产前超声在诊断胎儿完全性肺静脉异位引流中的应用

目的 探讨胎儿完全性肺静脉异位引流(TAPVC)的超声诊断特征,提高产前诊断率。 方法 回顾性分析2013年5月至2016年12月于无锡市妇幼保健院产前超声心动图检查中发现并部分经产后超声心动图或引产后尸检随访证实的12例TAPVC胎儿的声像图特点及临床指导意义。 结果 超声诊断11例TAPVC胎儿中,心上型5例,心下型2例,心内型3例,混合型1例。产前超声漏诊1例,产后诊断为心内型TAPVC。4例为单纯性TAPVC,8例合并复杂性先心病或心外其他畸形。典型二维超声表现为:胎儿四腔心观右房稍大于左房,左房后壁光滑,无肺静脉开口,左房与降主动脉间距离增大,于左房后方见共同肺静脉干,追踪共同肺静脉干走形可显示垂直静脉及引流途径。     

降低围生儿死亡的措施(附89例分析)

目的 :探讨围生儿死亡的主要原因 ,降低围生儿病死率。方法 :统计自 1994～1998在我院分娩的围生儿数 ,根据临床实验室检查、B超及其他检查结果将围生儿死亡病例进行归类。结果 :围生儿总数 42 86例 ,围生儿死亡 89例 ,围生儿死亡率 2 0 17‰ ,其中新生儿死亡率 9 91‰ ,围生儿死亡原因依次为妊娠期肝内胆汁瘀积症 (ICP)、早产脐带因素、畸形、新生儿窒息及其他。结论 :围生儿死亡与围生期保健 ,产程监测处理 ,接受技巧有密切关系 ,提高对ICP的认识 ,提高产前诊断技术 ,预防早产 ,产程各环节的合理处理和提高对新生儿窒息复苏的效果 ,是降低围生儿死亡的重要措施。     

产前超声在先天性心脏大血管畸形中的诊断价值

目的 探讨先天性心脏大血管畸形的超声特点及其产前诊断方法.方法 随机选取本院2012年3月至2015年3月受检胎儿2260例,对其行胎儿心脏四腔心切面联合胎儿头侧偏转法以对心脏畸形进行快速筛查.对疑似心脏畸形者行大动脉短轴切面、主动脉弓切面、肺动脉长轴切面、左右心室流出道、三血管气管平面超声检查,并对内部血流情况、血管内径大小、排列关系等进行观察记录.结果 本次研究中共计检出82例先天性心脏大血管畸形,其中以血管排列异常、血流性质异常、血管内径大小异常及血管数目异常四种超声线索最为常见.结 论产前超声检查是一种有效的先天性心脏大血管畸形诊断方法,其中大动脉数目异常、内径大小异常、血流异常及血管排列异常均可作为临床诊断的可靠线索.     

乌鲁木齐地区线粒体12SrRNA基因突变筛查分析

目的　研究乌鲁木齐地区非综合征性聋患者线粒体12S rRNA基因突变情况。方法　收集乌鲁木齐非综合征性聋患者标本609例,对其进行临床和分子遗传学评估。结果　12S rRNA基因突变分析共发现11个突变位点,已知的A1555G、961DelT、C1494T突变分别占2.96%,1.15%,0.16%。另外A1047G突变相关报道较少,A1585G突变未见相关报道。其他突变均为多态性位点。结论　线粒体12S rRNA突变是引起遗传性聋的重要因素,此次乌鲁木齐地区线粒体12S rRNA A1555G突变在聋病人群中的检出率与前期报道相比有所降低,可能与耳毒性药物使用量降低有关。A1047G与新发现的A1585G突变是否与聋相关,还需进一步研究。对筛查中阳性突变携带者及其母系家庭成员需告知氨基糖苷类抗生素使用风险,使其避免使用,逐步降低药物性聋的发生率。     

Characteristics of normal newborn transient-evoked otoacoustic emissions: Ear asymmetries and sex effects

Transient-evoked otoacoustic emissions (TEOAEs) were recorded from more than 30000 newborns over a six year period. Analysis was performed on all the TEOAEs that passed the bedside universal hearing screen (n=60431), in order to characterize the normal properties of neonatal TEOAEs and to study ear and sex effects. Short recording times (median=33 s) were observed in combination with high entire TEOAE level (median=18.8 dB SPL for an 81.8 dB SPL peak stimulus), and high reproducibility (median=86%). Signal-to-noise ratio (S/N) of the TEOAE was highly frequency-dependent, being poorer at low frequencies. Prolonged averaging increased median reproducibility to 97%, but the minor S/N-improvement at low frequencies did not justify the longer test time. Highly significant mean lateral asymmetries (right >left) and sex differences (female >male) existed in entire TEOAE level, S/N TEOAE, and in half-octave frequency bands (700–4000 Hz). Mean lateral and sex entire TEOAE level differences were 1.1 dB and 1.3 dB, respectively. Stimulus levels were not affected by ear or sex. Hence, physiological differences at the level of organ of Corti were demonstrated in newborns.     

