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1.
J Photochem Photobiol B ; 197: 111539, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31301638

RESUMO

Treatment of burn injury is clinically challenging one, therefore several steps and noteworthy approaches have been taken to improve wound mechanisms. Citrus pectin plays a stabilizing agent to synthesis of ZnO nanoparticles (ZnO NPs). The present study is focused on ZnO loaded collagen/chitosan nanofibrous were synthesized by electrospinning method using ZnO NPs. The chemical structure, phase purity and morphological observation were investigated under spectroscopic and mircoscopic techniques and demonstrated their suitable properties as a wound healing material. In addition, that prepared nanoparticles loaded biopolymeric fibrous nanomaterial showed suitable antibacterial activity against S. aureus and E. coli bacterial pathogens and also in vitro studies was confirmed the enhanced proliferation, cell viability and biocompatibility. In vitro evaluations have been exhibited acceptable cell proliferation is observed throughout the ZnO loaded Coll/CS nanofibrous within 3 days, which was comparable to the control material. In vivo wound healing ability was monitored on the rat wound experimental model. From the in vivo observations, revealed that the loaded of ZnO NPs with Coll/CS nanofibrous can effectively quicken wound healing mechanism, expressed in the initial stage healing process. These results suggest that ZnO loaded collagen/chitosan nanofibrous is a potential candidate for wound healing applications with enhanced biological properties.


Assuntos
Queimaduras/patologia , Quitosana/química , Colágeno/química , Nanopartículas Metálicas/química , Nanofibras/química , Animais , Antibacterianos/química , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/prevenção & controle , Queimaduras/veterinária , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Fibroblastos/citologia , Fibroblastos/efeitos dos fármacos , Fibroblastos/metabolismo , Humanos , Nanofibras/uso terapêutico , Nanofibras/toxicidade , Ratos , Pele/efeitos dos fármacos , Pele/patologia , Staphylococcus aureus/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Óxido de Zinco/química
2.
J Minim Invasive Gynecol ; 24(7): 1195-1199, 2017 Nov - Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28800968

RESUMO

STUDY OBJECTIVE: To evaluate an alternative monitoring protocol without day 4 ß-human chorionic gonadotropin (ß-hCG) measurement for predicting the need for a repeated methotrexate (MTX) dose in patients undergoing single-dose MTX therapy for ectopic pregnancy (EP). DESIGN: Single-center retrospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Included in the study were 184 EP patients treated with MTX between January 2009 and December 2016. INTERVENTIONS: Single-dose MTX treatment (50 mg/m2). MEASUREMENTS AND MAIN RESULTS: The patients were treated with repeated doses of MTX every 7 days, if necessary, according to Stovall's protocol, or with laparoscopic surgery in cases of tubal rupture. The success of a single-dose of MTX according to the alternative measure was defined as a >50% decrease in the ß-hCG level between days 1 and 7 in clinically stable patients. The sensitivity, specificity, false-negative rate, false-positive rate, and attributable risk of this new monitoring measure were calculated and compared with the traditional regimen. The new protocol had a sensitivity and specificity of 100% and 88.7%, respectively, for predicting a required second dose in patients whose day 1 ß-hCG levels were <2000 mIU/mL. For patients with day 1 ß-hCG level ≥2000 mIU/mL, both monitoring regimens had the same efficiency. CONCLUSIONS: The new monitoring model without the day 4 ß-hCG measurement may offer both patients and clinicians multiple options to monitor single-dose MTX therapy for selected EP patients, with a comparable clinical efficiency to Stovall's protocol and less expense and follow-up burden to patients.


Assuntos
Abortivos não Esteroides/administração & dosagem , Gonadotropina Coriônica Humana Subunidade beta/sangue , Metotrexato/administração & dosagem , Monitorização Fisiológica/métodos , Gravidez Ectópica/tratamento farmacológico , Adulto , Gonadotropina Coriônica , Gonadotropina Coriônica Humana Subunidade beta/análise , Testes Diagnósticos de Rotina , Relação Dose-Resposta a Droga , Resistência a Medicamentos , Feminino , Humanos , Laparoscopia , Gravidez , Gravidez Ectópica/sangue , Gravidez Ectópica/diagnóstico , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto Jovem
4.
Zhonghua Fu Chan Ke Za Zhi ; 49(4): 281-6, 2014 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-24969336

