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Dissertations / Theses on the topic 'Gestational trophoblastic disease. eng'

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Published: 4 June 2021
Last updated: 1 February 2022

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1

Soares, Patrícia Daniela Paranhos Batista. "Distribuição geográfica e características demográficas da doença trofoblástica gestacional em centro de referência terciária do Estado da Bahia, Brasil /." Botucatu : [s.n.], 2009. http://hdl.handle.net/11449/91394.

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Resumo: Traçar um padrão de distribuição geográfica da doença trofoblástica gestacional (DTG) em centro de referência do estado da Bahia, no Nordeste do Brasil e determinar as características demográficas na apresentação da doença. Estudo observacional descritivo com dados obtidos de prontuários de 140 pacientes com DTG encaminhadas ao Centro de Doença Trofoblástica Gestacional da Maternidade Climério de Oliveira, no estado da Bahia, Brasil, de 2002 a 2007. Foi feita uma distribuição geográfica das pacientes com DTG, nas macrorregiões de saúde e foram avaliadas variáveis demográficas, fonte de referência, e tipo de gestação antecedente. Para análise estatística foi usado teste qui-quadrado (p<0,05%). A principal procedência das pacientes foi da macrorregião de saúde Leste (77,9%). A incidência da DTG no centro de referência foi de 8,5/1.000 partos. A faixa etária foi predominante de 20 a 34 anos (65%). Uma pequena proporção de pacientes estava trabalhando (42,9%). O nível educacional foi baixo: 67,9% das pacientes cursaram apenas o ensino fundamental. Hospitais secundários foram a principal fonte de referência de pacientes (84,3%). A maioria das pacientes teve gestação de termo prévia à DTG (42,1%). Neste estudo, a DTG predominou na melhor faixa etária para fecundidade e em pacientes com aspectos sócio-demográficos desfavoráveis. A tendência de referência dessas pacientes foi principalmente da macrorregião de saúde Leste.
Abstract: To outline the geographical distribution pattern of gestational trophoblastic disease (GTD) in a referral center located in the state of Bahia, northeastern Brazil, and to determine the demographic characteristics in the presentation of the disease. Observational, descriptive study of the data retrieved from the medical records of 140 GTD patients referred to the Gestational Trophoblastic Disease Center of Climério de Oliveira Maternity, Bahia, Brazil between 2002 and 2007. The geographical distribution of GTD patients across healthcare macroregions was determined and demographic variables, referral sources and type of previous gestation were assessed. Statistical analysis was performed using the chi-square test (p<0.05%). Results: The majority of the patients originated from the East Healthcare Macroregion (77.9%). DTG incidence at the referral Center was 8.5/1.000 deliveries. The 20-34-year age group predominated (65%). A small percentage of the patients was employed (42.9%). Education level was low: 67.9% of the patients attended only elementary school. Secondary hospitals were the principal sources of patient referral (84.3%). In most cases (42.1%), GTD was preceded by term gestation. DTG predominated in the peak fertility age group and among patients of unfavorable socio-demographic status. Most referred patients tended to come from the East Healthcare Macroregion.
Orientador: Marilza Vieira Cunha Rudge
Coorientador: Izildinha Maestá
Coorientador: Olívia Lúcia Nunes Costa
Banca: Raul Cortes Charry
Banca: Sue Iazaki Sua
Mestre
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2

Braga, Neto Antônio Rodrigues. "Influência da quimioterapia para neoplasia trofoblástica gestacional sobre a gravidez: resultados maternos e perinatais /." Botucatu : [s.n.], 2007. http://hdl.handle.net/11449/95363.

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Resumo: Objetivo. Avaliar a influência da quimioterapia no resultado da primeira gravidez após a neoplasia trofoblástica gestacional (NTG). Pacientes e Métodos. Trata-se do estudo observacional restropsectivo e comparativo, realizado em 3590 pacientes acompanhadas com doença trofoblástica gestacional (DTG) no centro de NTG da Santa Casa Misericórdia do Rio de Janeiro, entre janeiro de 1960 e dezembro de 2005. Destas 867 reternaram grávidas e tiveram seus resultados obstétricos e perinatais confrontados entre grupos que cursaram com remissão espontânea (RE) e NTG, subgrupos de pacientes com NTG que engravidaram com menos de 6 meses, entre os 6 e 12 meses e com mais de 12 meses da última sessão de quimioterapia, e que receberam quioterapia por agente único (NTG-M) ou multiplos agentes (NTG-P)... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Objective. To evaluate the influence to chemoterapy on the results of the first pregnancy after gestational trophoblastic neoplasia (GTN). Patients and methods. It is an obsrvational, retrospective and comparative study comprising 3590 patients followed for gestational trophoblastic disease (GTD) at Santa Casa de Misericórdia do Rio de Janeiro GTN Center between January 1960 and December 2005... (Complete abstract click electronic access below)
Orientador: Izildinha Maestá
Coorientador: Odair Carlito Michelin
Banca: Luiz Camano
Banca: Paulo Belfort
Mestre
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3

Ferreira, Érika Goulart Veloso. "Avaliação da qualidade de vida e aspectos psicológicos em pacientes com doença trofoblástica gestacional /." Botucatu : [s.n.], 2008. http://hdl.handle.net/11449/99253.

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Abstract: Objective: to assess quality of life and psychological aspects in patients with gestational trophoblastic disease (GTD). Methods: This cross-sectional self-report study was carried out among 54 women treated at Botucatu Trophoblastic Diseases Center, São Paulo, Brazil. Validated questionnaires were used to assess quality of life (QoL) (WHOQOL-bref), symptoms of depression (Beck Depression Inventory-BDI) and anxiety (State-Trait Anxiety Inventory -STAI). Results: Most patients rated overall QoL as good (44.44%), and were satisfied with their health status (42.59%). However, these findings did not reach statistical significance. Mean QoL domain score was the highest for psychological health (53.86 ± 21.46), and the lowest for social relationships (65.74 ± 22.41). BDI mean was 15.81 ± 11.15, indicating dysphoria. STAI means were 46 ± 6.46 for trait-anxiety, and 43.72 ± 4.23 for state-anxiety, both evidencing medium-high anxiety. Among patients who were employed, the environment domain mean was the highest (p=0.024). The presence of children prior to disease onset resulted in the lowest means for physical health (p=0,041) and environment (p=0.045). The patients desiring to have children showed significantly higher means for physical health (p=0.004), psychological health (p=0.021) and environment (p=0.003). The need for chemotherapy to achieve complete response had no significant influence on QoL. Conclusion: This study evidenced the psychological impact on GTD patients. This information suggests that specialized care centers should provide psychological interventions during the treatment and follow-up of GTD patients... (Complete abstract click electronic access below)
Orientador: Marilza Vieira Cunha Rudge
Coorientador: Izildinha Maestá
Banca: Rafael Cortes-Chary
Banca: Olivia Lucia Costa
Mestre
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4

Lai, Yau-lin Caroline, and 黎幼蓮. "Genotyping of gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hdl.handle.net/10722/209581.

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5

Lai, Yau-lin Caroline. "Genotyping of gestational trophoblastic disease." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk/hkuto/record.jsp?B23427383.

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6

Cheung, Nga-yin Annie. "Pathobiological study of gestational trophoblastic disease." Click to view the E-thesis via HKUTO, 1999. http://sunzi.lib.hku.hk/hkuto/record/B31981690.

