子宫内膜癌相关危险因素及预防

子宫内膜癌是女性生殖道三大常见恶性肿瘤之一,其病因与发病机制尚未完全阐明。流行病学调查发现该病与肥胖、代谢综合征、高血压、糖尿病、激素使用、遗传等因素有关,控制这些危险因素可能会降低子宫内膜癌的发病风险。     

子宫内膜癌诊治策略的几点思考

子宫内膜癌是女性生殖道常见的恶性肿瘤,其发病率仅次于子宫颈癌。近年来,随着现代生活节奏的加快,饮食不均衡,缺乏锻炼,伴随高血压、高血脂-肥胖和糖尿病的增加,子宫内膜癌发病有增高并呈年轻化的趋势。2002年全球约有子宫内膜癌19.9万例,其发病率6.5/10万,为女性全部恶性肿瘤的第七位,死亡率为1.6/10万[1]。2008年全球发病患者上升为28.7万,无论是发病率还是死亡率,发达国家远高于发展中国家[2]。     

子宫内膜癌化疗进展

子宫内膜癌是女性最常见恶性肿瘤之一,占女性生殖道恶性肿瘤的20%~30%。在欧美等发达国家,子宫内膜癌发病率已成为女性生殖道恶性肿瘤的首位。据统计,2010年美国有43 470例新发子宫内膜癌患者,     

子宫内膜癌筛查和早期诊断专家共识(草案)

<正>子宫内膜癌是女性生殖道三大恶性肿瘤之一,在发达国家及我国部分经济发达地区,其发病率居妇科恶性肿瘤首位~([1-11])。子宫内膜癌发生的高危因素(肥胖、糖尿病、高血压等)人群数逐年上升,故近年来子宫内膜癌的发病率及死亡率逐年上升并呈现年轻化趋势。目前,我国尚缺乏子宫内膜癌筛查及早期诊断的相关策略。在不久的将来,子宫内膜癌在我国的北京、上海、广州等经济发达地区,将会变成严重的公共卫生问题。     

子宫内膜采集技术在子宫内膜癌早期诊断中的应用进展

子宫内膜癌是女性生殖道最常见的三大恶性肿瘤之一,癌组织大部分来源于子宫内膜腺体。其主要高危因素有年龄、不孕、高血压、糖尿病、肥胖及长期雌激素作用等。近年来,子宫内膜癌的发病率呈明显上升趋势,但其生存率却截然相反。因此,能够做到子宫内膜癌的早期诊断是必然的趋势。本文综述了几种子宫内膜采集技术在子宫内膜癌早期诊断的优劣及应用展望。     

子宫内膜细胞学检查在筛查子宫内膜癌中的应用

子宫内膜癌是女性生殖道三大恶性肿瘤之一,占女性恶性肿瘤总数的6%[1],在欧美地区其发病率已占妇科恶性肿瘤的第一位[2].近年来,由于我国经济的迅速发展、生活方式及饮食结构的改变、性激素的广泛应用等因素,子宫内膜癌的发病率明显上升.     

妊娠与子宫内膜癌

<正>子宫内膜癌是女性生殖道最常见的恶性肿瘤之一,其2008年全球新发病例数约287100例,位居女性生殖道恶性肿瘤第2位。在美国等发达国家,子宫内膜癌的患者例数已大大超过其他类型的生殖道恶性肿瘤,高居第1位。而在我国北京、上海等经济发达城市及地区,由于宫颈癌筛查的普及和人们生活方式的转变,子宫内膜癌也于近些年超过宫颈癌跃居成为     

绝经激素治疗在子宫内膜癌术后的应用

<正>子宫内膜癌又称为子宫体癌,为女性生殖道常见的恶性肿瘤之一,发病率在发达国家中居女性生殖道恶性肿瘤首位,在我国位于宫颈癌之后居第2位。按照子宫内膜癌的发病年龄、发病因素、病理类型、恶性程度及预后将其分为Ⅰ型和Ⅱ型子宫内膜癌。Ⅰ型子宫内膜癌所占比例较高,常见于相对较年轻的患者,其发病与无孕激素拮抗的雌激素长期作用有关;     

