卵巢低反应患者大剂量超排卵的助孕结局

在辅助生殖助孕中通常采用控制性卵巢刺激(controlled ovarian hyperstimulation, COS),以获得适当数量的卵子用于体外受精,既希望获得理想的辅助生殖助孕成功率,又能降低卵巢过度刺激并发症.COS中约有9%~24%[1,2]的卵巢低反应发生率.卵巢低反应者获得有效卵子数少、可移植胚胎数少或无胚胎移植、取消治疗周期率高,累计成功率更低等,导致较差的治疗结局,是辅助生殖助孕中面临的棘手问题.针对卵巢低反应者,大多数辅助生殖中心仍会采用增加促性腺激素(Gn)的起始和(或)总用量以期获得提高助孕结局的目的.而大剂量Gn是否为改善低反应患者助孕结局的有效策略却仍存在争议.     

电视硬质气管镜治疗大气道良性肿瘤

目的探讨电视硬质气管镜在大气道良性肿瘤治疗中的价值.方法2002年9月～2005年4月,我院应用电视硬质气管镜治疗大气道良性肿瘤7例,其中气管1例,隆突1例,左主支气管3例,右主支气管2例.手术采用静脉全身麻醉,喷射通气供氧,探查评估气道后,首先冷冻或电凝肿瘤,破坏肿瘤血供,再以活检钳分块取出,蒂部采用冷冻或氩气凝固处理;对于宽蒂肿瘤,内镜下将肿瘤主体清除后中转开胸行气管局部切除吻合术.结果7例手术均顺利,无一例死亡和严重并发症发生.6例气管窄蒂良性肿瘤镜下完整摘除,1例气管膜部宽蒂平滑肌瘤先内镜清除肿瘤主体后中转开胸行气管局部切除.术后病理为错构瘤2例,平滑肌瘤3例,嗜酸性肉芽肿性腺瘤1例,炎症组织1例.7例随访3～36个月,平均17.3月,无肿瘤复发.结论电视硬质气管镜治疗大气道良性肿瘤安全可靠.     

经阴道行良性卵巢囊肿剥离术195例报告

目的探讨经阴道行良性卵巢囊肿剥离术的临床实用价值.方法2001年1月2004年6月对有手术指征的良性卵巢囊肿195例实施阴式手术,并观察有关手术指标.结果经阴道完成手术190例,5例因盆腔广泛粘连中转开腹.手术时间45～83 min,平均50 min.术中出血30～90 ml,平均45 ml.术后排气时间4～24 h,平均8.5 h.术后病率18.4%(35/190).183例随访2周内恢复日常家务及工作者分别为72.1%(132/183)、48.1%(88/183).结论经阴道行良性卵巢囊肿剥离术是一种安全、微创的手术.     

胰岛素和睾酮对Ishikawa细胞葡萄糖转运蛋白4表达的影响

目的探讨胰岛素(INS)和睾酮(T)对多囊卵巢综合征(PCOS)子宫内膜腺上皮细胞生长的影响和葡萄糖转运蛋白4(GLUT4)表达的调节机制。方法体外培养Ishikawa细胞,予不同浓度INS(90、60、30、3、0.3 U/L)或T(10-3、10-4、10-5、10-6、10-7mmol/ml)刺激Ishikawa细胞48 h,MTT法检测INS、T对Ishikawa细胞生长的作用;免疫细胞化学检测GLUT4蛋白在Ishikawa细胞定位表达;分别以30 U/L INS和10-5mmol/ml T刺激Ishikawa细胞24和48 h,逆转录聚合酶链反应(RT-PCR)方法测定INS和T对Ishikawa细胞GLUT4 mRNA表达的影响。结果(1)不同浓度的INS均可促进Ishikawa细胞的生长,随着INS浓度的增加,INS促进Ishikawa细胞生长作用越强,INS浓度自0.3~30 U/L时,Ishikawa细胞生长依次加强,与对照组相比均有显著性差异(P<0.01)。INS浓度达60、90 U/L时,细胞生长状况与INS浓度为30 U/L相似。不同浓度的T均可抑制Ishikawa细胞的生长,随着T浓度的增加,T抑制Ishikawa细胞生长作用越明显。T浓度自10-7、10-6、10-5mmol/ml,Ishikawa细胞生长依次减弱,与对照组相比均有显著性差异(P<0.01,P<0.05),T浓度达10-4、10-3mmol/ml时,细胞生长抑制状况与T浓度10-5mg/ml相似。(2)GLUT4蛋白,定位表达于Ishikawa细胞的细胞浆内。(3)Ishikawa细胞中GLUT4 mRNA表达,在INS组和T组均较对照组减弱(P<0.01,P<0.05),INS组比T组减弱更明显(P<0.05),且INS和T作用24和48 h GLUT4 mRNA表达无显著性差异(P>0.05)。结论不同浓度INS和T均可影响Ishikawa细胞生长,并降低GLUT4 mRNA的表达,推测PCOS高胰岛素、高雄激素血症的病理生理特性有可能影响子宫内膜的代谢过程,与子宫内膜的病变相关。     

Endocrinology: Predictive value of serum oestradiol concentrations and oocyte number in severe ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a serious complicationof gonadotrophin usage but it is difficult to accurately predictits occurrence. Previous investigators have identified the combinationof high oestradiol concentrations and oocyte number as beingpredictive in 80% of cases. In this study we sought to identifythe incidence of severe OHSS in patients with high oestradiolconcentrations and large numbers of oocytes and to evaluatethe importance of pregnancy in the development of OHSS. Between1990 and 1993, we studied 139 cycles using two assisted reproductivetechniques [oocyte donor, n =72; in-vitro fertilization (IVF),n = 67] in which either oestradiol (>4000 pg/ml), oocytenumber (>25), or both were elevated. OHSS was diagnosed bystandard criteria. There were no cases of severe OHSS in theoocyte donor group and six in the IVF group. Among 10 patientswith oestradiol concentration >6000 pg/ml and >30 oocytes,only one had OHSS (10%). The relative risk of OHSS with pregnancywas 12 (confidence interval 2.18–66.14). We conclude thatthe risk of OHSS even at high levels of stimulation is lowerthan previously believed. Secondly, donors have a very low riskof OHSS, probably because of the absence of pregnancy. As such,cryopreservation of all oocytes in IVF cycles is a reasonablealternative to cycle cancellation or use of adjunctive medication.     

