复方熟地胶囊治疗青春期功能失调性子宫出血60例疗效观察

目的：观察复方熟地胶囊对青春期功能失调性子宫出血的临床疗效。方法：将90例青春期功血患者随机分为2组，治疗组60例根据月经周期分别以复方熟地胶囊1号（熟地黄、菟丝子、薏苡仁、续断、旱莲草、女贞子、淫羊藿、山茱萸、山药、白芍）和复方熟地胶囊2号（上方加益母草、炒蒲黄、炒五灵脂、紫草）治疗；对照组以己烯雌酚、安宫黄体酮治疗。结果：总有效率治疗组有85．0％，对照组为73．3％，2组总有效率比较，差异无显著性意义（P＞0．05）；3天内血止治疗组19例（31．7％），对照组6例（20．0％），2组差异无显著性意义（P＞0．05）。半年后随访，复发率治疗组为9．7％，对照组为52．9％，对照组明显高于治疗组（P＜0．005）。结论：复方熟地胶囊对青春期功能失调性子宫出血具有较好的治疗优势，既有调经止血作用，也有促排卵作用，且远期疗效巩固。     

口服或阴道用米索前列醇用于人工流产术前宫口扩张的比较

目的 :比较在人工流产术前阴道或口服用米索前列醇后宫口扩张的临床效果。方法 :将 16 1例行人工流产术的早孕妇女分成 3组。第 1组 5 3例和第 2组 5 7例于术前 1h分别经阴道用米索前列醇和口服米索前列醇各 4 0 0 μg ,第 3组为对照组5 1例 ,术前不用任何药物。结果 :第 1组和第 2组宫口扩张有效率分别是 92 % (49/ 5 3)和 89% (5 1/5 7) ,明显高于对照组 0 (0 / 5 1,P <0 .0 1) ;前 2组术中无需使用局部麻醉 (0 / 5 3和 0 / 5 7) ,而对照组则有 74 % (38/ 5 1)的病人需加用局部麻醉 (P <0 .0 1) ;前 2组术中出血量为 (7±s 4 )mL和 (7± 3)mL ,也少于对照组 (12± 4 )mL ,差异有非常显著意义 (P <0 .0 1)。阴道用米索前列醇组与口服米索前列醇组相比 ,术中扩宫口作用差异无显著意义 (P >0 .0 5 ) ,但口服用药组不良反应多于阴道用药组。结论 :阴道用米索前列醇组、口服米索前列醇组术中扩宫口作用肯定 ,出血量小、不良反应轻 ,两者疗效相似     

De novo uterine sarcoma with good response to neo-adjuvant chemotherapy

Abstract.  Numa F, Umayahara K, Ogata H, Nawata S, Sakaguchi Y, Emoto T, Kawasaki K, Hirakawa H, Sase M, Oga A, Kato H. De novo uterine sarcoma with good response to neoadjuvant chemotherapy. We report here the extremely rare case of a 28-year-old woman with advanced stage uterine sarcoma arising soon after a cesarean section. She underwent an abdominal cesarean section because of a breech presentation. At the time of the procedure, there were no abnormal findings such as leiomyoma of the uterus in the abdominal cavity. One year later, she was referred to our hospital because of a large abdominal tumor. Transabdominal power Doppler ultrasonography and magnetic resonance imaging (MRI) showed a large hypervascular tumor in the abdominal cavity. Her serum levels, for the two tumor markers carbohydrate antigen CA125 and LDH, were elevated, at 219 U/ml (< 35 U/ml) and 862 IU/l (115 U/ml−217 U/ml), respectively. On the basis of a diagnosis of malignant tumor of gynecological origin, exploratory laparotomy was performed, and through biopsy, the tumor was found to be advanced undifferentiated uterine sarcoma. She exhibited a good response to neoadjuvant chemotherapy consisting of cisplatin, epirubicin, and dimethyltriazenoimidazole carboxamide (DTIC) every 28 days, which was successfully followed by a hysterectomy.     

子宫动脉栓塞加中药治疗子宫肌瘤疗效分析

目的 :研究子宫动脉栓塞加中药治疗子宫肌瘤的疗效。方法 :40例子宫肌瘤患者 ,采用Seldinger技术 ,穿刺股动脉成功后 ,行双侧子宫动脉超选择插管 ,分别注入 3 5 5～ 70 0 μmPVA颗粒栓塞子宫动脉 ;术后配合中药治疗。分别于术后 3个月、6个月、1年观察疗效。结果 :治疗成功率为 10 0 % ,临床症状逐渐改善、消失。 3个月复查肌瘤平均缩小 3 8 48% ,6个月平均缩小 5 7 40 % ,1年后复查无再增大者。结论 :子宫动脉栓塞加中药治疗子宫肌瘤有很好的临床应用价值     

Direct gamete uterine transfer in patients with tubal absence or occlusion

Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development. Design: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used. Methods: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram-and laparoscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and menotropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of, ovulatory hCG administration, progesterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and six oocytes were returned to the uterine cavity, admixed with sperm, immediately following retrieval. Luteal support consisted of daily P4 administration. Results: Of the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achieved, with one early first-trimester loss, one late first-trimester loss (Trisomy 14), and two healthy term infants delivered. IVF of surplus oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage following cryopreservation. Conclusions: Human fertilization can be achieved through direct uterine transfer of gametes. Furthermore, administration of P4 prior to the ovulatory dose of hCG is compatible with in vitro or in vivo fertilization and implantation.     

