老年妇女阴式手术试验护理及应用己烯雌酚效果观察

子宫脱垂和阴道前后壁膨出是老年妇女的常见病,于绝经后症状逐渐加重,这与年龄增加及雌激素水平降低所致的退行性变有关[1]。此时,经阴道子宫全切和阴道前后壁修补术疗效最佳,因阴式手术对患者的刺激及创伤小,对肠管无干扰,对心脏及呼吸功能影响小,手术安全性较高,且术后恢复快。但术前术后护理的成败也是患者康复的关键。2000年以来,我们对实施该手术的老年妇女患者结合其生理特点,加强了护理管理,取得了良好效果。1资料与方法1.1资料来源与分组我院妇产科自1996～2004年对老年妇女实施阴式手术108例。其中子宫脱垂并阴道前后壁膨出39例(36…     

绝经后妇女子宫内膜厚度、子宫大小相关因素分析

目的　探讨绝经后妇女子宫内膜厚度和子宫大小的可能相关因素。方法　 32 7例绝经后妇女记录年龄、绝经年限、身高、体重、血压、妊娠情况 ,计算体重指数 (BMI) ,有无糖尿病、高血压及是否应用激素替代治疗 (HRT)等情况 ,并进行相应分组。由专门妇科B超医生进行阴道超声检查 ,测量子宫内膜厚度和长、宽、厚度。结果　目前应用HRT的子宫内膜厚度明显高于未应用HRT者 (P <0 0 1) ,且子宫大小也明显大于未应用HRT者 ;绝经年限超过 5年者子宫小于绝经年限短于5年者 (P <0 0 5 ) ;年龄在 5 5岁以上子宫的宽、厚度参数也较小。结论　应用HRT与子宫内膜厚度、子宫大小各参数关系密切 ,应引起重视。     

腹腔镜圆韧带阴道残端悬吊联合阴式子宫切除治疗绝经后子宫脱垂的疗效分析

目的 探讨腹腔镜圆韧带阴道残端悬吊联合阴式子宫切除治疗绝经后子宫脱垂的临床效果.方法 74例绝经后子宫脱垂患者,随机分为实验组和对照组,每组37例.对照组行传统的阴式子宫切除并(或不并)阴道前后壁修补治疗,实验组在对照组基础上行腹腔镜圆韧带阴道残端悬吊治疗.比较两组患者术后近期观察指标,术后1个月有效率,术后1个月及1...     

非脱垂子宫的阴式子宫切除术156例临床分析

目的比较非脱垂子宫阴式子宫切除术与腹腔镜子宫切除、腹式子宫切除术的手术效果,并探讨宫颈肌瘤、阔韧带肌瘤经阴道手术的技巧。方法分析156例非脱垂子宫改良阴式子宫切除术和同期指征相近的58例腹腔镜子宫切除、60例腹式子宫切除的手术时间、术中出血量、术后体温、肛门排气时间、下床活动时间、住院天数及术后3个月随访情况,并进行比较。结果改良阴式子宫切除术的肛门排气时间、下床活动时间均少于开腹组(P<0．01),以上各指标及住院时间、术后3个月随访阴道残端愈合等与腹腔镜组比较无显著性差异(P> 0．05)。结论改良阴式子宫切除术术后患者的恢复明显优于腹式子宫切除,且不需要昂贵的设备;对于<5 cm的宫颈肌瘤、阔韧带肌瘤、良性卵巢囊肿也可经阴道一并手术。     

不同剂量利维爱对绝经后妇女乳腺及血脂影响的研究

目的观察不同剂量利维爱对绝经后妇女乳腺及血脂的影响。方法63例绝经后妇女,分为两组:A组利维爱1.25mg/d,B组利维爱0.625mg/d,连续用药1年。用药前、后进行Kupperman评分、超声检查乳腺及检测血脂水平。结果A组症状改善程度明显优于B组,但服药1年后比较,差异无显著性(P>0.05)。A组用药后乳腺腺体层厚度较用药前组增加,差异有显著性(P>0.05),乳腺导管差异无显著性(P>0.05);B组用药前、后比较,差异均无显著性(P>0.05)。A组TC、TG、LDL-C治疗前、后差异有显著性(P>0.05),HDL无明显变化;B组治疗前后差异无显著性(P>0.05)。结论两种小剂量利维爱均可以缓解绝经后症状,达到HRT的治疗作用。利维爱0.625mg/d对乳腺刺激小,利维爱1.25mg/d可明显降低血脂水平,从而可降低绝经期妇女发生心血管疾病的危险。     

