使用内环境稳态模型评价多囊卵巢综合征患者胰岛素抵抗的患病率

Objective: To determine the prevalence of insulin resistance (IR) in a large p opulation of patients with the polycystic ovary syndrome (PCOS). Design: Prospec tive, case-control. Setting: University medical center. Patient(s): Two hundred seventy-one PCOS patients and 260 eumenorrheic, non-hirsute, control women. I ntervention(s): History and physical examination and blood sampling. Main Outcom e Measure(s): Total T, free T, DHEAS, sex hormone-binding globulin, and fasting glucose and insulin levels; homeostatic model assessment values for IR (HOMA-I R) and percent β-cell function (HOMA-%β-cell). Result(s): Patients with PC OS and controls differed significantly in all parameters studied, except fasting glucose. Because the HOMA-IR and HOMA-%β-cell values were variably associa ted with race, age, and body mass index, the HOMA-IR and HOMA-%β-cell value s were then adjusted for these cofounders. After adjustment, 64.4%of PCOS patie nts were noted to be insulin resistant, and 2.6%had β-cell dysfunction. Compa red with PCOS patients without IR (n = 96), patients with IR (n = 174) were more obese and had higher β-cell function. Conclusion(s): In patients with PCOS, t he prevalence of IR was 64%according to the HOMA-IR measurement, after adjustm ent. Patients with IR were more clinically affected. Although IR is a common abn ormality in PCOS, it does not seem to be a universal feature.

盆腔脏器支持组织研究(POSST):盆腔脏器支持组织缺陷的分布、临床定义及流行病学特点

Objective: The purpose of this study was to describe the distribution of pelvic organ support in a gynecologic clinic population to define the clinical disease state of pelvic organ prolapse and to analyze its epidemiologic condition. Study design: This was a multicenter observational study. Subjects who were seen at outpatient gynecology clinics who required an annual gynecologic examination underwent a pelvic organ prolapse quantification examination and completed a prolapse symptom questionnaire. Receiver operator characteristic curves were used to define pelvic organ prolapse with the use of symptoms and pelvic organ prolapse quantification examination measures. Standard age- adjusted univariate and multivariate logistic regression analysis were used to evaluate various relationships. Results: The population consisted of 1004 women who were aged 18 to 83 years. The prevalence of pelvic organ prolapse quantification stages was 24% (stage 0), 38% (stage 1), 35% (stage 2), and 2% (stage 3). The definition of pelvic organ prolapse that was determined by the receiver operator characteristic curve was the leading edge of their vaginal wall that was - 0.5 cm above the hymenal remnants. Multivariate analysis revealed age, Hispanic race, increasing body mass index, and the increasing weight of the vaginally delivered fetus as risk factors for pelvic organ prolapse, as defined in this population. Conclusion: The results from this population suggest that there is a bell- shaped distribution of pelvic organ support in a gynecologic clinic population. Advancing age, Hispanic race, increasing body mass index, and the increasing weight of the vaginally delivered fetus have the strongest correlations with prolapse.

宫颈环形电切术与随后行子宫切除术的时间间隔对宫颈上皮内瘤样病变患者发病率的影响

To improve clinical prospects by reducing intraoperative or postoperative complications, subsequent hysterectomy is generally conducted within 48 h or >6 weeks after cervical cold- knife conization. The loop electrosurgical excision procedure (LEEP) is widely used for cervical conization. However, no study has ever been undertaken on the relation between postoperative sequelae and the time between LEEP and hysterectomy. Therefore, this study was undertaken to evaluate the correlations between postoperative sequelae and the interval between LEEP and hysterectomy. The medical records of 338 patients, who underwent type 1 extended hysterectomy after LEEP at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine, were retrospectively reviewed. The subjects were divided into three groups according to time from LEEP to hysterectomy: group 1 (within 48 h, n = 210), group 2 (between 48 h and 6 weeks, n = 88), and group 3 (>6 weeks, n = 40). The three groups showed no significant differences with respect to patient characteristics (age, delivery history, body mass index, and a history of surgery). Postoperative complications such as fever, dysuria, and surgical region complications (effraction, infection, and rubefaction) were not significantly different among the three groups. Other complications, namely, ureter injury and abdominal wall hematoma, were found in one case in each group 1. The postoperative clinical courses were not significantly different regardless of time interval between LEEP and subsequent hysterectomy. Therefore, hysterectomies can be conducted at any time when the patient is in an appropriate condition, i.e., not precisely within 48 h or 6 weeks after LEEP.

