中医药防治中老年女性骨质疏松症

本文从骨质疏松症的中医发生机理、辨治方法及特色、预防措施等三个方面论述了中老年女性骨质疏松症的中医药防治策略。该病本于肾虚精亏,与心、肝、脾三脏功能失调相关,治以补肾益髓、强腰壮骨为根本大法,加以疏肝理气、活血化瘀,或健脾益气和胃之法辨证施治。治疗中可辅以口服中成药、中药热敷、熏洗等不同治疗手段,配合保健未病先防、药食相辅、运动疗法等方法综合治疗和预防。     

Papillary serous adenocarcinoma of the ovary diagnosed after malignant pericardial tamponade and embolic stroke

BACKGROUND: Epithelial carcinomas of the ovary are predominantly an intraperitoneal disease. Reports of epithelial ovarian carcinomas metastatic to the pericardium are rare. CASE: A 43-year-old woman was admitted with symptoms of a pericardial tamponade, as well as an embolic cerebrovascular accident, and transferred to the ICU where a pericardiocentesis was performed. Cytology revealed malignant cells in the pericardial fluid. CT scan of the abdomen and pelvis revealed bilateral pelvic masses. A laparotomy revealed a papillary serous adenocarcinoma of ovarian primary and an infarcted spleen with capsular tumor metastases. The malignant cells in the pericardial fluid were consistent with the ovarian primary. CONCLUSION: Ovarian cancer metastasis to the heart and pericardium presented an aggressive variant of tumor spread with significant morbidity and subsequent mortality.     

Pregnancy in patients with heart disease

PURPOSE: The study was carried out to ascertain the experience of pregnant women with cardiac disease in one referral center. METHODS: From 1986 to 2004, 242 pregnant women with heart disease were followed by the same obstetrical and cardiology center. The cardiac diagnosis was additionally confirmed with echocardiography and heart catheterization during cardiosurgery. The subjects were classified into groups with respect to the congenital heart abnormality type, and cardiovascular insufficiency according to the NYHA classification. The results from the evaluated groups were compared to a control group. RESULTS: A significant increase in percentage of congenital heart disease was found, however acquired cardiac defects prevailed. A significant increase in rate of congenital heart disease was found. A higher incidence of cesarean sections in women with underlying heart disease with respect to the control group was also found. CONCLUSIONS: In pregnant women with underlying heart disease, congenital heart disease is presently more frequent than acquired heart disease compared to the situation in the beginning of the analysis. Pregnancy duration time depends on cardiac sufficiency and it is statistically shorter in NYHA class III and IV patients.     

Pregnancy and Congenital Heart Disease - Maternal and Fetal Outcome

Summary: Two hundred and seventy five pregnancies in patients with congenital heart disease during 1980–1996 were analyzed retrospectively. Maternal and perinatal outcome was compared in 251 pregnancies of women with acyanotic and 24 pregnancies of women with cyanotic heart disease. Congenital heart disease was diagnosed during the index pregnancy in 26.1% of patients and the majority (88.4%) were in NYHA classes 1 and 2. Atrial septal defect (27.7%) was the most common lesion in women with acyanotic heart disease and the majority with cyanotic heart disease had Eisenmenger syndrome, 13 of 21 (61.9%). Sixty pregnancies occurred in patients with surgically corrected lesions (acyanotic, 56; cyanotic, 4). The incidences of abortions (8.3%), stillbirths (13.6%) and small for gestational age (SGA) (36.4%) were higher in cyanotic heart disease compared to acyanotic heart disease (stillbirth, 0.8%; SGA, 6.9%). There was a statistically significant difference in mean maternal age, mean gestational age and mean birth-weight in the surgically corrected and noncorrected lesions in both acyanotic and cyanotic heart disease. There was 1 maternal death in a woman with Eisenmenger syndrome.     

Solitary splenic metastasis of endometrial carcinoma ten years after hysterectomy. Case report and review of the literature

Solitary carcinomatous metastases to the spleen are rare. The reports of such cases in the literature usually concern late stages of the disease, with generalized carcinomatosis and metastatic foci in several other organs. Primary tumors that most often metastasize to the spleen are carcinomata of the breast, lung and ovaries, as well as malignant melanomata. Less often, carcinomata of the stomach, large bowel and kidneys are reported to implicate the organ with metastatic disease. The presence of solitary splenic metastasis of endometrial origin however, is extremely rare. We present a case of a 53-year-old female patient who ten years after hysterectomy due to the presence of endometrial carcinoma developed a metastatic focus to the spleen. This focus was diagnosed on the grounds of histology and immunohistochemistry, after splenic excision, to be of endometrial origin. Together with this case presentation, several aspects of the disease and its differential diagnosis are discussed, in correlation with the current literature.     

