左炔诺孕酮宫内缓释系统治疗子宫腺肌病临床观察

目的:观察左炔诺孕酮宫内缓释系统(LNG-IUS)应用于子宫腺肌病治疗中的临床价值,探究其临床疗效和安全性,为今后临床提供参考。方法:选取2011年1月至2013年12月期间门诊收入治疗的子宫腺肌病87例患者为研究对象,根据患者意愿将其分为对照组42例、治疗组45例。对照组予以孕三烯酮治疗,治疗组给予LNG-IUS。比较治疗后一般情况。结果:治疗前后,对照组的血清激素水平较治疗组变化更显著;治疗后组间在各激素水平相比差异显著(P<0.05);置放前,两组子宫内膜厚度无统计学意义;3个月后比较差异显著(P<0.05);6、12、24个月后,差异均显著(P均<0.01);与放置前比较,患者痛经评分、月经量、血红蛋白水平在置放3、6、12个月后具有显著差异(P<0.01);子宫体积、血红蛋白以及血清CA-125水平均有明显变化(P<0.01)。结论:左炔诺孕酮宫内缓释系统可有效改善子宫腺肌病症状,有利于控制AM进展,安全、有效,值得进一步研究。     

左炔诺孕酮宫内节育系统对子宫腺肌病患者细胞免疫平衡的影响分析

目的:分析左炔诺孕酮宫内节育系统对子宫腺肌病患者细胞免疫平衡的影响。方法:选取从2015年2月至2016年4月在本院生殖科诊断为子宫腺肌病的患者共75例,并于月经结束第4~7d放置左炔诺孕酮宫内节育系统进行治疗。检测患者治疗前卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)、泌乳素(PRL)水平及体内IL-6、IL-10、TNF-α水平;观察记录患者痛经评分、慢性盆腔痛评分、子宫内膜厚度及月经量。随访记录患者放置左炔诺孕酮宫内节育系统后3、6、12个月时上述指标变化。结果:患者放置左炔诺孕酮宫内节育系统后FSH、LH、E_2水平无明显变化,PRL水平显著下降(P<0.05)。所有患者痛经评分、慢性盆腔痛评分、子宫内膜厚度及月经量明显降低(P<0.05)。经治疗患者体内IL-6、TNF-α含量明显增高,IL-10明显降低(P<0.05)。结论:左炔诺孕酮宫内节育系统对治疗子宫腺肌病具有明显疗效,可帮助维持细胞免疫平衡。     

散结镇痛胶囊联合左炔诺孕酮宫内缓释系统治疗子宫腺肌症患者的疗效及对血清MMP-9、MMP-2、VEGF的影响研究

目的 探讨散结镇痛胶囊联合左炔诺孕酮宫内缓释系统(LNG-IUS)在子宫腺肌症患者治疗中的临床效果。方法 选取2020年1月至2021年6月中国人民解放军北部战区总医院诊治的106例子宫腺肌症患者作为研究对象。随机分为对照组和观察组,各53例。对照组采用LNG-IUS治疗,观察组采用散结镇痛胶囊联合LNG-IUS治疗。比较两组疗效、视觉模拟评分法评分、月经量积分、血清金属基质蛋白酶(MMP)-9、MMP-2、血管内皮生长因子(VEGF)水平及不良反应发生率。结果 观察组治疗总有效率(94.34%)高于对照组(77.36%),差异具有统计学意义(P<0.05);两组治疗后视觉模拟评分法评分、月经量积分、血清MMP-9、MMP-2、VEGF水平均较治疗前降低,且观察组降低幅度更大,差异具有统计学意义(P<0.05);两组总不良反应发生率比较,差异无统计学意义(χ²=0.392,P=0.511)。结论 子宫腺肌症患者采用散结镇痛胶囊联合LNG-IUS治疗,可有效调节其的血清MMP-9、MMP-2、VEGF水平,疗效明显,适合在临床推广应用。     

