User satisfaction with an intrauterine system containing 52 mg levonorgestrel: a Portuguese study.

OBJECTIVE: To characterise patient satisfaction 6 and 12 months after insertion of a 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS) in Portuguese women. STUDY DESIGN: A non-interventional and prospective study was conducted in Portuguese women of reproductive age who had Levosert® inserted. Two questionnaires (administered 6 and 12 months after 52 mg LNG-IUS insertion) were used to collect information on the patients' menstrual pattern, discontinuation rate, and satisfaction rate with Levosert®. RESULTS: A total of 102 women were enrolled, of which only 94 (92.2%) completed the study. Seven participants discontinued the use of the 52 mg LNG-IUS. At 6 and 12 months, 90.7% and 90.4% of participants, respectively, were either satisfied or very satisfied with the 52 mg LNG-IUS. At 6 and 12 months, 73.2% and 72.3% of participants, respectively, indicated that they were very likely to recommend the 52 mg LNG-IUS to a friend or family member. Most women (92.2%) continued to use the 52 mg LNG-IUS for the first year. The percentage of women who were 'much more satisfied' with Levosert® than with their previous contraceptive methods was 55.9% and 57.8% at 6 and 12 months, respectively, per questionnaire assessment. Satisfaction was associated with age (p = 0.004), amenorrhoea (p < 0.003) and absence of dysmenorrhoea (p = 0.003), but not with parity (p = 0.922). CONCLUSIONS: These data suggest that the continuation and satisfaction rates with Levosert® were very high, and that this system is well accepted among Portuguese women. Patient satisfaction was driven by a favourable bleeding pattern and absence of dysmenorrhoea.

Satisfaction with the 52 mg levonorgestrel­releasing intrauterine system was high among Portuguese women. Patient satisfaction was mainly driven by a favourable bleeding pattern and absence of dysmenorrhoea.

Amniotic Fluid Embolism. Is a New Pregnancy Possible? Case Report / Embolia do líquido amniótico. Será uma nova gestação possível? Relato de caso

Abstract Amniotic fluid embolism (AFE) is a rare but potentially catastrophic clinical condition, characterized by a combination of signs and symptoms that reflect respiratory distress, cardiovascular collapse and disseminated intravascular coagulation (DIC). Its pathogenesis is still unclear. More recently, the traditional view of obstruction of pulmonary capillary vessels by amniotic fluid emboli as the main explanation for the etiology has been ruled out, and immunologic factors and the activation of the inflammatory cascade took on an important role. Amniotic fluid embolism has an unpredictable character, its diagnosis is exclusively clinical, and the treatment consists mainly of cardiovascular support and administration of blood products to correct the DIC. No diagnostic test is recommended until now, though multiple blood markers are currently being studied. The authors present a case report of a woman who had survived AFE in her previous pregnancy and had a subsequent pregnancy without recurrence, providing one more clinical testimony of the low risks for the pregnancy after AFE.

Resumo A embolia do liquido amniótico (ELA) é uma situação clínica rara, mas potencialmente catastrófica, que se caracteriza por uma combinação de sinais e sintomas clínicos que refletem insuficiência respiratória aguda, colapso cardiovascular e coagulação intravascular disseminada (CID). A sua patogênese ainda não é totalmente compreendida. Mais recentemente, a visão tradicional de obstrução dos capilares pulmonares por êmbolo de líquido amniótico, como explicação principal para a etiologia desta síndrome, tem sido desconsiderada, assumindo os fatores imunológicos e a ativação das cascatas de resposta inflamatória um papel importante. A embolia do líquido amniótico tem um carácter imprevisível, e o seu diagnóstico é exclusivamente clínico, sendo o tratamento sobretudo de suporte respiratório e cardiovascular, com a concomitante administração de derivados do sangue para corrigir a CID. Nenhum teste de diagnóstico é recomendado até o momento, embora vários marcadores do sangue periférico se encontrem em estudo. Os autores apresentam um caso clínico de uma mulher que sobreviveu a um quadro de embolia de líquido amniótico na sua gravidez prévia, e que teve uma gravidez subsequente sem recorrência do quadro, contribuindo com mais um testemunho clínico do baixo risco na gravidez pós-ELA.

Amniotic Fluid Embolism. Is a New Pregnancy Possible? Case Report.