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7

Cheung, Nga-yin Annie, and 張雅賢. "Pathobiological study of gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31981690.

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8

何柏松 and Pak-chung Ho. "Immunological studies in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1989. http://hub.hku.hk/bib/B31981343.

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9

方佩儀 and Pui-yee Fong. "Differential gene expression in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31224362.

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10

Lee, Lee, and 李莉. "The ASPP family in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40738486.

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11

Tam, Hoi-lam Elizabeth, and 譚凱琳. "FBI-1 amplification in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206493.

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Gestational Trophoblastic Disease (GTD) encompasses a spectrum of disease that involves abnormal trophoblastic proliferation. It includes hydatidiform mole (HM), placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor (ETT) and choriocarcinoma (CCA). While HMs are abnormal pregnancies with limited invasive potential, CCAs are true malignancies requiring chemotherapy. Although the majority of HM is resolved by surgical intervention, approximately 8-30% of them would develop into persistent GTD. In addition to that, being the most aggressive neoplasm in GTD, choriocarcinoma is a frankly malignant gestational trophoblastic neoplasm (GTN) that could be arisen from HM and could be fetal when widespread metastasis is developed. However, the underlying mechanisms of this disease progression are still unclear. FBI-1 (Factor that Binds to Inducer of Short Transcripts (IST) protein 1) is a transcription factor that has been observed to be overexpressed in various types of human cancers. Recently, overexpression of FBI-1 is also reported in GTD and also in association with GTN development. However, the causes of FBI-1 overexpression in GTD are still unclear. This study aims to investigate gene amplification as a possible cause of FBI-1 overexpression in GTD. A quantitative real time PCR (qPCR) assay was established and was used to investigate ZBTB7A (the gene encoding FBI-1) amplification in GTD cell lines and clinical samples. Using our qPCR assay, we demonstrated that ZBTB7A is not amplified in the CCA cell lines JEG-3 and JAR, in comparison with an immortalized trophoblast cell line HTR-8/SVneo. Testing ZBTB7A amplification in clinical samples also obtained similar findings although overexpression of FBI-1 was demonstrated in our previous studies. This is the first report illustrating absence of ZBTB7A amplification in cells with FBI-1 overexpression. There are other techniques that can detect gene amplification and/or other genetic and epigenetic mechanisms that may govern FBI-1 expression in GTD. Further studies will be worthwhile to pursue as FBI-1 is a potential target for cancer therapy.
published_or_final_version
Pathology
Master
Master of Medical Sciences
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12

Fong, Pui-yee. "Differential gene expression in gestational trophoblastic disease /." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B23440132.

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13

Lee, Lee. "The ASPP family in gestational trophoblastic disease." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40738486.

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14

楊雋永 and Chun-wing Yeung. "PAK1, PAK2 and PAK4 in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40721905.

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15

Chiu, Ka-yue, and 招家裕. "The role of FoxD3 in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48333633.

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Gestational trophoblastic disease (GTD) is arised from the neoplastic trophoblasts in placenta. Trophoblasts have the characteristic of proliferation and invasion. GTD is classified as partial hydatidiform mole (PHM), complete hydatidiform form mole (CHM), invasive hydatidiform mole (IHM), choriocarcinoma (CCA), placental site trophoblastic tumour (PSTT), epithelioid trophoblastic tumour (ETT), exaggerated placental site trophoblastic reaction (EPSR) and placental site nodule (PSN). HM has the potential to develop into malignant trophoblastic disease, and metastasis to other parts of body. FoxD3 gene belongs to Forkhead family. Its protein acts as embryonic stem cell transcription factor and plays an important role in neural crest and placenta development. Previous studies from our team have reported that other embryonic stem cell transcription factors, such as Nanog, Sox2 Oct4 and Stat3, are related with pathogenesis of GTD. This study aim is to investigate the protein expression profile of FoxD3 in different types of GTD using immunohistochemistry method. In this study, 70 formalin fixed paraffin embedded tissue blocks from 16 normal first trimester placenta, 38 CHM, 9 CCA, 5 PSTT and 2 ETT were retrieved. Paraffin sections were prepared and stained with FoxD3 antibody by using immunohistochemistry method. Compared with normal placentas, there was significantly increased expression of FoxD3 in trophoblasts of CM and PSTT (p<0.05). In CCA, there was high expression of FoxD3 in syncytiotrophoblasts and intermediate trophoblasts (p<0.05). In ETT, the immunoreactivity of FoxD3 is not significantly increased when compared with intermediate trophoblasts (p=0.07). To conclude, FoxD3 was found to be over-expressed in GTD. FoxD3 may contribute to pathogenesis of GTD. Further investigations are needed to discover the relationship with other embryonic transcription factors and genes to improve the diagnosis, prognosis and treatment of GTD.
published_or_final_version
Pathology
Master
Master of Medical Sciences
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16

Yeung, Chun-wing. "PAK1, PAK2 and PAK4 in gestational trophoblastic disease." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40721905.

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17

Ho, Wing-kiu Joanna, and 何泳翹. "Role of kinesin superfamily 7 in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4659985X.

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18

Mak, Chun-yin, and 麥俊然. "Molecular studies on ASPP and FBI-1 in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B47236279.

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Gestational trophoblastic disease (GTD) encompasses a heterogeneous group of trophoblastic lesions. It includes hydatidiform mole (HM), choriocarcinoma (CCA), placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). While the latter three are classical malignancies, HM represents abnormal placenta harbouring malignant potential and may develop persistent gestational trophoblastic neoplasm (GTN) requiring therapy. Apoptotic activity and p53 are known to be important in pathogenesis of GTD. However, understanding on the underlying mechanisms is still limited. ASPP1 and ASPP2 are the two tumour suppressor members of the apoptosis stimulating protein of p53 (ASPP) family that stimulate p53-dependent apoptotic pathway. In this study, a differential downregulation of ASPP1 and ASPP2 was observed in GTD, illustrating their distinct roles in the pathogenesis. Results showed that both ASPP1 mRNA and protein levels were significantly downregulated in HM and CCA, when compared with normal placentas by quantitative polymerase chain reaction (qPCR) and immunohistochemistry. Methylation-specific polymerase chain reaction (MS-PCR) in placenta and GTD samples demonstrated a significant correlation between ASPP1 mRNA level and their hypermethylation status (P = 0.024). Most importantly, lower ASPP1 immunoreactivity was found in HM that progressed into persistent GTN than HM that regressed (P = 0.045). Significant correlation was also found between expression of ASPP1 and apoptotic activity (M30 CytoDeath index), p53 and caspase-8 immunoreactivities. In CCA cell lines, namely JEG-3 and JAR, ectopic expression of ASPP1 triggered apoptosis through intrinsic and extrinsic pathways as indicated by an increase in cleaved caspase-9 and Fas ligand protein expression, demonstrating a potent tumour suppressive function through its proapoptotic nature. Downregulation of ASPP2 was mainly detected in choriocarcinoma, the most aggressive form of GTD. In vitro, results showed that ASPP2 was a multi-functional protein with activities not limited to apoptosis stimulation. While activated Src is important in tumour progression, transfection of ASPP2 but not ASPP1 was found to be related to decreased Src-pY416 phosphorylation. This suggested an inactivating effect of ASPP2 on Src. Moreover, this ASPP2-induced inactivation of Src could be abolished by RNA interference (RNAi) with Csk small interfering RNA. Corresponding effect on aggressive behaviors such as cell migration was also confirmed. Hence, loss of ASPP2 in the choriocarcinoma implicates its crucial role in tumourigenesis. FBI-1 is a transcription factor frequently overexpressed in human cancers. Recently, overexpression of FBI-1 in GTD in association with GTN development was also reported. However, its role in GTD pathogenesis remains elucidated at molecular basis. This study unveiled the ability of FBI-1 in contributing overt aggressiveness in GTD. Ectopic FBI-1 expression resulted in decrease in apoptosis and repression of pro-apoptotic genes such as Bak, Fas and caspase-8 at mRNA level in vitro. FBI-1 overexpression also promoted Akt activation as indicated by Akt-pS473 phosphorylation. Interestingly, effect of FBI-1 on cell motility and invasiveness was eradicated in the presence of specific PI3 kinase inhibitor LY294002. This demonstrated that FBI-1 could promote cell migration and invasion through PI3K/Akt signaling. In summary, this study highlighted the effects of dysregulated ASPP and FBI-1 in apoptosis and aggressiveness, implicating their crucial roles in pathogenesis in GTD.
published_or_final_version
Pathology
Doctoral
Doctor of Philosophy
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19

