Contraception for renal transplant recipients in the Republic of Ireland : a review

Renal transplantation has extended the duration and quality of life for a growing number of women in the Republic of Ireland. Pregnancy has now become a reasonable and viable option for women who were previously too ill to conceive, leading the Royal college of Obstetricians and Gynaecologists to issue opinions on the management of women with renal disease in pregnancy. In the 10-year period, from 2000 to 2009, 1,412 renal transplants were undertaken at Beaumont Hospital, Dublin. Of these, 541 were female patients and 333 of these women were in the reproductive age group (18–49 years) and thus would have potentially required some method of contraception. Improvements in overall health can lead to an early return to fertility and menstruation following renal transplant. It is recommended that the optimal management after renal transplantation is to ensure graft stability and optimal function before pregnancy is considered. It is also advisable to titrate immunosuppressive medication to the lowest maintenance dose possible to minimise potential fetal effects. Thus, a duration of 1 year post-living donor renal transplant and 2 years post-cadaveric donor transplant is usually quoted before embarking on a pregnancy, although this may vary from case to case. Women of reproductive age undergoing renal transplantation have a need for highly effective contraception. This review provides an overview of methods available in the Republic of Ireland and the evidence for their use in renal transplant recipients.     

子宫肌腺病保守手术的临床分析

目的　 探讨子宫肌腺病保守手术在改善症状、增加妊娠几率方面的效果。方法　 为 2 6例有生育要求的子宫肌腺病患者施行子宫肌腺瘤剔除术或子宫肌腺病部分病灶切除术。患者平均年龄 35 .8岁 ,以痛经、经血过多为主要症状。已婚患者中 ,原发不孕 7例 ( 31 .8% ) ,继发不孕 1 0例 ( 45 .5 % ) ,习惯性流产 3例 ( 1 3.6 % )。结果　 子宫肌腺瘤组 1 0例 ,病灶均挖除干净。弥漫性子宫肌腺病组 1 6例 ,均仅作大部病灶切除 ,未能切净。术前 2 2例有痛经的患者 ,术后痛经消失或明显减轻 ,术后重度痛经发生率明显低于术前 ( P<0 .0 0 1 )。术前 1 7例经血过多患者 ,术后仅 4例仍有经血过多症状 ( P<0 .0 0 1 )。术后子宫肌腺瘤组 7例有生育要求的患者中 5例共妊娠 9次 ,5次足月生产 ;弥漫性子宫肌腺病组 1 4例有生育要求的患者中 3例妊娠 3次 ,1例足月生产 ,子宫肌腺瘤组术后妊娠及足月生产率明显高于弥漫性子宫肌腺病组 ( P=0 .0 3,P=0 .0 2 )。2 6例患者中 3例复发 ,平均复发时间 49.6个月。结论　 子宫肌腺瘤保守手术可以明显地改善症状、增加妊娠几率 ,故能够被年轻、有生育要求的患者所接受。弥漫性子宫肌腺病保守手术妊娠率较低 ,然仍有一定的治疗价值。     

Successful conservative treatment of microinvasive cervical cancer during pregnancy

Cervical cancer complicated by pregnancy is a rare event. While counseling patients with cervical cancer during pregnancy, many factors must be considered, including the patient's desire to continue the pregnancy, the stage of the disease, and the gestational age at diagnosis. Pregnant women with microinvasive cervical cancer should be fully informed of all possible treatment options and consequences. Herein, we report the case of a woman who was diagnosed with microinvasive cervical cancer during pregnancy at 10 weeks of gestation. After a combination treatment of cervical conization, cervical cerclage, and cesarean section, she delivered a healthy baby and at 7 months postpartum there was no indication of malignancy.     

早发性卵巢功能不全患者应用卵胞浆内单精子显微注射-胚胎移植获妊娠分娩1例及文献复习

报道1例早发性卵巢功能不全患者在长期密切监测过程中出现卵巢功能的波动,并行多次卵胞浆内单精子显微注射-胚胎移植治疗,最终获得临床妊娠和分娩的病例并进行相关文献复习.提示对于较年轻、有强烈生育愿望的早发性卵巢功能不全患者,应该在排除禁忌症后尽早开始激素替代治疗,积极进行辅助生殖助孕,仍有望在卵巢功能完全耗竭之前获得正常妊娠分娩.     

