妊娠合并甲状腺功能亢进症患者抗甲状腺药物治疗后对其新生儿先天畸形的影响

目的探讨妊娠合并甲状腺功能亢进症（甲亢）患者抗甲状腺药物（ATDs）治疗对其新生儿先天畸形的影响。方法采用回顾性分析方法对1983年1月1日-2003年12月31日在北京协和医院分娩的100例妊娠合并甲亢患者及其101例新生儿的临床资料进行研究。根据妊娠合并甲亢患者的甲状腺功能（甲功）状态及服用ATDs的情况对其新生儿先天畸形发生率、影响因素进行分析。结果（1）妊娠合并甲亢患者分娩的101例新生儿中,合并先天畸形7例,新生儿先天畸形发生率为6．9％,显著高于同期出生的新生儿先天畸形发生率的0．9％（212／22765）。其相对危险性为同期出生新生儿的7．9倍（P〈0．01）。（2）101例新生儿中,其母孕早期合并甲功亢进52例,新生儿先天畸形5例,先天畸形发生率为9．6％（5／52）;其母孕早期甲功正常49例,新生儿先天畸形2例,先天畸形发生率为4．1％（2／49）,两者新生儿先天畸形发生率比较,差异无统计学意义（P〉0．05）。（3）其母孕早期服用甲巯咪唑的12例新生儿中,合并新生儿先天畸形5例,先天畸形发生率为41．7％;其母孕早期服用丙基硫氧嘧啶的28例新生儿中,合并新生儿先天畸形1例,先天畸形发生率为3．6％;其母孕早期未服用ATDs的61例新生儿中,合并新生儿先天畸形1例,先天畸形发生率为1．6％。3者之间新生儿先天畸形发生率比较,差异有统计学意义（P〈0．01）。其中服用甲巯咪唑患者的新生儿先天畸形发生率显著高于服用丙基硫氧嘧啶者（P〈0．01）和未用药者（P〈0．01）。妊娠合并甲亢孕早期服用甲巯咪唑患者新生儿发生先天畸形的危险性,为服用丙基硫氧嘧啶患者的19．3倍;为未服用ATDs患者的42．9倍。对数线性模型分析显示,妊娠合并甲亢患者孕早期服用不同种类的ATDs,对新生儿先天畸形的形成存在显著的差异（P=0．0003）。结论妊娠合并甲亢患者其新生儿发生先天畸形的危险性增加。妊娠合并甲亢患者孕早期服用甲巯咪唑可能是导致新生儿先天畸形的主要因素之一。因此,妊娠合并甲亢患者应避免选用甲巯咪唑,以减少发生新生儿先天畸形的危险性。     

Changes in serum thyroglobulin and thyroid autoantibodies in patients with Graves' disease treated with antithyroid drug and their relationship to relapse.

Serum thyroglobulin (Tg) levels are elevated in some patients with Graves' disease. Several studies have pointed out the usefulness of this fact in predicting the outcome of the disease. Among the various antibodies, the antithyroglobulin (ATA) and antimicrosomal (AMA) antibodies are valuable in screening for thyroid autoimmunity. The aim of this study was to analyze the changes in serum Tg and autoantibodies during the course of antithyroid drug therapy and to evaluate their prognostic value. Serum Tg was measured by double antibody RIA, and ATA and AMA by the semiquantitative tanned red cell hemagglutination method in 65 patients before and after antithyroid therapy. Forty-two patients (64.6%) experienced a relapse and 23 patients (35.4%) remained in remission at the end of the study. The changes in the ATA or AMA titers, measured prior to and following therapy were nonsignificant in both groups. While the titers of ATA and AMA before and after therapy were not different between the two groups, there was a tendency for the patients with a positive ATA after therapy to have a relapse. When ATA-positive cases were excluded, there was no change in the Tg levels in either group. The Tg levels of the relapse group either before or after therapy were significantly higher than those of the remission group. There was no difference in T3 or T4 before therapy between the two groups. There was no relationship between the Tg levels after therapy and the duration of remission in either group. In conclusion, during the course of antithyroid therapy, patients with a relapse of Graves' disease had higher serum Tg levels, either before or after therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thyroid function abnormalities and antithyroid antibody prevalence in pregnant women at high risk for gestational diabetes mellitus.