Amniotic fluid embolism (AFE) is a rare but potentially catastrophic clinical condition, characterized by a combination of signs and symptoms that reflect respiratory distress, cardiovascular collapse and disseminated intravascular coagulation (DIC). Its pathogenesis is still unclear. More recently, the traditional view of obstruction of pulmonary capillary vessels by amniotic fluid emboli as the main explanation for the etiology has been ruled out, and immunologic factors and the activation of the inflammatory cascade took on an important role. Amniotic fluid embolism has an unpredictable character, its diagnosis is exclusively clinical, and the treatment consists mainly of cardiovascular support and administration of blood products to correct the DIC. No diagnostic test is recommended until now, though multiple blood markers are currently being studied. The authors present a case report of a woman who had survived AFE in her previous pregnancy and had a subsequent pregnancy without recurrence, providing one more clinical testimony of the low risks for the pregnancy after AFE.

A embolia do liquido amniótico (ELA) é uma situação clínica rara, mas potencialmente catastrófica, que se caracteriza por uma combinação de sinais e sintomas clínicos que refletem insuficiência respiratória aguda, colapso cardiovascular e coagulação intravascular disseminada (CID). A sua patogênese ainda não é totalmente compreendida. Mais recentemente, a visão tradicional de obstrução dos capilares pulmonares por êmbolo de líquido amniótico, como explicação principal para a etiologia desta síndrome, tem sido desconsiderada, assumindo os fatores imunológicos e a ativação das cascatas de resposta inflamatória um papel importante. A embolia do líquido amniótico tem um carácter imprevisível, e o seu diagnóstico é exclusivamente clínico, sendo o tratamento sobretudo de suporte respiratório e cardiovascular, com a concomitante administração de derivados do sangue para corrigir a CID. Nenhum teste de diagnóstico é recomendado até o momento, embora vários marcadores do sangue periférico se encontrem em estudo. Os autores apresentam um caso clínico de uma mulher que sobreviveu a um quadro de embolia de líquido amniótico na sua gravidez prévia, e que teve uma gravidez subsequente sem recorrência do quadro, contribuindo com mais um testemunho clínico do baixo risco na gravidez pós-ELA.

Systematic review of endometriosis pain assessment: how to choose a scale?

BACKGROUND: Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain. METHODS: A search of the MEDLINE and EMBASE databases was carried out for publications in English, French or Portuguese from 1980 to December 2012, for the words: endometriosis, treatment, pain. Studies were selected if they studied an endometriosis treatment and a pain scale was specified. A quantitative and a qualitative analysis of each scale was performed to define strong and weak points of each scale (systematic registration number: CRD42013005336). RESULTS: A total of 736 publications were identified. After excluding duplications and applying inclusion criteria 258 studies remained. We found that the visual analog scale (VAS) is the most frequently used scale. Both VAS and the numerical rating scale (NRS) show a good balance between strong and weak points in comparison with others such as the Biberoglu and Behrman scale. Concerning MCID, only VAS, NRS and Brief Pain Inventory scales have reported MCID and, among these, only VAS MCID has been studied in endometriosis patients (VAS MCID = 10 mm). Adding the Clinical Global Impression score (CGI) to the pain scale allows calculation of the MCID. CONCLUSIONS: When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response.

Unusual combination of gestational trophoblastic neoplasias: case report / Combinação rara de neoplasias trofoblásticas gestacionais: caso clínico

Gestational trophoblastic disease comprises a heterogeneous group of lesions arising from abnormal proliferation of trophoblastic cells. An elevation of human chorionic gonadotropin after evacuation of a molar pregnancy should suggest the hypothesis of a persistent gestational trophoblastic neoplasia. We present a rare case of coexistence of choriocarcinoma and placental-site trophoblastic tumor in the same tumor, whose diagnosis was made based on the correlation of morphological, microscopic and immunocytochemical studies, due to the difficulty in diagnosing these mixed tumors based on conventional histology only.

A doença trofoblástica gestacional compreende um grupo heterogêneo de lesões decorrentes da proliferação anormal de células trofoblásticas. A elevação da subunidade beta da gonadotrofina coriônica humana (β-hCG) após a evacuação de uma gravidez molar levanta a hipótese diagnóstica de neoplasia trofoblástica gestacional persistente. Apresentamos um caso raro de coexistência de coriocarcinoma e tumor trofoblástico do leito placentário em um mesmo tumor, cujo diagnóstico foi efetuado com base na correlação dos estudos morfológicos, microscópicos e imuno-histoquímicos, dada a dificuldade de diagnosticar esses tumores mistos com base apenas no exame histológico convencional.