Browsing by Author "Pedroso, C"
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- Acute Sheehan's Syndrome Presenting as Central Diabetes InsipidusPublication . Robalo, R; Pedroso, C; Agapito, A; Borges, ASheehan's syndrome occurs as a result of ischaemic pituitary necrosis due to severe postpartum haemorrhage. Improvements in obstetrical care have significantly reduced its incidence in developed countries, but postpartum pituitary infarction remains a common cause of hypopituitarism in developing countries. We report a case of severe postpartum haemorrhage followed by headache, central diabetes insipidus and failure to lactate, which prompted us to investigate and identify both anterior and posterior pituitary deficiency compatible with Sheehan's syndrome. A timely diagnosis allowed us to implement an adequate treatment and follow-up plan, which are known to improve clinical status and patient outcome.
- Ecografia Per-Operatória em Cirurgia das Vias Biliares. Estudo Comparativo Ecografia/Colangiografia Per-Operatória na Detecção de Cálculos na Via Biliar PrincipalPublication . Garcia, JP; Sousa, JT; Silva, E; Soares, E; Pedroso, C; Cid, MOOs autores apresentam a sua experiência de 3 anos, com a ecografia per-operatória em 200 doentes sujeitos a colecistectomia por litíase biliar. A ecografia per-operatória e a colangiografia per-operatória foram praticadas em todos estes doentes e comparadas com os achados operatórios. A precisão diagnóstica da ecografia foi 98% e a da colangiografia 96%, no total de doentes desta série. O valor da previsão duma ecografia positiva foi 92.5% enquanto que com uma colangiografia positiva foi inferior, 8 1.5%. Nos 32 doentes em que se praticou a exploração da via biliar principal a utilização destes dois métodos conjuntos levou a uma exploração positiva em 75% dos casos. A morbilidade total nestas séries foi 4.8% contra 12.8% (no grupo com exploração do hepato-colédoco) e cálculos retidos a seguir à exploração da via biliar, foram encontrados numa doente e em situação intra-hepática. A mortalidade total de toda a série de doentes foi 0%. A ecografia per-operatória das vias biliares como procedimento de estudo é um método valioso, possível substituto da colangiografia per-operatória, embora na realidade ambos os métodos possam ter um papel complementar.
- Implant Site Nexplanon Reaction?Publication . Pedroso, C; Martins, I; Palma, F; Machado, AINexplanon (Schering-Plough Limited/Merck Sharp & Dohme Limited (MSD)) is a long active reversible contraceptive method that provides effective contraception for 3 years. It consists of a single, flexible, rod-shaped implant, containing 68 mg etonogestrel. It is 4 cm long, consists of an ethylene vinyl acetate copolymer, a non-absorbable material, and also contains 15 mg of barium sulfate, which makes it visible by X-ray. We describe a case of a 39-year-old woman who experienced a local reaction to the barium sulfate in Nexplanon. She was given medical treatment, but only the removal of the implant resolved the symptoms. After removal there was gradual improvement and 72 h later the patient was asymptomatic. Allergic reaction to barium sulfate is extremely rare: until now, there have only been two cases associated with Nexplanon described in the literature.
- Late Stillbirth: a Ten Year Cohort StudyPublication . Robalo, R; Pedroso, C; Amaral, N; Soares, CIntroduction: Late fetal death is a desolating event that inspite the effort to implement new surveillance protocols in perinatal continues to defy our clinical pratice. Objective: To examine etiological factors contributing to main causes and conditions associated with fetal death in late pregnancies over a 10-year period. Methods: Retrospective cohort analysis of 208 late singleton stillbirth delived in a tertiary-perinatal referral maternity over a 10-year period. Clinical charts, laboratory data and feto-placental pathology findings were systematically reviewed. Results: The incidence of late fetal demise was 3.5 per 1000 pregnancies. No significant trend in the incidence of stillbirth was demonstrated during the study period. Stillbirth was intrapartum in 12 (5.8%) cases and 72 (35%) were term pregnancies. Fourteen percent of cases were undersurveilled pregnancies. Mean gestacional age at diagnosis was 34 weeks. The primary cause of death was fetal, it was present in 59 cases, 25% were considered small for gestational age. Stillbirths were unexplained in 24.5% of cases. Maternal medical disorders were identified in 21%. Hypertensive disorders were frequent and associated with early gestacional age (p = 0.028). Conclusion: There was no change in the incidence of late stillbirth during the 10 years under evaluation. The incidence was 3.5 ‰ which was identical to that described in developed countries. About one quarter of the stillbirths was unexplained. The most frequent maternal pathology was chronic hypertension.
- A Rare Abdomino-Pelvic Tumor: ParagangliomaPublication . Pedroso, C; Robalo, R; Sereno, P; Barros, C; Marques, CParagangliomas are rare tumors, with a reported incidence of 2–8 per million. They are chromaffin cell tumors that develop from the neural crest cells and may be divided in tumors derived from the parasympathetic or sympathetic ganglia. We report a case a of a 32-year-old nulliparous woman, referred to our Infertility Clinic. Abdomino-pelvic ultrasound identified a large abdominopelvic tumor, without ovarian origin (both ovaries were identified and had normal morphology). Magnetic Resonance Imaging suggested a right adnexal multicystic, vascularized mass close to iliac vessels and questioning an ovarian origin. At exploratory laparotomy, a 10 cm encapsulated and vascularized mass was found beginning just below right renal artery and extending to the level of the broad ligament. This mass was totally excised and histopathology was consistent with Paraganglioma.
- Restrição do Crescimento Fetal - Casuística de 4 AnosPublication . Robalo, R; Ribeiro, F; Pedroso, C; Figueiredo, A; Martins, I; Martins, ATOverview and aims: Fetal growth restriction (FGR) affects 15% of pregnancies and is associated with both increased perinatal and neonatal morbidity and mortality and long-term effects in adult life. Our aim was to describe cases and outcomes of FGR from a tertiary perinatal care centre and identify the predictors of neonatal morbidity and mortality. Study design: retrospective cohort. Population: pregnancies with early or late FGR caused by placental factors followed from 2006 to 2009 in a tertiary perinatal care centre. Methods: we collected data from clinical records on demographics, clinical history and fetal ultrasound parameters. Perinatal and neonatal outcomes were stratiied according to gestational age (above or below 28 weeks) and we used bivariate analysis to identify any associations with clinical and imaging indings. Results: we included 246 pregnancies; hypertension was the most prevalent maternal risk factor (16%). There were 15 cases of early FGR, 11 of which had cesarean delivery due to deterioration of fetal Doppler parameters. Outcomes in this group included one fetal and three neonatal deaths. Of 231 cases of late FGR, 64% were delivered early given a non-reassuring fetal status i.e. due to changes in Doppler evaluation or altered Manning biophysical proile. There were four cases of perinatal death in this group, three of which delivered at 28 weeks. Neonatal morbidity was associated with lower gestational age, lower birthweight and progressive placental dysfunction (p<0.01). Conclusion: there was an association between neonatal morbidity and gestational age, birthweight and Doppler deterioration, particularly for deliveries below 28 weeks. The assessment of vascular changes through Doppler analysis allows anticipation of fetal deterioration and is a helpful tool in deciding the optimum timing of delivery.