女性缩阴术30例临床分析

1 临床资料 2000-03/2004-06阴道松弛症女性30例,年龄24～44岁,其中24～30岁12例,占40%;31～40岁10例,占33.3%;41～44岁8例,占26.7%.术前检查阴道容三指以上,自诉因阴道松弛性生活时快感不足,均排除子宫脱垂、阴道炎及阴道肿瘤等疾病.手术在月经完全干净3 d后,采用硬膜外麻醉或局部麻醉下进行.患者取膀胱截石位,于阴道口外6点处设计出一弧形切口,左右宽度3～7 cm具体视阴道松弛程度而定,沿设计线在阴道黏膜下注射盐酸肾上腺素盐水以利止血和分离,切开并剥离阴道后壁黏膜,暴露黏膜下肌肉,以可吸收缝线拉拢缝合阴道黏膜下左右侧阴道括约肌及肛提肌等,从阴道深处开始缝合,缝到阴道口附近处.缝合后阴道容二指松.阴道后壁黏膜不切除,阴道黏膜下肌肉左右对叠缝合后阴道黏膜自然向上膨隆形成一皱襞.阴道外的横弧形切口因黏膜下肌肉左右拉拢缝合,变成竖形切口以丝线间断缝合.术后静滴抗生素3 d,每天以碘伏清洗切口1次,7 d拆线,2 mo内禁止性生活.术后随访3～6 mo,自诉性快感明显增强22例,改善8例.     

Follow-up of 146 spinal tuberculosis patients operated through an anterior approach

Summary From 1978 to 1995, 146 patients with spine tuberculosis were operated through an anterior approach. The mean age of the patients was 42, ranging from 18 to 74. Preoperative neurological deficit was present in 26% of cases. Paraplegia was present in 9 cases and paresis in 29 cases. The TB process was localized in cervical 2%, thoracic 64%, thoracolumbar 15%, lumbar 17% and lumbosacral in 2%. In 96% of the cases two vertebrae were affected with kyphosis and angulation (20–40° in 40%, 40–50° in 36% and over 50° in 24%). All patients had angulation and collapse of vertebral body more than a 1/4 of its height. There are no anamnestic data about smokers and non-smokers. Surgery consisted of anterior approach (thoracotomy, thoracophrenolumbotomy, lumbotomy), excision of the focus, decompression of spinal canal, solid interbody fusion with autogenous grafts (rib autograft in 62%, iliac crest in 18%, vascularised rib in 16%and fibula in 4%) and biopsy. All patients with neurological deficit improved after this type of treatment. Follow-up was possible in 110 patients. On follow-up after completion of treatment-operation, cast and drug, during 8 months none of the patients showed recurrence of disease, increase of deformity or any neurological deficit. Follow-up period was from 14 months up to 9 years. The authors believe that the anterior approach offers several advantages: wide exposure of the lesion, excellent opportunity for decompression and adequate solid body fusion with autografts.     

Living with Marfan syndrome I. Perceptions of the condition

We present data from an exploratory study of 174 adults with Marfan syndrome regarding their cognitive perceptions of the condition as postulated by the self-regulatory model (Leventhal H, Benyamini Y, Brownlee S et al. In: Petrie KI, Weinman JA, eds. Perceptions of Health and Illness: Current Research and Applications. Amsterdam, The Netherlands: Harwood Academic, 1997: 19-45; Leventhal H, Nerenz DR, Steele DJ. In: Baum A, Taylor SE, Singer JE, eds. Handbook of Psychology and Health. Hillsdale, NJ: Lawrence Erlbaum Associates, 1984: 219-252). The vast majority of the respondents had adequate general knowledge about Marfan syndrome. Eighty-three percent of the respondents perceived Marfan syndrome as having had significant adverse consequences on their lives. Having striae, pain (sore joints), and depression were each independently correlated with this view. Fifty-eight percent of the respondents indicated that they felt they had low to moderate control over their condition, demonstrating variability. History of aortic dissection, pain (sore joints), and depressive symptoms were each negatively correlated with the view that Marfan syndrome is a curable/controllable condition. Moreover, approximately 28% view the condition as a lethal condition, whereas 67% view it as a serious condition. Forty-four percent of the cohort were found to have significant symptomatology of depression independent of beta- and Ca2+-channel blockade use. Respondents cited both advantages and disadvantages of being affected. Genetic counseling that addresses patients' perceptions of Marfan syndrome, and its associated pain, fatigue, and depressive symptoms, may enhance patient adaptation to the condition.     

Erythroid progenitors in anemic Belgrade laboratory (b/b) rats

The anemia of Belgrade b/b rats has been shown to be due to intracellular iron deficiency. The aim of this study of erythropoiesis at the progenitor cell level in these rats was to determine if a defect is present in the early phase of red cell production. Both erythroid colony-forming unit (CFU-E)- and erythroid burst-forming unit (BFU-E)-derived colonies were found to be few in untreated b/b rats and made up of a small number of poorly hemoglobinized erythroblasts of different size and irregular cell shape. Following treatment with iron, the anemia of the rats improved, and the number of CFU-E-derived colonies and the number of cells per colony increased, but the peculiar erythroblast morphology persisted. The high serum level of biologically active erythropoietin (Ep) in b/b rats rules out inadequate Ep production as a cause of their anemia. The results presented indicate, in addition to the earlier described defective transmembrane iron transport, a defect in erythroid progenitor cells. The effect of iron treatment in these rats detected in vitro on erythroid progenitors confirms the importance of iron for cellular proliferation.     

Megakaryocyte progenitors in paroxysmal nocturnal haemoglobinuria are sensitive to complement

Abstract: We have investigated growth in vitro of bone marrow megakaryocytic progenitors (CFU-Mk) in 7 patients with paroxysmal nocturnal haemoglobinuria (PNH) to determine the sensitivity of CFU-Mk to complement. Bone marrow light density mononuclear cells were exposed to fresh or heat-inactivated AB human serum in the presence of medium or isotonic sucrose solution. We found that the proliferative activity of bone marrow CFU-Mk in PNH patients was significantly lower than in controls. In addition, the number of CFU-Mk in PNH bone marrow cells exposed to isotonic sucrose and complement was reduced to 25% of that in PNH cells exposed to isotonic sucrose without complement. In conclusion, our finding showed an increased sensitivity of CFU-Mk in PNH bone marrow cells to complement, supporting the hypothesis that the PNH defect is present at the level of CFU-Mk.     

Method for growing primitive erythroid progenitors (BFU-E) from rat bone marrow

A method for growing erythroid bursts from rat bone marrow cells is presented. The methylcellulose culture technique with rat spleen-conditioned medium was used. Successful growth of rat BFU-E was obtained with 20% fetal bovine serum when anemic rat plasma was used as the source of erythropoietin. Plating efficiency was 60 BFU-E per 2 x 10(5) nucleated cells seeded. The proliferative activity determined by cytosine arabinoside (Ara-C) suicide was about 22%. The effect of chronic hypertransfusion on erythroid colony formation is presented.