296例胎膜早破的临床分析

以２９６例胎膜早破（ＰＲＯＭ）作为研究对象，并以３５０例无ＰＲＯＭ作对照，探讨ＰＲＯＭ对母婴的影响。结果显示：ＰＲＯＭ组难产率为５６．０８％，产褥病率４．０５％，早产率为５．４０％，胎儿窘迫率为１３．００％，新生儿窒息率为４．３３％，新生儿肺炎发生率为３．６６％，均明显高于对照组，统计学处理后有显著或极显著性差异（Ｐ＜０．０５，Ｐ＜０．０１）。而且，ＰＲＯＭ隐惹期小于２４小时的产褥病率为２．２９％；大于２４小时的产褥病率则为８．９７％（Ｐ＜０．０５）。本文提示，应积极预防胎膜早破，一旦出现胎膜早破，宜在６小时内使用抗生素预防感染，并加强母儿监测。     

4-Methylumbelliferone inhibits hyaluronate synthesis in human uterine cervical fibroblasts

AIM: Hyaluronate plays an important role in the regulation of cervical function during parturition. In our previous study we showed that 4-methylumbelliferone (MU) suppresses hyaluronate synthesis by cultured human skin fibroblasts. The present study investigated the effects of MU on fibroblasts obtained from the human uterine cervix and assessed the possibility of controlling cervical ripening with MU. METHODS: Human uterine cervical fibroblasts were collected from uterine cervices obtained from the uteri of three patients who had a total hysterectomy for uterine myoma at Hirosaki University Hospital. The fibroblasts were cultured in Dulbecco's modified Eagle's medium until confluence. They were then cultured in medium containing [3H]glucosamine (0.074 MBq/mL) with various MU doses. Hyaluronate synthesis was evaluated by assessing the incorporation of [3H]glucosamine into the soluble fraction of hyaluronate. Three independent studies were carried out on each specimen to clarify whether MU causes compositional changes or promotes hyaluronate degradation, whether the inhibitory effects of MU on hyaluronate synthesis are dose-dependent, and whether the effects of MU are reversible. RESULTS: MU added to the medium of the cultured cells reduced the synthesis of hyaluronate in a dose-dependent manner. After MU was removed from the medium, hyaluronate synthesis recommenced, and the amount of [3H]hyaluronate synthesized was similar to the control level. CONCLUSIONS: MU inhibits the synthesis of hyaluronate in human uterine cervical fibroblasts.     

Treatment of uterine fibroids for abnormal uterine bleeding: myomectomy and uterine artery embolization

Uterine myoma is a common benign tumour in women and most cases do not require treatment. Excessive uterine bleeding is usually due to a submucous myoma or an intramural myoma that is encroaching into the uterine cavity. After eliminating endometrial malignancy, perimenopausal women could be managed expectantly or with gonadotrophin-releasing hormone agonist until menopause. Hysteroscopic myomectomy is highly effective in controlling menorrhagia that is related to submucous myoma. Concomitant endometrial ablation improves menorrhagia; however, the subsequent hysterectomy rate remains the same. For those with an intramural myoma, abdominal myomectomy results in good bleeding control. It could also be done by laparoscopic approach; however, the surgeon should have expertise in laparoscopic suturing and the uterine incision should be properly sutured. In women who have completed their family, hysterectomy remains the most effective treatment for excessive uterine bleeding. Compared with uterine artery embolization (UAE), it is associated with better improvement in pelvic pain. Nevertheless, UAE is a good alternative to hysterectomy.     

Subkapsularës leberhämatom bei HELLP-syndrom

Zusammenfassung Das HELLP-Syndrom (Hemolysis, Elevated Liver enzymes, Low Platelets) tritt als Komplikation einer Schwangerschaftspräeklampsie auf und kann zu ausgedehnten subkapsulären Leberhämatomen führen. Wegen der Rupturgefahr der Hämatome besteht eine lebensbedrohende Notfallsituation für Mutter und Ungeborenes. Anhand von 2 Fallbeispielen wird das interdisziplinäre Vorgehen diskutiert. Mit Diagnosestellung der subkapsulären Leberhämatome sollte die notfallmäßige Entbindung durch Sectio erfolgen. Dann kann die chirurgische Entscheidung für eine konservative, abwartende Therapie mit Intensivüberwachung oder für eine Notfalloperation im Falle einer Leberkapselruptur ohne vermeidbares Risiko getroffen werden.

