Mediastinitis necrotizante descendente de origen odontogénico / Descending necrotizing mediastinitis of odontogenic origin

Resumen Introducción: El tratamiento inoportuno e ineficaz de las infecciones odontogénicas puede causar complicaciones potencialmente mortales como la mediastinitis necrotizante descendente (MND). La MDN es una infección grave que afecta al cuello-tórax, con una alta tasa de mortalidad por sepsis e insuficiencia orgánica si no se trata de manera rápida y efectiva. Objetivo: Describir un caso de MND de origen odontogénico y su manejo médico-quirúrgico. Caso clínico: Presentamos un paciente de sexo masculino de 34 años que ingresa con un cuadro infeccioso agudo de origen odontogénico, que compromete espacios de la cabeza, cuello y tórax (mediastino superior), el cual se trata exitosamente. Discusión: Las infecciones odontogénicas son generalmente localizadas y que se pueden tratar mediante terapias convencionales. A pesar de esto, si estas infecciones no pueden controlarse, ya sea por no realización de tratamientos oportunos o por estados inmunosuprimidos del paciente, se pueden desarrollar diferentes complicaciones como la MND. Conclusión: Un diagnóstico rápido, el tratamiento quirúrgico agresivo, la terapia antibiótica adecuada y la atención de apoyo son los pilares fundamentales para el manejo de la MND.

Introduction: Inappropriate and ineffective treatment of odontogenic infections can cause life-threatening complications such as Descending Necrotizing Mediastinitis (MND). MDN is a serious infection that affects the neck-thorax, with a high mortality rate from sepsis and organ failure if it is not treated quickly and effectively. Aim: To describe a case of MND of odontogenic origin and its medical-surgical management. Case report: We present a 34-year-old male patient who is admitted with an acute infectious condition of odontogenic origin, which compromises spaces of the head, neck and thorax (upper mediastinum), which is treated successfully. Discussion: Odontogenic infections are generally localized and can be treated by conventional therapies. In spite of this, if these infections cannot be controlled, either by not carrying out appropriate treatments or by immunosuppressed states of the patient, different complications such as MND can develop. Conclusion: A rapid diagnosis, aggressive surgical treatment, adequate antibiotic therapy and supportive care are the fundamental pillars for the management of MND.

A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

OBJECTIVES: This study aims to compare the clinical efficacy of an integrated approach to prevent and treat the recurrence of moderate-to-severe intrauterine adhesions (IUA) after hysteroscopic transcervical resection of adhesion (TCRA). METHODS: The study included a total of 70 patients with moderate-to-severe IUAs who underwent TCRA. Patients were randomly divided into two groups: treatment group (n=35) and control group n=35). In the treatment group, patients underwent balloon uterine stent placement and artificial cycle as well as received intrauterine perfusion of Danshen injection and oral Chinese medicine. In the control group, patients underwent balloon uterine stent placement and artificial cycle as well as received hyaluronic acid sodium and intrauterine device (IUD). Follow-up was performed after treatment of uterine cavity, menstruation and pregnancy. RESULTS: After 3 months of treatment, we observed a significantly lower rate of intrauterine re-adhesion (45.71% versus 77.14%, p=0.044) and significantly higher clinical efficiency (82.86% versus 77.14%, p=0.025) in the treatment group than those in the control group. After 6 months of treatment, we observed a significantly higher clinical efficiency in the treatment group than that in the control group (88.57% versus 68.57%, p=0.039). During the follow-up period, the pregnancy rate was 45.71% and 37.14% in the treatment group and control group, respectively, although the difference was not statistically significant (p=0.628). CONCLUSIONS: After surgical management of IUA, the integrated treatment combining a uterus stent placement and artificial cycle with Danshen injection and oral Chinese medicine can improve the condition of menstruation, and prevent and treat recurrence of IUA.

