Browsing by Author "Machado, AI"
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- Avaliação do Tratamento da Dor Aguda em ObstetríciaPublication . Lança, M; Roncon, A; Simão, G; Machado, AI; Virella, D; Palhas, COs autores propuseram-se avaliar o tratamento da dor aguda no trabalho de parto e parto, (88 casos) e no post-operatório de cesariana (53 casos). Para a avaliação da dor utilizaram a VAS e a escala descritiva de dor; o grau de satisfação materna foi inquirido às 48 horas de internamento. A forma de administração influenciou a eficácia analgésica na altura do parto. Quanto à avaliação do pós-operatório às 2 horas após cesariana 24,5% das puérperas referiram VAS >3 e às 6 horas 20,8%, apesar de terem prescrição fixa de analgésicos. Às 24 horas 40% das puérperas referiram VAS >3 e às 48 horas 30%. Das 141 puérperas, 56 consideraram-se muito satisfeitas, 84 satisfeitas e apenas 1 insatisfeita.
- Burkitt’s Lymphoma Related to Epstein–Barr Virus Infection During PregnancyPublication . Cordeiro, A; Machado, AI; Borges, A; Alves, MJ; Frade, MJSetting: Burkitt’s lymphoma is a rare form of cancer and is an extremely rare diagnosis during pregnancy. This form of lymphoma is a very fast growing B cell neoplasm and chemotherapy is the treatment of choice for the disease in all its stages. Case report: The authors describe the case of a Caucasian 40-year-old nulliparous woman, with previous known Epstein–Barr virus infection, that presents at 28 weeks gestation with supraclavicular adenopathy and multiple bilateral breast nodules, in which biopsy showed non-Hodgkin lymphoma, Burkitt’s type. Discussion: There are few described cases of Burkitt’s lymphoma during pregnancy and in general the outcomes have been poor. In most of the cases, the patients were not treated by current standards or instead had a late diagnosis. This neoplasia is the most rapidly progressive human tumor, and any delay in initiating therapy can adversely aVect patient’s prognosis. The authors discuss treatment options in pregnancy and its perinatal implications.
- Cervical Ripening with Foley Catheter: A Tertiary Center ExperiencePublication . Marujo, AT; Rosado, V; Correia, L; Machado, AI; Campos, AOverview and Aims: In the presence of an unfavorable cervix, pre-induction cervical ripening is an important part of the labour induction process. Both mechanical and pharmacological methods are available for this purpose, with Foley catheter being the most commonly used mechanical method. We intend to describe the efficacy of Foley catheter for cervical ripening and to describe maternal and neonatal outcomes. Furthermore, we analyze the same results in high risk subgroups. Study Design: Retrospective observational study Population: 44 women with a singleton pregnancy, live fetus, cephalic presentation, intact membranes, with medical indication for labour induction and Bishop score ≤6. Methods: Medical records were reviewed and analyzed. Foley catheter was introduced until expulsion or for a maximum of 24 hours. Cervical ripening was considered effective when Bishop score after catheter was ≥8. Maternal outcomes considered were tachysystole, chorioamnionitis, post-partum bleeding and uterine rupture. Neonatal outcomes assessed were Apgar score, need for hospitalization in neonatal care unit and days of hospitalization. In the subgroup analysis, we divided the risk population in two subgroups: Group 1- Fetal growth restriction and/or oligohydramnios; Group 2- Previous caesarean section. Results: 72.7% of the labour inductions were indicated by maternal or fetal disease. The efficacy of cervical ripening was 65.9% and vaginal delivery rate was 63.6%. Regarding maternal and neonatal outcomes, there were only two cases (4.5%) of clinical chorioamnionitis. In subgroup analysis, the efficacy of cervical ripening and vaginal delivery rates were, respectively, 60.9% and 69.6% in Group 1 and 72.2% and 50% in Group 2.There was one case of chorioamnionitis in each subgroup. Conclusions: Foley catheter is an effective and safe method for cervical ripening. Due to its low association with adverse outcomes, it appears to be a good alternative for high-risk populations.
- Contracepção de Emergência: o que há de Novo?Publication . Soares Albergaria, F; Machado, AI; Palma, F; Sobral, D; Aleixo, F; Delgado, E; Moniz, LA Contracepção de Emergência é um método simples, seguro e não-abortivo de evitar gravidezes não desejadas. O desconhecimento dos métodos disponíveis compromete a difusão do seu uso e reduz as suas potencialidades na melhoria da Saúde Reprodutiva. Em Portugal estão disponíveis métodos hormonais (método de Yuzpe e pílula de Levonorgestrel) e o DIU de cobre. A pílula de Levonorgestrel impõe-se sobre o método de Yuzpe por ser mais eficaz (até 98,9%), apresentar consideravelmente menores efeitos secundários (redução superior a 50% da ocorrência de náuseas e vómitos) e por ser cómodo (administrável em toma única). Estudos recentes demonstraram que ambos os métodos hormonais podem ser usados até 120 horas após relações sexuais (RS) não protegidas com eficácia, embora esta pareça ser maior quanto maior a precocidade da toma, o DIU de cobre é o método de eleição para a CE que se inicia 72 horas após RS não protegidas.
