ABSTRACT
BACKGROUND: An evaluation of the performance of a Referral Center in the diagnosis, treatment and follow up of adolescents with gestational trophoblastic disease. METHODS: In a 13-year prospective cohort study, between March 1987 and March 2000, 124 adolescents with gestational trophoblastic disease were followed up and/or treated by a multidisciplinary team. Adolescents underwent strict clinical and laboratory control after mole evacuation to guarantee adhesion to follow up, early diagnosis, and prompt treatment of persistent disease. The Student-Fischer t-test and the chi-square test were used for the statistic analysis of the results. RESULTS: Adolescents represented 21.3% of the 583 patients with gestational trophoblastic disease: 102 (82.3%) had uncomplicated hydatidiform moles, and 22 (17.7%) underwent chemotherapy for persistent gestational trophoblastic disease or a gestational trophoblastic tumor. Complications were diagnosed earlier (p < 0.001) in patients managed and treated at the referral center. Of the adolescents with complications, 81.8% were low risk, 54.5% were at the International Federation of Gynecology and Obstetrics stage I, and 90.9% were treated with chemotherapy only. Time to remission and follow up were shorter for uncomplicated hydatidiform moles (9.8 +/- 3.4 weeks and 8.8 +/- 1.8 months, respectively) than for persistent disease (16.2 +/- 5.8 weeks and 45 +/- 24.5 months, respectively). Adhesion to follow up was similar in the two groups (84.2% and 91.8%). To this date, 50% of the adolescents have had one or more gestations, and 82% of these pregnancies were normal. CONCLUSIONS: Adolescents comprise approximately 20% of all gestational trophoblastic disease patients and have high adhesion to follow up. The disease did not affect their reproductive capacity, and chances of a normal subsequent gestation were high.
Subject(s)
Pregnancy in Adolescence , Trophoblastic Neoplasms/epidemiology , Uterine Neoplasms/epidemiology , Adolescent , Cohort Studies , Female , Humans , Pregnancy , Prospective Studies , Risk Factors , Time FactorsABSTRACT
A utilizaçäo de filtros de veia cava inferior para prevenir o deslocamento de êmbolos para a circulaçäo pulmonar é a principal alternativa terapêutica nos pacientes com contra-indicaçäo para a anticoagulaçäo plena ou na ineficácia desta. Relatam-se os três primeiros casos de colocaçäo de filtro (Kimray-Greenfield) em veia cava inferior no Hospital de Clínicas de Porto Alegre, devido a recidiva de embolia pulmonar sob anticoagulaçäo. Tanto a colocaçäo por dissecçäo de veia jugular (um caso) quanto por via femoral com técnica transcutânea (dois casos) foram bem sucedidas. Os pacientes tiveram boa evoluçäo do quadro clínico e mantiveram-se assintomáticos após a alta
