A qualitative analysis of patients’ perception of microwave endometrial ablation as a satisfactory treatment for heavy menstrual blood loss

To explore and analyse patients’ views and comments on microwave endometrial ablation (MEA), we designed a simple and concise questionnaire of 10 items that the participants answered by ticking boxes. They were invited to add their own comments and opinions if they wished. The questionnaire survey was posted to 470 patients who were treated with MEA at Derriford Hospital between 1997 and 2003. We received replies from 343 patients (73%), of whom 165 included handwritten comments (48%). These were reviewed using content thematic analysis. This paper describes the findings of this analysis. Of the 343 respondents, 127 expressed their satisfaction, 32 would recommend MEA to others, and 17 claimed that MEA had transformed their lives. They used words such as “delighted,” “grateful,” “fantastic,” “I cannot tell you how wonderful it has been,” “freedom at last,” “I feel so much better within myself,” “I cannot begin to describe the feelings of well-being and relief I have experienced since I had this treatment,” and “it has changed my life from being housebound to never giving my periods a thought.” Thirty-eight patients were not satisfied; of these, 14 were experiencing moderate to severe pain, and six claimed to have developed severe pain de novo. Their comments included “I was disappointed MEA did not work for me” and “I get heavy bleeding and pain each month, [whereas] before I had no period pains at all.” In conclusion, MEA has been a “miracle cure” for many women who responded, with around 77% being satisfied with this treatment. For a small number, MEA was not successful. For some women, pain was a problem that either developed de novo or was preexisting in the form of dysmenorrhoea. In this paper we also mention success rates and figures from quantitative studies, and we recommend including quotes from satisfied patients in patient information leaflets to further help women and their physicians make informed choices about managing heavy menstrual blood loss, particularly when medical treatment is known to be less successful and with some women being concerned about its side effects.Shortly after this paper was submitted, Emad Louis tragically died from complications following surgery, whilst waiting to take up his post as a Consultant at St. Mary’s Hospital, Isle of Wight. We remember him with great affection as a wonderful colleague, who is held in the highest regard by his patients and all who worked with him. He is greatly missed.He leaves a wife and son who are enormously proud that his research has been published.     

Laparoscopic surgical staging for uterine malignancies using harmonic shears (UltraCision) in comparison to electrosurgery: operative technique, feasibility and complications

This retrospective study assesses and compares perioperative parameters in two groups of patients treated by different operative techniques of laparoscopic surgical staging (LASS) for uterine cancer. Between April 1996 and May 2005, 119 consecutively selected women with cervical cancer (n=30) or clinical stage I endometrial cancer (n=89) underwent laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH) or radical laparoscopic assisted vaginal hysterectomy (RALVH) plus bilateral salpingo-oophorectomy (BSO) and/or lymph node dissection (LND) during a primary surgical procedure using an electrosurgery (ELC, n=37) or ultrasonic (US, n=82) operative technique (harmonic shears, UltraCision). The UltraCision was used as a primary method of dissection and hemostasis from 1999. We were unable to perform prompt and thorough hemostasis in 2 patients from the US group (successful procedure rate 97.5%) because of ineffective post-ultrasonic coagulation of venous paravaginal varices (RALVH procedure) and of vena ovarica varices (LAVH, BSO procedure). The UltraCision was effective in all cases of lymphadenectomy. Successful procedure rate of the ELC operative technique was 100%. There were no statistically significant differences between the groups with regard to operation time, blood loss, hospital stay, and complications. There was a significant difference (P<0.001) in the number of lymph nodes harvested: a mean of 18.1 in the US group and 13.7 in the ELC group. We think that the difference was influenced by an increase in experience with laparoscopic lymph node dissection. The UltraCision operative technique ensures efficient dissection, coagulation, cutting, and grasping for LASS in women with cervical and endometrial cancer.     

