Fernanda Pereira | Search PubMed

PubMed2006

White matter lesions in Fabry disease before and after enzyme replacement therapy: a 2-year follow-up.

PURPOSE: To report the clinical and neuroimaging, central nervous system (CNS) findings of patients with Fabry disease (FD) during 24 months of enzyme replacement therapy (ERT) with agalsidase-alpha. METHOD: Eight patients were included. Six completed 24 months of ERT. Clinical and magnetic resonance imaging (MRI) data were obtained at 0, 12 and 24 months of ERT. White matter lesions (WML) were evaluated as well as their relation to age, symptoms and neurological examination (CNS score). RESULTS: MRI was stable in 3 patients. WML and CNS score worsened in one patient, fluctuated in another, and improved in the sixth patient. In the whole series, there were 15 WML at baseline, and 19 at the 24th month. In two years, 4 lesions disappeared, whereas 8 appeared. CONCLUSION: A widespread pattern of silent WML in FD was seen. In two years, some WML appeared, and some disappeared. If these phenomena were related to the natural history, remains to be demonstrated.

Adult↗

PubMed2003

[Episiotomy -- routine versus selective use].

Episiotomy is a widely used surgical procedure, introduced in the medical practice with no support of its benefit from scientific evidence. It is still used routinely despite not accomplishing the major goals for which it was pretended. In fact, it does not decrease the risk of severe perineal lacerations, it fails to prevent the development of pelvic relaxation and it does not have any impact in newborn mortality or morbidity. Many trials, retrospective and prospective, have compared general versus selective use of episiotomy. A selective use is associated with better results, such as a decrease of severe lacerations, a highest number of women in whom the perineum remains intact, despite an increase in anterior lacerations. It seems correct to recommend a selective episiotomy, and many authors suggest the use of this procedure in 30% of the cases. It is now very important to improve new birthing techniques that maintain the integrity of the perineum and do not involve surgical procedures. More trials are necessary to clarify which are the real indications to use episiotomy. Meanwhile, without the proper scientific evidence, the most correct attitude seems to be a careful use of episiotomy, with decisions on a case-by-case basis.

Episiotomy↗