Papel actual de la videomediastinoscopía en el cáncer pulmonar / Current Role of Videomediastinoscopy in Lung Cancer

RESUMEN La exploración mediastinal comienza desde la época de Galeno. Su desarrollo se alcanzó en la segunda mitad del siglo XX, utilizada para el estudio de los ganglios y tumores mediastinales. En la actualidad su uso se ha ampliado no solo como diagnóstico, sino con fines terapéuticos, al lograr realizar resecciones pulmonares. El objetivo es realizar una revisión actualizada de la literatura, acerca del uso de la mediastinoscopia en el diagnóstico del cáncer pulmonar. Se realizó una revisión de la literatura médica donde se utilizaron las bases de datos Scopus, Medline y Cochrane bajo los criterios de sus revisores. Se emplearon las palabras claves en idioma español e inglés. El método de análisis y síntesis se usó para la interpretación de la bibliografía. Se revisaron 173 artículos, de los cuales, se escogieron 58, que cumplían con los criterios de selección, entre ellos, 6 meta análisis, 11 artículos de revisión y 41 artículos originales. La videomediastinoscopía constituye una herramienta válida para el diagnóstico, así como para el estadiamiento de enfermedades dentro y fuera de la cavidad torácica y mediastino. Por otra parte, permite el tratamiento de algunas enfermedades(AU)

ABSTRACT The mediastinal exploration begins from the time of Galen. Its development was reached in the second half of the 20th century, used for the study of lymph nodes and mediastinal tumors. At present its use has been expanded not only as a diagnosis, but also for therapeutic purposes, by achieving lung resections. The objective is to carry out an updated review of the literature on the use of mediastinoscopy in the diagnosis of lung cancer. A review of the medical literature was carried out where the Scopus, Medline and Cochrane databases were used under the criteria of their reviewers. The keywords in Spanish and English were used. The method of analysis and synthesis was used for the interpretation of the bibliography. 173 articles were reviewed, of which 58 were chosen, which met the selection criteria, including 6 meta-analyzes, 11 review articles, and 41 original articles. Videomediastinoscopy is a valid tool for diagnosis, as well as for the staging of diseases inside and outside the thoracic cavity and mediastinum. On the other hand, it allows the treatment of some diseases(AU)

Comparative evaluation of intravaginal slow release Dinoprostone insert, transcervical foley’s catheter, intracervical Dinoprostone gel for induction of labor in patients with poor Bishop’s score: a randomized control study

Background: Induction of labor is indicated when the continuation of pregnancy poses risk to the mother or fetus. A variety of mechanical and pharmacologic methods are available but the best method of labor induction still remains unknown, study aimed at comparing the efficacy and safety among the two agents: transcervical Foley’s balloon catheter (FBC) and intravaginal slow release Dinoprostone E2 insert (DVI) with dinoprostone gel as control.Methods: A total of 174 patients were randomized into three groups of 58 each (Group A: dinoprostone 10 mg slow release intravaginal insert, Group B: transcervical Foley’s 16 French catheters, and Group C as control: 0.5 mg intracervical Dinoprostone gel. The safety and efficacy was compared among the groups. A p value of < 0.05 was considered statistically significant.Results: The mean insertion to active labor time (in hours) was significantly lower in Group A as compared to Group B (5.88±3.06 versus 13.56±2.8, p < 0.0001). Meantime of insertion to delivery (in hours) was significantly lower in Group A as compared to Group B (10.91±5.24 versus 21.17±2.99, p < 0.0001). The requirement of oxytocin for induction and augmentation in Group A was significantly lower as compared to Group B. Majority of the patients had normal vaginal delivery (NVD) in all the three groups. Regarding safety profile we found that slow-release DVI had more incidence of uterine tachysystole, but none of the cases had any fetal heart rate abnormality. Maternal fever was more in the FBC group, however, neonatal outcomes were comparable in both groups.Conclusions: The study concludes that slow release DVI is better in terms of efficacy as compared to transcervical FBC for induction of labor as assessed by improvement in Bishop score, insertion to active labor time and insertion to delivery time and comparable in terms of safety profile.

Efficacy of severe intrauterine adhesions / 医学研究生学报

ObjectiveTo investigate the effect of COOK balloon placement time on the efficacy of severe intrauterine adhesions.Methods150 patients with severe IUA were prospectively enrolled and randomized divided into three short-term group, medium-term group and long-term group, with respectively balloon placement time 1 week, 1 month and 2 months. All subjects underwent transcervical resection of adhesion (TCRA). Re-adhesion and pregnancy rate after treatment, the relevant infection indicators, uterine cavity recovery, AFS score improvement rate, menstrual improvement, and endometrial thickness were analyzed.ResultsAll patients underwent transcervical resection of adhesion (TCRA) and COOK balloon placement successfully. Improvement of pregnancy rate and first pregnancy time were observed in group B and C than group A (P0.05).ConclusionPlacement of the uterine COOK balloon for more than 1 month may improve uterine cavity, pregnancy rate, AFS score, menstruation and endometrial thickness. However, the risk of infection increased at the second month after COOK balloon placement.

