Uterine fibroids and their treatment

Uterine fibroids are the most common benign disease of women. They occur in women under 30 years of 20-30% for women over 30 years in 50%. The most frequent indication for hysterectomy, uterine fibroids are just. Symptoms of uterine fibroids are various forms of pelvic pain and trouble from the oppression of the surrounding organs, irregular uterine bleeding and fertility disorders resulting from the inability to conceive or recurrent pregnancy loss. Problems of surgical treatment of fibroids applies not only to symptomatic patients who wish to preserve the uterus, but also women who have uterine fibroids negatively affect their reproduction. Treatment of uterine fibroids include monitoring, administration of medications and surgical techniques that preserve either the uterus or not. In recent years the conservatives have extended performance of minimally invasive surgery, which is a common feature of the endoscopic approach, or uterine fibroid devascularization. Gynecologist surgeon must be familiar with the history of the patient and based on history and examination to consider which procedure is best for the patient.     

MMPs及TIMPs在滋养细胞疾病中表达的分析

目的 :分析基质金属蛋白酶 (MMPs)及其组织抑制物 (TIMPs)在滋养细胞疾病中表达水平与预后的关系。方法 :采用免疫组化S P法检测 17例正常绒毛、39例葡萄胎 (HM)、4 2例侵蚀性葡萄胎 (IM)和 2 0例绒毛膜癌 (CC)组织中MMP 2、MMP 9及其TIMP 1、TIMP 2的表达情况。结果 :葡萄胎恶变组MMP 2、MMP 9表达较正常绒毛和葡萄胎未恶变组高 (P =0 .0 0 0 ,0 .0 0 0 ;P =0 .0 4 0 ,0 .0 11)。未化疗滋养细胞肿瘤 (包括IM和CC)MMP 2表达强于早孕绒毛和葡萄胎组 (P均 =0 .0 0 0 ) ,而≥ 3疗程化疗后MMP 2、9表达明显低于未化疗和≤ 2疗程化疗组 (P =0 .0 0 0 ,0 .0 35 ;P =0 .0 10 ,0 .0 18) ,TIMP 1在未化疗滋养细胞肿瘤组表达低于早孕绒毛和葡萄胎组 (P =0 .0 0 5 ,P =0 .0 0 0 )。MMP 2在Ⅱ、Ⅲ期的表达明显强于Ⅰ期 (P均 =0 .0 0 0 ) ,WHO预后评分中、高危者明显强于低危者 (P =0 .0 0 2 ,P =0 .0 0 5 )。结论 :MMPs及TIMPs表达水平高低与滋养细胞疾病预后有关 ,深入了解两者在滋养细胞疾病中的生物作用 ,有望为耐药患者的治疗提供新的途径     

化疗的副反应及其防治

化学治疗(化疗)在妇科恶性肿瘤治疗中的作用与价值日渐重要,化疗在临床的应用也越来越普遍.但是,化疗作为一种特殊的治疗手段,尤如一把双刃剑,如果不能合理的正确使用,不但未能起到治疗作用,反而带来一些严重的副反应,这在临床工作中时有所见.为此本文就化疗常见副反应的防治进行介绍.     

Bulking agents and their place in the treatment of urinary stress incontinence

Bulking agents are used in the treatment of urinary stress incontinence associated with intrinsic sphincter deficiency. Bovine collagen remains the gold standard despite problems such as allergic reaction and absorption of the injected material. Several new products are being evaluated or used clinically to try and overcome problems linked with bovine collagen. The aim of this paper is to review the bulking agents available and to put in prospect use of these products with the recent progress made in the treatment of urinary stress incontinence. The gold standard treatment for intrinsic sphincter deficiency is suburethral autologous or synthetic suburethral slings. Bulking agents are indicated for multi-operated patients with urinary stress incontinence and intrinsic sphincter deficiency. Bladder neck hypermobility is not a contraindication.     

Prolonged electroencephalogram monitoring for seizures and their treatment

This article reviews the diagnosis of neonatal seizures using routine electroencephalogram (EEG) examinations and long-term EEG monitoring. EEG is considered the gold standard for identifying the presence and quantifying the burden of neonatal seizures. The most common medication used to treat neonatal seizures is phenobarbital, although its efficacy has never been demonstrated by a formal, randomized, placebo-controlled drug trial.     

Possibilities of surgery and their differentiated use in the individual treatment of endometriosis

Numerous medical, surgical, and combined therapies have been proposed in the management of endometriosis. This range of treatment options contrasts remarkably with the evidence regarding their respective proven success rates. An exact preoperative differential diagnosis as well as adherence to operative recommendations that have been established meanwhile are essential for optimal results of surgery.     

Penile implant utilization following treatment for prostate cancer: analysis of the SEER-Medicare database

IntroductionProstate cancer treatments, including radical prostatectomy (RP) and radiotherapy (RT), may adversely affect erectile function. Penile implant surgery is a well-recognized erectile dysfunction (ED) treatment for prostate cancer survivors who wish to remain sexually active and in whom nonsurgical treatments are ineffective or unpalatable.AimTo describe the utilization of penile implants after RP or RT for prostate cancer and to identify predictors of such use.MethodsFrom Surveillance Epidemiology and End Results cancer registry data linked with Medicare claims, we identified men aged ≥66 years diagnosed with prostate cancer in 1998–2005 who were treated with RP or RT. Utilization of penile implants was identified in Medicare claims. Multivariable logistic regression was used to identify demographic and clinical predictors of implant utilization.Main Outcome MeasuresMedicare claim for penile implant surgery, impact of demographic and clinical factors on penile implant surgery utilization.ResultsThe study group comprised 68,558 subjects, including 52,747 who had RT and 15,811 who had RP as primary prostate cancer treatment. The penile implant utilization rate was 0.8% for the entire group, 0.3% for the RT group, and 2.3% for the RP group. Predictors of penile implant utilization were initial treatment modality, younger age, and African American or Hispanic race, being unmarried and residing in the South or West.ConclusionsPenile implant utilization after prostate cancer treatment is relatively uncommon in men over 65. Men who are younger, African American or Hispanic, and those who have an RP are more likely than their peers to receive a penile implant after prostate cancer treatment. Tal R, Jacks LM, Elkin E, and Mulhall JP. Penile implant utilization following treatment for prostate cancer: Analysis of the SEER-Medicare database.