血管内皮生长因子与妊娠高血压综合征发病的关系

目的　探讨血管内皮生长因子 (VEGF)在妊娠高血压综合征发病中的作用。方法　分别采用酶联免疫吸附试验检测 40例妊高征孕妇的血清VEGF水平 ,免疫组化检测胎盘及蜕膜组织VEGF及CD3 4表达情况 ,35例正常孕妇作对照。结果　①妊高征组孕妇的外周血VEGF水平及胎盘组织MVD明显低于正常妊娠组 (P <0 0 5 ) ;②两组胎盘绒毛滋养叶细胞和蜕膜组织中均有VEGF阳性表达 ,胎盘组织强阳性表达高于蜕膜。与对照组比较 ,其胎盘组织VEGF强阳性表达的轻度妊高征无显著性差异 ;而中度和重度妊高征与对照组相比 ,则明显降低 ,差异显著 (P <0 0 5 )。各组孕妇蜕膜组织中VEGF的表达强度和差异无显著性。③孕妇外周血VEGF水平与新生儿出生体重 (r =0 2 9,P <0 0 5 )和胎盘重量 (r =0 34,P <0 0 1)均存在直线正相关关系。结论　妊高征患者血清VEGF水平和胎盘组织MVD降低 ,胎盘组织VEGF表达明显下降 ,都可能在妊高征的发病中起一定的作用。     

三联药物治疗未破裂异位妊娠的临床研究

目的 :观察甲氨蝶呤(Methotrexate,MTX)、米非司酮(Mifepristron,Ru486)及中药三联用药治疗未破裂型异位妊娠的临床疗效。方法 :对171例未破裂型异位妊娠病人 ,按药物治疗方法不同分为两组进行对照研究 :A组使用MTX注射 +Ru486口服 +中药联合治疗。B组单独使用MTX注射治疗。测定法定期测定两组病人血HCG值以监测血HCG下降情况 ,测量异位妊娠包块三径线值以监测病灶包块缩小情况 ,同时观察临床症状持续时间、副反应发生率及总有效率。结果 :血HCG下降及病灶包块缩小A组较B组明显 ,差异有显著性(p<0 05,p<0 01);临床症状持续时间A组较B组短 ,差异有显著性(p<0 05);副反应发生率两组间无显著差异(p>0 05);A、B两组的总有效率分别为 :95 74%和71 43% ,A组较B组高 ,差异有显著性(p<0 05)。结论 :三联使用甲氨蝶呤、米非司酮及活血化瘀消包块杀胚的中药既有很强的杀胚功能 ,又能消除病灶包块 ,保留生育功能。三联药物联合治疗未破裂异位妊娠具有疗效肯定、安全     

输卵管妊娠保守治疗适应证选择

目的　探讨彩色多普勒超声 (CDFI)筛选合适药物保守治疗异位妊娠的临床价值。方法　 5 0例生命体征平稳的异位妊娠患者 ,在行CDFI检查后接受甲氨蝶呤 (MTX) 5 0mg/m2 单次肌肉注射配合米非司酮 2 5mg ,Bid 3d口服 ,随访直至临床结局。分析成功与失败病例CDFI的特点和绒毛膜促性腺激素 (HCG)的水平 ,并制作CDFI评分。结果　CDFI能直接反映胚胎生命力 ,不同CD FI图像和血清HCG水平的病例 ,保守治疗成功率有很大差异。结论　CDFI评分可应用于适合保守治疗异位妊娠病例的筛选。对评分 >10者 ,因失败率高 ,不推荐药物保守治疗     

利用主客体分子包结现象选择分离蛇床子有效成分的方法

利用1,1,6-四苯基-2,4-已二炔-1,6-二醇(I)的包结能力,可简单而迅速地从蛇床子中选择分离出有效成分欧前胡素(2)和花椒毒素(3),收率分别为0.054%(2)和0.002%(3)。本文用UV,IR,¹HNMR和¹³CNMR验证了2和3的化学结构,并用HPLC检验了2和3的纯度。X-射线衍射晶体结构分析表明主体分子I与组分2靠氢键形成包结物,它们的摩尔比为1:2,氢键长为2.8612A。包结物晶体属单斜晶系,空间群为已P₂₁/C,晶胞参数:a=15.468(5)A,b=8.595(3)A,c=18.663(7)A,β=93.64(5)°,Z=4和R=0.088。     

Natural history of extensive Mongolian spots in mucopolysaccharidosis type II (Hunter syndrome): a survey among 52 Japanese patients

BACKGROUND: Recent reports have shown a correlation between extensive Mongolian spots and mucopolysaccharidosis type II (Hunter syndrome). However, a statistical survey of the incidence and natural history of extensive Mongolian spots among the patients with Hunter syndrome is lacking. OBJECTIVES: To determine the prevalence of extensive Mongolian spots, to determine the natural course of the spots according to age in Japanese patients with Hunter syndrome, and to compare them with the results obtained from the patients' brothers who did not have Hunter syndrome. PATIENTS/METHODS: Fifty-two males with Hunter syndrome aged 3 to 40 years were studied. Twenty-five patients were examined in two clinics to determine the existence and characteristics of the spots. We interviewed their families about the spots in their neonates and the natural course of the spots according to their ages. The same survey was done among another 27 patients using a mailed questionnaire to their families. As control, we investigated 21 brothers of the patients by a mailed questionnaire to their families. RESULTS: The extensive Mongolian spots are identified in almost all the infants with Hunter syndrome and disappear extremely later in their life. The lesions had a high incidence of deep-blue hyperpigmentation. Regardless of age, the overall incidence was 78%. All of the brothers who did not have Hunter syndrome had common-type Mongolian spots in neonates, which regressed during their childhood. CONCLUSION: Our results confirm a strong correlation between extensive Mongolian spots and Hunter syndrome for the Japanese population. The presence of extensive Mongolian blue spots should alert the physician to the possibility of Hunter syndrome.     