Feng, Huichen. "Gene expression profile in human trophoblast and gestational trophoblastic disease." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31384742.

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20

Feng, Huichen, and 馮會臣. "Gene expression profile in human trophoblast and gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31384742.

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21

Xue, Weicheng, and 薛衛成. "Molecular cytogenetic, epigenetic and tissue dynamic study of gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B45015144.

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22

Zhang, Huijuan. "PKB/PAK4 and stem cell related signaling pathways in gestational trophoblastic disease." Click to view the E-thesis via HKUTO, 2010. http://sunzi.lib.hku.hk/hkuto/record/B44249937.

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23

Zhang, Huijuan, and 张慧娟. "PKB/PAK4 and stem cell related signaling pathways in gestational trophoblastic disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44249937.

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24

張綺雲 and Yee-wan Cheung. "Quantitative analysis of hTERT mRNA expression in gestational trophoblastic disease by real-time PCR." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31970436.

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25

Cheung, Yee-wan. "Quantitative analysis of hTERT mRNA expression in gestational trophoblastic disease by real-time PCR." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25139198.

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26

Wongweragiat, Sutatip. "Trophoblast proliferation and invasion in gestational trophoblastic disease : a study of decidual leucocytes and cytokines." Thesis, University of Newcastle Upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.366572.

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27

Ferreira, Érika Goulart Veloso [UNESP]. "Avaliação da qualidade de vida e aspectos psicológicos em pacientes com doença trofoblástica gestacional." Universidade Estadual Paulista (UNESP), 2008. http://hdl.handle.net/11449/99253.

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Objective: to assess quality of life and psychological aspects in patients with gestational trophoblastic disease (GTD). Methods: This cross-sectional self-report study was carried out among 54 women treated at Botucatu Trophoblastic Diseases Center, São Paulo, Brazil. Validated questionnaires were used to assess quality of life (QoL) (WHOQOL-bref), symptoms of depression (Beck Depression Inventory-BDI) and anxiety (State-Trait Anxiety Inventory –STAI). Results: Most patients rated overall QoL as good (44.44%), and were satisfied with their health status (42.59%). However, these findings did not reach statistical significance. Mean QoL domain score was the highest for psychological health (53.86 ± 21.46), and the lowest for social relationships (65.74 ± 22.41). BDI mean was 15.81 ± 11.15, indicating dysphoria. STAI means were 46 ± 6.46 for trait-anxiety, and 43.72 ± 4.23 for state-anxiety, both evidencing medium-high anxiety. Among patients who were employed, the environment domain mean was the highest (p=0.024). The presence of children prior to disease onset resulted in the lowest means for physical health (p=0,041) and environment (p=0.045). The patients desiring to have children showed significantly higher means for physical health (p=0.004), psychological health (p=0.021) and environment (p=0.003). The need for chemotherapy to achieve complete response had no significant influence on QoL. Conclusion: This study evidenced the psychological impact on GTD patients. This information suggests that specialized care centers should provide psychological interventions during the treatment and follow-up of GTD patients... (Complete abstract click electronic access below)
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28

Asmar, Flavia Tarabini Castellani [UNESP]. "Associação da Dopplervelocimetria das artérias uterinas com a evolução clínica da Mola hidatiforme." Universidade Estadual Paulista (UNESP), 2015. http://hdl.handle.net/11449/140237.

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Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia (GTN). However, there is limited information on whether uterine artery Doppler flow velocimetry (DFV) can predict GTN following complete hydatidiform mole (CHM). The purpose of this study was: 1) to compare uterine blood flow before and after CHM evacuation between women who developed post-molar GTN and those who achieved spontaneous remission; 2) to assess the usefulness of uterine DFV parameters as predictors of post-CHM GTN, and to determine the best parameters and cutoff values for predicting post-CHM GTN. Methods. This prospective cohort study included246 CHM patients attending three trophoblastic diseases centers (Botucatu -Sao Paulo State University, Rio de Janeiro Federal University and Fluminense Federal University) between 2013 and 2014. Pulsatility index (PI), resistivity index (RI), and sistolic/dyastolic ratio (S/D) were measured by DVF before and 4-6 weeks post CHM evacuation. Statistical analysis was performed using Wilcoxon's test, logistic regression and ROC analysis. Results. No differences in pre- and postevacuation DVF measurements were observed in patients who developed post-CHM GTN. In those that achieved spontaneous remission, PI and SD were increased after evacuation. Pre- and post-evacuation PI was significantly lower in patients who developed GTN with estimates of odds ratio of 13.9-30.5. Pre-evacuation PI ≤1.38 (77% sensitivity, 82% specificity), and post-evacuation PI≤1.77 (79% sensitivity, 86% specificity) were significantly predictive of GTN. Conclusions. Uterine DFV measurements, particularly pre- and post-molar evacuation PI, can be useful for predicting post-CHM GTN
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29

Asmar, Flavia Tarabini Castellani. "Associação da Dopplervelocimetria das artérias uterinas com a evolução clínica da Mola hidatiforme." Botucatu, 2015. http://hdl.handle.net/11449/140237.

