Misoprostol na Indução do Trabalho de Parto: Oral ou Vaginal?

Algumas complicações maternas ou fetais no decorrer da gravidez tornam necessária a indução do trabalho de parto. O misoprostol é um análogo sintético da prostaglandina Eı que mimetiza a acção endógena destas substâncias na maturação do colo do útero. A dose ideal, via e frequência de administração continuam sob investigação. O objectivo deste trabalho foi avaliar a eficácia do misoprostol na indução do trabalho de parto e a morbilidade associada à sua administração oral e vaginal. Foi efectuada uma avaliação retrospectiva das grávidas internadas para indução do trabalho de parto durante o ano de 2002, no serviço de Medicina Materno Fetal da Maternidade Dr. Alfredo da Costa. Foram seleccionadas as grávidas que efectuaram misoprostol oral (100 mg) e vaginal (50 mg). Foi avaliado o intervalo de tempo até à fase activa, ao parto, a necessidade de perfusão com occitocina, a via de parto e a morbilidade materna e fetal. Consideraram-se 238 grávidas, 194 efectuaram misoprostol oral e 44 vaginal. O intervalo da indução ao parto vaginal foi 24,3 horas na via oral e 16,9 horas na via vaginal (p=0.01), a dose total administrada foi significativamente inferior na via vaginal (p=0.00), a paridade foi um factor importante na via de parto (p=0.01). Não se verificaram diferenças entre os dois grupos em relação às complicações maternas e fetais. A administração vaginal de misoprostol, quando comparada com a oral, mostrou-se mais eficaz.

Histerectomia e Tumor Uterino: Estudo Comparativo entre Via Vaginal e Abdominal

Objectivos: Determinar a eficiência e segurança da via vaginal na patologia uterina benigna na ausência de prolapso e de contra-indicações absolutas. Material e métodos: Os autores efectuaram uma revisão das histerectomias vaginais (HV) efectuadas na ausência de prolapso urogenital (n=29). Como grupo controle foi estudado o mesmo número de histerectomias abdominais (HÁ). Resultados: Em n=29 houve 20,7% de complicações perioperatórias e pós-operatórias (via vaginal), e no grupo controle 65,5% (via abdominal). Conclusão: A via vaginal tem menor morbilidade e é mais eficiente em termos de custo operacional e benefício.

Laparoscopic Assisted Vaginal Hysterectomy Versus Vaginal Hysterectomy

Introduction: Hysterectomy is the commonest gynecologic operation, performed for malignant and benign conditions. There are many approaches to hysterectomy for benign disease. Studies comparing the techniques have showed that vaginal hysterectomy has benefits in terms of reduced hospital stay, faster recovery and less operating time. Objective: The purpose of this study is to compare the surgical and immediate postoperative outcomes of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) with those of Vaginal Hysterectomy (VH). Methods: Retrospective descriptive study, comparing two groups of women who underwent LAVH or VH in our department during a 24 months period, from January 2009 to December 2010. The two groups were compared regarding age, vaginal deliveries, previous abdominal surgery, uterine and adnexal pathology, intra-operative and post-operative complications, uterus weight, blood loss and number of days until discharge. Results: In our study 42 LAVH and 99 VH were included, with a patient mean age of 47 and 59, respectively. The most frequent indication for hysterectomy was fibroids (80%) for LAVH and POP(58.6%) for HV. In LAVH group 47.6% of patients had previous abdominal surgery, vs 28.2% in VH group. The medium operative time was 167 minutes for LAVH vs 99 minutes for HV. The intra-operative complications were one case (2%) of accidental incision of rectum in LAVH, and one bladder incision in the VH (1%). There were 3 conversions to laparotomy for difficult technique (7%) in LAVH group. There were no significant post-operative complications for LAVH. In VH group there were 2 cases of haemoperitoneum (2%) and 1 case requiring blood transfusion (1%). The mean time for discharge was 4.23 days for LAVH and 4.46 days for VH. Conclusions: In our study, the main advantage for VH was the reduced operative time. In terms of time to discharge there was no difference between the 2 groups. The main intra-operative complication of LAVH was the risk of conversion to laparotomy, but post-operatively this procedure had fewer complications than VH. In conclusion, LAVH is a safe option for women requiring hysterectomy in cases where VH is anticipated to be technically difficult.

