多囊卵巢综合征的胰岛素抵抗

胰岛素抵抗 (ｉｎｓｕｌｉｎｒｅｓｉｓｔｅｎｃｅ ,ＩＲ)是多囊卵巢综合征(ｐｏｌｙｃｙｓｔｉｃｏｖａｒｙｓｙｎｄｒｏｍｅ ,ＰＣＯＳ)患者主要和常见的代谢紊乱。多囊卵巢综合征和胰岛素抵抗是两种复杂的、牵涉广泛病理生理变化的病症。自 1980年 ,Ｂｕｒｇｈｅｎ[1] 等发现ＰＣＯＳ与高胰岛素血症相关后 ,对ＰＣＯＳ的胰岛素抵抗进行了广泛和深入的研究[2～ 4] ,本文对此进行简要的综述。1　胰岛素抵抗的概念1 1　胰岛素抵抗的定义胰岛素抵抗的定义目前仍不完全统一。根据美国糖尿病协会 (ＡｍｅｒｉｃａｎＤｉａｂｅｔｅｓＡｓｓｏｃ…     

Molecular Basis of MDR

ＭｏｌｅｃｕｌａｒＢａｓｉｓｏｆＭＤＲ（ｃｏｎｔｉｎｕｅｄ）ＧｅｎｇＹｉ；ＪｉａｎｇＳｅｎ；ＬｉＪｉａｆｕ；ＷａｎｇＬｉ；ＥｒｎｓｔＡ．ＤｅＢｒｕｉｊｎ；ＣｏｒｎｅｌＦｒａｅｆｅｌ；ＬｕｃＤｉｒｉｘ；ＡｌａｎＴ．ＶａｎＯｏｓｔｅｒｏｍ（Ｄｅｐａｒｔｍ...     

胰岛素样生长因子I,生长抑素在新生儿缺氧缺血性脑病血液？…

目的 观察胰岛素样生长因子Ｉ（ｉｎｓｕｌｉｎ－ｌｉｋｅ ｇｒｏｗｔｈ ｆａｃｔｏｒ－Ｉ，ＩＧＦ－Ｉ）、生长抑素（ｓｏｍａｔｏｓｔａｔｉｎ，ＳＳ）在新生儿缺氧缺血性脑病（ ｈｙｐｏｘｉｃ－ｉｓｃｈｅｍｉｃ ｅｎｃｅｐｈａｌｏｐａｔｈｙ，ＨＩＥ）极其和恢复期血液中的变化；探讨ＩＧＦ－Ｉ、ＳＳ在ＨＩＥ发病机制中的作用。方法 （１）用放射免疫分析法（ＲＩ）测定正常对照组、ＨＩＥ极期、恢复期血浆ＳＳ的水平。     

Molecular Basis of MDR

ＭｏｌｅｃｕｌａｒＢａｓｉｓｏｆＭＤＲＧｅｎｇＹｉ；ＪｉａｎｇＳｅｎ；ＬｉＪｉａｆｕ；ＷａｎｇＬｉ；ＥｒｎｓｔＡ．ＤｅＢｒｕｉｊｎ；ＣｏｒｎｅｌＦｒａｅｆｅｌ；ＬｕｃＤｉｒｉｘ；ＡｌａｎＴ．ＶａｎＯｏｓｔｅｒｏｍ（ＤｅｐａｒｔｍｅｎｔｏｆＯｂｓｔｅｔ...     

