A rare massive presentation of catamenial hemothorax

Catamenial hemothorax is a rare manifestation of thoracic endometriosis syndrome. It is commonly seen associated with pelvic endometriosis in nulliparous reproductive-age women. Most cases are minor and self-limiting. We present a case of a 32-year-old woman who presented with prolonged worsening dyspnea and was found to have a massive hemothorax on evaluation.     

酪氨酸激酶受体RON与E-cadherin在子宫内膜异位症上的表达及意义

目的探讨酪氨酸激酶受体RON及上皮型钙粘蛋白(E-cadherin)在子宫内膜异位症(endometriosis,EMs)上的表达及意义。方法选择2017年7~12月深圳市龙岗区人民医院收治的42例EMs患者,术中分别留取新鲜异位内膜组织和在位内膜组织,随机选取子宫切除或诊断性刮宫治疗的非EMs患者42例,术中留取其正常子宫内膜组织。采用逆转录聚合酶链反应(RT-PCR)检测子宫内膜组织中RON mRNA的表达,采用免疫组织化学方法检测对应42例石蜡组织中RON蛋白和E-cadherin的表达,并分析RON蛋白和E-cadherin的相关性。结果EMs异位内膜组织RON mRNA及RON蛋白阳性表达率显著高于在位内膜组织及正常子宫内膜组织(P<0.001),在位内膜组织及正常内膜组织中E-cadherin阳性表达率显著高于异位内膜组织(P<0.001),且异位内膜组织中RON mRNA及RON蛋白的表达与临床分期有关(P<0.001)。在同一标本中RON蛋白和E-cadherin表达呈负相关关系(r=-0.497,P<0.05)。结论RON的过度表达与EMs的发生发展密切相关,联合检测RON和E-cadherin的异常对判断EMs的发生发展有一定的参考价值,RON可能成为诊断治疗EMs的新靶点。     

Clinical analysis of high-intensity focussed ultrasound ablation for abdominal wall endometriosis: a 4-year experience at a specialty gynecological institution

Objective: To evaluate the long-term clinical effect of high-intensity focussed ultrasound (HIFU) as a non-invasive modality for ablation of abdominal wall endometriosis (AWE) foci.

Methods: All women who were diagnosed with cutaneous endometriosis and underwent HIFU ablation and 4-year follow-up were included. Patient symptoms, imaging performed, HIFU ablation, recurrence, lesion location, size and number were collected and analyzed.

Results: A total of 51 women with 57 painful abdominal wall masses with a median volume of 4.00?cm³ and a mean age of 30.5±2.12 years were treated with HIFU. The main symptoms were a palpable painful abdominal mass (93%), protrusion of the skin (28.1%, 16) or lack of protrusion of the skin (71.9%, 41). Ultrasound was initially performed in 100% (51) of women, whereas 6% (3) required MRI examinations to distinguish the features and range of the masses. Ablation was performed with a median 300?s of sonication time, 40?min treatment time, 150?W of power and 41800?J of total energy to treat lesions that were a median volume of 3.83?cm³. No severe complications occurred, except in one patient with a first-degree skin burn, during the 48-month follow-up period. The pooled recurrence of cutaneous endometriosis occurred in 3.9% (2) of women.

Conclusion: The diagnosis of AWE should be confirmed with imaging of the lesion number, location, size and features before HIFU ablation. HIFU should be the first choice for the treatment of AWE as it is a non-invasive method, with high efficiency and safety and rapid postoperative recovery.     

Study on therapeutic mechanism of Neiyifang in treating endometriosis

Objective: To observe the clinical effect of Neiyifang (NYF) in treating endometriosis and to explore its therapeutic mechanism through observing its influence on plasma β-endorphin (β-EP) in different menstrual stages and levels of prostaglandins (PGs) in menstruation.Methods:NYF was administered to 104 patients with endometriosis one dose daily with 3 successive menstrual cycles as one therapeutic course. Peripheral blood β-EP level in follicular, luteal and menstrual stages, as well as PGF_2α, PGE2, thromboxane B₂ and 6-keto-PGFl α levels in menstrual stage were detected by RIA, and controlled with those in 15 healthy persons.Results: (1) The total effective rate of NYF was 81.3% and it showed significant effect in improving patients’ clinical symptoms and physical signs; (2) In menstrual stage, the levels of β-EP, 6-keto-PGF_α/ TXB₂ were lower(P <0.05) and levels of PGF_2α, PGE₂, TXB₂ and 6-keto-PGF_1α were higher (P< 0. 05) in patients than those in control, and the higher the level of PGE₂, the severer the menalgia, (3) NYF could increase levels of β-EP, 6-keto-PGF_1α, and reduce levels of PGF_2α, PGE_2α in menstrual stage of patients (all P<0.05).Conclusion: (1) NYF has good clinical effect in treating endometriosis; (2) Patients’ symptom of menalgia is closely related with the excessive high levels of PGF_2α and PGE₂, PGI₂/TXA₂ ratio disturbance, and excessive low level of β-EP; (3) NYF could significantly decrease the PGE₂, PGF_1α levels, increase the 6-keto-PGF_1α/TXB₂ ratio and the level of β-EP, so as to alleviate the menalgia in patients with endometriosis. This item was supported by National Funds of Natural Sciences(No. 30070942)     

