腹腔内注射罗哌卡因对妇科腹腔镜术后镇痛效果观察（附60例报告）

目的观察妇科腹腔镜手术后腹腔内注射罗哌卡因用于术后镇痛的可行性和效果。方法采用随机、安慰剂对照和双盲的研究方法,将120例择期行腹腔镜下妇科手术患者分为A、B两组,A、B组术毕腹腔内分别注入0.5%罗哌卡因20ml、生理盐水20ml,术后4、8、12、24、48h对切口、内脏、肩部三个部位通过视觉模拟评分法(VAS)评估疼痛程度,VAS>4者予镇痛药处理。记录两组患者额外镇痛药的需要量并观察比较两组病人围手术期肺功能改变及术后恶心呕吐(PONV)等不良反应的发生情况。结果术后各时段各部位A组病人VAS评分均小于B组(P<0.05)。A组术后额外镇痛药用量小于B组。两组病人在围手术期肺功能及恶心呕吐等方面差异无统计学意义(P>0.05)。结论妇科腹腔镜手术后腹腔内注射0.5%罗哌卡因镇痛安全、有效、并发症少。     

TCT法筛查1007例宫颈细胞学的临床分析

目的:探讨新柏氏液基薄层细胞学制片技术(TCT)在妇科普查中的价值。方法:回顾性分析某高校妇科普查病理涂片结果。2005年采用传统巴氏涂片1 011例,2006年采用新柏氏液基薄层细胞学制片1 007例,对比分析宫颈细胞学异常的阳检率,并对阳检病例随访组织病理学结果。结果:TCT法1 007例取材均为满意涂片,检出异常结果有:未明确意义的不典型鳞状上皮细胞(ASC-US)11例,未能除外高度上皮内病变的不典型鳞状上皮细胞(ASC-H)6例,低度鳞状上皮内病变(LSIL)21例,高度鳞状上皮内病变(HSIL)8例,鳞状细胞癌(SCC)1例。宫颈细胞学与组织病理学结果符合率为91.49%。结论:新柏氏液基薄层细胞学制片技术在妇科普查中筛查宫颈病变阳性检出率高,癌前病变分型明确。     

Late hyponatremia in premature infants: role of aldosterone and arginine vasopressin

To assess the possible involvement of arginine vasopressin in the pathogenesis of late hyponatremia in preterm infants, serial measurements of sodium balance, fractional sodium excretion, plasma and urine osmolality and sodium concentration, and urinary aldosterone and arginine vasopressin excretion were performed at weekly intervals in nine healthy preterm infants. During the course of late hyponatremia, there was a significant increase in urinary aldosterone and arginine vasopressin excretion, from 0.94 +/- 0.16 to 4.30 +/- 0.76 micrograms/day and from 0.38 +/- 0.08 to 1.19 +/- 0.26 ng/day, respectively, from the first to the fourth to fifth weeks. A significant negative correlation was found between fractional sodium excretion and urinary aldosterone excretion. Aldosterone excretion, however, correlated positively with urinary arginine vasopressin excretion in seven of the nine infants. The parallel increase in urinary aldosterone and arginine vasopressin excretion in salt-losing premature infants may occur in response to the protracted contraction of the extracellular fluid compartment, and may contribute to the restoration of volume in the body fluid compartments and to the development of late hyponatremia.     

Vaginitis

Vaginitis is one of the most common complaints of women in the United States today. About 90% of patients with this problem suffer from infection of the vagina caused by Candida, Gardnerella, or Trichomonas. The diagnosis and effective treatment of these common infections depend on accurate identification of the entity, effective specific therapy, and restoration of the normal ecosystem of the vagina. At the same time women should be made aware that not all discharge means infection and that any attempts at self-treatment may only worsen their condition. Proper hygiene habits, dietary control, and management of stress are all helpful factors in the control of recurrent vaginal infections.     

Recurrent ovarian carcinoma: retreatment utilizing combination chemotherapy including cis-diamminedichloroplatinum in patients previously responding to this agent

Eleven women with advanced ovarian cancer treated postoperatively with combination chemotherapy (cytoxan, hexamethylmelamine, Adriamycin, and cis-platinum) had disease-free intervals of 5 to 46 months (mean: 22 months) and subsequently developed recurrent carcinoma. Each patient was then retreated with combination chemotherapy which included cis-platinum. There was a 72% response rate to retreatment (36% complete, 36% partial). These overall and complete remission rates are comparable to those of platinum-based combination chemotherapy in patients without prior treatment. Those patients who responded to retreatment had a significantly longer mean survival rate than those who did not.     