Discussion on a problem in Gynecologic Oncology:Bone m etastases

１　Ｍａｎｉｆｅｓｔａｔｉｏｎｏｆｂｏｎｅｍｅｔａｓｔａｓｅｓｏｆｐａｔｉｅｎｔｓｗｉｔｈｇｙｎｅｃｏｌｏｇｉｃｃａｎｃｅｒ１．１　Ｐａｉｎ　Ｂｏｎｅｍｅｔａｓｔａｓｅｓｗｅｒｅｔｈｅｍｏｓｔｃｏｍｍｏｎｃａｕｓｅｏｆｐａｉｎｆｒｏｍｃａｎｃｅｒ，ｗｈｉｃｈｒｅｓｕｌｔｅｄｆｒｏｍｅｉｔｈｅｒｍｅｃｈａｎｉｃａｌｏｒｃｈｅｍｉｃａｌｓｔｉｍｕｌａｔｉｏｎｏｆｐａｉｎｒｅｃｅｐｔｏｒｓｉｎｔｈｅｐｅｒｉｏｓｔｅｕｍａｎｄｅｎｄｏｓｔｅｕｍ．Ｔｈｅｓｐｉｎｅｗａｓｔｈｅｃｏｍｍｏｎｓｉｔｅｆｏｒｍｅ…     

Toxicity of Paclitaxel and Cisplatin in Combination for Advanced Ovarian Cancer

Ｏｖａｒｉａｎｃａｎｃｅｒ(ＯＣ)ｃｏｎｔｉｎｕｅｓｔｏｂｅａｍａｊｏｒｃａｕｓｅｏｆｍｏｒｔａｌｉｔｙｏｆｗｏｍａｎ .Ｉｔｉｓｔｈｅｌｅａｄｉｎｇｃａｕｓｅｏｆｄｅａｔｈｆｒｏｍｇｙｎｅｃｏｌｏｇｉｃｍａｌｉｇｎａｎｃｉｅｓ .Ｍｏｓｔｔｕｍｏｒｓａｒｅｃｈｅｍｏｓｅｎｓｉ ｔｉｖｅ ,ｍｅｔａ -ａｎａｌｙｓｅｓｏｆｒａｎｄｏｍｉｚｅｄｃｏｎｔｒｏｌｔｒｉａｌｓｏｆｃｈｅ ｍｏｔｈｅｒａｐｙｈａｖｅｓｕｇｇｅｓｔｅｄｔｈａｔｐｌａｔｉｎｕｍｂａｓｅｄｃｈｅｍｏｔｈｅｒ ａｐｙｅｆｆｅｃｔｓｂｅｔｔｅｒ…     

宫颈不典型鳞状上皮细胞诊断的探讨

1995年起 ,我国开始使用宫颈涂片电脑细胞学检测(ｃｏｍｐｕｔｅｒ ａｓｓｉｓｔｅｄｃｙｔｏｌｏｇｙｔｅｓｔ,ＣＣＴ)及ＴｈｅＢｅｔｈｅｓｄａＳｙｓｔｅｍ(ＴＢＳ)诊断标准 ,明显提高了宫颈细胞病理学的诊断准确率。但对未明确诊断意义的不典型鳞状上皮细胞 (ａｔｙｐｉｃａｌｓｑｕａｍｏｕｓｃｅｌｌｓｏｆｕｎｄｅｔｅｒｍｉｎｅｄｓｉｇｎｉｆｉｃａｎｃｅ ,ＡＳＣＵＳ)的诊断及治疗 ,至今尚无统一的治疗标准[1] 。我们通过对诊断为ＡＳＣＵＳ的妇女阴道镜及组织病理学检查 ,依据人类乳头瘤病毒 (ＨＰＶ)结果 ,探讨了ＡＳＣＵＳ的治…     

足月妊娠胎膜早破时引产和期待疗法的比较

足月妊娠胎膜早破时引产和期待疗法的比较９７０１８ＭａｒｙＥ．Ｈａｎｎａｈ，Ｍ．Ｄ．Ｃ．Ｍ，ＡｒｎｅＯｈｌｓｓｏｎ，Ｍ．Ｄ，ＤａｎＦａｒｉｎｅ，Ｍ．Ｄ．ＴｈｅＮｅｗＥｎｇｌａｎｄＪｏｕｒｎａｌｏｆＭｅｄｉｃｉｎｅ１９９６；３３４（１６）：１００５足月妊...     