IA2～IB1期宫颈癌患者切除宫旁组织的可行性和安全性

Objective. Several authors have proposed the use of a less aggressive surgery (i.e., modified or type 2 radical hysterectomy) for patients affected by early stages cervical carcinoma. However, little attention has been given to the evaluation of adverse prognostic factors before selecting the surgical approach. The aim of this study is to evaluate the feasibility and safety of tailoring parametrectomy on the basis of specific prognostic factors preoperatively assessed. Methods. Patients with cervical carcinoma FIGO IA2- IB1 entered the study. Eligibility criteria were: age < 75 years, no contraindications for surgery, informed consent, expected cooperation for follow- up. Tumor size was preoperatively assessed by pelvic examination under anesthesia and pelvic MRI. Patients were submitted to systematic lymphadenectomy of superficial obturator, external iliac, and interiliac nodes by laparotomy or laparoscopy. Lymph nodes were sent for frozen section. Node- negative patients were submitted to modified radical hysterectomy (type 2). Patients with nodal metastases underwent classical radical hysterectomy (types 3- 4) and systematic pelvic and aortic node dissection up to the inferior mesenteric artery. Survival rates were calculated using the Kaplan- Meier product- limit method. Results. Eighty- three patients were enrolled in the study. Among these, 63 patients were node- negative at frozen section, and therefore submitted to modified radical hysterectomy (Group A); 20 patients were found having nodal metastases intra- opera- tively, and therefore submitted to classical radical hysterectomy (Group B). Median follow up was 30 months. Five years overall survival was 95% for Group A, and 74% for Group B. Conclusions. Pre- treatment evaluation of adverse prognostic factors in patients affected by cervical cancer FIGO stages IA2- IB1 is feasible and mandatory to determine if a less radical surgery is applicable and safe.

轻度胎儿肾盂扩张的产前诊断和处理:新生儿并发症的结局及随访

Objectives: To describe the natural history of pyelectasis from its detection in the second trimester to delivery, its capability to predict renal pathology and whether prenatal development of pelvic dilatation is correlated to its postnatal evolution. Study design: A retrospective analysis involving 375 fetuses with a complete urological follow- up. Prenatal ultrasound was correlated with the results of postnatal investigation and frequency of postnatal surgery was established. Results: Two- hundred and eighty cases underwent at least two examinations before birth. 73.1% were male fetuses. 57.4% had a bilateral pyelectasis. Prenatal evolution of pelvic dilatation was the following:18.6% of the cases normalized, in 34.6% of the cases the dilatation reduced but did not disappear, in 30.7% it remained unchanged, while it worsened in 16.4% . One case from the first group, three cases from the second, seven cases from the third and 11 cases from the fourth needed surgical treatment. 1.9, 7.2, 18.6, 23.9% of cases respectively worsened after birth in the four groups (trend: P=0.001). Conclusions: Prenatal diagnosis of pyelectasis improves the outcome of these children due to a surgical approach that avoids renal damage. There is a good correlation between prenatal evolution and postnatal outcome, although a postnatal follow- up is opportune in those cases that normalized before birth.

宫颈上皮内瘤样病变和浸润性宫颈癌均可发生细胞表面硫酸乙酰肝素表达缺失

Objective. Syndecan- 1 binds to various extracellular matrix components via its heparan sulfate glycosaminoglycans (HS- GAG) and most of its biological functions are considered to be associated with this process. The aims of this study are to investigate its expression in cervical neoplasms. Methods. We investigated the expression of both the syndecan- 1 core protein and cell- surface HS- GAG by immunohistochemistry in 53 cervical intraepithelial neoplasm (CIN), 19 microinvasive, 143 invasive cervical cancers, and 29 metastatic lymph node samples, and analyzed correlations with various clinicopathological features. Results. The progression of CIN to early invasive cancer was found to associate with reduced levels of both syndecan- 1 and HS- GAG expression. In squamous cell carcinomas, HS- GAG expression was significantly lower in cases with lymph- vascular space invasion. Additionally, the overall survival rates for patients exhibiting low HS- GAG expression was significantly lower than patients exhibiting high HS- GAG expression (P = 0.019). Low HS- GAG expression in positive nodes was determined to be a disease- free and overall survival prognostic factor (P = 0.028 and P = 0.018, respectively). Conclusion. The loss of syndecan- 1 and HS- GAG expression is an early event in cervical carcinogenesis. The loss of HS- GAG expression particularly in positive nodes can serve as an indicator of aggressive disease potential and poor prognosis in patients with invasive cervical cancer.