Uterine myomas and factors associated with hysterectomy in premenopausal women

OBJECTIVE: Our purpose was to describe clinical characteristics in premenopausal women with uterine myomas and to identify factors associated with hysterectomy.STUDY DESIGN: Data were collected by chart abstraction in 421 premenopausal women with myomas and analyzed by univariate and multivariable regression.RESULTS: Over a median follow-up period of 29 months, 86% of women had symptoms associated with myomas and 40% had an increase in uterine size of >2 gestational weeks. By multivariable regression, bleeding symptoms at presentation and previous surgical history of cholecystectomy and adhesiolysis were significantly associated with greater odds of hysterectomy. There was a significant interaction between age and uterine size, so that as age increased, uterine size had a greater impact on the likelihood of hysterectomy.CONCLUSIONS: In this cohort of premenopausal women myomas were associated with symptoms in almost all women over the follow-up period. Hysterectomy was performed in 22% of women overall. (Am J Obstet Gynecol 1997;176:1213-9.)     

Human papillomavirus, cytomegalovirus and herpes simplex virus infections for cervical cancer in Taiwan

Previously, we had reviewed 43 cases of invasive cancers, adenosquamous cell carcinoma and adenocarcinoma for HPV type infections. With the same cases we extended the investigation to cytomegalovirus (CMV) and herpes simplex virus (HSV) infections. Results show that the prevalence of CMV and HSV infections from these cases of cervical carcinoma was 67 and 76%, respectively, by polymerase chain reaction. The results of the analysis of the association of HPV, CMV and HSV with various clinical characteristics of cervical cancer patients indicated that the correlation between HSV infections and clinical stages of squamous carcinoma was marginally significant (P=0.068). HSV infections seemed to have a higher association with cell keratinization pattern as compared with the other two viral infections.     

活血化瘀法治疗青春期痛经临床观察

观察活血化瘀药物－痛经冲剂对痛经的疗效，探讨痛经的病理生理改变。方法；用积分法观察痛经疗效，并用彩色多普勒超声诊断仪测量子宫动脉血流参数，用锥板式粘度计量血液流变学指标并与健康者比较。结果：痛经患者子宫动脉血流参数搏动指数，阻力指数，收缩期峰值／舒张期峰值均显著高于健康人组，经痛经冲剂治疗后上述参数数值明显下降。     

Intravenous Leiomyomatosis of the Uterus

Three cases of intravenous leiomyomatosis (IVL) of the uterus, a rare benign smooth-muscle tumor, are described. A preoperative diagnosis of IVL was not made in any of the patients, all of which presented with a pelvic mass with the presumptive diagnosis of leiomyoma. Surgical exploration confirmed the presence of uterine mass and two of the three cases showed extra-uterine extension into the ovarian or uterine veins. Histological examination demonstrated a fascicular pattern of bland spindle-shaped smooth-muscle cells, which extended to veins inside the myometrium or to extrauterine veins. This was confirmed by immunohistochemical stain for desmin and factor VIII. Despite their histological benignity, these lesions have a tendency to metastasize and are closely related to the conditions called “benign metastasizing leiomyoma” and “intracaval mass and cardiac extension”. The primary treatment of IVL is hysterectomy and excision of any extrauterine tumor, when technically feasible. Anti-estrogenic therapy has been suggested as potentially useful in controlling of unresectable tumor. According to the literature, the follow-up must be long and periodic postoperative ultrasonic or magnetic nuclear resonance imaging studies may be useful in detecting growth of residual intravascular tumor.     

抑癌基因PTEN在宫颈癌中的表达及意义

目的探讨一种新的抑癌基因PTEN在人宫颈癌中的表达及意义。方法采用免疫组化SP法,检测48例宫颈癌及癌旁正常组织石蜡切片中PTEN蛋白表达情况。经计算机图像分析,计算阳性细胞数,比较PTEN蛋白表达与临床病理特征的关系。结果PTEN蛋白表达于细胞浆。48例宫颈癌中PTEN蛋白阳性表达率40%(19/48),而癌旁正常组织阳性表达率96%(46/48),两者有显著性差异(P<0.05)。在淋巴结转移组织中PTEN蛋白阳性表达率(24%)明显低于未转移组织(52%,P<0.01),另外,PTEN蛋白表达与临床分期呈负相关趋势,而与病理分级、浆膜浸润无相关性(P均>0.05)。结论PTEN异常表达可能与部分宫颈癌发生、发展及预后有关。