RESUMO

OBJECTIVE: To report the clinical features of ovarian teratoma in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. METHODS: The clinical information of five female patients with ovarian teratoma and anti-NMDAR encephalitis in Peking Union Medical College Hospital and Beijing Tiantan Hospital affiliated to Capital Medical University from June 2011 to May 2013 were obtained. Relevant literatures were reviewed. RESULTS: The initial symptoms varied from respiratory prodromes or emotional incentives before the onset of psychiatric symptoms. Patients always presented with psychosis, bizarre dyskinesia and seizures. Antibodies to NMDAR in serum and cerebrospinal fluid (CSF) were positive; The psychiatric symptoms were dramatically relieved by tumor reception and immunotherapy which occurred in inverse order of symptom development. No evidence of tumor recurrence was observed during a short-time follow-up after the surgery. CONCLUSIONS: Ovarian teratoma with anti-NMDAR encephalitis always presents with psychiatric symptoms which could be misdiagnosed as psychiatric diseases. Patients respond to tumor resection and immunotherapy.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/etiologia , Neoplasias Ovarianas/complicações , Receptores de N-Metil-D-Aspartato/imunologia , Teratoma/complicações , Adulto , Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Encefalite Antirreceptor de N-Metil-D-Aspartato/terapia , Autoanticorpos/sangue , Autoanticorpos/líquido cefalorraquidiano , Feminino , Humanos , Imunoterapia , Laparoscopia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/terapia , Ovário/cirurgia , Teratoma/diagnóstico , Teratoma/imunologia , Teratoma/terapia , Adulto Jovem , gama-Globulinas/uso terapêutico
5.
Zhonghua Fu Chan Ke Za Zhi ; 49(4): 287-9, 2014 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-24969337

RESUMO

OBJECTIVE: To explore the operation skills of laparoendoscopic single site surgery (LESS) of total hysterectomy, to expand the application of LESS in the field of in gynecologic surgery. METHODS: A total of 23 cases of total hysterectomy were completed under laparoendoscopic single site surgery in Peking Union Medical College Hospital from January 2012 to August 2013, applying with combination of the traditional laparoscopic and special LESS apparatuses, intelligent electronic coagulation and excision device and the self-fixed absorbable sutures (V-LOC). The datas of the patients during the operations and the follow-up were recorded and analyzed. RESULTS: Twenty-three cases LESS-TH are accomplished. The weight of uterus was (230+38) g. The operation time was (73+22) minutes, with the intraoperative blood loss (99 ± 53) ml. The postoperative intestinal function recovery time was (13+4) hours, and postoperative hospitalized time was (1.8 ± 0.6) days, with the postoperative pain visual analogue scale 3.9 ± 1.6. There were no complications reported during intraoperative and postoperative time. All of our patients was finished the follow-up from 14 d to 2 months. As usual, vaginal discharge is normal, wound healed well, most of the wounds healing (19/23) hidden in umbillicus, no obvious scar, vaginal stub wound healed well. CONCLUSIONS: (1) LESS can accomplish total hysterectomy of uterus of gestational age less than 8 weeks safely and effectively. (2) Combination of traditional laparoscopic and special LESS appatatuses, the use of intelligent energy devices and V- LOC to suture vaginal stub could make the total hysterectomy by LESS much easier and safer.


Assuntos
Histerectomia/métodos , Laparoscopia/métodos , Suturas , Doenças Uterinas/cirurgia , Adulto , Neoplasia Intraepitelial Cervical/cirurgia , Feminino , Humanos , Laparoscopia/instrumentação , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Cistos Ovarianos/cirurgia , Medição da Dor , Dor Pós-Operatória , Estudos Retrospectivos , Neoplasias do Colo do Útero/cirurgia
6.
Zhonghua Fu Chan Ke Za Zhi ; 49(3): 176-8, 2014 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-24820300

RESUMO

OBJECTIVE: To investigate clinical outcome of laparoendoscopic single-site compared with traditional three-port in treatment of ovarian cystectomy. METHOD: From February 2012 to June 2013, 54 patients with ovarian cyst were randomized to the single-site group (n = 24) or the three-port group (n = 30) in Peking Union Medical College Hospital. The outcome of laparoscopic single-site and three-port ovarian cystectomy were evaluated. Operation time, blood loss, surgical complications, postoperative pain score, postoperative analgesic requirements, length of hospital stay, cosmetic satisfaction score, postoperative recovery and total cost were compared between both groups. RESULTS: No difference was found in blood loss, length of hospital stay, complications and total cost between the two groups (P > 0.05). Operation time was (31 ± 10) minute in three-port group and (40 ± 19) minute in single-site group. Visual analogue pain score was 5.6 ± 1.7 in three-port group and 2.7 ± 1.4 in single-site group, cosmetic satisfaction score was 92.5 ± 2.5 in three-port group and 97.4 ± 1.5 in single-site group. Those clinical parameter reached statistical difference (all P < 0.05). CONCLUSION: Laparoendoscopic single site surgery approach is feasible and safe to treat benign ovarian cyst disease. And it offers decreased pain and offer improved cosmesis.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Cistos Ovarianos/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Ovário/patologia , Ovário/cirurgia , Medição da Dor , Resultado do Tratamento , Adulto Jovem
7.
Arch Gynecol Obstet ; 290(5): 947-50, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24866888

