子宫肌瘤剔除术对不孕女性妊娠的影响及影响术后妊娠的相关因素分析

目的:研究分析合并子宫肌瘤的不孕妇女行子宫肌瘤剔除术后的妊娠情况以及影响术后妊娠的原因。方法:随机选取宝鸡市中心医院2012年5月至2015年6月收治的子宫肌瘤剔除术患者150例,回顾分析所有受试者的一般资料、肌瘤特征以及术后随访情况。结果:根据随访1年～2年结果显示,患者的术后总妊娠率52. 0%(78/150),胎儿存活率69. 2%(54/78);根据Cox回归分析显示,术后妊娠的危险因子是年龄[RR=0. 99,95%CI(0. 98,1. 31),P <0. 05],与不孕种类、不孕时间、孕产史以及肌瘤的数量、大小、质地、种类都无关。结论:不孕兼有子宫肌瘤妇女行子宫肌瘤剔除术后可提高患者的妊娠率和胎儿存活率,年龄是术后妊娠的危险因子,这与妊娠率为负相关关系,因此患者可根据实际的年龄而决定是否行子宫肌瘤剔除术。     

妊娠合并子宫肌瘤142例病例分析

目的:探究与分析妊娠合并子宫肌瘤的临床特点。方法:选取我院自2014年11月至2015年7月收治的142例妊娠合并子宫肌瘤孕产妇作为观察组,另选择同时期收治的140例妊娠无合并子宫肌瘤的孕产妇作为对照组,对比两组孕产妇孕期合并症、分娩期并发症发生率、分娩方式、术中处理及子宫肌瘤在妊娠期的变化。结果:观察组与对照组先兆流产、先兆早产、胎位异常、前置胎盘、妊高征、胎膜早破、胎儿生长受限、妊娠糖尿病发生率相比均无明显差异(P>0.05)。观察组与对照组脐带缠绕、胎儿窘迫、产后出血、胎盘早剥、新生儿窒息、低出生体重儿发生率相比均无明显差异(P>0.05)。观察组较对照组相比阴道分娩率降低,剖宫产率提高,具有统计学意义(P<0.05)。观察组术中同时行子宫肌瘤剔除术73例,占51.41%。孕晚期肌瘤直径较早期相比无增大或减小所占比例最高,占49.30%,明显高于其他情况,具有统计学意义(P<0.05)。剔除肌瘤后病理类型表现为肌瘤未伴变性比例最高,占47.95%,明显高于其他类型,具有统计学意义(P<0.05)。结论:妊娠合并子宫肌瘤不会增加孕产妇孕期及分娩期并发症发生率,同时不会增加肌瘤变性比例,且子宫肌瘤大小并非随着孕期延长而增大,但增加了剖宫产率,因此也应引起临床医师的重视。     

子宫内膜息肉不孕患者行宫腔镜治疗后自然妊娠相关因素研究

目的:探讨子宫内膜息肉不孕患者行宫腔镜治疗后的自然妊娠状况。方法:回顾性分析宫腔镜手术治疗的76例子宫内膜息肉合并不孕症患者的临床资料,并随访其自然妊娠状况。结果:76例患者中术后18个月内自然妊娠51例,自然妊娠率为67.11%,其中术后6个月内自然妊娠率为84.31%;术后妊娠组年龄明显低于未妊娠组,差异有统计学意义(P0.05),而两组在不孕年限、子宫内膜息肉类型比较均无统计学意义(P0.05)。结论对于无其他原因引起不孕的子宫内膜息肉患者来说,宫腔镜治疗可以明显提高患者术后自然妊娠率,年龄越小则术后自然妊娠的成功率越高,且术后6个月是妊娠的最佳时间。     

不同途径下子宫肌瘤剔除术对妊娠的影响研究

目的:探讨经腹子宫肌瘤剔除术(TAM)和腹腔镜子宫肌瘤剔除术(LM)对子宫肌瘤患者术后妊娠的影响。方法:对符合研究标准的子宫肌瘤患者进行回顾性分析,其中采用TAM手术的患者为74例为TAM组,LM手术的患者有63例为LM组,比较两组患者术后避孕时间、备孕时间、妊娠结局。结果:TAM组患者避孕时间及备孕时间均长于LM组患者,差异有显著统计学意义(P0.05);两组子宫肌瘤术后患者的妊娠、流产、子宫破裂、成功分娩情况比较,差异均无统计学意义(P0.05)。结论:与TAM比较,LM可以缩短患者避孕和备孕时间,而对妊娠结局并无影响,临床工作中,可以根据患者的实际情况选择合适的手术方式,达到人性化、个性化治疗模式。     

