Search

The incidence rate of cesarean scar pregnancy (CSP) after cesarean section increases rapidly in recent years due to the increase of cesarean delivery. The CSP is caused by poor healing of lower uterine segment of cesarean section scar. Although with the progress in transvaginal ultrasonography, the diagnosis of these conditions is not the challenge for clinical doctor anymore, but the standardized management of CSP is not well established and the patient's condition with CSP is various when visit the hospital, the treatment must be individualized as well. The main problem we face now is there has no standardized criteria for the selection of individualized treatment. The current opinion is that, for the patients with operation indications, operation can remove lesions as soon as possible could not only avoid life-threatening complications such as uterine rupture, hemorrhage, especially hysterectomy and loss of fertility, but also could repair the uterine scar defects and reduce the risk of CSP again. Laparoscopy had been widely used in China and many hospitals have the appropriate equipments and techniques, it is no doubt for operation safety and feasibility. In this review, we summarized the recent clinical researches about laparoscopic treatment cesarean scar pregnancy. The conclusion is that laparoscopic operation should be the first line treatment of CSP with operation indications, which had the lowest effect on the patient's life quality after operation. However, there had several points needs to be fully evaluated, the operation should be done by skilled surgeon, always be ready for heavy hemorrhage in the operation and change to hysterectomy anytime necessary, injury of bladder should be carefully checked before the operation ends. [ABSTRACT FROM AUTHOR]

Objective: To study the predictive value of the endometriosis fertility index (EFI)for the clinical pregnancy rate in intrauterine insemination (IUI)treatment cycles for endometriosis patients complicated with infertility. Methods:The clinical data of 75 endometriosis patients complicated with infertility after laparoscopic surgery undergoing 125 IUI cycles were analyzed. EFI score was calculated according to the endometriosis fertility index system, the ROC curve was used to assess the predictive value of EFI for the clinical pregnancy rate of IUI. Results:The areas under ROC curve of EFI and r-AFS were 0.708?0.059(P<0.05)and 0.375±0.065(P>0.05)respectively. The best point for diagnosis by EFI was 7, the sensitivity was 0.737 and the specificity was 0.613. The clinical pregnancy rate of EFI≤6, 7, 8, 9, 10 was 3.1%, 10.5%, 21.1%, 27.8%, 27.8% respectively. Compare to the group of EFI≤6, the clinical pregnancy rate of EFI=8, 9 and 10 was significantly higher(P<0.05). Conclusions:EFI can be used as a good and effective tool to predict pregnancy outcome in the endometriosis-associated infertile patients attempted to IUI after laparoscopic surgery, the clinical pregnancy rate was obviously increased among EFI≥8, which can provide an important basis for assisted reproductive technology treatment. [ABSTRACT FROM AUTHOR]

Septate uterus is the most common congenital malformation of the female genital tract. In 2013, ESHRE/ESGE reclassified the female genital tract deformity through expert consensus, after that the translation and interpretation of Chinese version also published. However, there is no published articles analyzed the impact of this updated classification consensus on clinical practice about the diagnosis and treatment of septate uterus in mainland China. The present article aims to focus on these issues. By quantifying the depths of the septum which protrudes into the uterine cavity and an external fundal indentation to cavity, the new classification system helps diagnosis and differential diagnosis of septate uterus. At the same time, it provides a clear standard for surgical resection of the septum or metroplasty. [ABSTRACT FROM AUTHOR]