1449例肝脏移植患者病种统计分析

目的对近五年某院肝移植患者进行疾病归类,了解不同性别和年龄段行肝脏移植患者的情况,为医院临床管理提供数据参考,对预防治疗有一定的指导作用。方法利用医院统计报表数据进行分析,采用疾病分类ICD-10和手术编码ICD-9-CM-3进行分类。所有数据均利用办公软件Excel分析处理。结果 2006年1月-2010年12月因终末期肝病行肝脏移植1449例患者中男性多于女性患者,男女性别比为5.11∶1;酒精性肝硬化患者100%为男性;肝炎后肝硬化患者644人,占肝脏移植人数的44.44%,肝移植患者平均年龄51.2.岁；50岁-59岁肝移植患者占肝脏移植的52．17％。10岁以下患者100％为先天性胆道闭锁患者。肝移植1年、3年、5年生存率分别为83．1％、72．9％、69．3％。结论肝移植是终末期肝病治疗的最佳手段。预防治疗策略是预防进展至终末期肝病的有效方法。戒酒是首要措施。中年人要成为医疗预防工作的重点对象。     

Preconception--a much neglected aspect of perinatal care

Recent advances in maternal-child health have resulted from improved care during pregnancy, labor and delivery, and the postpartum period. Organizations such as the Wisconsin Association for Perinatal Care have clearly defined the high-risk problems that can complicate pregnancies. A necessary further step is to include the preconceptional period in the total picture of perinatal care. Educational efforts should be directed toward making women as healthy as possible before pregnancy actually occurs. Potential parents should be psychologically and philosophically prepared for the responsibilities of parenthood. It has been recommended that such educational procedures begin with preadolescents and be geared progressively to meet the needs of the total reproductive ages. Another potential focus includes women who have physical or medical conditions that are absolutely incompatible with pregnancy or require careful monitoring during pregnancy. Genetic counseling can play a role in such cases. All women over 35 years of age should be informed that fetal abnormalities increase in frequency in these age groups. No woman should ever become pregnant until systemic chronic diseases have been treated adequately. By meeting these special needs of the preconceptional period, perinatal care will become even more complete and purposeful.     

育龄妇女经、孕、产褥三期性卫生知识状况分析

利用1997年全国人口与生殖健康调查资料对我国婚育龄妇女经,孕,产褥3期性卫生知识状况进行了调查,结果发现妇女对月经期,产褥期能否进行性生活的答对率较高,对妊娠的不同时期能否过性生活对率较低,妇女的年龄,文化程度,是否参加妇科检查,是否接受婚前教育,是否运过计生服务站等影响妇女的性卫生知识状况。     

原位肝移植3例报告

目的　探讨原位肝移植的手术技巧、围手术期处理及疗效。方法　2000年8～11月间,该院对2例Wilson病及1例肝门部肝内胆管癌实施了原位肝移植术,其中,采用“背驮式肝移植术”1例,“经典式肝移植术”2例。术后用“FK506+MMF+Pred”三联方案预防免疫排斥反应。结果　2例移植肝脏术后迅速恢复功能;另1例于术后22d出现不典型的轻度排斥反应,经对症治疗后好转。结论　肝移植是治疗良性终末期肝病唯一有效的方法.     

Pediatric liver transplantation in 31 consecutive children

Background Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements.
Methods Thirty-one children （≤18 years old） underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old （ranged from 5 months to 18 years） with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson＇s disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard （without venovenous bypass）, 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug （FK506, steroid, and mycophenolate mofetil） immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months.
Results Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus （HBV） or hepatitis C virus （HCV） infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.
Conclusions The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients＇ age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The     

原发性肝癌患者移植前、后肝内肿瘤的CT/MRI影像学对照研究

目的对照研究同一原发性肝癌患者移植前与移植后肝内肿瘤的CT/MRI影像学特征,分析肿瘤的生物学行为,为复发肿瘤的治疗提供依据。方法 43例原发性肝癌患者,男38例,女5例,中位年龄48岁。对照分析患者移植前原发肿瘤与移植后复发肿瘤的CT/MRI影像学特征,同时监测血清AFP浓度变化,并对同一患者移植前、后肝癌血供及血清AFP浓度差异进行统计分析。结果移植前、后肿瘤的分布均易累及多叶;移植前原发肿瘤以巨块型为主（29/43例,占67.4%）,移植后复发肿瘤以多发结节型为主（33/43例,占76.7%）。原发肿瘤（86.0%）与复发肿瘤（76.7%）均表现为富血供型为主。同一患者移植前、后肝癌血供差异无统计学意义（P=0.289）。同一患者移植前、复发后血清AFP浓度变化差异无统计学意义（P=0.092）。结论移植后肝内复发灶以富血供的多结节型为主,为患者行介入治疗提供依据。同时,同一患者移植前、后肝癌血供及血清AFP浓度均无显著差异,提示肿瘤生物学行为的相似性,进一步揭示肿瘤复发源于原发肿瘤的血行转移。     

不断总结和规范,全面提高我国肝脏移植水平

肝脏移植是目前治疗各种终末期肝脏疾病唯一有效的手段.我国肝脏移植起步较晚,但近年来发展迅速,移植数量大幅递增,移植的中长期疗效进一步提高.在国内一些大的移植中心,肝脏移植已成为一种常规手术,然而肝脏移植的基础研究、交叉学科发展、长期存活率和术后中长期管理与国际相比仍存在一定差距,尚未形成自己的特色.只有不断总结、不断规范、不断创新,才能全面提高我国肝脏移植的整体水平.本文就国内肝脏移植发展现状、存在的问题及发展趋势作简要概述.     

