Pathological Uterine Perfusion in the Second Trimester Is Not Associated with Neutrophil Activation

Objective: Preeclampsia and intrauterine growth retardation (IUGR) are associated with elevated concentrations of myeloperoxidase (MPO) and polymorphonuclear (PMN) elastase, which indicate maternal neutrophil activation. The aim of the study was to measure maternal MPO and PMN elastase plasma concentrations in second trimester pregnancies with pathological uterine perfusion that are a high risk group for preeclampsia and IUGR, and compare them to normal controls. Methods: The study includes 25 pregnancies with normal and 25 pregnancies with pathological uterine perfusion. In both groups, doppler‐sonographic measurement of uterine perfusion was performed in the twenty‐first week of gestation. Maternal plasma concentrations of MPO and PMN elastase were measured using a specific ELISA for both enzymes. Results: The plasma MPO concentration of pregnant women with normal perfusion did not differ significantly from that of the group with pathological perfusion (27.4 ± 3.3 vs. 23.7 ± 2.0 ng/mL). Likewise, the plasma PMN elastase‐concentration also did not show a significant difference between the groups (5.7 ± 0.5 ng/mL normal vs. 8.0 ± 1.0 ng/mL pathological). Patients with pathological perfusion that later developed preeclampsia or IUGR (9/25) showed unchanged MPO and PMN elastase values in the second trimenon compared to those with pathological perfusion and normal outcome. Conclusions: Pathological uterine perfusion in the second trimester was not associated with maternal neutrophil activation. The measurement of the MPO and PMN elastase concentration suggested that neutrophil activation in preeclampsia or IUGR is a secondary effect of the disease rather than a primary pathophysiological factor.     

Power morcellation inside a secure endobag: a pilot study

Introduction: Unprotected power morcellation can lead to a spread of previously undiagnosed malignancy. We present a new containment bag with two closable trocar insertion sites to reduce this risk. This pilot study was designed to assess the feasibility of this device under everyday conditions.

Material and methods: The containment bag was used in ten laparoscopic supracervical hysterectomies. We evaluated time requirement for bag insertion into the abdominal cavity and in-bag morcellation. A 2000?ml polyurethane morcellation bag was used for all interventions. All surgeries were carried out in a three-trocar setting.

Results: We carried out ten supracervical hysterectomies. No intraoperative complications and no bag ruptures occurred. The meantime requirement to insert the bag and prepare the specimen for morcellation was 10.5?min (range, 7–19?min). The mean specimen weight was 191.9?g (range, 32–710?g). Mean morcellation time was 10.5?min (range, 3–28?min), mean weight of remaining tissue and fluid in the bag after morcellation was 12.1?g (range, 7–19?g).

Conclusions: The presented data demonstrate that the endobag can be successfully applied in the clinical routine. Further studies are required to evaluate additional characteristics, such as individual learning curve and time requirements.     

宫颈腺癌的研究进展

宫颈腺癌是宫颈癌的一种特殊病理类型,较鳞癌少见.近年来,宫颈腺癌的发病率及其在宫颈癌中所占比例不断上升,且发病趋于年轻化,预后比同期鳞癌差.此外,宫颈腺癌卵巢转移率高于鳞癌,对放、化疗的敏感性显著低于鳞癌,这些均对宫颈腺癌的诊治有重要影响.从宫颈腺癌致病因素(雌激素、孕激素与人乳头瘤病毒)、卵巢转移高危因素及卵巢保留以及放化疗进展3个热点问题着手,简述近年来宫颈腺癌的研究进展.     

Cesarean Scar Pregnancy: Comparing the Efficacy and Tolerability of Treatment with High-Intensity Focused Ultrasound and Uterine Artery Embolization

The aim of this study was to investigate the clinical efficacy of high-intensity focused ultrasound (HIFU) for the treatment of a cesarean scar pregnancy compared with uterine artery embolization (UAE) and intra-arterial methotrexate infusion combined with uterine curettage. In this retrospective cohort study, 31 patients were treated with HIFU (HIFU group), and 45 patients were treated with UAE (UAE group). We compared the treatment and recovery of the patients, including follow-up. After UAE treatment, serum levels of the β subunit of human chorionic gonadotropin declined significantly on the first day, and the residual lesions disappeared in 3–17 wk. One patient underwent hysterectomy; intrauterine adhesions were found by hysteroscopic examination after 6 mo in 2 patients, whose menstrual function did not return to normal. The remainder of the 42 patients recovered normal menstrual functioning during the 3- to 18-wk follow-up. In the patients who underwent HIFU treatment, serum β-HCG levels did not decline rapidly; serum β-HCG levels increased in many patients and then declined to normal steadily within 2–12 wk. Lesions detached in 3–14 wk in all patients, and menstrual functioning was recovered in 3–9 wk without uterine curettage. Compared with the UAE group, the HIFU group had less pain and fewer complications; the patients in the HIFU group were not hospitalized or anesthetized and had lower costs. HIFU is an efficient, tolerable and non-invasive treatment.     

