The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications

Objective To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy. Methods Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up hysteroscopy performed 2–4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up hysteroscopy at about 12 months (8–16 months). The two groups were similar to composition. Postoperatively, none of the early diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was made to lyse them. Results At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60% of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one (P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to determine the subsequent reproductive outcome revealed similar conception rates in both groups. Conclusion The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting from the original surgery.     

Preimplantation sex selection demand and preferences among infertility patients in Midwestern United States

Purpose To determine the demand and preferences of infertility patients for sex selection for nonmedical reasons, and to investigate the relation between these choices and their demographic and socioeconomic characteristics. Methods A cross-sectional, self-administered survey by mail was conducted at a University hospital-based fertility center of 1,350 consecutive women who presented for infertility care, to assess patient demand and preferences for sex selection. Results Of respondents, 49% wanted to select the sex of their next child for no added cost. Of these patients, 56% had no living children and 37% had children all of one sex. After adjustment for observed predictors of gender preference, we found a significant preference for a female child among women who had only sons, had more living children, or were single. Nulliparous women did not significantly prefer one sex over the other. Among parous women, those with only daughters significantly desired to select a male child, whereas those with sons significantly desired to select a female child. Conclusion There is significant demand among infertility patients for preimplantation sex selection, with a significant portion of this demand coming from patients who do not have any children or have children all of one sex. Presented in part at the American Society for Reproductive Medicine (ASRM) Annual Meeting, New Orleans, Louisiana, October 2006. Financial support: none Conflict of interest: none     

女性原发性骨质疏松性骨折患者生命质量影响因素分析

目的:评价女性原发性骨质疏松性骨折患者的生命质量并探讨其影响因素,为提高女性骨质疏松性骨折患者的生命质量提供理论依据。方法:采用横断面调查的方法,应用SF-36健康调查量表和自制一般情况问卷对79例女性原发性骨质疏松性骨折患者进行调查。结果:除精神健康外,生命质量各维度得分女性原发性骨质疏松性骨折患者均低于大于等于60岁四川省城市女性,且差异均有统计学意义(P<0.05)。单因素分析发现,不同年龄、婚姻状况及月经史间比较,生理健康总分各组间差异均有统计学意义(P<0.05);不同年龄、文化程度和骨折时间间比较,心理健康总分各组间差异均有统计学意义(P<0.05);不同年龄、吸烟、骨折次数和月经史间比较,生命质量总分各组间差异均有统计学意义(P<0.05)。多元线性回归分析发现,年龄和婚姻状况是女性原发性骨质疏松性骨折患者生理健康的独立影响因素,年龄和文化程度是心理健康的独立影响因素,年龄和骨折次数是生命质量总分的独立影响因素。结论:女性原发性骨质疏松性骨折患者的生命质量差,且年龄、婚姻状况、文化程度及骨折次数是其主要影响因素,应该采取针对性的预防干预措施提高患者的生命质量。     

不育男性血清抑制素B水平检测及临床应用

目的探讨血清抑制素B（INHB）的水平与精子发生的关系及临床应用。方法对195例不育男性患者与30例正常生育男性进行血清抑制素B和血清促卵泡成熟激素（FSH）、黄体生成素（LH）检测,并进行精液常规分析。结果①少精子症各组和非梗阻性无精子症组血清INHB均低于正常对照组。非梗阻性无精子症组与梗阻性无精子症组比较,血清INHB差异有统计学意义（P〈0.05）。②血清INHB水平与精子密度、精子总数呈显著正相关（r=0.456,P〈0.01;r=0.604,P〈0.01）,与血清FSH、LH呈显著负相关（r=-0.537,P〈0.01;r=-0.413,P〈0.01）。结论血清INHB水平可反映睾丸精子的发生情况,可作为临床评价睾丸生精作用的重要指标。     

经尿道电切术治疗女性膀胱颈梗阻35例

目的 提高女性膀胱颈梗阻的诊断治疗水平。方法 对35例女性膀胱颈梗阻患者诊治过程进行分析。结果 35例行经尿道胶胱颈后唇电切术效果满意，无尿失禁及尿瘘发生。结论 经尿道膀胱颈切除是最佳方法。     

不育妇女个性特征与社会支持的相关性研究

对不育妇女的个性特征、社会支持情况及两者之间的相关性研究表明，不育妇女有偏于内向、情绪不稳、好掩饰的个性特征，她们获得的社会支持比已生育的健康女性少；不育妇女的社会支持情况与其情绪稳定性及个性类型密切相关，情绪不稳定、性格内向的不育妇女不易于接受社会支持。     

齐拉西酮与利培酮治疗女性精神分裂症对照研究

目的:比较齐拉西酮与利培酮治疗女性精神分裂症患者的疗效及不良反应。方法:将60例女性精神分裂症患者随机分成两组,分别给予齐拉西酮与利培酮治疗8周。采用阳性症状与阴性症状(PANSS)及不良反应量表(TESS)于治疗前及疗后2、4、8周末评估疗效和不良反应。结果:两组有效率分别为83.33%和86.67%,无显著差异(P>0.05),两药治疗女性精神分裂症疗效相当;齐拉西酮较少引起锥体外系反应(EPS),较少出现月经周期的改变。结论:齐拉西酮疗效和利培酮相当,且不良反应轻,是治疗女性精神分裂症患者的较好选择。