RESUMO
Abstract Introduction and hypothesis Internal vaginal pessary is among the leading treatments for pelvic organ prolapse (POP); however, it has a high adverse event rate. An external pessary was recently developed as an alternative. The study's objective was to compare the efficacy of external and internal pessaries in treating POP in postmenopausal women. Methods This parallel randomized (1:1 ratio) open-blind study included 40 symptomatic women with stage 2 or 3 POP. They were randomized into two groups: group 1 (internal pessary) and group 2 (external pessary) (n = 20 in each); and evaluated at the start of and 3 months after the treatment. Statistical analysis was performed to compare the results within and between the groups before and after the 3-month treatment. Results The groups were homogeneous, except for the variables previous pregnancies (p = 0.030) and POP-Q score of apical prolapse (p = 0.023) whose values were higher in group 2. A significant improvement in quality of life was observed in both groups after 3 months of follow-up; however, internal pessaries were found to be more effective (p < 0.001). In group 1 there were differences between the initial and final POP-Q scores of anterior (0.004) and apical prolapse (p = 0.005). The complication rate associated with internal pessary use was high (p = 0.044). Conclusions The present data suggested that external pessaries have a similar effect to internal ones for the treatment of POP and improvement of the quality of life of postmenopausal women.
RESUMO
A síndrome de Hamman foi descrita pela primeira vez por Louis Hamman, em 1939, como "enfisema mediastinal espontâneo" e corresponde à presença de ar livre no mediastino, sem relação com trauma e/ou procedimentos invasivos na região torácica. A condição apresenta sintomas inespecíficos como dor torácica, dispneia, tosse, disfonia, disfagia e dor cervical. Devido aos sinais e sintomas inespecíficos, essa condição pode ser subdiagnosticada, contribuindo para a sua baixa incidência. O diagnóstico é estabelecido com exames de imagem como radiografia e tomografia computadorizada de tórax. No relato de caso descrito, temos uma paciente de 31 anos, gestante, G2P1A0, que desenvolve a síndrome concomitantemente a episódios de hiperêmese gravídica com cinco semanas e cinco dias de idade gestacional. O objetivo deste relato concentra-se em destacar essa hipótese diagnóstica para assistência adequada à paciente, uma vez que tal condição não faz parte do escopo cotidiano dentro da obstetrícia.(AU)
Hamman's syndrome was first described by Louis Hamman in 1939 as "spontaneous mediastinal emphysema" and is characterized by the presence of air in the mediastinum, unrelated to trauma, and/or invasive procedures in the thoracic region. The condition presents nonspecific symptoms such as thoracic pain, cervical pain, dyspnea, cough, and dysphonia. Due to the nonspecific signs and symptoms, this condition can be misdiagnosed, contributing to its low incidence. A diagnosis is established through imaging examinations such as chest radiography and computerized tomography. Here, we report the case of a 31-year-old female who developed Hamman's syndrome concomitantly with episodes of severe hyperemesis when she was five weeks and five days pregnant. Hamman's syndrome is a rare presentation in the field of obstetrics. This report seeks to highlight how Hamman's syndrome was diagnosed, discuss the care given to the patient, and explain the correlation between hyperemesis gravidarum and Hamman's syndrome.(AU)