The treatment of recurrent ovarian cancer is the difficulty in gynecologic oncology. Its treatments include surgery,chemotherapy,targeted therapy,biological therapy, etc. The cytoreductive surgery is a treatment of recurrent ovarian cancer,including secondary cytoreductive surgery and multiple cytoreductive surgery. Principle treatment of recurrent ovarian cancer is ensuring patients′ quality of life and prolonging the survival time as long as possible. Strict surgical indications were involved in secondary cytoreductive surgery and multiple cytoreductive surgery. It is a key role that all visible leision must be removed during the cytoreductive surgery in recurrent ovarian cancer as much as possible ,in order to minimize the tumor burden and reduce the clones of resistant-drug. Secondary or multiple cytoreductive surgery is more complex ,multidisciplinary collaboration is required to complete the surgery and take good care after surgery. With premise of unchanging the quality of survival patients recovery should be promoted under multidisciplinary collaboration. Chemotherapy after optimal secondary or multiple cytoreductive surgery may improve the overall survival of patients. The rule of treatment must be complied. [ABSTRACT FROM AUTHOR]

microRNAs (miRNAs) are non-coding RNAs that can regulate mRNA in the level of post - translational modification, transcription and post-transcription. And they are associated with growth, development and invading of tumors as oncogenic miRNAs and tumor suppressor miRNAs. Relationships of miRNAs with endometrial cancer (EC) have recently emerged. For instance, miRNA-200 family, miRNA-205, miR-129-2, miR-203, miR-302, miR-194, miR-30c, miR-204, miR-34, miR-125, miRNA-152, miRNA-503, etc. With the deeper research, miRNA s may be used in clinical applications as one of new targets. In this article, there is an overview about the recent research of miRNAs and EC. [ABSTRACT FROM AUTHOR]

Endometriosis (EMs) is a common, benign and chronic disease of gynecology, it requires long-term or repeated courses of medication treatment to control its related symptoms. EMs is often treated surgically but with a higher rate of recurrence, patients of postoperation often need medical adjuvant therapy. EMs is a kind of estrogen dependent disease, the purpose of drug treatment is to creat an environment of low estrogen, inhibit the growth of ectopic endometrium or make it atrophy. Progestins have good tolerability, minor metabolic effects and low cost, there must therefore be considered drugs of choice and are currently the only safe and economic alternative to surgery, and levonorgestrel releasing intrauterine system is especially suitable for the patients who have EMs combined uterine muscle gland disease. According to the stage of individual, the choice of progestin program is different when select a therapeutic schedule drug adverse reaction and mechanism of accurate action should be considered. This article reviews the latest researches of progestins in treating EMs on molecular mechanism, commonly used types, commonly used formulations and dosage, application prospect. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and safety of uterine arteries embolization (UAE) for the treatment of cesarean scar pregnancies (CSP) and cervical ectopic pregnancy (CEP). Methods: A prospective study for case series of seventy-six women with CSP and fourteen women with CEP were accurately identified by Tianjin Central Hospital of Gynecology Obstetrics between April 1,2011 and April 1,2013. All of the patients underwent UAE combined with methotrexat (MTX). Results: All of the patients were successfully treated without any severe adverse reactions or complications, and did not need a repetitive uterine artery embolism or uterus resection or partial resection of the local lesions. No significant differences of blood loss were seen between whether the embryo was alive before UEA (CSP:t=0.234;CEP:t=0.730,P>0.05). There is no correlation between beta-human chorionic gonadotropin level before UAE and blood loss. The difference was found to be statistically significant between whether the beta-human chorionic gonadotropin level dropped obviously (CSP:t=-6.683 ;CEP:t=-5.461,P=0.000), and the difference was also found significant between the different types of CSP (t=5.731,P=0.000).The complications were mainly fever and abdominal pain; 70 patients were followed up, and all of them had recovered their normal menstruation. Conclusions: UAE with MTX appears to be a safe and effective treatment for CSP and CEP. [ABSTRACT FROM AUTHOR]

Ovarian cancers are the most common gynecological neoplasms, which has the highest mortality rate of cancers of the reproductive organs, because of lack of effective early diagnostic tool. DNA methylation is the first epigenetic changes discovered by human. Methlation of RASSFIA BRCA1 and hMLHl genes play an important role in the development of ovarian cancers. Detection of these genes could help early cancer diagnosis. However, some DNA methylation, like hMLHl, decline the sensitivity of chemotherapy drugs to tumor cells. Demethylation drugs which can reexpress those genes may improve the effect of chemotherapy and prognosis. In this review, we have summarized the newest researchs of DNA methylation changes in ovarian cancer. [ABSTRACT FROM AUTHOR]