电子阴道镜在宫颈癌筛查中的应用价值评价

目的：探讨电子阴道镜在诊断筛查宫颈癌中的临床应用价值。方法通过对上栗县9600位女性进行妇科疾病的筛查,使用妇检、白带常规、醋酸或碘染色试验、阴道镜检查、病理活检、B超等检查手段,比较分析阴道镜检查结果的准确率以及临床应用价值。结果电子阴道镜实查278例中,查出宫颈上皮内瘤样病变14例（5.0%）,宫颈癌5例（1.2%）,尖锐湿疣1例（0.4%）;病理活检实查46例,查出宫颈上皮内瘤样病变14例（30.4%）（包括CINⅠ7例,CINⅡ2例,CINⅢ5例）,宫颈癌1例（2.2%）（浸润癌1例）,尖锐湿疣1例（2.2%）。病理活检在宫颈上皮内瘤样病变、宫颈癌、尖锐湿疣等方面的检出率高于阴道镜检出率（P〈0.05）。结论电子阴道镜作为筛查宫颈癌的重要手段之一,其作用不可忽视,具有较高的临床价值。     

Effectiveness and safety of loop electrosurgical excision procedure in a low-resource setting

Objective

To evaluate the effectiveness and safety of the loop electrosurgical excision procedure (LEEP) to treat cervical intraepithelial neoplasia (CIN) in a low-resource setting.

Methods

Women participating in a cervical screening study in India with histologically confirmed CIN unsuitable for cryotherapy were advised to undergo LEEP. One year after treatment the cervix was visually inspected with acetic acid, followed by colposcopy and biopsy taken from abnormal areas. Cure was defined as no clinical or histologic evidence of CIN. Factors influencing cure rates were evaluated by ^χ2 tests.

Results

Of the 311 women who underwent LEEP, 283 reported for 1-year follow-up and 248 (87.6%) were disease free. Cure rates were 93.0% for CIN 1, 85.5% for CIN 2, and 72.7% for CIN 3. Minor adverse effects were observed in 34 women and complications were seen in 5 women.

Conclusion

LEEP was associated with minimal complications and acceptable cure rates in a low-resource setting, although women with larger lesions had lower cure rates.     

A precarious pregnancy involving a patient with a large placental chorioangioma: a case report

Chorioangiomas are common placental neoplasms that are primarily asymptomatic, but the larger subtypes have a variable presentation and can result in severe pregnancy complications. We report a case of a pregnant patient who presented with a 10 x 12 x 10 cm placental chorioangioma at 32 weeks, despite an unremarkable ultrasound at 28 weeks. Since these more substantial chorioangiomas can induce fetal mortality, close surveillance with perinatology and neonatology consultation is necessary to enhance the probability of a favorable patient prognosis.     

Implementing an oral health program in a group prenatal practice

The Rochester Adolescent Maternity Program (RAMP) has incorporated evidence-based oral health guidelines into its prenatal care. These guidelines focus on tracking oral health services, screening and triaging prenatal patients, and providing patient and staff with the education needed to decrease oral health risks to mother, fetus, and baby. The RAMP process serves as a model for promoting quality oral health practices in pregnant teenagers and their babies.     

Decision-making after ultrasound diagnosis of fetal abnormality

During the last few decades, the use of ultrasonography for the detection of fetal abnormalities has become widespread in many industrialised countries. This resulted in a shift in timing of the diagnosis of congenital abnormalities in infants from the neonatal period to the prenatal period. This has major implications for both clinicians and the couples involved. In case of ultrasound diagnosis of fetal anomaly, there are several options for the obstetric management, ranging from standard care to non-aggressive care and termination of pregnancy. This essay explores the context of both clinical and parental decision making after ultrasound diagnosis of fetal abnormality, with emphasis on the Dutch situation. While normal findings at ultrasound examination have strong beneficial psychological effects on the pregnant woman and her partner, the couple is often ill prepared for bad news about the health of their unborn child in the case of abnormal findings. This is, in particular, true in settings where ultrasonography for the detection of fetal abnormalities is offered as an integral part of antenatal care without appropriate counselling. An important question is to what extent the couple should be supported in decision making when a fetal abnormality is diagnosed. In this context, the parental perception of having a choice varies markedly. When parents consider end-of-life decisions, they experience both ambivalent and emotional feelings. On the one hand, they are committed to their pregnancy, while on the other hand, they want to protect their child, themselves and the family from the burden of severe disability. These complex parental reactions have implications for the counselling strategy.