RESUMEN
The capacity for autonomous functionality serves as the fundamental ability and driving force for the cross-generational upgrading of unmanned aerial vehicles (UAVs). With the disruptive transformation of artificial intelligence technology, autonomous trajectory planning based on intelligent algorithms has emerged as a key technique for enhancing UAVs' capacity for autonomous behavior, thus holding significant research value. To address the challenges of UAV trajectory planning in complex 3D environments, this paper proposes a multi-UAV cooperative trajectory-planning method based on a Modified Cheetah Optimization (MCO) algorithm. Firstly, a spatiotemporal cooperative trajectory planning model is established, incorporating UAV-cooperative constraints and performance constraints. Evaluation criteria, including fuel consumption, altitude, and threat distribution field cost functions, are introduced. Then, based on its parent Cheetah Optimization (CO) algorithm, the MCO algorithm incorporates a logistic chaotic mapping strategy and an adaptive search agent strategy, thereby improving the home-returning mechanism. Finally, extensive simulation experiments are conducted using a considerably large test dataset containing functions with the following four characteristics: unimodal, multimodal, separable, and inseparable. Meanwhile, a strategy for dimensionality reduction searching is employed to solve the problem of autonomous trajectory planning in real-world scenarios. The results of a conducted simulation demonstrate that the MCO algorithm outperforms several other related algorithms, showcasing smaller trajectory costs, a faster convergence speed, and stabler performance. The proposed algorithm exhibits a certain degree of correctness, effectiveness, and advancement in solving the problem of multi-UAV cooperative trajectory planning.
RESUMEN
OBJECTIVE: To compare the efficacy of intermittent intrauterine balloon dilatation versus standard care in the prevention of adhesion reformation. DESIGN: Single-blind randomised controlled trial. SETTING: Hysteroscopic Centre of a tertiary University Hospital. POPULATION: Two hundred patients with moderate to severe (European Society for Gynaecological Endoscopy Grade ≥II) intrauterine adhesions who underwent hysteroscopic adhesiolysis. METHODS: All participants were randomised to a balloon group or a control group postoperatively. The balloon group received intrauterine balloon dilatation therapy at 2 weeks and 6 weeks after surgery, whereas the control group did not. All patients underwent follow-up hysteroscopy at 4 and 8 weeks postoperatively. MAIN OUTCOME MEASURES: The adhesion reformation rate and the Pictorial Blood Loss Assessment Chart scores were analysed. RESULTS: A total of 191 patients successfully completed the study protocol (94 cases for the balloon group and 97 cases for the control group). According to hysteroscopic evaluation at the 8th week, the overall adhesion reformation rate was significantly lower in patients in the balloon group than patients in the control group (20.2% versus 40.2%, respectively; P < 0.05). There was also a significant increase in menstruation flow, as assessed by the Pictorial Blood Loss Assessment Chart score (30 versus 9, respectively; P < 0.001). CONCLUSIONS: Postoperative intermittent intrauterine balloon dilatation therapy can significantly reduce postoperative adhesion reformation and significantly increase menstruation flow. TWEETABLE ABSTRACT: RCT: Postoperative intermittent intrauterine balloon therapy can prevent adhesion reformation after hysteroscopic adhesiolysis.
Asunto(s)
Histeroscopía/efectos adversos , Dispositivos Intrauterinos , Complicaciones Posoperatorias/prevención & control , Adherencias Tisulares/prevención & control , Taponamiento Uterino con Balón/métodos , Enfermedades Uterinas/patología , Enfermedades Uterinas/prevención & control , Adulto , China , Femenino , Humanos , Complicaciones Posoperatorias/patología , Método Simple Ciego , Stents , Adherencias Tisulares/patología , Resultado del TratamientoRESUMEN
False passage in the uterus, if unrecognised, will almost certainly lead to perforation of the uterus and associated complications. We present our experience of the management of a false passage encountered during hysteroscopic surgery for the treatment of severe Asherman's syndrome. Five women with severe Asherman's syndrome resulting in complete obliteration of the uterine cavity and a false passage created during hysteroscopy were included in our study. A subsequent hysteroscopy was performed under ultrasound guidance with preoperative oestrogen therapy to increase endometrial thickness. In all 5 cases, the uterine cavity was successfully entered during the repeat hysteroscopy, which enabled the adhesiolysis procedure to be completed. There was satisfactory improvement in menstrual pattern and significant reduction in intrauterine the adhesion score. Two of the three patients who wished to conceive did become pregnant. The early recognition of a false passage inadvertently created during hysteroscopy is crucial in preventing further damage to the uterus.
