达那唑经小鼠阴道和口服给药后血药浓度及子宫内含量的比较

本文采用ＨＰＬＣ法，比较小鼠阴道给药后达那唑血浆浓度及子宫组织内分布与口服给药的差异，结果是：相同剂量的达那唑，阴道给药后在小鼠吸收入血的药量明显较口服给药的少，然而，子宫组织中的含量，在给药１ｈ内阴道给药比口服给药明显较高，１ｈ后两者含量相近。     

酪氨酰肼对着床前大鼠子宫胞浆雌二醇受体含量的影响

子宫内局部给酪氨酰肼１．５ｈ后，子宫胞浆雌二醇受体（ＥｃＲ）量明显下降，３ｈ下降最明显，５ｈ后这种作用基本消失。选择给药３ｈ后为最佳作用时间，观察到酪氨酰肼使子宫ＥｃＲ下降的作用呈剂效关系。酪氨酰肼使妊娠ｄ１、ｄ３、ｄ５大鼠子宫ＥｃＲ含量下降。血清雌激素（Ｅ）和孕激素（Ｐ）浓度在给药前和给药３ｈ后无显著性差异。去卵巢１０ｄ大鼠，在给酪氨酰肼３ｈ后，子宫ＥｃＲ也降低。提示酪氨酰肼的这种作用是对子宫的     

酪氨酸肼对着床前大鼠子宫胞浆雌二醇受体含量的影响

子宫内局部给酪氨酰肼１．５ｈ后，子宫胞浆雌二醇受体（ＥｃＲ）量明显下降，３ｈ下降最明显，５ｈ后这种作用基本消失。选择给药３ｈ后为最佳作用时间，观察到酪氨酰肼使子宫ＥｃＲ下降的作用是剂效关系。酪氨酰肼使妊娠ｄ１、ｄ３、ｄ５大鼠子宫ＥｃＲ含量下降。血清雌激素（Ｅ）和孕激素（Ｐ）浓度在给药前和给药３ｈ后无显著性差异。去卵巢１０ｄ大鼠，在给酪氨酰肼３ｈ后，子宫ＥｃＲ也降低。提示酪氨酰肼的这种作用是对子宫的直接作用，而不依赖卵巢内源性雌激素和孕激素。     

围绝经期雌激素补充口服及阴道用药72例对比性研究

目的 探讨不同途径给予结合型雌激素（CE）对围绝经期妇女血清E2、子宫内膜厚度和阴道细胞学及更年期症状的影响。方法 72例围绝经期妇女随机分为两组，口服给药组37例，阴道给药组35例，分别口服及阴道给予倍美力片剂0.625mg及倍美力霜2g ，比较两组用药前后血清E2、子宫内膜厚度和阴道细胞学评分（V分）的变化及症状改善程度。结果 用药后口服给药组血清E2较用药前增加（P＜0．05），内膜厚度用药前后有显著改变（P＜0．01），而V分改变不显著；阴道给药组血清E2及内膜厚度无显著改变，而V分较用药前明显提高（P＜0．01）。结论 围绝经期妇女全身症状以口服补充雌激素为佳，局部症状以阴道给药较好。     

阴道给药与肌内注射黄体酮对子宫内膜孕激素水平影响的研究

目的:探讨阴道给药和肌内注射黄体酮给药后在血中和子宫内膜激素水平的影响。方法:采用单中心、前瞻性、随机对照研究方法,随机选择2009年12月至2011年8月在北京协和医院妇科51例健康绝经后女性,知情同意后随机分为两组,临床常规给药剂量阴道给药组给予黄体酮阴道缓释凝胶90 mg阴道给药,肌内注射给药组肌内注射黄体酮油剂20 mg,两组均每日1次,连续用药7天。在给药5~7天后测定血激素水平,活检取子宫内膜组织并利用放射免疫法(RIA)测定内膜孕酮浓度。比较两组用药后子宫内膜组织中及血中孕酮浓度及用药前后血中孕酮浓度。结果:完成研究并符合条件共39例,两组基线水平包括年龄、停经时间、基础激素水平差异无统计学意义(P0.05),阴道给药组血中孕酮浓度与肌内注射组差异无统计学意义(P0.05)。阴道给药组子宫内膜孕酮浓度(11.13±11.44 nmol/L)与肌内注射组(2.54±1.90 nmol/L)比较,差异有统计学意义(P=0.005)。阴道给药组用药前后血孕酮浓度变化(20.03±12.08 nmol/L)与肌内注射组(19.71±9.22nmol/L)比较,差异无统计学意义(P=0.822)。结论:与肌内注射给药相比,阴道凝胶经阴道给药的子宫局部吸收更高,值得临床推广。     

