宫腔镜电切术治疗子宫纵隔23例临床分析

目的:探讨子宫纵隔患者接受宫腔镜电切术治疗后的妊娠结局。方法:回顾性分析23例子宫纵隔患者接受宫腔镜下子宫纵隔电切术后的妊娠结局。结果:23例子宫纵隔患者中,子宫完全纵隔5例,不完全纵隔18例,23例均在超声监视下完成手术,平均手术时间25min,平均出血30ml。与术前相比,术后足月活产率从4.35%增至48.83%,流产率从85.55%降至30.43%,具有显著性差异(P<0.01)。结论:宫腔镜电切术治疗子宫纵隔是安全、有效地治疗方法,能显著提高足月活产率,明显降低流产率。     

"Endoview" project of intrapartum endoscopy.

INTRODUCTION: The change in obstetrical practices over the last decade in favor of trials of labor in patients with uterine scars has resulted in increased incidences of uterine ruptures. Although neither repeat cesarean delivery nor a trial of labor is risk free, evidence from a large multicenter study shows vaginal birth after the cesarean (VBAC) is associated with shorter hospital stays, fewer postpartum blood transfusions, and a decreased incidence of postpartum maternal fever. The uterine rupture remains the most serious complication associated with VBAC. Factors associated with uterine rupture include excessive exposure to oxytocin, dysfunctional labor, and a history of more than 1 cesarean delivery.2 Because uterine rupture may be a life-threatening event, intrapartum surveillance and the ability to perform an emergency surgery are both necessary when trial of labor is allowed. Until now, no early symptoms pathognomonic to uterine rupture had been described. We share our experiences with the novel approach to the problem - an intrapartum endoscopy. MATERIALS AND METHODS: Endoscopic examination was accomplished by using the intraoperational fiberscope (Olympus and Endoview system (Costa Mesa, CA, USA). A gas-sterilized 25-cm long fiberscope is introduced into the amniotic cavity through the cervical canal after rupture of the membranes. The distance between the fiberscope and the object varies from 3 to 50 mm. The fiberscope has a separate channel for the fluid infusion (normal saline) throughout the procedure; the surgeon looks through the eyepiece directly and exhibits control over the flexible scope. The duration of endoscopy is less than 15 minutes. The inserting of the endoscopic device is very similar to that of insertion of an intrauterine pressure catheter. The IRB Committees of both participating institutions approved the study protocol. Twenty-eight patients with an unknown or poorly documented site of the uterine scar were included in the study. An ultrasound examination had been performed on all patients prior to endoscopy to assess fetal wellbeing and placental location. The ages of the patients ranged from 21 to 38 years. Eighteen women had 1 previous cesarean delivery, and 10 had 2. The performance of intrapartum endoscopy did not interfere with fetal monitoring; 21 fetuses were monitored externally, 7 internally. Indications for previous cesarean deliveries were as follows: fetal distress in 11 cases, failure to progress in labor in 8, placenta previa in 2, and unknown in 7. Twenty-one patients delivered vaginally; 7 had had repeat cesarean deliveries. All neonates were born in satisfactory condition. The Apgar scores at 1 minute varied from 7 to 9 and at 5 minutes from 8 to 10. The integrity of the uterine wall was assessed by manual postpartum uterine exploration in each case of vaginal delivery and by visualization and palpation of the scar site in each abdominal delivery. RESULTS: The lower uterine segment and contractile portion of the anterior uterine wall were visualized successfully in all patients. In 25 patients, the presumed scar site looked totally indistinguishable from the rest of the lower uterine segment and anterior uterine wall. Two scars were identified as vertical in 2 patients who were delivered by a repeat abdominal operation. A vertical scar appears as a groove running in a cephalad-caudad direction from the lower uterine segment into the contractile portion of the anterior uterine wall. The usefulness of the intrapartum endoscopy is best demonstrated by the following case reports (2 of 28 study cases).     

The relationship between receptor-effector unit heterogeneity and the shape of the concentration-effect profile: Pharmacodynamic implications

The apparent concentration-effect relationship is the ensemble of many effector units (such as individual cells or channels) that do not always exhibit a uniform stimulus-effect relationship. This concept is substantiated by many observations of heterogeneity in receptor-effector populations including hormone secreting cells, response to hormonal stimuli, activity pattern of second messengers, stimulus-evoked synaptic currents, and single ion channels. The relationship between drug concentration and magnitude of pharmacologic response is commonly described by the sigmoidalE _max model which was derived from the Hill equation. The sigmoidicity factor (N) in this model is assumed to be a pure mathematical parameter without physiological connotations. This work demonstrates that the numerical value ofN (measured empirically) is the product of two factors: (i) the degree of heterogeneity of the effector subunits, i.e., the elemental component that upon drug stimulus contributes its pharmacological effect independently and does not interact with other subunits (it could range from a single receptor up to a whole tissue), and (ii) value ofN ^*—the shape factor of the subunits' concentration-effect relationship. A special case of this approach occurs whenN ^*>5, which is an on-off case. HereN is determined by the distribution (density equation) of the subunit values. In case of heterogeneity of the microparameters of the effector subunits the apparentN will always have a lower value thanN ^*. According to this theory it can be concluded that without knowledge of the distribution of the microparameters no mechanistic interpretation can be deduced from the apparentN value. If in the futureN ^* can be determined by theoretical or experimental methods, the distribution function relatingN ^* toN can be calculated. The relevance of this theory is increased in view of the progress being made in advanced research techniques which may enable us to determine the concentration-effect relationship at the level of the individual effector unit.     

Reversible and irreversible effects of chemical fixation on the NMR properties of single cells.