老年妇女阴式手术的术前术后管理

老年妇女因子宫脱垂或阴道壁脱垂，常需行阴式手术。其卵巢功能衰退，愈合力差将直接影响手术预后。为此．对我院3年中12例老年妇女阴式手术的术前术后管理经验总结如下。     

阴式子宫切除术治疗子宫及阴道脱垂52例临床分析

目的探讨阴式子宫切除术治疗中老年妇女子宫、阴道脱垂的疗效。方法总结52例子宫及阴道脱垂患者的临床资料,均在腰麻硬膜外阻滞麻醉下行阴式子宫切除术＋阴道前后壁修补术（或同时行膀胱紧缩术）。结果术中经过顺利,无并发症发生,术后切口甲级愈合,临床症状得到明显改善,患者生活质量得到提高。结论阴式手术是治疗中老年女性盆腔器官脱垂的有效方法 ,具有很好的应用前景。     

绝经后长期低剂量激素替代治疗的临床观察

目的　观察绝经后长期低剂量激素替代治疗 (HRT)的有效性与安全性。方法　HRT48例 ,自然绝经组 2 2例 ,手术绝经组 2 6例。年龄 39～ 6 1岁 ,用药 2～ 6年。自然绝经组用倍美力 (CEE) 0 3mg/d× 2 2天 ,后 7天加安宫黄体酮 (MPA) 4mg/d。无子宫者不加MPA。服药前后抽血测E2 、FSH、血脂、骨密度检查 ,治疗前后自我对照 ,骨密度设正常对照组。结果　绝经症状均在用药3周内缓解。无子宫内膜增生过长、乳房病变发生 ;HRT后E2 明显上升 (P <0 0 1) ;FSH明显下降(P <0 0 0 1)。总胆固醇 (TC)、载脂蛋白B(APOB)HRT前后无明显变化 (P >0 0 5 ) ;甘油三酯 (TG)、高密度胆固醇 (HDL C)、载脂蛋白A1(APOA1) ,HRT后均上升 (P分别 <0 0 5 ,<0 0 1)。骨密度(BMD)L2～ 4 及股骨颈HRT后与对照组比 (P <0 0 0 1)。结论　长期服用低剂量HRT对绝经后妇女能改善临床症状 ,保护心血管及保持骨健康。     

改良阴式全子宫切除术在子宫脱垂中的临床应用

目的探讨改良阴式全子宫切除术在子宫脱垂治疗中的应用价值。方法对2005年4月至2009年8月收治的子宫脱垂伴阴道前、后壁膨出的68例患者行改良阴式全子宫切除加阴道前后壁修补术。结果68例顺利完成手术,在手术时间,出血量,肛门排气时间,膀胱、直肠的损伤,术后复发,术后阴道残端愈合及排尿改善等情况,与传统的阴式全子宫切除术比较,更有临床意义。结论术者在具备阴式手术操作,明了手术适应证的前提下,改良阴式全子宫切除术,具有微创、安全、简单、复发率低、费用低等优点,值得在临床推广应用。     

阴式全子宫切除术加阴道前后壁修补术治疗子宫脱垂的效果观察

目的观察阴式全子宫切除术联合阴道前后壁修补术治疗子宫脱垂的效果。方法将2013年3月至2018年10月45例在我院接受治疗的子宫脱垂患者纳入研究对象,遵循随机原则将患者分为观察组(23例)与对照组(22例),分别给予阴式全子宫切除术加阴道前后壁修补术治疗与单纯阴道前后壁修补术治疗,对两组患者手术相关指标以及预后情况进行综合评价。结果观察组患者手术时间、下床活动时间及住院时间均短于对照组,术中出血量较对照组少(P<0.05),有统计学意义;观察组患者术后并发症率与对照组差异不具统计学意义(P>0.05),但术后6个月复发率低于对照组(4.35%VS 27.33%),差异有统计学意义(P<0.05)。结论阴式全子宫切除术加阴道前后壁修补术治疗子宫脱垂能够促进患者术后恢复,降低复发率,值得推广应用。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.