降调节后激素预测体外受精周期中卵巢反应性

目的:探讨在体外受精周期中进行垂体降调节后的血清激素水平,预测不孕症患者卵巢的反应性,为选择最佳的超促排卵方案提供依据。方法:采用化学发光法,测定69例不孕症患者接受体外受精治疗周期中,应用促性腺激素释放激素激动剂进行垂体降调节前后月经第3天的血清卵泡刺激素和雌二醇水平,按卵巢反应性指标-获卵数及刺激程度,分为低反应组,正常反应组及过度刺激组,并作统计分析。结果:降调后月经第3天血清卵泡刺激素水平与获卵数呈显著负相关(r=-0.436,P=0.001)。基础卵泡刺激素水平与获卵数呈显著负相关(r=-0.334,P=0.005)。3组比较,年龄无差异性,获卵数、受精数均有显著性差异,P<0.05;促性腺激素总用量,低反应组与其他两组比较均有显著差异,P<0.05,而正常反应组与过度刺激组比较无差异性,P>0.05。降调后3组的妊娠结局无差异,P>0.05。结论:降调后月经第3天血清卵泡刺激素水平能较敏感地预测卵巢对促性腺激素刺激的反应性,优于基础血清卵泡刺激素水平的预测作用。     

垂体后叶素与奥曲肽治疗肝硬化上消化道出血的临床研究

目的探讨垂体后叶素与奥曲肽联合治疗对肝硬化上消化道出血的止血效果。方法回顾性分析了我院收治的85例肝硬化上消化道出血患者的临床资料,对照组42例采用常规止血治疗,观察组43例采用常规止血治疗加用垂体后叶素与奥曲肽联合治疗,比较两组的疗效、不良反应发生率、显效时间与止血时间。结果观察组总有效率为95.35%,对照组为71.43%,两组比较,差异有统计学意义（P〈0.05）;观察组不良反应发生率为13.95%,对照组患者不良反应发生率为14.29%,两组比较,差异无统计学意义（P〉0.05）;观察组显效时间为（5.64±1.34）小时、止血时间为（10.85±2.29）小时,对照组显效时间为（9.34±1.98）小时、止血时间为（14.61±2.75）小时,两组比较,差异有统计学意义（P〈0.05）。结论垂体后叶素与奥曲肽联合治疗肝硬化上消化道出血的疗效好、显效快、不良反应少。     

卵巢过度刺激综合征55例临床分析

目的探讨卵巢过度刺激综合征（ovarian hyperstimulation syndrome，OHSS）的发病机制、临床表现、预防及治疗措施。方法本研究对2005年1月至2008年2月在本院住院治疗的55例OHSS患者进行回顾性分析，根据OHSS发生时间，将其分为早发组和晚发组，早发组患者为31例（31／55，56．4％），晚发组为24例（24／55，43．6％）。并比较两组间患者的特征和实验室资料。结果早发组注射HCG当日雌二醇水平高于晚发组，两组比较，差异有显著意义（P〈0．05）。晚发组临床妊娠率（91．6％）、多胎妊娠率（16．7％）和重度OHSS率（41．6％）均高于早发组（P〈0．05）。结论早发OHSS，主要与在促排卵治疗过程中外源性HCG刺激有关；晚发OHSS，则更多与妊娠（尤其是多胎妊娠）产生的内源性HCG相关，更易发生重度OHSS。使用促排卵药物时，应注意预防OHSS，降低中、重度OHSS发生率。     

不同剂量长效曲普瑞林在体外受精-胚胎移植中应用的比较

目的:探讨体外受精-胚胎移植(IVF-ET)中不同剂量促性腺激素释放激素激动剂(GnRH-a)垂体降调节对临床结局的影响。方法:回顾性分析长效曲普瑞林1.0 mg和1.2 mg两种剂量降调节的治疗效果。结果:两种剂量长效曲普瑞林降调节后,血卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)水平比较差异无统计学意义(P>0.05);两组促性腺激素(Gn)使用时间、Gn总用量、穿刺卵泡数、获卵率、受精率、卵裂率、优质胚胎率、临床妊娠率、种植率、卵巢过度刺激综合征(OHSS)发生率比较均无显著差异(P>0.05)。结论:长效曲普瑞林1.0 mg和1.2 mg均可获得满意的垂体降调节效果和IVF结局,建议在达到同样效果的前提下尽量减少GnRH-a的用量。     

