MR扩散加权成像对卵巢病变定性诊断的研究

目的 探讨扩散加权像(DWI)对卵巢病变的鉴别诊断价值.资料与方法 73例81个病理证实的卵巢病变术前行常规MRI和DWI.比较不同性质病变囊性部分及实性部分间表观扩散系数(ADC)值及指数表观扩散系数(eADC)值差异.结果 良、恶性卵巢肿瘤间囊性部分ADC值和eADC值的鉴别诊断阈值分别为2.755×10-3 mm2/s和6.455×10-2,而实性部分ADC值和eADC值的最佳阈值分别为1.195×10-3 mm2/s和29.55×10-2.结论 DWI ADC值和eADC值有助于卵巢良、恶性肿瘤的鉴别诊断.     

输卵管积水的不同处理及附件手术对体外受精-胚胎移植结局的影响

目的探讨输卵管积水的不同处理、输卵管手术及卵巢手术对体外受精-胚胎移植（IVF—ET）结局的影响。方法选择2003年10月至2007年12月我中心常规IVF-ET助孕的1,452个周期的临床资料,按不同处理分为输卵管切除组与输卵管造口组;卵巢巧克力囊肿（巧囊）与非巧囊囊肿剔除组;输卵管积水近端结扎远端造口组、输卵管积水切除组、积水穿刺抽吸组与积水未治疗组,以单纯输卵管阻塞为对照组,比较各组超排卵中卵巢反应及妊娠结局。结果与对照组相比,输卵管切除组、造口组卵巢反应及妊娠结局无明显差异,单侧输卵管手术不影响术侧卵巢反应（P〉0．05）;卵巢囊肿剔除术后Gn用量显著增加,获卵数显著减少,单侧卵巢手术影响术侧卵巢功能（P〈0．05）。与输卵管积水未治疗组相比,积水手术治疗后临床妊娠率、胚胎种植率显著增加（P〈0．05）,积水穿刺抽吸组临床妊娠率显著升高（P〉0．05）。结论输卵管手术不影响卵巢功能;卵巢囊肿剔除术后卵巢储备能力降低;输卵管积水对IVF-ET有负面影响,适当处理可改善妊娠结局,与积水穿刺抽吸术比较,IVF-ET前积水输卵管切除疗效更佳。     

经阴道自然腔道内镜及传统腹腔镜手术治疗卵巢囊肿的临床对比分析

目的对比经阴道自然腔道内镜手术(transvaginal natural orifice transluminal endoscopic surgery, vNOTES)和传统腹腔镜下卵巢囊肿手术治疗的可行性及安全性。 方法回顾性分析2017年11月至2018年4月,于四川大学华西第二医院同期进行手术治疗的18例卵巢囊肿患者的相关信息,按照手术途经分为vNOTES组及传统腹腔镜组,每组9例。统计并分析患者基线情况、手术相关数据。 结果18例患者手术均顺利完成,均未改变手术方式,无围手术期并发症的发生。基线情况中的盆腹腔手术史部分,vNOTES组较传统腹腔镜组少,差异有统计学意义(P<0.05)。手术相关数据中vNOTES组与传统腹腔镜组的平均手术时间分别为115 min和108.89 min,术前与术后血红蛋白下降分别为16.22 g/L和16.33 g/L,住院时间分别为2.78 d和3.33 d,疼痛视觉模拟评分(visual analogue scale,VAS)分别为1.89分和2.78分,术后1周美容评分分别为22.67分和17.78分,组间差异均无统计学意义。但在术后4周、术后24周美容评分上vNOTES组满意度较高,vNOTES组与传统腹腔镜组分别为(23.44分vs 18.56分)和(23.89分vs 19.11分),与传统腹腔镜组存在统计学差异(P<0.05)。 结论vNOTES较传统腹腔镜手术治疗卵巢囊肿有着独到的美容优势,充分的病情评估及病例选择后vNOTES途经是安全可行的。     

