Thesis (M. Med. Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 46-54).

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 46-54). Also available in print.

Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 156-186). Also available in print.

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 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-01-19Bitstream added on 2014-06-13T19:56:27Z : No. of bitstreams: 1 delmanto_lrmg_me_botfm_prot.pdf: 1711857 bytes, checksum: 2ec370367716e8bbe7aaf35d7c70e19a (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / Objetivo: avaliar a utilidade da curva de regressão normal da gonadotrofina coriônica humana no diagnóstico de neoplasia trofoblástica pós molar (NTG). Metodologia: Foi construída curva de regressão normal considerando-se a média e o limite superior de confiança a 95% dos valores quinzenais de -hCG sérico de 80 pacientes com mola hidatiforme completa (MHC) e remissão espontânea. Nesta curva de regressão normal foram identificados o primeiro valor de -hCG acima do limite superior de confiança a 95% das 25 pacientes com MHC e evolução para NTG. Curvas individuais das 105 pacientes foram estabelecidas e analisadas sobre a curva de regressão normal, verificando-se o comportamento destas curvas. Os valores de 3-hCG que excederam o limite superior da curva normal foram considerados anormais. Resultados: As 25 pacientes que desenvolveram NTG pós-molar tiveram desvio da curva de regressão normal de 3-hCG em 3,84 l 2,57 semanas, enquanto platô ou ascensão ocorreu em 8,40 l 2,94 semanas, pós-esvaziamento uterino, com diferença significativa (p< 0,001). Do total de 25 pacientes com MHC e evolução para NTG, 20 (80%) apresentaram valores de -hCG acima do limite superior da curva de regressão normal dentro de quatro semanas, pós-esvaziamento uterino, enquanto nenhuma apresentou platô ou ascensão. Em seis semanas pós esvaziamento uterino, 23 pacientes com NTG (92%) apresentaram valores anormais, acima do limite superior da curva de regressão normal, enquanto somente 11 (44%) mostraram evolução com platô ou ascensão. Houve diferença no comportamento das curvas individuais dos dois grupos quando analisadas sobre a curva de regressão normal. Conclusões: A identificação de pacientes com MHC e evolução para NTG é mais rápida através da curva de regressão normal de 3-hCG, comparada ao platô ou ascensão. A curva de regressão normal de -hCG é útil no diagnóstico precoce de NTG pós molar. / To evaluate the usefulness of the normal 3-human chorionic gonadotrophin (p-hCG) regression curve in the diagnosis of post-molar trophoblastic neoplasia (PMTN). Methods: The normal regression curve was constructed by taking into account the mean and the 95% confidence limit of the bi-weekly values of serum 3-hCG from 80 patients with uneventful complete hydatidiform mole. In this normal regression curve, the first í3-hCG value over the 95% confidence upper limit of the 25 patients with complete hidatidiform mole (CHM) and the development to PMTN were identified. Individual curves of the 105 patients were established and analyzed over the normal regression curve, and the behavior of such curves was analyzed. The 3-hCG values exceeding the upper limit of the normal curve were regarded as abnormal. Results: The 25 patients who developed PMTN showed a devíance in the -hCG normal regression curve in 3.84 l 2.57 weeks while the plateau or increase occurred in 8.40 l 2.94 weeks after evacuation with a significant difference (p< 0.001). Of the total of 25 patients with CHM and development to PMTN, 20 (80%) showed -hCG values over the normal regression curve upper limit within four weeks postevacuation while none showed a plateau or increase. In six weeks post-uterine emptying, 23 patients with PMTN (92%) showed abnormal values over the normal regression curve upper limit while only 11(44%) showed development with a plateau or increase. A difference was noted in the behavior of indívidual curves in the two groups when they were analyzed over the normal regression curve. Conclusions: The identification of patients with CHM and development to PMTN is quicker when using the -hCG normal regression curve as compared to the plateau or increase. The -hCG normal regression curve is useful in the early diagnosis of post-molar NTG.

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