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PubMed | Federal University of São Paulo, Perola Byington Hospital and Guilherme Alvaro Hospital
Type: Journal Article | Journal: Pregnancy hypertension | Year: 2015

The maternity mortality rate in the Santos lowlands region, priority region of So Paulo/Brazil, is higher when compared to regions in the state of So Paulo. The hypertensive disorders are implicated in approximately 20% of death. Severe preeclampsia (PE) is recognized as the frequent diagnosis associated with maternal and fetal ominous outcomes. The recognition of potential risk support antenatal intervention which could anticipate the installation of catastrophic results. Identifying the epidemiological profile of women who may present with this evolution can guide public health policies and actions of the professionals involved in caring for these women avoiding preformed concepts and contributing to the recognition of local reality situation.Identify the epidemiological profile of women affected by severe PE.A descriptive study involving 46 pregnant women admitted to specialized hospital for high-risk pregnancy with the diagnosis of severe PE according to the criteria of NHBPEP (2000), as: blood pressure 160/110mmHg, proteinuria 2.0g/24h or +2 dipstick, serum creatinine >1.2mg/dl (new onset), platelets <100,000/mm(3), microangiopathic hemolysis (increased lactate dehydrogenase), elevated alanine aminotransferase or aspartate aminotransferase, persistent headaches or other cerebral or visual disturbance, persistent epigastric pain or eclampsia in the period from January/2008 to November/2010.The average age of the pregnant women was 25.5years (6.5), 11 women were multiparous and nulliparous and 35 (76.1%), the average gestational age at admission was 34 4/7, developing to eclampsia and/or HELLP syndrome were 07 women (15.2%), admission often occurred before the installation of labor in (93.5%) had a previous diagnosis of chronic hypertension (30.4%) and in all cases magnesium sulfate administration with an average length of 32h (16.6h).The occurrence of severe PE was more common in nulliparous women at the age of 25years, admitted in prematurity and not in preterm labor. The outcome of seizure and/or HELLP has a considerable impact. The association of chronic hypertension with severe PE is more than 1/4 of the cases. These data are equivalent to other areas of Brazil and may contribute to emphasize the practice of prenatal acting that can recognize and pre-comment possible adverse developments and attitudes aimed at intercepting the process.


PubMed | Perola Byington Hospital, Samaritano Hospital, University of Sao Paulo and Albert Einstein Hospital
Type: Journal Article | Journal: Reproductive sciences (Thousand Oaks, Calif.) | Year: 2015

The aim of this study was to analyze cell kinetics through expression and apoptosis of topoisomerase 2- (TOP2A), p53, and c-erb2 in rectosigmoid endometriotic lesions and in healthy endometrial tissue and to establish correlations between such findings and clinical data in patients with rectosigmoid endometriosis.Sixty patients with rectosigmoid endometriosis and 20 control women without endometriosis were included. Immunohistochemical assays were used to measure expression of TOP2A, p53, and c-erB-2. Apoptosis was quantified by directly counting the apoptotic bodies.The number of lesions was positively correlated with expression of TOP2A in the lesion. There was also significant correlation between the lesions size and number and cell turnover index. Apoptosis index (AI) was the same for endometriosis lesions and eutopic endometrium. Expression of TOP2A was significantly lower in the endometriosis group compared to the controls.Changes in cell proliferation but not in the AI in rectosigmoid endometriosis are indicative of an imbalance in cell kinetics that may lead to the development of the disease.


Rossetto L.A.,Federal University of São Paulo | Abla L.E.F.,Perola Byington Hospital | Vidal R.,Federal University of São Paulo | Garcia E.B.,UNIFESP EPM | And 5 more authors.
European Journal of Plastic Surgery | Year: 2010

The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of these patients had abdominal wall hernia and 26 (12.6%) had abdominal bulging. The incidence of hernia was significantly higher (P∈<∈0.05) among patients with body mass index (BMI)∈ ∈30 kg/m 2 (hernia incidence, 15.0%) than that among patients with BMI∈<30 kg/m 2 (hernia incidence, 3.2%), while the incidence of abdominal bulge was significantly lower (P∈<∈0.05) among patients with BMI∈ ∈30 kg/m 2 (abdominal bulge incidence, 5.0%) than that among patients with BMI∈ ∈30 kg/m 2 (abdominal bulge incidence, 19.1%). Therefore, obesity was identified as a risk factor for abdominal wall hernia. It was also found that the use of mesh to reinforce the abdominal wall significantly reduced (P∈<∈0.025) the incidence of hernia (use of mesh (hernia incidence, 2.5%) versus non-mesh (hernia incidence, 5.9%)) and abdominal bulge (use of mesh (abdominal bulge incidence, 9.9%) versus non-mesh (abdominal bulge incidence, 17.3%)) among the patients. © 2010 The Author(s).