Asunto(s)
Ginatresia/cirugía , Histeroscopía , Complicaciones Intraoperatorias/cirugía , Adulto , Estrógenos/uso terapéutico , Femenino , Ginatresia/etiología , Humanos , Complicaciones Intraoperatorias/diagnóstico por imagen , Complicaciones Intraoperatorias/tratamiento farmacológico , Reoperación , Estudios Retrospectivos , Adherencias Tisulares/complicaciones , Adherencias Tisulares/cirugía , Ultrasonografía Intervencional , Adulto JovenRESUMEN
BACKGROUND: The quality of segmentation of thyroid nodules in ultrasound images is a crucial factor in preventing the cancerization of thyroid nodules. However, the existing standards for the ultrasound imaging of cancerous nodules have limitations, and changes of the echo pattern of thyroid nodules pose challenges in accurately segmenting nodules, which can affect the diagnostic results of medical professionals. PURPOSE: The aim of this study is to address the challenges related to segmentation accuracy due to noise, low contrast, morphological scale variations, and blurred edges of thyroid nodules in ultrasound images and improve the accuracy of ultrasound-based thyroid nodule segmentation, thereby aiding the clinical diagnosis of thyroid nodules. METHOD: In this study, the dataset of thyroid ultrasound images was obtained from Hunan Provincial People's Hospital, consisting of a total of 3572 samples used for the training, validation, and testing of this model at a ratio of 8:1:1. A novel SK-Unet++ network was used to enhance the segmentation accuracy of thyroid nodules. SK-Unet++ is a novel deep learning architecture that adds the adaptive receptive fields based on the selective kernel (SK) attention mechanisms into the Unet++ network. The convolution blocks of the original UNet++ encoder part were replaced with finer SK convolution blocks in SK-Unet++. First, multiple skip connections were incorporated so that SK-Unet++ can make information from previous layers of the neural network to bypass certain layers and directly propagate to subsequent layers. The feature maps of the corresponding locations were fused on the channel, resulting in enhanced segmentation accuracy. Second, we added the adaptive receptive fields. The adaptive receptive fields were used to capture multiscale spatial features better by dynamically adjusting its receptive field. The assessment metrics contained dice similarity coefficient (Dsc), accuracy (Acc), precision (Pre), recall (Re), and Hausdorff distance, and all comparison experiments used the paired t-tests to assess whether statistically significant performance differences existed (p < 0.05). And to address the multi-comparison problem, we performed the false discovery rate (FDR) correction after the test. RESULTS: The segmentation model had an Acc of 80.6%, Dsc of 84.7%, Pre of 77.5%, Re of 71.7%, and an average Hausdorff distance of 15.80 mm. Ablation experimental results demonstrated that each module in the network could contribute to the improved performance (p < 0.05) and determined the best combination of parameters. A comparison with other state-of-the-art methods showed that SK-Unet++ significantly outperformed them in terms of segmentation performance (p < 0.05), with a more accurate segmentation contour. Additionally, the adaptive weight changes of the SK module were monitored during the training process, and the resulting change curves demonstrated their convergence. CONCLUSION: Our proposed method demonstrates favorable performance in the segmentation of ultrasound images of thyroid nodules. Results confirmed that SK-Unet++ is a feasible and effective method for the automatic segmentation of thyroid nodules in ultrasound images. The high accuracy achieved by our method can facilitate efficient screening of patients with thyroid nodules, ultimately reducing the workload of clinicians and radiologists.