妇科恶性肿瘤治疗反应性的三维立体超声评价

Objective. To report the potential role of 3D ultrasound to assess the response to treatment in gynecological malignancies. Methods. The volumes and three 3D power Doppler indices are measured in one case of cervix carcinoma and in one case of ovarian carcinoma with primary radio- and/or chemotherapy before and after treatment. Results. After treatment, tumor volume, vascularization index (VI), flow index (FI), and vascularization- flow index (VFI) were reduced in both two cases. Conclusion. 3D ultrasound may provide a new method to assess the response to treatment in gynecological malignancies.

前哨淋巴结活检对宫颈癌的作用:一种评论性的观点

To report our experience about the role of sentinel node biopsy in cervical cancer patients while debating provocatory arguments concerning this procedure. From June 2001 to February 2003, patients affected by stage IB1 cervical cancer were submitted to the sentinel node biopsy procedure. Patients were submitted to lymphoscintigraphy and, subsequently, to laparoscopy in order to locate the sentinel lymph node. Thirty- seven patients were enrolled in the study. Sentinel node(s) was(were)- identified with preoperative lymphoscintigraphy in 89% of the patients. Intraoperative detection rate was 70% . During surgery in 31% of the patients, sentinel node was detected bilaterally; in 15% , two sentinel nodes on the same side of the lymphatic vessels were detected. The sentinel node was located at the level of superficial common iliac vessels (26% ), external iliac vessels (69% ), and superficial obturator vessels (49% ). In 77% of the patients, the histologic specimen sent by the surgeon as unique sentinel node contained two or more nodes. Metastatic sentinel nodes were found in 23% of the patients. There was no case with a positive nonsentinel node in the presence of a negative sentinel node. Sentinel node detection is a feasible procedure in cervical cancer patients. However, a high percentage of patients is found with bilateral and/or more than one sentinel lymph node. Improvements in detection rate and pathological analysis are needed prior to consider the sentinel node biopsy a routine procedure in cervical cancer patients.

早产预测研究:孕妇体重指数与自发性早产及干预性早产的关系

Objective: The purpose of this study was to evaluate the relationship between prepregnancy maternal body mass index and spontaneous preterm birth and indicated preterm birth. Study design: This was a secondary analysis of the Maternal- Fetal Medicine Units Network, Preterm Prediction study. Patients were classified into categories that were based on their body mass index. Rates of indicated and spontaneous preterm birth were compared. Results: Five hundred ninety- seven (20.5% ) of 2910 women were obese. Obese women had fewer spontaneous preterm births at < 37 weeks of gestation (6.2% vs 11.2% ; P <. 001) and at < 34 weeks of gestation (1.5% vs 3.5% ; P =. 012). Women with a body mass index of < 19 kg/m2 had 16.6% spontaneous preterm birth, with a body mass index of 19 to 24.9 kg/m2 had 11.3% spontaneous preterm birth, with a body mass index of 25 to 29.9 kg/m2 had 8.1% spontaneous preterm birth, with a body mass index of 30 to 34.9 kg/m2 had 7.1% spontaneous preterm birth, and with a body mass index of ≥ 35 kg/m2 had 5.2% spontaneous eterm birth (P <. 0001). Indicated delivery was responsible for an increasing proportion of preterm births with increasing body mass index (P =. 001). Obese women had lower rates of cervical length < 25 mm (5% vs 8% pr.; P =. 012). Multivariable regression analysis confirmed a lower rate of spontaneous preterm birth in obese gravid women (odds ratio, 0.57; 95% CI, 0.39- 0.83; P =. 003). Conclusion: Obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