The relation of intraabdominal findings and retroperitoneal lymph node metastasis in the epithelial ovarian cancer patients

ＴｈｅｒｅｌａｔｉｏｎｏｆｉｎｔｒａａｂｄｏｍｉｎａｌｆｉｎｄｉｎｇｓａｎｄｒｅｔｒｏｐｅｒｉｔｏｎｅａｌｌｙｍｐｈｎｏｄｅｍｅｔａｓｔａｓｉｓｉｎｔｈｅｅｐｉｔｈｅｌｉａｌｏｖａｒｉａｎｃａｎｃｅｒｐａｔｉｅｎｔｓＴｈｅｒｅｌａｔｉｏｎｏｆｉｎｔｒ...     

Risk factors for HIV infection among women in Dodoma region,Tanzania

Ｉｎｔｈｉｓｐａｐｅｒ ,ｗｅｒｅｐｏｒｔｅｄｒｉｓｋｆａｃｔｏｒｓａｓｓｏｃｉａｔｅｄｗｉｔｈＨＩＶｉｎｆｅｃｔｉｏｎａｍｏｎｇｗｏｍｅｎａｎｄｔｈｅｉｒｉｍｐｌｉｃａｔｉｏｎｓｆｏｒＡＩＤＳｐｒｅｖｅｎｔｉｏｎｅｆｆｏｒｔｓｉｎｔｈｅＤｏｄｏｍａｒｅｇｉｏｎ ,Ｔａｎｚａｎｉａ .1　ＳＵＢＪＥＣＴＳＡＮＤＭＥＴＨＯＤＳ1.1　Ｔｈｅｐｏｐｕｌａｔｉｏｎａｎｄｓａｍｐｌｅｓｅｌｅｃｔｉｏｎ　ＴｈｅｓｔｕｄｙｗａｓｃｏｎｄｕｃｔｅｄｉｎｔｈｅＤｏｄｏｍａｒｅｇｉｏｎ ,ｗｈｉｃｈｈａｓａｎｅｓｔｉｍａｔｅ…     

Reflections on cervical cancer

The incidence of invasive cervical cancer and consequently mortality decreased due to adequate screening programmes in Canada from 1969 to 2003. Systematic cervical screening programmes similar to those in Europe should be implemented throughout Canada. The new techniques, including a liquid-based cytology, associated or not with identifying human papilloma virus (HPV), allow the best results in prevention and early diagnosis of cervical cancer and high-grade squamous intraepithelial lesions (HSIL). In the future a vaccine against HPV type 16 could reduce the incidence of cervical cancer worldwide.     

局部晚期宫颈癌术前治疗方法选择

发展中国家宫颈癌的发病率及病死率逐年上升,其中,局部晚期宫颈癌因其治疗难度高、预后差也让妇科肿瘤学者面临巨大的挑战。由于存在个体化差异及区域卫生事业发展不均衡,局部晚期宫颈癌治疗方案的选择仍存在较大争议。在美国、加拿大等发达国家同步放化疗作为治疗局部晚期宫颈癌的标准治疗方案,而在欧洲、亚洲尤其是发展中国家和地区则选择辅助治疗后进行手术治疗。文章就国内外相关文献及指南对局部晚期宫颈癌术前治疗方法的选择进行介绍。     

Trends in cervical cancer survival in Europe, 1983-1994: a population-based study

OBJECTIVE: To evaluate trends in survival from cervical cancer in Europe and in European countries participating in the EUROCARE study as a function of age, morphology and stage at diagnosis. METHODS: Relative survival and relative excess risk of death within 5 years of diagnosis, as a function of age, morphology and stage, among 73,022 women aged 15-99 years diagnosed during 1983-1994 and followed up to 1999 in each of 18 European countries participating in the EUROCARE study, using data from 34 population-based cancer registries. RESULTS: Overall five-year relative survival was 62%, rising by 2% during the period 1983-1994. The highest survival occurred in Northern and Western Europe and the lowest in Central Europe. Survival falls with age at diagnosis, but mainly for localised disease. Survival is higher for adenocarcinoma in younger women, but higher for squamous cell carcinoma in older women. The proportions of younger women, localised cancer and adenocarcinoma all increased. The main improvements in survival were for women under 65, and for metastatic disease. CONCLUSIONS: Survival in Europe has improved slowly but steadily, but the trend is not geographically uniform. Central European countries and the UK saw little or no improvement, and survival in those countries remains the lowest among participating countries in Europe. Further reduction of cervical cancer mortality in Europe may be expected from expansion of screening, and improvement in the treatment of older women, and of metastatic disease.     