A Contemporary Approach to the Obstetric Management of Women with Heart Disease

ObjectivesRecommendations for the peripartum obstetric management of women with heart disease have included early induction of labour, shortening the second stage of labour during vaginal delivery, and low threshold for elective Caesarean section, although such techniques may result in complications. The objective of this study was to determine whether a less aggressive approach without routine preterm induction, shortening of the second stage,or Caesarean section adversely affects the mother or neonate.MethodsWe examined peripartum obstetric management and its relationship with adverse maternal and neonatal outcomes in 1677 pregnancies: 559 in women with heart disease and 1118 in women without heart disease (control subjects). Logistic regression with propensity matching was used to compare outcomes in women with and without heart disease.ResultsWomen with heart disease were more likely than control subjects to undergo induction of labour (P < 0.001). Induction of labour tended to be at term and for logistical reasons, not for the indication of maternal heart disease. Assisted vaginal deliveries were more common in women with heart disease (29% vs. 11%, P < 0.001) than in those without, and the second stage of labour was also more prolonged in women with heart disease. Rates of Caesarean section were similar in both groups (P = 0.66). A significant proportion of women with heart disease had unassisted vaginal deliveries. Invasive cardiac monitoring was rarely used. Adverse maternal cardiac events at delivery were rare (2% of pregnancies) and were not associated with mode of delivery. In multivariate analysis, maternal heart disease was not predictive of adverse neonatal events or third- or fourthdegree lacerations. Maternal heart disease was associated with postpartum hemorrhage, but this was not related to assisted delivery or prolonged second stage of labour.ConclusionThis large study has shown that in women with heart disease, avoidance of early induction of labour, rare use of Caesarean section for cardiac indications, and selective use of invasive monitoring produces safe obstetric outcomes.     

妊娠合并心房颤动的诊治

目的:探讨妊娠合并心房颤动对母儿的影响及诊治方法。方法:回顾分析1998年1月至2006年6月上海仁济医院诊治的13例妊娠合并心房颤动的临床资料。结果:妊娠合并心房颤动患者多有器质性心脏病,其中风湿性心脏病是主要病因(76.92%);妊娠合并心房颤动且有器质性心脏病患者心功能Ⅲ~Ⅳ级发生率明显高于无器质性心脏病者(80%vs0%,P<0.05);医源性胎儿丢失率23.08%(3/13),早产发生率23.08%(3/13)。结论:患器质性心脏病的孕妇合并心房颤动易致母亲心功能恶化,应动态监测心功能,及时处理。为母亲安全,宜适时引产或行剖宫产术终止妊娠。     

First-trimester fetal heart block and increased nuchal translucency: an indication for early fetal echocardiography

Prevalence of congenital heart disease increases with nuchal translucency (NT) thickness. First-trimester fetal bradycardia may result from heart block associated with complex congenital heart disease. We report two cases detected in the first trimester of pregnancy, in which both fetuses showed an increased nuchal translucency and bradycardia. Fetal karyotype was normal in both fetuses. First-trimester fetal echocardiography was performed and, in both cases, complex congenital heart disease was diagnosed. We discuss the added role of fetal heart rate in first-trimester ultrasound screening, in fetuses with increased nuchal translucency and normal karyotype. We stress, as well, the importance of echocardiography performed in the first trimester as a potential tool for early diagnosis in selected cases.     

The course of pregnancy in patients with cardiac disease

The outcome of 240 pregnancies in 202 patients with cardiac disease, who delivered between Jan. 1982 and Dec. 1987 at the National Cardiovascular Center was analyzed. Ninety-six patients had congenital heart disease. Forty-two had acquired valvular heart disease, 83 had cardiac arrhythmia, 7 had aortitis syndrome, 7 had cardiomyopathy and 2 had secondary angina pectoris. There was one case of each of the following cardiac diseases: Primary pulmonary hypertension, Marfan's syndrome and pericarditis. Nineteen of the above lapsed into congestive heart failure and there were two cases of maternal death. One was a case of primary pulmonary hypertension and the other had had an aortic valve replaced with a Bjork-Shiley prosthesis because of rheumatic valve disease. Another 16 mothers had artificial preterm delivery at a gestational age of 30 weeks to 36 weeks to reduce the risk of congestive heart failure. There were 5 cases of IUFD, three of which were attributed to maternal cardiac disease and another to fetal failure. Neonatal congenital heart disease was found in 8 cases. The percentage of IUGR, excepting twin pregnancies, was 14.8%.     

