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Esterilização tubária histeroscópica com Essure ® : um estudo observacional de 7 anos
Get PDFIntroduction: Hysteroscopic sterilization with the Essure® device is a method of contraception considered safe and
effective already applied in more than 200,000 women. This study aims to evaluate the efficacy of this method of contraception and the adverse events associated with the placement of Essure®, including pain during the procedure and postprocedure complications.
Material and methods: We performed a retrospective observational study with inclusion of all the women submitted to
Essure® placement in a large urban hospital in Portugal, from January 2008 to December 2015 (7 years). The variables
age, parity, duration and intercurrences of the procedure, follow-up exams and final outcome were evaluated. The statistical analysis was performed with STATA 12.1.
Results: Of the 118 women only 100 finished the procedure with 16.9% reporting moderate or severe pain. Although less
than 3 intrauterine rings were found in 8.5% of cases, the success rate was 92%. The complications described were tubal
perforation (0.8%), pregnancy (1 case) and incorrect positioning of the implants (3%).
Discussion/Conclusion: The success rate of the procedure was very close to that described in the literature with a low incidence of complications. That advantages make it an idea method for women with high surgical risk and multiple co-morbiditiesinfo:eu-repo/semantics/publishedVersio
Early or Delayed Enteral Feeding for Infants with Abnormal Antenatal Doppler Flow Patterns
Get PDFIntrodução: O principal objetivo deste estudo foi determinar o efeito da introdução de alimentação entérica precoce comparado com introdução tardia, na incidência de morbilidade gastrointestinal e tempo até alimentação entérica total, em recém-
-nascidos com alteração de fluxos em ecografia pré-natal.
Métodos: Análise retrospetiva dos recém-nascidos internados numa unidade de cuidados intensivos neonatais de nível III, em
Portugal, entre janeiro de 2004 e dezembro de 2013 com alteração de fluxos em ecografia pré-natal. Foram criados dois grupos
baseados no tempo até introdução de primeira alimentação entérica: grupo de alimentação precoce (≤48 horas) e grupo de
alimentação tardia (> 48 horas). Os resultados principais foram morbilidade gastrointestinal e mortalidade devido a complicações gastrointestinais.
Resultados: Foram incluídos 46 (47%) de recém-nascidos no grupo de alimentação precoce e 52 (53%) no grupo de alimentação
tardia. Não houve diferenças significativas na morbilidade gastrointestinal, incluindo enterocolite necrosante, perfuração ou
cirurgia gastrointestinal, íleus séptico ou intolerância alimentar. A alimentação precoce resultou numa diminuição significativa
da sepsis tardia (p=0,016; odds ratio 0,276; intervalo de confiança 95% 0,096-0,789).
Discussão: A introdução precoce de alimentação entérica poderá não ter efeitos significativos na incidência de morbilidade
gastrointestinal em recém-nascidos com alteração de fluxos em ecografia pré-natal. Houve uma redução significativa na sepsis
tardia, sem condicionar um aumento de risco de morbilidade gastrointestinal.Introduction: The main objective of this study was to determine the effect of early versus late enteral feeding on
the incidence of gastrointestinal morbidity and on time
to establish full enteral feeding in neonates with abnormal antenatal Doppler flow patterns.
Methods: We retrospectively analysed neonates admitted to a level III neonatal intensive care unit in Portugal
between January 2004 and December 2013 with abnormal antenatal Doppler flow patterns. Two groups were
created based on the time of first enteral feeding: early
feeding group (≤48 hours) and late feeding group (> 48
hours). Primary outcomes were gastrointestinal morbidity and death due to gastrointestinal complications.
Results: Forty-six (47%) infants were included in the
early feeding group and 52 (53%) in the late feeding
group. There was no statistical difference in gastrointestinal morbidity, including necrotising enterocolitis,
gastrointestinal perforation or surgery, septic ileus or
feeding intolerance. Early feeding resulted in a significant decrease in late-onset sepsis (p=0.016; odds ratio
0.276; 95% confidence interval 0.096-0.789).