左炔诺孕酮宫内缓释系统治疗功能失调性子宫出血及子宫内膜增生过长临床疗效研究

目的:探讨左炔诺孕酮宫内缓释系统治疗功血的临床疗效及其对子宫内膜增生过长的影响。方法:对72例年龄在31岁至50岁之间确诊为功血并有子宫内膜增生过长的病例,放置LNG-IUS进行治疗,对比治疗期间月经量、月经周期、血红蛋白水平、子宫内膜厚度等指标,并与放置前进行对比。结果:放置LNG-IUS之后,患者的月经量显著性减少,放置1年左右后降至(9±3)m L,子宫内膜厚度明显变小,由放置LNG-IUS前(0.76±0.15)cm降至(0.39±0.08)cm,放置6个月之后,子宫内膜增生过长得到改善。同时,放置LNG-IUS后患者血红蛋白水平呈上升趋势,6个月后恢复至正常状态,这些数据间的差异具有统计学意义(P0.05),但放置前后月经周期之间的差异并不具有显著性。结论:左炔诺孕酮宫内缓释系统能有效治疗功血,减少月经量,对子宫内膜增生过长也有疗效,值得推广。     

GnRH-a联合LNG-IUS治疗大子宫腺肌病和子宫肌瘤的疗效观察

目的:探讨促性腺激素释放激素激动剂(GnRH-a)联合左炔诺孕酮宫内缓释系统(LNGIUS)治疗大子宫腺肌病和子宫肌瘤的临床疗效。方法:选取本院2012年7月至2013年12月诊治的大子宫腺肌病和子宫肌瘤患者62例,采用随机数字表法分为两组,31例患者采用GnRH-a治疗为对照组,31例患者采用GnRH-a联合LNG-IUS治疗为观察组,比较两组患者的治疗效果。结果:观察组患者VAS评分、PBAC评分在LNG-IUS治疗后3个月、6个月、9个月、12个月均明显低于对照组,血红蛋白在LNG-IUS治疗后3个月、6个月、9个月、12个月均明显高于对照组,子宫体积在LNG-IUS治疗后3个月、6个月、9个月均明显大于对照组(P0.05)。观察组患者不良反应发生率(41.94%)高于对照组(32.26%)(P0.05)。结论:GnRH-a联合LNG-IUS是治疗大子宫腺肌病和子宫肌瘤的有效方法,值得临床推广使用。     

左炔诺孕酮宫内节育系统对子宫内膜息肉宫腔镜术后患者性激素水平及子宫内膜厚度的影响

目的 探讨左炔诺孕酮宫内节育系统(LNG-IUS)在子宫内膜息肉(EP)患者宫腔镜术后治疗中的效果。方法 采用随机数字表法将2020年1月至2021年11月浙江省荣军医院和嘉兴市第一医院治疗的68例EP患者分为A组和B组,各34例。两组均给予宫腔镜手术,术后A组给予地屈孕酮片治疗,B组放置LNG-IUS。比较两组术前及术后6、12个月的子宫内膜厚度,术前、术后12个月的血管内皮生长因子(VEGF)、γ干扰素(IFN-γ)、总胆固醇(CHO)、载脂蛋白A1(LAA1)、性激素水平,治疗期间的不良反应。结果 两组术后12个月的子宫内膜厚度均低于术前、术后6个月,术后6个月低于术前;且术后6、12个月,与A组比较,B组子宫内膜厚度更低(P<0.05)。两组治疗前后及两组间血清性激素水平比较,差异无统计学意义(P>0.05)。与治疗前比较,术后12个月两组血清IFN-γ、VEGF、CHO、LAA1水平均降低,且与A组比较,B组更低(P<0.05)。治疗期间,B组不良反应发生率低于A组(P<0.05)。结论 将LNG-IUS应用于EP患者宫腔镜术后的治疗中可有效改善患者子...     

子宫腺肌病患者应用腹腔镜子宫楔形切除术并术后阴道置放左炔诺孕酮宫内缓释系统治疗效果观察

目的:观察对子宫腺肌病采用腹腔镜子宫楔形切除术并术后阴道置放左炔诺孕酮宫内缓释系统治疗方法的临床效果。方法:将63例子宫腺肌病患者根据治疗方法分为两组,研究组(n=33)采用腹腔镜子宫楔形切除术合并术后阴道置放左炔诺孕酮宫内缓释系统治疗,对照组(n=30)仅采用腹腔镜子宫楔形切除术治疗;观察比较两组患者术后3、6、12、24个月的子宫体积、月经量、痛经评分、血红蛋白、血清CA125水平及术后随访期间的复发和妊娠情况。结果:研究组患者术后12个月及24个月时的子宫体积小于对照组(P0.05),术后12月及24月时的疼痛评分显著低于对照组(P0.01),术后24个月时的月经量少于对照组(P0.01);研究组患者术后24月内的血清CA125及血红蛋白水平控制较好,而对照组术后血清CA125水平逐渐升高,而血红蛋白水平逐渐降低,但两组数据间比较差异无统计学意义(P0.05);研究组中术后24个月内0例复发,而对照组出现3例复发(P0.05);对照组2例患者顺利妊娠,研究组中无患者成功妊娠。结论:采用腹腔镜子宫楔形切除术并术后阴道置放左炔诺孕酮宫内缓释系统治疗子宫腺肌病可更有效地缓解患者的症状,控制疾病的进展,故具有较好的疗效。     

