妊娠期妇女外阴阴道念珠菌病的病原学和治疗研究

目的 调查孕妇外阴阴道念珠菌病(vulvovaginal candidiasis，VVC)的发病率，对检出的VVC进行病原学和治疗研究。方法 连续对产科门诊1000例孕妇进行VVC发病情况调查。对分离的念珠菌进行体外抗真菌药物敏感试验。对66例VVC患者应用咪康唑栓治疗，400mg／d，6d为一疗程。结果 孕妇VVC的发病率为12．7％(127／1000)。37．4％(374／1000)的孕妇以往有VVC病史，0．6％的孕妇为复发性VVc。127例VVC中，白念珠菌、光滑念珠菌、热带念珠菌和克柔念珠菌分别占87．1％、9．9％、1．5％和1．5％。有4例患者同时感染2种念珠菌。114株白念珠菌对咪康唑、克霉唑、氟康唑、伊曲康唑、制霉菌素耐药率依次为10．5％、2．6％、6．1％、7．9％和0。13株光滑念珠菌对咪康唑和制霉菌素均敏感，对克霉唑、伊曲康唑和氟康唑均敏感或剂量依赖敏感。应用咪康唑栓治疗的患者在治疗完成后1～2周及4～6周的病原学治愈率分别为84．8％和80．3％。结论 VVC是孕妇的常见病，白念珠菌仍然是主要致病菌，其次为光滑念珠菌。常用抗真菌药物对引起VVC的念珠菌存在不同程度的耐药率，应用咪康唑栓治疗孕妇VVC效果满意。     

Foetal radiation dose in radiotherapy for breast cancer

Management of breast cancer during pregnancy is complicated by the high risks of abortion and foetal malformation from the use of radio therapy and chemotherapy. A case of breast cancer during pregnancy, treated with radiotherapy, and the estimated foetal dose is reported.     

Transurethral resection of a bladder tumor in pregnancy: A report of 2 cases

Carcinoma of the urinary bladder presenting during pregnancy is rare. We report two such cases presenting with gross hematuria, both of which were managed by transurethral electroresection of the tumor; there was no adverse effect on the pregnancies. Transurethral resection thus appears to be the procedure of choice in the management of this condition, and carries minimal morbidity even when performed during pregnancy. EDITORIAL COMMENT: As these authors point out, bladder tumors are rare in pregnancy and frequently present as gross hematuria that is mistaken for vaginal bleeding due to the pregnancy. Ultrasound is very helpful in distinguishing the causes of bleeding, and will show the bladder filled with clots and frequently the tumor as well. Standard transurethral resection is effective when performed during pregnancy, bearing in mind the need to heed to the anesthetic risks inherent in any operative procedure during pregnancy.     

上海市闵行区流动人口中的孕产妇保健状况

通过对上海市闵行区580名外来孕产妇及580名作为对照的本地孕产妇的孕产期保健现况调查分析,表明外来孕产妇缺乏必要的孕产期保健措施,有47.6％的外来孕产妇从未做产前检查,产后保健则完全没有,并由此而造成外来产妇在急产、死产、甚至孕产妇死亡等方面令人忧虑的现状。为适应和促进当前经济发展的新形势,改善流动人口的孕产妇保健状况,应对流动人口中孕产妇保健状况深入研究,并采取相应的措施。     

米索前列醇用于正常足月妊娠计划分娩临床效果分析

目的:研究米索前列醇促宫颈成熟、诱发临产的效果及用药量。方法:将200例正常足月孕妇随机分为催产素组(对照组)100例和米索前列醇组(观察组)100例。结果:①引产有效率观察组明显高于对照组;②米索前列醇用药1天有效率为91％,用药量为100.54±25.27μg;2天有效率为97％,用药量为108.76±63.53μg;③孕妇产后出血及剖宫产率两组无显著差异;④羊水混浊发生率,观察组高于对照组差异有显著性;新生儿窒息率,两组相同,差异无显著性。结论:米索前列醇促宫颈成熟及诱发临产效果明显好于催产素,用于正常足月妊娠进行计划分娩是一种安全、有效、方便的方法,值得推广。     

