面向基层,面向未来,迎接挑战

中华医学会围产医学分会成立于1988年4月24日,至今已经有近22年历史.与其他学科相比,围产医学在我国的发展历史还比较短,但是在历届主任委员严仁英教授、黄德珉教授、赵瑞琳教授、叶鸿瑁教授以及其他老一辈专家的带领下,在所有围产医学工作者的共同努力下,我国的围产医学事业取得了可喜的进步.2009年11月,中华医学会围产医学分会进行了新一届委员会的改选,产生了第六届委员会.经过充分的讨论和酝酿,新一届委员会决定选择以下几个方面作为今后的工作重点.     

Brachycephaly, cutis aplasia congenita, blue sclerae, hypertelorism, polydactyly, hypoplastic nipples, failure to thrive, and developmental delay: a distinct autosomal recessive syndrome?

We report a 6-year-old male of first cousin parents with the unique constellation of frontal bossing with brachycephaly, cutis aplasia congenita, blue sclerae, hypertelorism, hypoplastic nipples, rudimentary unilateral post-axial polydactyly of the hand, failure to thrive, mild to moderate developmental delay and sociable personality. Knoblock-Layer syndrome and Smith-Lemli-Opitz syndrome were considered in the differential diagnosis and were excluded. No similar cases were found in LDDB or other databases.     

孕6+个月,先兆子痫,胎盘早剥,脑出血

1　病历摘要患者 36岁 ,因孕3产1 ,孕 2 7周 ,头痛头晕、眼花 2天 ,阴道流血 1小时左右 ,无下腹痛 ,于 2 0 0 0年 8月 2 2日 9:1 5ｐｍ入院。患者 1 987年顺产分娩一女婴 ,1 995年孕 5+ 个月 ,胎盘早剥剖宫取胎一次。自此血压增高 ,本次妊娠血压 1 57/ 1 2 0ｍｍＨｇ ,在家自服“降压片”治疗 (不定时 )。体检 :Ｔ 36 .6℃ ,Ｐ 76次 /分 ,Ｒ 1 7次 /分 ,ＢＰ 2 0 3/ 1 57ｍｍＨｇ,神志清楚 ,精神不振 ,一般情况可 ,心肺未闻及异常 ,双下肢Ⅰ度水肿。宫高 2 8ｃｍ ,胎位不清 ,可闻及胎心 1 2 0次 /分 ,未触及宫缩。阴道口见少量鲜血流出。辅…     

硒,铜,锌与卵巢肿瘤

近年来发现硒对肿瘤的发生及发展起抑制作用，在卵巢癌的化疗中要降低顺铂的毒副作用而不影响其抗癌力；而铜，锌，及Ｃｕ／Ｚｎ比值作为肿瘤的标志物之一，对卵巢癌的辅助诊断及手术后的随访有一定的临床应用价值。     

Too soon, too late, too often, too seldom?

Many variables determine the appropriate timing of diagnostic laparoscopy for suspected endometriosis. When initial treatments fail to relieve pain attributed to endometriosis, more detailed assessment is often indicated rather than escalation of treatment.     

Patientenverfügung, Patiententestament, Palliativmedizin, Tötung auf Verlangen

Problems of euthanasia are not only passionately discussed in medicine but also in jurisprudence and in the public domain. The legislator has not yet produced special regulations and the judiciary has not developed a unanimous comprehensive conception. The decision on continuation or cessation of treatment, assistance for dying or with death and the differentiation between active and passive euthanasia is therefore burdened with a high uncertainty risk for the physician. The advance directive could achieve greater clarity, but the legal binding effect is so far disputed and raises a number of questions which necessitate regulation and which must still be answered by the German parliament.     

孕31周,臀位,胎膜早破

1 病历摘要 产妇27岁,孕2产0,停经31周,阴道流水2+h,未见红,有不规则腹坠感,于1999年12月25日4:30PM入院.平素月经规律,末次月经1999年5月18日,预产期2000年2月25日.停经60+天尿酶免阳性,同时有少量阴道出血,无腹坠感,给予保胎治疗后血止.孕5月感胎动,孕6+月又有少量阴道出血,B超提示:①子宫畸形(子宫不完全纵隔?);②宫内孕单胎臀位,相当孕24周.一天后出血停止,其后定期产前检查,未见其他异常.1999年2月曾因孕2+月难免流产行清宫术.     

What matters matter? P values,H values,leadership, and us

Framed by the question "What matters matter?," this essay considers today's physicians' need for leadership, the principled road they embarked on, and the reasons to continue. Taken as a whole, the vast problems of health care seem unsolvable. Approached in small tangible steps, if not cure, could direction, even inspiration, appear? When people are sick, they look to physicians. By actually caring for patients, physicians have earned trust and learned, scientifically and artfully, about life in ways others cannot. Meaningful patient-centered care occurs at the junction of logical science and tenuous human needs: "p values" and "h values." Along with the privileged understanding gained from patients comes the responsibility to stand publicly for the rights of all patients to private moments. Standing up in these ways can never be easy; then again, it never was. It is the continued journey toward historic ideals. It is an imprecise place of struggle, where caring "leadership" has always been most needed, fulfilling and truly defining physicians. Despite today's seemingly insurmountable obstacles, in this place each physician can find ways to reenergize around what matters matter.