Generalized pustular psoriasis of pregnancy is a rare and severe disease. The development is rapid, with systemic generalized aseptic blain and severe systemic symptom for features, often associated with fever, hyperleukocytosis and hypoproteinemia, etc. It is a life-threatening disease either for pregnant woman or infant. The pathogenesis of the disease has not been illustrated completely. Glucocorticoid and retinoic acid are commonly used to treat this disease, because the drugs used during pregnancy is restricted, the treatment is still difficult. Early diagnosis, treatment and terminate pregnancy timely can improve the maternal and perinatal prognosis of this disease. This article is to review diagnosis and treatment progress of this disease. [ABSTRACT FROM AUTHOR]

The mechanisms responsible for the pathogenesis of preeclampsia are poorly understood by now, which is important reason for maternal-fetal death. P-selectin is one of adhesion molecules, having a start and an enlarged role of inflammation and thrombus formation, resulting in coagulation dysfunction, damage to the capillary endothelial cells, thereby causing specific maternal-fetal clinical manifestations, which mainly comes from platelets. Many studies have confirmed that P-selectin play an important role in the pathogenesis of preeclampsia. In the article, we will make a review about this progress. [ABSTRACT FROM AUTHOR]

Hormone replacement therapy (HRT) can alleviate postmenopausal women' menopausal symptoms, prevent osteoporosis and reduce fractures with a consensus, but its influence on breast cancer, cardiovascular disease and other chronic diseases is still controversial. Using estrogen alone may not increase the risk of breast cancer, while combining estrogen with progesterone may increase breast cancer's risk. Different breast disease patients may suffer different risks of breast cancer after HRT,the relationship between Chinese women HRT and breast cancer are uncertain. Benefits exceed risks when applying HRT on women who have indications close to post menopause, different types and occupy pathways of HRT may result in different breast cancer risks. Summarize the relationship between HRT and breast cancer as well as HRT applications in patients with different breast disease. [ABSTRACT FROM AUTHOR]

Implantation of conception tissue within a cesarean section scar, named cesarean scar pregnancy(CSP),is an extremely rare form of ectopic pregnancy with devastating complications, such as uterine rupture and intractable bleeding, which may also lead to other life-threatening complications such as the pregnancy advances, loss of subsequent fertility, or even maternal death. Recently, the diagnosis of CSP is increasing, which attributed to growing awareness, expanding use of early pregnancy transvaginal ultrasound and rising rates of caesarean delivery. While the mechanism which contributes to cesarean scar pregnancy is still unclear, and the most notable mechanism is that the blastocyst invades myometrium through a microscopic dehiscent tract, which is believed to develop from the trauma of a previous cesarean section or any other uterine surgery. Although ultrasonographic devices are used adequately for precise diagnosis, but there is still a lack of consensus concerning management strategies. Moreover, the optimal management of CSP is unclear and a variety of therapeutic strategies are used, without clear management consensus at this time. The current primary intervention is early interruption of the pregnancy. Both medical and surgical approaches to the management of CSP are reported. The article is a review of the diagnosis and treatment of cesarean scar pregnancy. [ABSTRACT FROM AUTHOR]

Endometrial polyps is one of the most common gynecological diseases, which can induce menstrual period extended, postmenopausal bleeding, infertility and other clinical symptoms. After treatment, endometrial polyps also are easy to relapse, have certain malignant transformation rate, whose etiology and pathogenesis is not clear. In recent research, this disease is correlated with genetic factors, local imbalanced steroid hormone receptor, proliferation and apoptosis, chronic inflammatory stimulation, certain drugs and cell factor. Age, postmenopausal, anomalistic uterine bleeding, use of tamoxifen, obesity, hypertension, diabetes mellitus may involved in its progression. Through translational ultrasonography, sonohysterography, hysteroscopy, uterine iodine oil imaging play an important role in its treatment process. Now from the epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment, recurrence, malignant related factors, prevention of endometrial polyps, we do a review, for we can more inclusively and more correctly promulgate the mechanism and characteristics of endometrial polyps, and then we can better guide further clinical research and therapy. [ABSTRACT FROM AUTHOR]