环状RNA在子宫内膜癌中的研究进展

环状RNA(circRNAs)是内源性非编码RNA(ncRNA)的一种,其主要结构特征是缺少5'帽状结构和3'腺苷酸尾,形成共价闭合环。与传统的线形RNA相比,具有稳定性高、不易降解、可作为miRNA海绵的特点,在疾病的发生与发展中发挥重要作用。子宫内膜癌是女性生殖道最常见的恶性肿瘤之一。近年来,子宫内膜癌的发病率呈逐渐上升的趋势。目前子宫内膜癌的病因和发病机制尚未明确,其发病高危因素包括雌激素长期刺激、肥胖、高血压、糖尿病和遗传因素等。本文就环状RNA的研究新进展以及其在子宫内膜癌的发生和发展中的作用做一综述,旨在为子宫内膜癌的发病机制、诊治及早期预防提供新的研究思路。     

子宫内膜癌动脉化疗进展

子宫内膜癌(carcinoma of endometrium)为女性生殖道常见三大恶性肿瘤之一,占女性生殖道恶性肿瘤的20%~30%,占女性癌症总数的7%。近年来发病率呈上升趋势并且年轻化明显。传统上认为子宫内膜癌是一个行为较为温和的肿瘤,实际上其与所有妇科恶性肿瘤一样,早期无高危因素的病例具有较好的临床疗效,而对中晚期或具有高危因素的病例同样预后不良,如晚期子宫内膜癌患者的3年及5年生存率约为56%及35.4%。多年来,对子宫内膜癌的治疗首选手术和放疗,多数作者认为子宫内膜癌对化疗尤其是对全身化疗不敏感,从而忽视了对子宫内膜癌化疗的系统研究。但事…     

Birth asphyxia: a crucial issue in the prevention of developmental disabilities.

Birth asphyxia is one of the most common causes of neonatal and infant mortality and morbidity in developing countries. In this paper the prevalence of the problem is described, and some suggestions for its prevention, identification and management are given.     

Genital schistosomiasis--diagnosis and therapy

The authors describe prevalence, diagnosis and treatment of genital schistosomiasis. Schistosomiasis is one of the most common parasitoses in tropical and subtropical developing countries. Genital schistosomiasis is caused by Schistosoma haematobium. By microscopical examination of abradates, operation material and coni schistosoma eggs could be detected in 29.2 per cent of all cases.     

Neurocisticercosis en el embarazo

Neurocysticercosis (NCC) is the most common parasitic disease of the brain and one of the most common neurological problems among the population of Mexico and other developing countries. NCC is highly prevalent in places with poor housing and sanitation, outdoor defecation, and environmental and socioeconomic conditions favoring infection. This disease is classified into various syndromes according to the location and number of parasites. Symptoms are also varied with headache and seizures being the most common. Treatment may be symptomatic, medical or surgical. The association of NCC and pregnancy is rare and has only been reported occasionally.     

Cervical cancer: the sub-Saharan African perspective

Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. While incidence and mortality rates of cervical cancer have fallen significantly in developed countries, 83% of all new cases that occur annually and 85% of all deaths from the disease occur in developing countries. Cervical cancer is the most common cancer among women in sub-Saharan Africa. The incidence is on the increase in some countries. Knowledge and awareness of this disease on the continent are very poor and mortality still very high. Facilities for the prevention and treatment of cervical cancer are still very inadequate in many countries in the region. Governments in sub-Saharan Africa must recognise cervical cancer as a major public health concern and allocate appropriate resources for its prevention and treatment, and for research. Indeed, cervical cancer in this region must be accorded the same priority as HIV, malaria, tuberculosis and childhood immunisations.     

Autotransfusion for ruptured ectopic pregnancy.

OBJECTIVES: Clinical outcomes following the exclusive use of autotransfusion in the management of ruptured ectopic pregnancy are reviewed. METHODS: A MEDLINE search (1966-2002) for relevant articles documenting the exclusive use of autotransfusion, and data collection and analysis was made. RESULTS: There were 21 studies, 16 from developing and five from developed countries, involving 632 cases of ruptured ectopic pregnancies. Hypovolemic shock with significant hemoperitoneum (>500 ml) was the most common complication. The procedure was performed completely manually in developing countries and with the help of a device in developed countries. The mean volume of autotransfused blood was over 1000 ml, with mean hemoglobin levels ranging from 6 to 12.5 g/dl. Mean posttransfusion hemoglobin levels were higher than pretransfusion levels. There was one death, thought to be due to pulmonary embolism, and nine major and minor complications. CONCLUSIONS: Autotransfusion is useful in the management of ruptured ectopic pregnancy.     

