严重晶状体不全脱位的小切口囊袋内吸出术

目的评价自闭性小切口囊袋内吸出术治疗严重晶状体不全脱位的疗效。方法对１４例１８眼悬韧带离断大于１８０°的严重晶状体不全脱位者,根据晶状体核硬度的不同,分别采用自闭性小切口手动囊袋内吸出术和超声乳化囊袋内吸出术。结果术后随访３月～２年,２例４眼因弱视矫正视力０１～０３,３例５眼０５～０７,８例外伤眼术中植入人工晶状体,７例裸眼视力０５～１０,另１眼因青光眼视神经损害视力００３。无术中及术后并发症。结论此手术方法具有切口小,对角膜、虹膜及玻璃体扰动小,便于联合其它手术,术中、术后并发症少,视力恢复好等优点,是一种安全、有效的手术方法。     

The Dalkon Shield IUD

The Dalkon Shield IUD was introduced to the list of contraceptives being distributed to developing countries by IPPF (International Planned Parenthood Federation) in 1973. By 1974, doubts had arisen about the safety of the Dalkon Shield and several cases of maternal mortality and sepsis in Dalkon Shield users had been reported. In 1974, IPPF stopped supplying Dalkon Shields to its affiliates. During the 1973-74 period of distribution, IPPF had distributed approximately 300,000 of the Shields in 41 countries. Almost 1/2 that amount had already been inserted. The position of IPPF's IMAP (International Medical Advisory Panel) on any relationship existing between use of IUDs and pelvic inflammatory disease is as follows as of 1980: 1) infection with actinomycosis makes up only a small component of all the incidents of pelvic inflammatory disease connected with IUDs; 2) the occurrence of pelvic inflammatory disease is not related to the length of use of an IUD; 3) data do not now support the recommendation that inert devices free from major side effects should be removed; and 4) any woman still wearing a Dalkon Shield should have it removed.     

Impact of the environment on reproductive health

The WHO workshop on the impact of the environment on reproductive health is summarized. Topics include the nature of environmental factors affecting reproductive health, environmental factors blamed for declining sperm quantity and quality, the effects of natural and man-made disasters on reproductive health, chemical pollutants, how the environment damages reproductive health, and research needs for better research methodologies and surveillance data. Recommendations are made to: 1) promote international research collaboration with an emphasis on consistency of methodological approaches for assessing developmental and reproductive toxicity, on development of improved surveillance systems and data bases, an strengthening international disaster alert and evaluation systems; 2) promote research capabilities for multidisciplinary studies, for interactive studies of the environment and cellular processes, and for expansion of training and education; and 3) take action on priority problems of exposure to chemical, physical, and biological agents, of exposure to pesticides among specific populations, and of inadequate screening methods for identification of environmental chemicals. The costs of environmental injury to reproduction include subfertility, intrauterine growth retardation, spontaneous abortion, and various birth defects. Developed country's primary threats are from chemical pollution, radiation, and stress. There is a large gap in knowledge. Caution is urged in understanding the direct relationship between environmental causes and infertility. Sexual health is difficult to assess and research is suggested. Exposure to excessive vitamin A and toxic chemicals are cited as agents probably having serious effects on malformations. Sperm quality has declined over the decades; there is speculation about the potential causes. The effects of radiation such as at Chernobyl are described. Toxic chemical exposure such as in Bhopal, India killed thousands. Neurological damage is reported for fetuses and infants exposed to methyl mercury. There is the beginning of evidence that complications of pregnancy may be related to pollution levels surrounding industrial plants. Reproductive health is affected through chromosome damage and cell destruction, prenatal death, altered growth, fetal abnormalities, postnatal death, functional learning deficits, and premature aging.     