RESUMO

OBJECTIVE: To investigate the clinical characteristics and treatment of the Herlyn-Werner-Wunderlich syndrome (HWWS). METHODS: Sixty-one patients diagnosed with HWWS were retrospectively analyzed. HWWS is categorized into three types in China. RESULTS: Age at presentation of all the cases was after menarche. The most common clinical presentations were dysmenorrhea for type I and vaginal discharge for types II and III. Clinical presentations of types II and III may not occur until reproductive age. HWWS occurred on the right in 39/61. Excision of the obstructed vaginal septum was the treatment utilized in this cohort. After surgery, subsequent pregnancies were ipsilateral in 52.9 %. CONCLUSIONS: Clinical presentation in untreated HWWS suggests the anatomic anomaly. Early recognition and treatment can reduce symptoms. Pregnancies occur in both the affected and unaffected uterus.


Assuntos
Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/cirurgia , Rim/anormalidades , Útero/anormalidades , Vagina/anormalidades , Vagina/cirurgia , Adulto , Idade de Início , China , Dismenorreia/etiologia , Feminino , Humanos , Menarca , Estudos Retrospectivos , Síndrome , Resultado do Tratamento , Descarga Vaginal/etiologia
8.
Eur J Pediatr ; 173(4): 509-15, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24240666

RESUMO

UNLABELLED: A prospective study was designed to evaluate the efficacy of azithromycin (AZM) when combined with prednisone therapy compared with prednisone therapy alone in children with primary nephrotic syndrome (PNS) undergoing induction treatment. A prospective randomly controlled clinical trial was conducted. Randomization was performed to select the research subjects who were composed of children with PNS and treated with AZM combined with prednisone (the intervention group) and with prednisone alone (the control group). A total of 211 randomly selected patients with PNS received either AZM combined with prednisone (n = 106) or prednisone alone (n = 105) for 6 months. At three months in the follow-up period, 12 patients were lost to follow up (intervention group, 7; control group, 5), and 6 patients had a transient hypocomplementemia (intervention group, 4 ; control group, 2). AZM was administered at a dose of 10 mg/kg q.d (1 dose per day) for three consecutive days. The median duration before remission was 6 days in the intervention group and 9 days in the control group (p < 0.0001). Relapse rate differed among the groups at 3 months (11.6 vs. 21.4 %, p = 0.049). No difference in relapse rate was observed between the two groups within 4 to 6 months and at 6 months (p = 0.168, 0.052). After 4 weeks of treatment, steroid resistance occurred in 1 out of 95 (1.05 %) patients in the intervention group and in 10 out of 98 (10.2 %) patients in the control group (p = 0.006). After 8 weeks of treatment, no difference was found in steroid resistance between two groups (1/95 vs. 3/98, p = 0.327). During follow-up at 6 months, no difference was exhibited by the two groups on frequent relapse rates (p = 0.134). CONCLUSION: If a course of AZM is added to the glucocorticoid-induced treatment among children with PNS, then the sensitivity of prednisone increases. This increase consequently reduces duration to remission and decreases relapse. However, further studies are necessary to confirm these results.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Glucocorticoides/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Prednisona/uso terapêutico , Adolescente , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Masculino , Prednisona/administração & dosagem , Estudos Prospectivos , Recidiva , Resultado do Tratamento
9.
Zhonghua Fu Chan Ke Za Zhi ; 49(11): 838-41, 2014 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-25603909