- 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.
- Esterilização Feminina: Estudo Comparativo entre Esterilização Histeroscópica e LaparoscópicaPublication . Correia, L; Queirós, A; Machado, AI; Delgado, E; Farelo, AOverview and Aims: Female sterilization is increasingly requested as a contraceptive method. Hysteroscopic sterilization by transcervical placing of Essure® micro-inserts in the initial portion of the tubes is a recent alternative to laparoscopic sterilization. The objective of this study is to evaluate the safety and effectiveness of hysteroscopic versus laparoscopic sterilization. Study Design: Retrospective cohort study. Population: A total of 98 women undergoing sterilization in an outpatient clinic between July 2005 and July 2009. Methods: Patients’ age, associated diseases, anesthesic risk, procedure time, discomfort, adverse events and success rate were evaluated. Results: Mean age at surgery was 37.8 years (19-49), and there were no statistically significant differences between the groups regarding this parameter. Women in the hysteroscopic group had a significant number of associated diseases (98% versus 47%), obesity (31% versus 6%), and anesthesic risk (ASA III- 31% versus 0%). The mean duration of the procedure was the same for both techniques (laparoscopy 28 minutes and hysteroscopy 26 minutes). All laparoscopic sterilizations were successfully completed. In the hysteroscopic group 4% failed to complete the technique. There were no cases of severe pain. Women in the hysteroscopy group reported pain less frequently (40% versus 57%, χ2 p<0.05). Long term success rate was similar in both groups (96% for hysteroscopy and 98% for laparoscopy). Conclusions: In spite of a higher incidence of associated diseases, obesity and anesthetic risks in the hysteroscopy group, there were no significant differences in the duration of the procedure, adverse events and success rate. The hysteroscopic approach can therefore be considered an alternative to laparoscopy, eliminating the need for incisional surgery and for general anaesthesia. If women with high surgical risk and several associated diseases can safely undergo this procedure, it could well become the preferred method for women who want a permanent and irreversible contraceptive method.
- 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.
- Headache and HormonesPublication . Costa Ribeiro, V; Correia, L; Ferreira, A; Machado, AIAs hormonas desempenham um papel fundamental na modulação e exacerbação da cefaleia. A revisão da literatura apresentada descreve e diferencia os vários tipos de cefaleias hormonais, sendo igualmente abordados os mecanismos fisiopatológicos assim como as diversas opções terapêuticas. Dado o maior atingimento no sexo feminino e em idade reprodutiva várias questões se colocam no que concerne ao uso de contraceção hormonal. Por último será discutido o risco vascular na presença de enxaqueca o qual contraindica o uso de estrogénios em mulheres com aura.
- Hérnia Diafragmática Congénita: Revisão de 12 CasosPublication . Martins, I; Amador, A; Martins, AT; Cohen, A; Machado, AI; Ferreira, A; Correia, JÉ apresentada uma revisão teórica sobre Hérnia Diafragmática Congénita (HDC). Os autores realizam um estudo retrospectivo de 12 casos de HDC referenciados ou diagnosticados na Unidade de Ecografia da Maternidade Dr. Alfredo da Costa (MAC) entre os anos de 1996 a 1999. Após avaliação o aconselhamento foi efectuado, caso a caso, sendo proposta Interrupção Médica da Gravidez ou cirurgia pós-natal.
- Hiperplasia Congénita da Supra-Renal por Deficiência de 21 Hidroxilase. A Propósito de um Caso ClínicoPublication . Sobral, D; Grilo, I; Dias, E; Machado, AI; Correia, J; Tomé, T; Soares, C; Gaspar, GA hiperplasia congénita da supra-renal (HCS) resulta, em mais de 90% dos casos, do défice de 21-hidroxilase. Este defeito condiciona um excesso de androgénios com virilização pré-natal dos fetos femininos. A terapêutica pré-natal com corticosteróides, quando iniciada precocemente (+- 6 semanas de gestação), parece prevenir ou reduzir a ambiguidade genital destes fetos. Os autores apresentam um caso clínico, com história familiar de HCS, em que a vigilância e a terapêutica foram iniciadas tardiamente (17 semanas de gestação) não tendo sido possível evitar a ambiguidade sexual. É realçada a importância do aconselhamento pré-concepcional e da terapêutica precoce das situações previamente identificadas.