Diagnostic accuracy of sonohysterography in the evaluation of uterine cavities in tamoxifen administered asymptomatic postmenopausal breast cancer patients with endometrial thickness ≥5 mm

To evaluate diagnostic efficacy of transvaginal saline infusion sonohysterography (TV-SHG) in the evaluation of uterine cavities in tamoxifen (TAM) administered asymptomatic postmenopausal breast cancer patients with increased endometrial thickness, sixty asymptomatic postmenopausal breast cancer women receiving adjuvant TAM treatment for at least 6 months and with endometrial thickness’ ≥5 mm measured in transvaginal ultrasonography (TVS) were enrolled. Each patient underwent TV-SHG, followed by outpatient hysteroscopy (HYS) with endometrial biopsy. TV-SHG application was accepted as unsuccessful in four cases (6.7%). When office HYS combined biopsy was considered as gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TV-SHG were estimated as 90%, 100%, 100%, and 95%, respectively. Our findings showed that TV-SHG was a valuable diagnostic tool in the evaluation of uterine cavities of TAM administered asymptomatic postmenopausal patients having an increased endometrial thickness.     

细胞角蛋白-20mRNA在子宫内膜癌淋巴结中的表达及意义

目的 探讨巢式RT-PCR法检测子宫内膜癌区域淋巴结中细胞角蛋白-20信使RNA（CK20 mRNA）的表达,以了解肿瘤细胞的微转移.方法 取2003年3月至2004年2月间在北京大学人民医院手术治疗的18例子宫内膜癌患者的100枚盆腔淋巴结,巢式RT-PCR法检测其CK20mRNA的表达,同时取5例子宫肌瘤患者的子宫组织及淋巴结20枚作为阴性对照.取子宫内膜癌细胞系Ishikawa及子宫内膜癌组织作为阳性对照.结果 CK20 mRNA在Ishikawa细胞及全部18例子宫内膜癌组织中均呈阳性表达,阳性率100%（敏感性100%）.而在对照的5例正常子宫组织及20枚正常淋巴结中均未表达（特异性100%）.18例子宫内膜癌中有16例经手术病理分期为Ⅰ、Ⅱ期,临床病理检查淋巴结均为阴性;而用巢式RT-PCR方法检测,有5例CK20 mRNA呈阳性表达,证实有肿瘤细胞的微转移,阳性率为31%.结论 CK20可以作为检测子宫内膜癌细胞微转移的标志物.Ⅰ、Ⅱ期子宫内膜癌中有约31%的病例存在有区域淋巴结的肿瘤细胞微转移,其术后复发可能与此有关.     

诊断性宫腔镜对临床Ⅰ期子宫内膜癌患者腹水细胞学及预后的影响

目的：探讨临床Ⅰ期子宫内膜癌患者使用诊断性宫腔镜的安全性,是否增加腹水细胞学的阳性率及对预后的影响.方法：回顾性分析本院52例术前官腔镜诊断为临床Ⅰ期子宫内膜癌患者的临床资料,了解术中腹水细胞学检查、手术方式、手术病理分期等,随访预后.结果：宫腔镜距离开腹手术的平均时间间隔是36天（5～82天）,腹水细胞学阳性率2/52（3.8%）,平均生存时间81个月（9～130个月）,5年生存率91.5%.结论：诊断性宫腔镜未增加临床Ⅰ期子宫内膜癌患者阳性腹水细胞学的风险,亦未对预后造成不良影响.     

米非司酮对子宫内膜癌细胞周期时相调控的研究

 目的 探讨抗孕激素米非司酮对子宫内膜癌细胞周期时相的调控作用. 方法 体外培养子宫内膜癌HHUA细胞,不同浓度米非司酮处理细胞24～96小时,流式细胞术（FCM）测定癌细胞周期分布的变化;免疫组化法观察细胞周期调控蛋白的表达变化. 结果 当抗孕激素米非司酮浓度≥5μmol/L作用癌细胞36小时,G1期细胞比率明显上升,S期细胞比率（SPF）降低（P〈0.05）;细胞周期调控蛋白p21和p16表达明显上调（P〈0.05）. 结论 抗孕激素米非司酮通过调节细胞周期相关蛋白表达使HHUA细胞阻滞于G1期,抑制癌细胞增殖.     

