LAWRENCE HSU LIN
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina
95 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 95
- Is Doppler ultrasound useful for evaluating gestational trophoblastic disease?(2015) LIN, Lawrence H.; BERNARDES, Lisandra S.; HASE, Eliane A.; FUSHIDA, Koji; FRANCISCO, Rossana P. V.Doppler ultrasound is a non-invasive method for evaluating vascularization and is widely used in clinical practice. Gestational trophoblastic neoplasia includes a group of highly vascularized malignancies derived from placental cells. This review summarizes data found in the literature regarding the applications of Doppler ultrasound in managing patients with gestational trophoblastic neoplasia. The PubMed/Medline, Web of Science, Cochrane and LILACS databases were searched for articles published in English until 2014 using the following keywords: ""Gestational trophoblastic disease AND Ultrasonography, Doppler."" Twenty-eight articles met the inclusion criteria and were separated into the 4 following groups according to the aim of the study. (1) Doppler ultrasound does not seem to be capable of differentiating partial from complete moles, but it might be useful when evaluating pregnancies in which a complete mole coexists with a normal fetus. (2) There is controversy in the role of uterine artery Doppler velocimetry in the prediction of development of gestational trophoblastic neoplasia. (3) Doppler ultrasound is a useful tool in the diagnosis of gestational trophoblastic neoplasia because abnormal myometrial vascularization and lower uterine artery Doppler indices seem to be correlated with invasive disease. (4) Lower uterine artery Doppler indices in the diagnosis of gestational trophoblastic neoplasia are associated with methotrexate resistance and might play a role in prognosis. CONCLUSION: Several studies support the importance of Doppler ultrasound in the management of patients with gestational trophoblastic neoplasia, particularly the role of Doppler velocimetry in the prediction of trophoblastic neoplasia and the chemoresistance of trophoblastic tumors. Doppler findings should be used as ancillary tools, along with human chorionic gonadotropin assessment, in the diagnosis of gestational trophoblastic neoplasia.
bookPart Doenças infecciosas parasitárias(2016) YOSHIZAKI, Carlos Tadashi; BAPTISTA, Fernanda Spadotto; OSMUNDO JUNIOR, Gilmar de Souza; LIN, Lawrence Hsu; BORTOLOTTO, Maria Rita de Figueiredo Lemos; PEREIRA, Pedro Paulo; COSTA, Rafaela Alkmin da; MARTINELLI, SilviobookPart Doença hipertensiva específica da gestação(2020) YOSHIZAKI, Carlos Tadashi; TESTA, Carolina Burgarelli; PAGANOTI, Cristiane de Freitas; MIKAMI, Fernanda Cristina Ferreira; LIN, Lawrence Hsu; BRIZOT, Maria de Lourdes; BORTOLOTTO, Maria Rita de Figueiredo Lemos; CARVALHO, Mário Henrique Burlacchini de; PEREIRA, Pedro Paulo; BITTAR, Roberto Eduardo; MIYADAHIRA, Seizo; MARTINELLI, Silvio; BUNDUKI, VictorbookPart Restrição do crescimento fetal(2016) LIAO, Adolfo Wenjaw; FITTIPALDI, Felipe Silva; LIN, Lawrence Hsu; BERNARDES, Lisandra Stein; BORTOLOTTO, Maria Rita de Figueiredo Lemos; PEREIRA, Pedro Paulo; COSTA, Rafaela Alkmin da; BITTAR, Roberto Eduardo; CODARIN, Rodrigo Rocha- Multiple pregnancies with complete mole and coexisting normal fetus in North and South America: A retrospective multicenter cohort and literature review(2017) LIN, Lawrence H.; MAESTA, Izildinha; BRAGA, Antonio; SUN, Sue Y.; FUSHIDA, Koji; FRANCISCO, Rossana P. V.; ELIAS, Kevin M.; HOROWITZ, Neil; GOLDSTEIN, Donald P.; BERKOWITZ, Ross S.Objective. To determine the clinical characteristics of multiple gestation with complete mole and coexisting fetus (CHMCF) in North and South America. Methods. Retrospective non-concurrent cohorts compromised of CHMCF from New England Trophoblastic Disease Center (NETDC) (1966-2015) and four Brazilian Trophoblastic Disease Centers (BTDC) (1990-2015). Results. From a total of 12,455 cases of gestational trophoblastic disease seen, 72 CHMCF were identified. Clinical characteristics 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 over the past 5 decades in NETDC (13 cases in 1966-1989 vs 13 cases in 1990-2015). Ten pregnancies were electively terminated and 35 cases resulted in viable live births (60% of 60 continued pregnancies). The overall rate of gestational trophoblastic neoplasia (GTN) was 46%; the cases which progressed to GTN presented with higher chorionic gonadotropin levels (p = 0.026) and higher frequency of termination of pregnancy due to medical complications (p = 0.006) when compared to those with spontaneous remission. Conclusions. The main regional difference in CHMCF presentation is related to a higher rate of potentially life threatening conditions in South America. Sixty percent of the expectantly managed CHMCF delivered a viable infant, and the overall rate of GTN in this study was 46%. Elective termination of pregnancy did not influence the risk for GTN; however the need for termination due to complications and higher hCG levels were associated with development of GTN in CHMCF.