Endocrinology: Intravenous albumin does not prevent the development of severe ovarian hyperstimulation syndrome in an in-vitro fertilization programme

A cohort study was undertaken to compare the effect at the timeof oocyte retrieval of the i.v. administration of either 1000ml of lactated Ringer' solution or 1000 ml of a 5% solutionof human albumin on in-vitro fertilization patients at riskfor severe ovarian hyperstimulation syndrome (OHSS). A totalof 207 patients with an oestradiol concentration > 10 000pmol/l and/or > 15 follicles (>10 mm diameter) on theday of human chorionic gonadotrophin (HCG) injection were reviewed.Of these, 158 women received 500 ml of lactated Ringer’ssolution both before and after egg retrieval, and 49 women receivedtwo infusions of 500 ml of 5% human albumin in normal salineat the time of egg retrieval. Severe OHSS developed in two patientswho received human albumin and in 10 women who did not receivethe albumin. This difference was not statistically significant.There were no differences between the two groups in terms ofage, number of follicles punctured at transvaginal oocyte retrievalor oestradiol concentration at the time of HCG injection. Theadministration of a 5% human albumin solution does not preventthe development of severe OHSS in at risk patients. It doesappear to blunt the severity of the condition.     

Prognostic role of immunosuppressive acidic protein in advanced ovarian cancer

OBJECTIVE: Our purpose was to investigate immunosuppressive acidic protein in the prognostic characterization of advanced ovarian cancer. STUDY DESIGN: Serum levels of immunosuppressive protein were prospectively measured in 80 patients with untreated ovarian carcinoma. To evaluate the prognostic significance of immunosuppressive acidic protein levels, cutoff points were studied every 50 μg/ml between 450 and 1350 μg/ml. RESULTS: Pretreatment immunosuppressive acidic protein levels were not significantly associated with stage, histotype, grade of differentiation, postoperative residual tumor, and response to chemotherapy. The most significant association with survival was observed at a cutoff value of 1100 μg/ml (p = 0.0089). In the univariate analysis for overall survival, International Federation of Gynecology and Obstetrics stage and immunosuppressive acidic protein status were found to have a role in predicting ovarian cancer prognosis. In the multivariate analysis only immunosuppressive acidic protein status was significantly associated with survival. A statistical correlation was found between serum levels and overall survival (p = 0.0104, χ² 6.56), including immunosuppressive acidic protein as a continuous variable. CONCLUSION: Our data suggest that immunosuppressive acidic protein assay is a potentially useful tool in the prognostic characterization of advanced ovarian cancer. (Am J Obstet Gynecol 1996;175:1606-10.)     

Mortality among female registered nurses and school teachers in British Columbia

The mortality profile of female nurses and teachers in British Columbia (BC) was examined using age-standardized proportional mortality ratios (PMRs) calculated for the period 1950–1984. Lowered overall mortality among nurses was seen for degenerative heart disease and for cerebrovascular accidents. Significantly elevated PMR values were observed for cancer of the breast and ovary in nurses of age 20–65 years. PMRs were significantly elevated for cancer of the pancreas and leukemia among those age 20 years and older. Elevated values were also observed for motor vehicle accidents and suicide among nurses in both age groups. Lower than expected mortality from degenerative heart disease and cerebrovascular accidents was seen in working age teachers (age 20–65 years). However, elevated PMRs were detected for carcinoma of the colon, breast, endometrium, brain, and melanoma. Among those 20 years and over, significantly elevated PMRs were also observed for cancers of the ovary and other digestive organs. Elevated PMRs were found for motor vehicle and aircraft accidents. Mortality from cirrhosis of the liver was lower than anticipated in both teachers and nurses. A number of significant PMRs declined when deaths of “homemakers” were withdrawn from the comparison group used to generate PMR values, suggesting that risk of death from various causes among women working outside the home differ from those seen in women who are predominantly in the home.     

Risk factors for capillary leakage syndrome after bone marrow transplantation

 Age, hematopoietic growth factors, cyclosporin A, mode of bone marrow transplantation (BMT) (autologous, allogeneic-related, unrelated), and underlying disease were assessed as potential risk factors for capillary leakage syndrome (CLS) in 96 patients after BMT. CLS was defined as unexplained weight gain of >3% within 24 h and nonresponsiveness to furosemide. CLS occurred in 9/21 patients after unrelated compared with 2/33 after allogeneic-related BMT (p=0.0017) for hematopoietic disorders (n=54) and in 6/7 patients after allogeneic-related compared with 3/35 after autologous BMT (p=0.0001) for solid tumors (n=42). Hematopoietic growth factors and cyclosporin A were no signficant risk factors on their own. We conclude that unrelated BMTs or high-intensity conditioning regimens used in combination with allogeneic-related BMT are the main risk factors for CLS. Received: 6 January 1997 / Accepted: 10 March 1997