RESUMO

OBJECTIVE: To explorer the diagnostic rationales for primary pelvic retroperitoneal tumors and summarize their clinical characteristics and treatments. METHODS: The clinicopathological data of total of 36 patients with primary pelvic retroperitoneal tumor, who visited Peking Union Medical Collage Hospital, Chinese Academy of Medical Sciences because of pelvic mass from January 1986 and September 2013 were analysed retrospectively. And their clinical manifestations, accessory examination, surgical findings, postoperative pathological results and prognosis were summarized. RESULTS: Among the 36 patients, twenty-nine cases were treated by gynecology department firstly, 7 cases were treated by surgical department firstly. Only 7 cases complained abdominal expanding while others had no uncomfortable complains before the discovery of the tumor. Among 27 cases who took color Doppler ultrasonography examination, only 3 cases reminded that the tumors might come from the pelvic retroperitoneal space. CT and MRI results were respectively 6/16 and 3/6, that the tumor might come from the pelvic retroperitoneal space. The level of CA125 of 18 cases were tested before the surgery: 17 out of 18 cases were normal or elevated lightly. The tumors of 8 cases were excised incompletely because of the blood vessels around the tumors and the close relationship between the tumors and the pelvic wall, while other's were excised completely. Among the 25 cases that had operation at the gynecological department, ten cases underwent operations collaboratively with surgical department; two cases had complications of urinary system injures. Postoperative pathological examinations revealed there were 28 cases (78%, 28/36)with benign lesions including 11 schwannoma, 6 leiomyoma, 3 teratoma, 1 lymphangioleiomyoma, 1 neurofibroma, 1 paraganglioma, 2 fibromatosis, 1 aggressive angiomyxoma, 1 mucinous cystadenoma and 1 solitary fibrous tumor; and 8 cases(22% , 8/36)with malignant lesions including 3 leiomyosarcoma, 2 liposarcoma, 2 adenocarcinoma and 1 squamous carcinoma. During the follow-up period, 28 cases whose tumors were excised completely had no recurrence. While, 3 out of 8 cases excised incompletely recurred. CONCLUSIONS: Primary pelvic retroperitoneal tumors have no typical manifestations, CT and MRI are more accurate. Surgery is a key for retroperitoneal tumors. Considering the complexity of the anatomy of the pelvic retroperitoneal space and the resulted difficulties of the surgeries, multidisiciplinary cooperation is needed and important.


Assuntos
Leiomioma/patologia , Leiomiossarcoma/patologia , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Teratoma/patologia , China , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/cirurgia , Imagem por Ressonância Magnética , Recidiva Local de Neoplasia , Neoplasias Pélvicas , Pelve , Prognóstico , Neoplasias Retroperitoneais/diagnóstico por imagem , Estudos Retrospectivos , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Ultrassonografia Doppler em Cores
10.
Chin Med J (Engl) ; 126(17): 3325-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24033958

RESUMO

BACKGROUND: Laparoscopic surgery in pregnant women has become increasingly more common; however, the safety of laparoscopy in this population has been widely debated in emergent situations and big size at bigger pregnant weeks. This study was to determine the characteristics of laparoscopic surgery for adnexal masses in different conditions during the second trimester of pregnancy. METHODS: Between April 2002 and December 2011, 24 patients with suspected ovary cyst during the second trimester underwent laparoscopic surgery at the Peking Union Medical College Hospital retrospectively. Clinical data were collected retrospectively and patient's outcomes were analyzed. RESULTS: The incidence of laparoscopic surgery for ovarian cysts during pregnancy was 0.12% of all laparoscopic gynecological surgeries performed at the hospital. No patients required conversion. There were 9 (37.5%) patients whose gestational age was no less than 16 weeks, and 15 patients whose gestational age was less than 16 weeks; no difference was noted in the operation time between the two groups (P > 0.05). Emergency surgery due to abdominal pain was performed in 4 (16.7%) patients, 2 (8.3%) of whom underwent simple salpingo-oophorectomy because of ovarian necrosis. The other patients underwent enucleation of the ovarian cyst. There were no severe complications. Twenty (83.3%) pregnant women delivered healthy term infants and 4 (16.7%) cases were lost to follow up. CONCLUSION: Laparoscopic surgery for ovary masses is a safe and feasible procedure for the treatment of ovary cyst in different conditions during the second trimester, even if gestational age reaching 16-19 weeks or in emergency.


Assuntos
Cistos/cirurgia , Laparoscopia/métodos , Adulto , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Adulto Jovem
11.
Chin Med J (Engl) ; 126(9): 1673-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23652049

RESUMO

BACKGROUND: The techniques of resection and repair of large lesions in the abdominal wall are very challenging in the area of gynecology. We explored the techniques of resection and plastic surgical repair of large abdominal wall lesions in gynecologic patients. METHODS: Twenty-six patients with large lesions in the abdominal wall underwent resection by the gynecologists and repair through abdominal plasty and V-Y plasty with or without fascia patch grafting by the gynecologists or plastic surgeons from March 2003 to October 2010. RESULTS: All patients had a history of cesarean section. One patient had an infected sinus tract after cesarean section, one patient had an inflammatory nodule, and the others had lesions of endometriosis, including one cancer. The average largest lesion diameter was (4.79 ± 4.18) cm according to the ultrasonography results. The lesions of all patients were completely resected with pretty abdominal contour. A polypropylene biological mesh was added to the fascia in 20 patients. One patient underwent groin flap repair, and one underwent V-Y advanced skin flap repair on the left of the incision to relieve the suture tension. CONCLUSIONS: Multi-department cooperation involving the gynecology and plastic surgery departments, and even the general surgery department, is essential for patients with large lesions in the abdominal wall. This cooperative effort enabled surgeons to completely resect large lesions. Abdominal wall plastic surgical repair can ameliorate large wounds of the abdominal wall.