Both gestational diabetes mellitus (GDM) and thyroid dysfunction in pregnancy compromise maternal and fetal health. The aim of the present study was to determine the prevalence of abnormal thyroid function and antithyroid antibodies during early pregnancy in a population at high risk for GDM. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured in 301 pregnant women who underwent routine 'universal screening' for GDM. The antithyroid peroxidase antibody (antiTPOAb) was also quantified in 255 of these women. GDM was confirmed by a 75-g oral glucose tolerance test using World Health Organization criteria. No statistically significant difference was found between the 80 (26.6%) women with GDM and the 221 (73.4%) women without GDM for any of the thyroid function tests. In the cohort tested for antiTPOAb, the 51 (20.0%) women who were positive for antiTPOAb had higher mean TSH (1.57 +/- 2.49 mIU/l; p < 0.001) than the women negative for antiTPOAb. Seventeen (5.6%) women had low FT4 while 12 (4.0%) women had high TSH; 28 (9.3%) women had low serum TSH, among whom three (1.0%) also had high FT4. The significantly higher prevalence of hypothyroxinemia and antiTPOAb titers than generally reported warrants routine screening for thyroid abnormalities. This screening, which can be effectively and easily incorporated into screening practices already in place for GDM, would result in improved obstetric care.     

孕早中期血清学指标及超声血流监测对子痫前期的预测价值

子痫前期是围产期母儿死亡的重要原因。早期筛选子痫前期发病高危人群,预测疾病进程及不良妊娠结局具有重要的意义。妊娠妇女孕早中期血清学标志物及超声血流等指标在预测子痫前期的发病方面具有重要的应用前景。     

Doppler velocimetry in the evaluation of fetal hypoxia.

Knowledge of fetal hemodynamic physiology has developed enormously during the last two decades due to Doppler ultrasound. Some of this knowledge has been utilized for routine surveillance of high-risk pregnancies. The prediction of fetal hypoxia before the development of life lasting sequel is of major importance, especially in the very premature case with absent end-diastolic blood flow in the umbilical artery before lung maturity. This review gives an overview of the present knowledge in this field.     

Prenatal evaluation of fetal neck masses in preparation for the EXIT procedure: the value of pulmonary Doppler ultrasonography (PDU)

Sonographic demonstration of normal tracheal diameter and breathing-related lung fluid flow at 30 weeks' gestation in a fetus with a giant neck mass confirmed patent airways, thus avoiding an EXIT procedure.     

Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding.

OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal ultrasonography, sonohysterography and hysteroscopy in patients presenting with abnormal uterine bleeding. DESIGN: Prospective, blind, comparative study. SETTING: Outpatient clinic and day surgery unit of a district hospital specializing in operative hysteroscopy. PATIENTS: One hundred consecutive patients referred with abnormal uterine bleeding (AUB). INTERVENTIONS: Transvaginal ultrasonography and sonohysterography were performed in the outpatient clinic. Within 1 week, all patients underwent operative hysteroscopy. MAIN OUTCOME MEASURES: All diagnoses established by transvaginal ultrasonography, and sonohysterography were compared to the appearance of the cavity using hysteroscopy as well as the histological diagnosis from removed tissues. RESULTS: In 88 patients information suitable for analysis was obtained by all methods. The detection rate of focal intrauterine pathology using sonohysterography was (94.1%), but was significantly lower with transvaginal ultrasonography (23.5%). In about 75% of all cases none of the methods used was able to correctly detect endometrial hyperplasia. CONCLUSIONS: Sonohysterography was significantly better than transvaginal ultrasonography in detecting focal intrauterine pathology. Visual examination at operative hysteroscopy yielded no additional information to the detection or exclusion of focal lesions than was obtained at outpatient sonohysterography. All methods performed equally in assessing endometrial pathology. We conclude that sonohysterography may replace diagnostic hysteroscopy in many patients with AUB.     