引产前使用30ml和80ml Foley尿管球囊促宫颈成熟效果的比较:一项随机试验

Objectives The purpose of this study was to compare the efficacy of cervical ripening with 2 Foley catheter balloon volumes. Study design Pregnant women admitted for induction of labor with a term singleton gestation were randomly assigned for cervical ripening by a balloon inflated with 30 mL or 80 mL of sterile saline. Results Two hundred and three women were included in the analysis. Ripening of the cervix with the larger balloon volume was associated with a significantly higher rate of postripening dilatation of 3 cm or more (76.0%vs 52.4%, P <.001). In primiparous women, the larger balloon volume resulted in a significantly higher rate of deliveries by 24 hours (71.4%vs 49%, P <.05), and a significantly less requirement of augmentation with oxytocin (69.3%vs 90.4%, P <.05). Conclusion Ripening of the unfavorable cervix in primiparous women with a Foley catheter balloon inflated with 80 mL provided effective more dilatation, faster labor, and decreased need for oxytocin than with a balloon inflated with 30 mL of sterile saline.

加强住院患者监护措施以改善单羊膜囊双胎围生期的存活率

The purpose of this study was to evaluate the impact of routine hospitalization for fetal monitoring on the perinatal survival and neonatal morbidity of monoamniotic twins. This was a multicenter retrospective cohort analysis of 96 monoamniotic twin gestations from 11 university and private perinatal practices. Overall mortality rates were calculated. The risk of intrauterine fetal death and neonatal morbidity was compared among women who were observed as inpatients versus outpatients. The overall mortality rate from enrollment was 19.8% (mean gestational age at enrollment, 17.4 weeks). The perinatal mortality and corrected perinatal mortality rates were 15.4% and 12.6% , respectively. Eighty- seven women had both twins who were surviving at 24 weeks of gestation; 43 women were admitted electively for inpatient surveillance at a median gestational age of 26.5 weeks; the remainder of the women were followed as outpatients and admitted only for routine obstetric indications (median gestational age, 30.1 weeks). No intrauterine fetal deaths occurred in any hospitalized patient. The risk of intrauterine fetal death in women who were followed as outpatients was 14.8% (13/88) versus 0 for women who were followed as inpatients (P <. 001). There also were statistically significant improvements in birth weight, gestational age at delivery, and neonatal morbidity for women who were followed as inpatients. We observed improved neonatal survival and decreased perinatal morbidity among women who were admitted electively for inpatient fetal monitoring.

阿莫西林舒巴坦在胎膜完整性先兆早产中的疗效:一项随机对照试验

Objective:To determine whether treatment with amoxicillinsulbactam in women with threatened idiopathic preterm labour will prolong the gestation and reduce preterm birth rates in a Latin- American population. Methods: A double- blind, placebo- controlled, randomized trial was conducted in 96 women who were hospitalized for preterm labour between 24 and 34 weeks of gestation at the Pereira Rossell Hospital, in Montevideo, Uruguay. The primary outcome measure was prematurity. The sample size was calculated a priori based on the hospital database. Statistical analyses were performed using the t- test, chi square, weighted mean difference (WMD) and relative risk (RR) with their confidence intervals (95% CI). Analysis by intention- to- treat. Results: Out of 47 patients assigned for antibiotics, 43 completed the treatment. There were no significant statistical differences between antibiotics and placebo group in prematurity (RR:1.04, 95% CI: 0.59, 1.84), prolongation of pregnancy (WMD:0.23, 95% CI: - 0.96, 1.42) and other perinatal outcomes. Conclusion: Antibiotics did not prove to have benefits in improving perinatal outcomes in this Latin American population.

1例宫内存活妊娠合并原发性输卵管绒毛膜癌治疗成功的病例报道

Background. Choriocarcinoma of the fallopian tube is extremely rare as is choriocarcinoma with a viable pregnancy. We present an unusual case of primi gravida at 33 weeks gestation that was diagnosed as having tubal choriocarcinoma which was successfully treated by chemotherapy. Case. A 31- year- old primi gravida at 32+ 3 weeks gestation was admitted complaining of dyspnea and blood tinged sputum. Suspecting a left adnexal malignant tumor with pulmonary metastasis, delivery of the baby for optimal treatment of the mother’s tumor was planned. Cesarean delivery was performed because of induction failure. Tumorectomy with left salpingectomy and infracolic omentectomy was performed for a left tubal tumor. Microscopic findings revealed choriocarcinoma with extensive hemorrhage. Its FIGO stage was III and its WHO prognostic score 12, representing high risk. After 4 cycles of chemotherapy, serum β - hCG level fell to the normal range. The patient and her baby remain disease- free 16 months after disease diagnosis. Conclusion. This is the first reported case of tubal choriocarcinoma coexistent with a viable pregnancy, in which the baby survived and the mother was successfully treated by chemotherapy.