Asunto(s)
Nódulo Tiroideo , Humanos , Nódulo Tiroideo/diagnóstico por imagen , Benchmarking , Redes Neurales de la Computación , Radiólogos , Procesamiento de Imagen Asistido por Computador , UltrasonografíaRESUMEN
Accurate consumption forecasting is of great importance to grasp the energy consumption habits of consumers and promote the stable and efficient operation of integrated energy system (IES). To this end, this paper proposes an interactive multi-scale convolutional module-based short-term multi-energy consumption forecasting method for IES. Firstly, based on multi-scale feature fusion and multi-energy interactive learning, a novel interactive multi-scale convolutional module is proposed to extract and share the coupling information between energy consumption from different scales without increasing network parameters. Then, a short-term multi-energy consumption forecasting method is proposed, where different forecasting network structures are selected in different seasons to make full use of seasonal and coupling characteristics of the energy consumption, thus enhancing prediction performance. Furthermore, a Laplace distribution-based loss function weight optimization method is proposed to dynamically balance the loss magnitude and training speed of joint forecast tasks more robustly. Finally, the effectiveness and superiority of the proposed method are verified by comparative simulation experiments.
RESUMEN
A SPhosAuNTf2-promoted DMF-modulated glycosylation approach with glycosyl (Z)-ynenoates as donors was developed for highly α-selective synthesis of various linkage types of α-glucans. The substituent groups were also found to play a significant role in the α-selective glucosylation reactions. The glycosylation approach was effectively applied to the stereospecific synthesis of the α-1,6-linked triglucoside.
Asunto(s)
Glucanos , Glucósidos , Glicosilación , EstereoisomerismoRESUMEN
A non-human primate is a valuable model for investigating the structure and function of the brain. Different from the human brain imaging using radio frequency (RF) head coils, in the present study, on a human whole-body 7 T magnetic resonance imaging system, we used an RF knee coil for monkey brain imaging in vivo due to the smaller size of the macaque's brain compared to that of a human, and particularly, high-dielectric pads were also utilized in order to improve brain imaging performance. Our experimental results suggest that high-dielectric pads can effectively enhance the B1 field strength and receive sensitivity, leading to a higher flip-angle magnitude, an image signal-to-noise ratio, and tissue contrast, and in the meantime, we did not observe elevated receive array element coupling and receive noise amplification nor apparent magnetic susceptibility-induced artifact or distortion, showing that the pads do not introduce adverse RF interferences in macaque brain imaging at 7 T.
Asunto(s)
Encéfalo , Macaca , Animales , Encéfalo/diagnóstico por imagen , Diseño de Equipo , Imagen por Resonancia Magnética , Neuroimagen , Fantasmas de Imagen , Ondas de Radio , Relación Señal-RuidoRESUMEN
Small-molecule hepatitis C virus (HCV) NS3 protease inhibitors such as boceprevir (SCH 503034) have been shown to have antiviral activity when they are used as monotherapy and in combination with pegylated alpha interferon and ribavirin in clinical trials. Improvements in inhibitor potency and pharmacokinetic properties offer opportunities to increase drug exposure and to further increase the sustained virological response. Exploration of the structure-activity relationships of ketoamide inhibitors related to boceprevir has led to the discovery of SCH 900518, a novel ketoamide protease inhibitor which forms a reversible covalent bond with the active-site serine. It has an overall inhibition constant (K*(i)) of 7 nM and a dissociation half-life of 1 to 2 h. SCH 900518 inhibited replicon RNA at a 90% effective concentration (EC(90)) of 40 nM. In biochemical assays, SCH 900518 was active against proteases of genotypes 1 to 3. A 2-week treatment with 5x EC(90) of the inhibitor reduced the replicon RNA level by 3 log units. Selection of replicon cells with SCH 900518 resulted in the outgrowth of several resistant mutants (with the T54A/S and A156S/T/V mutations). Cross-resistance studies demonstrated that the majority of mutations for resistance to boceprevir and telaprevir caused similar fold losses of activity against all three inhibitors; however, SCH 900518 retained more activity against these mutants due to its higher intrinsic potency. Combination treatment with alpha interferon enhanced the inhibition of replicon RNA and suppressed the emergence of resistant replicon colonies, supporting the use of SCH 900518-pegylated alpha interferon combination therapy in the clinic. In summary, the results of the preclinical characterization of the antiviral activity of SCH 900518 support its evaluation in clinical studies.
