Browsing by Author "Mahomed, F"
- Appendiceal Mucocele – Unexpected Diagnosis in a Gynecology DepartmentPublication . Correia, A; Mahomed, FAppendiceal mucocele is a rare entity, occuring in < 1% among appendicectomies, with a female predominance 4/1 (F/M) and a mean age of more than 50 years. The preoperative diagnosis is difficult; in most cases, it´s an intraoperative finding. In such work, we describe the two clinical cases occurring in last 10 years in our Department. Case 1 - 56 years old, posmenopausal, referred to our Department (02/2004) because an asymptomatic right adnexal septated cystic image, 53x48mm, with hipovascularized septa and a vascularised capsule with low flow resistance (IR 0,57). CA 125 elevated (71,3 U/mL).Exploratory laparotomy: an ovary increased, with a gelatanious consistency and an appendicular enlargement. Extemporaneous examination: a pseudomixoma peritonei, associated with a mucinous appendicular and an ovary tumor. It was performed a radical surgery. The histo-pathological analysis showed a mucinous cystadenoma of the appendix with peritoneal mucinous dissemination involving the ovary. Expectant attitude since the surgery, without clinical and imaging signs of recurrence. Case 2- 62 years old posmenopausal and asymptomatic woman, with a large adnexal mass detected on routine pelvic ultrasound: heterogeneous, 94x84mm without vascularisation signs in its interior. CEA was elevated (41,47U/ml). Exploratory laparotomy (02/2010): enlarged appendix and macroscopically normal pelvic organs. An appendicectomy was performed. The histo-pathological analysis showed a 10cm mucinous cystadenoma of the appendix and signs of localized (visceral peritoneal surface) pseudomyxoma peritonei. Currently she’s clinically well, in an expectant attitude. Despite mucoceles of the appendix are rare, they should be considered in women presenting with abnormal quadrant masses.
- Colestase Intra-Hepática da Gravidez Casuística da Maternidade do Hospital Dona EstefâniaPublication . Correia, A; Olival, V; Pereira, N; Ravara Bello, A; Caetano, M; Mahomed, FIntrodução: A CIHG é uma patologia que surge habitualmente na 2ª metade da gestação e tem carácter recorrente. Objectivo: Determinar a incidência da patologia, o outcome obstétrico e fetal das grávidas com diagnóstico de CIHG. Métodos: Estudo retrospectivo, de Janeiro/2004 a Outubro/2010. Variáveis estudadas: referentes à grávida (idade, antecedentes obstétricos), gravidez (idade gestacional ao diagnóstico, conduta clínica) e parto (incluindo complicações intra-parto), bem como complicações maternas/fetais pós-parto. Resultados: 57 grávidas (incidência 0,41% - 57/14053), com idade média 31,5±5,8 anos, 56,1% nulíparas e 36% com antecedentes pessoais de CIHG. A sintomatologia surgiu em média às 33,8±3,1 semanas (S). Em 55,9% procedeu-se a internamento imediato (IG 35±2,7S), 44,1% foram vigiadas em ambulatório (IG 32,1±3S), em média durante 3,7±1,9S. 57,9% necessitaram de terapêutica médica. Em 65% procedeu-se a indução do trabalho de parto, na maioria dos casos pela idade gestacional (≥37S); 17,5% iniciaram trabalho de parto espontâneo (70% pré-termo). Cesariana em 38,6%, das quais 72,7% em âmbito de urgência. 22,2% de casos de CTG intra-parto não tranquilizador e em 15,8%,líquido amniótico meconial. A idade gestacional média ao nascimento foi 36,2±2,2S; 38,6% RN prematuros (2/3 iatrogénicos), tendo-se verificado 1 caso de hemorragia pós-parto, 3 de febre puerperal e 1 de asfixia neonatal grave. Discussão: Patologia de baixa incidência, recorrente, atingindo frequentemente grávidas de grupo etário superior. Associa-se a marcada iatrogenia, prematuridade, risco de distócia e sofrimento fetal intra-parto. Estes dados estão de acordo com a literatura.
