36例新生儿胎粪吸入综合征综合护理措施分析

目的：探讨新生儿胎粪吸入综合征的综合护理措施,以降低其发病率和病死率。方法对36例新生儿胎粪吸入综合征采取综合护理措施,总结临床护理经验。结果36例患儿经治疗及护理后,治愈出院34例,因其他原因转院1例,死亡1例,治愈率91．67％。结论保持新生儿胎粪吸入综合征患儿呼吸道通畅、给予合理的供氧以及正确治疗和护理是综合护理新生儿胎粪吸入患儿的关键。     

胎粪吸入综合征

本文对长期以来关于胎粪的假说提出异议。以往认为:(1) 羊水中出现胎粪是胎儿窘迫的一个独立征象;(2) 胎粪吸入发生于胎儿出生时或宫内喘气,是对重度窒息的反应;(3) 胎粪吸入综合征是吸入的胎粪对新生儿肺产生有害影响所致。最近的报道认为胎粪吸入综合征不单由胎粪吸入所致,而是围产期窒息。     

胎粪吸入综合征患儿血中内皮细胞因子及纤溶功能的变化

胎粪吸入综合征发生率及病死率均很高，重型胎粪吸入综合征患儿常发生持续肺动脉高压、急性呼吸窘迫综合征、慢性肺疾病、肺出血等合并症。但胎粪吸入综合征的发病机制尚不完全清楚，内皮细胞因子在本病的发生、发展过程中可能起着重要作用。本研究通过观察胎粪吸入综合征患儿血中血小板活化因子（platelet-activating factor，PAF）、血栓调节蛋白（thrombomoduhne，TM）及组织型纤溶酶原激活剂（tissue-typeplasminogenactivator，t-PA）、     

新生儿湿肺的诊治进展

新生儿湿肺是引起新生儿呼吸困难最常见的原因,其临床表现是非特异性的,与呼吸窘迫综合征、肺炎、胎粪吸入综合征等不易鉴别,且有自限性的特点,易被临床漏诊或延误治疗。近年来重症新生儿湿肺增多,常常需要呼吸机辅助呼吸,甚至体外膜肺的应用。本文对新生儿湿肺的发病机制、诊断及治疗作一综述。     

羊水粪染：现代争议

羊水粪染发生率约９％－２０％。胎粪排入羊水可在产前或产时。胎粪吸入发生于前前、产时或第一次呼吸时，胎粪吸入综合征的新生儿预后与产前低氧血对肺的损害有关。本文综述胎粪排出和胎粪吸入综合征的病理生理学，预报胎粪吸入的治疗选择，以及胎儿监护的评估。     

新生儿湿肺症

新生儿湿肺症 (wetlungsyndromeofthenewborn) ,又称暂时性呼吸困难 (transienttachypnea)或Ⅱ型呼吸窘迫综合征 (typeⅡRDS) ,是因肺内液体积聚和清除延迟引起的轻度自限性呼吸系统疾病。新生儿出生后均有一过性的肺内液体积聚 ,绝大多数无临床症状 ,称为湿肺 (wetlung) ,可视为生理现象。极少数由于各种原因致使肺内液体清除延迟 ,出现呼吸增快 ,可伴青紫、呻吟 ,一般在 2～ 5天内消失 ;胸部X线检查可见肺泡及间质积液、肺淤血、肺气肿及叶间、胸腔积液 ,且消散延迟 ,应视为病理性病变 ,称为湿肺症[1] 1围生期因素与发病机制1 1胎肺液的…     

足月儿呼吸窘迫综合征18例临床特点分析

目的分析足月儿呼吸窘迫综合征(RDS)的临床特点。方法分析18例足月RDS患儿的临床资料。结果 18例患儿全部经剖宫产分娩,13例为男婴,8例有羊水胎粪污染。经治疗13例治愈,3例好转出院,2例放弃治疗后于院外死亡。结论剖宫产、男婴及羊水胎粪污染可能是足月RDS发病的危险因素,确诊后需尽早予机械通气为主的综合治疗。     

胎粪吸入综合征患儿肺组织的形态计量学研究

采用M168多用途试验测试格,对45例胎粪吸入综合征(MAS)患儿肺组织和5例正常肺组织进行了形态计量研究。结果表明:吸入胎粪的点计数(Pc)、肺泡交点数(Ic)、肺泡净切线数(Tnet)及肺小动脉平均直径(D)4项参数,MAS组与对照组间差别具有非常显著性意义,但D及肺泡物理形状与单位体积内胎粪吸入量无相关性。根据5例合并透明膜形成,提出了肺表面活性物质缺乏可能是肺不张原因之一。对肺不张病理生理过程提出商榷。     

分娩期及新生儿期胎粪吸入综合征

新生儿胎粪吸入综合征是胎儿在子宫内吸入了胎粪污染的羊水。本文介绍克利福兰总医院妇产科1986年6～10月间羊水内有胎粪污染的活婴238例对其产前胎心率,产后脐动脉血pH值、PCO_2值和Apgar评分与分娩期,新生儿期胎粪吸入综合征的相关性予以分析,以尽早发现并确诊。选择羊水有胎粪污染的新生儿,体重>2300g,胎龄>37周,根据胎粪污染程度分轻、中、重三组。每例新生儿在头娩出后肩娩出前用DeLee器吸引咽部,在出生后做胸部加压并做气管内插管吸引,对     

30例胎粪吸入综合征儿死因探讨

本文总结我院1982年1月～1989年12月,因胎粪吸入综合征(MAS)出生后一周内死亡的30例新生儿围产期临床和病理尸解资料.致死原因分析结果:重度窒息不可逆转2例(6.7％),气胸7例(23.3％),肺出血8例(26.7％),肺透明膜病6例(20.0％),肺炎1例(3.3％),脑水肿3例(10.0％),心力衰竭3例(10.0％)。文章并就MAS死因与胎儿宫内窘迫、呼吸道内胎粪和新生儿肺部并发症等诸因素的关系进行探讨。     

Preptin in women with polycystic ovary syndrome

Introduction: Polycystic ovary syndrome (PCOS) patients, frequently develop metabolic complications, such as insulin resistance (IR), impaired carbohydrate metabolism, dyslipidemia, obesity. Among the new markers responsible for metabolic disorders, preptin seems to be of great significance.

Material: One hundred and thirty-four women aged 17–45 were enrolled. PCOS was diagnosed in 73 women on the basis of ESHRE-ASRM criteria. Non-PCOS group consisted of 61 women with regular menstruation matched for nutritional status.

Methods: All women underwent anamnesis, physical examination, anthropometric measurements, the abdominal ultrasound examination, and dual energy X-ray absorptiometry (DXA). Serum adropin levels were determined by ELISA. Biochemical and hormonal (testosterone, androstenedione, LH, FSH, estradiol) measurements were also performed. Insulin resistance indices (HOMA, QUICKI, Matsuda) and free androgen index (FAI) were calculated with the test results according to the standard formula. For all comparisons, statistical significance was defined by p?≤?.05.

Results: Serum preptin levels were significantly higher in the PCOS group. No significant correlations between preptin level and metabolic and hormonal markers were observed. The logistic regression analysis demonstrated that serum preptin level was an independent factor differentiating the two groups.

Conclusions: Serum preptin levels were significantly higher in women with PCOS compared with controls. This peptide might be an independent predictor of PCOS in the future.     

Role of serum renalase levels in predicting the presence of metabolic syndrome in patients with polycystic ovary syndrome

ObjectiveThis study was designed to compare the serum renalase levels of polycystic ovary syndrome (PCOS) women with and without metabolic syndrome (MS) and those of healthy non-PCOS women.Materials and methodsSeventy-two patients diagnosed with PCOS and age-matched 72 healthy non-PCOS were included in the study. The PCOS group was divided into two groups as having metabolic syndrome or not. General gynecological and physical examination findings and laboratory results were recorded. Renalase levels in serum samples were determined using Enyzme-Linked ImmunoSorbent Assay method.ResultsMean serum renalase level was significantly higher in PCOS patients with MS compared with both PCOS patients without MS and healthy controls. Additionally, serum renalase correlates positively with body mass index, systolic and diastolic blood pressure, serum triglyceride and homeostasis model assessment-insulin resistance values among PCOS women. However, systolic blood pressure was found to be the only significant independent factor that can affect the serum renalase levels. A serum renalase level of 79.86 ng/L had a sensitivity of 94.7% and specificity of 46.4% in discriminating PCOS patients with metabolic syndrome from healthy women.ConclusionsSerum renalase level increases in women with PCOS in the presence of metabolic syndrome. Therefore, monitoring the serum renalase level in women with PCOS can predict the metabolic syndrome that may develop.     

Diagnostic Evaluation,Comorbidity Screening,and Treatment of Polycystic Ovary Syndrome in Adolescents in 3 Specialty Clinics

Study Objective

A polycystic ovary syndrome (PCOS) diagnosis in adolescence can have significant long-term health implications. The criteria for its diagnosis in adolescents have been subject to much debate. In this study we aimed to characterize the variability in diagnosis and management among different pediatric specialties.

Serum adiponectin is independently associated with the metabolic syndrome in Hong Kong,Chinese women with polycystic ovary syndrome

Objective: To evaluate the association of serum adiponectin level with the metabolic syndrome in Chinese women with polycystic ovary syndrome (PCOS).

Methods: This was a cross-sectional study carried out in Hong Kong Chinese women with PCOS at a university-affiliated tertiary hospital between January 2010 and January 2011. Clinical and biochemical parameters of the women were analysed. Prediction of the metabolic syndrome was determined by receiver–operator characteristic (ROC) curves, univariate and multivariate logistic regression analyses.

Results: A total of 116 women diagnosed to have PCOS were analysed. The area under the ROC curve of adiponectin for the prediction of metabolic syndrome was 0.820, 95% confidence interval (CI) 0.737–0.886. Univariate binary logistic regression showed that testosterone, sex hormone-binding globulin (SHBG), free androgen index (FAI), waist circumference, body mass index (BMI), quantitative insulin-sensitivity check index (QUICKI), homeostasis model assessment of insulin resistance (HOMA-IR) and adiponectin were significantly associated with the metabolic syndrome. On multivariate logistic regression analysis, adiponectin (p?= 0.020), HOMA-IR, age (p?= 0.011) and BMI (p?= 0.019) were independently associated with the metabolic syndrome, but not FAI (p?= 0.256).

Conclusions: Serum adiponectin is independently associated with the metabolic syndrome in Chinese women with PCOS. Further longitudinal follow-up studies are needed to determine whether serum adiponectin adds to the prediction of long-term cardiometabolic morbidity conferred by age, BMI and measures of insulin resistance.     

Adolescent gynaecology

Adolescent gynaecology is increasingly recognized as an area in which specific knowledge and expertise is required to ensure that patients achieve the best outcome. Gynaecological problems in adolescents are common, and although serious pathology is rare, distress and discomfort can be significant. Adolescent girls are under greater pressure than ever before, particularly in terms of examination performance; they find menstrual dysfunction particularly difficult to manage.Careful and sympathetic assessment is crucial, and simple treatment remedies may be all that is required. However, complex and rare medical conditions can also occur and must not be missed. Some congenital disorders present for the first time in adolescence.Early detection and appropriate treatment will ensure the best possible outcomes in terms of sexual function and potential fertility.     

No todo es lo que parece: miastenia gravis,una rara manifestación paraneoplásica del cáncer de ovario: caso clínico

Paraneoplastic neurological syndromes are an unusual diseases rarely associated with gynaecological tumours. Their presence must alert on the possible existence of an underlying malignant tumour.A rare case is presented of myasthenia gravis as a paraneoplastic manifestation of an advanced primary ovarian cancer.     

Meigs Syndrome Superimposed on Gorlin Syndrome in a 14-Year-Old Girl

BackgroundMeigs syndrome is a rare complication associated with ovarian fibromas. Although ovarian fibromas are rare in children, they are common in women with Gorlin syndrome after puberty.CaseA 14-year-old girl with Gorlin syndrome was admitted to our hospital for ablation of basal cell carcinoma. A chest x-ray revealed pleural effusion. Ultrasonography revealed bilateral multinodular ovarian masses. Meigs syndrome associated with ovarian fibromas was considered. A laparotomy revealed bilateral ovarian masses, which were resected. Microscopically, the masses were composed of mitotically active fibroma and areas resembling hemangiopericytoma and luteinized thecoma. The pleural effusion disappeared soon after the surgery.Summary and ConclusionPhysicians should consider the possibility that pleural effusion might precede the diagnosis of ovarian fibroma in patients with Gorlin syndrome.     

羊水量异常的超声诊断及临床意义

目的分析毛细血管内增生性肾炎致肾病综合征患儿的临床表现，病理改变和治疗。 方法2002-06—2004-08，对苏州大学附属儿童医院肾内科收治的毛细血管内增生性肾炎致肾病综合征6例进行回顾分析。 结果(1)6例患儿的临床表现均为肾炎型肾病综合征；(2)其病理特点为：在毛细血管内增生的基础上有细胞新月体形成，可见IgG、C3的颗粒状沉积物沿毛细血管袢连续排列，且发现“不典型驼峰”和部分足突融合；(3)治疗：6例均予激素治疗。其中2例治疗4周内完全缓解；4例未能在4周内达到完全缓解者，2例加用环磷酰胺，2例予雷公藤，均缓解。 结论(1)病理改变与临床表现关系密切，伴新月体者肉眼血尿时间较长，伴足突融合者蛋白尿程度重，持续时间长；(2)给予足量激素，或联合应用免疫抑制剂，可取得较好疗效，但长期预后尚待进一步观察。     

Auriculocondylar syndrome: Pathogenesis,clinical manifestations and surgical therapies

Auriculocondylar syndrome (ARCND) is a genetic and rare craniofacial condition caused by abnormal development of the first and second pharyngeal arches during the embryonic stage and is characterized by peculiar auricular malformations (question mark ears), mandibular condyle hypoplasia, micrognathia and other less-frequent features. GNAI3, PLCB4 and EDN1 have been identified as pathogenic genes in this syndrome so far, all of which are implicated in the EDN1-EDNRA signal pathway. Therefore, ARCND is genetically classified as ARCND1, ARCND2 and ARCND3 based on the mutations in GNAI3, PLCB4 and EDN1, respectively. ARCND is inherited in an autosomal dominant or recessive mode with significant intra- and interfamilial phenotypic variation and incomplete penetrance, rendering its diagnosis difficult and therapies individualized. To raise clinicians’ awareness of the rare syndrome, we focused on the currently known pathogenesis, pathogenic genes, clinical manifestations and surgical therapies in this review.