绝经激素治疗在子宫肉瘤术后的应用

<正>子宫肉瘤(uterine sarcoma)是临床上比较少见的恶性肿瘤,约占妇科恶性肿瘤的1%~3%,占子宫恶性肿瘤的3%~5%[1]。子宫肉瘤大多数恶性程度高、预后差。手术仍是治疗子宫肉瘤的首选方案,对于卵巢,术中一般采取切除术。部分年轻患者可以考虑保留卵巢,但术后的化疗、放疗可能导致卵巢功能的提前衰退。因此,子宫肉瘤患者术后提前出现的围绝经     

2022《NCCN遗传性/家族性卵巢癌风险评估与临床管理指南(第1版)》解读

<正>卵巢癌发病率居女性生殖系统恶性肿瘤第3位,死亡率居妇科恶性肿瘤之首[1]。约10%～24%的卵巢癌与特定基因的胚系突变有关[2～5],这种发生在生殖细胞或早期受精卵的基因突变具有家族遗传性[6]。随着遗传学和分子生物学的进步,目前已经发现许多与遗传性卵巢癌相关的基因,携带特定基因突变的人群患卵巢癌的风险明显高出普通人群[2],因此对遗传性卵巢癌高危人群进行癌症风险评估与遗传咨询很有必要。目前遗传性癌症高危人群的基因检测率普遍较低,     

p53基因突变对预测葡萄胎恶变的初步研究

随着人们对肿瘤分子生物学认识的不断深入 ,已知癌基因的激活和抑癌基因的失活对肿瘤的发生发展起重要作用。ｐ5 3基因是一种肿瘤抑制基因 ,在肝癌、肺癌、乳腺癌、胃癌、卵巢癌等肿瘤中有突变失活[1] 。而在葡萄胎组织中ｐ5 3基因突变与恶变的关系研究较少 ,尚无定论。本研究采用聚合酶链反应 单链构象多态分析 (ＰＣＲ ＳＳＣＰ)技术检测葡萄胎组织中ｐ5 3基因第 5～ 8外显子突变情况 ,并结合患者的临床随访结果进行初步研究。现报道如下。一、资料与方法1.资料来源与分组 :收集 1992～ 1996年在我院住院清宫的葡萄胎患者 2 0例 ,根据 2…     

卵巢恶性肿瘤端粒酶活性与C-myc基因mRNA表达的研究

目的　研究端粒酶活性、C -myc基因在卵巢恶性肿瘤中的表达和相互关系。方法　在卵巢恶性肿瘤、交界性肿瘤、良性肿瘤和正常卵巢组织中 ,采用PCR -ELISA方法检测端粒酶活性 ,RT -PCR方法检测C -myc基因的mRNA表达。结果　恶性卵巢肿瘤端粒酶活性值及阳性率 (91 30 % ) ,明显高于交界性卵巢肿瘤(2 0 0 0 % ,P <0 0 1 )、良性卵巢肿瘤 (7 1 3% ,P <0 0 1 )和正常卵巢 (0 0 0 % ,P <0 0 1 )。交界性卵巢肿瘤端粒酶表达率与后两者的端粒酶活性表达率也存在显著差异 (P <0 0 1 ) ;卵巢良性肿瘤与正常卵巢组织之间端粒酶活性无差别 (P >0 0 5 )。端粒酶活性值在恶性卵巢肿瘤Ⅲ、Ⅳ期明显高于Ⅰ、Ⅱ期 (P <0 0 5 ) ;分化程度低者高于分化高者 (P <0 0 5 ) ;但在组织类型和组织起源上差异无显著性 (P >0 0 5 )。恶性卵巢肿瘤组织中端粒酶活性值明显高于癌旁组织 (P <0 0 5 )。端粒酶阳性率在恶性卵巢肿瘤临床分期、组织类型和组织起源上均无差异 (P >0 0 5 )。利用RT -PCR检测C -myc基因的表达 ,发现 1 2例 (5 2 1 7% )恶性卵巢肿瘤C -myc基因有mR NA表达 ,而在良性、交界性和正常卵巢组织中均未见表达。C -myc基因阳性组端粒酶活性值显著高于阴性组。结论　端粒酶活化可以作为恶性肿瘤的分子生物     

原发性输卵管癌预后的影响因素

原发性输卵管癌是妇科少见的恶性肿瘤 ,在妇科恶性肿瘤中约占 0 1%～ 2 8% [1] 。由于本病较少见、早期不易发现、治疗效果不好、预后差。本文通过回顾性分析我院收治的 2 2例原发性输卵管癌的临床资料 ,探讨早期诊断、合理手术、化学药物治疗 (化疗 )、放射治疗 (放疗 )对原发性输卵管癌预后的影响。一、临床资料1 一般情况 :所有资料来自我院 1980～ 2 0 0 0年收治的2 2例原发性输卵管癌患者。患者年龄 33～ 80岁 ,平均年龄为 (5 2± 14 )岁 ,初潮年龄为 (15 5± 1 4 )岁 ;绝经 15例(6 8% )。有不孕史 12例 (5 5 % ) ,一次妊娠 4例 (18…     