Oral mifepristone 600 mg and vaginal gemeprost for mid-trimester induction of abortion: An open multicenter study

This open multicenter study was performed in 20 hospital gynecological units in the UK. The effects of 600 mg oral mifepristone as pretreatment to vaginal prostaglandin induction of second second trimester abortion was studied in 267 women.

The primary efficacy variable was the abortion induction interval, defined as the time taken to expel the fetus from the time of administration of the first prostaglandin pessary. Induction was commenced 36 to 48 hours following mifepristone intake.

The mean abortion induction interval was 7 h. A total of 81.9% of women aborted within 12 h. There was a significant relationship between abortion induction interval and age of gestation, and a significant inverse relationship between abortion induction interval and parity.

Vomiting, pelvic pain, and nausea were the most frequently reported adverse events. Two patients required transfusion and one patient with a uterine scar from a previous cesarean section suffered a ruptured uterus and hysterotomy.     

Screening and treatment of bacteriuria in pregnancy and postpartum period

The paper gives an overview of today's knowledge of urinary tract infection in pregnancy and different treatment procedures. Three different studies of urinary tract infection (UTI) in pregnancy and the postpartum period are reported. Urinary screening of 1798 pregnant women showed a cumulative frequency of bacteriuria of 4.8%, recurrent infection in one-fifth of the cases, and pyelonephritis in 0.6%. Chlamydial infection was observed as a cause of dysuria in pregnancy. In the postpartum period bladder bacteriuria was demonstrated in 3.7%. The condition persisted in 27%, while short-course treatment had significant effect.Presented at the Zambon Symposium on Bacteriuria in Pregnancy, International Urogynecological Association Annual Meeting, Riva del Garda, Italy, September 13, 1989.     

Interaction of Heparin With Antiphospholipid Antibodies (APA) From the Sera of Women With Recurrent Pregnancy Loss (RPL)

PROBLEM: To determine if heparin may act directly with antiphospholipid antibodies (APA) to prevent recurrent pregnancy loss (RPL). METHOD: Patients were seen at the University of Texas Southwestern Medical Center. Twenty women with a history of RPL (≥3 miscarriages), positive APA, and an otherwise normal evaluation were treated with heparin in two daily subcutaneous dosages during a successful pregnancy. APA levels were obtained prior to conception and again at 6, 20, and 30 weeks. RESULTS: Heparin reduced APA binding to cardiolipin and phosphatidylserine in a dose-dependent fashion in ELISA. Heparin affinity chromatography absorbed over 80% of the IgG anticardiolipin antibody in serum from women with high levels of APA. Women treated with increasing dosages of heparin during pregnancy had inversely decreasing levels of IgG anticardiolipin antibody. CONCLUSION: Heparin may act by directly binding APA in vivo, thereby decreasing the adverse effects of APA in women with APA associated RPL.     

Successful triplet pregnancy in a patient with a unicornuate uterus with a cavitary communicating rudimentary horn

In a patient with primary infertility, ovulation was inducedby monitored stimulation with human menopausal gonadotrophins(HMG) because of polycystic ovarian disease. Infertility work-uphad shown a unicornuate uterus with a cavitary communicatingrudimentary horn. The husband showed a varicocele-related moderateoligoasthenoterato-zoospermia. A triplet pregnancy occurredin a third HMG ovulation induction cycle combined with intra-uterineinsemination of the husband's washed semen. The pregnancy wascarefully monitored, and measures to prevent premature deliverywere taken. Because of the patient's obvious discomfort in thepresence of premature labour, Caesarean section was performedat 33 weeks gestation and three healthy infants were delivered.This is the first report of a successful triplet pregnancy ina women with a unicornuate uterus. The reproductive and obstetricoutcome of this condition in general, and in the case of multiplepregnancy, is discussed.     

The biomechanics of vibration and low back pain

This work is a review of the mechanical factors related to low back pain production in a vibration environment. The sitting posture is an extreme orientation for the lumbar intervertebral disc that 1) increases its internal pressure, 2) increases its anteroposterior shear flexibility, while: 3) decreasing its resistance to buckling instability and 4) stressing the posterior region of the disc. Vibration is an additional mechanical stressor. Several studies suggest that the following preventive measures be taken to reduce the risk of low back pain due to driving: 1) minimize the vibration reaching the driver, 2) avoid lifting or bending immediately following driving, and 3) walk around for a few minutes following driving. © 1993 Wiley-Liss, Inc.