卵巢黄体囊肿破裂53例临床特征及相关因素分析

目的 :探讨卵巢黄体囊肿破裂的临床特征及相关因素。方法 :对 5 3例卵巢黄体囊肿破裂患者进行回顾性分析。结果 :均发生于卵巢功能旺盛时期 ,41例 ( 77.4% )发生于月经黄体 ,12例 ( 2 2 .6% )发生于妊娠黄体 ;3 1例 ( 5 8 5 % )发生于右侧卵巢 ,2 2例 ( 41 5 % )有性交等紧张性活动的发病诱因 ,44例 ( 83 0 % )以突发性下腹痛为主要就医原因 ,48例( 90 6% )不伴阴道流血 ,5 1例 ( 96 2 % )后穹隆穿刺抽出不凝血 ,3 7例 ( 69.8% )初步诊断误诊。结论 :卵巢黄体破裂既发生于月经黄体 ,又发生于妊娠黄体 ,以右侧卵巢多见 ,常误诊为异位妊娠破裂等 ,阴道流血是鉴别诊断的主要指标之一。     

A Corpus Luteum Is Not a Prerequisite for the Expression of Progesterone Induced Blocking Factor by T-Lymphocytes a Week After Implantation

Purpose: To determine if production of the immunomodulatory protein, progesterone induced blocking factor (PIBF), requires merely progesterone or whether other factors made by the corpus luteum are required. Methods: The percentage of peripheral lymphocytes expressing PIBF was determined by obtaining a blood sample from women 9–12 days after embryo transfer. The embryos were either fresh ones following hyperstimulation and oocyte retrieval or were frozen-thawed embryos. Preparation for frozen embryo transfer required corpus luteum suppression with exogenous estrogen. The percentage of lymphocytes expressing PIBF was determined by an immunocytochemistry method. Results: PIBF expression (>1%) was found in 20.5% of COH and 13.3% of frozen embryo transfer cycles. There either was a significant difference or a trend for higher pregnancy rates when PIBF expression was detected. Conclusions: These data corroborate previous conclusions that PIBF is detected in a minority of women in the late luteal phase. A corpus luteum is not required for its expression.     

转化生长因子-α和myc癌基因蛋白在卵泡发育与黄体形成及退化中的表达

目的：探讨转化生长因子（ＴＧＦ）－α和ｍｙｃ癌基因蛋白（ｍｙｃ蛋白）对人卵巢卵泡发育的局部调控机理。方法：收集３６例月经规则、因不同妇科情况切除的子宫及卵巢标本，采用免疫组织化学方法，研究ＴＧＦ－α和ｍｙｃ蛋白在卵巢组织中的表达。结果：卵母细胞在始基卵泡阶段，ＴＧＦ－α和ｍｙｃ蛋白的表达呈强阳性，随着卵泡的发育与成熟表达逐渐减弱。在颗粒细胞中，ＴＧＦ－α和ｍｙｃ蛋白表达均出现在窦前卵泡阶段，随卵泡的增大与成熟，ＴＧＦ－α表达逐渐增强。闭锁卵泡中ＴＧＦ－α和ｍｙｃ蛋白表达仅限于卵泡膜细胞。在晚期退化的黄体中，ＴＧＦ－α和ｍｙｃ蛋白表达均局限于黄体中央瘢痕周围的黄体膜细胞。结论：ＴＧＦ－α和ｍｙｃ蛋白作为卵巢内局部的调节因子，通过自分泌和旁分泌途径，协同参与人卵母细胞最初的生长、卵泡细胞的增殖分化和黄体细胞凋亡的过程。     

A Rare Cause of an Acute Abdomen in Late Pregnancy

Summary: A case is presented where spontaneous rupture of a uterine arteriovenous malformation into the peritoneal cavity presented as an acute abdomen with fetal distress in late pregnancy. This is thought to be the first reported case of its type.     

