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

Made available in DSpace on 2014-06-11T19:25:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-12Bitstream added on 2014-06-13T20:32:44Z : No. of bitstreams: 1 soares_pdpb_me_botfm.pdf: 324440 bytes, checksum: f230b3dd4a45d393366209805ed781ec (MD5) / 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.

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

Made available in DSpace on 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-28Bitstream added on 2014-06-13T19:35:50Z : No. of bitstreams: 1 braganeto_ar_me_botfm_prot.pdf: 602090 bytes, checksum: f38c1cdc313cf9ea229f0e479bcde7c3 (MD5) / 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)

Made available in DSpace on 2016-07-01T13:10:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-08-25. Added 1 bitstream(s) on 2016-07-01T13:13:45Z : No. of bitstreams: 1 000866746.pdf: 1167888 bytes, checksum: 2ccca8898155c05e91242086adfebf49 (MD5) / 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

Resumo: Clicar acesso eletrônico abaixo. / 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

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

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-10-03Bitstream added on 2014-06-13T21:00:22Z : No. of bitstreams: 1 ferreira_egv_me_botfm.pdf: 578426 bytes, checksum: 965dd8dff1cdf74bb54609e4bbb1d19d (MD5) / Financiadora de Estudos e Projetos (FINEP) / Clicar acesso eletrônico abaixo. / 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: 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) / Mestre

Made available in DSpace on 2014-06-11T19:35:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-08-26Bitstream added on 2014-06-13T18:46:59Z : No. of bitstreams: 1 000740764.pdf: 2235530 bytes, checksum: e628de6741dd701bf903af87bad473a4 (MD5) / 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 ...