Assuntos
Parede Abdominal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Endometriose/cirurgia , Feminino , Humanos , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/cirurgia
12.
Hum Reprod ; 27(6): 1624-7, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22422793

RESUMO

BACKGROUND: The aim of this study was to investigate the appropriate measures for diagnosing and treating perineal endometriosis (PEM) with anal sphincter involvement. METHODS: Between January 1992 and April 2011, the clinical features, diagnosis and management of 31 patients who were diagnosed with PEM with anal sphincter involvement at the Peking Union Medical College Hospital were retrospectively analyzed using their clinical records. A range of 6-78 months of outpatient follow-up after surgery were conducted for these 31 patients but was extended by telephone interviews with 29 patients conducted in December 2011. RESULTS: All 31 patients had a history of vaginal delivery. The level of serum CA(125) was elevated in only 2 (6.5%) cases. All cases received surgical treatment, which included narrow excision (NE, close to the edge of the endometrioma) with primary sphincteroplasty (PSp) for 30 cases and incomplete excision (IE) for 1 case. Of the 30 cases in the NE group, 20 (66.7%) received hormone therapy preoperatively. Up until December 2011, there was one recurrence (3.6%) of PEM in the NE group. PEM relapse occurred in the IE patient 6 years after the initial IE surgery. Perineal abscesses were found in one patient post-operatively. No complaint of dyspareunia and no fecal incontinence episodes were observed during follow-up. CONCLUSIONS: Based on our own experience, NE and PSp may be indicated for the treatment of PEM with anal sphincter involvement.


Assuntos
Canal Anal/cirurgia , Endometriose/diagnóstico , Endometriose/cirurgia , Períneo/cirurgia , Adulto , Canal Anal/patologia , Canal Anal/fisiopatologia , Antígeno Ca-125/sangue , Endometriose/fisiopatologia , Feminino , Humanos , Períneo/patologia , Períneo/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Gravidez , Recidiva , Estudos Retrospectivos
13.
Zhonghua Fu Chan Ke Za Zhi ; 46(4): 266-70, 2011 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-21609579

RESUMO

OBJECTIVE: To investigate strategies of diagnosis and treatment of ureter endometriosis. METHODS: From 1983 to 2010, the cases registered in Peking Union Medical College Hospital and confirmed as ureter endometriosis by surgery were enrolled in this study. Clinical manifestations, pre-operative examinations, surgical categories and routes, surgical and pathological findings, post-operative medical treatment, relapse and relating factors were collected and studied. RESULTS: Totally 46 patients with ureter endometriosis underwent one or two surgeries. Forty-eight per cent (22/46) of patients were not be diagnosed with ureter endometriosis pre-operatively, and 46% (21/46) only presented dysmenorrhea or even no symptoms. Ureterolysis (72%, 33/46) and laparotomy (63%, 29/46) were the most common surgical category and surgical approach. There were 64% (25/39) of patients had left ureter involved and 80% (37/46) had extrinsic ureter endometriosis. Fifteen per cent (7/46) of patients had relapsed disease with median recurrent time of 24 months (13-49 months), and they all received second surgeries. Logistic regression analysis showed that only gonadotropin releasing hormone analogue agents were related with recurrence when compared with those patients without medical treatment post-operatively significantly (OR=23.2, 95%CI: 2.4-221.7, P=0.002). CONCLUSIONS: Ureter endometriosis was related with reproductive tract endometriosis. It has insidious process resulting in difficulty for early diagnosis. It's important to treat pelvic deep infiltrating endometriosis and ovarian endometrioma to prevent ureter from further involvement. Post-operative treatment of pelvic endometriosis is the key point of preventing relapse of ureter endometriosis.