宫颈癌患者行腹膜外淋巴结清扫术后的评估

Objective.The presence of nodal metastases is an important prognostic factor in patients with cervical cancer. To adjust our therapy to the anatomic extent of the disease, we performed a surgical staging with extraperitoneal lymph node dissection (EPLND). The goal of our study was to evaluate the clinical outcome and side effects of the combined treatment approach of EPLND and either radical hysterectomy in case of early stage cervical cancer (FIGO Ia/b and IIa) and negative nodes, or pelvic radiotherapy/extended field radiotherapy with concomitant chemotherapy in case of positive nodes or advanced stage cervical cancer (FIGO IIb, III, and IVa). Patients and methods. Fifty- nine patients with primarily diagnosed invasive cervical cancer underwent EPLND. The value of this procedure as a diagnostic tool for evaluating the extent of disease was determined. Additionally, treatment- related complications and clinical outcomes were monitored. Results. A total of 983 lymph nodes were removed during EPLND (mean 16.7). According to the results of EPLND, radical hysterectomy was abandoned due to histopathologically confirmed lymph node involvement by frozen section in 11 out of 36 patients with early stage cervical cancer (31% ). The most common adverse effects directly related to surgery in general (EPLND or combined EPLND and radical hysterectomy) were lymph cysts in seven patients (12% ). Only in the group of patients who received EPLND followed by radical hysterectomy, 2 out of 25 patients (8% ) developed a severe ileus postoperatively (WHO Grade 3 toxicity). The treatment approach of combined EPLND followed by radio- and chemotherapy was without major complications (WHO Grade 3 or 4 toxicity). After a mean follow up of 28 months (range 6- 60), 44 out of 58 patients (one patient lost to follow up) are without evidence of disease (76% ), 2 patients have progressive disease (3% ), and 12 patients died of their disease (21% ). Using Kaplan- Meier analysis, the estimated 5- year overall survival rate for all patients is 64% (SD ± .9% ). Performing the Cox proportional regression analysis, in contrast to clinical FIGO staging (P = 0.24; ns), lymph node involvement was the only significant independent predictor for overall survival (P = 0.04). Conclusion. Our data support the approach of pretherapeutic surgical staging by performing EPLND as a diagnostic tool with a low complication rate. This allows an individualized treatment for cervical cancer patients.

唐氏综合征妊娠中、晚期胎儿一种新的心脏影像学征象——右锁骨下动脉异位

The right subclavian artery arises normally as the first vessel from the brachiocephalic artery of the aortic arch. An aberrant right subclavian artery arises as a separate vessel from the aortic isthmus and crosses to the right, behind the trachea. This variant is present in <1% of the normal population; however, in subjects with Down syndrome, an incidence between 19% and 36% was reported. The purpose of this study was to assess the possibility of the detection of an aberrant right subclavian artery in fetuses with Down syndrome. Fourteen consecutive fetuses with prenatally detected Down syndrome were examined between 18 and 33 weeks of gestation. The presence of an aberrant right subclavian artery was determined by visualization of the transverse 3- vessel trachea view of the upper thorax with color Doppler ultrasonography. The right subclavian artery was visualized in 100% of fetuses (14/14) with Down syndrome. An aberrant right subclavian artery was identified in 35.7% of trisomy 21 fetuses (5/14). In 1 fetus, the aberrant right subclavian artery was the only abnormal ultrasound finding. In 3 fetuses, an aberrant right subclavian artery was associated with an intracardiac echogenic focus plus additional extracardiac markers. In the fourth fetus, an aberrant right subclavian artery was associated with an atrioventricular septal defect. All 9 fetuses with Down syndrome with a normal origin of the right subclavian artery had additional cardiac and/or extracardiac abnormalities. In 12 cases, pregnancy was terminated; 2 fetuses were live born. This preliminary study suggests that the in utero identification of an aberrant right subclavian artery may be a new ultrasound marker to be found in fetuses with Down syndrome. Further studies are required to assess the incidence of aberrant right subclavian artery in normal fetuses.

