TDx-FLMⅡ和卵磷脂鞘磷脂比预测胎儿肺成熟的比较

We evaluated the usefulness of the TDx- FLM II and lecithin to sphingomyelin (L/S) ratio assays in predicting fetal lung maturity. Study design: We retrospectively reviewed 218 consecutive paired TDx- FLM II and L/S ratio results. Women who delivered viable infants within 72 hours of amniotic fluid collection (n = 109) were included in the analysis of sensitivity and specificity. Concordance between tests was determined for all women tested during the study period, and in the subset of women who delivered viable infants within 72 hours of amniotic fluid collection. Results: There were 9 respiratory distress syndrome (RDS)- affected infants born during the study period. Both the TDx- FLM II and L/S ratios had 100% sensitivity in detecting RDS at their best apparent cut-offs. There was a trend towards increased specificity of the L/S ratio compared with the TDx- FLM II (80% for L/S vs 73% for FLM II). The overall concordance between the TDx- FLM II and L/S ratio was approximately 75% . Conclusion: The TDx- FLM II and L/S ratios are both sensitive tests for RDS; however, there is not good concordance between the two. The results provide new insight into the optimal use, in sequential or reflex cascade testing, of the TDx- FLM II and L/S ratio.

高危胎儿日间无应激试验变异

To compare the results of the nonstress test (NST) performed at 9:00 PM and 9:00 AM on women with high-risk pregnancies. Method: The NST was performed 2 h after a meal, at 9:00 AM and 9:00 PM, in a quiet room exposed to daylight, on 80 women with high-risk singleton pregnancies. Each session lasted 20 min. If the NST was nonreactive, the entire biophysical profile was immediately performed. The women’ s blood pressure was measured before, 10 min within, and at the end of the NST. Women who smoked or had uterine contractions were excluded from the study. Results: Diurnal nonstress test variations were manifested by a higher incidence of reactive NSTs and an increased number of fetal heart accelerations after 9:00 PM (82.5% ) than at 9:00 AM (68.8% ) (p < 0.027 P < 0.001). Conclusions: Evening appointments for fetal assessments, except in emergency conditions, may eliminate the need for additional tests such as the entire biophysical profile because of the decreased incidence of nonreactive NSTs. Evening NSTs would save time and decrease maternal anxiety.

囊性纤维化患者宫颈内膜化生报道1例

Objective: To report the case of an infertile female patient with cystic fibrosis who was diagnosed with endocervical metaplasia of the endometrium at diagnostic hysteroscopy and successfully treated with an oral estroprogestinic formulation. Design: Case report. Setting: University hospital. Patient(s): A 27- year- old infertile female patient with cystic fibrosis. Intervention(s): Hysteroscopy with multiple random biopsies was performed at the time of the first visit and after a 10- month cycle with an oral estroprogestinic formulation. Main Outcome Measure(s): Hysteroscopic evaluation with target biopsy; histological examinations of endometrial specimens. Result(s): Our patient benefited from a 10- month cycle with an oral estroprogestinic formulation. At the control visit we noticed a significant improvement in the hysteroscopic appearance of her endometrium, and the histological examination confirmed the complete reversion of the metaplastic alterations previously observed. Conclusion(s): The present report suggests a novel histological alteration possibly involved in affecting fertility in women with cystic fibrosis. In addition, the positive response to the estroprogestinic treatment observed in our patient poses new questions regarding the relationship between ovarian hormones and cystic fibrosis transmembrane conductance regulator protein regulation, offering interesting perspectives for a hormonal therapy in the treatment of subfertility in women with cystic fibrosis.

