Managing hereditary ovarian cancer

In this review we present an overview of recent developments in the management of hereditary ovarian cancer. Until recently, intensive screening of the ovaries was recommended to mutation carriers and their first-degree female relatives. However, since screening is not effective in detecting early-stage ovarian cancer, women are counselled for a prophylactic bilateral salpingo-oophorectomy (pBSO) shortly after child-bearing age (>35 years). Many mutation carriers already choose to undergo pBSO to reduce their cancer risks; however, the age of prophylactic surgery may interfere with reproductive and other important (psychosexual) issues in life. Due to the protective effect of oral contraceptives regarding ovarian cancer, we advise women at increased risk of ovarian cancer to use oral contraceptive pills for 3–5 years early in life (<25 years of age), when the absolute incidence of breast cancer is extremely low. A transient increased relative risk of breast cancer due to oral contraceptives at this age will result in a negligible increased absolute number of breast cancers, while the risk reduction of ovarian cancer remains for life. Research should aim at finding new molecular markers and screening strategies for detecting early-stage ovarian cancer in women with a hereditary ovarian cancer trait.     

Effect of the bilateral hip bone density measurement on clinical practice in elderly subjects

Objectives

The aim of this study was to determine whether the addition of the measurement of bilateral hip bone mineral density (BMD) has an impact on indications for osteoporosis (OP) treatment in community-dwelling elderly individuals, based on criteria from the National Osteoporosis Foundation (NOF).

Methods

In total, 605 consecutive community-dwelling elderly individuals who were 65 years and older were evaluated. Dual energy X-ray absorptiometry was used to determine the lowest T-score in the lumbar spine + unilateral hip, the bilateral hips, and the lumbar spine + bilateral hips. Risk factors associated with the lowest T-score in these three conditions were applied to indicate treatment in accordance with NOF criteria. McNemar's test was used to assess the difference of adding bilateral hip BMD measurements.

Results

There was a significant difference in the frequency of pharmacological indication using NOF criteria together with the lowest T-score for the three tests (72.8% for lumbar spine + bilateral hips and 71.2% for lumbar spine + unilateral hip; p = 0.002). A higher frequency of treatment indication was also observed for lumbar spine + unilateral hip (71.2%) compared to bilateral hips (61.1%) (p < 0.001). The discrepancies in treatment appeared to be more evident in women when analyzed by gender distribution.

Conclusion

Our finding supports the theory that evaluation of the bilateral hips with the lumbar spine seems to be more sensitive measure for identifying patients with an osteoporosis treatment indication. Furthermore, despite the well-known artifact in the lumbar spine, this site should not be excluded when determining the indication for OP treatment in elderly people.     

经单侧纵裂入路显微外科治疗大型双侧嗅沟脑膜瘤（附13例报告）

目的探讨经单侧纵裂入路切除大型双侧嗅沟腑嘎瘤的手术方法及治疗效果。方法回顾性分析我院神经外科2001年5月至2009年3月利用显微外科手术切除的13例大型双侧嗅沟脑膜瘤患者的临床资料。13例大型双侧嗅沟脑膜瘤多以头痛、嗅觉障碍为首发症状。手术均采用单侧纵裂入路,切开大脑镰,不结扎上矢状窦。结果肿瘤全部切除12例,大部分切除1例,无手术死亡病例,随诊疗效满意。结论经单侧纵裂入路分块切除大型双侧嗅沟脑膜瘤符合微侵袭观念,可以作为大型双侧嗅沟脑膜瘤手术切除的一种选择术式。     

子宫下段剖宫产瘢痕妊娠处理的临床分析

目的：探讨子宫下段剖宫产瘢痕妊娠（CSP）患者处理的相关因素。方法：将同期诊治的24例患者（1例行瘢痕妊娠病灶切除术除外）分成两组,传统治疗组11例,给予甲氨蝶呤（MTX）、米非司酮药物保守治疗;双侧子宫动脉栓塞术（UAE）＋MTX组12例,给予UAE及MTX灌注治疗。两者治疗后均在B超引导下或官腔镜下行清官术。监测两组患者B—HCG下降水平、阴道出血量、再次清官术等情况。结果：1周后B—HCG下降幅度比较,传统治疗组下降50％。60％,UAE＋MTX组下降60％～85％。血流比值及血流RI比较,传统治疗组与UAE＋MTX组治疗后均大于治疗前;治疗后UAE＋MTX组大于传统治疗组,差异均有高度统计学意义（均P〈0．01）。阴道出血量比较,传统治疗组4例〉200ml、4例〈100ml、3例介于两者之间;UAE＋MTX组均〈100ml。再次清宫术,传统治疗组3例;UAE＋MTX组均无需行再次清官术。住院时间比较,传统治疗组平均为11．5d,UAE＋MTX组平均为8d。结论：UAE＋MTX可迅速杀胚、止血．术后在B超引导或宫腔镜下行清宫术可彻底清除病灶,安全有效,阴道出血量少,无需再次清官术,避免子宫切除．创伤小．值得临床推广。     

双侧肝叶巨大海绵状血管瘤分期切除1例

目的:探讨双侧肝叶巨大血管瘤的外科手术方式并总结治疗经验.方法:对1例罕见的特大双侧肝叶血管瘤患者的临床资料进行完整详细的回顾性分析及术后随访.结果:1例罕见的特大双侧肝叶血管瘤患者因正常肝组织较少无法同时施行左、右侧肝叶血管瘤切除术.该患者接受了二期血管瘤切除术治疗:一期手术切除左侧肝叶巨大血管瘤,术后恢复顺利,残余正常肝组织向左侧增生,但同时右侧肝血管瘤也继续增大;术后3.5年时接受了二期手术切除了右侧肝叶巨大血管瘤,该患者术后逐渐康复.至今已经健康存活4年余.结论:双侧肝叶巨大血管瘤可先切除左侧肝叶巨大血管瘤,使正常肝组织解除压迫,获得生长空间,从而逐渐增生,随后择期二期切除右侧肝叶巨大血管瘤.     