来曲唑降低取卵术后卵巢过度刺激征发生率的临床研究

目的：探究具有卵巢过度刺激征高危因素患者在取卵术后,用来曲唑降低卵巢过度刺激征（OHSS）发生率的临床效果。方法：选取笔者所在医院生殖中心近一年内行IVF—ET助孕并具有卵巢过度刺激症高危因素的患者86例,于取卵术后口服来曲唑,并系统地回顾既往取卵术后用葡萄糖酸钙推注预防卵巢过度刺激征的资料,对比两种方案下卵巢过度刺激征的发生率以及中、重度OHSS的比例。结果：用来曲唑预防的86例患者中,雌激素水平下降明显,卵巢过度刺激征的发生率为12．79％,中、重度的发生率为2．33％,既往卵巢过度刺激征的发生率为13．02％,中、重度的发生率为4．69％。说明来曲唑可以更好地降低中重度卵巢过度刺激征的发生率。结论：取卵术后服用来曲唑不但可以预防OHSS的发生,而且可以降低中重度OHSS的发生率,可以考虑将来曲唑作为预防卵巢过度刺激征的一线药物使用。     

全胚冷冻预防卵巢过度刺激综合征42例分析

目的:研究全胚冷冻预防卵巢过度刺激综合征(OHSS)的临床疗效。方法:42例行体外受精-胚胎移植助孕的患者因有OHSS的风险取消新鲜胚胎移植,进行全胚胎冷冻,3个月后进行共59周期的冷冻胚胎移植,统计其临床资料。结果:42例患者有3例发生中、重度OHSS,发生率为7.10%,冷冻胚胎妊娠率为40.54%,累积妊娠率为58.57%,双胎妊娠率为25.78%。结论:全胚冷冻是预防OHSS并取得良好临床效果的有效方法。     

VEGF对卵巢过度刺激综合征的预测和监测价值

目的探讨血管内皮生长因子(VEGF)在IVF周期中对卵巢过度刺激综合征(OHSS)的预测和对其发病过程中的监测价值。方法选取IVF周期中患OHSS的患者11例为OHSS组，取卵数≥20的患者16例为高危组。收集各患者IVF周期中基础值、hCG日、取卵日(OPU日)、移植日(ET日)及ET后7、14d六个时点的血清和OPU日卵泡液，检测VEGF水平。对7例重度OHSS患者在症状明显期、症状减轻期和完全缓解期的血清测定VEGF值。结果OHSS组与高危组比较，血清VEGF、在ET后7d和14d显著升高，卵泡液VEGF、水平显著高于高危组。OHSS患者随病情缓解，血清VEGF、水平逐渐下降。结论卵泡液VEGF、水平可以预测OHSS的发生，血清VEGF可以监测OHSS的病情发展。     

超声下行卵泡抽吸术在治疗卵巢过度刺激综合征中的应用

目的:总结在超声引导下进行卵泡抽吸术治疗卵巢过度刺激综合征(OHSS)的作用。方法:回顾分析11例OHSS病例的超声下行卵泡抽吸术资料。结果:OHSS患者在行卵泡抽吸术后症状缓解快,效果满意。结论:超声引导下进行卵泡抽吸术对OHSS有积极治疗的作用。     

Selective effect of chlormadinone acetate on brain allopregnanolone and opioids content

Background

Synthetic progestins may have different biological actions depending on the target tissue, the dose administered or the coadministration of an estrogen molecule. The purpose of the present study was to evaluate the neuroendocrine effect of chlormadinone acetate (CMA) administration, analyzing the brain content of allopregnanolone (ALLO), an endogenous neurosteroid γ-aminobutyric acid agonist with anxiolytic properties, and the brain level of β-endorphin (β-END), an endogenous opioid implicated in pain mechanism, emotional state and autonomic control.