辅助生殖技术治疗子宫畸形合并不孕

【目的】分析64名子宫畸形患者行IVF/ICSI治疗的临床资料,对子宫畸形患者的助孕结局做出分析总结,以期为临床提供借鉴。【方法】回顾性分析2002年1月1日到2009年12月31日因不孕行IVF/ICSI治疗的子宫畸形患者,按照子宫畸形的类型进行分组,比较各组病人的基本资料及ART治疗结局。妊娠的患者追踪至分娩,比较自然流产率、早产率、活婴分娩率、新生儿体重和分娩孕周以及有无合并畸形。【结果】因子宫畸形行ART治疗患者共64人,按照子宫畸形的类型分为4组,鞍形子宫13人,不完全纵隔子宫14人,单角子宫19人,双子宫18人。4组患者在年龄,不孕年限,基础FSH水平方面都没有差异,获卵数,受精率,卵裂率,优质胚胎率4组相似,平均每病人妊娠率在不完全纵隔子宫组(78.57％)显著高于鞍形子宫组(38.46%)和双子宫组(38.89%),与单角子宫组(47.37％)无统计学差异。4组均未出现宫外孕情况,在流产率、早产率、活婴分娩率、多胎妊娠率、分娩孕周和出生体重方面均无统计学差异。所有出生婴儿均未发现有畸形。【结论】子宫畸形患者行IVF或ICSI有比普通不孕患者更差的临床妊娠率和种植率。不完全纵隔切除术后患者的临床妊娠率相对鞍形子宫和双子宫更高。     

肝脏相关干细胞的临床应用

肝脏疾病仍是一个世界性难题,我国肝病发病率高,目前还无有效的治愈措施。现在治疗终末期肝病最理想的方法是原位肝移植,而肝供体缺乏等限制了其应用。不同来源的干细胞具有自我更新、高度增殖和定向分化为肝细胞的特性,因而干细胞移植治疗可成为替代肝移植的最佳治疗手段,并有效改善患者的肝脏功能和生活质量。肝脏相关干细胞移植和基因综合治疗可望治愈肝癌和遗传代谢性肝病等肝脏疾病。     

Idiopathic thrombocytopenic purpura complicating pregnancy

Idiopathic thrombocytopenic purpura is a relatively common but unrecognised auto-immune disorder among women of child bearing age. Nearly one-third of patients present with bleeding tendency in pregnancy. Management necessitates care of mother during pregnancy and delivery and care of the baby. Steroids remain the chief, economical and effective method of raising platelet counts, but platelet transfusion and human intravenous high dose alpha-globulin may be required. Neonatal thrombocytopenia must be expected and managed. Management of patient, since it concerns two lives, should be individualised and carefully planned in consultation with haematologist and paediatrician.     

Successful outcome of gestation in a young woman with severe oesophageal varices throughout the pregnancy

During normal pregnancy there is an increase in the maternal blood volume leading to portal hypertension with some changes in liver functions. However, in an apparently healthy woman without known liver cirrhosis or other advanced liver disease, severe oesophageal varices with along with repeated variceal bleeding during pregnancy is rare. In this paper we described a case of severe oesophageal variceal bleeding in a young woman without having any pre-existing liver pathology. Due to repeated pregnancy with short intervel bleeding the patient developed severe anaemia. Packed cell transfusion was done repeatedly and oesophageal variceal ligation (EVL) was done three times. In spite of these measures variceal bleeding continued and patient's condition was deteriorating progressively; so caesarean section was at 33rd week of gestation and a preterm but healthy baby was delivered. The puerperium was uneventful with no haematemesis and there was gradual improvement of the condition. A brief review of the literature on pregnancy with oesophageal varices is also presented.     

