2011 Vol. 2, No. 2

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Original Contributions
Abstract:
  Objective  To investigate the influence of laparoscopic ovarian cystectomy on ovarian reserve function and pregnantic outcome in women with ovarian endometriotic cyst.  Methods  A total of 176 women with ovarian cyst undergoing laparoscopic cystectomy were divided into six groups:40 patients with uni-lateral teratoma(con1), 10 patients with bilateral teratoma(con2), 40 patients with unilateral ovarian endometriotic cyst less than 35y(A), 26 patients with unilateral ovarian endometriotic cyst no less than 35y(B), 41 patients with bilateral ovarian endometriotic cyst less than 35y(C), and 19 patients with bilateral ovarian endometriotic cyst no less than 35y(D).Blood samples were obtained from patients before operation, 24 hours after operation and on the second and third day of the menstrual cycle 6 months after operation.Mean ovarian diameter were evaluated by ultrasound 6 months after operation and pregnancy outcome was recorded in the following 18 months after the operation.  Results  In the bilateral groups(C and D), the serum level of follicle stimulating hormone(FSH)increased significantly after the operation(P < 0.05), while estradiol decreased significantly(P < 0.05).No significant difference between pre-and post-operational hormone levels were observed in the unilateral groups(A and B)and control group Serum basal FSH recovered to normal 6 months after the operation in 77.8% of patients in group C and 53.3% in group D(P < 0.05).The reduction of mean ovarian diameter six months after operation was significantly different between the affected and contralateral ovaries(P < 0.05).During the follow-up, the pregnancy rate was 92.9% in controlled group, compared to 45.2% in the endometriosis group(P < 0.05)and 60%, 37.5%, 46.2%, and 16.7%, respectively, for group A, B, C, and D.  Conclusion  The ovarian reserve function decreases after laparoscopic ovarian cystectomy in women with ovarian endometriotic cyst.However, most young patients recover after 6 months.Peri-operative ovarian function assessment and ovarian protection should be carefully designed and performed for women who intend to get pregnant.
Abstract:
  Objective  To compare the effectiveness, cost, and quality of life between loop electrosurgical excision procedure(LEEP)and CO2 laser vaporization in treating cervical intraepithelial neoplasia 2(CIN2).  Methods  Totally 338 women with colposcopic-histopathologically confirmed CIN2 were enrolled in this study, of whom 195 underwent LEEP(LEEP group)and 143 underwent CO2 laser vaporization(laser group).They were followed up 3, 6, and 12 months after treatment.A questionnaire of EORTC QLQ-C30 and QLQ-CX24 were filled out at 12 months follow-up.  Results  In LEEP group, CIN was cured in 174 patients(89.2%)and relapsed in 7(3.6%).In laser group, CIN was cured in 124 patients(86.7%)and relapsed in 1 patient(0.70%)(both P > 0.05).The recovery time, number of operation, bleeding volume, and costs were significantly different between these two groups(P < 0.05).Women treated with LEEP showed relatively identical quality of life compared with those treated with CO2 laser vaporization.  Conclusions  Both LEEP and CO2 laser vaporization are effective and reliable for the treatment of CIN2, while pre-operative evaluations and post-operative follow-up are essential.Attention should also be paid to the post-operative quality of life.
