Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n=129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR]=1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR=1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR=2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR=0,732; 95%CI: 0.240-2.232), TTN (OR=0.959; 95%CI: 0.297--3.091), and NIUC admission (OR=0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

Abstract Overview and aims: Surgery for Pelvic Organ Prolapse (POP) is increasing with the aging of population. When maintenance of vaginal length and coital function is not a surgical goal, obliterative surgery is effective for POP treatment, especially in women with comorbidities. Our primary study goal was to evaluate the objective and subjective cure rates of different obliterative surgeries. We also aimed to characterize this population of women and the complications of this type of surgery. Study design: We conducted an observational retrospective cohort study Population: 82 patients who underwent obliterative surgery as a treatment for primary or recurrent POP. Methods: Retrospective review of clinical charts, with descriptive and bivariate analysis. Results: All women were sexually inactive and their mean age was 77.3 years-old. Overall, they had excessive weight and 97.6% of them had a POP-Q stage of III or more. The majority of these women had two or more comorbidities at time of surgery, and cardiovascular disease was the most severe in 40% of them. Twenty eight percent of them had already underwent a surgery for POP. There were only two cases of minor complications after surgery, specifically lower urinary tract infection. Overall, objective cure rate was 89.7% and subjective cure rate was 98.5%, for a mean time of follow-up of 18.5 months. We found no differences between different obliterative procedures. De novo urge urinary incontinence developed in 22% of patients. Conclusions: Obliterative surgery is a good treatment option for severe POP, especially in women with anesthetic risk and no desire for future vaginal coitus. In our cohort we found excellent objective and subjective POP cure rates after obliterative surgeries, combined with low risks..

Resumo O hiperparatiroidismo primário é umdistúrbio endócrino caraterizado pela elevação do cálcio sérico associada a níveis de paratormona elevados ou inapropriadamente normais. O diagnóstico é baseado em análises bioquímicas, e, na gravidez, o exame de imagem de primeira linha é a ecografia cervical. É uma doença rara na gravidez, e pode se apresentar com complicações ameaçadoras de vida, pelo que o seu diagnóstico é desafiante. O tratamento médico disponível é limitado, havendo poucos dados relativos à sua eficácia e segurança na gravidez. A cirurgia é o único tratamento curativo, e pode ser realizada no segundo ou terceiro trimestres. Tem sido descrita uma relação entre hiperparatiroidismo primário e pré-eclâmpsia. Apresenta-se um caso de uma grávida de 27 semanas com pré-eclâmpsia com critérios de gravidade, o que obrigou ao término da gravidez por cesariana. Verificou-se agravamento clínico no período pós-parto, com aparecimento de complicações graves, tais como hipercalcemia grave e pancreatite aguda. Ecograficamente, constataram-se duas massas paratiróideias sugestivas de adenomas da paratiroide. A doente recebeu tratamento médico, e teve melhora apenas após a correção dos níveis de cálcio sérico.

Abstract Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsiamotivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.

Overview and aims: Breast tumors that invade or are proximal to the nipple-areolar complex (NAC) have been classically treated with mastectomy. As an alternative, on the edge of breast conserving surgery, these cases may be approached using central lumpectomy and immediate reconstruction with Grisotti flap. The aim of this study was to determine the involved margins rate and locoregional and systemic relapse rates in patients that underwent this surgical technique. Study Design: Retrospective observational descriptive study. Population: Women that underwent central lumpectomy and Grisotti flap reconstruction in our center, during a 4-year period. Methods: We reviewed clinical charts on patients’ data including: diagnosis, indication for surgery, pathological findings, adjuvant treatments and relapse. Descriptive and bivariate analysis was performed. Results: A total of 45 women were enrolled in the study. From these, 82.2% had invasive breast cancer, and the others had in situ disease. For characterization of tumor proximity to NAC, all patients were evaluated using Magnetic Resonance Imaging. All women underwent central lumpectomy with NAC excision, followed by Grisotti flap reconstruction. From these, 68.9% also underwent contralateral symmetrization on the same operating time. Also, in 80% we were able to perform sentinel lymph node biopsy and in 20% axillary lymphadenectomy was done. Median surgery duration was 71 minutes and median in-hospital stays was 1 day. In two cases, positive margins were present and reintervention was necessary. Considering other cancer treatments, 8.9% underwent neoadjuvant chemotherapy, 48.9% adjuvant chemotherapy, 93.3% radiotherapy and 88.9% hormonal therapy. For a median follow-up time of 31 months, we report one case of locoregional relapse and one case of systemic relapse. Conclusions: Central lumpectomy combined with immediate Grisotti flap reconstruction is a good alternative for centrally located breast tumors. We report low positive margins rates (4.4%) and low relapse rates (2.3% for locoregional and 2.3% for systemic relapse).