Navegando por Palavras-chave "gestational trophoblastic neoplasia"
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- ItemSomente MetadadadosCentralized Coordination of Decentralized Assistance for Patients with Gestational Trophoblastic Disease in Brazil A Viable Strategy for Developing Countries(Sci Printers & Publ Inc, 2016) Braga, Antonio; Burla, Marcelo; Freitas, Fernanda; Uberti, Elza; Viggiano, Mauricio; Sun, Sue Yazaki [UNIFESP]; Maesta, Izildinha; Elias, Kevin M.; Berkowitz, Ross S.OBJECTIVE: To report on the Brazilian Association of Gestational Trophoblastic Disease's (GTD) formation of a network of regional care at specialized centers for women with GTD. STUDY DESIGN: We developed a questionnaire composed of 15 questions, which was sent by email to the 38 Brazilian GTD Reference Center (BGTDRC) Directors who are members of the Brazilian Association of GTD, in order to characterize the professionals involved in the care of patients with GTD and the type of assistance provided. RESULTS: The Directors of the BGTDRCs are usually specialists in Gynecology and Obstetrics (97%), with a median experience of a decade in treating women with GTD. The BGTDRCs are linked to university hospitals in 75% of centers and provide completely free medical care in 87%. However, 52% of centers do not perform chemotherapy in their reference center, and patients are referred elsewhere for chemotherapy. Despite some difficulties, the rate of patients lost to follow-up before human chorionic gonadotropin remission is 9%, and the GTD mortality rate is 0.9%. CONCLUSION: Due to large regional disparities, the BGTDRCs are not uniformly organized. However, under the coordination of the Brazilian Association of GTD there is now strong communication and collaboration among reference centers, which has significantly advanced both patient care and research into the management of these diseases.
- ItemSomente MetadadadosEffect of race/ethnicity on clinical presentation and risk of gestational trophoblastic neoplasia in patients with complete and partial molar pregnancy at a tertiary care referral center(Mosby-Elsevier, 2016) Gockley, Allison A.; Joseph, Naima T.; Melamed, Alexander; Sun, Sue Yazaki [UNIFESP]; Goodwin, Benjamin; Bernstein, Marilyn; Goldstein, Donald P.; Berkowitz, Ross S.; Horowitz, Neil S.BACKGROUND: The reported incidence of molar pregnancy varies widely among different geographic locations. This variation has been attributed, at least in part, to racial/ethnic differences. While the incidence of molar pregnancies is decreasing, certain ethnic groups such as Hispanics, Asians, and American Indians continue to have an increased risk of developing gestational trophoblastic disease across the globe. OBJECTIVE: We sought to describe the potential effect of ethnicity/race on the presentation and clinical course of complete mole and partial mole. STUDY DESIGN: All patients followed up for complete mole and partial mole at a single institution referral center from 1994 through 2013 were identified. Variables including age, race, gravidity, parity, gestational age, presenting signs/symptoms, serum human chorionic gonadotropin values, and development of gestational trophoblastic neoplasia were extracted from medical records and patient surveys. Patients with complete mole and partial mole were categorized into race/ethnicity groups defined as white, black, Asian, or Hispanic. Due to low numbers of non-white patients with partial mole in each non-white category, patients with partial mole were grouped as white or non-white. Continuous variables were compared using the Kruskal-Wallis test and binary variables were compared using the Fisher exact test. RESULTS: A total of 167 complete mole patients with known race/ethnicity status were included (57.48% white, 14.97% Asian, 14.37% black, 13.17% Hispanic). Hispanics presented at younger age (median 24.5 years) compared to whites (median 32.0 years, P = .04) and Asians median 31.0 years, P = .03). Blacks had higher gravidity than whites (P < .001) and Hispanics (P = .05). There was no significant difference in presenting symptoms, gestational age at diagnosis, and preevacuation serum human chorionic gonadotropin level by race/ethnicity. Hispanics were significantly less likely than whites to develop gestational trophoblastic neoplasia (absolute risk difference, 28.6%
- ItemSomente MetadadadosEpidemiological Report on the Treatment of Patients with Gestational Trophoblastic Disease in 10 Brazilian Referral Centers Results After 12 Years Since International FIGO 2000 Consensus(Sci Printers & Publ Inc, 2014-05-01) Braga, Antonio; Hartmann Uberti, Elza Maria; Fajardo, Maria do Carmo; Viggiano, Mauricio; Sun, Sue Yazaki; Grillo, Bruno Maurizio; Padilha, Sergio Lunardon; Andrade, Jurandyr Moreira de; Souza, Christiani Bisinoto de; Madi, Jose Mauro; Maesta, Izildinha; Silveira, Eduardo; Universidade Federal do Rio de Janeiro (UFRJ); Irmandade Santa Casa Misericordia Porto Alegre Ma; Universidade Federal de Goiás (UFG); Universidade Federal de São Paulo (UNIFESP); Parana Univ Hosp; Universidade de São Paulo (USP); Caxias do Sul Univ; Guilherme Alvaro Hosp SantosOBJECTIVE: To evaluate treatment of Brazilian patients with gestational trophoblastic disease (GTD).STUDY DESIGN: A retrospective cohort study with analysis of medical reports performed in 10 Brazilian referral centers from January 2000 to December 2011.RESULTS: Of 5,250 patients 3 died (0.06%) at the time of uterine evacuation. Spontaneous remission of GTD (group G1) was observed in 4,103 cases, and 1,144 (21.8%) progressed to gestational trophoblastic neoplasia (GTN) (G2). In G1 2,716 (66.2%) had complete hydatidiform mole (HM) and 1,210, partial HM (29.5%); 3,772 patients (92.7%) recovered as noted in December 2012. In G2, of 1,118 patients treated, initial histopathological results of previous gestation were complete HM (77.5% [n = 886]), partial HM (8.8% [n = 100]), and choriocarcinoma (8.0% [n = 92]); 930 (81.3%) were low-risk, 200 (17.5%) were high-risk GTN, and 14 had placental site trophoblastic tumor (PSTT) (1.2%); cure was achieved in 1,078 cases (96.4%), but 26 patients (2.3%) died (4 low-risk [0.4%], 19 high-risk [9.5%], and 3 PSTT [21.4%]).CONCLUSION: The highest death rates were due to high-risk GTN and PSTT. Patients with molar pregnancy should be referred to a referral center for an early diagnosis and prompt treatment of GTN in order to reduce the morbidity and mortality found in advanced stages.
- ItemSomente MetadadadosVEGF 936C/T Polymorphism and Gestational Trophoblastic Neoplasia(Sci Printers & Publ Inc, 2016) Sun, Sue Yazaki [UNIFESP]; Daher, Silvia [UNIFESP]; Signorini Filho, Roney Cesar [UNIFESP]; Rocha, Claudia Lima [UNIFESP]; Souza, Renato Teixeira [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]OBJECTIVE: To evaluate the relationship between the 936C/T polymorphism of VEGF and the occurrence of gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A retrospective study that included 8 patients with complete hydatidiform mole (CHM) that evolved into spontaneous remission (SR), 12 patients with CHM that progressed to GTN, and 20 control (C) patients without obstetric complications. Polymorphisms were detected by polymerase chain reaction amplified technique of patients' DNA, and genotype frequencies were compared between the groups. RESULTS: The genotype frequencies of the VEGF 936C/T polymorphism were as follows: SR group, 100% CC genotype