Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy

Objectives

To determine whether the day-by-day recovery of general wellbeing was faster in women undergoing laparoscopic hysterectomy than in total abdominal hysterectomy and to analyse the association between stress coping and sick-leave and the day-by-day recovery measured as general wellbeing.

Study design

A randomised multicentre trial conducted in five hospitals in the South East of Sweden. Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study and 117 women completed the study. Fifty-five women were randomised to abdominal hysterectomy and 62 to laparoscopic hysterectomy. Day-by-day recovery of general wellbeing was measured by a visual analogue scale 1 week preoperatively, 35 days postoperatively, and during 1 week 6 months postoperatively. Stress-coping capability was measured preoperatively using a specific psychometric measurement. Sick-leave was granted with an initial period of 14 days and prolonged on patient demand with 7 days periods.Effects of operating method and stress-coping ability on the day-by-day recovery adjusted for postoperative complications and analgesics were analysed by means of analysis of variance for repeated measurements.

Results

No significant difference was found in the day-by-day recovery of the general wellbeing between the operating methods. Stress-coping ability did significantly influence the day-by-day recovery of general wellbeing. Duration of sick-leave was associated with the occurrence of postoperative complications but not with stress-coping ability.

Conclusions

The day-by-day recovery of general wellbeing is not faster in laparoscopic hysterectomy than in abdominal hysterectomy. Women with high stress-coping abilities have a better outcome in general wellbeing than women with low stress-coping capacity. Identification of women with low stress-coping abilities and prevention of complications might be of benefit for improving postoperative wellbeing.     

Morphologic,endocrinologic and natural pregnancy assessment of allogeneic ovarian orthotopic transplantation without a vascular pedicle in rabbits

Objective

The objective was to assess the natural pregnancy of rabbits subjected to bilateral oophorectomy and orthotopic allogeneic intact and sliced ovarian transplantation without a vascular pedicle, and to determine the morphofunctional aspects of the transplanted ovaries.

Study design

Thirty-two female rabbits were studied. The ovaries were removed and orthotopically transplanted without vascular anastomoses between the two breeds of rabbits. In Group 1 (n = 8), only laparotomy and laparorrhaphy were performed, in Group 2A (n = 8) intact ovaries were transplanted on both sides, in Group 2B (n = 8) both ovaries were sliced and orthotopically transplanted, and in Group 2C (n = 8) an intact ovary was transplanted on one side and a sliced ovary on the other side. Three months later, the animals were paired with males for copulation. Estradiol, progesterone, follicle-stimulating hormone, and luteinizing hormone levels were assessed. A histologic study was carried out and the numbers of pregnancies and litters were also determined.

Results

Pregnancies occurred in seven rabbits in Group 1, 37.5% of rabbits in Group 2A, 50% in Group 2B, and 62.5% in Group 2C. Hormone levels and histology confirmed the vitality and function of all ovaries.

Conclusions

Intact or sliced orthotopic allogeneic ovarian transplantation without a vascular pedicle is viable in rabbits, and preserves their hormonal and fertile functions.     

A multi-institutional review of outcomes of endometrial stromal sarcoma

OBJECTIVE: To compare the clinical behavior and outcomes of low- and high-grade endometrial stromal sarcomas (LGESS and HGESS), respectively. METHODS: Patients with endometrial stromal sarcoma from five different institutions were identified and reviewed for clinicopathologic variables, surgical management and outcomes. Statistical calculations including Chi-square, t-test and survival using the Kaplan-Meier method with the log rank test were performed. RESULTS: One hundred and five patients were identified with 72 having LGESS, 31 with HGESS and 2 having unclassified tumors. The mean age was 50 years for patients with LGESS and 64 years for those with HGESS (p<0.0001). In patients with LGESS, 68% (49 patients) had disease confined to the uterine corpus or cervix compared to 39% (12 patients) in HGESS (p=0.002). The median overall survival was 53 months for HGESS and had not yet been reached in LGESS with 87.8% alive at 80 months (p<0.0001). In HGESS patients with extrauterine disease, the presence of residual disease greater than 2 cm had a significant effect on median survival. Median survival was 52 months for those who underwent optimal cytoreduction versus 2 months for those with suboptimal residual disease (p=0.007). The impact of cytoreduction was not seen in LGESS patients with extrauterine disease with 82.1% alive at 78 months. CONCLUSIONS: Low-grade and high-grade endometrial stromal sarcomas represent two distinct clinical entities and should be treated as such. Survival in patients with high-grade tumors appears to be related to amount of residual disease at the completion of initial surgery and would suggest the need for aggressive cytoreduction. The role of surgical staging and optimal adjuvant therapy remains unclear.     

