棉酚所致低血钾及其与棉酚剂量关系的可能机理

1974年以来,我室试用棉酚男子避孕药255例,发生低血钾性瘫痪24例,这些病例均发生在15mg和20mg的给药组,而当剂量减至12.5mg和10mg时,低血钾不再发生。低血钾性瘫痪病例,用补钾能迅速治愈。通过实验和临床研究表明,部分服醋酸棉酚20mg/天作为起效剂量的对象,服药2个月后开始出现尿NAG和/或β_2M增高以及同时发生肾性失钾。这表明棉酚可能引起近端肾小管损害。作者认为降低棉酚起效剂量或许是一个防止发生低血钾症的途径,而棉酚所致低血钾症是由于肾小管损害所致。     

Return of Menses in Previously Overweight Patients with Eating Disorders

Study ObjectiveAdolescents with eating disorders and a history of overweight present with higher weights, longer duration of disease, but equally severe symptomatology compared with previously normal weight patients. To better delineate treatment goals for this understudied population, we compared weight at menses resumption with premorbid maximum weight among previously overweight and normal weight patients.DesignRetrospective cohort study.SettingOutpatient adolescent medicine clinic at an eating disorder referral center.ParticipantsPostmenarchal patients meeting criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition eating disorders. History of overweight was defined as a body mass index (BMI) greater than or equal to the 85th percentile or 25 or more.Interventions and Main Outcome MeasuresWeight characteristics at presentation and menses resumption (BMI, BMI z-score, change from maximum weight to presentation weight)ResultsPreviously overweight patients presented with greater mean weight, longer duration of disease, and higher BMI than previously normal weight patients. No difference was found in rates of amenorrhea at presentation or menses resumption. Previously overweight patients resumed menses at a younger age and higher BMI z-scores. The difference between weight at menses resumption and premorbid maximum weight was greater for previously overweight patients.ConclusionPreviously overweight patients with eating disorders present differently than their normal-weight peers, so reliance on weight status as a screening criterion might result in underdiagnosis. Although BMI z-scores associated with menses resumption are higher for previously overweight patients, there is no difference in weight gain between presentation and menses resumption and time to menses resumption compared with previously normal-weight patients. Moreover, menses resumption occurred at weights significantly lower than premorbid maximum weight for previously overweight patients, so restoration to highest premorbid weight is not necessary.     

Prevalence of Hemostatic Disorders in Adolescents with Abnormal Uterine Bleeding

Study ObjectiveTo evaluate the incidence of hemostatic disorders in a population of adolescents with various patterns of abnormal uterine bleeding (AUB).DesignRetrospective observational study.SettingUniversity hospital.ParticipantsOne hundred thirteen adolescents with AUB; mean age at menarche and mean age at the onset of symptoms 12 ± 1.2 years and 13.5 ± 2.8 years, respectively.Main Outcome MeasuresData on menstrual history, bleeding symptoms, co-existing medical conditions, and medical therapies were assessed. All patients were screened for hemostatic disorders with laboratory testing. The incidence of the disorders was calculated. Subjects were further divided in 2 groups based on whether the AUB started in the first 2 years from menarche (group 1) or later (group 2). A statistical analysis was performed using a chi-square test to compare incidence of hemostatic disorders between the groups.ResultsOne hundred thirteen adolescents with AUB were identified. Overall, 54 (47.8%) patients had some underlying hemostatic disorder, of which a platelet dysfunction was the most common (17.7%). Von Willebrand disease was detected in 13.3% of cases and a deficiency of a coagulation factor in 12.4%. In 7.1% of patients an isolated increase of bleeding time was observed. When divided in 2 groups, 44.2% of patients in group 1 and 59.2% in group 2 had a coagulation disorders, with no statistically significant difference between the 2 groups (P = .17).ConclusionAUB in adolescents is frequently associated with an underlying disorder of hemostasis, most commonly a platelet function disorder. The results highlight the importance of screening for coagulation disorders in adolescents with AUB, independently from the gynecologic age at onset.     

Disorders of hemostasis and excessive menstrual bleeding: prevalence and clinical impact

The prevalence and impact of most underlying disorders of hemostasis are reviewed in women with excessive menstrual bleeding. The most common underlying bleeding disorder is von Willebrand disease, which occurs in only 1% to 2% of the general population but in approximately 13% of women with excessive menstrual bleeding.     

Questionnaire Study on Menstrual Disorders in Adolescent Girls in Singapore

Study ObjectiveAdolescence, the transitional phase of physical and mental development between childhood and adulthood, is characterized by immense hormonal changes. Owing to the immaturity of the hypo-thalamo-pituitary-ovarian axis, menstrual cycles tend to be rather irregular. This variability poses a dilemma for physicians treating these girls and may result in a delay in the diagnosis and treatment of underlying problems. The purpose of this study was to collect data on the characteristics of menstrual cycles in Singapore adolescents to determine the prevalence of menstrual abnormalities and the pattern of use of medical treatments for these abnormalities.DesignCross-sectional study using a self-administered, 27-point structured questionnaire.SettingSixty-two secondary schools and junior colleges in Singapore from January to December 2004.ParticipantsData from 5561 girls, 12 to 19 years old, were included in the analysis.ResultsOf the 5561 participants, 23.1% reported having irregular cycles. Oligomenorrhea was the most frequently reported problem (15.3%), and polymenorrhea was much less prevalent (2.0%). With increasing body mass index (BMI), there was a significant increase in the prevalence of oligomenorrhea, whereas polymenorrhea was more prevalent in the girls with a low BMI. Dysmenorrhea was a significant problem, with 83.2% respondents reporting it in various degrees and 24% girls reporting school absenteeism owing to it. Dysmenorrhea was severe enough to require analgesics for pain relief in 45.1% of all subjects. In spite of menstrual problems being common, only 5.9% girls reported seeking medical advice for them. Traditional Chinese medications were used most commonly for menstrual cycle problems, and over-the-counter medications for dysmenorrhea. The use of oral contraceptives for menstrual problems was minimal.ConclusionMenstrual problems among adolescent females are common and a significant source of morbidity in this population. However, adolescent girls are reluctant to seek medical treatment, leading to delay in diagnosis and treatment. Appropriate health education measures need to be put into place to prevent this trend.     

卵子发育障碍原发性不孕姐妹2例

目的:报道2例IVF治疗中卵子发育障碍原发性不孕姐妹患者。方法:对本院收治的2例卵子发育障碍原发性不孕患者姐妹进行回顾性总结与分析。结果:均采用常规GnRHa长方案促排卵,取卵日卵泡穿刺镜检仅见卵丘颗粒细胞团,均未见到卵子,补救性hCG治疗亦未取得卵子,诊断为卵子发育异常。追问病史得知其祖父母为表兄妹近亲婚配。患者(妹妹)行受卵治疗,宫内单胎成功妊娠。结论:门诊IVF治疗建病历时应详细询问患者家族史,供卵方案是目前IVF治疗卵子发育障碍原发性不孕较常用且有效的方法。