The use of non-surgical glue to repair perineal first-degree lacerations in normal birth: A non-inferiority randomised trial.

BACKGROUND AND PROBLEM: Surgical glue has been indicated for uncomplicated operatory wounds; however, it has a considerable cost. Non-surgical glue, a commercially available and cheaper product, has not been studied for repairing postpartum lacerations. AIM: To compare non-surgical glue to traditional sutures on perineal first-degree lacerations after normal birth. METHODS: In a prospective, open-label, non-inferiority, randomised controlled trial, we selected childbearing women who were admitted for normal term births and in whom skin lacerations occurred. They were assigned to laceration repair using either non-surgical glue (ethyl 2-cyanoacrylate; Glue group) or catgut sutures (Suture group). The primary endpoint was the occurrence of dehiscence >3mm. Secondary endpoints were procedure runtime, pain score, satisfaction level, and aspects of perineal repair by the REEDA score (hyperaemia, oedema, ecchymosis, exudation, and coaptation) immediately (T0), 24-48h (T1), and 7-10 days (T2) after childbirth. FINDINGS: We included 126 women, 63 in each group, and found a non-inferiority dehiscence rate in the Glue Group compared to the Control group (T1=1.6% vs. 1.6%, P=0.999 and P<0.001 for non-inferiority; and T2=2.2% vs. 4.3%, P=0.557). In the Glue Group, the procedure runtime was shorter, pain score was lower, and women's satisfaction was greater. No women had any allergic reaction in the study. CONCLUSIONS: Non-surgical glue was not inferior to traditional sutures to repair postpartum first-degree lacerations. In addition, non-surgical glue was associated with less pain and greater satisfaction. Brazilian Clinical Trials Registry (www.ensaiosclinicos.gov.br/rg/RBR-5Z8MKC).

Pregnancy in patients with prosthetic heart valves: the effects of anticoagulation on mother, fetus, and neonate.

Maternal and fetal complications in a consecutive series of 60 pregnancies in 49 patients with prosthetic heart valves were prospectively evaluated. Group 1 consisted of 40 pregnancies in 31 patients who were taking oral anticoagulants. No oral anticoagulation was used in 20 pregnancies in 19 patients (group 2). In group 1 there were three instances of acute valvular thrombosis during the 35 pregnancies in patients with mechanical prostheses, with two maternal deaths. There were two episodes of cerebral embolism, one in group 1 and one in group 2. Patients with isolated aortic valve replacement had fewer maternal complications (2 of 13) than patients with isolated mitral valve replacement (15 of 42) without statistical significance. Severe bioprosthesis dysfunction occurred in 4 of 25 pregnancies (one rupture and three stenosis) with two maternal deaths, one in the puerperium and the other in the postoperative period of cardiac surgery during pregnancy. When analyzing obstetric events we observed seven spontaneous abortions and one hydatidiform mole. All spontaneous abortions occurred in group 1. The incidences of prematurity and low birth weight were significantly higher in group 1 than in group 2 (46.6% vs 10.5%, p less than 0.05, and 50% vs 10.5%, p less than 0.05, respectively). Moreover, there was a significant association between prematurity and the mother's New York Heart Association functional class (61.5% in classes III and IV vs 22.2% in classes I and II, p less than 0.05). There were five neonatal deaths, all in group 1 (p = NS vs group 2). Three infants had warfarin-related congenital defects.(ABSTRACT TRUNCATED AT 250 WORDS)

Glomerulopatia do transplante. / Transplantation glomerulopathy

Os autores apresentam 8 casos de glomerulopatia do transplante. A caracterizacao clinica do quadro constou de proteinuria (1,5 a 9,5g por dia), que surgiu tempo variavel pos-transplante (1 a 73 meses); hematuria microscopica foi observada em 4 casos; sete casos tiveram hipertensao arterial, sendo severa em 3. Em todos os casos houve perda progressiva de funcao renal e em 4 a perda foi total.Todos os doadores tinham 2 ou mais incompatibilidades no locus A e B. O aspectos histologico a microscopia de luz foi de um quadro de glomerulonefrite membranoproliferativa tipo I em 7 casos e glomerulosclerose segmentar a focal em um. A imunofluorescencia foi negativa e nao se observou a presenca de imunocomplexos na microscopia eletronica. Fibrose da intima de arterias e arteriolas esteve presente em todos os casos.A glomerulopatia do transplante parece ser uma forma particular de rejeicao cronica, com lesao predominantemente glomerular e vascular

Recidiva de glomerulonefrite pos-transplante renal. / Recurrence of glomerulonephritis after renal transplantation

De janeiro de 1965 a dezembro de 1981, em um grupo de 637 pacientes submetidos a 710 transplantes, observamos 26 casos de recidiva de glomerulnefrite em 306 pacientes transplantados com essa patologia (8,5%).Os tipos de glomerulonefrite que recidivaram foram: nefropatia por IgA, tres casos (15,7%); glomerulonefrite segmentar e focal, seis casos (12,0%); glomerulonefrite membranosa, cinco casos (8,1%); glomerulonefrite membrano-poliferativa, sete casos (6,6%); e glomerulonefrite proliferativa mesangial, tres casos (4,3%). O tempo pos-transplante em que ocorreram as recidivas foi muito variavel, de uma semana a mais de dois anos. A manifestacao clinica mais frequente foi a proteinuria e queda da funcao renal. Cinquenta e quatro por cento dos enxertos foram perdidos em consequencia da recidiva, mas os demais mantem funcao renal normal (31%) ou discretamente diminuida (15%) por tempo longo de seguimento (10 a 115 meses). A recidiva de glomerulonefrite e uma ocorrencia pouco frequente, o diagnostico diferencial deve ser feito com a glomerulopatia do transplante, com a glomerulonefrite de "novo" e rejeicao cronica, e somente foi responsavel por 1,97% de perda do enxerto. A recidiva nao e contra-indicacao para retransplante