Laparoscopic diagnosis and evaluation of danazol or gestrinone therapy for endometriosis in sterility

In forty-six sterile women, endometriosis externa was diagnosed and classified laparoscopically. 21 patients were treated with Gestrinone 5mg-10mg/week and 25 patients were treated with Danazol 300mg-400mg/day for 6 months. The effects of these hormonal treatments were evaluated by second-look laparoscopy according to adhesion severity, number of blueberry spots and chocolate cyst size, as well as dysmenorrhea and other complaints. The results were as follows; 1) Dysmenorrhea was relieved in 60.0% of the Gestrinone-treated group and 45.5% of the Danazol group. 2) Adhesion was weakened or partially separated spontaneously in 66.7% of the Gestrinone group and 63.6% of the Danazol group. 3) Blueberry spots decreased in number or paled in 61.9% of the Gestrinone group and 75.0% of the Danazol group. 4) Chocolate cyst size became smaller in 60.0% of the Gestrinone group and 77.8% of the Danazol group. 5) Peritoneal fluid volume was not decreased after the hormonal treatments but the prostaglandin E2 concentration in peritoneal fluid was decreased (p less than 0.05) after Gestrinone therapy. 6) The patients complained of some side effects, liver function especially was disturbed in 48.0% of the Danazol group and 9.5% of the Gestrinone group. Hoarseness was complained of in 33.3% of the Gestrinone group and 12.0% of the Danazol group. 7) Finally, 23.8% of the Gestrinone group and 28.0% of the Danazol group conceived after the hormonal treatments.     

Combination of color Doppler ultrasonography and ultrasound-guided fine-needle aspiration cytology for localization of parathyroid lesions.

We examined the usefulness of color Doppler ultrasonography combined with ultrasound-guided fine-needle aspiration cytology (FNAC) for preoperative localization of parathyroid lesions in patients with hyperparathyroidism. Twenty-eight patients (19 men, 9 women; mean age, 56 years) with clinical and laboratory evidence of hyperparathyroidism underwent preoperative color Doppler ultrasonography and ultrasound-guided FNAC prior to surgery. On ultrasonography, the parathyroid lesions were anechoic or hypoechoic, located behind or at the margin of the thyroid gland, and mimicked blood vessels in some cases. On color Doppler ultrasound, parathyroid lesions showed little or no vascularity. They were easily differentiated from blood vessels, thus improving the safety of ultrasound-guided FNAC. Thirty-four (76%) of 45 surgically confirmed parathyroid lesions were detected with ultrasonography in 21 (75%) of the patients. There was no significant difference in the detection rates of lesions in the right upper, right lower, left upper, and left lower parathyroid glands. Eight (29%) patients had coexisting thyroid lesions. FNAC of the ultrasound-detected abnormalities provided preoperative confirmation that they were parathyroid lesions. In conclusion, our findings show that color Doppler ultrasonogrphy in combination with ultrasound-guided FNAC is useful for preoperative localization of parathyroid lesions.     

A fever index evaluation of chloramphenicol or clindamycin in patients with serious pelvic infections.

The fever index measured the responses of 102 women with serious pelvic infections who had received either chloramphenicol or clindamycin, in combination with other antibiotics. There was no statistical difference in the number of degree hours in the two populations. Patients with salpingo-oophoritis had significantly more fever than those with a septic abortion. Bacteremia did not delineate a group of women with a markedly elevated febrile response. Within the populaton with salpingo-oophoritis, neither black women nor women with an intrauterine device in place had significantly more fever, but patients requiring operation had more fever while those with an endocervical culture positive for the gonococcus at the time of admission had the most favorable clinical response. The significance of these findings is discussed.     