化疗药物抵抗性胎盘滋养层细胞瘤伴肺门淋巴结转移:罕见的转移部位

Placental site trophoblastic tumor (PSTT) is an uncommon variant of gestational trophoblastic diseases. In most cases, disease is confined to the uterus and treated with a simple hysterectomy. However, 30% of these patients will present with metastatic disease. Patients with metastases frequently have progression of disease and die despite aggressive multiagent chemotherapy. We present a case of 33- year- old female with PSTT and metastases to the hilar lymph nodes of the right lung. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo- oophorectomy was followed by six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy. After the completion of chemotherapy, β hCG titers stayed within normal range, but a repeated CT scan of chest revealed enlargement of the hilar lymph nodes. The patient underwent right thoracotomy with hilar lymph nodes resection. The resected nodules were pathologically consistent with primary PSTT. In this case report, we have determined a PSTT with hilar region metastasis other than parenchyma of lung and confirmed the chemoresistant nature of tumor with the guidance of the previous reports.

晚期浆液性卵巢癌环氧合酶2的表达与肿瘤细胞增殖、凋亡、血管生成及生存率的关系

Objective: Cyclo-oxygenase-2 seems to be involved at various steps in the processes of tumor progression. The abstract Objective of this study was to examine the relationship between cyclo- oxygenase- 2 expression and tumor proliferation, apoptosis and angiogenesis in patients with advanced stage high- grade ovarian carcinoma. Study design: Specimens from 118 patients with high- grade and advanced stage (III, IV) serous ovarian carcinoma were evaluated by immunohistochemistry for cyclo- oxygenase- 2, Ki- 67, vascular endothelial growth factor, and bcl- 2 expression. Tumor microvessel density was assessed with CD34 immunostaining. We investigated the relationships between cyclo- oxygenase- 2 expression and clinicopathologic characteristics, tumor angiogenesis (tumor microvessel density and vascular endothelial growth factor expression), and tumor proliferation and apoptosis. The effect of cyclo- oxygenase- 2 expression on patient survival was determined. Results: There was a significant positive correlation between cyclo- oxygenase- 2 expression in tumor cells and markers of tumor proliferation and angiogenesis. In univariate survival analysis, high cyclo- oxygenase- 2 and high Ki- 67 expression showed a significant impact of on patient survival (P <. 001). In multivariate regression analysis, only Ki- 67 expression retained its significance as an independent poor prognostic factor (death hazard ratio, 2.0; 95% CI, 1.2- 3.3;P <. 001). Conclusion: Expression of cyclo- oxygenase- 2 correlates with tumor proliferation and tumor angiogenesis but not with apoptotic markers (bcl- 2 expression) in high- grade, advanced- stage serous ovarian carcinoma. Catastrophizing labor pain compromises later maternity adjustments Ferber S.G./Granot M./Zimmer E.Z. [Dr. S.G. Ferber, Fac. Social Welf. and Hlth. Studs., University of Haifa, Mount Carmel, Haifa 31905, Israel] Abstract Objective: The purpose of this study was to evaluate the impact of labor pain intensity and labor pain catastrophizing on maternity blues and postpartum social functioning. Study design: Pain intensity and pain catastrophizing were assessed in 89 women in active labor before the administration of analgesia. Both these measures were assessed again retrospectively 2 days after delivery in 82 women who had a spontaneous vaginal delivery. Women also filled out the Edinburgh Postnatal Depression Scale. Six weeks later women completed the social functioning domain of the short form SF36 health survey. Results: Pain catastrophizing during labor significantly predicted both maternity blues (P =. 001) and postpartum social functioning (P =. 001) when being controlled for maternal age and education, parity, type of analgesia, and labor pain intensity. Low level of education and younger age also contributed to the prediction of maternity blues and social functioning. Conclusion: Labor pain catastrophizing rather than labor pain intensity predicts postpartum maternal adjustments.

