盐酸哌替啶联合宫术宁胶棒用于终止8～10周妊娠的临床效果观察

目的观察盐酸哌替啶联合宫术宁胶棒用于终止8~10周妊娠的人工流产术中的效果。方法对130例符合孕周的妇女在静脉注射盐酸哌替啶的同时,将宫术宁胶棒置于宫颈内口处,10分钟后开始手术。观察镇痛效果、宫口松弛程度、宫颈损伤情况、人工流产综合反应发生率、出血量、手术时间、术后离院时间。结果盐酸哌替啶联合宫术宁胶棒用于人工流产术,宫口松弛程度好,起效快,与对照组比较有显著差异(P<0.01)。观察组镇痛效果确切,有效率达100%,与对照组比较无显著差异(P>0.05)。观察组无人工流产综合反应发生,与对照组相比有显著性差异(P<0.01)。观察组出血量少,与对照组比较有显著性差异(P<0.05)。观察组手术时间较对照组短,两组相比较有显著差异(P<0.01)。观察组无宫颈损伤,与对照组相比较有显著差异(P<0.01)。两组术后离院时间无显著性差异(P>0.05)。结论盐酸哌替啶联合宫术宁胶棒用于人工流产术是一项有效镇痛,减少人流并发症的适宜技术,可达到无痛人流的效果。特别适用于基层医院。     

丙泊酚联合宫术宁胶棒用于孕8-10周无痛人流的临床观察

目的观察丙泊酚联合宫术宁胶棒用于孕8—10周无痛人流的应用效果。方法在人流术中对130例符合孕周的妇女将宫术宁胶棒置于宫颈内口处,10分钟后静脉注射丙泊酚,随即开始手术。观察镇痛效果、宫口松弛程度、人工流产综合反应发生率、出血量、手术时间、术后离院时间。结果丙泊酚联合宫术宁胶棒用于人工流产术,宫口松弛程度好,起效快,与对照组比较有显著差异（P〈0．01）。观察组镇痛效果明显,有效率达100％,与对照组比较有显著差异（P〈0．05）。观察组无人工流产综合反应发生,与对照组相比有显著性差异（P〈0．01）。观察组出血量少,与对照组比较有显著性差异（P〈0．05）。观察组手术时间较对照组短,两组相比较有显著差异（P〈0．01）。观察组无宫颈损伤,与对照组相比较有显著差异（P〈0．01）。两组术后离院时间无显著性差异（P〉0．05）。结论丙泊酚联合宫术宁胶棒用于孕8—10周无病人流是一项有效镇痛,减少人流并发症的适宜技术,适用门诊孕8—10周的无痛人流。     

米索前列醇与己烯雌酚用于绝经后妇女取出宫内节育器80例临床观察

目的：观察米索前列醇配伍复方萘普生栓用于绝经后妇女取出宫内节育器的效果。方法：对160例绝经后要求取出宫内节育器的妇女,随机分为观察组和对照组各80例,观察组取器前3 h口服米索前列醇400μg,术前15 min复方萘普生栓塞入肛门。对照组术前不用任何药物,按常规进行节育器取出术。结果：观察组与对照组在宫颈软化程度、取器术中综合反应、取器成功率方面均存在明显差异（P﹤0.01）。结论：米索前列醇配伍复方萘普生栓用于绝经后妇女取出宫内节育器,可软化扩张宫颈,减轻患者痛苦,提高取器成功率,是值得基层服务站推广使用的一种方法。     

戊酸雌二醇在绝经后妇女取环术前的应用

目的：探讨戊酸雌二醇（商品名补佳乐）在绝经后妇女取环中的作用。方法：将60例绝经后要求取环的妇女随机分成观察组（30例）和对照组（30例）。观察组在取环术前1w每日服用补佳乐3mg；对照组不用任何药物。两组术中均宫颈注射1％利多卡因。比较两组在取器成功率、扩宫率、手术时间等方面的差异。结果：观察组30例（100％）取器成功，4例（13．3％）需要扩宫，平均手术时间（3．0&#177;1．3）min；对照组25例（83．3％）取器成功，25例均（83．3％）需要扩宫，平均手术时间（15．0&#177;2．8）min。两组在取出成功率、扩宫率、手术时间方面差异均有统计学意义（P〈0．01）。结论：补佳乐用于绝经后取环能提高手术成功率，减轻受术者痛苦，缩短手术时间，值得临床推广。     