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Orientador: Izildinha Maestá
Coorientador: Marcos Consonni
Banca: Joelcio Francisco Abbade
Banca: Antonio Rodrigues Braga Neto
Resumo: Não disponível
Abstract: Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia (GTN). However, there is limited information on whether uterine artery Doppler flow velocimetry (DFV) can predict GTN following complete hydatidiform mole (CHM). The purpose of this study was: 1) to compare uterine blood flow before and after CHM evacuation between women who developed post-molar GTN and those who achieved spontaneous remission; 2) to assess the usefulness of uterine DFV parameters as predictors of post-CHM GTN, and to determine the best parameters and cutoff values for predicting post-CHM GTN. Methods. This prospective cohort study included246 CHM patients attending three trophoblastic diseases centers (Botucatu -Sao Paulo State University, Rio de Janeiro Federal University and Fluminense Federal University) between 2013 and 2014. Pulsatility index (PI), resistivity index (RI), and sistolic/dyastolic ratio (S/D) were measured by DVF before and 4-6 weeks post CHM evacuation. Statistical analysis was performed using Wilcoxon's test, logistic regression and ROC analysis. Results. No differences in pre- and postevacuation DVF measurements were observed in patients who developed post-CHM GTN. In those that achieved spontaneous remission, PI and SD were increased after evacuation. Pre- and post-evacuation PI was significantly lower in patients who developed GTN with estimates of odds ratio of 13.9-30.5. Pre-evacuation PI ≤1.38 (77% sensitivity, 82% specificity), and post-evacuation PI≤1.77 (79% sensitivity, 86% specificity) were significantly predictive of GTN. Conclusions. Uterine DFV measurements, particularly pre- and post-molar evacuation PI, can be useful for predicting post-CHM GTN
Mestre
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30

Braga, Neto Antônio Rodrigues [UNESP]. "Influência da quimioterapia para neoplasia trofoblástica gestacional sobre a gravidez: resultados maternos e perinatais." Universidade Estadual Paulista (UNESP), 2007. http://hdl.handle.net/11449/95363.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Fundação para o Desenvolvimento Médico e Hospitalar (Famesp)
Objetivo. Avaliar a influência da quimioterapia no resultado da primeira gravidez após a neoplasia trofoblástica gestacional (NTG). Pacientes e Métodos. Trata-se do estudo observacional restropsectivo e comparativo, realizado em 3590 pacientes acompanhadas com doença trofoblástica gestacional (DTG) no centro de NTG da Santa Casa Misericórdia do Rio de Janeiro, entre janeiro de 1960 e dezembro de 2005. Destas 867 reternaram grávidas e tiveram seus resultados obstétricos e perinatais confrontados entre grupos que cursaram com remissão espontânea (RE) e NTG, subgrupos de pacientes com NTG que engravidaram com menos de 6 meses, entre os 6 e 12 meses e com mais de 12 meses da última sessão de quimioterapia, e que receberam quioterapia por agente único (NTG-M) ou multiplos agentes (NTG-P)...
Objective. To evaluate the influence to chemoterapy on the results of the first pregnancy after gestational trophoblastic neoplasia (GTN). Patients and methods. It is an obsrvational, retrospective and comparative study comprising 3590 patients followed for gestational trophoblastic disease (GTD) at Santa Casa de Misericórdia do Rio de Janeiro GTN Center between January 1960 and December 2005... (Complete abstract click electronic access below)
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31

Soares, Patrícia Daniela Paranhos Batista [UNESP]. "Distribuição geográfica e características demográficas da doença trofoblástica gestacional em centro de referência terciária do Estado da Bahia, Brasil." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/91394.

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Financiadora de Estudos e Projetos (FINEP)
Traçar um padrão de distribuição geográfica da doença trofoblástica gestacional (DTG) em centro de referência do estado da Bahia, no Nordeste do Brasil e determinar as características demográficas na apresentação da doença. Estudo observacional descritivo com dados obtidos de prontuários de 140 pacientes com DTG encaminhadas ao Centro de Doença Trofoblástica Gestacional da Maternidade Climério de Oliveira, no estado da Bahia, Brasil, de 2002 a 2007. Foi feita uma distribuição geográfica das pacientes com DTG, nas macrorregiões de saúde e foram avaliadas variáveis demográficas, fonte de referência, e tipo de gestação antecedente. Para análise estatística foi usado teste qui-quadrado (p<0,05%). A principal procedência das pacientes foi da macrorregião de saúde Leste (77,9%). A incidência da DTG no centro de referência foi de 8,5/1.000 partos. A faixa etária foi predominante de 20 a 34 anos (65%). Uma pequena proporção de pacientes estava trabalhando (42,9%). O nível educacional foi baixo: 67,9% das pacientes cursaram apenas o ensino fundamental. Hospitais secundários foram a principal fonte de referência de pacientes (84,3%). A maioria das pacientes teve gestação de termo prévia à DTG (42,1%). Neste estudo, a DTG predominou na melhor faixa etária para fecundidade e em pacientes com aspectos sócio-demográficos desfavoráveis. A tendência de referência dessas pacientes foi principalmente da macrorregião de saúde Leste.
To outline the geographical distribution pattern of gestational trophoblastic disease (GTD) in a referral center located in the state of Bahia, northeastern Brazil, and to determine the demographic characteristics in the presentation of the disease. Observational, descriptive study of the data retrieved from the medical records of 140 GTD patients referred to the Gestational Trophoblastic Disease Center of Climério de Oliveira Maternity, Bahia, Brazil between 2002 and 2007. The geographical distribution of GTD patients across healthcare macroregions was determined and demographic variables, referral sources and type of previous gestation were assessed. Statistical analysis was performed using the chi-square test (p<0.05%). Results: The majority of the patients originated from the East Healthcare Macroregion (77.9%). DTG incidence at the referral Center was 8.5/1.000 deliveries. The 20-34-year age group predominated (65%). A small percentage of the patients was employed (42.9%). Education level was low: 67.9% of the patients attended only elementary school. Secondary hospitals were the principal sources of patient referral (84.3%). In most cases (42.1%), GTD was preceded by term gestation. DTG predominated in the peak fertility age group and among patients of unfavorable socio-demographic status. Most referred patients tended to come from the East Healthcare Macroregion.
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32

Desmarais, Cecilia Canedo Freitas [UNESP]. "Investigação em 20 anos (1990-2009) da doença trofoblástica gestacional em um Centro de Referência da Região Sudeste do Brasil." Universidade Estadual Paulista (UNESP), 2013. http://hdl.handle.net/11449/106368.