滚球电凝子宫内膜去除术后妊娠

报道滚球电凝子宫内膜去除术后33个月宫内妊娠1例,并综述了该并发症的发生率和危险性。 病人40岁,1991年11月因月经过多2年就诊。月经周期间隔24天,持续6～10天。足月正常产6次。阴道检查:子宫前屈,稍大。血红蛋白126g/L。宫腔镜检查:正常宫腔,深9cm。病理为增殖期子宫内膜。病人选择子宫内膜去除术,术后避孕,术前口服达那唑6周。1992年2月行宫腔镜滚球电凝子宫内膜去除术,电流功率100W,手术结束前切除5处内膜肌条,病检观察组织破坏深度,测量3个肌条的子宫内膜最大厚度仅0.8mm,其下方肌层内无明显腺肌病。全部内膜去除过程中,一部分     

子宫动脉栓塞术和口服达那唑治疗子宫腺肌病的临床对比分析

目的:探讨行子宫动脉栓塞术和口服达那唑胶囊两种方法治疗子宫腺肌病的临床效果。方法:将我院2006年5月至2010年3月84例子宫腺肌病患者的临床资料进行回顾性分析,根据治疗方法的不同将患者分为两组,行子宫动脉栓塞术治疗的为子宫动脉栓塞组(44例),口服达那唑胶囊的为口服药物组(40例),观察2组患者治疗后3个月、6个月、1年、2年痛经变化、月经周期和量的改变、子宫体大小改变及部分患者的妊娠情况。结果:子宫动脉栓塞组术后痛经减轻、月经量明显减少和子宫体缩小情况均优于口服药物组(P<0.01,P<0.05)。子宫动脉栓塞组在随访过程中有妊娠愿望的患者妊娠率(66.7%)高于口服药物组(33.3%),而子宫动脉栓塞组肝功能损伤、闭经和术后复发的发生率(0、4.5%、6.8%)均低于口服药物组(27.5%、32.5%、67.5%),差异有统计学意义(P<0.05,P<0.01)。结论:子宫动脉栓塞术在子宫腺肌病临床治疗中疗效明显优于口服达那唑,并能够完整保留子宫,不良反应小,是值得推广的针对子宫腺肌病的微创治疗方法。     

米非司酮阴道给药对血清雌孕激素及输卵管生理状态的影响

目的:探讨米非司酮不同给药方式对血清雌孕激素及输卵管生理状态的影响。方法:新西兰大白兔米非司酮阴道给药(6ml/kg,1mg/ml)以及灌药口服给药(6mg/kg)后不同时间,利用高效液相色谱法;放射免疫分析法;结合化学分离与原子吸收分光光度法等方法,研究血清米非司酮浓度和雌二醇、孕酮浓度以及输卵管内分泌液、输卵管组织中Ca2+浓度。结果:灌药口服给药组的各时间点血清米非司酮浓度均明显低于阴道给药组,1h,2h时间点两组有显著差异(P<0.05);两种给药方式均可使血清孕酮水平降低,雌二醇浓度明显增加。阴道给药组孕酮的浓度最低值以及雌二醇浓度的最高值均明显早于口服给药组,0.5h,1h,2h时间点两组对比之间有显著差异(P<0.05);米非司酮阴道给药与灌药口服给药对Ca2+含量的影响无明显差异(P>0.05)。结论:米非司酮两种给药方式对输卵管生理状态的影响无显著差异,阴道给药对血清孕酮、雌二醇的影响明显大于口服给药。     

RU_（486）对大鼠早、中期妊娠影响的研究

应用光、电镜方法观察ＲＵ４８６对早期和中期妊娠大鼠脑垂体、卵巢、子宫、胎盘及肝脏的影响。妊娠大鼠分别在受孕第７天（ｄ７）和第１０天（ｄ１０）给药１．２５ｍｇ／只。中期妊娠大鼠给药后２４ｈ全部流产，蜕膜坏死；４８ｈ子宫内膜修复正常。黄体细胞内脂滴增多、退变。血清孕酮水平低于对照组。早期妊娠大鼠给药后４８ｈ，个别胚胎发育与对照组相似，其余胚胎和胎盘均解体，其中２例子宫已修复。黄体和脑垂体促性腺激素细胞的结构及血清孕酮水平与对照组比较无明显差异。提示：ＲＵ４８６对大鼠抗中期妊娠效果比抗早孕好。     