Endometrial carcinoma is the most common parenteral tumor in female patients with Lynch syndrome. The disease is different from sporadic endometrial carcinoma, which is autosomal dominant genetic disease, and the pathogenesis and mechanism are the abnormalities of mismatch repair genes (MLH1,MSH2,MSH6 and PMS2). Patients are much younger compared to sporadic endometrial carcinoma and pathological type is more diversity, including endometrial carcinoma, clear cell carcinoma, serous carcinoma and undifferentiated carcinoma and sarcoma, etc. Due to the higher risk of tumor recurrence and its great harmfulness of the disease, timely treatment of the Lynch syndrome related endometrial carcinoma is the key to inhibit the secondary tumor. This article is to summarize the new progress the etiology and pathogenesis of endometrial carcinoma, the clinical pathological characteristics and diagnosis, treatment and screening of Lynch syndrome related endometrial carcinoma. [ABSTRACT FROM AUTHOR]

Granular cell tumor of the vulva is a rare vulvar disease without typical clinical features. Preoperative diagnosis is extremely difficult. In this paper, we present a 34-year-old female who underwent local excision of vulvar nodules due to recurrent vulval pain. Because of the rarity in clinical gynecology, multidisciplinary consultation was organized to identify the benign or malignancy, and developed a postoperative follow-up program. The patient has not relapsed. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effects of uterine fibroids treated with transvaginal and laparoscopic hysteromyoma. Methods:80 patients with uterine fibroids from February 2009 to February 2011 were treated, according to the random number table they were divided into transvaginal groups (40 cases) and laparoscopic group (40 cases). Two group of patients for surgical trauma, postoperative pain and postoperative morbidity rates were compared. Results: The operative time, blood loss, postoperative anal exhaust time, postoperative pain and postoperative morbidity rate of vaginal hysterectomy excision are better than laparoscopic myomectomy, the differences are statistical significant (P<0.05). Conclusions: On selecting the appropriate indications, vaginal hysterectomy excision and laparoscopic myomectomy are both safe and effective minimally invasive surgical clinic. But vaginal hysterectomy surgery is much better with the advantages of less trauma, lighter pain and postoperative pain surface without scars, etc. [ABSTRACT FROM AUTHOR]

Metformin as the first-line drugs, play an important role in the treatment of diabetes. Metabolic syndrome (MS) is a pathological condition of abnormal aggregation of multiple metabolite resulting. The long-term adverse outcomes were payed more and more attention by people. The study found, MS is recognized risk factor of endometrial adenocarcinoma, there may be a common pathophysiological basis of insulin resistance. Metformin reduces insulin resistance, regulates the level of cytokines and exerts anti-tumor stem cell function, it is a potent inhibitor of metabolic syndrome and endometrial adenocarcinoma. [ABSTRACT FROM AUTHOR]

Pelvic inflammatory disease (PID) is a polymicrobial asending infection that causes inflammation of the upper genital tract, including endometritis, salpingitis, tubo -ovarian abscess and pelvic peritonitis. PID has various clinical manifestation but low accuracy rate of diagnosis. Failed to get the correct diagnosis and treatment in time, PID can cause serious sequelae including infertility, ectopic pregnancy, chronic pelvic pain and repeated attacks of inflammation, which impacts women?s physical and mental health. Laparoscopic evaluation is considered to be golden standard for PID, especially for acute PID, which is not only can help to confirm the diagnosis and obtain the pathogenic microorganism testing samples, but also at the same time can supply surgical treatment for pelvic lesions accordingly. [ABSTRACT FROM AUTHOR]