Study Design

Seven groups of Wistar ovariectomized (OVX) rats received one of the following treatments: oral CMA at a dose of 0.1, 0.5 or 1 mg/kg per day; estradiol valerate (E₂V) at a dose of 0.05 mg/kg per day; CMA plus E₂V (CMA 0.1 or 0.5 or 1 mg/kg per day + E₂V 0.05 mg/kg per day) for 14 days. One group of fertile rats and one group of OVX rats were used as controls.

Results

CMA increased ALLO content in the hippocampus and, when it was administered with E₂V, also in the hypothalamus and anterior pituitary, evidence of a synergic effect with estrogens only in selective brain areas. β-END content increased in the neurointermediate lobe and anterior pituitary after CMA administration, and it did not antagonize the positive, estrogen-induced increase of β-END level.

Conclusion

CMA is effective in increasing ALLO and β-END in selective brain areas showing a specific pattern of interaction with brain function, different compared to progesterone or to other synthetic progestins. In particular, CMA action on part of the limbic system (hippocampus and hypothalamus) and on the anterior pituitary support the hypothesis that this progestin might affect cognitive function, emotional state and autonomic control.     

Treatment of recurrent gastrointestinal haemorrhage in a patient with von Willebrand's disease with administration of octreotide LAR and propranolol

We report a patient with von Willebrand' s disease who had had recurrent and life-threatening bleeding from the gastrointestinal tract. Despite extensive investigation, no apparent cause of haemorrhage was identified. He was successfully treated with combined administration of octreotide LAR (long-acting release) and propranolol. This is the first report on the successful use of octreotide LAR in a patient with von Willebrand' s disease.     

来曲唑降低取卵后黄体期雌激素水平及OHSS的发生率

目的:研究卵巢过度刺激综合征(OHSS)高危患者取卵后使用来曲唑对黄体期性激素的影响及对OHSS的预防作用。方法:193例患者196个OHSS高危体外受精(IVF)/卵胞浆单精子注射(ICSl)周期取卵后行全部胚胎冷冻,并于取卵后根据是否添加来曲唑分为实验组和对照组,实验组取卵后口服来曲唑,对照组不予来曲唑。比较两组患者HCG日(d0)、d2、d4、d9的LH、E2、P水平及中、重度OHSS发生率。结果:实验组和对照组d0和d2的LH、E2、P以及d4LH和P、d9LH和P差异均无统计学意义(P>0.05),实验组d4 E2、d9E2和中、重度OHSS率低于对照组(P<0.01)。结论:OHSS高危患者取卵后添加来曲唑显著降低黄体期E2水平,有效降低中、重度OHSS发生率。     

卵巢过度刺激的相关急腹症15例报道

目的探讨超促排卵后合并卵巢过度刺激的急腹症的发生原因、临床特点、早期诊断方法及合理的应对措施。方法回顾1999年—2009年收治入院的617例卵巢刺激综合征（ovarian hyperstimulation syndrome,OHSS）相关急腹症,分析其病因、发生率、临床特点,与妊娠、助孕方式、OHSS程度的关系以及治疗措施。结果 617例OHSS者中共有15例发生相应急腹症,发生率为2.43%。其中,发生相应急腹症最主要的原因为卵巢扭转。15例急腹症中共有8例证实已怀孕,其中12例卵巢扭转者同时妊娠的占7例。8例妊娠者除1例发生流产外,其余妊娠结局良好。结论 OHSS合并妊娠是卵巢扭转的高危因素,容易引起急腹症,B超检查是早期诊断的有效方法,及时诊治不影响妊娠结局。     

Treatment of carcinoid syndrome with a somatostatin analogue]