Asunto(s)
Antivirales/farmacología , Dipéptidos/farmacología , Hepacivirus/efectos de los fármacos , Hepacivirus/enzimología , Inhibidores de Proteasas/farmacología , Sulfonas/farmacología , Proteínas no Estructurales Virales/antagonistas & inhibidores , Antivirales/administración & dosificación , Antivirales/química , Ciclopropanos , Dipéptidos/administración & dosificación , Dipéptidos/química , Descubrimiento de Drogas , Evaluación Preclínica de Medicamentos , Farmacorresistencia Viral/genética , Genotipo , Hepacivirus/genética , Humanos , Técnicas In Vitro , Interferón alfa-2 , Interferón-alfa/administración & dosificación , Cinética , Leucina/análogos & derivados , Mutación , Prolina/análogos & derivados , Prolina/farmacología , Inhibidores de Proteasas/administración & dosificación , Inhibidores de Proteasas/química , Proteínas Recombinantes , Replicón/efectos de los fármacos , Sulfonas/administración & dosificación , Sulfonas/química , UreaRESUMEN
SUMMARY: Polyps from the endometrium is a common cause of abnormal uterine bleeding and sometimes cause infertility and pelvic pain. The objective of this study was to measure the expression of hormone receptors (oestrogen receptor and progesterone receptor) in endometrial polyps and compare the results to surrounding endometrial tissue. This prospective study recruited 53 women prior to menopause. The study showed that the expression of oestrogen receptor was higher whereas the expression of progesterone receptor was lower than that of adjacent endometrial tissue. The results suggest that abnormal expression of hormone receptor contribute to endometrial polyps formation.
Asunto(s)
Endometrio/metabolismo , Receptor alfa de Estrógeno/metabolismo , Pólipos/metabolismo , Premenopausia/metabolismo , Receptores de Progesterona/metabolismo , Adulto , Endometrio/patología , Femenino , Fase Folicular/metabolismo , Hormonas/metabolismo , Humanos , Inmunohistoquímica , Pólipos/patología , Estudios ProspectivosRESUMEN
Age-related changes in the activities of superoxide dismutase, catalase, and glutathione peroxidase were determined in brain, heart, hepatocytes, intestinal mucosa, and kidney from male Fischer F344 rats. Superoxide dismutase activity decreased significantly with age in all five tissues studied. The activity of catalase decreased with age in brain, hepatocytes, and kidney while glutathione peroxidase activity decreased significantly with age only in intestinal mucosa and kidney. The relative levels of superoxide dismutase, catalase, and glutathione peroxidase mRNA were measured in brain, hepatocytes, and kidney. An age-related decrease in SOD and catalase mRNA was observed for brain, hepatocytes, and kidney. GPX mRNA levels decreased with age in hepatocytes and kidney but did not change with age in brain. In general, the age-related changes in the activities of SOD, catalase, and GPX were paralleled by a similar change in the relative level of the mRNAs coding for these enzymes.
Asunto(s)
Envejecimiento/metabolismo , Catalasa/metabolismo , Glutatión Peroxidasa/metabolismo , Superóxido Dismutasa/metabolismo , Animales , Catalasa/genética , Expresión Génica , Glutatión Peroxidasa/genética , Masculino , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas , Ratas Endogámicas F344 , Superóxido Dismutasa/genética , Distribución TisularRESUMEN
The nonstructural protein 5B (NS5B) of hepatitis C virus (HCV) is an RNA-dependent RNA polymerase (RdRp) which plays an essential role in viral RNA replication. Antibodies that specifically recognize NS5B will have utilities in monitoring NS5B production and subcellular localization, as well as in structure-function studies. In this report, three mouse monoclonal antibodies (mAbs), 16A9C9, 16D9A4 and 20A12C7, against a recombinant NS5B protein (genotype 1a, H-77 strain) were produced. These mAbs specifically recognize HCV NS5B, but not RdRps of polivirus (PV), bovine viral diarrhea virus (BVDV) or GB virus B (GBV-B). The mAbs can readily detect NS5B in cellular lysates of human osteosarcoma Saos2 cells constitutively expressing the nonstructural region of HCV (NS3-NS4A-NS4B-NS5A-NS5B). NS5B proteins of different HCV genotypes/subtypes (1a, 1b, 2a, 2c, 5a) showed varied affinity for these mAbs. Interestingly, the epitopes for the mAbs were mapped to the palm subdomain (amino acid 188-370) of the HCV RdRp as determined by immunoblotting analysis of a panel of HCV/GBV-B chimeric NS5B proteins. The binding site was mapped between amino acid 231 and 267 of NS5B for 16A9C9, and between 282 and 372 for 16D9A4 and 20A12C7. Furthermore, these mAbs showed no inhibitory effect on the NS5B polymerase activity in vitro.