Tonezzer T.,Perola Byington Hospital | Pereira C.M.A.P.,Centro Universitario UniItalo | Filho U.P.,Samaritano Hospital | Marx A.,FACIS
European Journal of Gynaecological Oncology | Year: 2010

In recent years, breast cancer has witnessed some notable improvements regarding early diagnosis and new therapeutical strategies, mainly because of the utilization of new drugs and systemic treatment protocols, which have had a direct impact in the increase of these patients' global survival rate. At the same time, it is an ever-growing concern among oncology professionals to identify and minimize as much as possible the effects of long-term toxicity resulting from cancer therapies. Within this context, physiotherapy fits as a preventive and rehabilitating factor regarding functional and skeletal alterations, deriving not only from the direct action of breast cancer, but also from the treatment to which these patients are submitted. Objectives: The aim of this study was to revise the scientific literature on possible adjuvant chemotherapy-induced secondary deleterious effects on the bone mass of patients diagnosed with breast cancer, and also to revise the literature on the intervention of physiotherapy in cases of secondary bone mass loss caused by adjuvant chemotherapy in patients suffering from breast cancer. Methodology: The research was carried out by consulting the following medical websites: Medicus Medline Index, Lilacs, Sciello, PubMed (National Library of Medicine), Google Academic and Capes (a Brazilian website for scientific information). The selection gathers articles written in different languages, English in special, published from January 1998 to October 2008. Results: 24 studies explicitly mention chemotherapy-induced direct and/or indirect effects upon bone mass. Different authors refer to bone mass loss as one possible secondary deleterious effect resulting from adjuvant chemotherapy applied in breast cancer treatment. Nonetheless, no scientific articles were found on the subject of physiotherapy intervention aimed at patients in this specific condition. Conclusion: the results achieved in this revision study point out the possible chemotherapy-induced late deleterious effects on patients diagnosed with breast cancer, as well as the additional risks for the development of further osteoporotic conditions. Hormone therapy and adjuvant chemotherapy treatments may in fact augment and accelerate the loss of bone mass, be it directly, through the action of chemotherapeutical drugs, or indirectly, through the reduction of estrogenic levels and precocious menopause. The scarce material on the rehabilitation of bone mass loss deriving from adjuvant treatments reveals, as it seems, a strong need for new studies on the subject.


Carbinatto F.M.,University of Sao Paulo | Inada N.M.,University of Sao Paulo | Lombardi W.,Woman Health Ambulatory | Da Silva E.V.,Woman Health Ambulatory | And 3 more authors.
Progress in Biomedical Optics and Imaging - Proceedings of SPIE | Year: 2016

Cervical intraepithelial neoplasia (CIN) is the precursor of invasive cervical cancer and associated with human papillomavirus (HPV) infection. Photodynamic therapy (PDT) is a technique that has been used for the treatment of tumors. PDT is based on the accumulation of a photosensitizer in target cells that will generate cytotoxic reactive oxygen species upon illumination, inducing the death of abnormal tissue and PDT with less damaging to normal tissues than surgery, radiation, or chemotherapy and seems to be a promising alternative procedure for CIN treatment. The CIN high grades (II and III) presents potential indications for PDT due the success of PDT for CIN low grade treatment. The patients with CIN high grade that were treated with new clinic protocol shows lesion regression to CIN low grade 60 days after the treatment. The new clinical protocol using for treatment of CIN high grade shows great potential to become a public health technique. © 2016 SPIE.


Cavagna M.,Fertility Assisted Fertilization Center | Cavagna M.,Sapientiae Institute Educational and Research Center in Assisted Reproduction | Cavagna M.,Perola Byington Hospital | Maldonado L.G.L.,Fertility Assisted Fertilization Center | And 7 more authors.
Fertility and Sterility | Year: 2010