Caesarean section in developing countries

In developing countries, obstetric practice, including the performance of caesarean section, is complicated by problems that are no longer seen in developed countries. The various indications for caesarean section might be the same but the operation is often technically more difficult to perform in developing areas. Developing countries lack resources. This chapter highlights the problems encountered in the developing world. Because cephalopelvic disproportion is one of the main indications for performing caesarean section in our sub-region, the technique of delivery of the impacted fetal head is discussed and alternatives to caesarean section are also suggested.The current view on myomectomy at caesarean section is described; including the technique of bloodless myomectomy at caesarean section. It is hoped that, with the training of postgraduate doctors in anaesthesia and obstetrics, the delivery of obstetric care will be accessible to rural areas in the developing world.     

Recent advances in optical imaging for cervical cancer detection

Cervical cancer is one of the most common and lethal gynecological malignancies in both developing and developed countries, and therefore, there is a considerable interest in early diagnosis and treatment of precancerous lesions. Although the current standard care mainly based on cytology and colposcopy has reduced rates of cervical cancer morbidity and mortality, many lesions are still missed or overcalled and referred for unnecessary biopsies. Optical imaging technologies, spectroscopy approaches and high-resolution imaging methods are anticipated to improve the conventional cervical cancer screening providing in vivo diagnosis with high sensitivity and specificity. Their concept is that morphologic and biochemical properties of the cervical tissue are altered in response to its malignant transformation. In addition, contrast agents that target against specific neoplastic biomarkers can enhance the effectiveness of this new technology. Due to the unprecedented growth of these optical techniques accompanied probably by favorable cost-effectiveness, the primary detection of premalignant lesions may become more accessible in both the developing and the developed countries and can offer see-to-treat workflows and early therapeutic interventions.     

An open label evaluation of topotecan in patients with relapsed or refractory epithelial ovarian cancer – single institution experience in a developing country

Abstract. Malik IA. An open label evaluation of topotecan in patients with relapsed or refractory epithelial ovarian cancer–single institution experience in a developing country.
Investigators in developing countries rarely get an opportunity to participate in clinical drug trials in oncology. We recently participated in two clinical trials involving the use of topotecan in patients with advanced epithelial ovarian cancer who had failed initial platinum based chemotherapy. It provided us an opportunity to gain experience with the use of a rather highly myelosuppressive drug and also enabled us to compare our data with those reported from the western countries. Thirty-nine patients with good performance status and adequate bone marrow, liver, and renal functions were accrued. All patients had previously received at least one platin containing regimen of chemotherapy. The most common histologic sub type was serous adenocarcinoma. Almost half of the patients had platinum refractory disease. Mean number of cycles delivered was 7.5. Eleven patients (28%) achieved complete or partial remission. Time to progression was 4.6 months. Mean overall survival was 11.3 months. Toxicity was primarily hematologic and manageable. Performance status was the only variable predictive of response. Ability to obtain informed consent, data management, and availability of adequate radiologic and laboratory facilities were important limitations. Our results confirm the applicability of results obtained in the western countries to other patient groups and ability to conduct clinical trials in oncology in the developing countries.     

Rotavirus infection and the current status of rotavirus vaccines

Among children, rotaviruses are the most common cause of severe gastroenteritis worldwide and of diarrheal deaths in developing countries. Current vaccines (e.g., Rotarix, GlaxoSmithKline Biologicals; RotaTeq, Merck and Company) effectively reduce rotaviral gastroenteritis, emergency department visits, and hospitalizations. The tremendous burden of rotavirus-related diarrhea in children across the world continues to drive the remarkable pace of vaccine development. This review assesses the global epidemiological and economic burden of rotavirus diseases, summarizes the relevant principles of the development of rotavirus vaccines, and presents data on the efficacy and effectiveness of currently licensed vaccines in both developed and developing countries.     

Mortality risk associated with female sterilization

The mortality risk associated with female sterilization in an analysis of 255 812 procedures performed in developing countries from 1973 to 1979 is reviewed. Fifteen sterilization-related deaths were reported during this period. The overall mortality was 5.86/100 000 procedures. The most common cause of death was the result of anesthetic complications, with infection in second place. The risk of death by procedure was higher with culdoscopy than with minilaparotomy or laparoscopy. The authors believe that low mortality figures are realistic and can be achieved in developing countries when experienced surgical teams are provided with adequate facilities, observe strict medical standards, utilize minilaparotomy and laparoscopy and avoid general and spinal anesthesia.