子宫内膜异位症并发不孕患者子宫内膜超微结构观察

目的：探讨子宫内膜异位症（EM）并发不孕患者围着床期子宫内膜的超微结构。方法：选择轻度子宫内膜异位症并不孕患者10例为研究组，已生育妇女7例作为对照组，选择在月经周期第19－22天刮取少量子宫内膜，进行扫描及透射电镜观察。结果：异位症患者围着床期子宫内膜出现超微结构改变，内膜表面腺体开口数少，纤毛再生不全，分泌细胞表面微绒毛极少，子宫内膜着床窗的形态学标记－细胞表面胞饮小泡减少 或缺失；胞质肿胀疏松，有的细胞出现核固醇，结论：异位症患者围着床期在位子宫内膜出现超微结构改变，细胞出现轻度变性，可能是其不孕的原因之一。     

祛瘀解毒颗粒治疗子宫内膜异位症患者卵泡液对小鼠胚胎发育的影响

目的 观察经祛瘀解毒颗粒治疗后子宫内膜异位症（endometriosis，EM）患者卵泡液对小鼠胚胎发育的影响。 方法 在常规培养液中分别加入治疗组EM患者卵泡液（祛瘀解毒颗粒）、对照组EM患者卵泡液及空白组（因输卵管因素行体外受精－胚胎移植）患者卵泡液，20只小鼠超排卵共收集189枚2 细胞鼠胚分别放入各组培养液进行培养，其中治疗组培养液70枚，对照组培养液60枚，空白组培养液59枚,观察和检测2 细胞鼠胚在体外发育至8细胞期、桑葚胚期和囊胚期的比率，及早期鼠胚优质胚胎数目和优质胚胎率。 结果 治疗组培养液有53枚鼠胚（75.71%，53/70）发育到8细胞期，48枚（68.57%，48/70）发育到桑葚胚期，45枚（64.28%，45/70）发育到囊胚期，与对照组培养液(56.67%，34/60、48.33%，29/60、35.00%，21/60)比较差异有统计学意义(P＜0.05)。治疗组有61枚优质胚胎（87.14%），对照组为44枚（73.33%），两组比较差异有统计学意义（P＜0.05）。 结论 EM患者卵泡液对早期鼠胚存在毒性作用，经祛瘀解毒颗粒治疗后EM患者卵泡液可提高早期鼠胚培养质量。     

子宫内膜异位症患者血清TNF-α和TNF-β的测定

目的:了解子宫内膜异位症（简称内异症）患者血清中肿瘤坏死因子-α(TNF-α)和肿瘤坏死因子-β（TNF-β）的水平以及在腹腔镜保守性手术治疗前后的变化。方法:采用酶联免疫吸附法检测82例内异症患者（内异症组）和68例非内异症妇女（对照组）血清中TNF-α和TNF-β的含量及49例手术前后两者水平的变化。结果：内异症组血清TNF-α和TNF-β含量均显著高于对照组（Ｐ<0.01），且二者表达量随病情加重有上升趋势（Ｐ<0.05）。手术后Ⅲ～Ⅳ期患者血清中的TNF-α和Ⅰ～Ⅳ期患者血清TNF-β的含量随着内异灶的清除逐渐下降。结论:检测患者血清中TNF-α和TNF-β的含量，对术后随访、监测及手术效果的评价具有重要意义。     

Extraperitoneal endometriosis: a diagnosis to be considered

Summary BACKGROUND: Endometriosis is a relatively common pathology in women of childbearing age and of low parity but rarely shows extraperitoneal involvement. The main aim of this paper is to raise the attention of specialists to the necessity of carrying out penetrating diagnosis of nonspecific extraperitoneal masses occurring in women of reproductive age. METHODS: We performed a retrospective review of six patients diagnosed with extraperitoneal endometriosis who were treated at the Vega Baja University Hospital (Spain) during the last 5 years. RESULTS: Surgical treatment had positive results in five patients. The preoperative diagnosis was correctly made in only two patients. The accurate aetiology of endometriosis remains unknown and diagnosis is based on clinical and cytopathological findings. CONCLUSIONS: Surgical treatment of extraperitoneal endometriosis is recommended. However, postoperative follow-up is obligatory and hormonal suppressive therapy may be necessary. Medical treatment with gestagens, Danazol, or agonists of the gonadotropin-releasing hormone are ineffective in endometriomas which are bigger than 2 cm.      

子宫内膜异位症患者子宫内膜人白细胞抗原的免疫组化研究

目的 研究子宫内膜异位症(内异症)患者在位和异位子宫内膜人白细胞抗原HLA—DR的表达。方法 采用酶标链霉亲合素—生物素(LSAB)技术对19例内异症不孕患者在位和异位子宫内膜腺细胞HLA—DR抗原的表达进行免疫组化研究，以19例非子宫内膜异位症的不孕患者作为对照。结果 内异症患者在位和异位子宫内膜腺细胞HLA—DR抗原的表达较对照组明显增强(P＜0．01)。结论 子宫内膜HLA—DR抗原的异常表达可能参与了内异症免疫学异常的发生。