Recurrent cervical cancer presenting as small bowel obstruction

A case report of a patient with recurrent squamous cell carcinoma of the cervix is presented in whom the recurrence was confined to the gastrointestinal tract and omentum in the upper abdomen. No evidence of recurrent disease was present in the pelvis or paraaortic lymph node bearing areas. Possible mechanisms for this unusual location of recurrence are discussed.     

Silent chorioamnionitis as a cause of preterm labor refractory to tocolytic therapy

Thirty-seven consecutive patients with singleton pregnancies in "uncomplicated" preterm labor with intact membranes suitable for tocolysis were evaluated for evidence of silent chorioamnionitis by means of maternal serum C-reactive protein and amniotic fluid white blood cell count, Gram stain, and cultures. Abnormalities in these markers of infection were found to be significantly more common in cases that were refractory to tocolysis. These cases also showed both pathologic evidence of chorioamnionitis and a significantly greater neonatal early infectious morbidity. We conclude that silent chorioamnionitis is a significant cause of "uncomplicated" preterm labor refractory to conventional methods of tocolysis.     

Changes in the management of severely Rh-immunized patients

Since July 1, 1978, we have instituted the following changes in the management of severely Rh-immunized patients: (1) serial amniotic fluid optical density (delta OD450 ) values and real-time ultrasound scanning beginning at 21 weeks' gestation, (2) fetal transfusions as early as the twenty-third week, (3) ultrasound surveillance during and after intrauterine transfusions, and (4) planned premature delivery with neonatal exchange transfusions for selected cases between 29 to 32 weeks and for all patients after 32 weeks' gestation. The perinatal survival rate (83.8%) in 37 isoimmunized pregnancies managed with this regimen was significantly higher (p less than 0.05) than in 34 such pregnancies (55.9%) managed according to the protocol utilized during the previous four years.     

Human uterine fluid, examined in undiluted samples for osmolarity and the concentrations of inorganic ions, albumin, glucose, and urea

Human uterine fluid and serum, when analyzed, had the same osmolarity. Both the total cation concentration and that of albumin were lower in uterine fluid than in serum. Decreased cation concentration is probably a regulatory mechanism maintaining electroneutrality in uterine fluid when the protein concentration is decreased, since protein molecules have multiple negative charges. Compared with their serum values, concentrations of potassium were high, and those of sodium and calcium were low. Concentrations of potassium and calcium in uterine fluid were found to vary cyclically, both having lower values at midcycle than in the proliferative and luteal phases. The concentrations of chloride, urea, glucose, and fructose in uterine fluid did not differ significantly from those in serum. A possible influence of the ionic composition of uterine fluid on sperm migration at midcycle and on the implantation process in the luteal phase was also considered.     

The relationship of placental grade, fetal lung maturity, and neonatal outcome in normal and complicated pregnancies

Ultrasonically diagnosed maturity changes in the placenta, Grades 0 to III, have been previously shown to correlate with fetal lung maturity. In a prospective study of 230 term and preterm complicated pregnancies, we compared the relationship between sonographic placental grading, amniotic fluid phospholipids, and neonatal outcome. The frequencies of gestational age less than 38 weeks, lecithin/sphingomyelin (L/S) ratio less than 2.0, negative phosphatidylglycerol, and neonatal hyaline membrane disease were found to decrease as placental grade advanced from 0 to III. Patients were divided into subgroups on the basis of maternal complications. In patients with Grade III placentas, the frequencies of gestational age less than 38 weeks and L/S ratio less than 2.0 were significantly increased when the subgroup of patients with chronic hypertension was compared individually to both of the subgroups, repeat cesarean section deliveries, and Classes A, B, and C diabetes mellitus (both with p less than 0.05) All three infants who developed hyaline membrane disease in association with Grade III placentas were from pregnancies of less than 38 weeks complicated by chronic hypertension. These findings suggest that the presence of a Grade III placenta is affected by both gestational age and pregnancy complications. Hence, when an elective cesarean section delivery is being planned near term gestation, a Grade III placenta is a reliable predictor of lung maturity. In preterm complicated pregnancies, an ultrasound-diagnosed Grade III placenta may still be associated with hyaline membrane disease.