静脉用吗啡和局部用丁卡因治疗早产新生儿中心静脉穿刺时的疼痛

Context: There is limited evidence of the analgesic effectiveness of opioid analgesia or topical anesthesia during central line placement in neonates, and there are no previous studies of their relative effectiveness. Objective: To determine the effectiveness and safety of topical tetracaine, intravenous morphine, or tetracaine plus morphine for alleviating pain in ventilated neonates during central line placement. Design, Setting, and Participants: Randomized, double- blind, controlled trial enrolling 132 ventilated neonates (mean gestational age, 30.6 [SD, 4.6] weeks at study entry) and conducted between October 2000 and July 2005 in 2 neonatal intensive care units in Toronto, Ontario. Interventions: Prior to central line insertion, neonates were randomly assigned to receive tetracaine (n=42), morphine (n=38), or both (n=31); a separate nonrandomized group of 21 neonates receiving neither tetracaine nor morphine was used as a control group. Main Outcome Measures: The primary outcome measure was a pain score for the proportion of time neonates displayed facial grimacing (brow bulge) during different phases of the procedure (skin preparation, needle puncture, and recovery). In randomized neonates, safety assessments included blood pressure, ventilatory support, and local skin reactions. Results: Compared with no treatment, pain scores were lower in the morphine and tetracaine- morphine groups during skin preparation (mean difference,- 0.22; 95% confidence interval [CI],- 0.4 to- 0.04; P=.02 and - 0.29; 95% CI,- 0.49 to- 0.09; P=.01, respectively), and needle puncture (mean difference, - 0.35; 95% CI,- 0.57 to- 0.13; P=.003 and- 0.47; 95% CI,- 0.71 to- 0.24; P < .001, respectively), but pain scores did not differ statistically for tetracaine alone vs no treatment. Pain scores were lower for morphine and tetracaine- morphine vs tetracaine during the skin preparation phase and for tetracaine- morphine vs tetracaine during needle puncture. Compared with neonates without morphine, morphine- treated neonates required larger increases in ventilation rate in the first 12 hours (mean difference, 3.9/min; 95% CI, 1.3- 6.5/min; P=.003). Local skin reactions occurred in 30% of neonates given tetracaine vs 0% for morphine (risk difference, 0.30; 95% CI, 0.19- 0.41; P < .001). Conclusion: In this study of ventilated neonates undergoing central line placement, morphine and tetracaine plus morphine provided superior analgesia to tetracaine; however, morphine caused respiratory depression and tetracaine caused erythema.

6例原发性宫颈淋巴瘤的临床病理特点

Primary lymphoma of the uterine cervix is rare, with less than 60 cases reported. We present a series of 6 patients with cervical lymphoma and review the literature. Study design: Between 1988 and 2003, we identified 6 women with primary lymphoma of the uterine cervix treated at our institutions. Data for analysis were obtained from hospital charts, office records, and tumor registry files. We also reviewed 20 published reports on cervical lymphoma, providing information on 58 additional patients. Results: The median age at diagnosis was 52 years (range 40- 76). Three patients had an abnormal Papanicolaou test within 6 months of the diagnosis. Mean tumor size was 8.3 cm (range 3- 14 cm). On the basis of the Ann Arbor system of staging where “ E” denotes extranodal tumor origin, 2 patients had stage IE, 1 had stage IIIE, and 3 had stage IVE disease. The median follow-up for these 6 women was 33 months (range 12- 120). Adding the 6 patients in our series to the 58 patients obtained from published reports, 43 had stage IE, 14 had stage IIE, 2 had stage IIIE, and 5 had stage IVE disease. There was no consistent pattern of treatment identified from our literature review. Conclusion: Primary lymphoma of the uterine cervix is a rare malignancy. Most patients present with stage IE disease. Women with localized disease typically respond to various combinations of surgery, chemotherapy, and radiotherapy. Combination chemotherapy with tailored radiotherapy appears to be the preferred treatment option in women with advanced disease.

既往成功肾移植患者的妊娠

To evaluate the risk factors affecting pregnancy, perinatal outcomes, and short-term graft condition in women who underwent renal transplantation. Method: Between May 1998 and January 2005, the histories of 20 pregnancies in 17 renal transplant recipients were reviewed retrospectively at the Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital. Result: There were significant associations between high serum creatinine level (>1.5 mg/dL) prior to pregnancy and preterm delivery (P = 0.04), and between short interval between transplantation and pregnancy ( < 2 years) and increased rate of cesarean sections (P = 0.04). There were no significant changes in serum creatinine levels during pregnancy in these women, and there were no acute rejection and graft loss during pregnancy or in the 6 months following delivery. Conclusion: These findings suggest that, although pregnancy does not adversely affect short-term renal allograft function, the rates of obstetric and perinatal complications are increased. Risk factors present before conception are a short interval between renal transplantation and pregnancy and poor renal function.