Statement on periodic abstinence for family planning

IPPF does not advise that periodic abstinence be considered an equal alternative to more effective family planning methods because of findings from recent, carefully conducted trials that show unusually high failure and discontinuation rates compared with other methods. Periodic abstinence for family planning depends upon identifying the fertile phase of the menstrual cycle which occurs around the time of ovulation and avoiding sexual intercourse during that time. Abstinence is sometimes necessary during a large part of the cycle because of the difficulty of accurately predicting the fertile phase. In recent major studies, almost 20% of women using the sympto-thermal method became pregnant within a year, as did about 25% of those using the cervical mucus method, compared with less than 5% of those using oral contraceptives or IUDs. The sympto-thermal method appears more effective than the cervical mucus method, but both show wide ranges of pregnancy and discontinuation rates among different groups of women. Nevertheless, family planning associations should familiarize themselves with the periodic abstinence techniques for couples for whom periodic abstinence techniques for couples for whom periodic abstinence is the only choice. Such couples should be clearly informed that the method is not considered an effective method of family planning. Periodic abstinence is better than no method, however, and various other benefits can be obtained, such as knowledge of female physiology. Couples may identify the fertile phase to use barrier methods only on days estimated to be fertile, and it may lead to use of more effective contraception. Methods of detecting ovulation are also useful in diagnosis and treatment of infertility.     

Statement on voluntary sterilization

Voluntary surgical sterilization offers the advantages over other methods of being a once only procedure which eliminates the risk of unwanted pregnancy, does not entail regular checkups or require supplies or sustained motivation, and has a small risk of complication when properly performed. Counseling is particularly important in the case of voluntary sterilization and should include discussion of all contraceptive methods including their risks and benefits, emphasis on the permanence of the procedure and the small risk of failure, and discussion of all aspects of sterilization procedures and types of anesthetic available. Voluntary informed consent should be ensured and an adequate time interval should be allowed after counseling. The sterilizlation decision should not be made at a time of emotional stress. Both male and female sterilization can be carried out under local anesthetic with mild sedative, but when a general anesthetic is given the patient should be in the hands of a health professional trained in anesthesia and should fast for at least 6 hours preoperatively. Intubation and positive-pressure ventilation are recommended, and emergency resuscitation equipment must be available. Anesthesia is the most important cause of morbidity and mortality associated with female sterilization. Vasectomy is a simple operation performed under local anesthetic as an outpatient procedure, and should have no risk of mortality when properly done. Another method should be used until approximately 15 ejaculations have taken place. Laparoscopic female sterilization requires costly and sophisticated equipment and training and is best carried out in hospitals with specialized equipment and staff. Complications, although uncommon, may require experienced surgical intervention. The chance of puncture of abdominal viscera or blood vessels may be minimized with the new technique of open laparoscopy. Minilaparotomy is relatively simple, has less sophisticated training and equipment requirements, and is suggested for most family planning programs. Both procedures can be carried out under local or general anesthetic, and women can be discharged the same day. Vaginal approaches to the tubes are associated with more complications and are not frequently used. Studies are underway to assess the various occluding techniques; at present the Pomeroy technique is recommended for minilaps and rings and clips for laparoscopy. The most important late complication of female sterilization is pregnancy, which may be ectopic.     

Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights

Coronary computed tomography angiography is a noninvasive heart imaging test currently undergoing rapid development and advancement. The high resolution of the three‐dimensional pictures of the moving heart and great vessels is performed during a coronary computed tomography to identify coronary artery disease and classify patient risk for atherosclerotic cardiovascular disease. The technique provides useful information about the coronary tree and atherosclerotic plaques beyond simple luminal narrowing and plaque type defined by calcium content. This application will improve image‐guided prevention, medical therapy, and coronary interventions. The ability to interpret coronary computed tomography images is of utmost importance as we develop personalized medical care to enable therapeutic interventions stratified on the bases of plaque characteristics. This overview provides available data and expert's recommendations in the utilization of coronary computed tomography findings. We focus on the use of coronary computed tomography to detect coronary artery disease and stratify patients at risk, illustrating the implications of this test on patient management. We describe its diagnostic power in identifying patients at higher risk to develop acute coronary syndrome and its prognostic significance. Finally, we highlight the features of the vulnerable plaques imaged by coronary computed tomography angiography.