Objective: It focuses on how to improve the success rate of treatment of long -standing cervico-vaginal fistulas in different conditions and to relief the patients′symptoms. Methods:We analysed 15 cases registered and treated in Peking Union Medical College Hospital from September 2000 to October 2013, on their clinic conditions, surgery methods, effectiveness and follow-up. Results: According to the patients' individual conditions, 15 patients received different treatments respectively. Among 15 cases, 4 cases received directly-simple-repair, 5 cases received longitudinal-incision-repair, 4 cases received amputation and deformation of cervix, and 2 cases received hysterectomy. Only one case needed reoperation for relapse, the other 14 patients didn′t relapse or recomplain for those related symptoms as abnormal vaginal bleeding and vaginal secretions. Conclusions: According to individual conditions, it can improve the success rate of treatment and relief the patients′symptoms greatly by adopting different treatment. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influencing factors of cesarean scar pregnancy (CSP) and the suitable measures of diagnosis and treatment. Methods: From January 2007 to August 2012,51 cases were diagnosed as CSP in our hospital. The patients' information were analyzed such as the indications of cesarean, postoperative recovery and the CSP time. According to patients' condition curettage, uterine artery embolism, laparoscopic and/or hysteroscopic treatment, exsecting the focus per vagina, hysterectomy were selected. Results: All the cases were diagnosed by transvaginal ultrasound. The time of occurrence CSP were 5-147 months (average 60.5±9.5). Gravidity 2-6. Excepting 10 (19.61%) cases performed cesarean after uterine contraction, 41 (80.39% ) cases were selectively cesarean without any uterine contraction. 48(94.12%) cases were cured successfully by conservative treatment. Of those 8 cases with ultrasonic monitoring, 19 cases after uterine artery embolism, 8 cases monitored by laparoscope or/and hysteroscope, 11 intramuscular or cervical injection with methotrexate, 2 anterior uterine wall neoplasty per vagina. 3 cases were performed hysterectomy with heavy bleeding, one case died of hemorrhagic shock. Conclusions: CSP are high -risk pregnancy, it' s very important with early diagnose and suitable treatment. Transvaginal ultrasound is the preferred diagnostic method of CSP. [ABSTRACT FROM AUTHOR]

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction characterized by skeletal muscle weakness. The course of MG during pregnancy is unpredictable. The stage and medication of MG will have effects on fetus, neonate and long-term outcome of the offspring. There will be an interaction between MG and pregnancy, partum, anaesthesia. The patients should be given individual regimen during pregnancy. If well-controlled, the patient will undergo caesarean section only with obstetric indication. The duration should be shortened by forceps when vaginal delivery. Strict surveillance and therapeutic regimen are crucial to the pregnant women with MG. This article reviews the advances on clinical research in pregnancy complicated with MG. [ABSTRACT FROM AUTHOR]

Hot flush is complained by three out of four perimenopausal women. The exact etiology of hot flush is unclear, which may underline menopausal--associated hypoestrogenism. The altered sympathetic nervous activity and core body temperature adjust mechanism is also related with menopausal-associated hypoestrogenism. Enhanced sympathetic tone may change vascular endothelial dysfunction, blood pressure, lipids and insulin resistance, which are associated with cardiovascular disease (CVD). Many researches indicate that perimenopausal hot flush is significantly related to CVD. This article reviews the relation between perimenopausal hot flush and CVD, and the guide role to hormone therapy (HT). [ABSTRACT FROM AUTHOR]

Going with the social olden, the incidence rate of Alzheimer's disease increase evidently, the treatment become more important. More and more studies show that estrogen can prevent Alzheimer's disease. Estrogen can lower brain Aβ content, suppress tau phosphorylation, improve the acetylcholinesterase activity, regulate apolipoprotein-E expression, increase cerebral blood, decrease inflammation and maintain the balance of calcium. This review recapitulates the important role of estrogen in the mechanism of the prevention of AD from the angle of the pathogenesis of AD, in order to provide basis for clinical treatment. [ABSTRACT FROM AUTHOR]