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.

A Rare Obstetric Outcome in Uterus Didelphys with Obstructed Hemivagina and Ipsilateral Renal Agenesis

Background: The unique clinical syndrome of uterus didelphys, obstructed hemivagina, and ipsilateral renal anomaly is very rare and can be quite difficult to recognize because of the enormous heterogeneity in its clinical presentation. There are few long-term reports of the reproductive performance of women with this syndrome following treatment, or about the location of subsequent pregnancies. Case: A case in which two spontaneous pregnancies occurred alternatively in both hemiuteri: one despite a previous ipsilateral large hematometra and hematocolpos and the other, 8 years after, simultaneously with contralateral hematometra and hematocolpos(because of vaginal restenosis), is reported. Drainage of hematocolpos was performed at 14 weeks of pregnancy with immediate pain relief. Results: Pregnancy proceeded without complications. Eight month after delivery, a vaginoplasty was performed by excising the longitudinal vaginal septum, and marsupializing the vaginal cuff. Conclusions: This case highlights the importance of a correct and early diagnosis of developmental anomalies of the urogenital tract, as well as how a conservative approach in a Mullerian anomaly with unilateral obstruction led to two successful pregnancies occurring alternatively in the unaffected and in the previously blocked side. This is additional information supporting that every effort should be made to preserve the obstructed uterus.

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.

Heuristics and policies for online pickup and delivery problems

Master Thesis

EFFECT OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY ON VAGINAL Candida spp. ISOLATION IN HIV-INFECTED COMPARED TO HIV-UNINFECTED WOMEN

 Vulvovaginal candidiasis (VVC) in HIV-infected women contributed to the impairment of their quality of life. The aim of this study was to evaluate the effect of highly active antiretroviral therapy (HAART) use on the vaginal Candida spp. isolation in HIV-infected compared to HIV-uninfected women. This cross-sectional study included 178 HIV-infected (HIV group) and 200 HIV-uninfected women (control) that were studied at the Specialized Assistance Service (SAE) for sexually transmitted diseases (STD)/AIDS of the city of Maringá, Brazil, from April 1 to October 30, 2011. The yeasts were isolated and identified by phenotypic and molecular methods. The in vitro antifungal susceptibility to fluconazole, itraconazole, nystatin and amphotericin B was tested by the reference microdilution method. Higher frequencies of total vaginal Candida spp. isolation were found in the HIV-infected group than in the control group. However, both groups showed a similar frequency of colonization and VVC. Although C. albicans was the most frequent and sensitive to azolics and polyenes in both HIV-infected and uninfected women, the emerging resistance of C. glabrata to amphotericin B in the HIV-infected women was observed. Although higher frequency of vaginal Candida spp. isolation had been observed in the HIV-infected than in HIV-uninfected women, colonization and VVC showed similar frequency in both groups, indicating that HAART appears to protect against vaginal colonization and VVC.

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.

Women's Attachment as a Predictor of Pain During Labour and Post-Delivery: a Prospective Observational Study

INTRODUCTION: Labour is considered to be one of the most painful and significant experiences in a woman's life. The aim of this study was to examine whether women's attachment style is a predictor of the pain experienced throughout labour and post-delivery. MATERIAL AND METHODS:Thirty-two pregnant women were assessed during the third trimester of pregnancy and during labour. Adult attachment was assessed with the Adult Attachment Scale ' Revised. The perceived intensity of labour pain was measured using a visual analogue scale for pain in the early stage of labour, throughout labour and post-delivery. RESULTS:Women with an insecure attachment style reported more pain at 3 cm of cervical dilatation (p < 0.05), before the administration of analgesia (p < 0.01) and post-delivery (p < 0.05) than those securely attached. In multivariate models, attachment style was a significant predictor of labour pain at 3 cm of cervical dilatation and before the first administration of analgesia but not of the perceived pain post-delivery. DISCUSSION: These findings confirm that labour pain is influenced by relevant psychological factors and suggest that a woman's attachment style may be a risk factor for greater pain during labour. CONCLUSION:Future studies in the context of obstetric pain may consider the attachment style as an indicator of individual differences in the pain response during labour. This may have important implications in anaesthesiology and to promote a relevant shift in institutional practices and therapeutic procedures.

Rotura Uterina em Mulheres com Cesariana Anterior em Prova de Trabalho de Parto

Uterine rupture during a trial of labor after previous cesarean (TOLAC) delivery is a rare, but serious complication. Several factors can increase the risk of uterine rupture, so the assessment of individual risks with adequate counseling is ne - cessary. The initial signs and symptoms are usually nonspecific, hampering timely diagnosis and prompt delivery of the fetus, necessary for optimal outcome. The purpose of this document is to review the risks factors for uterine rupture during TOLAC, as well as the current clinical value of the classically described premonitory signs and symptoms.

