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Moleiro ML, Gouveia AB. Extra-abdominal Lymph Node Metastases as the First Presentation in Ovarian and Fallopian Tube Carcinomas. Reprod Sci 2023; 30:1017-1032. [PMID: 35941512 DOI: 10.1007/s43032-022-01049-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Abstract
Revision of ovarian and fallopian tube cancer presentation as extra-abdominal lymph nodes to understand the diagnostic challenges and prognostic features of these situations. Literature review in PubMed and Cochrane databases using the terms "ovarian cancer," "fallopian tube cancer," "extrapelvic lymph nodes," extra-abdominal lymph nodes," "distant lymph nodes," "initial presentation," "metastases," and "unusual presentation of ovarian cancer/unusual presentation of fallopian tube cancer" isolated and in conjunction. Articles in English were analyzed regarding revision's purpose, inclusion, and exclusion criteria and 65 were included in the final document. Statistical data was obtained with Microsoft Excel software analysis. Distant manifestations of ovarian cancer may occur through the lymphatic system and, less frequently, through hematogenous spread. These forms of spread may exist with almost no symptoms related to the primary cancer location and can justify distant disease at the initial presentation. Extra-abdominal lymph node involvement poses a clinical challenge for oncologists and oncologic gynecologists because it may occur with no or mild symptoms, and even in situations where no macroscopic disease is seen in the pelvic cavity. Histology and immunohistochemistry analyses together with a high level of suspicion are paramount to help in the diagnostic workup decisions and in finding a correct diagnosis when an extra-abdominal lymph node is the first manifested sign. Given its rarity and scarcity of information dispersed in a few case reports and small case series, further investigation is needed to understand the particularities of these tumors and their prognostic relevance.
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Affiliation(s)
- Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte - Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Alfredo Barroco Gouveia
- Clínica de Ginecologia, Instituto Português de Oncologia Do Porto Francisco Gentil, Porto, Portugal
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Maduro C, Castro LFD, Moleiro ML, Guedes-Martins L. Pregestational Diabetes and Congenital Heart Defects. Rev Bras Ginecol Obstet 2022; 44:953-961. [PMID: 36446562 PMCID: PMC9708403 DOI: 10.1055/s-0042-1755458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.
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Affiliation(s)
- Catarina Maduro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Address for correspondence Catarina Maduro, MSc Rua Jorge de Viterbo Ferreira 228, 4050-313, PortoPortugal
| | - Luís Ferreira de Castro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal,Unidade de Investigação e Formação, Centro Materno Infantil do Norte, Porto, Portugal,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Rocha AS, Andrade ARA, Moleiro ML, Guedes-Martins L. Doppler Ultrasound of the Umbilical Artery: Clinical Application. Rev Bras Ginecol Obstet 2022; 44:519-531. [PMID: 35405757 PMCID: PMC9948152 DOI: 10.1055/s-0042-1743097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To provide a survey of relevant literature on umbilical artery Doppler ultrasound use in clinical practice, technical considerations and limitations, and future perspectives. METHODS Literature searches were conducted in PubMed and Medline, restricted to articles written in English. Additionally, the references of all analyzed studies were searched to obtain necessary information. RESULTS The use of this technique as a routine surveillance method is only recommended for high-risk pregnancies with impaired placentation. Meta-analyses of randomized trials have established that obstetric management guided by umbilical artery Doppler findings can improve perinatal mortality and morbidity. The values of the indices of Umbilical artery Doppler decrease with advancing gestational age; however, a lack of consensus on reference ranges prevails. CONCLUSION Important clinical decisions are based on the information obtained with umbilical artery Doppler ultrasound. Future efforts in research are imperative to overcome the current limitations of the technique.
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Affiliation(s)
- Ana Sá Rocha
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Ana Rosa Araújo Andrade
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal.,Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Unidade de Investigação e Formação, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Abstract
A 72-year-old woman noted a lump in her left supraclavicular fossa with no other symptoms or other signs on physical exam. A cervical biopsy indicated metastatic carcinoma. On the diagnostic workup: thoracic-abdominal-pelvic CT revealed augmented lymph nodes (LNs) in the retroperitoneum; Positron Emission Tomography-CT showed uptake in the LNs described and in two small areas in the pelvis; blood tests showed elevated CA125 and CA72.4. Another biopsy, considering a para-aortic LN, proved to be metastasis of a high-grade serous carcinoma (HGSC). Gynaecological exam and pelvic imaging were innocent. Diagnostic laparoscopy, including hysterectomy and bilateral adnexectomy, was performed and anatomopathological examination confirmed a HGSC in the fallopian tube (FT), in a tiny focus of 1.5 mm. The patient continued treatment with adjuvant chemotherapy. Literature review indicates that supraclavicular LN as first manifestation of FT carcinoma is not usual, and widespread lymphadenopathies with no macroscopic pelvic disease at diagnosis are even rarer.