Reactivation of codogenic endogenous retroviral (ERV) envelope genes in human endometrial carcinoma and prestages: Emergence of new molecular targets

Endometrial carcinoma (EnCa) is the most common invasive gynaecologic carcinoma. Over 85% of EnCa are classified as endometrioid, expressing steroid hormone receptors and mostly involving pathological prestages. Human endogenous retroviruses (ERV) are chromosomally integrated genes, account for about 8% of the human genome and are implicated in the etiology of carcinomas. The majority of ERV envelope (env) coding genes are either not present or not consistently represented between common gene expression microarrays. The aim of this study was to analyse the absolute gene expression of all known 21 ERV env genes including 19 codogenic and two env genes with premature stop codons in EnCa, endometrium as well as in hyperplasia and polyps. For EnCa seven env genes had high expression with >200 mol/ng cDNA (e.g. envH1-3, Syncytin-1, envT), two middle >50 mol/ng cDNA (envFc2, erv-3) and 12 low <50 mol/ng cDNA (e.g. Syncytin-2, envV2). Regarding tumor parameters, Syncytin-1 and Syncytin-2 were significantly over-expressed in advanced stage pT2 compared to pT1b. In less differentiated EnCa Syncytin-1, erv-3, envT and envFc2 were significantly over-expressed. Syncytin-1, Syncytin-2 and erv-3 were specific to glandular epithelial cells of polyps, hyperplasia and EnCa using immunohistochemistry. An analysis of 10 patient-matched EnCa with endometrium revealed that the ERV-W 5'' long terminal repeat regulating Syncytin-1 was hypomethylated, including the ERE and CRE overlapping MeCP2 sites. Functional analyses showed that 10 env genes were regulated by methylation in EnCa using the RL95-2 cell line. In conclusion, over-expressed env genes could serve as indicators for pathological pre-stages and EnCa.     

MRI成像对子宫内膜癌侵犯肌层的评估

目的探讨MRI对子宫内膜癌肌层浸润深度的评估价值。方法回顾性分析67例经分段刮宫并施行手术治疗的子宫内膜癌患者MRI表现,并与术后病理结果进行对照。结果 MRI判断子宫内膜癌局限于内膜、浸润浅肌层、浸润深肌层及浸透浆膜层的准确性分别为92.5%、80.5%、88.0%、80.5%。结论磁共振可多方位、多序列、多角度成像,对软组织有较高分辨率,对准确判断子宫内膜癌肌层有无浸润具有明显优势。     

氯米芬联合HCG对不孕症患者内分泌指标及子宫内膜容受性的影响

目的:探讨氯米芬联合人绒毛膜促性腺激素(HCG)对不孕症患者内分泌指标及子宫内膜容受性(ER)的影响。方法:回顾性分析某院妇产科2018年11月~2019年11月接收的96例不孕症患者临床资料,将采用氯米芬联合HCG治疗的患者归为观察组(49例),将单独采用氯米芬治疗的患者归为对照组(47例),对比两组患者治疗前、治疗3个月内分泌指标、ER及卵巢体积变化情况以及治疗期间不良反应发生情况。结果:治疗3个月后,两组促卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)及孕酮(P)水平均较治疗前高,且观察组FSH、LH、E_2及P水平高于对照组,差异有统计学意义(P<0.05);治疗3个月后,两组子宫内膜厚度(Em)指标较治疗前上升,卵巢体积较治疗前缩小,且观察组Em指标较大,卵巢体积较小,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:不孕症患者采用氯米芬联合HCG治疗效果良好,可有效改善内分泌指标,提升ER指标,且安全性较高,值得临床推广。