卵巢上皮性癌组织中p15、p16基因突变及其临床意义

ｐ15、ｐ16基因是近年来发现和分离的两个抑癌基因。研究表明,ｐ15、ｐ16基因突变与人类肿瘤的发生有关,在多种原发性肿瘤及其肿瘤细胞系中均存在ｐ15、ｐ16基因纯合性缺失与点突变[1]。本研究旨在通过检测卵巢上皮性癌(ＯＥＣ)中ｐ15、ｐ16基因纯合性缺失与点突变,探讨其在ＯＥＣ发生、发展中的作用,并评价其可否作为肿瘤标记物应用于ＯＥＣ的诊断、监测及预后的判断。一、资料与方法1.研究对象:43例ＯＥＣ、11例卵巢良性上皮性瘤及4例卵巢交界性上皮性瘤取自山东医科大学附属医院、山东省立医院及解放军第九○医院妇产科1995～1997年住院…     

卵巢硬化性间质瘤二例临床分析

卵巢硬化性间质瘤 (ｓｃｌｅｒｏｓｉｎｇｓｔｒｏｍａｌｔｕｍｏｕｒｏｆｏｖａｒｙ)是罕见的卵巢肿瘤[1] ,属卵巢性腺间质肿瘤。此瘤多发生于 30岁以下年轻妇女 ,发病率占卵巢性腺间质肿瘤的 1 5 %～7 0 % [2 ] 。 1990年至 1991年我院收治卵巢肿瘤 16 1例中 ,性腺间质肿瘤 13例 ,其中硬化性间质瘤 2例 ,占同期卵巢肿瘤总数的 1 2 % ,占性腺间质肿瘤的 15 4%。现报告如下。一、临床资料1 病例简介 :例 1为 2 1岁 ,发现下腹部包块 3个月 ,月经不规则 3年 ,月经量多。妇科检查 :宫颈光滑 ,子宫后位、正常大小、质中 ,右侧附件区可扪及约 15…     

TIMP-1基因突变与卵巢恶性肿瘤临床病理关系的初步探讨

目的:探讨TIMP-1突变与临床的相关性。方法:采用PCR-SSCP染色技术和核苷酸序列测定对正常组织、良性卵巢肿瘤组织及恶性卵巢肿瘤组织中TIMP-1基因突变进行检测,并分析TIMP-1基因突变与其临床病理因素的关系。结果:(1)所有的标本TIMP-1第1,2,3编码外显子扩增产物均为一个带型,DNA测序显示未见突变;(2)TIMP-1基因第4外显子在恶性肿瘤组织中突变率为69.2%(27/39),高于良性肿瘤[20%(2/10)]和正常组织的[27.8%(5/18)],差异均有统计学意义(P=0.014,P=0.030);TIMP-1基因第5外显子在恶性肿瘤组织中突变率为61.5%(24/39),显著高于正常组织[22.2%(4/18)](P=0.013),但与良性肿瘤组织[40%(4/10)]比较无统计学差异(P=0.384)。9例(23.1%)编码外显子错译突变全部为卵巢恶性肿瘤。结论:卵巢恶性肿瘤组织中存在TIMP-1编码子突变现象,MMPs和TIMPs之间平衡失调可能与TIMP-1编码子突变有关。     

p16基因与卵巢恶性肿瘤的研究现状

ｐ１６基因是新近发现的抑癌基因，定位于人类染色体９ｐ２１区，所编码的核磷酸蛋白ｐ１６为细胞周期蛋白Ｄ／ＣＤＫ激酶的抑制因子。参与对正常细胞周期演进的调控，防止细胞增生。已发现在大多数恶性肿瘤中有ｐ１６基因的缺失或突变，说明ｐ１６基因的失活与肿瘤的发生、发展及恶化及极为密切的关系。     

卵巢肿瘤组织中p53和P－糖蛋白的表达及其临床意义

目的：评价卵巢肿瘤组织中突变型ｐ５３基因和Ｐ－糖蛋白（Ｐ－ｇｐ）表达的临床病理意义及其相互关系。方法：采用免疫组织化学法测定卵巢恶性肿瘤５３例，卵巢良性肿瘤２０例和正常卵巢组织１７例的ｐ５３和Ｐ－ｇｐ的表达，并与临床病理因素进行相关分析。结果：１．卵巢恶性肿瘤组织中ｐ５３和Ｐ－ｇｐ阳性表达率分别为４６．７％和３５．８％，卵巢良性肿瘤和正常卵巢组织中则无一例ｐ５３和Ｐ－ｇｐ表达。２．Ⅲ～Ⅳ期患者和低分化卵巢恶性瘤组织中ｐ５３表达阳性率高于Ⅰ～Ⅱ期和高、中分化者，而Ｐ－ｇｐ表达与临床分期、组织学类型和分级无明显相关性。３．Ｐ－ｇｐ表达阳性和阴性的卵巢恶性肿瘤患者，对化疗的有效率分别为３１．６％和６４．７％，而ｐ５３阳性表达与化疗效果无明显相关性。结论：组织中的ｐ５３和Ｐ－ｇｐ表达测定对判断卵巢恶性肿瘤的预后和对化疗的敏感性有一定的价值。     

Adolescent sexuality and the internet: the good, the bad, and the URL

The Internet has become a widely used resource for sexual health information, especially among adolescents. The appeal lies in the ease and anonymity with which online seekers can obtain advice and reassurance, particularly regarding sensitive topics. This article reviews the positive and negative influences of the Internet on this age group. Specific aspects of how this medium affects adolescents as well as how it can be used to assist them are discussed.     