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Analisar os resultados de 20 anos de atividades de um centro de referência da região Sudeste do Brasil para tratamento e seguimento de pacientes com doença trofoblástica gestacional (DTG). Revisão de prontuários médicos de 260 pacientes com DTG atendidas no Centro de Doenças Trofoblásticas de Botucatu do Hospital das Clínicas da Faculdade de Medicina de Botucatu-UNESP (CDTB), no período de 1990 a 2009. Dados clínicos das pacientes incluíram idade, tipos de DTG, métodos de diagnóstico, tratamento, tempo de remissão e de seguimento. Em adição, a incidência da DTG foi estimada por 1.000 partos. Análise estatística foi realizada com teste de Mann-Whitney e modelo de regressão logística. Diferenças foram significativas se valor de p <0,05. De 1990 a 2009, foram registrados 24.568 partos no serviço e 280 casos de DTG, resultando em uma incidência geral de 11,4 casos de DTG por 1.000 partos. Das pacientes com mola hidatiforme (MH), 204 (75,6%) realizaram esvaziamento uterino no CDTB e 66 (24,4%) foram encaminhadas de outras instituições (OI), após o esvaziamento. Dentre os 204 casos de MH do CDTB, a ocorrência de NTG pós-molar foi de 20,9% entre as molas completas (MC) e de 3,9% das molas parciais (MP). Houve diferenças dos métodos de diagnóstico e de tratamento da MH entre o CDTB e outras instituições (OI). A curva de regressão anormal de hCG associada à anormalidades do endométrio/miométrio na ultrassonografia transvaginal com Doppler, diagnosticou mais de dois terços dos casos de NTG pós-molar, em pacientes do CDTB e de OI. Do total de 61 casos de NTG pós-molar, 53 (86,9%) foi classificado de baixo risco e oito (13,1%) de alto risco. Todas as pacientes com NTG de baixo risco alcançaram remissão, enquanto duas pacientes com NTG de alto risco morreram devido à progressão da doença. Houve efeito da idade sobre o risco de desenvolvimento de NTG pós-molar entre pacientes...
To review 20 years’ clinical experience in the treatment and followup of patients with gestational trophoblastic disease (GTD) at a reference Center in southeaster Brazil. Review of the medical records of the 260 patients with GTD that received care at the Trophoblastic Diseases Center of Botucatu Medical School Hospital, São Paulo State University-UNESP (CDTB) between 1990 and 2009. Data collected included age, GTD type, diagnostic method, treatment, time to remission and followup length. In addition, GTD incidence per 1000 births was estimated. Statistical analysis was performed using the test of Mann-Whitney and a logistic regression model. Significance level was set at p <0.05. From 1990 to 2009, there 24,568 births and 280 cases of GTD in our center. As a result, the overall GTD incidence during this period was 11.4 cases per 1,000 births. Among patients with hydatidiform mole (HM), 204 (75.6%) underwent uterine evacuation at our center, while 66 (24.4%) were referred to our center after having undergone evacuation in other institutions. Of the 204 HM cases that underwent evacuation at our center, post-molar gestational trophoblastic neoplasia (GTN) occurred in 20.9% of the patients with complete moles (CM), and in 3.9% of those with partial moles (PM). There were differences between the diagnostic methods and HM treatments used in our center from those used in other institutions. An abnormal hCG regression curve associated with endometrial/myometrial abnormalities seen on transvaginal Doppler Ultrasound diagnosed more than two thirds of the cases of post-molar GTN both at our center and at other institutions. Of the 61 cases of post-molar GTN, 53 (86.9%) were classified as low-risk, and eight (13.1%) as high-risk. All low-risk GTN patients achieved remission whereas two high-risk patients died due to the progression of the disease. In MC patients, age was associated with the risk of ...
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33

Desmarais, Cecilia Canedo Freitas. "Investigação em 20 anos (1990-2009) da doença trofoblástica gestacional em um Centro de Referência da Região Sudeste do Brasil /." Botucatu, 2013. http://hdl.handle.net/11449/106368.

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Orientador: Izildinha Maestá
Coorientador: Maria Inês Bianconi
Banca: Marcos Consonni
Banca: Antônio Rodrigues Braga Neto
Resumo: Analisar os resultados de 20 anos de atividades de um centro de referência da região Sudeste do Brasil para tratamento e seguimento de pacientes com doença trofoblástica gestacional (DTG). Revisão de prontuários médicos de 260 pacientes com DTG atendidas no Centro de Doenças Trofoblásticas de Botucatu do Hospital das Clínicas da Faculdade de Medicina de Botucatu-UNESP (CDTB), no período de 1990 a 2009. Dados clínicos das pacientes incluíram idade, tipos de DTG, métodos de diagnóstico, tratamento, tempo de remissão e de seguimento. Em adição, a incidência da DTG foi estimada por 1.000 partos. Análise estatística foi realizada com teste de Mann-Whitney e modelo de regressão logística. Diferenças foram significativas se valor de p <0,05. De 1990 a 2009, foram registrados 24.568 partos no serviço e 280 casos de DTG, resultando em uma incidência geral de 11,4 casos de DTG por 1.000 partos. Das pacientes com mola hidatiforme (MH), 204 (75,6%) realizaram esvaziamento uterino no CDTB e 66 (24,4%) foram encaminhadas de outras instituições (OI), após o esvaziamento. Dentre os 204 casos de MH do CDTB, a ocorrência de NTG pós-molar foi de 20,9% entre as molas completas (MC) e de 3,9% das molas parciais (MP). Houve diferenças dos métodos de diagnóstico e de tratamento da MH entre o CDTB e outras instituições (OI). A curva de regressão anormal de hCG associada à anormalidades do endométrio/miométrio na ultrassonografia transvaginal com Doppler, diagnosticou mais de dois terços dos casos de NTG pós-molar, em pacientes do CDTB e de OI. Do total de 61 casos de NTG pós-molar, 53 (86,9%) foi classificado de baixo risco e oito (13,1%) de alto risco. Todas as pacientes com NTG de baixo risco alcançaram remissão, enquanto duas pacientes com NTG de alto risco morreram devido à progressão da doença. Houve efeito da idade sobre o risco de desenvolvimento de NTG pós-molar entre pacientes ...
Abstract: To review 20 years' clinical experience in the treatment and followup of patients with gestational trophoblastic disease (GTD) at a reference Center in southeaster Brazil. Review of the medical records of the 260 patients with GTD that received care at the Trophoblastic Diseases Center of Botucatu Medical School Hospital, São Paulo State University-UNESP (CDTB) between 1990 and 2009. Data collected included age, GTD type, diagnostic method, treatment, time to remission and followup length. In addition, GTD incidence per 1000 births was estimated. Statistical analysis was performed using the test of Mann-Whitney and a logistic regression model. Significance level was set at p <0.05. From 1990 to 2009, there 24,568 births and 280 cases of GTD in our center. As a result, the overall GTD incidence during this period was 11.4 cases per 1,000 births. Among patients with hydatidiform mole (HM), 204 (75.6%) underwent uterine evacuation at our center, while 66 (24.4%) were referred to our center after having undergone evacuation in other institutions. Of the 204 HM cases that underwent evacuation at our center, post-molar gestational trophoblastic neoplasia (GTN) occurred in 20.9% of the patients with complete moles (CM), and in 3.9% of those with partial moles (PM). There were differences between the diagnostic methods and HM treatments used in our center from those used in other institutions. An abnormal hCG regression curve associated with endometrial/myometrial abnormalities seen on transvaginal Doppler Ultrasound diagnosed more than two thirds of the cases of post-molar GTN both at our center and at other institutions. Of the 61 cases of post-molar GTN, 53 (86.9%) were classified as low-risk, and eight (13.1%) as high-risk. All low-risk GTN patients achieved remission whereas two high-risk patients died due to the progression of the disease. In MC patients, age was associated with the risk of ...
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34

Souza, Juliana Maria Quinalha [UNESP]. "Comparação de dois imunoensaios para dosagem do hCG sérico utilizados no monitoramento da doença trofoblástica Gestacional." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/144283.