Objective: To compare the outcomes of protocols for ovarian stimulation with recombinant hCG microdose, with GnRH agonists and antagonists for pituitary suppression. Design: Prospective nonrandomized clinical trial. Setting: A private assisted reproduction center. Patient(s): We studied 182 patients undergoing intracytoplasmic sperm injection (ICSI) cycles, allocated into two groups: GnRH agonist group, in which patients received a GnRH agonist (n = 73), and a GnRH antagonist group, in which patients were administered a GnRH antagonist for pituitary suppression (n = 109). Intervention(s): Pituitary suppression with GnRH agonist or GnRH antagonist. Ovarian stimulation carried out with recombinant FSH and supplemented with recombinant hCG microdose. Main Outcome Measure(s): Total dose of recombinant FSH and recombinant hCG administered; E2 concentrations and endometrial width on the day of hCG trigger; number of follicles aspirated, oocytes and mature oocytes retrieved; fertilization, pregnancy (PR), implantation, and miscarriage rates. Result(s): The total dose of recombinant FSH and recombinant hCG administered were similar between groups, as were the E2 concentrations and endometrial width. The number of follicles aspirated, oocytes, and metaphase II oocytes collected were also comparable. There were no statistically significant differences in fertilization, PR, implantation, and miscarriage rates in the GnRH agonist and GnRH antagonist groups. Conclusion(s): When using recombinant hCG microdose supplementation for controlled ovarian stimulation (COS), there are no differences in laboratory or clinical outcomes with the use of either GnRH antagonist or agonist for pituitary suppression. © 2010 American Society for Reproductive Medicine.


Silva L.F.I.,São Paulo State University | Silva L.F.I.,Center for Human Reproduction Prof Franco Jr | Silva L.F.I.,Paulista Center for Diagnosis | Oliveira J.B.A.,São Paulo State University | And 17 more authors.
Reproductive Biology and Endocrinology | Year: 2012

Background: This study aimed to investigate the influence of age on sperm quality, as analysed by motile sperm organelle morphology examination (MSOME).Methods: Semen samples were collected from 975 men undergoing evaluation or treatment for infertility. Sperm cells were evaluated at 8400× magnification using an inverted microscope equipped with Nomarski (differential interference contrast) optics. Two forms of spermatozoa were considered: normal spermatozoa and spermatozoa with large nuclear vacuoles (LNV, defined as vacuoles occupying > 50% of the sperm nuclear area). At least 200 spermatozoa per sample were evaluated, and the percentages of normal and LNV spermatozoa were determined. The subjects were divided into three groups according to age: Group I, less than or equal to 35 years; Group II, 36-40 years; and Group III, greater than or equal to 41 years.Results: There was no difference in the percentages of normal sperm between the two younger (I and II) groups (P > 0.05). The percentage of normal sperm in the older group (III) was significantly lower than that in the younger (I and II) groups (P < 0.05). There was no difference in the percentage of LNV spermatozoa between the younger (I and II) groups (P > 0.05). The percentage of LNV spermatozoa was significantly higher in the older group (III) than in the younger (I and II) groups (P < 0.05). Regression analysis demonstrated a significant decrease in the incidence of normal sperm with increasing age (P < 0.05; r = -0.10). However, there was a significant positive correlation between the percentage of spermatozoa with LNV and male age (P < 0.05, r = 0.10).Conclusion: The results demonstrated a consistent decline in semen quality, as reflected by morphological evaluation by MSOME, with increased age. Considering the relationship between nuclear vacuoles and DNA damage, these age-related changes predict that increased paternal age should be associated with unsuccessful or abnormal pregnancy as a consequence of fertilisation with damaged spermatozoa. Given that sperm nuclear vacuoles can be evaluated more precisely at high magnification, these results support the routine use of MSOME for ICSI as a criterion for semen analysis. © 2012 Silva et al; licensee BioMed Central Ltd.


Dias L.P.N.,Perola Byington Hospital | Faria A.L.A.,Perola Byington Hospital | Scandiuzzi M.M.,Perola Byington Hospital | Inhaia C.L.S.,Perola Byington Hospital | And 2 more authors.
World Journal of Surgical Oncology | Year: 2015