235例妊娠合并心脏病围产期的处理

分析了１９７８年至１９９１年妊娠合并心脏病２３５例的临床资料，结果表明患病率为１％，产妇病死率１７‰，心脏病孕产妇病死率占非产科原因死亡的第一位。围产儿病死率为５９．６‰。本组剖宫产率为３６．１％，其中心功能Ⅲ、Ⅳ级者１５例，占６．４％。认为改善母婴预后的关键在于良好的孕产妇系统管理及高危妊娠的临护，积极防治贫血、妊高征、产程延长及各种并发症，适时终止妊娠可获良好的妊娠结局。     

Fetal echocardiographic screening for congenital heart disease: the importance of the four-chamber view

The four-chamber view of the heart has been proposed as a screening method for obstetrical sonographers to assess the fetus for the presence of congenital heart disease. We examined the fetuses in 1022 pregnancies and found 74 structurally abnormal hearts. Seventy-one of these (96%) were found to have an abnormality as seen in the four-chamber view. The four-chamber view of the heart had 92% sensitivity and 99.7% specificity in the detection of congenital heart disease. The positive predictive value was 95.8%, and the negative predictive value was 99.4%. We conclude that the four-chamber view may be a useful screen for the presence of congenital heart disease and should be included as a part of all routine obstetric ultrasound examinations.     

Pregnancy outcome in women with heart disease undergoing induction of labour

OBJECTIVE: To examine the safety and outcome of induction of labour in women with heart disease. DESIGN: Prospective single-centre comparative study. SETTING: Major university-based medical centre. POPULATION/SAMPLE: One hundred and twenty-one pregnant women with heart disease. METHODS: The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. MAIN OUTCOME MEASURES: Pregnancy outcome. RESULTS: Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. CONCLUSION: Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour.     

Quantitative analysis of cardiac function in non-immunological hydrops fetalis

The present study was designed to quantitatively evaluate fetal cardiac dysfunction in fetal congestive heart failure associated with cardiogenic hydrops fetalis. Thirty-seven cases of non-immunological hydrops fetalis and/or fetal heart disease were assigned to four groups: (1) hydrops fetalis with structural heart disease; (2) hydrops fetalis without heart disease; (3) structural heart diseases without hydrops, and (4) complete A-V block without hydrops. One hundred and ten control fetuses were also studied. The ejection fraction in the first and third groups was significantly lower than that in the control. In the first group, systolic flow velocity in the descending aorta normalized but gestational age was significantly lower than that in the controls. Compensation of fetal cardiac function in the fourth group (complete A-V block) was noted on the basis of higher flow velocity and higher contractility. The cardiothoracic area ratios of the pathological and control groups were also evaluated.     

心脏矫正术对先天性心脏病妇女妊娠结局影响的Meta分析

目的：探讨孕前行心脏矫正术对先天性心脏病（先心病）孕产妇妊娠结局的影响。方法：检索2018年9月以前在中国知网（CNKI）、万方数据库（WangFang data）、维普数据库（VIP）、PubMed、Cochrane Library等数据库关于孕前心脏矫正术对先心病孕产妇妊娠结局影响的文献。对纳入文献进行质量评价及数据提取,使用RevMan 5.3软件对数据进行Meta分析。结果：共纳入17个队列研究共1 181例患者,其中手术组457例,未手术组724例。对于先心病妇女,孕前的心脏矫正术可以改善孕妇的心功能情况,心力衰竭发生率、剖宫产率、早产率、胎儿生长受限发生率、小于胎龄儿发生率、新生儿窒息发生率及围生儿死亡率与未手术组比较差异均有统计学意义（均P＜0.05）。然而,关于孕妇的死亡率及新生儿心脏病发生率,2组间比较差异无统计学意义（均P＞0.05）。结论：相比于孕前未行心脏矫正术的先心病患者,手术患者能取得较为理想的妊娠结局。     

妊娠合并心脏病266例临床分析

探讨妊娠合燕心脏病患者不同心功能状态对母亲和围产儿的影响。方法对我国院１９９３年１月至１９９９年３月间、２６６例妊娠合并心脏病患者的临床资料进行回顾性分析。结果（１）妊娠合并心脏病患者以心肌炎、心肌炎后遗症及不明原因性心律失常的发生率最高（１７９例,６７．２９％）,其次为先天性心脏病（４１例,１５．４１％）,其发生率高于风湿性心脏病（２８例,１０．９１％）。（２）风湿性心脏病的先天性心脏病是导致心     

