非脱垂子宫经腹、阴式全切除术临床比较

目的 探讨非脱垂子宫经阴道与经腹全切术的临床比较。方法 2000年5月～2001年1月对阴式子宫全切术 (TVH)28例及腹式子宫全切术 (TAH)35例分为两组进行手术 ,对临床指标进行观察比较。结果 28例TVH手术均成功。平均重量255g(120～510g)。与TAH手术比较 ,其术后病率、肛门排气时间及术后住院天数有显著性差异 ( p<0.001及 p<0.05) ,但其手术时间及术中出血量无显著性差异 ( p>0.05)。结论 随着微创手术的开展 ,利用阴道天然孔道 ,经阴道切除较大的子宫是有效和安全的 ,手术的成功与术者经验、技术及子宫活动度有关 ,有合适器械也是手术成功的因素。     

特殊部位异位妊娠的临床分析

目的探讨特殊部位异位妊娠的临床特点，误诊原因及治疗原则。方法对1996年1月至2003年12月诊治的256例特殊部位异位妊娠进行回顾性分析。结果特殊部位异位妊娠发生率占同期异位妊娠的3．36％，术前诊断率48．4％，所有的患者均行手术。视术中情况进行不同的处理，所得标本均经病理切片证实，全部患者愈后良好。结论特殊部位异位妊娠的临床表现不典型，容易漏诊误诊，一旦怀疑本病应尽早住院，及时明确诊断并手术，患者愈后良好。     

分娩期子宫破裂64例分析

目的 分析分娩期子宫破裂的发病原因及预防措施。方法 回顾分析1985年8月至2001年12月，16a间64例分娩期子宫破裂的临床资料。结果 子宫收缩剂使用不当3l例，占48．4％；胎先露下降受阻13例，占20．3％；子宫疤痕16例，占25％；阴道助产4例，占6．3％。初产妇10例(10．9％)；经产妇54例(89．1％)。结论 降低分娩期子宫破裂发生率关键在于加强计划生育工作及围生期保健，严格掌握子宫收缩剂的适应证及剂量；严格首次剖宫产指征；严密观察产程，及时处理异常分娩。     

Ovarian and uterine findings in pelvic sonography: comparison between prepubertal girls, girls with isolated thelarche, and girls with central precocious puberty.

OBJECTIVE: To describe pelvic sonographic findings in girls as old as 7 years, to compare prepubertal girls with girls who had isolated thelarche or central precocious puberty, and to verify the accuracy of sonographic variables for distinguishing prepubertal girls from girls with central precocious puberty. METHODS: Ninety-six prepubertal girls and 2 reference groups (8 girls with isolated thelarche and 8 with idiopathic central precocious puberty) were included. Ovaries were classified morphologically as homogeneous, paucicystic, macrocystic, multicystic, and having isolated cysts. Receiver operating characteristic curves were used to choose the best cutoff points. RESULTS: Chronologic and bone age were correlated with uterine length, area, and volume and ovarian volume in prepubertal girls (P < .0001). Ovarian morphologic characteristics in prepubertal girls differed significantly from those of the reference groups (P < .0001). The best cutoff points were uterine length of 4.0 cm, uterine area of 4.5 cm2, uterine volume of 3.0 cm3, and ovarian volume of 1.0 cm3. CONCLUSIONS: Uterine and ovarian growth are proportional to age in prepubertal girls. Mean ovarian volume greater than 1 cm3 showed 100% sensitivity and specificity for discriminating between prepubertal girls and girls with central precocious puberty. Microcysts are common in prepubertal girls, but the presence of 6 or more follicles up to 10 mm in diameter may suggest central precocious puberty in girls younger than 8 years.     

鸡矢藤提取物对小白鼠离体子宫的作用

鸡矢藤[Paederia Scandens]提取物0.32mg 加入营养槽内,对小白鼠各期离体子宫的收缩张力、收缩强度、收缩频率以及子宫活动力均有增强作用。与给药前比较,诱导期组分别增加85%、47%、21%和72%;动情期组分别增加70%、77%、41%和41%;非动情组分别增加47%、76%、62%和66%,而且三组间作用无显著性差异。本品还能增强 PGE_2对小白鼠离体子宫的收缩张力、收缩强度、收缩频率以及子宫活动力。与 PGE_2的作用比较,分别增加34%、39%、9%和45%,但收缩频率增加无统计学意义(P>0.05)。上述结果表明,鸡矢藤提取物对小鼠子宫有显著性兴奋作用,而且还能增强PGE_2对小鼠子宫兴奋作用,其机制尚待进一步研究。     

产后子宫内翻临床分析

目的 提高对产后子宫内翻诊治及预防的认识。方法 回顾性分析我院收治的3例子宫内翻患的临床资料。结果 3例年龄分别为26、28、29岁，均有多次生育史，临床表现为出血、休克、疼痛、阴道口见脱出的红色球状肿物，多伴有排尿困难。第三产程的非适当处理为其主要原因。结论 提倡新法接生，提高助产技术，正确处理第三产程是预防子宫内翻的关键。而提高对子宫内翻的认识，早期发现，及时正确的处理，又是治疗子宫内翻的关键。     

Perivascular epithelioid cell tumor of the uterus: immunohistochemical, ultrastructural and molecular study