Trends in cervical cancer survival in Europe, 1983-1994: a population-based study

OBJECTIVE: To evaluate trends in survival from cervical cancer in Europe and in European countries participating in the EUROCARE study as a function of age, morphology and stage at diagnosis. METHODS: Relative survival and relative excess risk of death within 5 years of diagnosis, as a function of age, morphology and stage, among 73,022 women aged 15-99 years diagnosed during 1983-1994 and followed up to 1999 in each of 18 European countries participating in the EUROCARE study, using data from 34 population-based cancer registries. RESULTS: Overall five-year relative survival was 62%, rising by 2% during the period 1983-1994. The highest survival occurred in Northern and Western Europe and the lowest in Central Europe. Survival falls with age at diagnosis, but mainly for localised disease. Survival is higher for adenocarcinoma in younger women, but higher for squamous cell carcinoma in older women. The proportions of younger women, localised cancer and adenocarcinoma all increased. The main improvements in survival were for women under 65, and for metastatic disease. CONCLUSIONS: Survival in Europe has improved slowly but steadily, but the trend is not geographically uniform. Central European countries and the UK saw little or no improvement, and survival in those countries remains the lowest among participating countries in Europe. Further reduction of cervical cancer mortality in Europe may be expected from expansion of screening, and improvement in the treatment of older women, and of metastatic disease.     

2型糖尿病勃起功能障碍的相关影响因素分析

目的探讨2型糖尿病勃起功能障碍(ED)的相关危险因素,为其早期临床干预治疗及进一步研究提供科学依据。方法采用病例对照研究方法。选取153例男性2型糖尿病患者为研究对象,根据ED问卷调查结果,分为ED组和非ED组,分析糖尿病ED的相关危险因素。结果 153例男性2型糖尿病患者中,伴有ED者90例(ED组),ED发生率为55.2%,不伴ED者63例(非ED组)。单因素分析显示,2组间年龄、糖尿病病程及有无高血压病、高脂血症、糖尿病视网膜病变及周围神经病变比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析,年龄、糖尿病病程、高血压病病史、高脂血症病史、糖尿病视网膜病变病史及周围神经病变病史为ED的相关危险因素(P<0.05)。结论年龄、糖尿病病程、高血压病病史、高脂血症病史、糖尿病视网膜病变病史及周围神经病变病史为男性糖尿病性ED的相关危险因素。     

生活事件社会支持压力反应对医务人员应对方式的影响

目的研究生活事件、社会支持、应激反应等应激有关因素对医务人员应对方式的影响 ,探讨应对方式在应激系统中的理论意义。方法应用特质应对方式问卷、领悟社会支持量表、自编压力反应问卷和生活事件量表 ,及一般情况调查表对 5 5 6名医务人员进行调查 ,将结果输入SPSS10 .0软件进行统计分析。结果单因素相关分析显示 :医务人员消极应对方式与压力反应、家庭事件、工作学习事件、社交与其他事件和经济事件呈正相关 ,与家庭内支持、年龄、性别、文化程度有负相关 (P <0 .0 5或P <0 .0 1)。医务人员积极应对方式与压力反应、工作学习事件呈负相关 ,与家庭内支持、家庭外支持、性别有正相关 (P<0 .0 1)。多元逐步回归分析提示 :影响医务人员消极应对方式的主要因素有压力反应总分、年龄、性别和工作学习问题 (P <0 .0 5或P <0 .0 0 1) ,影响医务人员积极应对方式的主要因素有家庭外支持、压力反应和性别 (P <0 .0 1或P <0 .0 0 1)。结论医务人员的应对方式与生活事件、社会支持、压力反应、性别和年龄有关 ,提示心理应激是一个多因素交互作用的系统。     

不同碘摄入量地区硒与甲状腺功能关系的流行病学研究

目的　探讨三个不同碘摄入量地区人群硒营养状态与甲状腺功能异常的关系。方法盘山、彰武和黄骅地区分别为低碘、碘充足和高碘地区。将各地区流行病学调查中发现的 32 9例甲状腺功能异常者 (包括临床甲减、亚临床甲减、临床甲亢和亚临床甲亢 )以及同地区的 183名正常人作为研究对象。测定上述研究对象的血清硒、促甲状腺激素 (TSH)和游离甲状腺激素 (FT3及FT4 )水平。结果　盘山、彰武和黄骅地区正常对照组的血清硒中位数分别为 91 4、89 1和 83 2 μg L。各地区甲减、亚甲减及甲亢患者血清硒水平与正常对照比较均无差异 ;只有亚甲亢患者与对照组相比血清硒水平明显下降 (血清硒中位数分别为 82 6 μg L和 87 3μg L) ;且亚甲亢患者与正常对照比较FT3 FT4值下降 ,FT4值升高 ,FT3值无差异。未发现性别和年龄对正常人群血清硒水平有明显影响。各地区正常对照人群血清硒水平与TSH负相关 ,且血清硒≤ 80 μg L组与血清硒 80～ 10 0 μg L及 10 0～ 12 0 μg L组相比TSH值明显升高 (TSH中位数分别为 2 10、1 2 9和 1 2 8mU L)。彰武地区甲状腺过氧化物酶抗体 (TPOAb)阳性的甲状腺功能异常者血清硒与TPOAb滴度负相关 ,且高度阳性组 (TPOAb >6 0 0IU ml)血清硒水平显著低于TPOAb低度和中度阳性组 (血清硒中位