Conservative Management versus Aspiration of Functional Ovarian Cysts Before Ovarian Stimulation for Assisted Reproduction

Purpose: To compare the efficiency of transvaginal ultrasound-guided functional ovarian cyst aspiration, withconservative management, in the outcome of patientsundergoing assisted reproductive technique (ART) (in vitrofertilization or intracytoplasmic sperm injection). Thesecysts were identified before ovarian stimulation begun andafter administration of a midluteal GnRH agonist. Methods: Fifty nine patients undergoing ART from January1, 1997 to February 28, 1999, who developed functionalovarian cysts were included. Aspirations of these cysts(n = 14) versus conservative management(n = 45) were compared. Total number of ovarian folliclesdeveloped, number of oocytes retrieved, estradiol levels onthe day of human chorionic gonadotropin, fertilization rate,number of good quality embryos transferred, implantation,and clinical pregnancy rate per cycle were evaluated. Results: No statistical differences were observed betweenthe two groups in any of the selected parameters. Conclusions: Cyst aspiration and conservative managementshowed similar implantation and pregnancy rates, in patientswho develop functional ovarian cysts after pituitarydown-regulation following luteal phase gonadotropin-releasinghormone agonist administration. Prospective studies areneeded to confirm this trend.     

构建面向应用的医学特色计算机课程教学体系

概述国内外医学信息技术与职业技能教育的发展趋势，以及信息时代对医学人才IT技术知识结构、技能结构的新要求。强调医学计算机基础教育应该紧密结合本专业医信技术应用的需求，紧跟本学科未来发展的方向，科学合理的完善大学生的IT知识结构，同时以“生态学”教育模式培养学生自主学习的意识及方法，使各层次医药类院校培养的学生能够适应各自专业工作中对网络技术、信息技术和本专业数字化技术的要求，为将来从事数字诊疗技术夯实基础。提出要用科学发展观深化教育改革，构建面向应用的医学特色计算机课程体系，又好又快地落实培养适应未来信息社会发展需求的现代医学人才目标。     

Renal salvage procedure for synchronous bilateral Wilms' tumor

This report describes a renal salvage procedure performed in a 2-year-old girl with bilateral renal tumors comprising a multilocular, cystic tumor of the right kidney and a solid and cystic nephroblastoma of the left kidney after chemotherapy. Surgery was performed because the right kidney became hydronephrotic due to compression by the enlarged cysts, while the left tumor showed only minimal shrinkage even after three courses of chemotherapy. The right-sided cysts were simply unroofed and the left-sided tumor was extirpated by partial nephrectomy. Her postoperative course was uneventful with considerable recovery of the function of each kidney. This procedure should be considered if the pathological features of the tumor are relatively favourable. Accepted: 20 January 1999     

The Swift operation: a modification of the Leiden nerve-sparing radical hysterectomy

In 2002, our group introduced an operation to avoid damage to the pelvic autonomous nerves during radical hysterectomy that proved to be feasible, effective and safe. During the last five years, we have adapted our surgical technique to make this procedure easier and safer in terms of radicality. We report on the changes in the surgical approach and the results in the first 15 consecutive patients. The Swift operation is more radical in the area of the uterosacral ligaments than the original operation, and it dissects the hypogastric nerve free under direct vision. In the area of the parametria, it is more radical in the deep lateral part. The vascular parametrial tissue is dissected and separated ventrally from the ureters. From October 2006 to February 2007, 15 consecutive patients with cervical cancer stage IA2 to IB2 underwent the Swift operation. The extra operating time amounted to 20 min, which was similar to the original operation, and with no extra blood loss. The suprapubic catheter was removed after a median of five days. Up until now (February 2008), no recurrences have been seen in these patients. It was concluded that the Swift procedure is easy to perform and that it offers advantages over the original operation in terms of safety and radicality.     

不孕症合并子宫内膜非典型增生患者助孕治疗的临床分析

目的探讨不孕症合并子宫内膜非典型增生患者经保守治疗后助孕治疗的疗效和安全性。方法回顾性分析8例不孕症合并子宫内膜非典型增生患者，经孕激素或促性腺激素释放激素激动剂（GnRHa）治疗子宫内膜非典型增生缓解后，采用助孕治疗，观察助孕治疗的疗效及其对子宫内膜的影响。结果经孕激素或GnRHa治疗后，8例患者子宫内膜非典型增生全部缓解。共进行单纯促排卵治疗7个周期，促排卵联合人工授精2个周期，体外受精-胚胎移植（IVF—ET）7个周期，冻融胚胎移植2个周期。单纯促排卵周期均未妊娠，人工授精1个周期双胎妊娠；7个IVF—ET周期中，胚胎移植6个周期，3个周期获得临床妊娠；冻融胚胎移植1个周期获得临床妊娠。现足月分娩6活婴。1例未妊娠患者在促排卵后4个月发现子宫内膜癌变。结论不孕症合并子宫内膜非典型增生的患者经孕激素或GnRHa治疗缓解后，及时助孕治疗能提高妊娠率，但需严密观察，注意子宫内膜癌发生的可能。     