孕早期妊娠黄体结合孕囊胚芽对妊娠结局的临床研究

目的:探讨在孕早期(孕12周以前)联合妊娠黄体平均直径和孕囊平均直径与胚芽最大长度之间的差值,对不同年龄孕早期妇女妊娠结局的预测价值。方法:选择采用经阴道彩色多普勒检查313例孕早期的妇女,按年龄分为17～29岁组(184例)、30～39岁组(96例)和≥40岁组(33例),并将各组中满足妊娠黄体平均直径≤1.5cm且孕囊平均直径和胚芽最大长度之间的差值≥1.8cm的归为A组;其余的归为B组,对不同年龄组中A组和B组孕妇胚胎存活和凋亡的情况进行分析。结果:313例孕妇中A组总的胚胎凋亡率(50.00%)高于B组(3.80%),差异有统计学意义(χ2=90.30,P<0.001);3个年龄组中分别对A组和B组的胚胎凋亡情况比较,差异均有统计学意义(χ2=38.99;χ2=32.69;χ2=15.35,P<0.001)。313例中B组共10例发生胚胎凋亡,其中妊娠黄体直径介于1.6～1.7cm或孕囊平均直径和胚芽最大长度之间的差值介于1.5～1.7cm出现胚胎凋亡达6例。结论:妊娠黄体平均直径≤1.5cm且孕囊平均直径和胚芽最大长度之间的差值≥1.8cm可作为判别胚胎凋亡风险的指标临界值,有重要的预测价值;妊娠黄体直径介于1.6～1.7cm或孕囊平均直径和胚芽最大长度之间的差值介于1.5～1.7cm时,有出现胚胎凋亡的风险,临床上应高度警惕并根据病情给予及时治疗。     

Acute pancreatitis: a rare cause of acute abdomen in pregnancy

Pancreatitis in pregnancy is rare and occurs in approximately 1 in 1,000 to 1 in 10,000 births. Acute pancreatitis rarely complicates pregnancy, can occur during any trimester but over half (52%) occur during the third trimester and rarely during post-partum period. A case of idiopathic pancreatitis in pregnancy has been reported. Pancreatitis often presents as an acute abdomen and can have lethal effect on the mother and the fetus.     

Acute Abdominal Pain as a Result of a Ruptured Hematosalpinx: A Rare Complication of an Unusual Müllerian Anomaly

Case ReportA 15-year-old virgin Caucasian female presented to the emergency room with a 40-hour history of acute left lower quadrant abdominal pain and nausea. Evaluation suggested a left pelvic kidney with obstructed ureter being the etiology. Her pain continued to escalate so further workup with laparoscopy was performed. This demonstrated a left pelvic sidewall hemi uterus with ruptured hematosalpinx. This is an unusual clinical presentation of a müllerian anomaly not previously documented.DiscussionThe differential diagnosis of acute unilateral abdominal pain in adolescent females should include müllerian anomalies. The incidence of this diagnosis is low but the evaluation and treatment can be performed in an expeditious manner if the diagnosis is considered. The laparoscopic excision of a unilateral noncommunicating uterine horn is a valid and recommended treatment approach of this rare malformation.     

Fetiform Teratoma in the Ovary of a 7-Year-Old Girl: A Case Report

Background

Fetiform teratoma, a highly differentiated mature cystic teratoma resembling a fetus, is rare and typically found in the ovaries of women of reproductive age. In this report we describe, to our knowledge, the youngest case of ovarian fetiform teratoma.