正电子发射发射计算机断层成像发现正常妊娠后的隐性绒癌

Background. Positron emission tomography (PET) is commonly used to detect occult or recurrent malignancy, including tumors of the female genital tract. Recently, there have been reports of PET scans used in patients with Gestational Trophoblastic Disease (GTD). Case. A 22- year- old female presented with vaginal bleeding and elevated β - hCG 7 months after a spontaneous vaginal delivery of a healthy infant. She had a history of molar pregnancy and persistent GTD requiring multi- agent chemotherapy. Metastatic evaluation with computed tomography and magnetic resonance imaging showe d no evidence of GTD. A positron emission tomography/computed tomography (PET/CT) scan revealed a focus of metabolic activity in the left pelvis. The patient underwent an exploratory laparotomy that revealed metastatic choriocarcinoma in the left broad ligament. Conclusion. PET/CT may be useful in the evaluation of occult choriocarcinoma when conventional.

胰岛素和优降糖的治疗剂量、妊娠期糖尿病严重程度与妊娠结局的关系

We sought to investigate the association between glyburide dose, degree of severity in gestational diabetes mellitus (GDM), level of glycemic control, and pregnancy outcome in insulinand glyburide- treated patients. In a secondary analysis of our previous randomized study, 404 women were analyzed. The association among glyburide dose, severity of GDM, and selected maternal and neonatal factors was evaluated. Severity levels of GDM were stratified by fasting plasma glucose (FPG) from the oral glucose tolerance test (OGTT). Infants with birth weight at or above the 90th percentile were considered large- for- ges- tational age (LGA). Macrosomia was defined as birth weight ≥ 4000 g. Well- controlled was defined as mean blood glucose ≤ 95 mg/dL. The association between glyburide- and insulintreated patients by severity of GDM and neonatal outcome was evaluated. The dose received for the glyburide- treated patients was 2.5 mg- 32% ; 5 mg- 23% ; 10 mg- 17% ; 15 mg- 8% ; and 20 mg- 20% . Patients were grouped into low (≤ 10 mg) and high (<10 mg) daily dose of glyburide. A comparison between severity of the disease (fasting plasma glucose categories) and highest dose of glyburide revealed a significant difference between the low- 95 FPG and the other severity categories (P =. 02). Of patients in the well- controlled glycemic group, only 6% required the high dose of glyburide (<10 mg). In patients with poor glycemic control (mean blood glucose <95 mg/dL), 38% received the high dose of glyburide (P =. 0001). Comparison between the high glyburide (<10 mg) and the low glyburide dosages (≤ 10 mg) revealed that the rate of macrosomia was 16% vs 5% and LGA 22% vs 8% , (P =. 01), respectively. No significant difference was found in composite outcome, metabolic complications, and Ponderal Index between the 2 dose groups. Stratification by disease severity revealed a significantly lower rate of LGA for both the glyburide- and insulin- treated subjects. No significant difference was found between metabolic, respiratory, and neonatal intensive care unit (NICU) for patients within each fasting plasma glucose severity category. Glyburide and insulin are equally efficient for treatment of GDM in all levels of disease severity. Achieving the established level of glycemic control, not the mode of pharmacologic therapy, is the key to improving the outcome in GDM.

锻炼对孕妇腰部疼痛强度的影响

Objective:To investigate the effect of exercise during pregnancy on the intensity of low back pain and kinematics of spine. Method: A prospective randomized study was deigned. 107 women participated in an exercise program three times a week during second half of pregnancy for 12 weeks and 105 as control group. All filled a questionnaire between 17- 22 weeks of gestation and 12 weeks later for assessment of their back pain intensity. Lordosis and flexibility of spine were measured by Flexible ruler and Side bending test, respectively, at the same times. Weight gain during pregnancy, Pregnancy length and neonatal weight were recorded. Result: Low back pain intensity was increased in the control group. The exercise group showed significant reduction in the intensity of low back pain after exercise (p < 0.0001). Flexibility of spine decreased more in the exercise group (p < 0.0001). Weight gain during pregnancy, pregnancy length and neonatal weight were not different between the two groups. Conclusion: Exercise during second half of the pregnancy significantly reduced the intensity of low back pain, had no detectable effect on Lordosis and had significant effect on flexibility of spine.