Assuntos
Endometriose/cirurgia , Ureter/cirurgia , Doenças Ureterais/cirurgia , Adulto , Dismenorreia/etiologia , Dismenorreia/terapia , Endometriose/diagnóstico , Endometriose/patologia , Feminino , Seguimentos , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Laparoscopia , Pessoa de Meia-Idade , Doenças Ovarianas/patologia , Doenças Ovarianas/cirurgia , Estudos Retrospectivos , Prevenção Secundária , Resultado do Tratamento , Ultrassonografia , Ureter/patologia , Doenças Ureterais/diagnóstico , Doenças Ureterais/patologia
14.
Zhonghua Fu Chan Ke Za Zhi ; 45(8): 588-92, 2010 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-21029614

RESUMO

OBJECTIVE: To investigate the characteristics and trends of surgical management on endometriosis in Peking Union Medical College Hospital From 1983 to 2009. METHODS: The medical documents of patients with endometriosis diagnosed by surgical pathology were studied retrospectively in Peking Union Medical College Hospital (PUMCH). The ratio of different surgical approaches (laparoscopic and laparotomic surgery) and surgical categories (conservative, semi-radical or radical surgery) were compared in all the cases with endometriosis to investigated alterations trends of approaches and methods of surgery. RESULTS: Totally integrated records of 13 972 patients underwent surgeries on endometriosis were reviewed and consisted of 24.974% (13,972/55,945) of all gynecologic surgeries. 59.490% of cases (8312/13,972) were treated by laparoscopic approach, which were significantly higher than the rate of 37.700% (15,824/41,973) of laparoscopic approaches in the other gynecologic diseases (P < 0.01). The proportion of laparoscopic surgeries in all endometriosis surgery was 67.31% (947/1407) between 2005 and 2009, which were significantly higher than 55.98% (510/911) of laparoscopic surgeries between 2000 and 2004 (P < 0.01). Conservative surgery (i.e., with uterus and ovaries intact) consisted of 64.014% (8663/13,533) of endometriosis surgeries. The proportion of conservative surgeries was 66.24% (4176/6304) between 2005 and 2009. The proportion of laparoscopic approaches consisted of 81.10% (7026/8663) of conservative surgeries and 26.30% (1281/4870) of semi-radical or radical surgeries (P < 0.01). The average number of annual surgeries, the average number of annual laparoscopic surgeries and its proportion in endometriosis, and the average number of annual conservative surgeries and its proportion in pelvic endometriosis between 2005 - 2009 were all increased significantly than those at range of 1983 to 1999 and 2000 to 2004. The rate of severe complication 0.351% (49/13,972) was observed in all endometriosis surgeries. CONCLUSION: Surgery was the major treatment of endometriosis in PUMCH, laparoscopic surgery was the major approach and conservative surgery was the major surgery type.


Assuntos
Endometriose/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia , Complicações Pós-Operatórias/epidemiologia , Endometriose/patologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Ovário/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Vagina/cirurgia
15.
Zhonghua Fu Chan Ke Za Zhi ; 45(5): 342-7, 2010 May.
Artigo em Chinês | MEDLINE | ID: mdl-20646442

RESUMO

OBJECTIVE: To identify the differentially expressed genes in cardinal ligament between patients with pelvic organ prolapse (POP) and postmenopausal women without POP by Human Genome Expression Chip and explore the potential molecular mechanism involved in POP. METHODS: From January to May, 2007, cardinal ligament samples were obtained from 3 postmenopausal patients with POP-Q stage III and 3 postmenopausal patients underwent hysterectomy due to other benign gynecologic diseases without POP in Peking Union Medical College Hospital. HE and Masson's trichrome staining was used to verify tissue origin and inspect histological changes. Those differentially expressed genes in cardinal ligaments were identified by Human Genome Chip and further interrogated with Gene Ontology (GO) and Pathway Analysis. Those remarkable expressed genes were confirmed by qRT-PCR. RESULTS: Alterations of ligament architecture in POP patients included disarrangement and collapse of smooth muscle bundles and collagen fibers. A total of 179 differentially expressed genes were screened between POP and non-POP cardinal ligament tissue, including 20 functional unknown genes. A total of 107 genes were upregulated in POP group, while 72 genes downregulated. Those differentially genes were revealed associated with multiple functional proteins and metabolic pathways by biological analysis. Among these, Wnt signaling pathway exhibited the most remarkable changes. Real-time quantitative PCR showed the genes of COL1A1, DKK1, SFRP1, FZD5, WNT16b in POP group (2.98+/-1.40, 3.03+/-0.48, 8.13+/-4.42, 5.19+/-3.50, 12.40+/-3.88) were upregulated significantly compared with non-POP group (1.09+/-0.08, 1.20+/-0.18, 0.41+/-0.51, 0.87+/-0.24, 1.40+/-0.47; P<0.05). CONCLUSIONS: The pathophysiology of POP is complex and associated with multiple functional proteins and metabolic pathways. Among these, the antagonist DKK1, SFRP1 in Wnt signaling pathway may contribute to a neurodegenerative role in POP development.


