Comparison of various methods of cryopreservation of human pre-embryos

A human egg and embryo freezing program for non-fertilized eggs and spare embryos has been established in our in vitro fertilization clinic. In the following we report on our first experience with different methods of human pre-embryo cryopreservation. In a simple evaluation we have compared different conventional freezing techniques using cryoprotectant substances such as glycerol, DMSO and 1.2 propanediol and an "ultrarapid" technique. So far we have achieved 6 normal ongoing and 2 biochemical pregnancies out of a total number of 61 embryo transfers. This equals 9.8% pregnancy rate per embryo transfer. Two methods seem preferable, i.e. sucrose and 1.2 propandiol which has the highest success rate and the ultrarapid method which gives a good rate of embryo survival on the one hand and a simple handling on the other.     

克罗米芬对增殖期子宫内膜组织形态影响的定量研究

应用图像分析仪，定量分析１４例因男方因素（６例）或不明原因（８例）不孕妇女克罗米芬（ＣＣ）用药前、后增殖期子宜内膜细胞结构及ＤＮＡ含量。结果：ＣＣ周期第１２天子宜内膜细胞核ＤＮＡ含量显著低于自然周期同期水平，表面上皮、腺上皮细胞核面积、核周长、核最大直径小于自然周期值，面积减小程度与ＤＮＡ量下降程度呈正相关。提示：ＣＣ抑制ＤＮＡ合成，影响上皮细胞核增殖、分裂及细胞结构，作用机理可能与ＣＣ在受体水平阻断雌二醇作用有关。     

胎膜早破162例临床分析

目的探讨胎膜早破与难产及母儿并发症的关系.方法对829例无妊娠合并症及并发症的产妇资料进行回顾性分析,其中胎膜早破病例162例,胎膜未破病例682例作为对照组.结果胎膜早破组的剖宫产率、早产率、新生儿窒息及肺炎发病率均较对照组显著升高,母亲产褥病率两组间无差异.破膜距妊娠结束时间及早产与新生儿窒息及肺炎关系密切.结论胎膜早破与难产互为因果关系.对不同孕周胎膜早破患者应采取不同治疗方案,以尽可能减少母儿并发症.     

Modes of action of IUDs

There are between 14-17 million women in the world, excluding China, who wear an IUD, or about 3-5% of all married women younger than 45. Studies on the mode of action of IUDs have been conducted mostly on laboratory animals; they show that ovulation and fecundation are not inhibited by the presence of an IUD. Contrary to what was generally believed, the latest studies have shown that the principle mode of action of the IUD is not its anti-implantation effect, but it depends on the adjustment inside the uterine cavity between the size of the uterine cavity itself, and the size and shape of the device. Endometrial modifications caused by IUDs include inflammatory phenomena, and inhibition of endometrial maturation. Moreover, copper IUDs act directly on spermatozoa and on endometrial steroid receptors. It is still not clear what role prostaglandins play in the mechanism of action of IUDs. Incidence of ectopic pregnancy is not greater in IUD wearers than in women who do not use contraception. Follicle stimulating hormone and luteinizing hormone levels also are comparable in IUD wearers and in nonwearers. IUD wearers have a shorter luteal phase, which entails an earlier menstrual bleeding due to the antifibrinolytic action of the IUD; progesterone levels are identical in users and in nonusers of IUDs.     

早产儿视网膜病107例临床特点及预后分析

摘要：目的　评价早产儿视网膜病（ROP）临床特点及远期治疗效果。方法　回顾性分析2004-01-01—2009-07-31复旦大学附属儿科医院新生儿科收治的107例ROP患儿临床资料、ROP分期、治疗情况及远期预后。结果　1期和2期ROP共64例,6例2期病变达Ⅰ型阈值前病变而采用激光治疗,其他均未进行特殊治疗;除失访和死亡病例外,所有随访病例ROP病变均消退,远期视力不受影响。3期病变15例,其中14例达阈值病变者给予激光或冷凝治疗,1例未达阈值病变者不需要治疗。有完整随访资料的11例患儿中3例术后视力严重受损,仅存在光感,其余8例视力正常。4期和5期ROP共28例,随访的18例患儿中,仅1例手术后保存了正常视力（占5.6％）,失明者达12例（占66.7％）,其余5例虽保存视力,但视力极差,仅存光感（占27.7％）。结论　ROP防治关键在于预防ROP发生,当出现ROP早期病变时应严格筛查和及时干预,一旦疾病进入晚期,出现视网膜脱离时再治疗,则治疗效果不佳。     