Asunto(s)
Anticuerpos Monoclonales/química , Anticuerpos Monoclonales/metabolismo , Hepacivirus/inmunología , Anticuerpos contra la Hepatitis C/química , Anticuerpos contra la Hepatitis C/metabolismo , ARN Polimerasa Dependiente del ARN/inmunología , Proteínas no Estructurales Virales/inmunología , Genoma Viral , Hepacivirus/enzimología , Humanos , Estructura Terciaria de Proteína , ARN Polimerasa Dependiente del ARN/metabolismo , Células Tumorales Cultivadas , Proteínas no Estructurales Virales/metabolismoRESUMEN
Sigma receptor antagonists have been proposed as leading clinical candidates for use in various psychotic disorders. Prior to clinical testing, it is imperative that a new agent be correctly identified as an antagonist and not an agonist since the latter may worsen the psychosis. For sigma-ligands many behavioral and pharmacological assays have been developed in an attempt to classify agonist/antagonist activity. These assays evaluate a response or a behavior in an animal model that can be related to clinical efficacy. However, is the action by the presumed antagonist a consequence of sigma-receptor activity? Previously we have identified sigma-receptors in acinar cells of the main lacrimal gland of the New Zealand white rabbit and have measured protein release after the addition of various N,N-disubstituted phenylalkylamine derivatives known to be sigma-ligands by receptor binding studies. Although protein release from acinar cells has been attributed to either muscarinic or alpha-adrenergic stimulation, protein release from sigma-receptor stimulation was also confirmed. In the reported studies here, we isolated and incubated acinar cells with varying concentrations of known sigma-ligands and measured protein concentration. A knowledge of the receptor profile for the disubstituted phenylalkylamines permitted experiments to be designed in which various alpha, muscarinic, serotonergic, and dopaminergic antagonists could be added in equimolar concentrations. Under the conditions of these experiments, statistically significant increases in protein release for sigma-ligands could be attributed to stimulation of sigma-receptors. Haloperidol, an apparent sigma-antagonist, caused a statistically significant decrease in protein release and also inhibited protein release when tested with a known sigma-ligand, AF2975 [N,N-dimethyl-2-phenylethylamine]. In this system, stimulation and inhibition of protein release were defined as agonist and antagonist behavior, respectively. Of particular interest were the results for BMY14802 and +/- pentazocine, both of which were found to be agonists. Various antipsychotic and antidepressant drugs were measured for their agonist/antagonist behavior. Because of multireceptors present in acini, their agonist or antagonist behaviour could not be attributed solely to interaction with the sigma-receptor unless specific antagonists were added.
Asunto(s)
Proteínas del Ojo/metabolismo , Aparato Lagrimal/efectos de los fármacos , Receptores sigma/agonistas , Receptores sigma/antagonistas & inhibidores , Animales , Antidepresivos/farmacología , Antipsicóticos/farmacología , Guanidinas/metabolismo , Guanidinas/farmacología , Haloperidol/metabolismo , Haloperidol/farmacología , Técnicas In Vitro , Aparato Lagrimal/citología , Aparato Lagrimal/metabolismo , Pentazocina/farmacología , Fenetilaminas/farmacología , Pirimidinas/farmacología , Conejos , Receptores sigma/metabolismoRESUMEN
Acini cells were obtained from the lacrimal gland of the white New Zealand rabbit. Following isolation and purification, the cells were used to study the uptake of N,N'-dimethyl-2-phenylethylamine HCl (AF2975), which was found to be sodium- and proton-independent, but energy-dependent. Uptake was mainly accomplished via a carrier-mediated transport system for which a Km of 8.72+/-0.96 mM, a Vmax of 602.6+/-41.3 nmol/mg of protein/min, and an exponential coefficient of 2.55+/-0.46 were obtained following a least squares nonlinear fit to the Hill equation. With the addition of the metabolic inhibitors, sodium azide or 2,4-dinitrophenol, the initial uptake rates were reduced from the control experiments by 35.7% and 26.2%, respectively.