尼尔雌醇配伍米索前列醇用于绝经妇女取器的临床观察

目的观察使用尼尔雌醇配伍米索前列醇（简称米索）用于绝经后妇女取器，不同给药途径对宫颈扩张的作用。以及副反应程度。为推广应用提供经验依据。方法将绝经后取器妇女88例，随机分为口服组和局部组进行对照观察。结果阴道用药组对宫颈的扩张作用明显优于口服组，用药副反应发生率明显低于口服组。结论绝经后妇女取器在口服尼尔雌醇的基础上，于取器术前阴道后穹隆放置米索前列醇是理想的方法。     

绝经后妇女摘取宫内节育器的临床观察

目的 观察尼尔雌醇联合米索前列醇用于绝经后妇女摘取宫内节育器(IUD)的临床疗效.方法 绝经后要求摘取宫内IUD的妇女265例,尼尔雌醇联合米索前列醇用于摘取宫内IUD,观察镇痛效果、宫颈松弛情况、一次性取环成功率及不良反应.结果 观察组疼痛0级/Ⅰ级百分率为96.98%显著高于对照组的44.44%(P＜0.01);观察组宫颈管内口5号扩张器通过率(90.94%)显著高于对照组的51.11%(P＜0.01);观察组一次性摘取宫内IUD的成功率(90.19%)显著高于对照组(48.89%).观察组26例一次性摘取宫内IUD失败,失败率为9.81%.观察组术中及术后未见严重不良反应.结论 尼尔雌醇联合米索前列醇用于绝经后妇女摘取宫内IUD手术临床疗效显著,可减少摘取宫内IUD的痛苦及提高一次性成功率.     

米索前列醇用于绝经后宫内节育器取出之临床分析

目的探讨米索前列醇在绝经后妇女IUD取出者的疗效。方法比较分析我院收治的实验组（术前口服米索前列醇）和对照组（不服用任何药物）共50例绝经在1年以上且要求取出宫内节育器（IUD）者的临床资料。结果在宫颈软化和宫颈扩张的比较,实验组显著优于对照组;在手术效果的比较上,实验组的顺利取器率显著优于对照组;在手术镇痛的效果上,实验组镇痛有效明显优于对照组。结论米索前列醇能有效降低术中IUD的取器难度,减轻患者痛苦和减少取器并发症的发生。     

维尼安联合米索前列醇在绝经妇女取环术中的应用

目的:探讨绝经后妇女宫内节育环(IUD)更有效的取出方法.方法:将绝经后要求取IUD的妇女120例随机分为3组:甲组口服尼尔雌醇联合术前阴道放置米索前列醇;乙组单纯术前阴道放置米索前列醇;丙组宫颈局部注射利多可因.比较三组取IUD时,宫颈松弛程度及取IUD难易和成功与否.结果:甲组宫颈软化程度最好;乙组次之,丙组最差.取IUD时甲组均顺利取出,无操作困难;乙组部分取出困难,无取IUD失败.两组和C组比较差异有统计学意义.结论:绝经后取IUD口服尼尔雌醇联合米索前列醇效果最好.     

利多卡因在绝经后妇女IUD取出术中的应用

妇女绝经后,其内生殖器萎缩,宫颈组织变硬,弹性差,使绝经后取宫内节育器（IUD）难度增大,特别是绝经时间长的老年妇女,若强行取出,可造成宫颈损伤,子宫穿孔等严重后果。我院采用2％利多卡因宫颈注射,取器成功率高,且无不良后果,受术者感觉良好。现报告如下。     

卡孕栓在绝经后妇女取环术中的应用

绝经后妇女由于卵巢功能衰退,体内雌激素水平下降,其内生殖器萎缩,宫颈变硬,弹性差,使绝经后取IUD难度增大。自2009年1月～2010年3月我院计划生育门诊对30例绝经后取环妇女术前应用卡孕栓,获得满意的扩张宫颈的效果,现报道如下。     