磁共振压脂序列在脊柱急性损伤中的应用

目的:进一步认识MRI的T2WI压脂序列在脊柱急性损伤检查中的作用。方法:回顾性分析脊柱损伤MRI资料109例,比较常规T2WI和FST2WI对椎体骨折、骨髓水肿、脊髓损伤的检出率。结果:FS T2WI对隐匿性骨折和骨髓水肿的检出率明显高于常规T2WI,还能较准确地显示骨质损伤范围及突出损伤部位的解剖结构特征。结论:FST2WI能提高脊柱骨质损伤显示的敏感性和诊断的准确性,应作为脊柱损伤MRI检查中的常规序列。     

Transfer of embryos into the uterus: How much do technical factors affect pregnancy rates?

Objective Our objective was to identify the effect on outcome of (a) ultrasound-assisted embryo transfer, (b) the use of different embryo transfer catheters, and (c) the length of time the patients remain in the supine position after embryo transfer.Setting The setting was a private fertility center.Subjects This was a prospective study of 178 in vitro fertilization and embryo transfers (IVF-ET) and 63 frozen embryo replacements (FER).Results The pregnancy rate was 28.7% following IVF-ET and 31.8% for FER. Ultrasound-assisted transfer did not affect the outcome (29 vs 30.3%). There was no difference in the performance of the Wallace and Frydman catheters with regard to outcome (30.3 vs 30.7%). Although there was an increase in pregnancy rate as the time interval in the supine position after ET increased, this needs a larger study.Conclusion The parameter studies did not affect the outcome of IVF/ET or FER. Some factors encouraged us to recommend ultrasound-assisted transfer in some cases, and the use of a Frydman catheter for transfer and to encourage the supine position after transfer for longer periods.     

BCG vaccination in India and tuberculosis in children: Newer facets

With the extended programme of immunisation and since 1985 the universal programme of immunisation and the coverage status of BCG vaccination in India has been very good, although it is still unsatisfactory in the eastern states. It is emphasized that BCG vaccination cannot prevent natural tuberculous infection of the lungs and its local complications, although it reduces the haematogenous complications of primary infection. However, this is not true for malnourished children who, inspite of BCG vaccination, develop serious, and often fatal types of tuberculosis such as miliary, meningitic and disseminated tuberculosis. The tuberculin anergy in malnourished children, is mainly responsible for high morbidity and mortality. BCG vaccinated, well-nourished children manifest modified patterns of tuberculous disease, following infection. The most important manifestation is the increased incidence of intrathoracic tuberculosis, specially enlargement of the various groups of mediastinal nodes and their local complications. Localisation of the disease by T cell immunity, due to BCG vaccination is responsible for this and the much lower incidence of haemotological complications such as neurotuberculosis and disseminated disease. In these children, the clinical picture of neurotuberculosis is also modified, with a tendency for more localised involvement of the brain and meninges. Similarly, vaccinated children may present with hepatomegaly, splenomegaly or isolated organ disease. It is important to relearn the new patterns of tuberculosis disease seen in vaccinated, non-malnourished children, and to a lesser extent in children with grade 1 to 2 protein energy malnutrition (PEM). With these limitations of BCG vaccination, other strategies like chemoprophylaxis need multicentric trials in high risk children, in different parts of the country.     

Persistent value of air-augmented radiograph in neonatal high gastrointestinal obstruction, despite more modern techniques

Air is a safe and effective natural contrast agent in neonatal high gastrointestinal (GIT) obstruction. Successful early decompression often results in plain abdominal radiographs of low diagnostic yield. We present a series of neonates with high GIT obstruction in whom air-augmented abdominal radiographs (AAAR) were performed instead. Fourteen neonates presented with suspected high GIT obstruction. In 12 sick babies, obstruction was confirmed and the level of obstruction was determined. The other two neonates required additional positive contrast upper GIT studies. These confirmed small bowel malrotation. For neonatal high GIT obstruction an AAAR can provide a rapid and accurate diagnosis. Positive contrast agent studies should be performed when the AAAR is non-diagnostic.