Sexual function after anterior vaginal wall prolapse surgery

OBJECTIVE: The aim of this study was to compare female sexual function after surgical treatment of anterior vaginal prolapse with either small intestine submucosa grafting or traditional colporrhaphy. METHODS: Subjects were randomly assigned, preoperatively, to the small intestine submucosa graft (n = 29) or traditional colporrhaphy (n = 27) treatment group. Postoperative outcomes were analyzed at 12 months. The Female Sexual Function Index questionnaire was used to assess sexual function. Data were compared with independent samples or a paired Student's t-test. RESULTS: In the small intestine submucosa group, the total mean Female Sexual Function Index score increased from 15.5±7.2 to 24.4±7.5 (p<0.001). In the traditional colporrhaphy group, the total mean Female Sexual Function Index score increased from 15.3±6.8 to 24.2±7.0 (p<0.001). Improvements were noted in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. There were no differences between the two groups at the 12-month follow-up. CONCLUSIONS: Small intestine submucosa repair and traditional colporrhaphy both improved sexual function postoperatively. However, no differences were observed between the two techniques.Universidade Federal de São Paulo (UNIFESP) Department of Gynecology Section of Urogynecology and Pelvic SurgeryUNIFESP, Department of Gynecology Section of Urogynecology and Pelvic SurgerySciEL

Sondagem ao mercado de emprego dos quadros, em 1989 e 1997.

Realizou-se uma análise do mercado de emprego dos quadros, num período caracterizado por um forte afluxo de diplomados de nível superior e secundário no mercado. Os resultados mostram nomeadamente uma alteração das estratégias de recrutamento externo das empresas perante aquele afluxo. As melhor posicionadas no seu ramo beneficiaram os diplomados mais jovens, transferindo sobre as outras os custos da sua socialização no mundo empresarial, enquanto o conjunto das empresas passou a recrutar mais diplomados de nível universitário e da área tecnológica, bem como a exigir mais competências não certificadas escolarmente.The author of this article analysed the executive job market during a period that was characterised by a substantial flow of higher and secondary education graduates onto the market. The results particularly reveal a change in firms’ external recruiting strategies. Market leaders invested in younger graduates and transferred the costs of their socialization in the business world onto others. At the same time, businesses as a whole are now recruiting more university-level graduates and staff with a technological background. They are also demanding more skills of types that do not form the object of academic qualifications.Une analyse du marché de l’emploi des cadres a été réalisée sur une période marquée par une arrivée massive de diplômés de l’enseignement supérieur et secondaire sur le marché. Les résultats montrent notamment un changement des stratégies de recrutement externe des entreprises face à cet afflux. Les entreprises les mieux placées dans leur branche ont préféré les diplômés les plus jeunes, en transférant sur les autres les coûts de leur socialisation dans le monde de l’entreprise, tandis que l’ensemble des entreprises a commencé à recruter plus de diplômés de l’enseignement supérieur et du domaine technologique, ainsi qu’à exiger plus de compétences extra-scolaires.Se realizó un análisis del mercado de trabajo de los cuadros en un periodo caracterizado por un fuerte aflujo de diplomados de nivel superior y secundario en el mercado. Los resultados muestran sobretodo una alteración de las estrategias de reclutamiento externo de las empresas ante aquél aflujo. Las mejores colocadas en su ramo se beneficiaron de los diplomados más jóvenes, trasladándose a las otras los costes de su socialización en el mundo empresarial, mientras que el conjunto de las empresas pasó a reclutar más diplomados a nivel universitario y del área tecnológica, así como a exigir más competencias no certificadas escolarmente

Avaliação ultra-sonográfica e urodinâmica em pacientes com incontinência urinária Ultrasonographic and urodynamic evaluation of patients with urinary incontinence

Objetivos: avaliar a concordância entre os diagnósticos urodinâmico e ultra-sonográfico de incontinência urinária, bem como correlacionar as variáveis de ambos os exames. Metodologia: Foram selecionadas 381 pacientes com perda de urina, entre as atendidas no Setor de Uroginecologia e Cirurgia Vaginal da Disciplina de Ginecologia da Escola Paulista de Medicina - Universidade Federal de São Paulo. Todas foram submetidas a estudo urodinâmico, seguindo a padronização da Sociedade Internacional de Continência, e ultra-sonografia do colo vesical, com transdutor endovaginal de 6 MHz. No estudo urodinâmico, medimos a pressão máxima de fechamento uretral (PMFU) e obtivemos o diagnóstico etiológico da perda de urina. As mulheres foram agrupadas segundo o diagnóstico urodinâmico em incontinência urinária de esforço, instabilidade do detrusor e incontinência urinária mista. Na ultra-sonografia, foram avaliados a posição do colo vesical em relação à borda inferior da sínfise púbica e sua mobilidade e os diâmetros da uretra e do colo vesical. Resultados: 1) o colo vesical, quando em repouso, esteve mais freqüentemente acima da borda inferior da sínfise púbica e, durante o esforço, abaixo ou na sua altura nos três grupos; 2) a mobilidade do colo vesical foi semelhante nos grupos; 3) não houve correlação significante entre PMFU e diâmetro da uretra e do colo vesical, tanto em repouso quanto ao esforço. Conclusão: a ultra-sonografia do colo vesical é sempre complementar à avaliação clínica e ao estudo urodinâmico.<br>Purpose: to evaluate the agreement between the urodynamic and ultrasonography diagnoses of urinary incontinence, as well as to correlate the variables of both examinations. Methodology: three hundred eighty-one patients with urine loss were selected, from the Sectior of Urogynecology and Vaginal Surgery of the Division of Gynecology, Escola Paulista de Medicina - Federal University of São Paulo. All of them were submitted to urodynamic study, according to the standardization of the International Society of Continence, and to ultrasonography of the bladder neck, with a 6 MHz trasvaginal transducer. We analyzed the maximum closing urethral pressure (MCUP) and the etiological diagnosis of the urine loss. In the ultrasonography, the position of the bladder neck was evaluated in relation to the inferior border of the pubic symphysis, and its mobility as well as the diameter of the urethra and bladder neck. The women were categoriaed according to the urodynamic study in to stress urinary incontinence, detrusor instability and mixed urinary incontinence. Results: 1) the bladder neck, at rest was most frequently above the inferior border of the pubic symphysis and, during effort, below or at the height of the bony reference, in the three groups; 2) the mobility of the bladder neck was similar in the groups; 3) there was no significant correlation between MCUP and the diameter of the urethra and of the bladder neck. Conclusion: we deem that ultrasonography of the bladder neck is always a complement to the clinical evaluation and the urodymanic study