Background: Dermatomyositis and polymyositis are both types of idiopathic inflammatory myositis characterized by inflammation and weakness of proximal skeletal muscles and skin rash. Case: A 49-year-old Caucasian woman recently diagnosed with breast cancer classified as T1N2M0, stage IIIA, presenting skin rash associated with heliotrope and Gottron's papules. In addition, there was a progression to a severe reduction in proximal muscle strength with severe dysphagia. The initial treatment was conducted, and the patient recovered from all symptoms and followed adjuvant cancer management. Treatment: At first, high dose of corticosteroid was administered as pulse therapy, and a radical mastectomy was indicated due to the severe symptoms of the paraneoplastic syndrome. Then chemotherapy and radiotherapy were applied, and oral corticoid associated with immunosupressive drug was administered for dermatomyositis control. Discussion: The association between myositis and an increased risk of cancer has been demonstrated over the years. This patient has a high probability of dermatomyositis diagnosis. The initial treatment with high dose of glucocorticoids may result in an improvement of muscle lesions. Second-line treatment with azathioprine, methotrexate, or cyclophosphamide may be required for aggressive disease. Removal of the cancer induces improvement of paraneoplastic syndrome. Conclusion: Dermatomyositis can be a clinical manifestation of a paraneoplastic syndrome in patients with breast cancer. It is a rare diagnosis, and there is little evidence to guide treatment until now. It is possible to control the evolution of dermatomyositis with high doses of glucocorticoids in almost all cases; however, in severe cases of paraneoplastic syndrome, cancer treatment should start immediately. © 2015 Dias et al.; licensee BioMed Central.


PubMed | Perola Byington Hospital
Type: | Journal: World journal of surgical oncology | Year: 2015

Dermatomyositis and polymyositis are both types of idiopathic inflammatory myositis characterized by inflammation and weakness of proximal skeletal muscles and skin rash.A 49-year-old Caucasian woman recently diagnosed with breast cancer classified as T1N2M0, stage IIIA, presenting skin rash associated with heliotrope and Gottrons papules. In addition, there was a progression to a severe reduction in proximal muscle strength with severe dysphagia. The initial treatment was conducted, and the patient recovered from all symptoms and followed adjuvant cancer management.At first, high dose of corticosteroid was administered as pulse therapy, and a radical mastectomy was indicated due to the severe symptoms of the paraneoplastic syndrome. Then chemotherapy and radiotherapy were applied, and oral corticoid associated with immunosupressive drug was administered for dermatomyositis control.The association between myositis and an increased risk of cancer has been demonstrated over the years. This patient has a high probability of dermatomyositis diagnosis. The initial treatment with high dose of glucocorticoids may result in an improvement of muscle lesions. Second-line treatment with azathioprine, methotrexate, or cyclophosphamide may be required for aggressive disease. Removal of the cancer induces improvement of paraneoplastic syndrome.Dermatomyositis can be a clinical manifestation of a paraneoplastic syndrome in patients with breast cancer. It is a rare diagnosis, and there is little evidence to guide treatment until now. It is possible to control the evolution of dermatomyositis with high doses of glucocorticoids in almost all cases; however, in severe cases of paraneoplastic syndrome, cancer treatment should start immediately.


PubMed | Perola Byington Hospital
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

135 Background: Endocrine therapy is a well-established treatment for hormone-positive breast cancer, both in the adjuvant and the metastatic setting. Neoadjuvant chemotherapy has been used to increase the number of patients who are eligible for breast-conservation therapy (BCT) by inducing tumor downstaging. Neoadjuvant endocrine therapy (NET) is mostly used in patients who are not eligible for chemotherapy (almost reserved to postmenopausal patients). The clinical response with NET in postmenopausal patients with locally advanced breast cancer (LABC) and positive hormonal receptors is almost 75% with aromatase inhibitors (AI). The comparison among tamoxifen and the three AI (anastrozole, letrozole, and exemestane) shows a superiority to AI regarding BCT. There are few data in premenopausal women and NET.29 women with rich positive hormone receptor were enrolled in the study between January to September of 2010. Patients received exemestane 25mg/day (EXE) and as we included both pre (12 patients) and postmenopausal (17 patients) women, the premenopausal ones were submitted to ooforectomy.All patients were clinical stage III. In the premenopausal group 6 patients were submitted to surgery and 5 are still taking EXE. Between the two groups 9 patients were submitted to surgery, 4 showed response and are scheduling to surgery, 10 are still taking exemestane. Five patients had serious comorbidities and were submitted to radiotherapy after 9 months of EXE (one without clinical tumor) and are asymptomatic for at least 4 months. Just one patient (premenopausal) had tumor progression after 5 months of EXE and was switched to chemotherapy. Most common side effects were arthralgia/myalgia grade 1/2.In Brazil LABC is frequent and neoadjuvant chemotherapy is the standard treatment. We offered a treatment with a lower cost and especially lower side effects. Because of the initial stage, BCS was not possible, but we had clinical response in about 75% of the patients. This approach was good for patients with comorbidities, and despite the NET is not established for premenopausal patients our initial results encourage us to recommend it.

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