米非司酮配伍米索前列醇用于绝经妇女取环术的临床研究

目的：探讨米非司酮与米索前列醇不同配伍方式用于绝经妇女取环术的效果。方法：选择门诊要求取环的绝经妇女400例,随机分为A、B、C、D四组各100例。均在术前3 d口服米非司酮2次/d,每次25 mg,术前2 h阴道放置米索前列醇A组600μg、B组400μg、C组200μg、D组不放置。比较四组取环成功率、取环时间、术中宫颈扩张情况、腹痛情况、出血情况及不良反应。结果：与D组比较,A、B、C三组取环成功率高,取环时间短,术中宫颈扩张有效率高,腹痛发生率低,出血量少,不良反应发生率低。有显著性差异（P〈0.05）。A、B、C三组间无显著性差异（P〈0.05）。结论：米非司酮配伍米索前列醇用于绝经妇女取环术可有效扩张宫颈,减轻患者痛苦,明显提高取环成功率。最佳配伍剂量及方法为术前3 d口服米非司酮2次/d,每次25 mg,术前2 h阴道放置米索前列醇200μg。     

Lifetime physical activity and breast cancer risk in pre- and postmenopausal women

PURPOSE: This research examined associations between leisure time and occupational physical activity (PA) across the lifespan and pre- and postmenopausal breast cancer. METHODS: In a population-based case-control study, 301 premenopausal cases, 316 premenopausal controls, 439 postmenopausal cases, and 494 postmenopausal controls, 40- to 85-yr-old reported time spent in exercise or sports strenuous enough to sweat and miles walked per week for time periods 2, 10, and 20 yr before the interview and at age 16. Lifetime occupational history was obtained. Jobs were coded according to the National Cancer Institute's PA job matrix. RESULTS: Strenuous PA was generally associated with a reduced breast cancer risk. Among women categorized as active at all four periods [at least 91+ h.yr(-1) (1.75+ h.wk(-1) avg)], a strong, significant protective effect was observed in postmenopausal [odds ratio (OR) 0.50 (0.28-0.90)] but not in premenopausal women [OR 1.06 (0.54-2.08)]. A strong protective effect was observed for activity performed 20 yr prior, in both pre- and postmenopausal women, although CIs overlapped for different time periods. Using women who reported no strenuous activity as the referent, OR (95% CIs) for the highest PA category [182+ h.yr(-1) (3.5 h.wk(-1) avg)] 20 yr ago were 0.57(0.31-1.05) and 0.51(0.31-0.83) for pre- and postmenopausal women, respectively. Walking was generally unrelated to risk. There was some indication of increased risk for the upper category of occupational PA for postmenopausal women, perhaps related to other industrial occupational exposures. CONCLUSION: Our results suggest a modest protective effect of strenuous leisure time PA on breast cancer risk in both pre- and postmenopausal women. The effects appear strongest for those active at least 20 yr prior and among postmenopausal women who were consistently active throughout their lifetime.     

米非司酮与妈富隆治疗围绝经期功能失调性子宫出血的临床疗效观察

目的:评价米非司酮与妈富隆治疗围绝经期功能失调性子宫出血的临床疗效。方法:将围绝经期功能失调性子宫出血患者120例随机分为米非司酮组和妈富隆组,治疗随访3个月,比较两组治疗前后调经效果、激素水平变化、子宫内膜厚度、药物副作用等。结果:治疗3个月后,米非司酮组在治疗期间均有效止血,无复发;妈富隆组停药后有撤退性出血,复发率为21.7%;米非司酮组血清激素水平FSH、LH、E2、P较治疗前有所下降,妈富隆组E2、P较治疗前下降;两组子宫内膜厚度均较治疗前变薄,治疗前后比较具有统计学差异(P<0.05)。结论:米非司酮治疗绝经期功能失调性子宫出血较妈富隆疗效确切,值得推广。     

The cardiovascular effects of chronic hypoestrogenism in amenorrhoeic athletes: a critical review

In premenopausal women, the most severe menstrual dysfunction is amenorrhoea, which is associated with chronic hypoestrogenism. In postmenopausal women, hypoestrogenism is associated with a number of clinical sequelae related to cardiovascular health. A cardioprotective effect of endogenous oestrogen is widely supported, yet recent studies demonstrate a deleterious effect of hormone replacement therapy for cardiovascular health. What remain less clear are the implications of persistently low oestrogen levels in much younger amenorrhoeic athletes. The incidence of amenorrhoea among athletes is much greater than that observed among sedentary women. Recent data in amenorrhoeic athletes demonstrate impaired endothelial function, elevated low- and high-density lipoprotein levels, reduced circulating nitrates and nitrites, and increased susceptibility to lipid peroxidation. Predictive serum markers of cardiovascular health, such as homocysteine and C-reactive protein, have not yet been assessed in amenorrhoeic athletes, but are reportedly elevated in postmenopausal women. The independent and combined effects of chronic hypoestrogenism and exercise, together with subclinical dietary behaviours typically observed in amenorrhoeic athletes, warrants closer examination. Although no longitudinal studies exist, the altered vascular health outcomes reported in amenorrhoeic athletes are suggestive of increased risk for premature cardiovascular disease. Future research should focus on the presentation and progression of these adverse cardiovascular parameters in physically active women and athletes with hypoestrogenism to determine their effects on long-term health.     