Assuntos
Colágeno Tipo I/genética , Perfilação da Expressão Gênica , Diafragma da Pelve/fisiopatologia , Prolapso Uterino/genética , Útero/patologia , Idoso , Estudos de Casos e Controles , Colágeno Tipo I/metabolismo , Feminino , Humanos , Histerectomia , Peptídeos e Proteínas de Sinalização Intercelular/genética , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Prolapso de Órgão Pélvico/genética , Prolapso de Órgão Pélvico/metabolismo , Prolapso de Órgão Pélvico/patologia , Reação em Cadeia da Polimerase/métodos , Pós-Menopausa , RNA Mensageiro/genética , Prolapso Uterino/metabolismo , Prolapso Uterino/patologia , Útero/metabolismo
16.
Zhonghua Fu Chan Ke Za Zhi ; 45(2): 93-8, 2010 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-20420777

RESUMO

OBJECTIVE: To investigate the characteristics of the anatomical distribution of posterior deeply infiltrating endometriosis (PDIE) lesions, pain symptoms and effects of laparoscopic surgery. METHODS: Clinical data of 176 PDIE patients with laparoscopically diagnosed and histologically confirmed were analyzed and compared with data of 179 cases with non-PDIE. According to the invasion of rectum or vaginal fornix, 176 PDIE cases were divided into three groups: simple (144 cases), fornix (18 cases) or rectum group (14 cases). RESULTS: Compared with the non-PDIE patients, the risk of pain symptoms in PDIE patients were significantly increased, OR for dysmenorrhea, chronic pelvic pain, deep dyspareunia, dyschezia were 6.73 (95%CI, 3.66-12.40), 1.90 (95%CI, 1.17-3.05), 3.09 (95%CI, 1.94-4.92) and 4.90 (95%CI, 2.07-8.11), respectively (all P < 0.05). The highest incidence of dyschezia was observed in rectum group (50.0%, P < 0.05), while deep dyspareunia in fornix group (72.2%, P < 0.05). The longest operative duration (82 +/- 31) minutes and the postoperative hospitalization (7.7 +/- 2.1) days were observed in rectum group (P < 0.01). The median pain relief time was 56 months in the patients with complete excision of PDIE lesions, which was significantly longer than that in patients with incomplete excision (25 months, P < 0.01). Multivariate analysis demonstrated that only incomplete excision of PDIE lesions was the risk factor for shorter pain relief time (P < 0.05). CONCLUSION: Conservative laparoscopic surgery may effectively relieve pelvic pain symptoms in patients with PDIE, while incomplete excision of PDIE lesions was the only significant predictor of shorter pain relief time.


Assuntos
Endometriose/patologia , Endometriose/cirurgia , Laparoscopia/métodos , Dor/etiologia , Reto/patologia , Vagina/patologia , Adulto , Dismenorreia/epidemiologia , Dismenorreia/etiologia , Endometriose/classificação , Endometriose/complicações , Feminino , Seguimentos , Humanos , Doenças Ovarianas/cirurgia , Dor/epidemiologia , Dor Pélvica/epidemiologia , Dor Pélvica/etiologia , Reto/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Vagina/cirurgia
17.
Zhonghua Fu Chan Ke Za Zhi ; 44(8): 601-4, 2009 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-20003789

RESUMO

OBJECTIVE: To establish the diagnostic model for endometriosis by screening the plasma biomarkers of endometriosis using surface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS)coupled with bioinformatics. METHODS: Plasma samples from 36 patients with endometriosis (endometriosis group) matched with 35 patients with infertility or benign ovarian tumors (control group) before laparoscopy were collected at Peking Union Medical College Hospital from January to October 2007. Plasma protein profiling were detected using SELDI-TOF-MS and protein chip and peak intensities were compared between the two groups. Biomarker Discovery Software was used for data analysis and model was build by classification and regression tree software (CART), sensitivity and specificity of the diagnostic model were verified. RESULTS: There were 14 protein peaks abnormally expressed in endometriosis group compared with those of control group (P < 0.01). The diagnostic model composed of three protein peaks with the molecular weight of 3,956,000, 11,710,000 and 6,986,000 showed a sensitivity of 92% and specificity of 83%. In the blind test the model showed a sensitivity of 88% and specificity of 80%. CONCLUSIONS: SELDI-TOF-MS is a new approach for screening markers of endometriosis. Its clinical value deserves further investigation.