宫腔操作前米索前列醇不同给药途径对宫颈成熟影响的Meta分析

目的:评价宫腔操作前米索前列醇通过不同给药途径促宫颈成熟的作用效果及不良反应。方法:计算机检索Medline、Embase、The Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库,时限为自建库至2014年10月。由2名研究者按照纳入标准与排除标准独立筛选文献、提取资料和评价文献质量后,采用Rev Man5.2软件进行Meta分析。结果:共纳入12篇文献,共2 529例患者。Meta分析结果显示,口服、舌下含服和阴道给药3种给药方式两两比较均提示其宫颈宽度的差异无统计学意义(均P0.05);阴道给药后宫腔操作用时少于口服给药(P0.05),但扩张宫颈耗时差异无统计学意义(P0.05);舌下含服后扩张宫颈耗时和宫腔操作用时均少于阴道给药(均P0.05)。在药物相关不良反应方面,口服及舌下含服米索前列醇后腹泻与恶心发生率明显高于阴道给药(均P0.05),舌下给药后呕吐发生率明显高于阴道给药(P0.000 1);此外,各种给药途径子宫痉挛收缩、阴道出血、发热、寒颤等不良反应的发生率比较差异无统计学意义(P0.05)。结论:口服、舌下含服和阴道给药3种给药途径在促宫颈成熟方面无差异;考虑避免药物相关不良反应,建议在宫腔操作前采取阴道给予米索前列醇。     

Early pregnancy termination with mifepristone and misoprostol in Norway.

OBJECTIVES: Medical abortion was first introduced in Norway in April 1998. The aims of this study were to assess the efficacy, side effects, and acceptability of medical abortion using mifepristone orally and misoprostol vaginally in a Norwegian population. DESIGN: The study included the first 226 pregnant women with gestational age of <63 days who requested nonsurgical abortion during the first year in the first Norwegian hospital using this regimen. METHODS: All women received a single dose of mifepristone 600 mg orally, followed at 48 hours by 800 microg misoprostol vaginally. Treatment outcome and complications were the principal outcome measures. We also measured the rates of side effects such as abdominal pain and bleeding and the women's acceptability of treatment. RESULTS: Abortion was successful in 95%, surgical evacuation became necessary in 4%, and the pregnancy continued in one woman. During the study period the method was chosen by 23% of those requesting abortion before 63 days amenorrhea; 80% would use the method again; 81% would recommend it to a friend; in retrospect, 69% would not have been willing to be randomly allocated to either a medical or a surgical method. CONCLUSIONS: The combination of orally administrated mifepristone and vaginally administrated misoprostol is an abortion method that is both effective and safe, has few side effects and is well accepted by Norwegian women.     

A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labor induction.

OBJECTIVE: Our purpose was to compare orally administered with vaginally administered misoprostol for cervical ripening and labor induction. MATERIAL AND METHODS: Two hundred twenty subjects with medical or obstetric indications for labor induction and undilated, uneffaced cervices were randomly assigned to receive orally administered or vaginally administered misoprostol. Fifty micrograms of oral misoprostol or 25 microgram of vaginal misoprostol was given every 4 hours. If cervical ripening (Bishop score of >/=8 or cervical dilatation of >/=3) or active labor did not occur, repeated doses were given to a maximum of 6 doses or 24 hours. Thereafter, oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum of 22 mU/min. RESULTS: Of the 220 subjects evaluated, 110 received orally administered misoprostol and 110 received vaginally administered misoprostol. Fewer subjects who received the oral preparation (34/110, 30.9%) were delivered vaginally within 24 hours of initiation of induction, in comparison with those who received the vaginal preparation (52/110, 47.3%) (P =.01). The average interval from start of induction to vaginal delivery was nearly 6 hours longer in the oral treatment group (mean and SD 1737.9 +/- 845.7 minutes) than in the vaginal treatment group (mean and SD 1393.2 +/- 767.9) (P =.005, log-transformed data). Orally treated patients required significantly more doses than vaginally treated patients (orally administered doses: mean and SD 3.3 +/- 1.7; vaginally administered doses: mean and SD 2.3 +/- 1.2) (P <.0001). Oxytocin administration was necessary in 83 (75.4%) of 110 orally treated subjects and in 65 (59.1%) of 110 vaginally treated subjects (P =.01, relative risk 1. 28, 95% confidence interval 1.06-1.54). Vaginal delivery occurred in 95 (86.4%) orally treated subjects and in 85 (77.3%) vaginally treated subjects (P =.08, relative risk 1.12, 95% confidence interval 0.99-1.27), with the remainder undergoing cesarean delivery. There was no difference in the incidence of uterine contractile abnormalities (tachysystole, hypertonus, or hyperstimulation), intrapartum complications, or neonatal outcomes between the 2 groups. CONCLUSIONS: Oral administration of 50-microgram doses of misoprostol appears less effective than vaginal administration of 25-microgram doses of misoprostol for cervical ripening and labor induction. Further investigation is needed to determine whether orally administered misoprostol should be used for cervical ripening and labor induction.     