- Induced Labor– Is There an Increased Risk of Perinatal Infection?Publication . Olival, V; Correia, A; Mahomed, F; Mira, R; Virella, DObjectives: To assess induced labor-associated perinatal infection risk at Hospital D.Estefânia from January to June of 2010 at Hospital de D. Estefânia’s delivery rooms, reviewing the indications for inducing labor as well as the techniques used. Material and Methods: Performing an historical prospective study searching the clinical processes as well as the mother and newborn’s computer database from January to June of 2010. An exposed and an unexposed group were created; the first group comprises pregnant women and their newborns whose labor was induced. The unexposed group is constituted by newborns and pregnant women whose labor was spontaneous. Labor induction was performed using intra-vaginal prostaglandins in women who didn’t start it spontaneously; perinatal infection was defined either clinically or using blood tests. The gestational age was ≥ 37 weeks for both groups. 19 variables were studied for both groups. Results: A total of 190 mother-newborn pairs were included: 55 in the exposed group and 135 in the unexposed group. 3 cases of perinatal infection were reported, two in the exposed group and one in the unexposed group. Preliminary data resulted in a perinatal infection rate of 3.6% in the exposed group and 0.7% in the unexposed group; preliminary data suggest that the risk of perinatal infection may be increased in up to 5-fold when labor is inducted. Conclusions: A larger series of patients and a multivariable analysis using logistic regression are both necessary in order to perform a more thorough assessment of labor induction’s role in perinatal infection risk. One must also try to distinguish labor inducing- and clinical practicesrelated factors.
- Ovarian Borderline Tumor and Fertility-Sparing SurgeryPublication . Correia, A; Olival, VG; Leitão, C; Mahomed, FOvarian borderline tumors (OBTs) are frequently diagnosed in women of reproductive age. There is no consensus about their management, and it sometimes represents a dilemma aboutwhat should be done: fertility sparing surgery or a hysterectomy with salpingo-oophorectomy? Case: A 32-year-old nulligravida, diagnosed with a right ovarian borderline tumor is presented. She underwent pelvic washings, right salpingo-oophorectomy, appendectomy, and omental and peritoneal biopsies (laparotomic approach). Macroscopically, the left ovary was normal and subsequent exploration for staging was also normal, including the lymph nodes. Intraoperatively, frozen section examination was unclear, suggesting an OBT. Results: The final histopathologic diagnosis was ovarian borderline tumor, stage IIC (International Federation of Gynecology and Obstetrics [FIGO] staging). The patient expressed a desire to preserve her fertility. Thirty-six months postsurgery, she became pregnant spontaneously and delivered a healthy newborn at term. Conclusions: Conservative surgery can be performed in young patients treated for an OBT, provided they are closely followed up and that this surgery is performed after careful consideration and informed consent. It is, however, controversial with respect to performing hysterectomy and salpingo-oopherectomy upon the patient’s completion of childbearing.
- Postmenopausal Bleeding and Endometrial Changes: Clinical Significance?Publication . Correia, A; Barreto, S; Mahomed, F; Bernardo, MJIntroduction: Postmenopausal bleeding is a common complaint from women seen in general practice, although majority of them, will have no major problem. Objective: Study of endometrium in postmenopausal women with suspicious sonographic endometrial changes. Comparison of findings in asymptomatic women and those who reported metrorrhagia. Methods: Consultation of outpatient medical records of 487 women undergoing endometrial study (sonohysterography, hysteroscopy), between January/2004 and July/2010. Patients were subdivided into two groups: women with (G1) and without (G2) complaints of postmenopausal metrorrhagia. Results: G1 and G2 comprises 78 and 409 women, respectively. G1: 23.1% normal uterine cavity, 74.3% benign pathology (majority endometrial polyps) and 2.6% of them endometrial carcinoma. G2: 14.4% normal uterine cavity, 83.7% benign pathology (majority endometrial polyps), 1.4% endometrial hyperplasia and endometrial carcinoma in 0.49%. Conclusion: Postmenopausal metrorrhagia is associated with an increased risk of endometrial malignancy, in relation to asymptomatic, although represents a minority of the population. To highlight the existence of premalignant and malignant pathology in asymptomatic endometrial thickening.