深部浸润型子宫内膜异位症对患者生存质量的影响

摘要：深部浸润型子宫内膜异位症（DIE）为一种特殊类型的子宫内膜异位症,可导致痛经、慢性盆腔痛、性交痛及排便痛等症状。由于疾病本身及其治疗过程,给患者的生理、心理和社会功能造成严重的影响。改善症状、提高患者生存质量是DIE现阶段的治疗目的。该文主要从DIE对患者的生存质量、性生活和排便功能的影响几个方面进行探讨。     

卵巢子宫内膜异位症恶性变25例临床分析

目的 探讨卵巢子宫内膜异位症恶性变的临床表现、病理特征、治疗方法和预后。方法 回顾性分析２５例卵巢子宫内膜异位症恶性变患者和病量资料。结果 卵巢子宫内膜异位症恶性变患者的主要症状为盆腔包块、腹胀、腹痛、异常阴道流血和流液。病理类型为子宫内膜样癌１４例,透明细胞癌２例,腺棘癌２例,浆液性腺癌１例,混合性卵巢上皮性癌６例,镜下均可见良性的异位子宫内膜向恶性移行的证据。临床分期为Ⅰ１４例,Ⅱ期７例,Ⅲ期３例,Ⅳ期１例。治疗方法均采用肿瘤细胞减灭术＋化学治疗。患者５年生存率达７７．７％。结论 卵巢子宫内膜异位症恶性变的确切发生率难以估计,该病的治疗以肿瘤细胞减灭术＋化学治疗为主。     

Cytologic findings of aspiration of tumors of the breast

Fine needle aspiration biopsy for cytologic diagnosis has been shown to be an effective adjunct to the clinical evaluation of masses of the breast by physical examination and mammography. In addition to adequately decompressing cystic masses, the procedure has been beneficial in obtaining a pathologic interpretation of any mass that is to be observed. Preoperative knowledge of the malignant nature of a mass of the breast allows the physician to investigate more selectively the possibility of metastatic disease and to consider more intelligently treatment options. Furthermore, the psychologic agony of the unknown for the patient and her family is avoided. Although histologic confirmation is always recommended before proceeding with mastectomy, a positive cytologic diagnosis can suffice when clinically advanced carcinoma is present or when there are medical contraindications to surgical treatment. Because of the false-negative rate of aspiration cytologic diagnosis, all clinically malignant or suspicious masses should have a biopsy in the face of benign cytology. This point cannot be over emphasized and is particularly pertinent to those patients in whom high risk factors of carcinoma of the breast are present. Inconclusive aspirates should be repeated or a biopsy of the mass should be done.     

Review of ovarian cancer of the University of Athens

One hundred and eight patients with cancer of the ovaries were studied retrospectively for a period of seventeen years. All the patients were managed in the Second Department of Obstetrics and Gynecology of the University of Athens. The symptoms of the patients were: pelvic pain in 43, ascites in 27, metrorrhagia in 23 and weight loss in 12. Fifty six per cent of the patients were between 40 to 60 years old and 63% were menopause. The PAP-smear in 40% was class I or II, in 50% was class III and in 10% was class IV-V. The stage of the disease was: 3 patients stage I, stage II 38, stage III 42 and 25 stage IV. No patient had stage 0. Laparotomy was done in all the patients. Thirty eight patients had Co-treatment and 42 patients chemotherapy. The pathology report was: serous cystadeno-Ca in 40, mucinous cystadeno-Ca in 38 of the cases, adenocarcinoma 18 and 12 other types of malignant tumors. The follow up of the patients showed a five years survival rate in 10% for stage I, 25% for stage II, 5% for stage III and none for stage IV.     

Comparative assessment of the methods of treatment of Condylomata acuminata

The treatment of Condylomata acuminata often causes disappointment to both the physician and the patient since most of the current medical approaches require multiple examines while on the other hand success rates are low and recurrence rates remain high. The treatment approaches include surgical as well as non-surgical methods. The non-surgical treatment includes the application of local agents such as imiquimod, podophyllotoxin, and 5-fluorouracil. Other local agents, used in outpatient treatment settings, include trichloroacetic acid (TCA), podophyllin, or the intralesional application of agents such as interferon and bleomycin. The surgical methods include cryotherapy, electrosurgery, excision and laser therapy. Their major goal is the removal of the visible lesions. The development of the laser systems and the new HPV vaccines are a significant progress in the treatment and prevention of the HPV infections.     

