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Objective:To observe the efficacy and safety of single-port laparoscopy for giant ovariotubal cysts.Methods:38 patients with giant ovarian and fallopian tube cysts in Ruijin Hospital Affiliated to Shanghai Jiaotong University Hospital from January 2018 to June 2019 were retrospectively analyzed. They were divided into transumbilical single-port laparoscopy group (18 cases) and traditional laparoscopy group (20 cases). The perioperative related indexes such as operation time, intraoperative bleeding and the number of analgesic cases were compared between the two groups.Results:All 38 patients successfully completed the operation without conversion to laparotomy, and no auxiliary hole was added in the single-port laparoscopy group; There were no postoperative complications and no cystic fluid leakage. In the single-port laparoscopy group, 18 patients were satisfied with the concealment of umbilical scar. There was no statistically significant difference in operation time [(51.67±13.72)min vs (55.50±14.59)min], intraoperative blood loss [(52.22±24.38)ml vs (61.50±28.88)ml] and first postoperative anal exhaust time [(25.77±8.59)h vs (27.60±6.67)h] between single-port laparoscopy group and traditional laparoscopy group (all P>0.05); The number of cases requiring postoperative analgesia in the single-port laparoscopy group (2 cases vs 12 cases) was less than that in the traditional laparoscopy group ( P<0.05); The out of bed activity time [(20.95±3.65)h vs (26.95±5.43)h] and postoperative discharge time [(3.11±0.68)h vs (4.30±1.21)h] were shorter than those in the traditional laparoscopy group (all P<0.05). All 38 patients were followed up in the gynecological clinic for 6-24 months. The incision healed well without recurrence. Conclusions:Transumbilical single-port laparoscopic surgery for giant ovarian and fallopian tube cysts is reliable and safe when the possibility of malignant ovarian and fallopian tube tumors was excluded before operation.
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Objective:To study the clinical manifestations, diagnosis and treatment of primary hyperparathyroidism (PHPT) in pregnancy.Methods:This study involved six pregnant patients with PHPT who were admitted to Ruijin Hospital of Shanghai Jiao Tong University from August 2014 to November 2019. Their clinical manifestations, treatment strategies (multidisciplinary consultation with departments including Obstetrics, Endocrinology, Neonatology, General Surgery, Anesthesiology and Intensive Care Unit), maternal complications and maternal and infant outcomes were described and retrospectively analyzed.Results:(1) The median age of the six patients was 34(23-38) years old. PHPT was diagnosed in one case before pregnancy, four in the second or third trimester and one after delivery. The main clinical manifestations of four cases were nausea, vomiting, anorexia and other non-specific symptoms. Anemia was the most common maternal complication (five cases). Other complications included hypercalcemia crisis with renal failure (one case), multiple bone destruction and osteoporosis (one case). The median levels of serum calcium, parathyroid hormone and 25-hydroxyvitamin D were 3.08 (2.84-4.21) mmol/L, 216.7(93.1-2 603.6) ng/L and 29.66 (13.50-90.24) nmol/L, respectively. Results of parathyroid ultrasonography showed all patients had hypoechoic focus. Four cases underwent routine parathyroid radionuclide imaging showing abnormal radioactive concentration areas. (2) Obstetricians initiated the multidisciplinary team (MDT) for all patients to determine the treatment plans after communication with the patients and their families. One case received surgical treatment five months after delivery. Three cases received surgical treatment in the second trimester and among them, one terminated the pregnancy in the second trimester and the other two continued and achieved good pregnancy outcomes. Two cases underwent surgical treatment after giving up pregnancy and induced abortion. Postoperative pathology revealed that five cases were isolated parathyroid adenoma and one was parathyroid carcinoma. All of the patients were followed up and no abnormal serum calcium was reported. (3) One newborn had hypocalcemic convulsions one month after birth and was recovered by intravenous calcium supplementation. The newborn was followed up and the serum calcium level was normal so far. The other two neonates had normal serum calcium during follow-ups, but one of them was diagnosed with autism at the age of four and is now undergoing rehabilitation treatment.Conclusions:Pregnancy complicated by PHPT may lead to serious maternal and infant complications. MDT consultation ensures timely diagnosis, comprehensive treatment for the patients and better pregnancy outcomes.
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Objective To investigate the perinatal outcomes after elective neurosurgery in pregnant women complicated by space-occupying lesions in saddle area.Methods Clinical data were retrospectively collected and analyzed from five gravidas with space-occupying lesions in saddle area,who underwent neurosurgery at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to February 2018,including gestational age,perioperative management,surgical procedures,postoperative complications,pregnancy outcomes and pathological results.Results (1) Progressively deteriorated impaired vision was the chief complaint of all five patients.Space-occupying lesions in saddle area were detected by cranial MRI (plain scan).The surgical indication was clear as there was compression on optic nerve and a risk of blindness due to optic nerve atrophy,Two patients were operated in the third trimester and three in the second trimester.Postoperative pathology showed there were two cases with meningioma,two with pituitary macro adenoma and one with abscess of pituitary.Only one patient had mild postoperative cerebrospinal fluid rhinorrhea,which was improved three months later,and no complications were reported in the other four cases.All five patients had obvious improvement of vision after surgical intervention and no relapse was reported during a follow-up of 4-12 months.(2) Four gravidas continued their pregnancies to full or nearly full term,among which three underwent cesarean section due to obstetrical indications (one breech pregnancy,one twin pregnancy with scarred uterus and one complicated by hypertensive diseases of pregnancy with poor blood pressure control) and one delivered vaginally.Postpartum involution of the uterus was well in all of the four cases 42 d after delivery.The women with pituitary abscess terminated the pregnancy due to intraamniotic injection of ethacridine lactate at 20 weeks of gestation.Five neonates were all born with Apgar scores of 10 at 1,5 and 10 min without any visible defects at birth and all grew and developed normally at 4-12 months after birth.Conclusions For gravidas with space-occupying lesions in saddle area,it is necessary to weigh the pros and cons and choose an individualized treatment plan.Resection of saddle area lesions in the second or third trimester backed by a multidisciplinary team is a safe and feasible procedure if postponing the operation until delivery may cause irreversible or even life-threatening consequences.
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OBJECTIVE:To investigate the preparing process and method of quality control of the podophyllotoxin film former METHODS:To sift the formula of podophyllotoxin film former with orthogonal function and to determine the content by second derivative UV-spectrophotometry RESULTS:The peak area of podophyllotoxin against the concentration was linear with a correlation coefficient of 0 9 999 over the range of 80～180?g/ml and detecting at wavelength 301 5nm～315nm CONC_LUSION:The preparing process of podophyllotoxin film former is simple and the method of quality control is feasible