重度先天性心脏病新生儿期进行流量可调性的双侧肺动脉环缩术

Objective： Although the outcomes after operation for severe congenital heart diseases are improving, the morbidity rates continue to be higher than those of many other congenital heart diseases. We perform bilateral pulmonary artery banding （BPAB） in the neonatal period followed by percutaneous pulmonary artery balloon dilatation （PABD） for severe congenital heart diseases. The objective of this study was to assess the impact of our management strategy for treatment of severe congenital heart diseases.     

双侧乳糜尿腹腔镜治疗

目的：探讨腹腔镜下肾蒂淋巴管结扎术治疗双侧乳糜尿的手术方法、临床价值以及临床疗效。方法：随机选取本院2007年10月～2009年12月间确诊为双侧乳糜尿的10例患者,对其采用腹腔镜行双侧肾蒂淋巴管结扎术,术中使用超声刀,不放置钛夹,未完全游离肾脏,并对手术的时间、手术疗效、术中并发症、术中出血量、术后功能恢复情况以及住院时间等具体指标进行观察和评定。结果：10例患者行腹腔镜行双侧肾蒂淋巴管结扎术后,均恢复正常。10例患者平均手术时间为165min;术中平均出血量为120ml;术后肠道功能恢复时间平均52h;患者术后平均住院时间为7d。术后有7例患者出现肉眼血尿的症状,2例出现皮下气肿的症状,均在术后3d内自行消失。在跟踪随访中发现,无复发现象。结论：腹腔镜行双侧肾蒂淋巴管结扎术治疗双侧乳糜尿具有创口小、出血少、复发少、恢复快、费用低等特点,值得临床推广。     

Recurrent heterotopic pregnancy after bilateral salpingectomy in an IVF patient: Case report

Purpose: To report a rare clinical case of recurrent heterotopic pregnancy in the same patient following bilateral salpingectomy and in-vitro fertilization (IVF) treatments. Methods: A 35 year-old woman, suffering from mechanical infertility, was treated by IVF, resulting in two episodes of heterotopic pregnancies within 2 years. The first episode ended in bilateral salpingectomy due to unilateral tubal pregnancy and contralateral severely damaged tube. The intrauterine pregnancy ended in early missed abortion. The second heterotopic pregnancy presented as bleeding cornual pregnancy, managed by laparoscopic resection of the tubal stump, and ended in a term singleton delivery. Conclusion: The possibility of cornual heterotopic pregnancy following bilateral salpingectomy, though very rare, should be considered by every gynecologist treating IVF patient.     

Bilateral diaphragm paralysis following cardiac surgery in children: 10-years' experience

Objective To review the incidence and complications of conservative management of bilateral diaphragm paralysis following pediatric cardiac surgery.Design and setting Retrospective clinical review based on computerized database with daily follow-up in a pediatric cardiac intensive care unit in a tertiary care center.Patient and participants Were reviewed the data on nine patients with bilateral diaphragm paralysis from the 3,214 consecutive children (0.28%) after operations performed between 1995 and 2004.Measurements and results A fluoroscopy-confirmed diagnosis of bilateral diaphragm paralysis was made in all nine patients. Mechanical ventilation was required for 14–62 days; maximum time to recovery was 7 weeks. Three patients underwent unilateral plication. Patients with a complicated postoperative course required longer mechanical ventilation. All patients were managed with a nasotracheal tube. One patient had minor subglottic stenosis. All patients survived.Conclusions Bilateral diaphragm paralysis can be managed conservatively with good prognosis and minor complications. The recovery time is relatively short, less than 7 weeks.This article is discussed in the editorial available at:     

Sex steroids to maintain cognitive function in women after the menopause: A meta-analyses of treatment trials

It is still debated whether estrogen treatment after the menopause could result in improved cognitive function in women. This debate is based on many animal and cell culture data showing that estrogens can positively affect the aging brain. Observational data also show a halved risk of dementia in women who took estrogens around the age of menopause. However, large treatment trials have shown negative effects of long-term treatment with estrogens in older women. The present meta-analyses included 36 randomised treatment trials and tested various hypotheses which have been developed to attempt to explain discrepant data. Results indicated that, contrary to expectations, age of women and duration of time elapsed when treatment was initiated since menopause (‘window of opportunity’ hypothesis) did not significantly affect treatment outcome, nor did it matter whether women were symptomatic or not. It was not clear whether bilateral oophorectomy affected the outcome, as this effect was based on only a few studies from the same group and some observational studies show negative effects on cognition in surgical menopausal women treated with hormones for more than 10 years. Duration of treatment overall significantly affected outcome. More negative effects were seen in longer studies, where positive effects were mainly seen in short term studies (<4 months). Treatment with combined estrogens and progestagens also negatively affected the outcome. Whether women with symptoms should be treated for a couple of months or using other (intermittent) modes of treatment and whether this could have long-term positive consequences remains to be investigated.