Indeterminate ovarian mass at US: incremental value of second imaging test for characterization--meta-analysis and Bayesian analysis

PURPOSE: To compare value of current diagnostic strategies in assessment of changes in posttest probability of ovarian cancer when menopausal status and combination and sequence of diagnostic imaging tests are considered. MATERIALS AND METHODS: Prevalence of ovarian cancer according to menopausal status in women with an ovarian mass and performance of combined gray-scale and Doppler ultrasonography (US), computed tomography (CT), and non-enhanced magnetic resonance (MR) imaging and contrast material-enhanced MR imaging after indeterminate results at gray-scale US were derived from meta-analysis by using MEDLINE database and institutional data. Study was approved by the institutional review board of University Hospital Geneva, Geneva, Switzerland; informed consent was waived. Posttest probability values were computed through Bayesian analysis and Monte Carlo simulation after initial gray-scale US and secondary combined gray-scale and Doppler US, CT, or MR imaging, while dependence of test results among imaging modalities was considered. Changes in posttest probability were compared among imaging modalities with summary receiver operating characteristic curves. RESULTS: Prevalence of ovarian cancer was 8.75% in premenopausal women and 32.40% in postmenopausal women with an ovarian mass. After characterization with initial gray-scale US, posttest probability in pre- and postmenopausal women changed, respectively, to 25% and 63% for indeterminate results and to 2% and 7% for benign results. Subsequent use of combined gray-scale and Doppler US, CT, or MR imaging had significant higher positive and lower negative posttest probability than did use of gray-scale US alone. In women with an indeterminate initial US result, posttest probability decreased after secondary testing with benign results for all imaging modalities to 2% in premenopausal women and to 8%-10% in postmenopausal women. After secondary testing for suspicious lesions, posttest probability increased more after non-enhanced (premenopausal women, 70%; postmenopausal women, 92%) or contrast-enhanced MR imaging (premenopausal women, 80%; postmenopausal women, 95%) than it did after combined gray-scale and Doppler US (premenopausal women, 30%; postmenopausal women, 69%) or CT (premenopausal women, 38%; postmenopausal women, 76%) (P < .001). CONCLUSION: In women with an indeterminate ovarian mass at gray-scale US, MR imaging results contributed to change in probability of ovarian cancer in both pre- and postmenopausal women more than did CT or combined gray-scale and Doppler US results.     

Comparative bone density measurements in healthy women and women with osteoporosis

To compare methods of noninvasive measurement of bone mineral content, 40 healthy early postmenopausal women and 68 postmenopausal women with osteoporosis were studied. The methods included mono- and dual-energy quantitative computed tomography (QCT) and dual-photon absorptiometry (DPA) of the lumbar spine, single-photon absorptiometry (SPA) of the distal third of the radius, and combined cortical thickness (CCT) of the second metacarpal shaft. Lateral thoracolumbar radiographic studies were performed and the spinal fracture index calculated. There was good correlation between QCT and DPA methods in early postmenopausal women and moderate correlation in postmenopausal osteoporotic women. Correlations between spinal measurements (QCT or DPA) and appendicular cortical measurements (SPA or CCT) were moderate in healthy women and poor in osteoporotic women. Measurements resulting from one method were not predictive of measurements obtained by another method for individual patients. The strongest correlation with severity of vertebral fracture was provided by QCT and the weakest by SPA. There was good correlation between single- and dual-energy QCT results. Osteoporotic women and younger healthy women can be distinguished by the measurement of spinal trabecular bone density using QCT, and this method is more sensitive than the measurement of spinal integral bone by DPA or of appendicular cortical bone by SPA or CCT.     