来曲唑对子宫内膜异位症患者内分泌激素的影响

目的:探讨来曲唑对子宫内膜异位症患者内分泌激素的影响。方法:选取2013年6月至2015年6月我院收治的子宫内膜异位症患者82例作为研究对象。所有对象均服用来曲唑治疗,连续6个月。观察治疗效果,并分析比较患者治疗前后的疼痛评分和性激素水平。结果:来曲唑治疗子宫内膜异位症的总有效率为87.8%,不良反应发生率为3.7%。患者治疗后的痛经VAS评分与盆腔触痛VAS评分均较治疗前降低,差异有统计学意义(P0.05)。治疗3个月及6个月时,患者的LH和E2水平均较治疗前降低,差异有统计学意义(P0.05)。治疗后患者的AST水平及ALT水平与治疗前相比较,差异无统计学意义(P0.05)。结论:来曲唑治疗子宫内膜异位症疗效显著,可明显缓解痛经和盆腔痛的症状,并可有效调节患者体内雌激素水平。     

左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜切除术治疗围绝经期异常子宫出血的临床疗效

目的探讨左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜切除术治疗围绝经期异常子宫出血的临床疗效。方法选取2017年1月至2018年6月东阳市中医院诊治的围绝经期异常子宫出血患者146例作为研究对象。随机分为观察组和对照组,各73例;两组患者均采取左炔诺孕酮宫内节育系统治疗,观察组联合宫腔镜子宫内膜切除术。随访12个月,比较两组患者不同时间点的月经失血图(PBAC)评分、子宫内膜厚度、子宫体积,以及血红蛋白、血清糖类抗原125(CA125)水平,比较有效率,观察复发率和不良反应发生情况。结果两组患者在治疗前PBAC评分上差异无统计学意义(P0.05);观察组治疗后1个月、3个月、6个月、12个月PBAC评分均较治疗前明显降低,与对照组比较,差异均具有统计学意义(P0.05)。两组患者在治疗前子宫内膜厚度、子宫体积上差异均无统计学意义(P0.05);观察组治疗后6个月、12个月的子宫内膜厚度、子宫体积均较治疗前明显减小,与对照组比较,差异均具有统计学意义(P0.05)。两组患者在治疗前血红蛋白、CA125水平上差异无统计学意义(P0.05);观察组治疗后6个月、12个月的血红蛋白均较治疗前明显升高,CA125水平均较治疗前明显降低,与对照组比较,差异均具有统计学意义(P0.05)。观察组治疗后1个月、3个月、6个月、12个月的有效率均明显高于对照组,差异均具有统计学意义(P0.05);观察组复发率和不良反应发生率均明显低于对照组,差异均具有统计学意义(P0.05)。结论左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜切除术治疗围绝经期异常子宫出血患者,其临床疗效确切、安全可靠,在控制病情、减少复发和不良反应发生方面均具有优势,值得临床推广应用。     

数字减影血管造影不同血供特点对左炔诺孕酮宫内缓释系统治疗子宫腺肌病效果的影响

目的 探讨数字减影血管造影(DSA)不同血供特点对左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病效果的影响。方法 选取2019年2月至2020年2月于南充市中心医院行LNG-IUS治疗的109例子宫腺肌病患者作为研究对象,按照DSA血供分型,将患者分为Ⅰ型组(n=37)、Ⅱ型组(n=45)和Ⅲ型组(n=27)。月经结束后第3天三组患者宫腔内均置入LNG-IUS,术后每3月随访1次。记录并比较三组患者的基线资料和治疗效果。结果 Ⅰ型组、Ⅱ型组、Ⅲ型组的总有效率分别为72.97%、68.89%、66.67%。治疗后3个月、6个月、9个月、12个月,大部分患者痛经、月经血量过多症状均有改善,且三组比较,差异具有统计学意义(P<0.05)。结论 子宫腺肌病患者的血供特点与LNG-IUS治疗效果具有一定的相关性,值得临床医师重视。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.