Discussion: Early introduction of enteral feeding may
not have a significant effect on the incidence of gastrointestinal morbidity in neonates with abnormal antenatal
Doppler flow patterns. There was a significant reduction
in late-onset sepsis, without incurring an increased risk of gastrointestinal morbidity.info:eu-repo/semantics/publishedVersio
How to Treat Cesarean Scar Pregnancy: A Difficult and Rare Case
No full textBackground: Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy. Due to high morbidity and mortality associated with delayed diagnosis of this condition, a high index of suspicion is important, as well as a thorough transvaginal ultrasound. There is still no consensus on the best treatment of these cases. The choice for conservative options, including medical therapy with methotrexate and transvaginal evacuation, avoids mutilating surgeries, such as hysterectomy, which can compromise women's fertility. Case: A 32-year-old patient with a cesarean scar pregnancy with a 7 weeks live embryo. Results: The patient was treated with transvaginal evacuation and a single dose of intramuscular methotrexate, after an initial attempt with medical treatment, consisting of a local injection of potassium chloride into the sac, proved to be technically impossible. Conclusions: Due to the low incidence of cesarean scar pregnancies and the nonexistence of consensus regarding their treatment, this case report can improve understanding of these pregnancies, which could lead to the establishment of new guidelines.info:eu-repo/semantics/publishedVersio
Distinctive clinical phenotype of anti-centromere antibody-positive diffuse systemic sclerosis
Get PDFOBJECTIVES:
The aim was to define clinical characteristics and long-term survival of patients with dcSSc and positive ACA.
METHODS:
We identified all cases of ACA+ SSc in our cohort (n = 1313). Those with dcSSc (ACA+ diffuse) were compared with representative groups of consecutive ACA+ patients with limited subset (ACA+ limited) and ACA- dcSSc (non-ACA diffuse).
RESULTS:
Thirty-five patients (2.7%) were ACA+ diffuse. The peak modified Rodnan skin score was not significantly different between the dcSSc subgroups, but it occurred later in the disease course in ACA+ diffuse (88.54 vs 30.65 months, P < 0.001). Patterns of organ involvement were different between the groups. ACA+ diffuse had a higher incidence of interstitial lung disease than ACA+ limited (22.86 vs 4.43%, P = 0.001), but lower than non-ACA diffuse (41.18%, P = 0.042). More patients developed pulmonary hypertension in the ACA+ diffuse group (28.5 vs 12.0% ACA+ limited or 12.0% non-ACA diffuse), although this was attributable to the longer follow-up in these patients. The cumulative incidence of pulmonary hypertension was not different from the other two groups. The incidence of cardiac involvement was similar between the dcSSc groups, and scleroderma renal crisis was more frequent in the non-ACA diffuse group. Survival in ACA+ patients was similar in both subsets, whereas non-ACA diffuse had higher mortality.
CONCLUSION:
ACA+ dcSSc is uncommon and has a distinct clinical phenotype, with a more insidious onset of skin and organ involvement. Even in dcSSc, ACA appears protective for organ-based complications, namely interstitial lung disease and scleroderma renal crisis, and is associated with a better survival than expected in dcSSc.info:eu-repo/semantics/publishedVersio
Ultrasound Requested by General Practitioners or for Symptoms Unrelated to the Thyroid Gland May Explain Higher Prevalence of Thyroid Nodules in Females
No full textBackground: A higher prevalence of thyroid nodules/carcinoma in females is well-known from the literature. The reasons for this difference are not fully explained. We intended to assess gender variation in the referral for ultrasound-guided fine needle aspiration (FNA) of thyroid nodules, to study reasons for gender referral differences, and to assess differences in nodules characteristics between genders.
Methods: Included were 272 consecutive patients, with 290 nodules submitted to FNA. Patients were questioned on the reason why ultrasound (US) examination was required. Electronic medical records were reviewed. Nodules' ultrasound/cytological characteristics were assessed. Variables studied: referral cause; referral pattern (hospital-specialist versus general-practitioner); number of nodules; age, thyroid function; nodule size, TIRADS classification, resistive index, Doppler pattern, Bethesda categorisation. Variables were compared between males and females referred for FNA. Significant variables were assessed with logistic regression.
Results: Of the 272 patients, 215(79%) were women with a female:male referral ratio for FNA of 3.8:1. Non-parametric statistically significant differences (p < 0.05) were found between genders in: thyroid function, nodule size, referral pattern and referral cause. Nodule size and thyroid function tests became non-significant in logistic regression. Cause and referral pattern remained significantly associated with gender. Referral by a general-practitioner was associated with a 2.6-fold increase in odds of referring a female. Causes unrelated to the thyroid were associated with a 3.2-fold increase in odds of female reference.
Conclusions: A referral bias might be responsible for the higher rate of thyroid nodules in female patients, both due to referral by general practitioners and due to causes indirectly related to the thyroid gland.info:eu-repo/semantics/publishedVersio
Ablação de Fibrilhação Auricular: Isolamento das veias pulmonares Experiência inicial no HFF
Get PDFN/
Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding.
Get PDFBACKGROUND/AIMS:
The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12-24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding.
METHODS:
: This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding.
RESULTS:
: A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome.
CONCLUSION:
s: Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.info:eu-repo/semantics/publishedVersio