años posterior a una histerectomía por leimiomatosis atípica, debuta con metástasis pulmonares de un leimiosarcoma, sin evidencias de otro foco primario que el uterino. Realizamos una revisión y discusión del tema, motivados por la rara forma de presentación y evolución de la lesión maligna

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Na disciplina de obstetrícia da EPM, no período de janeiro de 1980 a dezembro de 1989, foi realizada revisao microscópica de 58 casos de mola hidatiforme, com o objetivo de classificá-las em completas ou parciais. Todos os 58 casos corresponderam a molas completas, e esse resultado é discutido pelos autores.

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A neoplasia trofoblástica gestacional, do ponto de vista clínico, é classificada em formas benigna e maligna. A forma benigna corresponde à mola hidatiforme e a maligna compreende a mola invasora e o carcinoma. A porcentagem de malignizaçäo da mola hidatiforme, segundo vários autores, variou de 0,9 a 51,3 por cento. No período de janeiro/1980 a dezembro/1989 realizaram-se 65 esvaziamentos molares na Escola Paulista de Medicina, entre os quais cinco casos evoluíram para malignidade. Considerando-se todos os casos atendidos, a porcentagem de malignizaçäo foi de 7,65 por cento (cinco em 65). Se considerarmos somente aquelas com acompanhamento pós-molar por 12 ou mais meses e, portanto, com remissäo completa, a porcentagem se eleva para 23,81 por cento (cinco em 21). Esta porcentagem preocupa-nos quanto à evoluçäo daquelas que näo compareceram ao ambulatório ou o fizeram por tempo insuficiente.

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