腹腔镜诊治不孕症患者盆腔病变临床分析

目的探讨应用腹腔镜手术诊治不孕症的临床价值。方法对126例女性不孕症患者行腹腔镜诊断和治疗,观察术后妊娠率。结果 126例中发现盆腔病变117例,占92.86%;慢性盆腔炎是不孕症的第1位病因;其次为子宫内膜异位症、多囊卵巢综合征。腹腔镜手术术后妊娠率为47.50%,1例发生异位妊娠。结论腹腔镜手术对女性不孕症盆腔病变的诊治具有重要的价值。     

Roy适应模式在不孕症腹腔镜手术患者心理护理中的应用

目的 探讨Roy适应模式在不孕症腹腔镜手术患者心理护理的应用效果.方法 根据Roy适应模式护理工作方法的六个步骤,对120例不孕症腹腔镜手术患者常见的各种刺激源进行评估,采取护理措施,控制刺激强度,扩大患者的适应性.结果 120例不孕症腹腔镜手术患者能以良好心理状态,较好地配合手术治疗.结论 应用Roy适应模式,对不孕症腹腔镜手术患者进行进行全面评估,能及时发现影响手术患者心理的刺激因素,收到良好的心理护理效果.     

腹腔镜用于诊治女性不孕症的临床应用

目的：探讨腹腔镜在诊治不孕症中的应用。方法对78例不孕症患者行腹腔镜检查术,对不孕病因进行诊断,同时根据所查病因在腹腔镜下作出相应的手术治疗。结果盆腔粘连,输卵管阻塞,子宫内膜异位症和多囊卵巢综合征是引起女性不孕症的主要盆腔疾患。78例均行腹腔镜下输卵管通液和各种疾病的治疗。结论腹腔镜技术能早期、迅速明确不孕症输卵管及盆、腹腔病因,融诊断、治疗于一体,具有创伤小、出血少、康复快等优点,增加术后妊娠率,避免了治疗中的盲目性。     

腹腔镜治疗子宫内膜异位症伴不孕症围手术期护理

目的探讨子宫内膜异位症伴不孕症患者实施腹腔镜手术的术前、术后的护理重点。方法对95例子宫内膜异位症伴不孕症患者腹腔镜下手术术前、术后的护理。结果 95例患者全部康复出院,无术后并发症。结论子宫内膜异位症伴不孕症行腹腔镜手术术前充分的准备和术后严密的观察对术后的康复起重要作用,术后指导不孕专科治疗予辅助生殖手段明显提高受孕率。     

妇科电视腹腔镜手术66例分析

目的 探讨腹腔镜手术在妇科的临床应用价值。方法 用腹腔镜行不孕症诊治手术,附件手术、子宫切除手术共66例,进行手术时间,术中出血,术后镇痛,用药率,术后输液日,住院日和术后发热率进行总结。结果 腹腔镜下绝大部分妇科良性疾病的手术获得成功,表明腹腔镜手术具有出血少,术后用药少,痛苦小,住院日短,术后发热率低。结论 腹腔镜手术创伤小恢复快,术后并发症少,可应用于大部分妇科良性疾病。     

腹腔镜在治疗输卵管、卵巢性不孕症诊治中的应用

目的:探讨腹腔镜在输卵管、卵巢性不孕症治疗中的疗效及影响因素.方法:对35例不孕症患者行腹腔镜诊疗,其中原发性不孕症11例、继发性不孕症24例.结果:35例手术均顺利,无并发症.术后29例获随访,随访3～18个月,术后宫内妊娠率达37.93%(11/29).结论:腹腔镜手术对输卵管远端阻塞、盆腔粘连及肿块导致输卵管扭曲的不孕症有良好的治疗效果,对不明原因的不孕症能尽早明确诊断.     