卵巢颗粒细胞瘤的超声影像与病理对照分析

目的探讨超声检查在诊断卵巢颗粒细胞瘤(OGCT)中的应用价值。方法回顾性分析38例经手术病理证实为卵巢颗粒细胞瘤且临床资料完整的患者,对患者子宫、卵巢行多切面仔细扫查,观察患者一般临床表现,分析超声图像特点分型、不同声像类型颗粒细胞瘤大小和血流分布情况,分析患者病理结果。结果38例卵巢颗粒细胞瘤患者均为单侧发病,形态规则,边界清,平均肿块最大径范围(8.8±3.8)cm。16例合并子宫内膜增厚,4例合并子宫内膜息肉,10例有腹水。声像图类型实性6例,平均径线(5.0±2.0)cm,肿块内血流信号分级:0级1例,2级2例,3级3例,平均血流阻力指数(0.49±0.05);声像图类型为囊实混合性30例,平均径线(8.8±3.2)cm,19例表现为多发小囊散在分布于实性成分内,呈“蜂窝”征改变,肿块内血流信号分级:0级4例,1级3例,2级13例,3级10例,平均血流阻力指数(0.42±0.08);声像图类型为囊性2例,平均径线(21.0±1.3)cm,肿块内血流信号分级:0级1例,1级1例,平均血流阻力指数(0.53±0.03)。33例病理诊断为成年型卵巢颗粒细胞瘤,5例诊断为幼年型颗粒细胞瘤。18例合并子宫内膜增生,4例合并子宫内膜息肉,病理结果与术前超声发现大致符合。结论卵巢颗粒细胞瘤以囊实混合性最常见,具有一定的超声图像特征,肿块内含多发小囊散在分布于实性成分,呈“蜂窝”征改变,彩色多普勒显示病灶可见较丰富血流信号。超声有助于卵巢颗粒细胞瘤的术前诊断。     

Unusual findings in the inguinal canal: a report of four cases

Masses in the inguinal canal other than hernias are rare occurrences, and their preoperative diagnosis requires a high index of suspicion. A soft, partly reducible groin mass in a 3-month-old boy proved to be a cystic lymphangioma within the inguinal canal. A 15-month-old female who presented with an irreducible inguinal mass was found to have a neuroblastoma metastasis in the groin. An irreducible groin mass in a 6-year-old female proved to be an inguinal canal epidermal inclusion cyst. A 14-year-old female presented with a painful groin swelling that represented an incarcerated hemorrhagic ovarian cyst. An awareness of the wide spectrum of entities other than the standard bowel, testicle, and ovary in the inguinal canal can help to identify uncommon pathologies preoperatively. Accepted: 6 January 1998     

Nasal septal perforation secondary to systemic bevacizumab

Importance

A case of nasal septal perforation secondary to systemic bevacizumab therapy for ovarian cancer is reported. Bevacizumab is a vascular endothelial growth factor A (VEGF-A) inhibitor that is becoming more widely utilized in the oncologic community. There is only one prior report of septal perforation secondary to bevacizumab in the Otolaryngology specific literature. The purpose of this report is: 1) to raise awareness and discuss the literature surrounding the sinonasal complications of bevacizumab and 2) provide workup and treatment recommendations based on the sum of the available literature.

ENDOSCOPIC DIAGNOSIS OF INTRADUCTAL PAPILLARY‐MUCINOUS NEOPLASM OF THE PANCREAS BY MEANS OF PERORAL PANCREATOSCOPY USING A SMALL‐DIAMETER VIDEOSCOPE AND NARROW‐BAND IMAGING

Background: Intraductal papillary‐mucinous neoplasm (IPMN) is an intraductal tumor in which the mucin‐producing epithelium shows proliferated papillary and a wide variety of pathological changes ranging from hyperplasia to adenocarcinoma. Therefore, it is important to determine whether an IPMN is benign or malignant. In the present study of patients with IPMN, the protrusion was observed by a peroral pancreatoscopy (PPS) using a small‐diameter videoscope and narrow‐band imaging (NBI). We carried out the differential diagnosis of benign lesion to malignant lesion. Methods: Between April 2003 and May 2009, PPS using a small‐diameter videoscope by means of NBI was carried out on 21 hospitalized patients with IPMN (10 cases of adenocarcinoma, 11 cases of adenoma or hyperplasia; 14 males and seven females, with a mean age of 69.4 years). Results: Fifteen focal lesions of the 16 cases in the head of the pancreas (93.7%) and four focal lesions of the five cases in the pancreatic body (80%) were observable, whereas two lesions (adenocarcinoma in the pancreatic body, and adenoma in the uncus of pancreas) were not observable. Endoscopically, seven cases were classified as villous type and two cases as vegetative type, and nine cases were diagnosed as adenocarcinoma. Ten cases with sessile type or semipedunculated type were diagnosed as adenoma or hyperplasia. Vascular patterns and protrusions were detected more clearly in the NBI images than under white light observation. Conclusions: When combined with a videoscope and NBI, pancreatoscopy provided a clear image and was useful for evaluating whether the IPMN was benign or malignant.     