Octreotide, a long-acting somatostatin analogue has recently been introduced in the therapy of gastroenteropancreatic endocrine tumors, but home experience has been lacking. With the aim of drawing attention to this therapeutic possibility, a case of malignant carcinoid syndrome treated with octreotide for 18 months is reported. Despite the therapeutic attempts preceding the octreotide administration a gradual progression in clinical symptoms was observed and cardiac failure due to fibrotic and valvular heart disease developed. Cytotoxic chemotherapy, serotonin antagonists or repeated selective embolisation of the hepatic artery only resulted in a short transitional improvement. Octreotide in a dose of 100 micrograms three times daily by subcutaneous injection provided effective and rapid relief from episodic flushing and serious diarrhoea. Plasma level of serotonin and 24-hour urinary excretion of 5-hydroxyindolacetic acid decreased from 6 micrograms/ml to 2 micrograms/ml and from 800 mumol/day to 70 mumol/day, respectively. No changes in the number and extension of liver metastases could be seen after introducing the octreotide treatment. The patient's compensated cardiac status could be preserved and continuous therapy provided an acceptable quality of life.     

迈之灵预防卵巢过度刺激综合征的临床价值

目的:评价口服迈之灵对预防和治疗体外受精-胚胎移植（ in vitro fertilization-embryo transfer, IVF-ET）后卵巢过度刺激综合征（ovarian hyperstimulation syndrome,OHSS）发生及其严重程度的作用。 方法:选择2018年2月...     

Octreotide in the treatment of acute gastrointestinal hemorrhage caused by ruptured esophageal varices

AIMS: To asses the value of octreotide in the control of acute bleeding esophageal varices in a retrospective study. METHODOLOGY: Fourty two patients admitted for esophageal variceal bleeding confirmed at endoscopy were recruited. An initial 50 micrograms bolus of octreotide followed by a two day continuous infusion of 25 micrograms/h were evaluated for the control of bleeding. RESULTS: Twenty nine patients were endoscopic stigmata of recent bleeding and thirteen were active bleeding at emergency endoscopy. Octreotide was found to be effective regarding hemostasis at 48 hours and on day 7 after the index bleeding episode. 30-day mortality was 11.9%. Echec of octreotide was significantly associated with severity of cirrhosis (p<0.03). CONCLUSION: These results suggest that octreotide is effective in the treatment of esophageal variceal bleeding and it is a valuable adjuvant treatment in association with endoscopic management.     

Non-surgical management of a lymphatic fistula, after laparoscopic colorectal surgery, with total parenteral nutrition, octreotide, and somatostatin

OBJECTIVE: We report the case of an external lymphatic fistula that appeared through an abdominal drainage after laparoscopic resection of the rectum and sigmoid colon for cancer, with lymphadenectomy. There was no chylous ascites because of controlled external drainage. METHODS: The fistula was managed conservatively by interruption of oral feeding and administration of total parenteral nutrition and subcutaneous octreotide and management then shifted to intravenous somatostatin, with decreased lymph output through the fistula to 100 to 200 mL/d. RESULTS AND CONCLUSION: Somatostatin seemed to be more effective than subcutaneous octreotide. At postoperative day 18, refusal of treatment by the patient with oral resumption of clear liquids resulted in a transient increase in lymph output to 600 mL/d, and treatment was resumed. Subsequently, progressive withdrawal of the abdominal drainage was associated with complete healing of the fistula. The drain was removed at day 28, treatment was interrupted at day 30 after verifying by ultrasound the absence of chyloperitoneum, and the patient was discharged without further problems.     

β-Endorphin-stimulated prolactin release in lactating rats following alcohol administration

To delineate the mechanism of alcohol inhibition of the suckling-induced prolactin increase, we examined β-endorphin-stimulated prolactin release in lactating rats separated from their litters. On day 2 of lactation litters were adjusted to eight pups. On day 7, dams were implanted with an atrial catheter; experiments were conducted on lactation day 10. Litters were separated from their dams at 0800. After five hours, a PE50 extension tube filled with heparinized saline was attached to the catheter. At 1400 a preinfusion blood sample was removed and was followed by infusion of saline (control) or alcohol in saline (1.0 and 2.0 g/kg/body weight). Following the removal of a postinfusion blood sample, β-endorphin (600 μg/kg/body weight) was administered. Additional blood samples were withdrawn 10, 30, 60, and 120 min after β-endorphin.Alcohol infusion did not alter basal prolactin. β-Endorphin administration resulted in pronounced prolactin increases in all groups. Alcohol failed to inhibit β-endorphin-induced plasma prolactin increase. From the present study with β-endorphin and our previous studies with sulpiride and thyrotropin-releasing hormone (TRH) it is concluded that the anterior pituitary is not the site where alcohol acts to inhibit suckling-induced prolactin release in rats.     