宫腹腔镜联合手术诊治不孕症120例分析

目的探讨宫、腹腔镜联合手术在女性不孕症诊治中的应用优势。方法联合应用宫、腹腔镜对120例不孕症患者进行检查,并对病因明确者行相应治疗。结果盆腔粘连和输卵管阻塞是造成妇女不孕的主要原因。子宫内膜异位症和卵巢疾病也是常见因素。术后妊娠率达43．8％。结论应用宫、腹腔镜联合诊治不孕症患者能直观、准确、全面地明确盆腔、官腔疾患,并予以针对性治疗,提高手术疏通输卵管的成功率,提高女性不孕患者的妊娠率。     

不孕症患者腹腔镜术后跟踪随访结局的分析

目的探讨腹腔镜手术治疗不孕症的效果及对术后转归辅助生殖技术妊娠的影响。方法采用腹腔镜对58例不孕症患者的盆腔情况进行观察，同时进行腹腔镜手术治疗，跟踪随访，了解腹腔镜术后的治疗转归及妊娠情况。结果经腹腔镜诊治的不孕症随访术后妊娠情况，接受随访的58例患者中，术后半年内自然妊娠4例，人工授精妊娠6例，妊娠率18．52％，半年后接受体外受精-胚胎移植辅助妊娠的IVF-ET或ICSI20例，妊娠17例，剩余28例消极等待，至今未孕。结论腹腔镜手术治疗不孕症，如术后半年内未受孕，积极采取助孕措施，尽管腹腔镜术后未孕，但腹腔镜手术能为通过辅助生殖技术助孕，能明显提供患者的妊娠率。     

宫腹腔镜联合手术在诊治不孕症中的临床应用

目的:探讨宫腔镜-腹腔镜联合手术在诊治不孕症手术中的要点和临床应用价值。方法:采用宫、腹腔镜联合手术治疗52例不孕症患者,并视术中的不同情况,选择不同的手术方式,术中评价手术效果。结果:52例病人全部明确不孕病因。镜下确诊子宫肌瘤11例,子宫发育畸形5例,子宫内膜异位症8例,结核2例,盆腔炎症31例。梗阻28例,多囊卵巢9例,子宫内膜息肉9例,卵巢囊肿8例。结论:应用宫腹腔镜联合手术可对不孕症做出明确病因诊断。     

腹腔镜、宫腔镜联合手术诊治不孕症效果探讨

目的：探讨腹腔镜、宫腔镜联合手术诊断治疗女性不孕症的临床效果。方法回顾分析我院2011年5月~2014年2月收治的120例采用腹腔镜、宫腔镜联合手术治疗不孕症的女性患者的临床资料,探讨其诊断治疗的临床效果。结果腹腔镜联合宫腔镜诊断出的异常率为98.3%(118/120),其中子宫内膜病变、盆腔子宫内膜异位症以及输卵管病变是不孕症的主要病因。腹腔镜、宫腔镜联合手术治疗后随访102例,47例成功宫内受孕,治愈率46.1%,输卵管性和非输卵管性不孕妊娠率分别为29.1%和64.6%,两者均有显著性差异(P<0.05)。结论腹腔镜、宫腔镜联合手术结合了二者的优势,能够同时进行腹腔和宫腔疾病的诊断治疗,具有创伤小、恢复快、疗效显著等特点,是重要的不孕症诊治手段,值得进一步推广使用。     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Establishing Safety with Patients with Dissociative Identity Disorder

Abstract

The incidence of self-mutilation and suicidality among patients with dissociative disorders is quite high. It is necessary for clinicians working with this population to be adept at dealing with safety problems. This article presents a sequence of basic steps that can be used when helping dissociative patients establish safety, a discussion of the functions of self-destructiveness, and an overview of specific experiences and thinking patterns that contribute to self-destructiveness among dissociative patients.     

Gynecomastia with marked cellular atypia associated with chemotherapy

Gynecomastia is a common benign male breast disease, which may exhibit mild cellular atypia in cytology specimens. However, marked cytologic atypia can be seen in gynecomastia superimposed by chemotherapy. The case described in this report demonstrated severe cytologic atypia of gynecomastia mimicking carcinoma in a patient treated with chemotherapy for acute leukemia. A distinct cytologic feature helpful in avoiding the diagnostic error is described, namely, atypical cells admixed with bland ductal cells and appearing at a different plane. The importance of applying strict diagnostic criteria in breast cytology and clinical correlation is also emphasized.     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.     

Satellite RNA associated with bamboo mosaic potexvirus shares similarity with satellites associated with sobemoviruses

Summary A putative nonstructural protein encoded by a satellite RNA associated with bamboo mosaic potexvirus shares 46% identity with the capsid protein of satellite virus of panicum mosaic sobemovirus. The sequence similarity among satellite plant viruses which have no apparent relationship implies a common origin.