阴道超声结合CDFI诊断卵巢肿瘤的价值

目的探讨经阴道超声结合彩色普勒超声鉴别附件肿瘤良恶性的价值。方法对84例附件肿瘤患者进行术前阴道超声检查,对声像图行形态学特征分析及Lerner评分;同时用彩色多普勒检测获得PI值和RI值,将诊断结果与手术病理相对照。结果以B超积分≥3分诊断卵巢恶性肿瘤的符合率为90.3%,以B超积分〈3分诊断卵巢良性肿瘤的符合率为92.5%,良恶性肿瘤Lerner评分差异有统计学意义（P〈0.01）。良性肿瘤血管多分布于肿瘤周边或隔上,而恶性肿瘤血供丰富,血管主要分布于肿瘤实质区。良恶性肿瘤RI、PI值差异有统计学意义（P〈0.01）。以B超积分≥3分和PI〈1.0、RI〈0.4诊断卵巢恶性肿瘤的符合率为96.8%,以B超积分〈3分和PI≥1.0、RI≥0.4诊断卵巢良性肿瘤的符合率为96.2%。结论不能单纯用PI或RI等某一指标来判断肿瘤的性质,联合应用二维超声、CDFI及动力学指标,综合分析,可最大限度地提高对附件肿瘤诊断的准确性。     

Female offspring sired by diet induced obese male mice display impaired blastocyst development with molecular alterations to their ovaries,oocytes and cumulus cells

Purpose

To investigate the impacts that a paternal high fat diet (HFD) has on embryology, ovarian/cumulus cell gene expression and COC metabolism from female offspring, using a mouse model.

Methods

Founder male mice were either fed a control diet (CD) or a HFD for 12 weeks. The HFD induced obesity but not diabetes, and founder males were then mated to normal weight CD fed female mice. Female offspring were maintained on a CD, super-ovulated, mated and the resultant zygotes were cultured to the blastocyst stage for embryo morphology, blastocyst cell number and apoptosis assessment. Ovaries and cumulus cells from offspring were collected for gene expression analysis of selected genes that maintain chromatin remodeling and endoplasmic reticulum (ER), metabolic and inflammatory homeostasis. Cumulus/oocyte complexes were also investigated for glucose uptake and lipid accumulation.

Results

Female offspring sired by obese fathers produced embryos with delayed development and impaired quality, displayed increases in ovarian expression of Glut1, Glut3 and Glut4, and an increase in cumulus cell expression of Glut4. Interestingly their COCs did take up more glucose, but did accumulate more lipid.

Conclusions

A paternal HFD is associated with subfertility in female offspring despite the offspring being fed a CD and this subfertility is concomitant with ovarian/cumulus cell molecular alterations and increased lipid accumulation.

Electronic supplementary material

The online version of this article (doi:10.1007/s10815-015-0470-x) contains supplementary material, which is available to authorized users.     

IVF for fertility preservation in breast cancer patients—efficacy and safety issues

Background

Potential risks on future fertility have become a dominant issue in consultation and management of newly diagnosed young cancer patients. Several fertility preservation strategies are currently available. Of those, ovarian stimulation followed by IVF and embryo cryopreservation is the most established one and is especially applicable in reproductive aged breast cancer patients.

Aim

The aim of this study is to provide a comprehensive review on ovarian stimulation and IVF for fertility preservation in newly diagnosed breast cancer patients.

Methods

Review of relevant literature is available through PubMed and Google scholar.

Results

The use of IVF for fertility preservation in breast cancer patients raises dilemmas regarding efficacy and safety of controlled ovarian stimulation. Among these are the suggested role of malignancy and BRCA mutation in reducing ovarian response to stimulation, strategies designated to protect against hyper-estrogenic state associated with stimulation (co-treatment with tamoxifen or letrozole), and possible adjustments to accommodate oncologic-related time constraints.

Conclusion

Ovarian stimulation followed by IVF forms an important fertility preservation strategy for newly diagnosed young breast cancer patients, though live born rates following thawed embryo transfer in these patients are still lacking. Recent advances in controlled ovarian stimulation protocols provide practical options for some of the challenges that breast cancer patients present.