妊娠剧吐:一项大型队列研究中的流行病学发现

This study was undertaken to quantify the frequency, clinical course, charges, and outcomes of hyperemesis gravidarum. Study design: California birth certificate data linked with maternal and neonatal hospital discharge data in 1999 were used (N = 520,739). Hyperemesis was defined by ICD- 9 codes. The frequency, estimated charges, and demographic characteristics associated with hyperemesis patients were assessed. Maternal and neonatal perinatal outcomes were compared by maternal hyperemesis status. Results: Hyperemesis complicated 2,466 of 520,739 births. The average length of stay was 2.6 days and the average charge was ＄ 5,932. Singleton hyperemesis infants were smaller (3,255 vs 3,380 g; P < .0001 and more likely to be small for gestational age (29.21% vs 20.8% ; P < .0001). Conclusion: Hyperemesis occurs in 473 of 100,000 live births and is associated with significant charges. Infants of mothers with hyperemesis have lower birth weights and the mothers are more likely to have infants that are small for gestational age.

阴道内置米索前列醇600μg和800μg治疗早期流产

To compare the respective effectiveness and safety of 600 μ g and 800 μ g of intravaginal misoprostol for complete abortion in cases of early pregnancy failure (occurring in the first 12 weeks). Method: A total of 114 women with a diagnosis of early pregnancy failure made by transvaginal ultrasonography at Rajavithi Hospital between November 25, 2002 and July 31, 2003, were assigned randomly to 2 groups of equal size. In one group the women received 600 μ g of misoprostol and in the other 800 μ g of misoprostol intravaginally. Results: The rate of complete abortion within 24 h was significantly higher in the group that received 800 μ g of misoprostol (68.4% ) than in the other group (45.6% ) (P < 0.05). There were no significant differences between the 2 groups regarding time interval between misoprostol insertion and complete abortion or side effects. Conclusion: Intravaginal misoprostol 800 μ g is significantly more effective than vaginal misoprostol 600 μ g for the termination of an early pregnancy failure, with no significant differences in side effects.

腹壁子宫内膜异位症

To investigate the clinical characteristics, treatment, and factors of recurrence of abdominal wall endometriomas (AWE). Method: Sixty-four cases of AWE diagnosed at Peking Union Medical College Hospital (PUMCH) from 1983 to 2003 were reviewed retrospectively. Result: There was an AWE incidence of 0.044% among the parturients undergoing cesarean section at PUMCH, of whom 87.5% had the typical complaint of an enlarging mass and pain during menstruation. Among these women, 62 underwent low abdominal surgery for endometrioma (2 for primary umbilicus endometrioma); 2 women with small endometriomas opted for a temporary medical solution and had relief after menopause. The latent period of AWE positively correlated to the women’ s age at onset of symptoms (P < 0.001). Of the 62 women who underwent local excision, 19 had an unsatisfactory experience with medical management. There were 5 recurrences and 1 evolution to malignancy during a mean follow-up of 83.7 months. Recurrence was closely related to the size and depth of lesions. Conclusion: Because of its typical clinical manifestations, abdominal wall endometriomas could be diagnosed before pregnancy. Surgical excision is the only effective treatment and wide local excision with clear margins is the key point to prevent recurrence.

发生1次和发生2次完全性会阴Ⅲ度裂伤的妇女出现肛门失禁的比较

To compare the rate of anal incontinence and severe incontinence among women who had 0, 1, and ≥ 2 additional vaginal deliveries after sustaining a third-degree perineal laceration and between subjects with one versus two third-degree tears. Method: A telephone survey was done to assess the anal function of all subjects who sustained a complete third-degree tear as a nullipara. Result: The rate of anal incontinence and severe incontinence was similar among women who had 0, 1, and ≥ 2 additional deliveries (11/65, 11/67, and 12/40, p = 0.179; 2/65, 1/67, and 2/40, p = 0.811) and between women who had one sphincter tear and no additional delivery versus those with two tears and ≥ 2 subsequent deliveries (11/65 and 10/37, p = 0.225. 2/65 and 2/37, p = 0.460). Conclusion: Additional vaginal deliveries and a repeat sphincter tear afte r the initial third-degree laceration were not associated with a higher rate or severity of anal incontinence.

静脉血栓风险增高妊娠妇女的处理

To evaluate the usefulness of score based management of pregnancies with high risk of venous thromboembolism (VTE). Method: 116 consecutive pregnancies in 109 women with confirmed thrombophilia and/or history of VTE were studied. Patients were managed in accordance with international recommendations. Recently, a VTE risk prediction score was established. An independent group assessed retrospectively and in a blinded way the usefulness of this score. Results: Of the 116 pregnancies, an antithrombotic prophylaxis by low molecular weight heparin was prescribed in 61 cases (52.6% ). All patients with a positive score (n = 57, 49.1% ) have been treated with an antenatal thromboprophylaxis. In the population where the score was negative (n = 55 cases), none of the patients received antenatal prophylaxis. But, despite a negative score, four patients were treated by their general practitioner. During the study period, there was only one episode of VTE. Conclusion: Implementing this scoring system has resulted in favorable outcomes and a low risk of recurrent thrombosis in this limited series of women with increased risk of VTE.