Asunto(s)
Aparato Lagrimal/metabolismo , Fenetilaminas/farmacocinética , 2,4-Dinitrofenol , Animales , Cromatografía Líquida de Alta Presión , Concentración de Iones de Hidrógeno , Aparato Lagrimal/citología , Análisis de los Mínimos Cuadrados , Modelos Lineales , Conejos , Azida Sódica/farmacocinética , Espectrofotometría , Desacopladores/farmacocinéticaRESUMEN
OBJECTIVE: To evaluate the incidence of deep venous thrombosis (DVT) after gynaecological laparoscopy. METHODS: The incidence of DVT was studied in 72 consecutive patients who underwent gynaecological laparoscopy in the Liverpool Health Service between May and September 1997. B-mode ultrasound supplemented by Doppler was used to examine venous patency and intraluminal echoes to diagnose DVT. Sixty-one patients who had pneumoperitoneum less than 60 minutes were classified a minor procedure and 11 who had pneumoperitoneum more than 60 minutes were classified as major procedure. Two Doppler ultrasound scans were planned for every patient. The first one was done within 24 hours and the second was performed on day 7 post-surgery. All 72 patients had the first scan and 40 out of 61 in the minor procedure group and 9 out of 11 in the major procedure had the second scan. Twenty-three patients who did not come for the second scan were followed up by phone. RESULTS: No DVT was found in our study. CONCLUSION: This study confirms an impression that gynaecological laparoscopic procedure has a very low incidence of DVT. If it occurs, the diagnosis and treatment must be made as soon as possible so that the fatal complications such as pulmonary embolus can be avoided.
Asunto(s)
Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Laparoscopía/efectos adversos , Trombosis de la Vena/etiología , Adulto , Anciano , Australia/epidemiología , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Neumoperitoneo/etiología , Factores de Tiempo , Ultrasonografía Doppler , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/epidemiologíaRESUMEN
OBJECTIVE: To introduce the procedures, preliminary experience, and advantages of operation using combination of hysteroscopy and laparoscopy. METHODS: Sixty-five women underwent transcervical resection of endometrium (11), myoma (38), polyp (2), septa (9), adhesion (1) or foreign body (4). All had the indications for simultaneous laparoscopic monitoring and operation. They were first diagnosed laparoscopically to decide the type of laparoscopic operation. Then they were treated hysteroscopically and finally received laparoscopic operation. RESULTS: Laparoscopic examinations confirmed the original diagnoses, revealed the causes of pelvic pain in 8 patients, and detected ovarian cyst, endometriosis, and pelvic adhesion in 5. Two cases of uterine perforation were found by laparoscopic monitoring. Thirty laparoscopic operations included removal or puncture of ovarian cyst, lysis of adhesion, coagulation of endometriosis, Rubin's test, and partial salpingectomy. The postoperative course was smooth and the operative result was satisfactory. CONCLUSIONS: Operations using combination of hysteroscopy and laparoscopy are safe and effective. They also reduce the pain, and save the time and money of patients. Laparoscopic monitoring may detect uterine perforation in time.