Health-Related Quality of Life in Adolescents and Young Adults with Polycystic Ovary Syndrome: A Systematic Review

Study ObjectiveTo review recent data exploring the relationship between polycystic ovary syndrome (PCOS) and health-related quality of life (HRQoL) in adolescents and its implication for management of adolescents with this syndrome.Design and SettingWe performed a systematic literature search in MedLine, Embase and PsychInfo from 1980 to September 2015 and manual search in reference lists of selected articles. Inclusion criteria were articles in English or French with a focus on HRQoL in patients with PCOS aged between 13 and 24 years. Qualitative, cross-sectional, or interventional studies were considered as eligible. Two reviewers each independently selected and reviewed the relevant articles.ResultsOf a total of 93 publications, 7 were selected through a systematic search, and 2 were added after a manual search. Seven studies used quantitative methods and 2 studies used a qualitative one. A meta-analysis was not possible because of the methodological diversity among the selected articles. All articles showed that PCOS has a negative influence on HRQoL in adolescents. Body weight issues and body mass index (BMI) appeared to have the strongest effect on HRQoL; some studies reported a normalization of HRQoL scores after adjustment for BMI. Patient information and patient-provider relationship were also reported to affect HRQoL. Elements in favor of the effectiveness of multidisciplinary management, associated lifestyle modifications, and psychological support, in improving HRQoL were identified.ConclusionPCOS significantly reduces HRQoL in adolescent girls. The extent to which body weight issues and BMI mediate this effect deserves further evaluation. A detailed understanding of the psychosocial challenges that patients with PCOS face is limited, mainly because of the small number of studies available, restricted sample size, and the methodological diversity of the questionnaires used. The effect of early lifestyle modification, and medical and psychological treatment should continue to be explored.     

Acute Renal Insufficiency in Pregnancy: A Review of Thirty Cases

A review of women with acute changes in renal function during pregnancy including cases with only mild or moderate azotemia was performed to determine the etiology, associated disorders and frequency of this problem in an inner-city population. A retrospective review of the clinical and laboratory data of all patients admitted to the Tulane Obstetric Service at Charity Hospital of New Orleans from 1985-1989 that contained a final diagnosis of hypertension, pre-eclampsia/eclampsia or renal disease was performed to determine if acute renal insufficiency or renal failure occurred during that admission. Renal disease was defined as a serum creatinine level of greater than or equal to 1.2 mg/dl with either a rising or falling level during the hospitalization. Thirty cases of either acute renal insufficiency or renal failure during pregnancy were identified with an incidence of one in 450 deliveries. Seventeen women had either pre-eclampsia or eclampsia. Their clinical and biochemical characteristics were reviewed and found to be similar to those of the 13 women who had other causes of acute renal dysfunction complicating their pregnancies. The mean serum creatinine for all patients in this series was 3.4 mg/dl (range: 1.2-16). Four patients required dialysis, two of whom never regained function. There were no cases of cortical necrosis. Most patients still had abnormal renal function at the time of discharge. There were 21 live births and 9 fetal deaths. Fetal death was more likely to occur with shorter gestation, higher serum creatinine, and lower platelet count. Even in cases with mild acute renal insufficiency complicating pregnancy, there was significant maternal morbidity and fetal mortality. Pre-eclampsia/eclampsia was the most common disorder associated with this problem in pregnancy. In an inner-city population, acute renal insufficiency and renal failure in pregnancy occur more frequently than previously reported; recognition of this problem is necessary to provide appropriate follow-up.     

Green tea as an adjunctive therapy for treatment of acute uncomplicated cystitis in women: A randomized clinical trial

Backgroundand purpose: Different in vitro studies have reported the antimicrobial effects of green tea catechins and also their synergistic effects with trimethoprim–sulfamethoxazole against E. coli. The aim of the present study was to evaluate the efficacy of green tea as an adjunctive therapy to standard antimicrobial treatment in women with acute uncomplicated cystitis.Materials and methodsIn this blinded randomized trial, 70 patients were assigned to receive four 500 mg capsules of green tea or starch as placebo daily for three days along with trimethoprim–sulfamethoxazole. The presence of acute uncomplicated cystitis symptoms was recorded and urinalysis was performed.ResultsWomen in the green tea group showed a statistically significant decrease in the prevalence of cystitis symptoms and a statistically significant improvement in the urinalysis results except for hematuria after 3 days of treatment.ConclusionGreen tea was an effective adjunct to trimethoprim–sulfamethoxazole to treat acute uncomplicated cystitis in women.