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Affiliation(s)
- Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte Dr Albino Aroso - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Helena Veloso
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte Dr Albino Aroso - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rafael Duarte Brás
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte Dr Albino Aroso - Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Alfredo Gouveia
- Clínica de Ginecologia, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
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Moleiro ML, Braga J, Machado MJ, Guedes-Martins L. Uterine Compression Sutures in Controlling Postpartum Haemorrhage: A Narrative Review. ACTA MEDICA PORT 2022; 35:51-58. [PMID: 32208130 DOI: 10.20344/amp.11987] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/06/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Postpartum haemorrhage is still the main cause of maternal morbidity and mortality. Many treatments are available, but they may threaten fertility potential. As a uterine sparing procedure, we aimed to review uterine compression sutures in order to better understand when they should represent an appropriate option. MATERIAL AND METHODS A comprehensive search in MEDLINE and PubMed databases including the terms 'postpartum haemorrhage' and 'uterine compression sutures' was performed. Results were revised and articles reviewing or presenting case reports of uterine compression sutures to treat postpartum haemorrhage were included. RESULTS The first description of uterine compression sutures to control postpartum haemorrhage was published in 1997, by B-Lynch et al. After this publication, many others have reported successful management of postpartum haemorrhage with different suturing techniques. Most of them describe success rates above 75% and the possibility of fertility preservation, with cases of uneventful pregnancy after uterine compression sutures already published. Complications associated with each technique are rare. DISCUSSION Reports of use of uterine compression sutures include small series of cases or even single case reports which limits the quality of existing evidence to support one technique over another. Nevertheless, uterine compression sutures are recognized as an effective surgical conservative strategy to control postpartum haemorrhage due to uterine atony and its use is recommended, if possible, prior to hysterectomy. CONCLUSION Uterine compression sutures are effective, safe and simple to perform in an emergent situation and preserve fertility potential in cases of postpartum haemorrhage.
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Affiliation(s)
- Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva. Centro Materno Infantil do Norte. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - Jorge Braga
- Departamento da Mulher e da Medicina Reprodutiva. Centro Materno Infantil do Norte. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | | | - Luís Guedes-Martins
- Departamento da Mulher e da Medicina Reprodutiva. Centro Materno Infantil do Norte. Centro Hospitalar Universitário do Porto. Porto. Unidade de Investigação e Formação. Centro Materno Infantil do Norte. Centro Hospitalar Universitário do Porto. Porto. Instituto de Investigação e Inovação em Saúde. Universidade do Porto. Porto. Portugal
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Moleiro ML, Guedes-Martins L. Prenatal diagnosis of absent pulmonary valve syndrome. BMJ Case Rep 2021; 14:14/1/e240567. [PMID: 33414127 PMCID: PMC7797262 DOI: 10.1136/bcr-2020-240567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Maria Lúcia Moleiro
- Department of Women and Reproductive Medicine, Centro Hospitalar do Porto, Porto, Portugal
| | - Luís Guedes-Martins
- Department of Women and Reproductive Medicine, Centro Hospitalar do Porto, Porto, Portugal
- Department of Experimental Biology, University of Porto, Porto, Portugal
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Braga M, Moleiro ML, Guedes-Martins L. Clinical Significance of Ductus Venosus Waveform as Generated by Pressure- volume Changes in the Fetal Heart. Curr Cardiol Rev 2019; 15:167-176. [PMID: 30644348 PMCID: PMC6719393 DOI: 10.2174/1573403x15666190115142303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 12/17/2022] Open
Abstract
The ductus venosus is a vascular shunt situated within the fetal liver parenchyma, connecting the umbilical vein to the inferior vena cava. This vessel acts as a bypass of the liver microcirculation and plays a critical role in the fetal circulation. The ductus venosus allows oxygenated and nutrient-rich venous blood to flow from the placenta to the myocardium and brain. Increased impedance to flow in the fetal ductus venosus is associated with fetal aneuploidies, cardiac defects and other adverse pregnancy outcomes. This review serves to improve our understanding of the mechanisms that regulate the blood flow redistribution between the fetal liver circulation and fetal heart and the clinical significance of the ductus venosus waveform as generated by pressure-volume changes in the fetal heart.
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Affiliation(s)
- Madalena Braga
- Instituto de Ciencias Biomedicas Abel Salazar, University of Porto, Porto, Portugal
| | - Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciencias Biomedicas Abel Salazar, University of Porto, Porto, Portugal.,Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Porto, Portugal.,Unidade de Investigacao e Formacao, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal.,Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal
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Moleiro ML, Zulmira R, Veloso H, Brás R, Reis R, Carvalho S, Morgado A. Hyaluronic acid gel after ressectoscopy for uterine synechiae in perimenopause - case report. Maturitas 2019. [DOI: 10.1016/j.maturitas.2019.04.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Moleiro ML, Guedes-Martins L, Mendes A, Marques C, Braga J. Authors' Reply. Rev Bras Ginecol Obstet 2019; 41:207-208. [PMID: 30991434 PMCID: PMC10316821 DOI: 10.1055/s-0039-1683361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Maria Lúcia Moleiro
- Woman's and Reprodutive Medicine Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Guedes-Martins
- Woman's and Reprodutive Medicine Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Alexandrina Mendes
- Woman's and Reprodutive Medicine Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Cláudia Marques
- Woman's and Reprodutive Medicine Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Braga
- Woman's and Reprodutive Medicine Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Moleiro ML, Guedes-Martins L, Mendes A, Marques C, Braga J. Modified Pereira Suture as an Effective Option to Treat Postpartum Hemorrhage due to Uterine Atony. Rev Bras Ginecol Obstet 2018; 40:92-95. [PMID: 29490413 PMCID: PMC10316881 DOI: 10.1055/s-0037-1613690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Nowadays, postpartum hemorrhage is the major cause of maternal mortality and morbidity worldwide. Uterine atony is its main cause; thus, prophylactic measures, as well as medical and surgical fast approaches, have been developed to manage it. The uterine compression sutures are a possible treatment that preserves the uterus and, consequently, the fertility potential. Bearing that in mind, we report two cases of postpartum hemorrhage after caesarean section, successfully treated with a new modification of Pereira suture - longitudinal and transverse uterine sutures were applied after no response was registered to the first-line therapies. Both women recovered, and the postpartum evaluation revealed a normal uterus with an adequate blood supply, suggesting potential fertility, as described in the literature regarding this kind of therapeutic approach.
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Affiliation(s)
- Maria Lúcia Moleiro
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Guedes-Martins
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Alexandrina Mendes
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Cláudia Marques
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Braga
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
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