Neonatal thyrotrophin and mode of delivery

This study was performed to assess the association between labour and the mode of delivery with the umbilical cord plasma thyroxine (T4) and thyroid-stimulating hormone (TSH) concentrations in full-term uncomplicated pregnancies delivered in our hospital. Babies born vaginally had statistically significantly higher umbilical cord plasma TSH but similar T4 concentrations than babies born by caesarean section. Labour was not associated with either higher TSH or T4 concentrations. All the babies with an elevated TSH concentration (greater than 20 miu/l) were born vaginally. Our findings indicate that the mode of delivery should be taken into consideration in the interpretation of umbilical cord plasma TSH results.     

Assessment of the treatment of endometriosis by an antigonadotropin

Danazol (2-3 isoxazole-17 beta ethinyltestosterone) is an antigonadotropin used to treat endometriosis. It has a half-life of 4.4 hours in humans. It has no known teratogenic or embryotoxic effects. Danazol use causes slight alterations of liver functions and hyperglycemia curves. Danazol dosages of 200 mg induce ovulation. The secretion of luteinizing hormone is normal or elevated among women using Danazol. Atrophy of the endometrium is observed after 5 or 6 weeks of Danazol use. Regeneration begins on about the 10th day after Danazol use is discontinued. 54 women with endometrial lesions were treated with Danazol. 15 women were treated for severe endometrial lesions with 800 mg of Danazol; 5 experienced significant amelioration of the lesions. Of 31 infertile women, treated with 600-800 mg Danazol, 9 pregnancies were observed. Of 8 women with small endometrial lesions who had been sterile for more than 3 years, 4 pregnancies occurred after treatment with 200-600 mg. Danazol. Sudden flushes, decreased breast size, metrorrhagia, acne, weight gain, artralgia, and digestive and emotional disturbances were the most frequent side effects. The continuity rate was about 90%.     

RU 486处理后大鼠垂体前叶对GnRH反应的影响

本实验选用动情前期的雌性Sprague-Dawley 大鼠在GnRH 刺激之前不同时间(0,0.5,1,2,24,48h)先肌肉注射RU 486,剂量为2mg/kg 体重,大鼠麻醉后由外颈静脉插入套管,从套管中分两次(0及1h)注入GnRH 各100ng,随后分别不同时间采血,用放射免疫法测定血浆中的LH 含量。实验结果显示在GnRH 诱导后LH 分泌出现两次高峰,正常对照组大鼠与注射RU 486的实验组大鼠作比较,实验组的LH 分泌量在0,0.5,1,2h 与对照组比有明显的降低,P<0.05;24和48h 实验组与对照组比P>0.05无明显差异;实验进行到4h 后血浆中LH 的浓度都逐渐恢复到起始基准线所需的时间,RU 486实验组与正常对照组无显著性差异(P>0.05)。以上实验表明RU 486处理后会显著降低大鼠垂体对GnRH 的反应,而对LH 水平的恢复无明显影响。     

Laparoscopic diagnosis and evaluation of danazol or gestrinone therapy for endometriosis in sterility