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Introdução: A Doença Trofoblástica Gestacional (DTG) compreende dois tipos clínicos: mola hidatiforme (MH) e neoplasias trofoblásticas gestacionais (NTG). A dosagem do hCG é o parâmetro mais importante para detecção da persistência de trofloblasto ativo na parede do útero ou em outros locais do organismo. Objetivo: Comparar concentrações séricas do hormônio hCG em pacientes com DTG utilizando duas variações do método de quimioluminescência comercialmente disponíveis em nosso centro. Métodos: Este estudo incluiu pacientes com DTG avaliadas e acompanhadas no Centro de Doenças Trofoblásticas da Faculdade de Medicina de Botucatu (CDTB) – UNESP, de novembro de 2014 a outubro de 2015. Amostras de soro das pacientes foram testadas para dosagem de hCG em duas variações do método de quimioluminescência ARCHITECT® i2000 SR e IMMULITE® 2000 Xpi. Concentrações séricas de hCG foram comparadas contra a hipótese nula e a concordância clínica foi determinada em dois momentos: admissão da paciente e evolução pela curva de hCG de acordo com os valores de hCG entre os dois equipamentos. Resultados: 73 pacientes com DTG foram incluídas no estudo. Destas, 45 tinham MH e remissão espontânea, enquanto 28 tiveram NTG. Uma boa concordância nos valores médios de hCG entre IMMULITE® 2000 Xpi e ARCHITECT® i2000 SR quando hCG <100 mUI/mL. Para valores de hCG >100 mUI/mL, houve diferença significativa entre ensaios (p<0,05), com valores medidos pelo ARCHITECT® i2000 SR sendo maior que aqueles medidos pelo IMMULITE® 2000 Xpi em pacientes com MH e remissão espontânea ( Immulite = 0.79Architect ; p < 0,01 ) ; R2 = 90 % ) e NTG ( Immulite = 0,51Architect ; p < 0,01 ) ; R2 = 98 % ). As condutas clínicas no momento da admissão das pacientes foram concordantes em 100% dos casos [73/73(100%); kappa1; p<0,001] e pela evolução da curva de hCG, a concordância observada foi de 98% [71/72(98%); kappa 0,93; p<0,001].Conclusão: O uso do equipamento IMMULITE® é recomendado para monitoramento de pacientes com DTG, entretanto, ARCHITECT® apresentou desempenho analítico e coerência clínica em relação aos resultados de hCG, o que faz deste equipamento uma boa alternativa.
Introduction: Gestational trophoblastic disease (GTD) is a group of disorders spanning the conditions that range from hydatidiform mole (HM) to gestational trophoblastic neoplasia (GTN). Determining human chorionic gonadotrophin (hCG) serum levels is crucial for the early detection and optimal management of GTN. Objective: To compare serum hCG levels in patients with GTD using 2 commercially available hCG immunoassays. Methods: Serum samples were obtained from patients with GTD attending the Botucatu Trophoblastic Diseases (Botucatu Medical School, São Paulo State University- Unesp) from November 2014 to October 2015. Serum hCG levels were measured with both IMMULITE® 2000 XPi and ARCHITECT® i2000 chemiluminescence tests. Serum hCG levels were compared against the null hypothesis. Agreement with clinical management was determined by comparing baseline hCG measures as well as the hCG curves obtained with both assays. Results: Seventy-three patients with GTD were included in the analysis. Of these, 45 had HM and experienced spontaneous remission, while 28 had GTN. There was a perfect (zero difference) agreement in mean hCG levels between IMMULITE® 2000 XPi and ARCHITECT® i2000 when hCG < 100 mUI/mL. For hCG values greater than 100 mUI/mL, there was a significant difference between assays (p < 0.05), with levels measured via ARCHITECT® i2000 being higher than those measured with IMMULITE® 2000 XPi in patients with spontaneous remission (Immulite = 0.79Architect; p < 0.01); R2 = 90%) and GTN (Immulite = 0,51Architect; p < 0,01); R2 = 98%). Baseline test results agreed in all cases (73/73(100%); kappa1;p<0,001] and hCG curve agreement was 98% [71/72(98%); kappa0,93;p<0,001].Conclusion: IMMULITE® has been the assay recommended for diagnosing and monitoring patients with GTD. However, our results suggest that as ARCHITECT® and IMMULITE® show similar performance in measuring hCG levels and determining clinical management, ARCHITECT® may be used an alternative.
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35

Souza, Juliana Maria Quinalha de. "Comparação de dois imunoensaios para dosagem do hCG sérico utilizados no monitoramento da doença trofoblástica Gestacional." Botucatu, 2016. http://hdl.handle.net/11449/144283.

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Orientador: Izildinha Maestá
Resumo: Introdução: A Doença Trofoblástica Gestacional (DTG) compreende dois tipos clínicos: mola hidatiforme (MH) e neoplasias trofoblásticas gestacionais (NTG). A dosagem do hCG é o parâmetro mais importante para detecção da persistência de trofloblasto ativo na parede do útero ou em outros locais do organismo. Objetivo: Comparar concentrações séricas do hormônio hCG em pacientes com DTG utilizando duas variações do método de quimioluminescência comercialmente disponíveis em nosso centro. Métodos: Este estudo incluiu pacientes com DTG avaliadas e acompanhadas no Centro de Doenças Trofoblásticas da Faculdade de Medicina de Botucatu (CDTB) - UNESP, de novembro de 2014 a outubro de 2015. Amostras de soro das pacientes foram testadas para dosagem de hCG em duas variações do método de quimioluminescência ARCHITECT® i2000 SR e IMMULITE® 2000 Xpi. Concentrações séricas de hCG foram comparadas contra a hipótese nula e a concordância clínica foi determinada em dois momentos: admissão da paciente e evolução pela curva de hCG de acordo com os valores de hCG entre os dois equipamentos. Resultados: 73 pacientes com DTG foram incluídas no estudo. Destas, 45 tinham MH e remissão espontânea, enquanto 28 tiveram NTG. Uma boa concordância nos valores médios de hCG entre IMMULITE® 2000 Xpi e ARCHITECT® i2000 SR quando hCG <100 mUI/mL. Para valores de hCG >100 mUI/mL, houve diferença significativa entre ensaios (p<0,05), com valores medidos pelo ARCHITECT® i2000 SR sendo maior que aqueles medidos pelo... (Resumo completo, clicar acesso eletrônico abaixo)
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36