卵巢过度刺激综合征患者的心理状况调查及心理护理

目的探讨激惹、抑郁和焦虑量表（IDA）用于卵巢过度刺激综合征（OHSS）患者心理调查的可行性,并考察有效的心理护理对OHSS患者激惹、焦虑及抑郁水平的影响。方法OHSS患者42例（OHSS组）和接受不孕症治疗无该并发症的患者42例（不孕组）,根据患者存在的心理问题,对OHSS组实施针对性的心理护理1～2周。对两组患者心理干预前后的IDA量表评分进行比较分析。结果心理干预前OHSS组各项IDA（抑郁、焦虑、内向性激惹、外向性激惹）评分均高于不孕组[（5．9±2．2）、（6．4±2．1）、（3．9±1．8）、（4．4±2．1）分比（3．7±1．9）、（4．5±2．0）、（1．9±1．2）、（2．2±1．8）分],差异均有统计学意义。OHSS组患者经心理治疗后,与干预前相比IDA量表评分明显降低[（3．2±1．3）、（4．7±2．3）、（1．54-1．1）、（2．1±1．7）分比（5．9±2．2）、（6．4±2．1）、（3．9±1．8）、（4．4±2．1）分],与不孕组IDA评分结果比较差异无统计学意义。结论IDA量表可应用于OHSS患者的心理调查,有效的心理护理有助于降低OHSS患者的激惹、焦虑及抑郁水平。     

促性腺激素释放激素激动剂在辅助生殖技术黄体支持中的应用

在辅助生殖技术（assisted reproduction technique,ART）周期中,控制性超促排卵及取卵后容易导致黄体功能不全,为了解决这个问题,常规需要在ART周期中进行黄体支持（luteal phase support,LPS）。目前疗效肯定的LPS方案是单独或者联合使用不同剂量孕激素和人绒毛膜促性腺激素（human chorionic gonadotropin,hCG）,但hCG会增加卵巢过度刺激综合征（ovarian hyperstimulation syndrome,OHSS）发生的风险。近年来有学者发现在LPS中添加促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist,GnRHa）不仅可减少OHSS的发生,还能获得良好的妊娠结局。虽然如此,目前有关GnRHa使用剂型、剂量、给药途径、时间、机制和效果仍不清楚,尚需进一步探索。     

奥曲肽治疗晚期肝癌的Meta分析

目的 综合评价奥曲肽对晚期肝癌患者生存期的影响.方法 检索各种电子数据库,对所有关于奥曲肽治疗晚期肝癌的随机对照试验进行Meta分析.结果 共纳入5项随机对照临床试验,579例晚期肝癌患者.Meta分析显示奥曲肽治疗对于患者的6、12和24个月生存率无显著影响(6个月:OR值1.69,95%CI 0.89～3.21,P=0.11;12个月:OR值2.41,95%CI 0.83～6.93,P=0.10;24个月:OR值0.58,95%CI 0.28～1.17,P=0.13).敏感性分析中分别剔除了空白对照的研究、排除生长抑素受体阴性患者的研究、患者生存期较短的研究和随访期较短的研究,结果均显示奥曲肽治疗对于患者的6、12个月生存率均无显著影响.有2项敏感性分析显示奥曲肽治疗组24个月生存率显著低于对照组(OR值0.51,95%CI 0.27～0.98,P=0.04).结论 奥曲肽并不能延长晚期肝癌患者的生存期,不应推荐用于晚期肝癌的治疗.