One-hour post-glucola results and pre-pregnancy body mass index are associated with the need for insulin therapy in women with gestational diabetes

Objective.?The purpose of this study was to analyze the relationship of 1-h post-glucola (PG) screening results and the need for insulin therapy in women with gestational diabetes (GDM).

Methods.?The study group was comprised of women with GDM treated at a single institution during calendar years 2000–2004. Women with singleton, term (≥37 weeks gestation), liveborn fetuses were included. The association of 1-h PG results and other perinatal risk factors to the need for subsequent insulin therapy was analyzed using multivariable logistic regression models.

Results.?Of the 1451 women were included in the analysis, 18.1% required insulin treatment. The mean 1-h PG result was 170.0?±?26.1?mg/dl (range 140–414?mg/dl). We determined that a 1-h PG?≥?190?mg/dl (p?<?0.0001), an obese body mass index (BMI) (p?<?0.0001), an overweight BMI (p?=?0.0019), prior GDM (p?=?0.0019), and prior macrosomia (p?=?0.0210) were each highly associated with the need for subsequent insulin therapy during the pregnancy.

Conclusions.?A 1-h PG?≥?190?mg/dl was strongly associated with the need for insulin therapy in women with GDM. These data may be helpful in counseling and managing women with GDM.     

经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠的临床价值

目的探讨经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠(CSP)的临床价值。方法收集2012年10月至2014年10月沈阳市妇婴医院收治的64例经阴道超声诊断为剖宫产切口瘢痕妊娠患者的影像及临床资料,分析其超声声像图特征及与临床结局的关系。结果超声诊断为CSP的64例患者中59例(92.2%)经病理证实,5例为难免流产。根据超声声像图特征将59例CSP分为2型:孕囊型(41例)和混合回声型(18例)。孕囊型分为3个亚型:I型妊娠囊边缘位于切口处(24例),Ⅱ型妊娠囊陷入切口内(15例),Ⅲ型妊娠囊向膀胱方向凸出(2例)。I型治疗以宫腔镜为主,Ⅱ型、Ⅲ型及混合回声型治疗以腹腔镜为主。结论经阴道彩色多普勒超声为诊断CSP的有效方法,正确的超声分型及对切口瘢痕厚度的准确测量有助于临床医生选择更加适合患者的个体化治疗方案。     

Transrectal ultrasonography in the evaluation of rectal and extrarectal disease

Transrectal ultrasonography is a technique that is gaining popularity in the assessment of rectal and extrarectal disease. From April 1987 to May 1989, 53 transrectal sonograms were done to evaluate rectal disease. Twenty-seven of 30 adenocarcinomas have been correctly staged. The operative procedure and the decision to use preoperative radiotherapy have been influenced by the results of these studies. Recurrent tumors and less common anorectal disease have also been evaluated with this technique. When feasible to perform, ultrasonographically guided biopsies yield specimens that can provide added information on which to base a therapeutic approach.     

三维及彩色多普勒超声对多囊卵巢综合征的辅助诊断价值

目的探讨三维及彩色多普勒超声对多囊卵巢综合征(PCOS)的辅助诊断价值。方法对中国医科大学附属盛京医院2005年2月至2007年6月收治的60例PCOS患者和60例健康育龄女性进行三维及彩色多普勒超声检查,检测卵泡数目、三维容积和血流动力学指标,并进行对比分析。结果PCOS组的卵泡数目、卵巢容积、卵巢间质容积、卵泡容积大于对照组[分别为(16.91±4.34)个、(12.56±3.96)cm3、(11.49±3.50)cm3、(1.07±0.61)cm3对(5.48±2.10)个、(4.76±1.78)cm3、(4.43±1.74)cm3、(0.32±0.21)cm3],差异均有统计学意义(P<0.01);卵巢间质内动脉阻力指数低于对照组(0.53±0.06对0.65±0.09),收缩期峰值血流速度高于对照组[(12.68±3.10)cm/s对(9.30±1.64)cm/s],差异具有统计学意义(分别P<0.01,P<0.05)。结论三维超声和彩色多普勒超声增加了鉴别PCOS的客观定量指标,对多囊卵巢综合征有较高的辅助诊断价值。     