Dantas, Patrícia Rangel Sobral [UNESP]. "Influência do local de seguimento da mola hidatiforme no prognóstico e tratamento da neoplasia trofoblástica gestacional pós-molar." Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/99193.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Avaliar o prognóstico da mola hidatiforme (MH) e tratamento da neoplasia trofoblástica gestacional (NTG) pós-molar acompanhadas no Centro de Referência para Doenças Trofoblásticas (CDT) versus outras instituições (OI). Estudo de coorte que incluiu 270 pacientes com MH (204 pacientes acompanhas do CDT-Botucatu, onde essa investigação está sendo realizada, e 66 pacientes inicialmente acompanhadas em OI). Todas as pacientes foram registradas no banco de dados do CDT-Botucatu (Universidade Estadual Paulista, Brasil) entre janeiro de 1990 e dezembro de 2009. O prognóstico da MH, bem como as características da NTG e seu desfecho foram analisados e comparados de acordo com o local de seguimento pós-molar. As seguintes variáveis de confundimento foram incluídas: idade (anos), número de gestação, paridade, número de abortamentos, e o tipo de MH (Completa/Parcial). O desfecho da NTG pós-molar consoante o local de seguimento pós-molar foi comparado utilizando-se o teste de Mann-Whitney, teste do Qui-Quadrado ou teste Exato de Fisher. NTG pós-molar ocorreu em 34 (34/204=16,7%) das pacientes que foram acompanhadas no CDT, e em 27 (27/66=40,9%) daquelas que realizaram o seguimento em OI. Pacientes que foram seguidas no CDT cursaram com características de NTG com melhor prognóstico, tais como: menor índice de metástases (5,8% versus 48%,p=0,003), menor mediana do escore FIGO 2000 [2,00 (1,00; 3,00) versus 4,00 (2,00; 7,00), p=0,003] e início mais precoce da quimioterapia em semanas [7,0 (6,0; 10,0) versus 10,0 (7,0; 16,0), p=0,04]. NTG de alto-risco não foi observada em nenhuma paciente submetida ao EUCDT, ocorrendo em 29% daquelas que foram acompanhadas em OI (p<0,001). Quimioterapia com múltiplos agentes para o tratamento da NTG pós-molar foi necessária em dois casos...
To review treatment results of gestational trophoblastic neoplasia (GTN) after hydatidiform mole (HM) evacuation at a referral center (ERC) versus HM evacuation at other institutions (EOI). This cohort study included 270 patients undergoing HM evacuation (204 at the study referral center and 66 at other institutions). All patients were registered in the database of Botucatu Trophoblastic Diseases Center (São Paulo State University, Brazil) between January 1990 and December 2009. GTN characteristics and outcomes were analyzed and compared according to HM evacuation setting. The confounding variables assessed included age (years), number of gestations, parity, number of abortions, and HM type (Complete/Partial). Post-molar GTN outcomes according to HM evacuation setting were compared using Mann-Whitney’s test, Chi-square test, or Fisher’s exact test. Post-molar GTN occurred in 34 (34/204=16.7%) patients undergoing HM evacuation at the referral center, and in 27 (27/66=40.9%) of those undergoing HM evacuation in other institutions. Patients undergoing HM ERC showed GTN characteristics indicative of better prognosis such as: lower metastasis rate (5.8% versus 48%, p=0.003), lower median FIGO 2000 score [2.00 (1.00; 3.00) versus 4.00 (2.00; 7.00), p=0.003], and earlier chemotherapy onset in weeks [7.0 (6.0; 10.0) versus 10.0 (7.0; 16.0), p=0.04]. High-risk post-molar GTN was observed in no patient undergoing HM ERC, and in 29% of those undergoing HM EOI (p<0.001). Multi-agent chemotherapy for the treatment of post-molar GTN was required in two cases of HM evacuation at the referral center (5.9%) and in eight cases of HM EOI (29.6%) (p=0.017). Median time interval between chemotherapy onset and hCG. normalization in weeks was shorter among patients undergoing HM ERC [9.00 (6.25; 12.0) versus... (Complete abstract click electronic access below)
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37

Dantas, Patrícia Rangel Sobral. "Influência do local de seguimento da mola hidatiforme no prognóstico e tratamento da neoplasia trofoblástica gestacional pós-molar /." Botucatu : [s.n.], 2012. http://hdl.handle.net/11449/99193.

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Orientador: Izildinha Maestá
Coorientador: Marilza Vieira Cunha Rudge
Coorientador: Rafael Cortés-Charry
Banca: Antônio Rodrigues Braga Neto
Banca: Jurandyr Moreira de Andrade
Resumo: Avaliar o prognóstico da mola hidatiforme (MH) e tratamento da neoplasia trofoblástica gestacional (NTG) pós-molar acompanhadas no Centro de Referência para Doenças Trofoblásticas (CDT) versus outras instituições (OI). Estudo de coorte que incluiu 270 pacientes com MH (204 pacientes acompanhas do CDT-Botucatu, onde essa investigação está sendo realizada, e 66 pacientes inicialmente acompanhadas em OI). Todas as pacientes foram registradas no banco de dados do CDT-Botucatu (Universidade Estadual Paulista, Brasil) entre janeiro de 1990 e dezembro de 2009. O prognóstico da MH, bem como as características da NTG e seu desfecho foram analisados e comparados de acordo com o local de seguimento pós-molar. As seguintes variáveis de confundimento foram incluídas: idade (anos), número de gestação, paridade, número de abortamentos, e o tipo de MH (Completa/Parcial). O desfecho da NTG pós-molar consoante o local de seguimento pós-molar foi comparado utilizando-se o teste de Mann-Whitney, teste do Qui-Quadrado ou teste Exato de Fisher. NTG pós-molar ocorreu em 34 (34/204=16,7%) das pacientes que foram acompanhadas no CDT, e em 27 (27/66=40,9%) daquelas que realizaram o seguimento em OI. Pacientes que foram seguidas no CDT cursaram com características de NTG com melhor prognóstico, tais como: menor índice de metástases (5,8% versus 48%,p=0,003), menor mediana do escore FIGO 2000 [2,00 (1,00; 3,00) versus 4,00 (2,00; 7,00), p=0,003] e início mais precoce da quimioterapia em semanas [7,0 (6,0; 10,0) versus 10,0 (7,0; 16,0), p=0,04]. NTG de alto-risco não foi observada em nenhuma paciente submetida ao EUCDT, ocorrendo em 29% daquelas que foram acompanhadas em OI (p<0,001). Quimioterapia com múltiplos agentes para o tratamento da NTG pós-molar foi necessária em dois casos... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: To review treatment results of gestational trophoblastic neoplasia (GTN) after hydatidiform mole (HM) evacuation at a referral center (ERC) versus HM evacuation at other institutions (EOI). This cohort study included 270 patients undergoing HM evacuation (204 at the study referral center and 66 at other institutions). All patients were registered in the database of Botucatu Trophoblastic Diseases Center (São Paulo State University, Brazil) between January 1990 and December 2009. GTN characteristics and outcomes were analyzed and compared according to HM evacuation setting. The confounding variables assessed included age (years), number of gestations, parity, number of abortions, and HM type (Complete/Partial). Post-molar GTN outcomes according to HM evacuation setting were compared using Mann-Whitney's test, Chi-square test, or Fisher's exact test. Post-molar GTN occurred in 34 (34/204=16.7%) patients undergoing HM evacuation at the referral center, and in 27 (27/66=40.9%) of those undergoing HM evacuation in other institutions. Patients undergoing HM ERC showed GTN characteristics indicative of better prognosis such as: lower metastasis rate (5.8% versus 48%, p=0.003), lower median FIGO 2000 score [2.00 (1.00; 3.00) versus 4.00 (2.00; 7.00), p=0.003], and earlier chemotherapy onset in weeks [7.0 (6.0; 10.0) versus 10.0 (7.0; 16.0), p=0.04]. High-risk post-molar GTN was observed in no patient undergoing HM ERC, and in 29% of those undergoing HM EOI (p<0.001). Multi-agent chemotherapy for the treatment of post-molar GTN was required in two cases of HM evacuation at the referral center (5.9%) and in eight cases of HM EOI (29.6%) (p=0.017). Median time interval between chemotherapy onset and hCG. normalization in weeks was shorter among patients undergoing HM ERC [9.00 (6.25; 12.0) versus... (Complete abstract click electronic access below)
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38

Lin, Lawrence Hsu. "Gestação múltipla com mola completa e feto normal coexistente: coorte multicêntrica." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-30012018-085959/.