Abstract:
  Objective  To investigate the clinical significance of modified laparoscopic hysterectomy(MLH).  Methods  Totally 71 patients received MLH in our hospital from June 2007 to May 2008.Their procedure characteristics and clinical outcomes including surgery duration, intra-operative blood loss, and complications were compared with those of 28 patients who received total laparoscopic hysterectomy(TLH)and 36 patients who received laparoscopic assisted vaginal hysterectomy(LAVH)during the same period.  Results  Compared with TLH and LAVH group, the main modifications in MLH group included:suturing the vaginal vault via vaginal approach instead of laparoscopic approach; use of special uterus manipulator and novel electronic coagulation equipment(Biclamp); and reducing uterine volume with electric comminuter via laparoscopy before the circular amputation of vaginal wall(i.e in situ volume reduction)instead of reducing manually via vaginal approach.The mean uterine sizes in MLH, TLH, and LAVH group were equivalent to the gestational ages of(12.3±2.6), (10.3±1.9), and(11.6±2.2)weeks, respectively.Uterine volume reduction procedure was performed in 39 patients(54.9%)of MLH group, 3 patients(10.7%)of TLH group, and 18 patients(50.0%)of LAVH group, obviously, there was a significant difference between MLH and TLH group(P < 0.05).The mean surgery duration was 78.0 min in MLH group, which was significantly shorter than those in TLH group(90.4 min)and LAVH group(94.7 min)(both P < 0.05).The mean intra-operative blood loss was significantly higher in LAVH group(144.2 ml)than in MLH(81.3 ml)and TLH group(81.1 ml).The post-operative morbidity rate was 16.9%, 10.7%, and 13.9% in MLH, TLH, and LAVH group; obviously, there was a significant difference between MLH and TLH group(P=0.0439).One patient from MLH group and one patient from LAVH group experienced ureter injury, and one patient form TLH group suffered from post-operative vaginal vault bleeding.  Conclusions  The use of special uterus manipulator and novel electronic coagulation equipment improves the feasibility of laparoscopic hysterectomy.In situ uterine volume reduction via laparoscope is an alternative method for uterine volume reduction.Suturing vaginal vault through vaginal approach is more practical than laparoscopic approach, especially for patients whose uterus volume needs to be reduced vaginally.
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  Objective  To explore the incidence of vaginal fungal infection and its influencing factors during in vitro fertilization and embryo transfer(IVF-ET)cycles.  Methods  In this multicenter open-label clinical trial, 301 patients who underwent IVF-ET due to tubal factors from January 2006 to December 2006 were enrolled.Vaginal fungal cultures were performed before the commencement of ovarian stimulation, on the day of human chorionic gonadotropin(HCG)injection and on the day of embryo transfer.The possible influencing factors of vaginal fungal infections including age, body mass index(BMI), type and duration of infertility, dosage of ovarian-stimulating drug, follicle numbers, oocyte numbers, estrogen levels, and use of antibiotics were analyzed using Logistic regression analysis.  Results  Vaginal fungal cultures showed negative results before the commencement of ovarian stimulation in all patients.However, 32 cases(10.6%)had positive vaginal swab on HCG injection day and 22 cases(7.3%)on ET day.The average age of patients were(32.23±3.86)years.BMI(21.54±2.73)kg/m2.Sterile period(5.32±3.23)years, usage of total gonadotropin(35.45±14.08)ampous, average numbers of follicles(13.26±7.01), retrieved oocytes(12.77±7.47), and estradiol levels(2520.69±1686.04)pg/ml.Antibiotics were used in 66.78% of the patients after ovulation.Multiple factor Logistic regression analysis that factors such as age, BMI, type and duration of infertility, ovarian stimulation, and the use of antibiotics after oocyte retrieval were not significantly correlated with vaginal fungal infection(P> 0.05), which estradiol levels, follicle numbers, and oocyte numbers significantly influenced the incidence of vaginal fungal infection(P < 0.05).  Conclusions  The incidence of vaginal fungal infections is low during IVF-ET treatment.Age, type and duration of infertility, drug dosage, use or not of antibiotics after oocyte retrieval has little effect on vaginal fungal infection, while larger number of follicles/oocyte numbers and the higher levels of estrogen may increase the incidence of vagina fungal infection.
Abstract:
  Objective  To evaluate the clinical outcome of patients who underwent cystectomy only as part of their surgical treatment for malignant ovarian germ cell tumor(MOGCT).  Methods  Totally 255 MOGCT patients were diagnosed and treated in our department between January 1980 to December 2010.Among them 21 patients underwent cystectomy only as their initial surgery.These 21 patients entered the final analysis.  Results  Of these 21 MOGCT patients, 15 were with immature teratoma[Grade 1, n=9;grade 1-2, n=4;grade 2, n=2), one with yolk sac tumor, four with dysgerminoma, and one with mixed germ cell tumor.All except three patients(two with grade 1 and one with grade 1-2 disease)received adjuvant chemotherapy.All patients were followed up, with a median duration of 52 months.No recurrence was observed during this period except one patient experienced mixed germ cell tumor.Two patients(one with dysgeminoma and one with immature teratoma)successfully became pregnant and delivered healthy babies.  Conclusions  Cystectomy followed by adjuvant chemotherapy can achieve satisfactory effectiveness for apparent early-stage immature teratoma, dysgerminoma, and even yolk sac tumor under close follow-up.However, studies with larger samples are required to confirm whether cystectomy alone is enough for curing MOGCT.