护理质量持续改进在子宫肌瘤护理中的应用简

目的 评价护理质量持续改进在子宫肌瘤护理中的效果.方法 选择2008年11月～2012年3月首都医科大学附属北京妇产医院收治的子宫肌瘤患者86例作为研究对象,将其随机分为观察组和对照组,每组各43例.对照组采用一般常规护理,观察组在常规护理基础上护理质量持续改进,比较两组临床疗效和生活质量,并对两组护理质量进行考核比较.结果 观察组痊愈16例,有效23例,总有效率为90.69％,对照组痊愈12例,有效22例,总有效率为79.07％,两组总有效率比较,差异有高度统计学意义（Ridit Z=36.954,P=0.000）;护理干预后,两组在生理、心理、社会、疾病、满意度及生活质量评分总分方面均有明显好转,差异有统计学意义（P＜0.05）,观察组好转程度优于对照组（P＜ 0.05或P＜ 0.01）;实施护理质量持续改进后,观察组在基础护理、护理安全、病房管理、消毒隔离、护理文书和急救物品方面改善均优于对照组,差异有统计学意义（P＜0.05）.结论 护理质量持续改进可以不断提高护理人员服务质量,提高患者生活质量,在子宫肌瘤护理中效果显著.     

超声在子宫动脉栓塞介入治疗宫颈妊娠中的临床应用价值

目的:分析超声在子宫动脉栓塞介入治疗宫颈妊娠中的临床应用价值。方法:将74例宫颈妊娠患者随机分为观察组和对照组,每组37例。观察组采用子宫动脉栓塞介入序贯超声引导下清宫术治疗,对照组采用甲氨蝶呤治疗。观察两组的血清β-HCG水平、孕囊回声直径、局部血流阻力指数、搏动指数和临床疗效。结果:观察组患者的血清β-HCG水平和孕囊回声直径明显低于对照组,阻力指数和搏动指数则明显高于对照组,差异有统计学意义(P<0.05);治疗愈显率也明显高于对照组(χ2=8.044 9,P<0.05)。结论:超声在子宫动脉栓塞介入治疗宫颈妊娠中具有重要的临床价值。     

MRI评估子宫肌瘤患者行腹腔镜下肌瘤剔除术的可行性

目的探讨MRI评估子宫肌瘤患者行腹腔镜下肌瘤剔除术的可行性。方法回顾性分析2019年1月至2019年12月于我院收治的60例子宫肌瘤患者临床资料,根据2011年FIGO新的子宫肌瘤分类标准对子宫肌瘤分类,测量子宫肌瘤大小及数目,按照临床及腹腔镜下子宫肌瘤剔除术的适应症标准,筛选符合腹腔镜下子宫肌瘤剔除术的病例,计算MRI对腹腔镜下子宫肌瘤剔除术的排除率、手术率。结果本研究中60例患者经MRI检查,病灶单发者19例,多发者41例,子宫肌瘤病灶数目共计119个,其中112个位于子宫体,5个位于子宫颈,阔韧带2个;其中6-7型子宫肌瘤55个,3-5型子宫肌瘤48个,0-2型子宫肌瘤5个,混合型6个,特殊类型5个。最终符合腹腔镜下子宫肌瘤剔除术手术标准者25例,排除者35例,手术率为41.67%,排除率为58.33%。结论MRI能对子宫肌瘤患者行腹腔镜下肌瘤剔除术的可行性进行评估,筛选适宜手术的患者,且能为临床医师行腹腔镜下肌瘤剔除术提供影像学基础。     

肺良性转移性平滑肌瘤的临床病理研究及文献回顾

目的:研究发生于肺的良性转移性平滑肌瘤(BML)的临床病理特点。方法:收集本病1例,分析研究其临床表现、影像学资料、大体形态、组织学形态及免疫组化结果并查阅对照相关文献。结果:本例BML为49岁女性患者,子宫平滑肌瘤术后15年发生肺转移,无全身其他部位转移。组织形态类似于子宫平滑肌瘤,细胞无异型,未找到核分裂象,免疫组化染色结果符合子宫原发。结论:BML是一种罕见的发生于有子宫平滑肌瘤手术史的女性,肺是主要转移部位,呈激素依赖性,定期全身体检是早期发现肿瘤转移的关键。