高强度聚焦超声对子宫肌瘤患者术后血清白介素-10、肿瘤坏死因子-α、C反应蛋白水平及妊娠结局的影响

目的探讨高强度聚焦超声(HIFU)对子宫肌瘤患者术后血清白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平及妊娠结局的影响。方法选取2016年5月至2018年6月诸暨市第二人民医院诊治的93例子宫肌瘤患者作为研究对象。依据治疗方案不同分为HIFU组(n=46)和腹腔镜组(n=47)。HIFU组采取HIFU子宫肌瘤消融术,腹腔镜组采取腹腔镜下子宫肌瘤剔除术。对比两组手术情况,术前、术后当日IL-10、TNF-α、CRP水平,术前、术后3个月子宫内膜容受性指标情况,以及两组肌瘤复发率、妊娠率、妊娠结局。结果 HIFU组手术时间、住院时间、术后恢复正常生活时间短于腹腔镜组,术中出血量少于腹腔镜组(P0.05);两组术后当天血清IL-10、TNF-α、CRP水平较术前增高,但HIFU组低于腹腔镜组(P0.05);两组术后3个月子宫内膜容积与厚度均较术前提高,且HIFU组高于腹腔镜组(P0.05);HIFU组术后18个月妊娠率高于腹腔镜组,剖宫产率低于腹腔镜组(P0.05)。结论 HIFU治疗子宫肌瘤可降低手术创伤与血清炎症反应水平,促进术后恢复,改善妊娠结局。     

卵巢子宫内膜异位囊肿患者临床妊娠结局分析

目的:探讨卵巢子宫内膜异位囊肿不孕患者体外受精与胚胎移植前行非手术治疗后影响妊娠结局的相关因素。方法:对51例卵巢子宫内膜异位囊肿不孕患者临床资料进行分析,IVF-ET前行阴道超声介入穿刺治疗。结果:行IVF-ET治疗后妊娠28例,未妊娠23例,妊娠率为54.9%(28/51)。妊娠组与失败组相比,妊娠组血清CA125水平小于失败组,有显著性差异。结论:卵巢子宫内膜异位囊肿不孕患者,阴道超声介入穿刺治疗后妊娠率与血清CA125有密切关系。     

子宫肌瘤对女性生育能力的临床影响分析

目的:探讨子宫肌瘤对女性生育能力的临床影响分析。方法:回顾性分析2011年11月至2013年11月期间来我院就诊的子宫肌瘤且有生育要求的患者18例(观察组)以及同样来院就诊有生育要求的正常患者18例(对照组)的临床资料。分析对比两组患者的临床妊娠率、着床率、继续妊娠/活产率以及自然流产率。结果:经分析对比后发现,观察组患者的临床妊娠率和继续妊娠/活产率均显著性低于对照组患者(P0.05);结论:子宫肌瘤对女性的生育能力有着潜在的不良影响。若子宫肌瘤患者有生育要求,则需要经过仔细的评估后进行安全可靠的治疗。     

子宫动脉阻断对腹腔镜下行子宫肌瘤剔除术的临床意义探讨

目的:探讨腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术对子宫肌瘤患者的临床应用价值及其影响。方法:回顾分析2011年1月至2013年1月我院收治的288例子宫肌瘤患者的临床资料,根据手术方式分为观察组和对照组,其中观察组在腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术,对照组仅行腹腔镜下子宫肌瘤剔除术。对比两组在术前肌瘤最大径≤9cm、>9cm以及总体分析时术中情况、术后卵巢功能恢复、预后、妊娠等方面的差异。结果:观察组手术时间、术中出血量及住院时间均少于对照组,而术前肌瘤最大径≤9cm患者手术中,对照组手术时间少于观察组(P<0.05);观察组FSH、LH及E2均低于对照组(P<0.05);与对照组相比,观察组月经异常症状缓解明显、肌瘤复发率降低、发生闭经较少及子宫体积缩小明显(P<0.05),而术前肌瘤最大径≤9cm患者手术中,两组术后2个月月经异常症状缓解无统计学差异(P>0.05);随访2年,两组妊娠情况比较无统计学差异(P>0.05)。结论:腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术能有效减少术中出血、减小手术创伤、降低子宫肌瘤复发率,对内分泌及妊娠无明显影响,值得临床推广。     

