宫腔声学造影联合经阴道三维超声对宫腔异常不孕症患者宫腔粘连诊断灵敏度及准确性的影响

目的:探讨宫腔声学造影联合经阴道三维超声对宫腔异常不孕症患者宫腔粘连诊断灵敏度及准确性的影响。方法:选取2014年10月至2017年4月宝鸡市妇幼保健院85例宫腔粘连不孕症患者,均于入院后行宫腔声学造影联合经阴道三维超声检查,于上述检查结束3 d内行宫腔镜检查,并将宫腔镜检查结果作为诊断金标准,分析宫腔造影联合经阴道三维超声检查在宫腔粘连分度、分型中的灵敏度。结果:宫腔镜诊断19例(22.35%)为轻度粘连,23例(27.06%)为中度粘连,43例(50.59%)为重度粘连,其中单纯性颈管粘连22例(25.88%),宫腔内粘连37例(43.53%),混合型粘连26例(30.59%);宫腔声学造影联合阴道三维超声诊断宫腔粘连轻度19例(22.35%),中度25例(29.41%),重度41例(48.24%),宫腔粘连分度准确度为92.94%(79/85);单纯性颈管粘连24例(28.24%),宫腔内粘连36例(42.35%),混合型粘连25例(29.41%),宫腔粘连分型准确度为96.47%(82/85)。结论:宫腔声学造影联合经阴道三维超声检查宫腔粘连不孕症患者,可以有效提高宫腔粘连诊断准确性,有利于后期治疗方案的制定和干预措施的顺利开展。     

宫腔镜为主综合治疗在不孕症中的研究

目的:宫腔镜下取出宫内异物、分离宫腔粘连、重建宫腔治疗宫腔因素不孕症的最新应用.方法:我们对2009~2010年两年内就诊于妇科门诊的不孕症患者进行宫腔镜检查,对术中发现胎骨等胚物残留、息肉等占位及宫腔粘连的患者进行宫腔镜下异物清除术及宫腔粘连分离术,术后留置 Foley双腔球囊导尿管,并宫腔内注入玻璃酸钠3ml,同时上带铜的金属节育环,补佳乐及黄体酮胶囊人工周期治疗2~3个月.对照组为暂时不愿意接受宫腔镜治疗,单纯宫腔球囊扩张、宫腔留置金属节育器、人工周期治疗的患者.两者均预防感染5~7d.结果:治疗组30例,术后月经量明显增多或闭经者月经复潮28例(93.3%).治疗后妊娠者17例(56.6%),痛经等其他症状缓解29例(96.6%).对照组28例,术后月经量明显增多或闭经者月经复潮13例(46.4%).治疗后妊娠者4例(15%),痛经等其他症状缓解18例(64.3%).结论:宫腔镜治疗为主的配合球囊及抗粘连生物制剂及人工周期治疗明显优于单纯球囊、人工周期,宫腔镜为治疗宫腔因素性不孕症的金标准.     

宫腔镜下不同手术方式治疗宫腔粘连的应用效果

目的探究宫腔镜下不同手术方式在治疗宫腔粘连的应用效果。方法选取2016年6月至2017年6月重庆市巴南区人民医院收治的60例宫腔粘连患者作为研究对象。根据治疗方式的不同对患者实施分组,电切分离组30例,给予宫腔镜下电切分离治疗;剪刀分离组30例,给予宫腔镜下微型剪刀切除术治疗。对两组患者手术相关指标、不同程度宫腔粘连的分离效果以及并发症发生情况进行综合评价。结果剪刀分离组患者手术时间、术中出血量多于电切分离组,差异具有统计学意义(P0.05);电切分离治疗中度宫腔粘连,其宫腔粘连评分差及术中出血量均较剪刀分离组低,其治疗各种程度宫腔粘连手术时间均短于剪刀分离组,差异具有统计学意义(P0.05);电切分离组患者治疗后并发症率为6.7%,与对照组的3.3%比较差异无统计学意义(P0.05)。结论宫腔镜下微型剪刀分离手术与电切分离治疗宫腔粘连疗效相当,尽管其手术时间较长,但对中度宫腔粘连具有显著改善作用,并发症少,可在基层医院推广应用。     

宫腔镜粘连分离术后两种不同治疗方法预防再粘连的效果比较

目的:采用两种不同方法预防宫腔镜粘连分离术后再粘连的发生,并对其治疗效果进行比较。方法:采用随机数字表法将我院2012年10月至2014年10月收治的70例宫腔粘连患者分为两组,A组35例患者采取术后宫腔放置宫内节育器(IUD)联合戊酸雌二醇及孕激素进行预防治疗,B组患者采取术后每月加强宫腔镜复查,联合宫腔注入透明质酸钠、戊酸雌二醇及孕激素进行预防治疗,观察并比较两组患者术后分离粘连次数、月经改善、妊娠及满意情况。结果:A组患者分离粘连≥2次者12例,B组分离粘连≥2次者6例,两组比较具有显著性差异(P0.05);A组患者月经改善率为80.0%,明显低于B组的94.3%,两组比较具有显著性差异(P0.05);A组患者妊娠率和满意率分别为14.3%和80.0%,明显低于B组的25.7%和88.5%,两组比较具有显著性差异(P0.05);两组随访12个月,均无不良反应及异常情况。结论:宫腔镜粘连分离术后加强宫腔镜检查,术后宫腔注入透明质酸钠可明显预防再粘连的发生,同时采取孕激素周期治疗可明显提高妊娠率。     