A case of perivascular epithelioid cell tumor of the uterus is reported, occurring in a 32-year-old woman. The tumor (8.0 cm in dimension) showed exophytic growth from the outer half of the myometrium. Histopathologically, the tumor was composed of thick blood vessels and perivascular epithelioid cells. The neoplastic cells were strongly immunoreactive for HMB45 antigen, CD117 (c-kit), vimentin and the progesterone receptor, but completely negative for S-100 protein, smooth muscle actin, desmin, CD34, the estrogen receptor and p16. The Ki-67 labeling index was low (1.25%). Ultrastructurally, the neoplastic cells had numerous premelanosomes with some glycogen deposits. Single-stranded DNA conformational polymorphism of p53 and methylation-specific polymerase chain reaction of p16 revealed negative results. Definite melanosomes on electron microscopic analysis and coexpression of HMB45 antigen and stem cell factor receptor (CD117) may provide the clue to understanding perivascular epithelioid cell tumor because angiomyolipoma also coexpresses HMB45 antigen and CD117.     

The induction of baboon glycodelin expression by progesterone is not through Sp1

Glycodelin is a major secretory product of the uterine glandular epithelial cells of the human and non-human primate during the late luteal phase of the menstrual cycle and early pregnancy. Since progesterone levels are elevated during these periods we sought to determine how progesterone modulates glycodelin gene expression. Co-transfection of various deletions of the baboon glycodelin promoter with the progesterone receptor (PR) into Ishikawa cells, a human endometrial cell line, revealed that full progesterone responsiveness is retained within the region -119/+48. In COS-1 cells, a kidney cell line, progesterone failed to elevate luciferase levels when various deletion constructs and the PR were co-transfected. Mutation of the Sp1 site in the -67/+48 region lowered basal expression but did not affect the ability of progesterone to increase expression of the luciferase reporter in Ishikawa cells. These findings suggest that Sp1 sites are not involved in the progesterone regulation of the baboon glycodelin gene. We propose that progesterone induces a factor that regulates glycodelin gene expression in the uterus since we failed to obtain a similar response in a non-uterine cell line.     

Investigation of the role of the serotonergic activity of certain subtype-selective alpha1A antagonists in the relaxant effect on the pregnant rat uterus in vitro

Results from recent studies have shown that alpha(1A)-adrenergic receptor (alpha(1A)-AR) antagonists could offer a new alternative in the treatment of preterm delivery. However, members of this group [2-(2,6-dimethoxyphenoxyethyl)aminomethyl-1,4-benzodioxane hydrochloride (WB4101), 5-methylurapidil (5-MU)] are known to influence serotonin (5-hydroxy-tryptamine) (5-HT(1A)) receptors, too. Our objective was to clarify the role of their 5-HT(1A) activities in the uterus relaxant effect. RT-PCR was used to determine mRNA expression of the receptor subtypes in 22 day pregnant rat uteri. Isolated uteri were stimulated by 5-HT or electrical field to investigate the contraction-inhibiting effect and the 5-HT(1A) activity of the alpha(1A) antagonists. Both receptor subtypes are present in rat myometrium. 5-HT induced contractions were inhibited by the alpha(1A) antagonists. Besides shifting the dose-response curve of 5-HT to the right, 5-MU decreased its maximal effect. The alpha(1A) antagonists inhibited electrical field stimulation-induced contractions. 5-HT(1A) blockade increased the maximal effect of 5-MU but did not change that of WB4101. These results suggest that the contraction increase caused by 5-HT is mediated by alpha(1A) receptors. Serotonergic activity of alpha(1) antagonists and especially alpha(1A) antagonists should be investigated as it may alter their efficacy and could interfere with their side-effects. It is proposed that novel alpha(1A) antagonists should be designed with no 5-HT(1A) activity to achieve maximal relaxant effect.     

Effect of oestradiol on mouse uterine epithelial cell tumour necrosis factor-alpha release is mediated through uterine stromal cells

Oestradiol-17beta (Oe(2)) stimulates uterine epithelial cell proliferation and is critical for normal uterine differentiation and secretory function. Oe(2) can act directly on the epithelium via the epithelial oestrogen receptor (OR) or indirectly via the OR-positive underlying stroma. A primary role for epithelial-stromal interactions has been established for mediating steroid hormone action in the uterus. This study was undertaken to determine the mode of Oe(2) action in regulating epithelial cell cytokine release in the uterus. Mouse uterine epithelial and stromal cells were isolated and cultured separately. Transepithelial resistance (TER) was monitored with an EVOM voltohmmeter to determine monolayer polarity and integrity. Epithelial cells grown alone or in coculture with stromal cells were treated with Oe(2). Supernatants collected were assayed for transforming growth factor-beta (TGF-beta) and tumour necrosis factor-alpha (TNF-alpha) by bioassay and enzyme-linked immunosorbent assay, respectively. While Oe(2) treatment of epithelial cells led to a significant decrease in TER, the amount of TNF-alpha released was not altered. However, when epithelial cells were cocultured with stromal cells and treated with Oe(2), apical TNF-alpha release was significantly decreased, compared to cells not treated with hormone. As determined by oestrogen receptor antagonist studies, Oe(2) primed epithelial cells for the action of the stromal paracrine factor(s). In contrast, TGF-beta release by epithelial cells was not affected by Oe(2) when grown alone or in the presence of stromal cells. These studies indicate that Oe(2) has both direct and indirect effects on the uterine epithelium. While epithelial monolayer integrity is directly influenced by Oe(2), TNF-alpha release in response to Oe(2) is dependent on the presence of stromal cells, indicating that paracrine communication is necessary for steroid regulation of some but not all cytokines.