Abstract:
  Objective  To compare the effects of total intravenous anesthesia(TIVA)with propofol-remifentanil and isoflurane-sufentanil on the wake-up test in the scoliosis correction surgery of adolescence.  Methods  Thirty-two 10-18-year-old patients undergoing elective scoliosis procedures were randomly allocated into two groups:group P(propofol/remifentanil)and group I(isoflurane/sufentanil).The wake-up time and quality during and after the surgery were compared.  Results  Group P(9.2±3.3 min vs 12.5±6.0 min, P=0.066)required shorter wake-up time during the surgery.The patients in group P had significantly shorter time for the onset of opening eyes(11.6±7.8 min vs 19.7±9.8 min), motion of the feet(12.6±7.9 min vs 22.9±8.7 min), and the extubation(13.4±8.3 min vs 20.4±8.7 min)than those in groug I(P < 0.05).More patients in group I had agitation during the intra-operative wake-up tests(P=0.033).No significant difference was found between the two groups in the incidence of hemodynamic instability or intraoperative awareness.  Conclusion  The total intravenous anesthesia with propofol and remifentanil can shorten the wake-up time, reduce agitation, and do not induce intra-operative awareness.
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  Objective  To explore the prevalence of depressive and/or anxiety disorders in outpatients in neurology, gastroenterology, cardiology, and gynecology department from a general hospital.  Methods  A hospital-based cross-sectional study was conducted in the Peking Union Medical College Hospital in 2007.Totally 621 outpatients were recruited within one month.All of the subjects completed the self rated Hospital Anxiety and Depression(HAD)scale for screening, and patients with HAD scores ≥ 8 were further interviewed by psychiatrists.Psychiatric diagnoses were made using the Mini International Neuropsychiatric Interview(MINI).  Results  A total of 353 outpatients(56.8%)had ≥ 8 during screening, of them 281 were further interviewed by psychiatrists and 111 subjects were diagnosed as with depressive and/or anxiety disorders.Theses patients had more trouble in living, working, and social activities.The adjusted prevalence of depressive and/or anxiety disorders in outpatients in neurology, gastroenterology, cardiology, and gynecology were 33.4%, 18.8%, 12.4%, and 25.5% respectively.Only 18.9% of those patients were recognized during their outpatient visits.Among these interviewes, the preferred treatment mode was pharmacotherapy, followed by psychotherapy and referral to psychiatry.  Conclusions  The prevalence of depressive and/or anxiety disorders is high among outpatients in a general hospital.However, their treatment needs usually are not met due to low percentages of diagnosis and treatment.
Abstract:
  Objective  To investigate the effects of overnight orthokeratology lens on corneal endothelium and corneal thickness after one year of treatment.  Methods  Totally 40 patients(79 eyes)aged 8-14 years received orthokeratology lens treatment in our hospital from August 2008 to February 2009 were observed.Corneal endothelium and corneal thickness were assessed before the treatment, 6 months and 1 year after the treatment.Uncorrected visual acuity, diopter, and corneal topography were documented at the same time points as well.  Results  Corneal endothelial cell density showed no significant reduction 6 months and 1 year after the treatment when compared with the baseline level(P > 0.05).Cell Variant Index and percentage of hexagonal cells showed no significant change 6 months after the treatment but the former slightly increased and the later decreased after 1 year of the treatment(both P < 0.05).Corneal thickness showed no significant change after 6 months or 1 year of treatment(both P > 0.05).Uncorrected visual acuity, diopter, and corneal topography significant changed after 1 year of treatment(P < 0.01).  Conclusion  Orthokeratology lens can correct refractive error and control the development of myopia.However, its long-term wear may have slight deformative effect on corneal endothelium.Strictly monitoring and follow-up are required to ensure long-term effectiveness and safety.
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2011, 2(2): 115-116. doi: 10.3969/j.issn.1674-9081.2011.02.001
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2011, 2(2): 119-119. doi: 10.3969/j.issn.1674-9081.2011.02.005
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