A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer

OBJECTIVES: Increasing survival rates of cervical cancer (CC) patients and the trend towards more toxic multimodal therapy have led to focus on the quality of life (QOL) of cervical cancer survivors (CCSs). The aim of this critical review was to summarize and discuss the research findings of QOL in CCSs based on self-report measures in terms of physical, psychosocial, and sexual well-being. METHODS: Electronic databases were used to identify studies published between 1966 and August 2005. A quality assessment using methodological and treatment-related criteria was performed to distinguish between studies with good and less good methodology. RESULTS: Twenty-three studies were included, whereof eight had a good methodology. Eight studies used at least one questionnaire that had not been validated previously, and only one of the validated questionnaires had been tested in former studies of CCSs. The studies with good methodology focused primarily on sexual and social function after treatment, and less on physical and psychological well-being. The trend is that radiotherapy is more associated with reduced QOL dimensions than surgery or chemotherapy. In earlier stages of CC and following surgery alone, there seem to be minor differences between CCSs and control groups concerning various QOL domains. CONCLUSIONS: Reviewed studies indicate that quality of life in cervical cancer survivors is reduced compared to the general female population following radiotherapy, but less so following surgery and earlier stages of cervical cancer. Shortcomings of both methodology and content of the studies reviewed preclude definite conclusions concerning QOL for the moment.     

Prospective assessment of quality of life of female cancer patients

OBJECTIVE: The aims of this study were to compare the quality of life (QOL) of women with different cancer sites; to identify predictors of QOL; and to examine the agreement between patient self-reported QOL and QOL ratings provided by clinicians and significant others. METHODS: A prospective study was conducted including 248 patients with gynecologic and breast cancer. QOL data were collected at six time points before, during, and after treatment, using the EORTC QLQ-C30 and the Spitzer QL index (QL-I). RESULTS: Baseline assessments showed comparable QOL scores among patients with different gynecologic malignancies and breast cancer. During active treatment breast cancer patients had significantly higher mean scores in physical functioning compared to women with gynecologic cancers and higher scores in role functioning compared to patients with cervical cancer. After completion of treatment there were no statistically significant differences in QOL among the groups. For all women, global QOL and emotional functioning were mostly affected during and after treatment. Regression analysis showed that patients' global QOL was significantly predicted by severity of surgery (t = 3.903, P < 0.01) and pretreatment performance status (t = 3.116, P = <0.01). Comorbidity, family support, number of treatments, age, and stage of disease were not predictive. The comparison of patient self-rated QOL and observer-rated QOL showed that the QL-I mean scores of health providers and relatives were generally in close agreement with those of patients. Intraclass correlations were moderate to high during active treatment and excellent after completion of treatment. CONCLUSION: In female cancer patients, global QOL and emotional functioning are mostly affected during the course of disease, independent of their diagnosis. Significant others and health professionals are able to provide useful information on QOL of patients recovering from cancer.     

Pharmacology of drugs of abuse

The pharmacology of most addictive substances is being studied extensively, not just for their acute effects but also the mechanisms that lead to drug seeking and addiction. The understanding of how these drugs alter their effects at the molecular level with continuing use gives promise toward investigation of novel substances that may be used for treatment. Genetic predisposition and gender differences are also some of the areas where more research is needed. Women who are addicted are likely to continue drug use during pregnancy, which can have an impact on the next generation. Prevention measures at the population level are as important. Programs need to address risks, social issues, and environmental factors that promote drug use and addiction.     

阴道平滑肌瘤25例临床分析

目的 探讨阴道平滑肌瘤的组织来源、临床特点和治疗方法。方法 回顾性分析1988年1月-1999年1月在我院住院手术并经病理检查证实的阴道平滑肌瘤25例。结果 阴道平滑肌瘤多高产田单雪,生长缓慢,症状与肿瘤的大小及部位有关,可复发及恶性变。治疗方式为阴道平滑肌瘤剔除术,结论 阴道平滑肌瘤临床少见,一旦发现,均应及时手术治疗,以免肌瘤增大产生症状甚至恶性变。     

双胎之一胎儿宫内死亡原因及处理19例临床分析

目的 :探讨双胎妊娠中一个胎儿宫内死亡的原因及处理。方法 :回顾性分析 1995～ 2 0 0 0年我院收治的 19例双胎之一胎儿宫内死亡的原因及妊娠结局。结果 :5例 <2 8周者 4例放弃胎儿作引产术 ,1例孕 2 6周及 7例 2 8～ 34周从确诊一个胎儿死亡后继续保胎到存活儿分娩 ,平均延长 6周 ,5例 >34周者确诊后随即行剖宫产 ,此 13例新生儿均存活。另 2例足月但未及时处理 ,活胎死亡。死亡主要原因 :脐带因素 2例、帆状胎盘 3例 ,胎儿畸形 2例 ,原因不明 12例。妊娠并发症比例较高占 6 3.16 %。结论 :孕周 <2 8周者一般作终止妊娠处理 ;妊娠 2 8～ 34周存活的胎儿继续妊娠到孕 34周预后良好 ;对孕 34周以后发现的应及时终止妊娠抢救存活儿     