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Objetivo: Comparar características clínicas e resultados de gestações múltipla com mola completa e feto normal coexistente (MHCFC) no New England Trophoblastic Disease Center (NETDC) e em centros de doença trofoblástica (CDT) brasileiros. Métodos: Coorte retrospectiva composta por pacientes com MHCFC provenientes do NETDC (1966-2015) e quatro CDT brasileiros (1990- 2015). Foram realizadas comparações referentes à localização geográfica (NEDTC vs CDT brasileiros), períodos diferentes no NETDC (1966-1989 vs 1990-2015) e quanto evolução para neoplasia trofoblástica gestacional (NTG). Resultados: No período, foram identificados 12.455 casos de doença trofoblástica gestacional, sendo 72 casos de MHCFC inclusos neste estudo. As características clínicas e resultados foram semelhantes entre os casos dos CDT brasileiros (n=46) e NETDC (n=13) entre 1990 e 2015, com exceção de um número significativamente maior de condições potencialmente letais no Brasil (p=0,046). Não houve diferença quanto à apresentação clínica ou aos resultados em dois períodos diferentes no NETDC (13 casos de 1966-1989 vs 13 casos de 1990-2015). Houve 10 casos de interrupção eletiva da gestação (14% das 70 gestações em que o resultado obstétrico estava disponível) e 36 nascimentos de fetos viáveis (60% das 60 gestações nas quais se optou por conduta expectante). A taxa de NTG foi de 46% (31 de 68 casos em que o resultado quanto evolução para NTG estava disponível); os casos que progrediram para NTG apresentaram níveis mais elevados de gonadotrofina coriônica (250.000 mUI/mL vs 120.000 mUI/mL; p=0,026), menor idade gestacional no término da gravidez (17 semanas vs 28,5 semanas; p < 0,001), menor viabilidade fetal (27% vs 69%; p < 0,001), maior taxa de evolução para abortamento espontâneo (35% vs 9%; p=0,020) e mais interrupções da gestação por conta de intercorrências clínicas graves (26% vs 0%; p=0,003). No entanto, a interrupção eletiva da gestação não teve associação com o desenvolvimento de NTG. Conclusões: A maior diferença regional nas MHCFC foi a presença de mais condições potencialmente letais no Brasil. Quando adotada conduta expectante, houve possibilidade de nascimento de feto viável na maior parte das MHCFC. Foi observada elevada taxa de evolução para NTG em MHCFC. A interrupção eletiva da gravidez não influenciou a progressão para NTG, porém interrupções da gestação por complicações clínicas graves, evolução da gestação para abortamento espontâneo, menor idade gestacional no término da gestação, menor viabilidade fetal e níveis elevados de gonadotrofina coriônica foram associados ao desenvolvimento de NTG em MHCFC
Objective: To determine the clinical characteristics and outcomes of multiple pregnancies with complete mole and coexisting normal fetus (CHMCF) in New England Trophoblastic Disease Center (NETDC) and Brazilian trophoblastic disease centers (BTDC). Methods: Retrospective non-concurrent cohorts comprised of CHMCF from NETDC (1966-2015) and four BTDC (1990-2015). Comparisons were made regarding: geographical location from 1990 to 2015 (NETDC vs BTDC), two different periods of time in NETDC (1966-1989 vs 1990-2015) and patients who developed gestational trophoblastic neoplasia (GTN) with the ones that spontaneously regressed. Results: From a total of 12,455 cases of gestational trophoblastic disease seen at the referral centers, 72 CHMCF were identified. Clinical characteristics and outcomes were similar between BTDC (n=46) and NETDC (n=13) from 1990 to 2015, apart from a much higher frequency of potentially life-threatening conditions in Brazil (p=0.046). There were no significant changes in the clinical presentation or outcomes in two different time periods in NETDC (13 cases in 1966-1989 vs 13 cases in 1990-2015). Ten pregnancies were electively terminated (14% of 70 cases with available obstetric outcome) and 36 resulted in viable live infants (60% of 60 pregnancies that were expectantly managed). The rate of GTN was 46% (31 out of 68 cases with available information on GTN development); the cases that progressed to GTN presented with higher chorionic gonadotropin levels (250.000 mIU/mL vs 120.000 mIU/mL; p=0.026), lower gestational age at the end of pregnancy (17 weeks vs 28,5 weeks; p < 0,001), lower fetal viability (27% vs 69%; p < 0,001), higher rate of spontaneous abortions (35% vs 9%; p=0.020) and higher frequency of termination of pregnancy due to medical complications (26% vs 0%; p=0.003) when compared to those with spontaneous remission. However, elective termination of pregnancy was not associated with GTN development. Conclusions: The main regional difference in CHMCF was related to a higher rate of potentially life-threatening conditions in Brazil. Most of the women with CHMCF who were managed expectantly delivered a viable fetus. CHMCF exhibited a high GTN rate. Elective termination of pregnancy did not influence the risk for GTN; however the need for termination due to severe medical complications, spontaneous abortions, lower gestational age at the end of pregnancy, lower fetal viability and higher hCG levels were associated with GTN progression in CHMCF
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39

Budhram, Samantha. "Profile of mortality amongst women with gestational trophoblastic disease (GTD) infected with the human immunodeficiency virus (HIV) in relation to HIV non-infected women." Thesis, 2008. http://hdl.handle.net/10413/1997.

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OBJECTIVES: To determine if women with Human Immunodeficiency Virus infection with severe degrees of immunosuppression are more predisposed to mortality from Gestational Trophoblastic Disease compared with HIV-infected women with less severe degrees of immunosuppression and Human Immunodefiency Virus (HIV) non-infected women. DESIGN: Retrospective review of case records. METHOD: A retrospective review was performed on all patients with Gestational Trophoblastic from 2003 to July 2007. A chart review was conducted and information captured on a data sheet. This retrospective audit was performed at the combined gynaecology oncology clinic of Inkosi Albert Luthuli Central Hospital. All information was kept confidential and was strictly for the purposes of the audit. STATISTICS: Factors associated with mortality were tested using Fisher's exact test. Odds ratios were reported as a measure of the strength of association. Breslow-Day's test for homogeneity in odds ratios was used to compare mortality in HIV-infected and HIV non-infected women. The analysis was done using Stata 9. i RESULTS: A total of 78 patients with Gestational Trophoblastic Disease were reviewed. There were 53 patients with invasive molar pregnancy and 25 patients with choriocarcinoma. The HIV sero-prevalence was 31%. There were 15 deaths (19%). There were 8 HIV-infected (33%o) and 7 HIV non-infected (13%) women who demised. Of the 8 patients with CD4 counts less than 200 cells/ uL, 7 patients demised. There were no mortalities amongst patients with CD4 counts more than 200 cells/uL. Of the 15 deaths, 5 HIV-infected patients and 5 HIV non-infected patients received chemotherapy. There were 5 patients admitted in very poor general condition precluding the administration of chemotherapy. Amongst the 10 patients who received chemotherapy and demised, the causes of death included widespread disease, multiorgan failure and toxicity due to chemotherapy. CONCLUSION: The overall survival of all patients managed with Gestational Trophoblastic Disease was 82% in keeping with the expected high survival reported elsewhere. The majority of patients who demised were admitted in poor general condition and had abnormal blood profiles. Despite resuscitation, these patients failed to improve precluding the administration of chemotherapy which is the mainstay of treatment. Although the numbers are small, there is clear evidence that if patients are HIV-infected with CD4 counts 200 cells/uL despite transient grade 2 myelotoxicity.
Thesis (MMed)-University of KwaZulu-Natal, Durban, 2008.
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