宫腔镜下水刀+微型剪刀分离术治疗宫腔粘连患者的临床疗效

目的探讨宫腔镜下水刀+微型剪刀分离术治疗宫腔粘连患者的临床疗效。方法选取2015年6月至2018年6月阜阳市人民医院诊治的86例宫腔粘连患者,随机分为两组,各43例,研究组采用宫腔镜下水刀+微型剪刀分离术,对照组采用宫腔镜下电切法。比较两组患者的临床效果及并发症发生情况。结果研究组患者术后月经改善总有效率显著高于对照组,差异具有统计学意义(P0.05)。研究组患者术后3个月宫腔形态恢复总有效率显著高于对照组,差异具有统计学意义(P0.05)。研究组患者术后1个月、3个月宫腔粘连复发率均低于对照组,差异具有统计学意义(P0.05)。两组患者均无并发症发生。结论宫腔镜下实施水刀+微型剪刀分离术治疗宫腔粘连患者的临床疗效显著,且降低了患者术后发生再粘连的可能。     

球囊支撑与宫内节育器预防再次宫腔粘连效果的对比

目的:探讨宫腔镜下宫腔粘连分离术后放置球囊支撑和宫内节育器在预防宫腔粘连再次发生中的疗效对比。方法:选择2016年1月至2016年12月武汉大学人民医院东院区妇科收治的61例(中度37例、重度24例)在宫腔镜下诊断为宫腔粘连并成功行宫腔粘连分离术的患者为研究对象,将其分为两组,分别为放置宫内节育器(intrauterine device)组和球囊支架组,术后均给予戊酸雌二醇辅助治疗。比较两组患者术后再次发生宫腔粘连的情况。结果:中度宫腔粘连的患者,两组差异具有统计学意义(P0.05);重度宫腔粘连患者,两组差异无统计学意义(P0.05)。结论:中度宫腔粘连患者术后放置球囊组与术后放置节育器组相比,再粘连发生率相对较低,效果相对更好。同时,两组重度宫腔粘连患者比较,差异甚微,效果欠佳。     

经阴道三维超声诊断宫腔粘连的价值探讨

目的:研究宫腔粘连经过阴道三维超声检查诊断的价值。方法:我院选择2013年5月至2015年5月间诊治的可疑为宫腔粘连的232例患者,对其临床资料进行分析,所选的患者均进行宫腔镜和病理检查,对阴道二维超声和三维超声诊断的准确率进行比较,同时描述患者声像图资料与宫腔粘连的情况。结果:通过对两种方法进行检查得出,二维超声对宫腔粘连诊断的准确率为73.0%,三维超声为91.0%;两者进行比较,差异显著,有统计学意义(P0.05)。对于中、重度宫腔粘连患者来说,三维彩超诊断的检出率达到94.0%。结论:宫腔粘连患者通过阴道三维超声检查诊断准确率相对较高,而且具有有效、简便、无创的优势,值得在临床上推广应用。     

宫腔镜下宫腔粘连分离术后综合治疗的临床应用效果观察

目的观察评价宫腔镜下宫腔粘连分离术后综合治疗的临床应用效果。方法选取2015年1月至2017年7月佛山市南海区第四人民医院采用宫腔镜下宫腔粘连分离术结合综合诊治的45例患者作为研究对象。术毕4例使用透明质凝胶,11例放置宫内节育器,15例放置COOK球囊支架,预防粘连。术后采用雌激素序贯法人工周期治疗,最后7 d～10 d联合安宫黄体酮,停药转经第5日再次进行人工周期治疗1个～2个疗程。首次手术治疗后,再次进行宫腔镜检查,方法与初次手术同,术中发现粘连进行分离,循环处理,直至宫腔恢复正常,2个月后再次进行三维彩色超声检查,若出现可疑的粘连,再次进行宫腔镜检查。结果 1个月、3个月和6个月后,月经逐步恢复,6个月后月经恢复率达到75.56%,总有效率97.78%,差异具有统计学意义(χ~2=62.06,P=0.00)。随着时间推移,子宫粘连复发率逐渐上升,第1个月复发率0.0%、3个月8.89%,6个月15.56%,差异具有统计学意义(χ~2=103.68,P=0.0000.05)。重复子宫粘连分离术范围1次～5次,重复子宫粘连分离术(2.6±0.5)次。随访6个月～1.1年,子宫内膜厚度、子宫容积、子宫动脉PS高于治疗前,子宫动脉、螺旋动脉PI与RI低于治疗前,差异具有统计学意义(P0.05)。末次随访与治疗前,子宫内膜血流分型差异具有统计学意义(P0.05),C型子宫内膜血流比重53.33%较治疗前15.56%上升。末次随访,子宫内膜连续性中断、宫腔线分离、内膜显示不清、锯齿状改变发生率分别为4.44%、0.00%、0.00%、0.00%低于治疗前57.78%、13.33%、24.44%和20.00%,差异具有统计学意义(P0.05)。34例不孕症成功妊娠率47.06%(16/34)。宫腔镜下宫腔粘连分离术后综合治疗有一定的疗效,可改善子宫容受性,治疗不孕症,但随着时间的推移,也会出现粘连复发。     

