Browsing by Author "Isidro Amaral, P"
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- Essure®: Effectiveness, Complications and Satisfaction in 13 Years of ExperiencePublication . Félix, N; Carvalho, C; Isidro Amaral, P; Sousa, F; Delgado, E; Machado, AI; Mira, ROverview and aims: Female sterilization is the most used contraceptive method in the world. The hysteroscopic route is especially attractive for women at high surgical and anesthetic risk. Publications worldwide reported several possible adverse events, doubting the safety of the method. The objectives of this study are to evaluate the technical difficulties and complications, the adverse events in the short and long term, the effectiveness of the method and satisfaction. Study design: Retrospective cohort study. Population: A total of 105 women undergoing hysteroscopic sterilization with Essure® between 2005 and 2017 (13 years of study). Methods: The epidemiological and procedural data were accessed by consulting the clinical processes the family planning appointments. Long term follow-up was evaluated by telephone contact of all the women, with success in 68 cases. Results: The mean age was 38 years (SD 4,7). The procedure was successful in the first attempt in 99% (n=67) cases, the main technical difficulty identified was the permeabilization of the internal cervical os (8.6%; n=6) and the only intercurrence documented was vasovagal reaction (4.8%; n=3). The mean immediate pain post procedure was 4 (numeric pains cale, SD 2). Long term complications identified were: 1.5% (n=1) migration, 1.5% (n=1) partial unilateral expulsion, 4.4% (n=3) gynecological reoperation, 9% (n=7) headache, 11.8% (n=8) weight gain, 22.1% (n=15) chronic pelvic pain and 24.6% (n=17) abnormal uterine hemorrhage. There were no cases of pregnancy or allergic reaction. Most women were very or completely satisfied and would advise Essure® as a contraceptive method, 94% (n=64) and 97.1% (n=66) respectively. Conclusions: Hysteroscopic sterilization was highly effective and associated with low and mild difficulties and acute complications. Most women were satisfied with the method and long term adverse effects identified are difficult to promptly associate with Essure® since their high frequency in the peri-menopause, forcing more studies.
- Fluoroscopia na Remoção de Implantes Profundos de EtonogestrelPublication . Coelho, A; Isidro Amaral, P; Silveira Reis, I; Machado, AIA fluoroscopia é uma técnica de imagem que permite obter imagens em tempo real com recurso a raio-X. Apesar de descrita na literatura a utilização da fluoroscopia em diversas áreas da medicina, em determinadas especialidades esta técnica permanece pouco difundida. Neste sentido, os dois casos clínicos descritos demonstram o sucesso na extração de implantes radiopacos de etonogestrel profundos através do uso da fluoroscopia, revelando-se uma técnica promissora alternativa ou complementar às técnicas convencionais utilizadas, o raio-X e a ecografia. A fluoroscopia tem um perfil de segurança elevado com uma fácil curva de aprendizagem, pelo que o seu domínio pelas especialidades envolvidas na remoção de implantes poderá contribuir para a resolução de casos mais complexos de extração de implantes subcutâneos.
- Implante Contraceptivo Não Palpável - Estratégias para a sua Localização e RemoçãoPublication . Isidro Amaral, P; Correia, L; Silveira Reis, I; Machado, AIOverview and Aims: The contraceptive implant is frequently used to provide contraceptive protection over three years. The implant is inserted into the subcutaneous tissue of the upper arm, and should be palpable and easily removed. We evaluated the best imaging strategy for non-palpable implant (Implanon®) localization and removal. Study Design: Retrospective study. Population: A total of 11 women referred to a tertiary care hospital, between October 2009 and January 2012, for localization and removal of their non-palpable implants. Methods: Different localization methods (ultrasound and magnetic resonance imaging) were evaluated for non-palpable rod. Results: Seven of the nonpalpable implants were inserted in a health care center, three in a district hospital and one in a private clinic. In three women, the reasons for requesting removal were the end of the implant validity, two wanted to become pregnant, two had weight gain, one had weight loss, one referred irregular bleeding, one had two implants and one did a hysterectomy. In 81.8% (9) of the women, the implants were identified and localized by ultrasound, and successfully removed. In two patients the implant was not found and therefore not removed. Conclusions: In our study, high resolution ultrasound proved to be a sensitive method in implants localization, being the primary choice for determining the location of nonpalpable implants.
- Pregnancy in Marfan Syndrome – Two Case ReportsPublication . Isidro Amaral, P; Campos, A; Patrício, LMarfan syndrome is a connective tissue disorder, autosomal dominant, which affects multiple organ systems, namely the cardiovascular, ocular and skeletal. Morbidity and mortality result primarily from aortic and cardiac complications including dilatation, dissection and rupture of the aorta. As a result, pregnancy in women with the Marfan syndrome has an increased risk. Main causes of complications are related with hemodynamic and hormonal modifications caused by pregnancy. The approach to pregnancy in patients with this syndrome is challenging and deserves special care. A multidisciplinary surveillance plan should be developed with support from cardiology, maternal fetal medicine, anesthesiology, genetics and pediatrics.