Failure of initiation of parturition after electrocoagulation of the pituitary of the fetal lamb

Electrocoagulation lesions were made in the pituitaries of fetal lambs between the ninety-third and one hundred and forty-third day of gestation. Initiation of parturition failed to occur in 9 ewes operated on before 134 days in which the fetal pituitary lesion involved more than 70 per cent of the gland. Operation at the one hundred and forty-third day was followed by spontaneous delivery as was also the case in 3 ewes in which the fetal pituitary lesion involved less than 60 per cent of the gland. Four multiple pregnancies, with one fetus spared operation in each, and 4 shamoperated pregnancies terminated spontaneously at term. Pregnancy was prolonged in 2 ewes carrying fetuses with intact pituitaries; in one, the fetal hypothalamus was extensively damaged and, in the other, the pituitary stalk had been coagulated at the one hundred and forty-first day of gestation. It is concluded that the integrity of the fetal pituitary and probably of the hypothalamus is essential to the initiation of parturition in the sheep.     

454例足月妊娠胎膜早破妊娠结局的临床分析

目的:探讨胎膜早破与分娩方式及围产儿不良结局的关系,为临床围产期保健和并发症防治提供参考。方法:对2005年1月至2008年12月在我院住院分娩的454例足月妊娠无骨盆异常胎膜早破的病例进行回顾性分析。结果:胎膜早破占同期分娩总数的11.76%,无骨盆异常,其难产率为46.47%,剖宫产率为33.7%,新生儿窒息率10.79%,新生儿肺炎发生率1.54%,明显高于对照组。结论:胎膜早破与难产互为因果关系,及时终止妊娠,以改善新生儿预后,减少母婴并发症。     

Analysis of benefit of anticoagulation after placement of Kimray-Greenfield filter

The Kimray-Greenfield venal caval filter is widely accepted as a means of preventing pulmonary embolism when medical anticoagulation has failed or complications have developed. When indicated, anticoagulants are usually resumed after placement of the filter. A retrospective study was performed comparing the thromboembolic and postphlebitic complications in patients who continued to receive anticoagulants after placement of the filter versus those who did not. Sixty-eight Kimray-Greenfield filters were placed in 68 patients (43 men and 25 women) during a four year period. After placement of the filter, 26 patients received anticoagulants and 42 did not. Three of those receiving anticoagulants and six of those who did not had significant swelling of the leg; two of those receiving anticoagulants and two of those who did not had a recurrent deep venous thrombosis. There were no instances of recurrent pulmonary embolism. There were no significant differences in the results of these two groups of patients. These results are consistent with those reported in the literature in that no correlation has been found between the use of anticoagulants after placement of the filter and recurrent thromboembolism or stasis sequelae. In view of the complications associated with medical anticoagulation, we recommend its discontinuation in all patients after placement of the Kimray-Greenfield filter.     

妊娠肝内胆汁淤积症患者的胎儿淋巴细胞研究

目的探讨胎儿淋巴细胞在妊娠肝内胆汁淤积症(ICP)发病中的作用。方法采用单向混合淋巴细胞反应法,检测20例ICP患者(ICP组)及20例正常孕妇(对照组)的脐血胎儿淋巴细胞与母体外周血已灭活的淋巴细胞、皮肤组织可溶性抗原、蜕膜组织可溶性抗原的增殖反应情况。结果(1)ICP组脐血胎儿淋巴细胞与母体已灭活的淋巴细胞混合反应中,胎儿淋巴细胞的增殖反应程度为2．75±0．36,显著高于对照组的1．45±0．19,两组比较,差异有统计学意义(P＜0．05);(2) ICP组脐血胎儿淋巴细胞与母体蜕膜组织可溶性抗原混合反应中,胎儿淋巴细胞的增殖反应程度为1．45±0．19,显著高于对照组的0．67±0．24,两组比较,差异有统计学意义(P＜0．05);(3)ICP组脐血胎儿淋巴细胞与母体皮肤组织可溶性抗原反应中,胎儿淋巴细胞的增殖反应程度为1．22±0．44,显著高于对照组的0．66±0．27,两组比较,差异有统计学意义(P＜0．05)。结论胎儿淋巴细胞可能是ICP发病过程中的主要效应细胞之一;母-胎间免疫失衡是ICP发病的重要机制之一。