A cohort analysis of cervical cancer in Israeli Jewish women

The incidence of squamous cell cervical cancer was studied in Jewish Israeli women between 1961 and 1981. The 1052 cases and the 27,832,272 women-years of observation were divided according to continent-of-origin, year-of-birth, and immigration-wave cohorts. Age-adjusted odds ratios were calculated for each cohort and compared. The incidence of cervical cancer was shown to have changed according to cohort year of birth, most significantly in women born in Europe and America. The highest risk in this group was seen in women born in 1891-1895 and 1941-1945 and the lowest in women born between 1926 and 1935. A high risk was also observed in all cohorts of North African women. There was a sharp rise in risk for women of all origins born after 1940. Immigration to Israel at a younger age was correlated with reduced risk for cervical cancer. It has been shown that epidemics of sexually transmitted diseases (STDs) are followed in time by epidemics of cervical cancer. Since there was an epidemic of STDs in Israel between 1967 and 1970, our results also suggest that there is a rise in the risk for cervical cancer in women who were sexually active during the epidemic of STDs. Because of the low rates for cervical cancer traditionally observed in Israeli women, routine screening was not done in Israel in the past. Should the relative risk for cervical cancer in women exposed during the 1967-1970 epidemic continue to be high, screening may prove worthwhile.     

Neoadjuvant chemotherapy: an alternative option of treatment for locally advanced cervical cancer

Although the incidence of cervical cancer has declined in both North America and Europe, it still represents the second most common cancer in women and the fifth most common malignancy worldwide. Most patients in the developed countries present with disease either confined to the cervix or with limited extension beyond it. Historically, the standard treatment was usually radiotherapy or radical hysterectomy with node dissection. In 1999, five randomized clinical trials performed by the Gynecologic Oncology Group, the Radiation Therapy Oncology Group and the Southwest Oncology Group have demonstrated a significant outcome advantage when cisplatin-based chemotherapy was administered during radiation in patients with cervical cancer. In the current review, we will analyze the role of neoadjuvant chemotherapy followed by radiotherapy and surgery as an alternative option treatment to the standard chemoradiation for locally advanced cervical cancer (stage Ib2 or larger).     

局部晚期宫颈癌新辅助化疗和放疗联合治疗

铂类为基础的同步放化疗在美国国立综合癌症网络（NCCN）指南中被认为是局部晚期宫颈癌的标准治疗方案,而在欧洲、日本、韩国以及拉丁美洲,局部晚期宫颈癌的其他治疗方式被认为具有同样的治疗效果。目前我国医疗机构水平参差不齐,放疗设备不一,新辅助化疗（NACT）联合放疗或同步放化疗不失为一种可选择的方法。不可忽视手术在局部晚期宫颈癌中的作用,新辅助化疗仅是局部晚期宫颈癌综合治疗措施中的一部分,临床应用需谨慎,不可滥用,不能将NACT作为单一的、主要的治疗手段。     

In vitro adjuncts to the pap smear

The Pap smear has been recognized widely as the most effective cancer screening test in the history of medicine. It is widely believed that the use of this test has been responsible for the drastic reduction in the incidence and mortality of cervical cancer in the United States, Canada, and much of Western Europe in the last 50 years. Several adjuncts to the Pap smear including liquid based cytology, computer-assisted screening, human papilloma virus and molecular testing are discussed.     