超声测量子宫肌层厚度预测未足月胎膜早破和羊水过少妇女的潜伏期

Term labor is associated with global thinning of the myometrium. We hypothesized that a thickened myometrium at the time of preterm premature rupture of membranes (P- PROM) predicts less myometrial wall stress and, consequently, a longer latency interval. Study design: Myometrial thickness was measured prospectively in 76 pregnant women enrolled in the following groups: PPROM (n = 28, mean [range], gestational age [GA]: 29.5 weeks [w] [21.0 w- 33.0 w]), preterm nonlabor control group (P- CTR), (n = 21, GA: 27.5 w [23.0 w- 32.0 w]) and term nonlabor control (T- CTR) (n = 27, GA: 38.6 w [37.0 w- 41.6 w]). All PPROM women had oligohydramnios (AFI: 1.4 cm [0.0 cm- 5.1 cm]). MT was measured ultrasonographically at the midanterior, fundal, posterior, and lower uterine segment wall in cases and controls with an intraoperator variability < 10% . Results: Women in the PPROM group displayed uniform thickness of the uterine body (mean ± SEM, anterior: 10.6 ± 0.6 mm, fundal: 10.7 ± 0.7 mm, posterior: 8.9 ± 0.5 mm, P = .078). At midanterior site the myometrium of the PPROM group was thicker compared to both P- CTR (P < .001) and T- CTR (P = .025) groups. This difference was preserved at the fundus (PPROM vs P- CTR, P < .001; PPROM vs T- CTR, P = .015). There was a positive correlation between fundal MT and latency period (r = 0.43, P = 0.02) that persisted after adjusting for GA (P = .04). A fundal MT less than 12.1 mm was 93.7% sensitive and 63.6% specific for the identification of women whose latency period was less than 120 hours. Conclusion: Significant thickening of the anterior and fundal walls of the uterus follows PPROM. A thick myometrium in nonlaboring patients with PPROM is associated with longer latency interval. Sonographic evaluation of MT may represent an alternative clinical tool for the prediction of a short latency interval in women with PPROM.

促性腺激素释放激素激动剂或拮抗剂治疗后人前颗粒细胞凋亡水平相当

Objective: To compare levels of apoptosis in granulosa cells from women treated with the gonadotropin- releasing hormone (GnRH) agonist triptorelin or the GnRH antagonist cetrorelix. Design: Randomized, prospective study. Setting: University hospital. Patient(s): Thirty- two women undergoing assisted reproduction techniques after ovulation induction with recombinant follicle- stimulating hormone (FSH) plus GnRH agonist or antagonist. Intervention(s): Granulosa cells were isolated from follicular aspirates after oocyte removal. Main Outcome Measure(s): Apoptosis was assessed with Annexin V binding assay, terminal deoxynucleotidyl transferase (TdT)- mediated nick- end labeling (TUNEL) assay, flow cytometric analysis of DNA, and ultrastructural analysis of cell morphology in transmission electron microscopy. Serum and follicular hormonal levels were also determined. Result(s): Annexin V binding and TUNEL assays revealed comparable percentages of apoptosis in the two groups under investigation. Analysis of DNA histograms revealed a similar cell cycle distribution in the two groups. Ultrastructural analysis only occasionally displayed patterns of chromatin margination in apoptotic cells. The mean concentrations of all the follicular fluid steroid hormones evaluated (E2, T, and P) were significantly lower in the GnRH antagonist- treated group. Conclusion(s): Therapy with a GnRH agonist or antagonist is associated with comparable levels of apoptosis in granulosa cells.

切口缺血性坏死:一种无法预料的腹腔镜并发症

A case of necrosis of the 10- mm umbilical port site after laparoscopic closure of enterocele in a 66- year- old woman is reported. Ischemic necrosis of the superficial tissue with cellulitis of the umbilical wound was seen during debridement. This highlights a hitherto unforeseen complication of laparoscopic surgery.