新生儿体重与孕妇年龄和体重指数的关系

目的：分析母亲年龄与新生儿出生体重的关系,以及孕期体重指数对新生儿出生体重的影响。方法：回顾性分析2005年1-12月在重庆医科大学附属第一医院产科出生的1301例新生儿体重;以及1999年1月至2003年7月在我院住院并进行阴道试产的初产妇576例,其中早孕期肥胖即体重指数（BMI）≥24有184例,分娩时肥胖（BMI）≥27有152例。观察出生体重与孕妇年龄和体重指数之间的关系。结果：在排出了妊娠合并糖尿病,非足月妊娠以及双胎、三胎妊娠,1301例新生儿平均出生体重为3396g．男婴平均出生体重为3453g,女婴为3397g,其中只有20-24岁组分娩的新生儿出生体重低于总体平均体重;早孕期肥胖孕妇巨大儿的发生率与对照组比较,差异有显著性,分娩时肥胖的产妇巨大儿的发生率与对照组比较,差异有显著性,早孕期体重增加≥15kg者巨大儿的发生率高于体重增加〈15kg者,差异有显著性。结论：母亲年龄过小影响胎儿生长发育,孕期母亲体重增长过多可导致巨大儿发生率增加。     

Urolithiasis in pregnancy: Survey in clinical epidemiology

This study examined the association of pregnancy with urolithiasis and provided new insights into urolithiasis in pregnancy. A total of 462 subjects were studied from January 2004 to December 2009 in Foshan Maternal and Child Health Hospital, China. Among the 462 subjects, 162 cases of urolithiasis during pregnancy (UPG) were selected as the observation group, 150 cases of no urolithiasis during pregnancy (NUPG) served as pregnancy control group, and 150 cases of no pregnancy (NPG) at reproductive age who took part in physical examination were randomly assigned into non-pregnant control group. At the same time, the patients in observation group were divided into the following sub-groups: no symptomatic urinary calculus (NSUC) and symptomatic urinary calculus (SUC) groups; SUC group was further divided into surgical intervention (SI) and conservative management (CM) groups. The general information and the data of blood and urine were collected and compared among the groups. The results showed that the incidence of urinary calculi in pregnant women was lower than that in non-pregnant women, the formation of urinary stone was associated with the change of metabolism of protein and sugar in pregnant women, and the surgical intervention was a practicable alternative to treat the clinical intractable symptomatic urinary calculi in pregnancy.     

自发宫内宫外同时妊娠并发输卵管破裂出血术后足月分娩1例报告

[摘要]目的强调宫内孕合并急腹症时发生自发宫内宫外同时妊娠（HP）的风险。方法和结果报道1例自发HP患者,有继发性不孕高危因素。在孕13周时因宫内孕合并输卵管妊娠破裂,出现失血性休克,行开腹患侧输卵管切除术。术后宫内胎儿孕期情况平稳,孕37+2周时因前置胎盘经剖宫产分娩一健康婴儿。结论HP多发生于接受辅助生殖技术的妇女,但当有高危因素存在时,也可发生于自然受孕人群。尽管宫内孕合并宫外输卵管妊娠破裂、失血性休克,如能积极抢救、加强支持治疗,仍能获得满意的结局。     

179例试管婴儿孕妇发生先兆流产的病例对照研究

目的：分析试管婴儿的孕妇发生先兆流产的相关影响因素,为预防试管婴儿孕妇发生先兆流产提供科学依据。方法病例组选取因患先兆流产而住院的孕妇87例;对照组均来自于同期做试管婴儿且无先兆流产的孕妇,共92例,调查试管婴儿孕妇先兆流产的影响因素。应用 EpiData3．1数据库及 SPSS 17．0软件进行数据录入及统计分析,分析方法主要包括秩和检验、χ2检验、单因素和多因素条件 Logistic回归分析;并计算各影响因素与先兆流产的关联强度（OR值）及其95％CI。结果单因素分析结果表明：两组研究对象的职业、文化程度、身高、体重、体质指数差异无统计学意义（P ＞0．05）。但年龄差异有统计学意义（P ＜0．05）,两组研究对象在不良妊娠史、既往疾病史、不孕类型、不孕年限方面差异无统计学意义（P ＞0．05）;而两组在移植时子宫内膜厚度、移植的胚胎数目、移植胚胎的周期类型、孕妇的焦虑评分显示有统计学意义。多因素条件 Logistic 回归分析结果显示,胚胎移植时子宫内膜的厚度、移植胚胎的周期类型、妊娠期心理压力是先兆流产发生的独立危险因素（OR ＝1．169、0．304、0．898,95％CI 分别为1．005～1．361、0．135～0．683、0854～0．944）。结论移植时子宫内膜厚度、移植胚胎的周期类型、妊娠期心理压力可能是先兆流产发生的独立危险因素。     

肾移植术后妊娠1例报告及文献复习

移植术后合并妊娠的病例在国内尚属于较罕见病例,产科医生缺乏相关的诊治经验.北京大学第一医院妇产科曾于2008年收治了1例肾移植术后合并妊娠的患者,经积极治疗和及时终止妊娠,母婴结局良好.本文结合文献复习,讨论肾移植术后妊娠的特点及相关并发症的诊疗.