Prolonged pregnancy: surveillance of the fetus and the neonate and the course of labor and delivery

The perinatal events in 184 term control pregnancies and 129 prolonged pregnancies were prospectively compared. Fetal surveillance consisted of weekly biophysical profile testing. Thirty-two infants were dysmature, and 10 of these had advanced dysmaturity. The incidence of advanced dysmaturity rose quickly after 44 weeks. This group was at greater risk for fetal distress, lower Apgar scores, and emergency cesarean section. The combination of oligohydramnios, a suboptimal nonstress test, and a low profile score was highly predictive of a neonate with advanced dysmaturity. In the control pregnancies, the rate of induction of labor was 13.81% compared with 39.84% in the prolonged pregnancies. The induced labor group had a 51.32% cesarean section rate. Our approach to prolonged pregnancy consists of elective induction of labor when the cervix is favorable and biweekly profile testing when it is not; however, the high incidence of advanced dysmaturity after 44 weeks warrants delivery.     

Early- and late-onset preeclampsia and the tissue-specific epigenome of the placenta and newborn

IntroductionPreeclampsia (PE) carries increased risks of cardiovascular- and metabolic diseases in mothers and offspring during the life course. While the severe early-onset PE (EOPE) phenotype originates from impaired placentation in early pregnancy, late-onset PE (LOPE) is in particular associated with pre-existing maternal cardiovascular- and metabolic risk factors. We hypothesize that PE is associated with altered epigenetic programming of placental and fetal tissues and that these epigenetic changes might elucidate the increased cardiovascular- and metabolic disease susceptibility in PE offspring.MethodsA nested case-control study was conducted in The Rotterdam Periconceptional Cohort comprising 13 EOPE, 16 LOPE, and three control groups of 36 uncomplicated pregnancies, 27 normotensive fetal growth restricted and 20 normotensive preterm birth (PTB) complicated pregnancies. Placental tissue, newborn umbilical cord white blood cells (UC-WBC) and umbilical vein endothelial cells were collected and DNA methylation of cytosine-guanine dinucleotides was measured by the Illumina HumanMethylation450K BeadChip. An epigenome-wide analysis was performed by using multiple linear regression models.ResultsEpigenome-wide tissue-specific analysis between EOPE and PTB controls revealed 5001 mostly hypermethylated differentially methylated positions (DMPs) in UC-WBC and 869 mostly hypomethylated DMPs in placental tissue, situated in or close to genes associated with cardiovascular-metabolic developmental pathways.DiscussionThis study shows differential methylation in UC-WBC and placental tissue in EOPE as compared to PTB, identifying DMPs that are associated with cardiovascular system pathways. Future studies should examine these loci and pathways in more detail to elucidate the associations between prenatal PE exposure and the cardiovascular disease risk in offspring.     

The concentration of collagen and the collagenolytic activity in the amnion and the chorion

Fetal membranes obtained from second-trimester abortions, elective Caesarean sections and after normal deliveries were studied. The hydrolytic activity against a DNP-peptide expressing the collagen turn-over was found to be very high in the second trimester and relatively high at term of pregnancy. The activity in the chorion was twice that in the amnion. The concentration of another collagen-degrading enzyme, leukocyte elastase, which is present during inflammatory reactions was high at the site of rupture. The collagen concentration given as micrograms hydroxyproline per mg dry weight was unchanged throughout pregnancy and labour in both fetal membranes. The concentration in amnion was twice that in the chorion. After delivery, the collagen content given as microgram/cm2 in the chorion was decreased at the rupture line. This was due to decreased thickness of the membrane, whereas the hydroxyproline concentration (microgram/mg dry weight) was unchanged. The amnion was thinner than the chorion, but the decreasing collagen content (micrograms/cm2) at the rupture line was less pronounced. The thinning of especially the chorionic membrane might be secondary to the mechanical stress of pregnancy and labour and/or, as our results suggest, due to enhanced catabolism.     

Read between the lines--mass media and the making of public opinion--medicine and the media

There has been a continuous change of civilization and communication in our society since the mid-nineties of the last century. Even medicine has to accept new fields of activity and bring up to date its response in the cooperation with the media. Both, medicine in general and gynaecology in particular will have to get used to a close relationship between public relation and professional skills. That is to say, communication, criteria and system, must undergo permanent reconsideration and development. Excellent knowledge of communication both in theory and practice together with the know-how of handling media and journalists are therefore required. The author of the following dissertation will make an effort to explain and to cover the wide range of public relation spreading between newspaper reports and interviews. Doctors whatever and wherever their job is but gynaecologists in particular must realize that co-operation with the media will be a challenge and a duty in the years ahead.