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Subcapsular liver hematoma with HELLP-syndrome — an interdisciplinary urgency

Summary The HELLP-syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), known as a complication during pregnancy, is associated with preeclampsia and may cause subcapsular liver hematomas. In case of hepatic rupture the lives of mother and unborn are threatened. Therefore, an interdisciplinary diagnostic and therapeutic approach is discussed and compared to two examples. The diagnosis of subcapsular liver hematoma must lead to urgent delivery through Cesarean section. Thereafter, the surgeon may decide between observation on an intensive care unit and urgent operation in case of hepatic rupture, without endangering the unborn.

     

Extensive replacement of the aorta from the ascending aorta to the supraceliac abdominal aorta during a one-stage operation

A successful replacement of the aorta from the ascending aorta to the supraceliac abdominal aorta in one operation is herein reported. The patient was 66-year-old woman who had DeBakey type I chronic aortic dissection with a pre-disseminated intravascular coagulation (DIC) condition. The image diagnosis revealed a markedly enlarged false lumen with a narrow true lumen in the ascending aorta extending to the diaphragm level while below the diaphragm level, the aortic dilatation was mild. The operation was performed through both a thoracoabdominal incision and a median sternotomy to expose the whole thoracic aorta, and the aorta was replaced from the ascending aorta to the supraceliac abdominal aorta. Selective cerebral perfusion was used for cerebral protection and this was a useful adjunct since no time limitations were thus required during repair of the aortic arch. Although the patient developed several complications postoperatively, she eventually recovered and was discharged from the hospital without any neurological disorders.     

胎盘血流量下降对大鼠胎仔生长和胎盘结构的影响——宫内生长迟缓动物模型的研究

本实验采用 SD 大鼠,在孕后期行孕鼠一侧子宫动脉中段完全结扎,另一侧作对照.23只孕鼠(150只胎仔)分成未结扎上、下(CU 和 CL)与结扎上、下(LU、LL)四组.结果表明,LU 组宫内胎仔体重、胎盘重、脑肝重均较其它三组有显著下降(P<0.01);LU 组脑/肝重比值及脑/体重比值较其它三组有显著增加(P<0.01).其胎仔呈不均称性宫内生长迟缓(IUGR)。52只胎盘作了光镜观察,12只胎盘作了电镜观察。在已知子宫胎盘血流不足,且胎仔发生 IUGR 的情况下,其胎盘的改变与以往报道的人类 IUGR 胎盘病理改变相一致,从而证实了子宫胎盘血流量下降是 IUGR 发病的重要原因之一。     

子宫肌瘤与细胞凋亡的研究

目的:探讨子宫平滑肌瘤的发生与细胞凋亡的关系.方法:采用凝胶电泳技术对子宫平滑肌瘤患者的肌瘤核组织(实验组)及其周围的正常肌组织(对照组)进行DNA片段分析;采用碘化丙啶(PI)对DNA染色,流式细胞仪检测两组细胞的凋亡率,进行细胞凋亡的定量分析.结果:实验组有9例出现DNA断裂的梯形条带(9/30,30.0%),对照组有20例出现DNA梯形条带(20/30,66.7%),二者比较有明显差异;实验组凋亡率明显低于对照组.结论:子宫肌瘤的发生与细胞凋亡异常有关.     

INTRA-AORTIC BALLOON RUPTURE CAUSING FEMORAL ENTRAPMENT

Rupture of an intra-aortic balloon counterpulsator (IABCP) demands immediate removal. We report a case of thrombus formation within a Datascope IABCP secondary to IABCP rupture, necessitating surgical exploration for removal. There is a disturbing pattern of balloon ruptures with this type of IABCP.     

医源性小儿气管及支气管破裂外科治疗方法的选择

目的探讨医源性小儿气管、支气管破裂的外科治疗方法．方法根据气管、支气管破损程度，分别采用颈部深筋膜切开１４例，胸膜腔闭式引流１０例，气管膜部修补５例，病肺切除术２例．结果本组３１例患儿全部治愈．结论严密观察，及时处理，恰当选择外科手术方法是提高疗效的关键．