Asunto(s)
Endometrio/cirugía , Histeroscopía , Laparoscopía , Leiomioma/cirugía , Neoplasias Uterinas/cirugía , Adulto , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Histeroscopía/métodos , Laparoscopía/métodos , Persona de Mediana EdadRESUMEN
OBJECTIVE: To investigate the methods of earlier diagnosis, treatment and precautions on the severe complications of hysteroscopic procedures. METHODS: There were 12 921 cases of diagnostic hysteroscopy and 2 221 cases of operative hysteroscopy were performed. For diagnostic hysteroscopy B ultrasonography were scaned meanwhile and fluid media were used to distend the uterus. For operation hysteroscopy B ultrasonography or laparoscopy was used for monitoring. RESULTS: Thirty five cases of severe complications encountered. There were 9 cases of severe intraoperative bleeding. Foley catheter inserting, bleeding spots coagulating, uterine cavity tampon or hysterectomy were used to stop intraoperative and postoperative bleeding successfully. Eleven cases of uterine perforation were treated by conservativetherapy, laparoscopy or hysterectomy. An air embolism happened on hysteroscopic examination was survived with aggressive rescue. There were 4 cases of postoperative infection that had history of pelvic inflammatory disease and cured by antibiotics. Diuretic agent and saline infusion were used to treat 5 cases of transurethral resection of prostate (TURP) syndrome effectively. For 4 cases of post-ablationsterilization syndrome (PASS) dilating the cervix canal and expelling the hematometra, transcervical resection of adhesions or hysterectomy were managed effectively. One case of endometrial adenocarcinoma stage I a was diagnosed 8 years after transcervical resection of endometrium (TCRE) & transcervical resection of polyp (TCRP), and radical hysterectomy plus selective pelvic lymphadenectomy was performed. CONCLUSIONS: Foley catheter insertion is a simple and efficient method to stop uterine bleeding. Uterine adhesion is a high risk factor of uterine perforation. Monitoring by B ultrasonography or laparoscopy could not prevent uterine perforation. Prevention was essential for air embolism. Control the pressure of irrigating flow and operating time can reduce the incidence of TURP syndrome. To intensify follow-up is the best method to detect PASS and uterine adenocarcinoma.
Asunto(s)
Histeroscopía , Complicaciones Intraoperatorias , Complicaciones Posoperatorias , Enfermedades Uterinas/etiología , Pérdida de Sangre Quirúrgica , Femenino , Humanos , Histerectomía , Histeroscopía/efectos adversos , Histeroscopía/métodos , Laparoscopía/métodos , Ultrasonografía/métodos , Enfermedades Uterinas/terapia , Hemorragia Uterina/etiología , Hemorragia Uterina/terapia , Útero/lesionesRESUMEN
Transcervical resection of endometrium was performed in 65 cases by endoscopic continuous flow resectoscope under epidural anesthesia and B ultrasonic monitoring to treat dysfunctional uterine bleeding which had been treated by conservative measures no avail. Resected tissue included functional and basal layers of endometrium as well as underlying 1-2 mm myometrium. Bleeding immediately after the operation was rare serious followed by watery discharge usually persisted for about 4 weeks. Follow-up examination for 5-20 months showed that 19 cases had amenorrhea, 12 cases spotting, 31 cases had obvious reduced menstrual flow and 3 cases no improvement. Hysteroscopic examination and hysterography in all 24 cases showed no adhesions. This operation involves no abdominal incision and is therefore less traumatic. It is associated with very little bleeding and minimal morbidity. No long term effects on ovarian function was noticed. Endoscopic surgery will probably replace most conventional hysterectomies done for dysfunctional uterine bleeding.
Asunto(s)
Endometrio/cirugía , Hemorragia Uterina/cirugía , Femenino , Estudios de Seguimiento , Humanos , Histeroscopía , Leiomioma/complicaciones , Menorragia/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Ultrasonografía , Hemorragia Uterina/diagnóstico por imagen , Hemorragia Uterina/etiología , Neoplasias Uterinas/complicacionesRESUMEN
OBJECTIVE: To observe the changes of plasma electrolytes and osmolarity during and after transcervical resection of endometrium using 5% dextrose solution as distending medium. METHODS: We used 5% dextrose solution as distending medium for 500 cases of operative hysteroscopy. Plasma sodium, potassium, chloride, glucose concentrations and plasma osmolarity were measured before, at the end of 1 hour, 4 hours and the day after operation respectively in 22 cases. RESULTS: None of the 500 cases presented with transurethral resection of prostate (TURP) syndrome. No apparent change were found in plasma sodium, chloride concentrations and plasma osmolarity. Plasma potassium concentration decreased gradually but significantly 4 hours after surgery. The elevation of plasma glucose concentration was significant and was positively correlated with the absorption of 5% dextrose. All changes of plasma electrolytes and osmolarity restored in the next morning. It was 1 hour after surgery that the lowest plasma sodium, potassium concentration as well as the highest plasma glucose concentration appeared. Therefore, it is important to observe patient 1 hour after operation. CONCLUSIONS: 5% dextrose solution, used as the distending medium, is safe and inexpensive, and could be widely applied in transcervical resection of endometrium.