Lung hypoplasia and the application of Doppler ultrasonography in the assessment of fetal pulmonary circulation

The paper presents a review of literature concerning the use of Doppler technique in the evaluation of pulmonary blood flow. Especially, it is important to monitor the development of lung in suspicion of lung hypoplasia that closely correlates with abnormal development of pulmonary vessels. In the literature there are single reports pointing on its usefulness in the detection of lethal lung hypoplasia. It has been suggested that this technique may provide valuable information of the development of vascular bed in lung. Recent data concerning Doppler blood flow velocimetry in hypoplastic lung stimulate to further studies suggesting their significant value in the diagnosis and distinguishing the lethal form of pulmonary hypoplasia.     

Reference values for resistance index and pulsatility index of uteroplacental Doppler flow velocity waveforms based on 612 uneventful pregnancies.

Using a 4-MHz continuous-wave Doppler device, standard rates were established for resistance index (RI) and pulsatility index (PI) of uterine and arcuate arteries of 612 patients with uneventful pregnancies and deliveries. From 18 to 41 weeks of gestation, neither RI nor PI of uterine or arcuate arteries proved to vary with gestational age, maternal heart rate, or maternal age. By contrast, a significant effect of placental location on the measurement results was found in both uterine and arcuate arteries. The differences between measurements on the placental or opposite site are more distinct in arcuate than in uterine arteries. Taking the 90th percentile as a localization gauge, cutoff levels of 0.52 (RI) and 0.98 (PI) were found in uterine arteries. In arcuate arteries, cutoff levels of 0.45 (RI) and 0.82 (PI) were found on the placental site or with a placenta without lateralization. On the nonplacental site of a lateralized placenta, the cutoff levels were 0.51 (RI) and 0.92 (PI).     

Three- and four-dimensional ultrasonography for the structural and functional evaluation of the fetal face

Ultrasonographic examination of the fetal face can provide information that may lead to the diagnosis of anomalies in other organs or systems. Thus, the fetal face represents a "diagnostic window" for fetal diseases and syndromes. Three-dimensional ultrasonography (3DUS) improves the evaluation of anatomic fetal facial anomalies over what is possible by 2-dimensional ultrasonography (2DUS). Four-dimensional ultrasonography (4DUS), by adding the temporal component to the examination, allows visualization of facial expressions that might be useful in the study of fetal behavior and maternal-fetal bonding. In this article, we evaluate the potential of 3D/4DUS for the study of structural and functional development of the fetal face.     

Trends in nursing and midwifery research and the need for change in complementary therapy research

In recent years there has been a change in nursing and midwifery research. Whilst many of the subjects being studied remain the same, nurses and midwives have started to employ a range of data collection methods that are relatively new to the profession. Predominantly quantitative research, which concentrates on reduction, objectivity, manipulation, categorization, passivity, control, prediction, causality and generalizability (Munhall & Oiler 1986), is starting to be replaced by other approaches perhaps more congruent with nursing, midwifery and caring. As Moody (1990) stated, 'the 1980s ushered in an array of diverse, sophisticated research methods...' with other authors adding that 'nursing is just beginning to authenticate new territory that incorporates a plurality of methods' (Nagle & Mitchell 1991). The following is an exploration of the recent apparent shift away from a focus on quantitative research in nursing and midwifery towards the use of qualitative methods which emphasize a greater degree of individuality, humanism, participation and interaction. It is suggested that the traditional quantitative research paradigm still exists in the field of complementary therapy research and that the shift that has taken place in nursing and midwifery research needs to be considered more seriously in the field of research in complementary therapies.