Bone mineral content in early-postmenopausal and postmenopausal osteoporotic women: comparison of measurement methods

To investigate associations among methods for noninvasive measurement of skeletal bone mass, we studied 40 healthy early postmenopausal women and 68 older postmenopausal women with osteoporosis. Methods included single- and dual-energy quantitative computed tomography (QCT) and dual-photon absorptiometry (DPA) of the lumbar spine, single-photon absorptiometry (SPA) of the distal third of the radius, and combined cortical thickness (CCT) of the second metacarpal shaft. Lateral thoracolumbar radiography was performed, and a spinal fracture index was calculated. There was good correlation between QCT and DPA methods in early postmenopausal women and modest correlation in postmenopausal osteoporotic women. Correlations between spinal measurements (QCT or DPA) and appendicular cortical measurements (SPA or CCT) were modest in healthy women and poor in osteoporotic women. Measurements resulting from one method are not predictive of those by another method for the individual patient. The strongest correlation with severity of vertebral fracture is provided by QCT; the weakest, by SPA. There was a high correlation between single- and dual-energy QCT results, indicating that errors due to vertebral fat are not substantial in these postmenopausal women. Single-energy QCT may be adequate and perhaps preferable for assessing postmenopausal women. The measurement of spinal trabecular bone density by QCT discriminates between osteoporotic women and younger healthy women with more sensitivity than measurements of spinal integral bone by DPA or of appendicular cortical bone by SPA or CCT.     

Endometrial thickness after menopause: effect of hormone replacement.

Ultrasound (US) images of the pelvis were evaluated in 112 asymptomatic postmenopausal women to investigate the normal range of endometrial thickness (double-layer measurement) and the effect of hormone replacement on these measurements. Twenty-one patients (19%) had endometrial thickness greater than 0.8 cm. One patient, with an endometrial thickness of 2.5 cm, had endometrial carcinoma. Consideration of the known actions of estrogen and progestogen on the endometrium led the authors to believe that the clinical significance of an endometrium measuring more than 0.8 cm depends on the patient's hormonal status. Among asymptomatic postmenopausal women with an endometrial thickness between 0.8 and 1.5 cm, those receiving unopposed estrogen or continuous estrogen and progestogen need to undergo dilatation and curettage (D&C) or biopsy and those receiving no hormones or receiving sequential estrogen and progestogen should be encouraged to undergo D&C or biopsy. If a patient in one of the latter two groups is unwilling to undergo an invasive procedure, then US examination at 3-month intervals is acceptable. Any patient with endometrial thickness of at least 1.5 cm should undergo histologic diagnosis, regardless of symptoms or hormone status.     

Reduced-dose adjuvant CMF-chemotherapy combined with postoperative irradiation in breast cancer with lymphatic metastases. A prospective study of 45 patients

From 1978 to 1982, 45 postoperative cases of breast cancer with lymphatic spread received radiation to the chestwall and axillary, supra- and infraclavicular lymph nodes up to 40 Gy. In addition, we gave 600 mg cyclophosphamide, 50 mg methotrexate and 750 mg 5-fluorouracil intravenously on day 1 of altogether nine 21-day cycles. The median follow-up is 37 months, and we calculate a 5-year over-all actuarial survival-rate which was 83% in the premenopausal and 77% in the postmenopausal patients. The disease-free 5-year survival-rate was 74% for the premenopausal and 61% for the postmenopausal women. There were twice as many patients with stage N2 in the postmenopausal group. No severe side-effects were observed. These promising preliminary results and the good tolerance of the above-mentioned combined therapy recommend it for future randomized studies.     

绝经前女性正常宫颈组织的表观弥散系数值研究

目的探讨不同年龄段绝经前女性正常宫颈组织在不同生理周期的表观弥散系数值（apparent diffusion coef ficient,,ADC）变化。方法将82名健康女性按年龄段分成3组（A组27例,20～29岁;B组28例,30～39岁;C组27例,40～49岁）,采用3．0TMRl分别于增殖中期及分泌中期行2次盆腔MR检查,研究不同结构区、年龄段及生理周期的宫颈ADC值的变化。结果子宫3层结构的ADC值两两比较差异均有统计学意义（肌层最高,黏膜层居中,结合带最低）,宫颈黏膜层及结合带的ADC值在分泌中期均低于增殖中期,而肌层的ADC值在不同周期问差异不明显,宫颈每层结构在同一周期的各年龄组之间无明显差异,宫颈粘膜层在增殖中期的ADC值更为稳定。结论不同结构区及生理周期会对正常宫颈组织的ADC值产生影响,当利用ADC值探测早期宫颈癌、监测疗效及鉴别肿瘤早期复发时应考虑这些因素,绝经前女性应在增殖期行盆腔MR扫描。