妊娠期嵌顿痔手术治疗91例临床观察

目的:探讨妊娠期嵌顿痔手术治疗的可行性和安全性。方法:采用手术方法治疗妊娠期嵌顿痔91例,观察疗效。结果全部治愈,均能及时解除痛苦,恢复排便功能。结论:手术方法治疗妊娠期嵌顿痔基本安全可靠。     

Arteriovenous malformations that rupture during pregnancy: a management dilemma

Summary Intracranial haemorrhage due to rupture of an arteriovenous malformation (AVM) during pregnancy is a rare but serious condition that warrants prompt recognition. Once the diagnosis is made, the management is primarily based on neurosurgical rather than obstetric considerations. Due to its rarity, no definitive guidelines exist, and the best time to perform elective surgery (i.e., at presentation or at completion of the pregnancy) is ill-defined. This report describes three patients recently treated at our institution who had AVMs that ruptured during pregnancy. These cases well summarize the difficulties encountered in treating such patients. The diagnostic as well as the therapeutic implications of this condition are discussed.     

低剂量阿司匹林在辅助生育技术中的应用

目的　探讨在进行体外受精 -胚胎移植 ( IVF-ET)或卵母细胞浆内单精子注射 ( ICSI)患者口服低剂量阿司匹林对治疗结果的影响。　方法　 IVF或 ICSI治疗的 3 2 4个 ET周期 ,分为是否服用阿司匹林两组 ,分别统计患者注射人绒毛膜促性腺激素 ( h CG)时子宫内膜厚度及 ET胚胎数 ,比较两组的胚胎种植率、临床妊娠率及流产率 ,并进行统计学处理。　结果　两组在注射 h CG日内膜平均厚度、ET中优质胚胎的比率及流产率均无显著性差异 ;未服用阿司匹林组的 ET胚胎数明显多于服用组 ( P<0 .0 1 ) ,而前者的种植率、临床妊娠率却明显低于后者 ( P<0 .0 1 )。　结论　低剂量阿司匹林在 IVF-ET或ICSI的辅助生殖治疗中能有效地提高胚胎种植率 ,增加患者的临床妊娠率     

Smoking in Pregnancy and Parenthood: What is the Role of Depression, Anxiety and Nicotine Addiction?

This paper presents some of the findings from the Smoking in Pregnancy study of attitudes towards smoking among pregnant women, mothers of young children and their partners in East Surrey. As part of the study, respondents completed a General Health Questionnaire to identify mental health difficulties and, if they were smoking at the time of the study, they also completed the Fagerstrom nicotine addiction test. Eleven female respondents had high scores on the General Health Questionnaire, suggesting symptoms of depression, anxiety and/or social dysfunction for these women. There was no evidence that smokers were suffering from greater mental health difficulties than ex-smokers or non-smokers. However, the General Health Questionnaire scores of smokers were positively associated with their level of nicotine dependence. Furthermore, when General Health Questionnaire scores of all respondents were compared with self-reported health status there was a marked discrepancy suggesting under-reporting of symptoms by women.     

流产鼠Caspase-3与laminin B和PAI-1的表达及对妊娠结局的影响

目的:研究阻断CD86协同刺激分子对自然流产模型孕鼠母胎界面Caspase-3、laminin B和PAI-1的表达及对妊娠结局的影响。方法:实验组于妊娠第4.5天腹腔注射大鼠抗小鼠CD86单抗,实验对照组注射大鼠同型IgG2b,正常妊娠组不作任何处理。于妊娠第13.5天计算胚胎吸收率,用免疫组化测定Caspase-3、laminin B和PAI-1的表达,并进行图像分析、检测免疫组化染色灰度值(A)。结果:①实验组的胚胎吸收率显著低于实验对照组(P<0.05);②实验组中Caspase-3蛋白灰度值明显高于实验对照组(P<0.05),实验组中laminin B和PAI-1蛋白灰度值均明显低于实验对照组(P<0.05)。结论:妊娠早期阻断CD86协同刺激分子可使母胎界面中的Caspase-3、laminin B和PAI-1分别通过各自不同的途径发挥免疫耐受作用并且使自然流产模型孕鼠的胚胎吸收率降低至正常妊娠水平。