The effects of chemical fixation are known to alter MR parameters, such as relaxation times and the apparent diffusion coefficient (ADC) of water. It is often assumed that such changes are reversible after samples have been reimmersed in a buffer solution for a sufficient period of time. In this study we characterize the changes associated with fixation of single Xenopus laevis oocytes and their subsequent reimmersion in buffer. Substantial reductions in both T(1) and T(2) values were measured for all compartments of the cell after fixation, with the cytoplasm showing larger changes than the nucleus. After reimmersion in buffer, there were small but statistically significant differences in MR parameters between fresh and reimmersed cells. Experiments with a gadolinium (Gd) contrast agent showed evidence of irreversible changes in the permeability of cellular membranes to small molecules.     

曲肘式机构的优化设计

以功效系数为目标函数,相应地确定了设计变量和约束函数,对塑料注塑机合模机构的参数进行优化计算,提高了机构的综合性能。     

磁共振扩散加权成像在肝癌介入治疗前后应用的初步研究

目的探讨肝癌经导管动脉化疗栓塞术(TACE)前后不同b值下瘤区组织的平均表观扩散系数(ADC)的变化及其意义。方法对17例临床及影像学诊断为肝癌并行介入治疗的患者,术前及术后7天行常规平扫和磁共振扩散加权成像,比较不同b值下瘤区组织的平均ADC值的变化。结果在b值为50和100s/mm2时术前术后比较无统计学意义。在b值为300、500和700s/mm2时,术前术后的平均ADC值变化有显著性差异。当b值大于300s/mm2时,随着b值的升高平均ADC值逐渐升高,术后瘤区组织的平均ADC值较术前升高,在b值为1000和1300s/mm2时图像质量太差无法测量。结论对肝癌TACE术后疗效进行评价时,b值最好选择300～700s/mm2之间。DWI通过瘤区DWI图像、eADC图像、ADC图像信号的变化和平均ADC值可以反映TACE术后瘤组织内的微观及超微结构的变化,平均ADC值可以为其早期疗效的判断提供量化标准。     

子宫角妊娠13例临床分析

目的：探讨子宫角妊娠的早期诊断，以提高对该病的认识和警惕，减少临床误诊率。方法：回顾性分析我院10年间收治的13例子宫角妊娠，总结其临床表现、诊断、处理。结果：子宫角妊娠占同期异位妊娠的1．35％，术前确诊率约30．7％，易误诊为宫内妊娠、输卵管妊娠。结论：认为血β-HCG、B超、腹腔镜检查对本病的早期诊断有重要意义，避免了如子宫破裂、大出血、胎盘滞留等严重并发症。     

腹腔镜辅助阴式较大子宫切除手术时间延长因素的分析

目的:分析影响腹腔镜辅助阴式较大子宫(超过如孕12周)切除术(laparoscopic assisted vaginal hysterectomy,LAVH)手术时间的因素。方法:回顾分析47例LAVH手术时间>150min患者的临床资料,对影响手术时间的多因素进行Lo-gistic回归分析。结果:子宫重量>500g时,手术时间延长的几率增加16倍(P<0.05);合并附件手术时手术时间的延长可增加20倍(P<0.05);普通妇科医师手术时间延长的几率高出内窥镜医师33倍(P<0.001)。结论:加强腹腔镜手术技能的培训是缩短腹腔镜辅助阴式较大子宫切除手术时间的关键。     

Comparing diffusion-weighted and T2-weighted MR imaging for the quantification of infarct size in a neonatal rat hypoxic–ischemic model at 24 h post-injury

PURPOSE: In a neonatal rat model of hypoxic-ischemic (HI) brain injury, using T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), we aim to determine the best MRI method of lesion quantification that reflects infarct size. MATERIALS AND METHODS: Twenty 7-day-old rats underwent MRI 24h after HI brain injury was induced. Lesion size relative to whole brain was measured using T2WI and apparent diffusion coefficient (ADC) maps, applying thresholds of 60%, 70% and 80% contralateral control hemisphere mean ADC, and at day 10 post-HI on pathology with TTC staining. Multiple linear regression analysis was used to study the relationships between lesion size at MRI and pathology. RESULTS: Lesion size measurement using all MRI methods significantly correlated with infarct size at pathology; using T2WI, r=0.808 (p<0.001), using 80% ADC, 70% ADC and 60% ADC thresholds, r=0.888 (p<0.001), 0.761, (p<0.001) and 0.569 (p=0.014), respectively. Eighty percent ADC threshold was found to be the only significant independent predictor of final infarct volume (adjusted R(2)=0.775). CONCLUSION: At 24h post-HI, lesion size on DWI, using 80% ADC threshold is the best predictor of final infarct volume. Although T2WI performed less well, it has the advantage of superior spatial resolution and is technically less demanding. These are important considerations for experiments which utilize MRI as a surrogate method for lesion quantification in the neonatal rat HI model.     

经阴道与经腹子宫肌瘤剔除术的比较

目的探讨经阴道子宫肌瘤剔除术的可行性、安全性及临床疗效.方法对92例子宫肌瘤分别施行经阴道肌瘤剔除术(研究组,n=46)及开腹肌瘤剔除术(对照组,n=46),并对两种术式的临床疗效进行比较.结果经阴道与经腹肌瘤剔除术均获成功.手术时间研究组与对照组比较差异无显著性(t=-0.734, P=0.465);平均术中出血量、术后肛门排气时间、术后疼痛、术后病率、住院日期研究组与对照组比较差异均有显著性.结论经阴道子宫肌瘤剔除术具有创伤小、术中出血少、术后肛门排气早、疼痛轻、术后病率低及住院时间短的优点,是一种安全可行的微创手术方式.但须正确掌握适应证.