Assuntos
Biomarcadores/sangue , Proteínas Sanguíneas/análise , Endometriose/diagnóstico , Proteômica/métodos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Adulto , Biomarcadores/análise , Endometriose/sangue , Feminino , Humanos , Modelos Biológicos , Peso Molecular , Análise Serial de Proteínas/métodos , Sensibilidade e Especificidade
18.
Int J Gynaecol Obstet ; 105(3): 230-2, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19329117

RESUMO

OBJECTIVE: To analyze the clinical presentation of perineal endometriosis and evaluate its treatment. METHODS: Clinical data were analyzed from the records of 36 patients with perineal endometriosis who were operated on between 1983 and 2007 at Peking Union Medical College Hospital, and followed up for 0.5 to 14 years. RESULTS: The incidence of perineal endometriosis was 0.31% among the women with endometriosis treated surgically at the hospital. The latent period was between 4 months and 13 years. All patients had cyclical and painful lesions. Of the 36 patients, 5 (13.9%) also suffered from pelvic endometriosis. All patients without anal sphincter involvement were cured after complete surgical excision. In 7 patients who had anal sphincter involvement, disease recurred because of incomplete excision. CONCLUSION: Perineal endometriosis can be diagnosed on the basis of clinical features and surgical excision is the treatment of choice. The recurrence rate of perineal endometriosis is related to sphincter involvement making preoperative evaluation of anal sphincter important.


Assuntos
Canal Anal/cirurgia , Endometriose/cirurgia , Períneo/cirurgia , Adulto , Canal Anal/fisiopatologia , China/epidemiologia , Endometriose/diagnóstico , Endometriose/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Períneo/fisiopatologia , Recidiva , Resultado do Tratamento , Adulto Jovem
19.
Zhonghua Fu Chan Ke Za Zhi ; 43(7): 514-7, 2008 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-19080515

RESUMO

OBJECTIVE: To set up the proteomic protein profiling of adenomyotic tissue and normal uterine muscle and identify the abnormally expressed proteins in adenomyotic tissue. METHODS: Samples of adenomyotic tissue (adenomyosis group) and age-matched healthy uterine muscle (control group) were collected from totally 10 patients undergoing transabdominal hysterectomy for adenomyosis and cervical diseases at Peking Union Medical College Hospital from January 2007 to October 2007. The proteomics profiling of adenomyotic tissue and normal uterine tissue were established using two dimensional gel electrophoresis (2-DE) and gel staining method. The differently expressed protein spots were detected by gel comparison using image analysis software and identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). RESULTS: In Coomassie blue stained gels there were on average (512 +/- 36) spots and compared with the reference gel the matching rate was 83.7%. In silver stained gels there were (762 +/- 54) spots and compared with the reference gel the matching rate was 81.1%. Compared with normal uterine muscle, there were 15 protein spots disregulated in adenomyotic tissue. Among them 10 protein spots were successfully identified by mass spectrometry. The functions of these disregulated proteins included cell skeleton, oxidation, apoptosis and immune reaction. CONCLUSIONS: Comparative proteomics analysis is a useful approach for the study of adenomyosis. Compared with normal uterine muscle there are abnormalities in cell skeleton, oxidation, apoptosis and immune reaction. These life processes may participate in pathophysiology of adenomyosis.


Assuntos
Endométrio/metabolismo , Proteínas/metabolismo , Proteômica/métodos , Doenças Uterinas/metabolismo , Adulto , Proteínas do Citoesqueleto/metabolismo , Eletroforese em Gel Bidimensional , Endométrio/patologia , Feminino , Proteínas de Choque Térmico/metabolismo , Humanos , Pessoa de Meia-Idade , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Doenças Uterinas/patologia
20.
Zhonghua Yi Xue Za Zhi ; 87(17): 1181-3, 2007 May 08.
Artigo em Chinês | MEDLINE | ID: mdl-17686237

RESUMO

OBJECTIVE: To investigate the diagnosis and treatment of perineal endometriosis. METHODS: The clinical date of 30 patients with perineal endometriosis, aged 32.3 (23 approximately 44), who were admitted 1983 - 2006, operated on, and followed up for 0.5 approximately 13 years, were analyzed. RESULTS: The incidence of perineal endometriosis was 0.32% among the total endometriosis cases. Five of these 30 patients (16.7%) suffered from perineal endometriosis combined with pelvic endometriosis. The latent period was 4 months to 13 years. There was no significant difference in onset of age. All patients had cyclical and painful lesions. The level of CA125 was normal. All patients were cured after complete surgical excision. CONCLUSION: Diagnosis of perineal endometriosis can be made based on the patients' history and clinical manifestations. Surgical excision is the first choice of treatment. The recurrent rate of the cases without anal sphincter involvement is lower than that with anal sphincter invasion since the complete incision can be made. It is important to evaluate pre-operatively if the anal sphincter is involved.


Assuntos
Endometriose/diagnóstico , Endometriose/cirurgia , Períneo , Adulto , Feminino , Seguimentos , Humanos , Estudos Retrospectivos
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