Variação clínica indesejada no parto no SNS português : o papel da oferta

RESUMO - A variação clínica indesejada é um problema global que atinge os diversos sistemas de saúde. Vários autores relacionaram as instituições de saúde e suas características (a oferta) com as decisões clínicas, originando variação clínica entre prestadores de cuidados de saúde. Este estudo procurou identificar a existência de variação clínica indesejada nos nascimentos assistidos no SNS entre 2002 e 2009. É conhecido que uma taxa elevada de cesarianas é prejudicial para as mães e crianças. Neste sentido, procurou analisar-se a variação na percentagem de cesarianas realizadas por hospital do SNS e a influência do número de profissionais nestes valores. A metodologia utilizada foi a análise de fontes de informação que incluíram a caracterização dos internamentos e o número e especialidade dos profissionais de saúde no SNS português. Os resultados permitem afirmar que existe de variação clínica indesejada nos nascimentos no SNS, nomeadamente: (1) a percentagem de cesarianas realizada por hospital varia entre 19,78% e 40,09%; (2) o número de médicos obstetras varia entre os hospitais do SNS, entre 2,1 e 31,1 por 1000 partos; (3) o número de enfermeiros obstetras varia entre 3,8 e 50,7 por 1000 partos; (4) o número médio de dias internamento da mulher é 1,54 dias mais curto nos partos vaginais, que nos partos por cesariana, e 1 dia para o tempo mediano; (5) o tempo mediano de internamento da mulher submetida a cesariana é mais curto nos hospitais que realizam mais este procedimento; (6) não existe relação entre a idade da mãe e a percentagem de cesarianas; (7) nem do número de profissionais de saúde ajustado por 1000 partos; (8) não é possível identificar alterações significativas na percentagem de cesarianas entre hospitais universitários e não universitários.

Intracoronary Delivery of Human Mesenchymal/Stromal Stem Cells: Insights from Coronary Microcirculation Invasive Assessment in a Swine Model

BACKGROUND: Mesenchymal stem/stromal cells have unique properties favorable to their use in clinical practice and have been studied for cardiac repair. However, these cells are larger than coronary microvessels and there is controversy about the risk of embolization and microinfarctions, which could jeopardize the safety and efficacy of intracoronary route for their delivery. The index of microcirculatory resistance (IMR) is an invasive method for quantitatively assessing the coronary microcirculation status. OBJECTIVES: To examine heart microcirculation after intracoronary injection of mesenchymal stem/stromal cells with the index of microcirculatory resistance. METHODS: Healthy swine were randomized to receive by intracoronary route either 30x106 MSC or the same solution with no cells (1% human albumin/PBS) (placebo). Blinded operators took coronary pressure and flow measurements, prior to intracoronary infusion and at 5 and 30 minutes post-delivery. Coronary flow reserve (CFR) and the IMR were compared between groups. RESULTS: CFR and IMR were done with a variance within the 3 transit time measurements of 6% at rest and 11% at maximal hyperemia. After intracoronary infusion there were no significant differences in CFR. The IMR was significantly higher in MSC-injected animals (at 30 minutes, 14.2U vs. 8.8U, p = 0.02) and intragroup analysis showed a significant increase of 112% from baseline to 30 minutes after cell infusion, although no electrocardiographic changes or clinical deterioration were noted. CONCLUSION: Overall, this study provides definitive evidence of microcirculatory disruption upon intracoronary administration of mesenchymal stem/stromal cells, in a large animal model closely resembling human cardiac physiology, function and anatomy.

Development of chitosan-based microparticles for pulmonary drug delivery

Dissertação para obtenção do Grau de Mestre em Engenharia Química e Bioquímica

Overexpressing BDNF in Neural Stem Cells using non-viral gene delivery strategies

Dissertação para obtenção do Grau de Mestre em Biotecnologia

Texts prepared for delivery at Paul Krugman's honorary doctorate by three Lisbon universities on 27 February, 2012

Three texts were prepared for delivery at the first honorary doctorate awarded simultaneously by three Lisbon universities on 27 February, 2012: an introduction, a lecture and a comment. The event included the award of member of the Lisbon Academy of Science (ACL) by Manuel Jacinto Nunes, dean of the economics and finance section of ACL who proposed his name and Olivier Blanchard’s on the 30th anniversary of James Tobin receiving an honorary doctorate from Nova University. On 24 February , Paul Krugman visited ACL and participated in a session of the project dubbed “Letter to the lusofonia Queen”. Since this project is promoted by Nova SBE’s Center for Globalization and Governance and has been featured in some of the graduate courses, a short note on the meeting is included in annex. On 15 June, the three universities authorized an edition in Portuguese and donated the copyrights to a student award on “Krugman economics”, in a way still to be determined by the editor. The lecture and the comment will be translated as soon as a suitable publisher is found. Since a lot of the teaching at Nova SBE is in English, it seemed appropriate to reproduce the original texts in the order in which they were presented. A lively question and answer period was also recorded by Nova TV and should be made available in the book, together with highlights of the media coverage. Introduced as a “militant economist”, he speaks about a crisis “his mind loves but does not let the heart forget the poor and the unemployed”. The Nobel prize winner described as a“progressist pessimist of the world economy” concludes with a severe indictment of the profession. “In normal times, when things are going pretty well, the world can function reasonably well without professional economic advice. It’s in times of crisis, when practical experience suddenly proves useless and events are beyond anyone’s normal experience, that we need professors with their models to light the path forward. And when the moment came, we failed”. The comment, by the official responsible for Paul Krugman’s mission to Portugal in 1976, contains an equally dire prediction: “I would very much like to see in the near future the weakening of the influence not only of freshwater economists but also of their conservative European followers. But I fear that this will not happen until we find ourselves in a more calamitous situation than at present”. Fortunately Silva Lopes closes in the hope “that the ideas of Paul Krugman will soon have more influence in policy makers than at present seems to be the case”.

Business development in Siemens global shared services delivery center Portugal

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics