大剂量孕激素治疗子宫内膜不典型增生及早期子宫内膜癌的疗效及妊娠结局分析

目的:探讨大剂量孕激素治疗子宫内膜不典型增生及早期子宫内膜癌的疗效及妊娠结局。方法:选择2014年1月至2018年12月广州医科大学附属第三医院就诊的年轻且有生育要求的子宫内膜不典型增生患者24例及早期子宫内膜样腺癌患者6例,分析应用大剂量孕激素保守治疗的临床效果及妊娠结局。结果:24例子宫内膜不典型增生患者中完全缓解20例(83.33%),部分缓解0例,疾病稳定1例(4.17%),疾病进展1例(4.17%),疾病复发2例(8.33%);20例完全缓解中1例未婚,余19例中成功妊娠10例(52.63%),其中4例足月分娩,3例孕中期双胎流产,2例孕早期流产,1例孕早期随访中;2例疾病复发患者继续药物治疗后均完全缓解,其中1例自然受孕后足月分娩。6例早期高分化子宫内膜样腺癌完全缓解3例(50.00%),部分缓解0例,疾病稳定2例(33.33%),疾病进展0例,疾病复发1例(16.67%);疾病稳定2例最终行子宫内膜癌全面分期手术,余4例保留生育功能患者目前未成功妊娠。结论:密切随访下,大剂量孕激素治疗子宫内膜不典型增生和早期子宫内膜癌是安全有效的。     

盆腹腔内恶性肿瘤脐转移三例临床分析

目的 探讨盆腹腔内恶性肿瘤脐转移（Sister Mary Joseph nodule SMJNH)的发生率,转移途径,治疗和预后,方法 对1987-2001年间收治的3例SMJN患者的临床资料进行回顾性分析及文献复习。结果 3例盆腹腔内恶性肿瘤的原发病分别为原发性腹膜癌1例,卵巢黏液性乳头状腺癌1例和子宫内膜癌1例,3例患者经病理检查证实均为SMJN,其中例3术前针吸涂片为腺癌,治疗原则为尽量手术切除原发灶和转移灶后,辅以化学药物治疗（化疗）和放射治疗（放疗）,患者平均生存期为63个月,除例1死于原发性腹膜癌广泛转移外,例2和例3现已分别存活58和44个月。结论 SMJN虽发生率低,但是恶性肿瘤晚期和预后差的标志,如果患者一般状况良好,应积极手术切除脐部转移性癌灶,术后辅助化疗和（或）放疗。     

子宫内膜切除术后妊娠结局的探讨

目的 探讨经宫颈子宫内膜切除术（TCRE）后妊娠的结局及其处理方法。方法 回顾分析我院TCRE后妊娠26例32例次的妊娠情况及其结局。结果 1例次自然流产,27例次人工流产,其中1例次宫腔粘连,狭窄,用宫腔电切镜切开后吸宫,1例次吸出完整胎囊后出血700ml,一般处理无效,行宫腔球囊压迫止血,另1例次右宫角妊娠,吸宫失败,行经腹子宫切除术,1例次宫颈妊娠,大出血;2例输卵管妊娠,1例足月妊娠,胎盘植入,剖宫产分娩一足月小样儿,同时切除子宫。结论 TCRE后仍有妊娠可能,但其困难流产,胎盘植入,胎儿生长受限,第三产程异常等并发症发生率升高,故应视为高危人群,加强监护。     

Three-dimensional volume-rendered imaging of normal and abnormal fetal fluid-filled structures using inversion mode

A total of six normal and eight abnormal fetuses at 16-38?weeks of gestation were studied using transabdominal three-dimensional sonography with an inversion mode. In normal fetuses, the stomach, gallbladder and bladder could be depicted. In particular, peristalsis of the stomach was noted. In the case of holoprosencephaly, fused hemispheres were evident. In the case of hydrocephalus, the enlargement of ventricular cavities was noted. In the case of bilateral pleural effusion, the spatial relationship and size of the effusions were depicted. In the case of meconium peritonitis, the spatial relationship between the dilated intestines and ascites was depicted. In two cases of hydronephrosis, the dilated renal pelvis and calyces were clearly shown. In the case of multicystic dysplastic kidney, the number and size of cysts were clearly identified. In the case of left ovarian cyst, the anatomical relationships among the ovarian cyst, kidney, stomach and bladder could be easily understood.     

Giant lymph node hyperplasia: Report of two interesting cases

Giant lymph node hyperplasia is usually found in the thorax and it is rarely encountered in the field of obstetrics and gynecology. We are presenting two cases of this interesting lesion. One case was in the right pelvic sidewall and caused the arrest of labor. This is believed to be the first case of this lesion associated with pregnancy and the third case in the female pelvis. The other case was in the sigmoid mesentery and it was thought to be an ovarian tumor preoperatively. Systemic manifestations, such as intermittent fever, fatigability, anemia, elevated sedimentation rate, hypoalbuminemia, and hypergammaglobulinemia, disappeared after resection of the lesion.     

Brenner tumor as encountered in a southern Nigerian Hospital

Brenner tumor is an uncommon ovarian tumor whose etiology and hormonal activity have aroused controversies. The salient features of three cases of this tumor seen at the University of Port Harcourt Teaching Hospital, Nigeria, between March 1981 and March 1987 are discussed. In one case, the tumor was bilateral and was associated with secondary polycythemia. Another case was associated with a full term pregnancy and here the tumor contained luteinized stromal cells. Although such cells are usually associated with estrogenic activity, the full term pregnancy in this case will suggest at best a low level of hormonal activity. The last case was an incidental microscopic lesion in a postmenopausal woman.     

True and pseudo-Meigs' syndrome]

In this paper two cases were reported. The first case concerns the truth Meigs syndrome at 70-year old woman, who was admitted into gynaecological clinic because of quickly increasing abdominal circumference, metrorrhagia and liquid in pleural cavity. In this woman benign ovarian neoplasm-thecoma was detected. The second case concerns pseudo Meigs syndrome at 57-year old woman, who was operated because of ovarian cancer. In this patient recurrent ascites was observed. In this case radical surgery and chemotherapy was performed.     

Unilateral congenital short femur: a case report

A case of congenital short femur in an otherwise healthy infant is described. Antenatal sonographic diagnosis was made at 26 weeks of gestation. The left femur was shorter than the right (ratio 0.82-0.85). In this case, the occurrence of congenital short femur was sporadic. The diagnosis was confirmed after delivery. This case illustrates the importance of ultrasound as an early detector of certain congenital anomalies and as a useful tool in their follow-up.     

Apparent primary follicle-stimulating hormone deficiency is a rare cause of treatable male infertility

OBJECTIVE: To find the underlying defect in a case of primary FSH deficiency and to estimate the beneficial effect of FSH treatment. DESIGN: Case report. SETTING: University hospital fertility clinic. PATIENT(S): Normal, healthy, 37-year-old male patient with severe oligoteratozoospermia. INTERVENTION(S): Levels of FSH, LH, LHRH provocation test, karyotyping, genomic analysis on the Y-chromosomal AZF region and sequencing of the FSHB gene, FSH treatment. MAIN OUTCOME MEASURE(S): We compiled detailed clinical and molecular data on four pregnancies. We compare this case with a similar case published recently. RESULT(S): There were detectable but very low FSH levels after LHRH provocation; the LH response was not entirely normal, and no genomic abnormalities were found in the FSHB gene. The FSH treatment resulted in four pregnancies, two of which ended in abortion; the other two resulted in the birth of two healthy children. Both our case and the published case had detectable but abnormally low FSH levels on some occasions, but normal or highly normal inhibin B levels that differed from the expected low levels. Both patients had a normal male phenotype and no detectable mutation in the FSHB gene. The published case differed from our patient in that the published case was azoospermic whereas ours was extremely oligoteratozoospermic. The beneficial effect of FSH treatment was only shown in our patient. CONCLUSION(S): The published case and ours may have a common, as yet unidentified, underlying defect. The dramatic and immediate effect of FSH treatment on our patient's fertility was clearly demonstrated.     

The Conservative Management of a Hydatidiform Mole with Coexistent Living Fetus. A Case Report

EDITORIAL COMMENT: This is the second case we have published of successful prospective management of hydatidiform mole with coexistent living fetus, although in both cases delivery by Caesarean section was required at 29–30 weeks' gestation. A similar successful case recently managed at the Mercy Maternity Hospital following ultrasonographic diagnosis at 16 weeks' gestation (because of hyperemesis gravidarum), also required emergency Caesarean section, at 34 weeks' gestation, because of antepartum haemorrhage due to 'molar placenta praevia'; the infant was a healthy living female, birth-weight 1,760 g (case details courtesy of Dr Ian Maclsaac). Khoo et al (10) recommended that such pregnancies be selected for conservative management by performing amniocentesis and determination of chromosomal karotype and amniotic fluid alpha fetoprotein level, a regimen that was put into practice in the case reported by Thomas et al (11) and in Maclsaac's case summarized above.     

亚甲基四氢叶酸还原酶基因677位多态性、高同型半胱氨酸血症与复发性流产

目的:探讨亚甲基四氢叶酸还原酶基因(MTHFR)多态性(C677T)与高同型半胱氨酸(Hcy)血症以及复发性流产之间的关系。方法:采用前瞻性病例对照研究方法,收集71例复发性自然流产患者为病例组,另征集同期58例有正常妊娠史者为对照组,利用PCR-RFLP方法研究MTHFR基因多态性(C677T);同时应用酶法测定血清同型半胱氨酸水平;并随访病例组的妊娠结局。结果:①MTHFR基因677位点的3种基因型在病例组和对照组分布分别为CC:14.1%vs 43.1%、CT:49.3%vs 25.9%、TT:36.6%vs 31.0%,组间比较有极显著统计学差异(χ2=14.7,df=2,P=0.001);其中CC基因型在病例组显著降低(P=0.000,OR=0.216,95%CI:0.093-0.505);T等位基因分布在病例组显著升高(61.3%vs 38.7%,P=0.006)。②129例研究对象中TT基因型血同型半胱氨酸水平显著升高(P=0.000):TT为19.0±9.5 nmol/L、CC为13.1±6.2 nmol/L、CT为11.7±4.0 nmol/L,病例组和对照组高Hcy水平组间无统计学差异(P>0.05)。③病例组中有38.0%(27/71)为高Hcy血症,叶酸治疗有效。结论:MTHFR基因多态性(C677T)与复发性流产有关;MTHFR基因TT型与高Hcy血症有关;叶酸可用于治疗高Hcy血症且有助于改善下次妊娠结局。     

Genetic identification of pregnancies responsible for choriocarcinomas after multiple pregnancies by restriction fragment length polymorphism analysis.

The pregnancies responsible for two cases of choriocarcinomas were determined by the restriction fragment length polymorphism of human leukocyte antigen-DQ genes in the tumors and leukocytes from the patients, their husbands, and their children. The first case was preceded by three normal pregnancies, and the second case was preceded by two normal pregnancies and a complete hydatidiform mole. Comparison of the restriction fragment length polymorphism patterns revealed that the first case of choriocarcinoma carried the parental genome and originated from the third normal pregnancy, whereas the second case was of androgenetic origin from the complete mole. By choosing an appropriate probe (or probes), restriction fragment length polymorphism analysis is shown to be a useful method for identification of the pregnancy responsible for choriocarcinoma.     

Can three-dimensional ultrasound be used for the assessment of the fetal lung volume in cases of congenital diaphragmatic hernia?

We report on 2 fetuses with congenital diaphragmatic hernia (CDH) in whom the fetal lung volumes were estimated by three-dimensional ultrasound and the results compared with the postmortem lung volume measurements. Both examiners (sonographer and pathologist) were blinded to each other's results. The 1st case was a right CDH diagnosed at 20 weeks of gestation. The 2nd case was a left CDH diagnosed at 22 weeks of gestation. Both pregnancies were terminated upon request of the parents. Three-dimensional ultrasound estimation of the fetal lung volume was performed 1 day before termination of pregnancy using the technique of rotation of the three perpendicular planes. The left and right lung volumes estimated by three-dimensional ultrasound were 3.88 and 1.87 cm(3), respectively, in the 1st case and 0 and 5.52 cm(3), respectively, in the 2nd case. On postmortem examination, the left and right lung volumes were 3.0 and 2.2 cm(3), respectively, in case 1 and 1.1 and 5.6 cm(3), respectively, in case 2. This suggests that a three-dimensional estimation of pulmonary volumes may be correlated with postmortem findings in cases with CDH.     

Persistence of a normal pregnancy after an early luteectomy. A report of two cases.

Two cases occurred of early luteectomy/left cystectomy. In one case it resulted from a hemorrhagic corpus luteum at four weeks' gestation. In the second case it resulted from a left adnexectomy at five weeks from torsion of the adnexa. Histologic analysis defined the lesions as a hemorrhagic corpus luteum and necrotic ovary, respectively. Despite the lack of a corpus luteum and the absence of hormonal replacement therapy, both pregnancies developed normally, in the first case for 7 weeks, until it was terminated on the patient's request, and in the second case until 38 weeks, when a normal infant was delivered by cesarean section.     

Hysterectomy for hematometra in a 15-year-old mentally handicapped girl with congenital cervicovaginal agenesis and concomitant ovarian adenoma

We report a case of hematometra and bilateral hematosalphinx in a 15-year-old mentally handicapped adolescent girl, complicated by vaginal agenesis over cervical atresia in the presence of an ovarian adenoma. The case was managed by abdominal hysterectomy and bilateral salphingectomy of the hematosalphinx, which had formed a tubo-ovarian mass. One ovary was preserved. This case also considers the management of the mentally handicapped patient unable to comprehend pain arising from cryptomenorrhea.     

Rapidly growing endometrial cyst of the uterus in a young woman

A case of a rapidly growing endometriotic cyst of uterus in young women diagnosed for sterility, and previously treated by GnRH analogues was presented. The case was difficult to diagnose before the operation.     

Intussusception and incarceration of a fallopian tube: report of 2 atypical cases, with differential considerations, clinical evaluation, and current management strategies

Herein are presented 2 cases from the last 5 years. In case 1, a fallopian tube intussusception without perforation, misdiagnosed as a myoma, was observed at hysteroscopy of the uterine cavity 18 months after last vacuum aspiration. In case 2, a fallopian tube incarceration, misdiagnosed as a placental polyp, was observed 3 months after last suction curettage. Although uterine perforation caused by suction curettage after abortion or of afterbirth occurs rarely, it is a complication that must be taken into account because after this procedure there may be painful symptoms such as the typical triad of abdominal pain, vaginal discharge, and dyspareunia. In some situations, as in case 2, amenorrhea occurs alone, without other distressing symptoms. In both cases, a hysteroscopic approach was used; laparoscopy was necessary only in case 2.     

Non-puerperal uterine inversion. Report of a case

Non-puerperal uterine inversion is extremely rare. We report a case associated with leiomyoma. It is presented the case of a multiparous of 46 year-old for presenting severe vaginal bleeding, pelvic pain and strange body vaginal sensation. The diagnosis was uterine myoma in abortive phase. An abdominal hysterectomy was performed to find a complete uterine inversion. This report represents an anecdotal case of non-puerperal uterine inversion successfully treated surgically.     

Fetal bradycardia during pregnancy. Apropos of 2 cases without fetal distress

The authors report two cases of fetal bradycardia discovered at the beginning of the 8th month. The pregnancy history was normal. Sonography was helpful in the etiological diagnosis. It concerns a case of atrial extrasystole and another case of physiological bradycardia. The evolution was satisfactory with normal, spontaneous, vaginal delivery. During the pregnancy, the tracing combined a severe bradycardia around 80, a flat rhythm and an areactive rhythm. There was alternation with normal rhythms. The pregnancy history was reassuring. At the beginning of labor, the cardiac rhythm was normal. In the opposite case, vaginal delivery could only be advocated after determination of the capillary pH.     

Hematoma hepático subcapsular como complicación del síndrome de HELLP: reporte de caso

A case is presented on a patient diagnosed with a hepatic subcapsular haematoma as a complication of the HELLP syndrome. Due to the low volume of published cases, the therapeutic behaviour of this condition has not been clearly defined. In the case presented, the early execution of an imaging study was a key factor in establishing the diagnosis. In the case of a haematoma without haemodynamic compromise, conservative treatment can be successful, as demonstrated in our case.