宫腔镜为主的综合治疗在中、重度宫腔粘连中的应用

目的:探讨以宫腔镜为主的综合治疗在中、重度宫腔粘连病例中的应用价值.方法:回顾性分析62例中、重度宫腔粘连病例以宫腔镜手术为主的综合治疗的疗效.结果:54例分离1次成功重建宫腔,8例分次手术重建宫腔.术后30例恢复正常月经,占48.4％(30/62);23例月经改善,占37.1％(23/62);9例月经无改善或仍闭经,占14.5％(9/62).8例术后宫腔再粘连12.9％ (8/62).结论:宫腔镜对于中、重度宫腔粘连的治疗是最有效的.使用宫腔镜联合超声是手术安全成功的保障,宫腔镜术后宫腔内注入几丁糖后宫腔持续放置Foils导尿管,术后的雌孕激素周期治疗促进子宫内膜修复、宫腔放置合适的宫内节育器三个月以上以及每月宫腔气囊扩张术,均有利于预防术后宫腔再粘连.     

人工流产患者术后宫腔粘连风险的知情度调查研究

目的:探讨人工流产患者术后宫腔粘连风险的知情度。方法:选自我院于2015年6月至2016年12月行人工流产术孕妇146例,均采用负压吸引术,且于术后抗菌药物常规预防和注射透明质酸钠凝胶2~3 mL至宫腔底部,平卧30 min。术后宫腔粘连采用宫腔镜检查明确。观察患者术后宫腔粘连知情度情况、术后宫腔粘连发生情况、术后腹痛时间、术后阴道出血时间及术后月经复潮时间。结果:本组146例患者中,完全不明确患者9例、很不明确患者20例、不明确患者55例、基本明确47例、很明确15例;本组146例患者发生术后宫腔粘连患者43例,占29.45%。其中轻度宫腔粘连20例、中度宫腔粘连16例、重度宫腔粘连7例;本组146例患者经术后干预后术后腹痛时间为(36.42±6.51)min,术后阴道出血时间为(6.54±1.46)d,月经复潮时间为(32.14±4.56)d。结论:人工流产患者对术后宫腔粘连风险的知情度不高。     

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.     

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.     

Therapie der Akne mit Antiandrogenen – Eine evidenzbasierte Übersicht

Background: Increased sebaceous gland activity with seborrhea is one of the major pathogenetic factors in acne. Antiandrogen treatment targets the androgen‐metabolizing follicular keratinocytes and the sebaceous gland leading to sebostasis, with a reduction of the sebum secretion rate of 12.5 – 65 %. Antiandrogens can be classified based on their mechanism of action as androgen receptor blockers, inhibitors of circulating androgens by affecting ovarian function (oral contraceptives), inhibitors of circulating androgens by affecting the pituitary (gonadotropin‐releasing hormone agonists and dopamine agonists in hyperprolactinemia), inhibitors of adrenal function, and inhibitors of peripheral androgen metabolism (5α‐reductase inhibitors, inhibitors of other enzymes). Methods: All original and review publications on antiandrogen treatment of acne as monotherapy or in combination included in the MedLine system were extracted by using the terms “acne”, “seborrhea”, “polycystic ovary syndrome”, “hyperandrog*”, and “treatment” and classified according to their level of evidence. Results: The combinations of cyproterone acetate (2 mg)/ethinyl estradiol (35 µg), drospirenone (3 mg)/ethinyl estradiol (30 µg), and desogestrel (25 µg)/ethinyl estradiol (40 µg) for 1 week followed by desogestrel (125 µg)/ethinyl estradiol (30 µg) for 2 weeks showed the strongest anti‐acne activity. Gestagens or estrogens as monotherapy, spironolactone, flutamide, gonadotropin‐releasing hormone agonists, and inhibitors of peripheral androgen metabolism cannot be endorsed based on current knowledge. Low dose prednisolone is only effective in late‐onset congenital adrenal hyperplasia and dopamine agonists only in hyperprolactinemia. Treatment with antiandrogens should only be considered if none of the contraindications exist. Conclusion: Antiandrogen treatment should be limited to female patients with additional signs of peripheral hyperandrogenism or hyperandrogenemia. In addition, women with late‐onset or recalcitrant acne who also desire contraception can be treated with antiandrogens as can those being treated with systemic isotretinoin. Antiandrogen treatment is not appropriate primary monotherapy for noninflammatory and mild inflammatory acne.