高强度聚焦超声对子宫肌瘤治疗效果的相关因素研究

目的探究高强度聚焦超声对子宫肌瘤疗效的相关因素。方法选取2015年3月至2018年3月北部战区总医院治疗的388例子宫肌瘤患者作为研究对象。按照子宫肌瘤消融率将患者分为低消融率组(直径减少率50%,77例)、中消融率组(直径减少率为50%～75%,132例)和高消融率组(直径减少率75%,179例)。随访6个月,比较三组子宫肌瘤的直径、位置、MRI信号强弱,对有统计学意义的指标行多因素Logisitic回归分析,探究高强度聚焦超声治疗子宫肌瘤疗效影响因素。结果低消融率组子宫肌瘤直径以30mm为主,肌瘤位置以后壁、侧壁和宫底为主;中消融率组子宫肌瘤直径以30～50mm为主,位置以前壁为主;高消融率组子宫肌瘤直径以50mm为主,肌瘤位置以前壁为主;三组差异具有统计学意义(P0.05);三组中T_1WI增强强度和T_2WI信号强度处于高等的比例呈现出低消融率组中消融率组高消融率组,三组分布比较,差异具有统计学意义(P0.05);多因素Logisitic回归分析显示,子宫肌瘤直径50mm、位置为前壁、T_1WI增强强度低、T_2WI信号强度低是子宫肌瘤女性高强度聚焦超声疗效高的影响因素。结论子宫肌瘤女性高强度聚焦超声疗效与子宫肌瘤直径、位置、T_1WI增强程度和T_2WI信号强度有关,临床上应该加以重视。     

精子DNA碎片率与AIH或IVF-ET临床妊娠率的相关性

目的:探讨精子DNA碎片率与因常见男性因素为主行夫精人工授精术(AIH)或体外受精-胚胎移植术(IVF-ET)治疗夫妇临床妊娠率的相关性。方法:筛选因常见男性因素为主行AIH的患者64例及IVF-ET的患者46例,其中女方的促排方案相同,男女年龄均在40岁以下,平均年龄(31±9)岁,基本排除女方常见不孕因素。根据术中精子DNA碎片率的高低,分为五组:组1:术前3个月内精子DNA碎片检查结果正常组,24例(AIH,16例);组2:术前精子DNA碎片检查结果异常,经治疗后好转组,44例(AIH,30例);组3:术前精子DNA碎片检查结果异常,经治疗后未见明显好转或拒绝治疗组,22例(AIH,10例);组4:术前未做精子DNA碎片率检查,术中留取精液检测结果异常组,10例(AIH,4例);组5:术前未做精子DNA碎片率检查,术中留取精液检测结果正常组,10例(AIH,4例);分别统计各组AIH及IVF-ET的临床妊娠率,计算两者均值,并比较各组差异。结果:组1、组2、组3、组4、组5妊娠率分别为37.5%、31.8%、31.8%、20.0%、45.5%。结论:精子DNA碎片率会显著影响以男性因素为主的AIH或IVF-ET的妊娠结局。     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.     

[Translated article] Pruritus in Dermatology: Part 1—General Concepts and Pruritogens

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.     

Anästhesieverfahren in der Dermatologie

Zusammenfassung Die Verfahren der Lokalanästhesie sind integraler Bestandteil der operativen Dermatologie. Sie gewährleisten eine effiziente und sichere Analgesie in umschriebenen Haut- und Weichteilregionen und ermöglichen, einen sonst schmerzhaften diagnostischen oder therapeutischen Eingriff bei erhaltenem Bewusstsein zu tolerieren. Einzelne Methoden der Applikation sind "konkurrenzlos", wie die topische Applikation von EMLA^® oder die Kryoanästhesie, andere bieten alternative Optionen zur Allgemeinanästhesie. Die Tumeszenzlokalanästhesie wurde—jenseits der kosmetischen Liposuktion—zu einer effizienten Anästhesieform für größere Operationen bei Tumoren der Haut, plastische Rekonstruktionen und in der Phlebochirurgie weiterentwickelt. Die Wahl des Verfahrens im Einzelfall wird vom Alter, der Kooperationsfähigkeit und der Komorbidität des Patienten bestimmt. Für Infiltrationsanästhesien werden heute vorwiegend Lokalanästhetika vom Amidtyp eingesetzt. Fundierte Kenntnisse über die Anatomie der sensiblen Nerven sind Voraussetzung für erfolgreiche operationsfeldnahe periphere Blockaden. Wenn die Wirkungsweise der Lokalanästhetika, ihre toxischen Effekte und potenzielle Arzneimittelinteraktionen bei ihrem Metabolismus in der Praxis beachtet werden, dann ist das Risiko von Komplikationen relativ gering. Es sollte dennoch nicht unterschätzt, und adäquate Notfallmaßnahmen im Operationsteam sollten regelmäßig trainiert werden.     

Occupational allergic contact dermatitis caused by decorative plants

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria ), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.     

Leprosy in a University Hospital in Southern Brazil

BACKGROUND

Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient''s quality of life and leading to loss of working years.

OBJECTIVES

To evaluate the epidemiological profile of patients followed at a University Hospital.

MATERIALS AND METHODS

This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.

RESULTS

The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.

CONCLUSIONS

This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.