Castro J.,Centro Hospitalar Of Vila Nova Of Gaia
BMJ case reports | Year: 2013
Arthrogryposis multiplex congenita refers to a clinical condition or syndrome characterised by multiple congenital contractures that affect two or more different areas of the body. Of the cases reported so far, an important percentage had to be terminated before pregnancy term, predominantly by caesarean section. We describe a 36 year-old woman who wanted to conceive. A multidisciplinary approach was set from the preconceptional period and special attention was given to respiratory function, potential anaesthetic difficulties and thromboembolic risks. She delivered by caesarean section at 38 weeks. This case emphasises the possibility of achieving a term delivery in these patients and points out the importance of a multidisciplinary team, specially of obstetricians and anaesthesiologists.
Santos I.,Centro Hospitalar Of Vila Nova Of Gaia |
Clissold S.,Content Ed Net
Gynecological Endocrinology | Year: 2010
Urogenital disorders associated with oestrogen deficiency affect many women throughout menopausal transition. Symptoms such as vaginal dryness, burning, pruritus, dyspareunia, urinary tract urgency/frequency and incontinence have a significant impact on the individual's quality of life. For younger and healthy menopausal women, systemic oestrogen replacement may improve both vasomotor and urogenital symptoms and will be the treatment of choice. However, a proportion of women on systemic therapy still experience symptoms associated with urogenital atrophy, and patients with oestrogen-dependent cancers may be at risk from systemic oestrogen replacement. For women with mainly urogenital symptoms, local oestrogen is a logical choice and it is often more effective than systemic hormone replacement therapy. Generally speaking, there are no contraindications to local therapy. In terms of which topical preparation to use, a wide range of products are available. Promestriene is an analogue of oestradiol which is minimally absorbed and it has been shown to be effective in reversing atrophic changes caused by oestrogen deficiency in women undergoing natural or surgically induced menopause. Given the absence of systemic activity, promestriene may be a good choice in women requiring purely locally oestrogen, and those who have survived, or who are at risk of breast cancer and who have severe vulvo-vaginal symptoms. © 2010 Informa UK Ltd.
Fontes-Carvalho R.,Servico de Fisiologia |
Fontes-Carvalho R.,Centro Hospitalar Of Vila Nova Of Gaia |
Leite-Moreira A.,Servico de Fisiologia
Arquivos Brasileiros de Cardiologia | Year: 2011
Over the last decades, heart failure with preserved ejection fraction (HFpEF) has received less attention by the medical and scientific communities, which led to the emergence of a number of misconceptions concerning its characteristics, diagnostic and therapeutic approach. In recent years, new studies have changed the concepts traditionally associated with HFpEF, contributing to a new view towards this disease. This review is intended to discuss the latest evidence on HFpEF and to fight the main misconceptions associated with it in order to improve its diagnostic and therapeutic approach. Today we have several data showing that HFpEF is a condition that requires a different clinical approach from that used in systolic heart failure (SHF). HFpEF is no longer seen as a "benign" disease because it is associated with a poor prognosis and high prevalence. Its pathophysiology is complex and not fully clarified. In addition to diastolic dysfunction, we now know that other cardiac and extracardiac factors are also involved in its onset and progression. Using recent consensus guidelines we have objective criteria for its diagnosis, especially by using the new echocardiographic parameters for assessing diastolic function, including the E/e' ratio obtained by tissue Doppler. Finally, treatment of HFpEF remains unknown, because no therapeutic strategy has been shown to improve HFpEF prognosis. Thus, in this review we will also discuss the potentially new therapeutic targets for HFpEF.
Guedes R.,Centro Hospitalar Of Vila Nova Of Gaia |
Leite L.,Clinica Laser de Belem
Indian Journal of Dermatology | Year: 2012
Unilateral nevoid telangiectasia is a rare congenital or acquired disorder. The majority of the authors propose that it is probably related to elevated estrogen receptors, although other authors advocate different theories. We report the occurrence of lesions clinically compatible with this diagnosis in a child and two adults. Only one of the patients had a background of estrogen elevation. The other two patients were healthy. We stress the occurrence of this disease in a rare idiopathic form and point out to the relative elevated incidence of it, because the patients discussed in this article were observed for a short period of time.
Myocardial remote ischemic preconditioning: From pathophysiology to clinical application [Pré-condicionamento isquémico remoto do miocárdio: Dosmecanismos fisiopatológicos à aplicacão na prática clínica]
Costa J.F.,University of Porto |
Fontes-Carvalho R.,University of Porto |
Fontes-Carvalho R.,Centro Hospitalar Of Vila Nova Of Gaia |
Leite-Moreira A.F.,University of Porto |
Leite-Moreira A.F.,Centro Hospitalar Sao Joao
Revista Portuguesa de Cardiologia | Year: 2013
Short periods of myocardial ischemia followed by reperfusion induce a cardiopro-tective mechanism when the myocardium is subsequently subjected to a prolonged period ofischemia, a phenomenon known as ischemic preconditioning.As well as its application in the myocardium, ischemic preconditioning can also be inducedby brief interruptions of blood flow to other organs, particularly skeletal muscle. Transientischemia induced noninvasively by inflating a cuff on a limb, followed by reperfusion, helpsreduce the damage caused to the myocardium by interruption of the coronary circulation.Remote ischemic preconditioning involves activation of humoral and/or neural pathways thatopen mitochondrial ATP-sensitive potassium channels in the myocardium and close mitochon-drial permeability transition pores, making cardiomyocytes less vulnerable to ischemia-inducedcell death.This cardioprotective mechanism is now being translated into clinical practice, with positiveresults in several clinical trials in coronary artery bypass surgery, surgical repair of abdominalaortic aneurysms, valve replacement surgery and percutaneous coronary intervention. However,certain factors weaken the subcellular mechanisms of preconditioning - Age, comorbidities,medication, anesthetic protocol - And appear to explain the heterogeneity of results in somestudies.Detailed understanding of the pathways involved in cardioprotection induced by ischemic pre-conditioning is expected to lead to the development of new drugs to reduce the consequencesof prolonged ischemia. © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rightsreserved.