Radical hysterectomy for stage IIB cervical cancer: a review

Patients with stage IIB cervical cancer in some countries in Europe and Asia especially in Japan are usually treated with radical hysterectomy and pelvic lymphadenectomy. Extrauterine diseases, ie, nodal metastases, parametrial invasion, and intraperitoneal spread, can be readily identified. We present the literature review of radical hysterectomy in stage IIB cervical cancer by searching data since 1980 from Medline, and we found that the parametrial involvement of patients in this stage was only 21-55%, the incidence of pelvic node metastases was about 35-45%, and 5-year survival rate was between 55% and 77%. Lymph node metastases and the number of positive nodes were significant prognostic factors of patients in this stage.     

High incidence of severe urologic complications following radiotherapy for cervical cancer in Japanese women

BACKGROUND: Good results have been obtained with radiation therapy for cervical cancer, but many patients suffer radiation-induced complications of adjacent organs. Some authors have reported that about 10% of patients treated with radiotherapy experience radiation-induced complications. We have previously reported that the incidence of spontaneous rupture of the urinary bladder is high in Japan but extremely low in the United States and Europe. In this study, we examined whether incidence or type of radiation-induced complications differs between Japan and the United States and Europe. METHODS: A retrospective study was performed to determine the incidence among Japanese women of severe complications requiring surgical intervention following radiotherapy for cervical cancer. A total of 271 patients were treated at Kobe City General Hospital using external-beam therapy from December 1981 to March 1989. In 232 external-beam therapy was combined with high-dose-rate intracavitary brachytherapy with a remotely controlled afterloading system (RALS). The incidence and type of radiation-induced complications of the urinary tract, rectum, and intestine were determined following exclusion of 74 patients with evidence of disease recurrence or progression. RESULTS: A total of 16 patients (8.1%) had urologic complications that required surgical intervention following irradiation, while a total of 26 patients (13.2%) had complications of the rectum or intestine that required surgical intervention following irradiation. Urologic complications occurred significantly later than those of the rectum and intestine (6.4 and 2.2 years, respectively) (P < 0.0001). The overall incidence of severe complications was comparatively higher than reported in the United States and Europe. The incidence of spontaneous rupture of the urinary bladder was particularly high (2.0%) in Japan. CONCLUSIONS: The incidence of severe complications following radiotherapy is comparatively higher in Japan than in the United States and Europe. In particular, spontaneous rupture of the urinary bladder is common in Japan. This might be due to the use of high-dose-rate brachytherapy. Since brachytherapy is currently being used for prostate cancer, urologists and radiologists must consider the possibility of a high incidence of such severe complications, especially when using high-dose-rate brachytherapy.     

Cervical cancer epidemiology in historical perspective

In 1846, uterine cancer was the most frequently observed malignant tumor in western Europe. It accounted for nearly 1/3 of all reported deaths in Paris. The cervix was regarded as the primary source in most cases. Several etiological theories in vogue today were discussed then. The relative infrequency of cervical cancer among Jewish women was reported by numerous writers. The possible role of circumcision of husbands was not seriously considered until 1935. More recent such studies have been inconclusive. A definite reduction in the death rate from cervical cancer has been evident since 1950. The parallel rise in incidence is accounted for by the more numerous in situ cases detected through cytologic screening. Nonwhite women in America above age 60 as well as the elderly in England and Wales have not shown equally improved rates. The hypothesis that the genital strain of herpes simplex virus (HSV-2), a venereally transmitted virus, is associated with cervical cancer has been advanced and much new evidence has recently been reporte d. A positive association between cervical cancer and HSV-2 antibodies is evident. Progression of dysplasia and carcinoma in situ is of uncert ain occurrence. Prolonged periodic check-up studies are needed to deter mine this. If the facts warrant, follow-up by aggressive therapy is indicated. Observer variability has been a problem. 1 pathologists' interpretation of dysplasia may be another's carcinoma in situ. The more severe dysplasias have been more likely to progress. Periodic cytological screening has reduced the percentages of cases 1st diagnosed in the invasive stage to 1/2 on 1/3 of the former incidence. Increases in survival rates have followed. Patients with regional spread have experienced little gain. Women at highest risk have tended to elude examinations.