bookPart Doenças hematológicas(2016) YOSHIZAKI, Carlos Tadashi; BAPTISTA, Fernanda Spadotto; OSMUNDO JUNIOR, Gilmar de Souza; LIN, Lawrence Hsu; BORTOLOTTO, Maria Rita de Figueiredo Lemos; PEREIRA, Pedro Paulo; COSTA, Rafaela Alkmin da; MARTINELLI, SilviobookPart Doenças endócrinas(2016) YOSHIZAKI, Carlos Tadashi; BAPTISTA, Fernanda Spadotto; OSMUNDO JUNIOR, Gilmar de Souza; LIN, Lawrence Hsu; BORTOLOTTO, Maria Rita de Figueiredo Lemos; PEREIRA, Pedro Paulo; COSTA, Rafaela Alkmin da; MARTINELLI, SilviobookPart Obesidade e gravidez(2020) YOSHIZAKI, Carlos Tadashi; TESTA, Carolina Burgarelli; PAGANOTI, Cristiane de Freitas; BAPTISTA, Fernanda Spadotto; OSMUNDO JUNIOR, Gilmar de Souza; LIN, Lawrence Hsu; GALLETTA, Marco Aurélio Knippel; BORTOLOTTO, Maria Rita de Figueiredo Lemos; PEREIRA, Pedro Paulo; COSTA, Rafaela Alkmin da; RIBEIRO, Renata Lopes; FRANCISCO, Rossana Pulcineli Vieiraarticle 3 Citação(ões) na Scopus Management of Symptomatic Uterine Arteriovenous Malformations After Gestational Trophoblastic Disease The Brazilian Experience and Possible Role for Depot Medroxyprogesterone Acetate and Tranexamic Acid Treatment(2018) BRAGA, Antonio; LIMA, Lana; PARENTE, Raphael Camara Medeiros; CELESTE, Roger Keller; REZENDE FILHO, Jorge de; AMIM JUNIOR, Joffre; MAESTA, Izildinha; SUN, Sue Yazaki; UBERTI, Elza; LIN, Lawrence; MADI, Jose Mauro; VIGGIANO, Mauricio; ELIAS, Kevin M.; HOROWITZ, Neil S.; BERKOWITZ, Ross S.OBJECTIVE: To identify predictive variables of heavy vaginal bleeding from uterine arteriovenous malformation (uAVM) after gestational trophoblastic disease (GTD) and review outcomes with different treatment strategies. STUDY DESIGN: This is a retrospective study of patients with uAVM presenting with vaginal bleeding after postmolar follow-up or treatment for postmolar gestational trophoblastic neoplasia, with normal hCG levels for at least 6 or 12 months, respectively, followed at 9 Brazilian GTD reference centers, from January 2004-January 2016. Patients were treated preferentially with uterine artery embolization (UAE), but when UAE was not available, depot medroxyprogesterone acetate and tranexamic acid (DMPA + TA) was offered. RESULTS: The incidence of symptomatic uAVM after GTD was 0.6% (39/6,129). Risk factors associated with class III-IV hemorrhage included number of previous curettages (aRR 4.23, 95% CI 1.36-13.1, p=0.013), uterine artery index of resistance <= 0.32 (aRR 35.2, 95% CI 3.58-347.5, p=0.002), and uterine artery peak systolic velocity >= 78.7 cm/s (aRR 10.7, 95% CI 1.15-100.6, p=0.037). Patients with class I-II hemorrhage treated with DMPA + TA had a higher rate of uAVM resolution (N=14/16 [87.5%]) versus UAE (N=4/8 [50%], p=0.033). Patients with class III-IV hemorrhage were 87% less likely to have successful treatment with DMPA + TA compared to class I-II hemorrhage (cRR 0.13, 95% CI 0.02-0.83, p=0.013). CONCLUSION: Although UAE is preferred for cases of heavy vaginal bleeding, there may be a role for DMPA + TA in the management of less severe bleeding complications.- Fetal-Maternal Hemorrhage in First-Trimester Intrauterine Hematoma(2021) NARCISO, Thaisa A. R. M.; HOSHIDA, Mara S.; COSTA, Priscilla R.; NIQUIRILO, Andrea; BIANCOLIN, Sckarlet E.; LIN, Lawrence H.; FRANCISCO, Rossana P. V.; BRIZOT, Maria L.Objective: The objective of this study was to compare the frequency and percentage of fetal hemoglobin (HbF%) by flow cytometry of (1) first-trimester asymptomatic patients with intrauterine hematoma (IUH), (2) first-trimester pregnant patients with vaginal bleeding (VB), and (3) first-trimester asymptomatic pregnant women without hematoma. Methods: Prospective study involving pregnant women in the first trimester of pregnancy. Patients with ultrasound findings of asymptomatic hematoma and with VB were paired with asymptomatic pregnant women of same gestational age without hematoma (control group [CG]). Maternal blood HbF% was evaluated by flow cytometry. The groups were compared in terms of circulating fetal hemoglobin and HbF%. Results: Sixty-six patients were selected, 22 with hematoma, 17 with bleeding, and 27 in the CG. Fetal hemoglobin was detected in 15 patients with hematoma (68.2%) and 13 with bleeding (76.5%) and in 20 of the control (74.1%) (p = 0.830). The mean HbF% of each group was 0.054, 0.012, and 0.042 for hematoma, bleeding, and control, respectively, and differences were not significant (p = 0.141). There was a moderate negative correlation between the volume of hematoma and HbF% (r(Spearman) = -0.527; p = 0.012). Conclusions: The fetal-maternal hemorrhage expressed by Hbf% in first-trimester pregnancies did not seem to differ between patients with and without ultrasound findings of IUH.