In forty-six sterile women, endometriosis externa was diagnosed and classified laparoscopically. 21 patients were treated with Gestrinone 5mg-10mg/week and 25 patients were treated with Danazol 300mg-400mg/day for 6 months. The effects of these hormonal treatments were evaluated by second-look laparoscopy according to adhesion severity, number of blueberry spots and chocolate cyst size, as well as dysmenorrhea and other complaints. The results were as follows; 1) Dysmenorrhea was relieved in 60.0% of the Gestrinone-treated group and 45.5% of the Danazol group. 2) Adhesion was weakened or partially separated spontaneously in 66.7% of the Gestrinone group and 63.6% of the Danazol group. 3) Blueberry spots decreased in number or paled in 61.9% of the Gestrinone group and 75.0% of the Danazol group. 4) Chocolate cyst size became smaller in 60.0% of the Gestrinone group and 77.8% of the Danazol group. 5) Peritoneal fluid volume was not decreased after the hormonal treatments but the prostaglandin E2 concentration in peritoneal fluid was decreased (p less than 0.05) after Gestrinone therapy. 6) The patients complained of some side effects, liver function especially was disturbed in 48.0% of the Danazol group and 9.5% of the Gestrinone group. Hoarseness was complained of in 33.3% of the Gestrinone group and 12.0% of the Danazol group. 7) Finally, 23.8% of the Gestrinone group and 28.0% of the Danazol group conceived after the hormonal treatments.     

Plasma opioids in the newborn in relation to the mode of delivery

Elevated plasma concentrations of beta-lipotropin (beta-LPH) and beta-endorphin (beta-EP) are present in vaginally delivered babies in the first 24 h of life. To establish if fetal distress or different types of delivery influence the secretion of these peptides in the neonatal period, we studied 16 vaginally delivered newborns (VD), 11 neonates extracted through elective cesarean section (CS) and 8 babies suffering from acute intralabor fetal distress (FD). In all groups of newborns the plasma levels of beta-LPH and beta-EP were measured in arterial and venous cord blood, at 1 and 24 h from delivery. beta-LPH and beta-EP were determined by specific radioimmunoassays after silicic acid extraction and Sephadex G-75 column chromatography. In cord plasma, there were no differences between arterial and venous concentrations of either beta-LPH or beta-EP in any of the groups. In the 1st h after delivery the plasma levels of VD newborns were similar to umbilical cord values (beta-LPH: 19.9 +/- 5.2; beta-EP: 18.1 +/- 2.4), while those of CS (beta-LPH: 30.6 +/- 4.5; beta-EP: 30.1 +/- 5.8) and FD (beta-LPH: 64.9 +/- 11.8; beta-EP: 65.7 +/- 24.4) showed a significant increase. At the 24th h of life the plasma concentrations of both peptides decreased significantly in the three groups, but CS and FD babies showed significantly higher plasma values than VD newborns (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Plasma levels of oestrone, oestradiol and gonadotrophins in postmenopausal women after oral and vaginal administration of conjugated equine oestrogens (Premarin).

Peripheral plasma from five postmenopausal women was analyzed for oestrone and oestradiol during 48 hours after administration of 1.25 mg Premarin (conjugated equine oestrogen) orally and vaginally. Oestrone and oestradiol were separated on columns of Sephadex LH 20 before radioimmunoassay. Administration of 1.25 mg of Premarin produced a marked increase in plasma oestrone levels and 24 hours after treatment the oestrone levels were still above follicular phase levels. The plasma pattern of oestradiol was similar but the elevation was less pronounced. The biological activity of Premarin as indicated by depressed gonadotrophin levels was similar with the intravaginal and oral routes of administration.     

Treatment of endometriosis by vaginal administration of gestrinone

The effectiveness and acceptability of gestrinone administered by vaginal route was evaluated in a group of 110 patients with endometriosis. Patients were divided into four groups. The first three groups were treated by vaginal route. Group I (n = 17) received two 2.5-mg tablets weekly; group II (n = 31) received three 2.5-mg tablets weekly; group III (n = 35) received two 5.0-mg tablets weekly. Group IV consisted of 27 patients who received 2.5 mg of gestrinone orally twice weekly. Ninety-eight women completed the 6- to 8-month treatment period. Amenorrhea developed in all treatment groups, including group I (34%). The disappearance of both dyspareunia and dysmenorrhea occurred in most patients in all treatment groups soon after the second month of therapy. Patients treated by vaginal route had significantly less seborrhea and acne than those treated by oral route. Weight gain was also significantly less in vaginally treated women than in those treated orally. Pregnancy rate following discontinuation was not significantly different for the various groups.