The assessment of persistent bradycardia in prenatal life

Twelve patients with persistent fetal bradycardia were referred for echocardiographic assessment; in 10 patients the fetus had complete heart block, six isolated and four with associated structural heart disease. In the remaining two patients an atrial arrhythmia was producing a fetal sinus bradycardia. Complete heart block with structural heart disease has a poor prognosis. Isolated complete heart block has a good prognosis if the pregnancy is carefully managed. A sinus bradycardia due to atrial ectopic beats is a benign arrhythmia. Echocardiographic assessment of the heart can give an accurate prognosis in fetal bradycardia and provide a basis for appropriate obstetric management.     

Pregnancy and delivery in women with congenital heart disease

OBJECTIVES: Perinatal care of women with congenital heart disease is very important for obstetrician. DESIGN: The purpose of this study was to analyse the course of pregnancy, delivery and after birth period of women with congenital heart disease. MATERIAL AND METHODS: A group of 35 pregnancies and deliveries in patients with congenital heart disease cured in 1998-2003 in the Department of Obstetrics and of Medical University in Gdansk were analysed. The control group was a total of 1657 deliveries in the Department of Obstetrics in the 1998. For statistical analysis of the results the T-Student test was used with the significance level p = 0.05. RESULTS: Time of pregnancy, birth weight and length were statistically different to the control group. CONCLUSIONS: We found no cardiological complications during pregnancy in patients with congenital heart disease at I and II stage NYHA. Time of pregnancy, birth weight and length were statistically different to the control group.     

Outcome of pregnancy in 110 patients with organic heart disease

Organic heart disease is still one of the main causes of maternal and fetal mortality. The outcome of pregnancy in 110 patients with organic heart disease ranging from class I to IV (New York Heart Association Classification) was studied. The incidence of intrauterine growth retardation in the study group was examined with regard to severity of the disease. Birth weight was compared to that in a matched control group, and no statistically significant difference between the two groups was found.     

455例妊娠合并心脏病患者不同心功能状况对妊娠结局的影响

目的探讨妊娠合并心脏病不同心脏功能对妊娠结局的影响。方法对北京大学第三医院1994年1月至2008年12月间妊娠合并心脏病455例患者的临床资料进行回顾性分析。结果妊娠合并心脏病以心律失常（223例,49.01%）和先天性心脏病（140例,30.77%）最为常见,风湿性心脏病居第三位（33例,7.25%）。妊娠合并心律失常患者心功能均为Ⅰ～Ⅱ级,妊娠合并先天性心脏病患者心功能为Ⅰ～Ⅱ级者为135例,Ⅲ～Ⅳ级为5例,其中1例为为妊娠合并艾森曼格综合征,产后7 d猝死;妊娠期高血压性心脏病17例心功能Ⅲ～Ⅳ级,其中1例孕妇死亡;围生期心肌病5例,其心功能均为Ⅳ级。心脏功能Ⅲ～Ⅳ级患者的妊娠孕周明显小于心功能Ⅰ～Ⅱ级（P〈0.05）,医源性早产和围产儿死亡率显著增加（P〈0.01）。结论心脏功能Ⅲ～Ⅳ级患者以妊娠期高血压性心脏病、先天性心脏病和围生期心肌病多见,其医源性早产、孕产妇及围产儿死亡的发生增加。妊娠合并心脏病患者的心脏功能状态与其孕产妇及围产儿结局密切相关。     

Induction of multifocal lesions of the testis by passive transfer of immune cells

Spleen cells obtained from Wistar rats bearing a multifocal damage of the testis that had been induced by an antiserum against a non-collagenous fraction of basement membranes, were able to transfer similar testicular lesions into normal recipients. Damage was characterized by multiple foci of seminiferous tubules with different degrees of cell sloughing and a mild interstitial mononuclear cell infiltrate. The incidence of testicular damage in the transferred recipients was 83%, while in the control group of rats transferred with spleen cells from donors that had been injected with normal rabbit serum only 4% of the animals presented mild lesions. In order to determine which lymphocyte subpopulations were effective in transferring the disease, rat spleen cells were treated with murine monoclonal antibodies W3/25 and OX8 or with a rabbit anti-rat IgG serum and complement, before the transfer. A multifocal damage of the testes, indistinguishable from that obtained with the untreated spleen cells was transferred in 50% and 25% of the rats injected with spleen cells depleted in B or in T lymphocytes, respectively. The most severe lesions were observed in the rats transferred with cell populations depleted in B cells.