Analysis of Synaptic Proteins in the Cerebrospinal Fluid as a New Tool in the Study of Inborn Errors of Neurotransmission

Abstract In a few rare diseases, specialised studies in cerebrospinal fluid (CSF) are required to identify the underlying metabolic disorder. We aimed to explore the possibility of detecting key synaptic proteins in the CSF, in particular dopaminergic and gabaergic, as new procedures that could be useful for both pathophysiological and diagnostic purposes in investigation of inherited disorders of neurotransmission. Dopamine receptor type 2 (D2R), dopamine transporter (DAT) and vesicular monoamine transporter type 2 (VMAT2) were analysed in CSF samplesfrom 30 healthy controls (11 days to 17 years) by western blot analysis. Because VMAT2 was the only protein with intracellular localisation, and in order to compare results, GABA vesicular transporter, which is another intracellular protein, was also studied. Spearman’s correlation and Student’s t tests were applied to compare optical density signals between different proteins. All these synaptic proteins could be easily detected and quantified in the CSF. DAT, D2R and GABA VT expression decrease with age, particularly in the first months of life, reflecting the expected intense synaptic activity and neuronal circuitry formation. A statistically significant relationship was found between D2R and DAT expression, reinforcing the previous evidence of DAT regulation by D2R. To our knowledge, there are no previous studies on human CSF reporting a reliable analysis of these proteins. These kinds of studies could help elucidate new causes of disturbed dopaminergic and gabaergic transmission as well as understanding different responses to L-dopa in inherited disorders affecting dopamine metabolism. Moreover, this approach to synaptic activity in vivo can be extended to different groups of proteins and diseases.

Tension-Free Vaginal Tape (T.V.T) - Nova e Revolucionária Técnica para o Tratamento Cirúrgico da Incontinência Urinária de Esforço (I.U.E.) Feminina Introduzida na MAC pelo Núcleo de Ginecologia Urológica

Este artigo pretende fazer uma revisão de uma das últimas e inovadoras alternativas cirúrgicas viáveis para a cura da incontinência urinária de esforço feminina, com um sucesso superior a 86%. É uma cirurgia mini invasiva e que induz um suporte da uretra média livre de tensão, muito eficaz. Tem vantagens, poucas complicações, curto tempo operatório e benefícios para a doente no pós-operatório imediato e tardio.

Apresentação Pélvica: Parto Vaginal ou Cesariana?

A apresentação pélvica ocorre em 3% das gravidezes únicas de termo e está associada ao aumento do risco de complicações maternas e fetais. Os autores fizeram uma avaliação retrospectiva de 118 partos pélvicos por via vaginal. Foram considerados os recém-nascidos com pesos compreendidos entre 2000 e 4000 g, de gestação maior ou igual a 34 semanas. Comparou-se a morbilidade materna e do recém-nascido com apresentação pélvica, em 118 partos vaginais e 244 cesarianas. Constatou-se que a morbilidade neonatal major foi significativamente superior no parto vaginal (5,9%), em relação à cesariana (0,4%). A morbilidade materna foi ligeiramente superior na cesariana (3,6%), em relação ao parto vaginal (1,6%), sem significado estatístico.

Cerebrospinal Fluid Synaptic Proteins as Useful Biomarkers in Tyrosine Hydroxylase Deficiency

Tyrosine hydroxylase (TH) deficiency is an inborn error of dopamine biosynthesis and a cause of early parkinsonism. Two clinical phenotypes have been described. Type “B”: early onset severe encephalopathy; type “A”: later onset, less severe and better response to L-dopa. We aimed to study the expression of several key dopaminergic and gabaergic synaptic proteins in the cerebrospinal fluid (CSF) of a series of patients with TH deficiency and their possible relation with the clinical phenotype and response to L-DOPA. Dopamine transporter (DAT), D2-receptor and vesicularmonoamine transporter (VMAT2)weremeasured in the CSF of 10 subjectswith THdeficiency byWestern blot analysis. In 3 patients, data of pre- and post-treatmentwith L-DOPA were available, and in one of them, GABA vesicular transporter was determined. Results were compared to an age-matched control population. The concentration of D2-receptors in CSFwas significantly higher in patients with TH deficiency than in controls. Similarly, DAT and vesicular monoamine transporter type 2 were up-regulated. Studies performed before LDOPA, and on L-DOPA therapy showed a paradoxical response with D2 receptor expression increase as L-Dopa doses and homovanillic concentration gradually raised in a B phenotype patient. The opposite results were found in two patients with A phenotype. However, this is a very small sample, and further studies are needed to conclude robust differences between phenotypes. Synaptic proteins are detectable in the CSF and their quantification can be useful for understanding the pathophysiology of neurotransmitter defects and potentially to adjust and personalize treatments in the future.