Efficacy of severe intrauterine adhesions / 医学研究生学报

ObjectiveTo investigate the effect of COOK balloon placement time on the efficacy of severe intrauterine adhesions.Methods150 patients with severe IUA were prospectively enrolled and randomized divided into three short-term group, medium-term group and long-term group, with respectively balloon placement time 1 week, 1 month and 2 months. All subjects underwent transcervical resection of adhesion (TCRA). Re-adhesion and pregnancy rate after treatment, the relevant infection indicators, uterine cavity recovery, AFS score improvement rate, menstrual improvement, and endometrial thickness were analyzed.ResultsAll patients underwent transcervical resection of adhesion (TCRA) and COOK balloon placement successfully. Improvement of pregnancy rate and first pregnancy time were observed in group B and C than group A (P0.05).ConclusionPlacement of the uterine COOK balloon for more than 1 month may improve uterine cavity, pregnancy rate, AFS score, menstruation and endometrial thickness. However, the risk of infection increased at the second month after COOK balloon placement.

A prospective study to compare levonogestrol intrauterine system and trans-cervical resection of endometrium for treatment of abnormal uterine bleeding

Background: This article is a study comparing the two most accepted forms of treatment for abnormal uterine bleeding - levonorgestrol intrauterine treatment and transcervical resection of endometrium, with regards to its acceptability, efficacy, adverse effects and user satisfaction. Aim of this study was to compare the acceptability, efficacy, adverse effects and user satisfaction of LNG-IUS and TCRE for treatment for AUB.Methods: A prospective observational study conducted in SKNMC and GH. Forty-nine women with abnormal uterine bleeding after hysteroscopic evaluation were included in this study; where 17 opted for LNG-IUS; 32 opted for TCRE with bipolar electrode. 15 patients in LNG-IUS group and 28 pts in TCRE group completed follow up. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, acceptability, satisfaction and reason for discontinuation were recorded at 6 weeks, 6 months and 12 months after the procedure. Prior to LNG-IUS insertion or endometrial ablation, endometrial and cervical pathology were excluded by D and C and cervical smear, respectively. TVUS was used to exclude possible causes of menorrhagia, including myomas and endometrial polyp as well as adnexal pathology. LNG-IUS insertion was performed as an office procedure one day after cessation of menstrual bleeding with a negative urine pregnancy test.Results: Menstrual blood loss reductions in TCRE and LNG-IUS groups were by 85.7% and 87.6% respectively after a year. Amenorrhoea was more common in TCRE group while spotting and systemic effects were more common in LNG-IUS group. Satisfaction and acceptance rates are higher in TCRE group.Conclusions: The TCRE and LNG-IUS are equally effective in reducing bleeding in AUB patients. Acceptance and satisfaction are better with TCRE, as a modality of treatment for AUB.

Transcervical resection of endometrium as a conservative management of dysfunctional uterine bleeding in premenopausal patients

Background: Dysfunctional uterine bleeding (DUB) affects 10% to 15% women of reproductive age group. A prospective observational study was performed to study the efficacy, rate of satisfaction and adverse effects of Transcervical resection of endometrium (TCRE) in the treatment of DUB in premenopausal women.Methods: 30 patients with DUB attending the hospital underwent TCRE and patients were followed up after 6 week, 3 months, 6 months up to 1 year and there bleeding score was calculated. Their response to treatment, complications and satisfaction rate were studied.Results: 43.3% of the women in this study were in the age group of 40-44 years. Post TCRE, 43.33% (n=13) had hypomenorrhea. 33.33% (n=10) had regular cycle, 13.33% (n=4) women had amenorrhea and 10% (n=3) had no response and underwent hysterectomy. 86.66% (n=26) women were satisfied with the treatment whereas 13.33% (n=4) were not satisfied. One patient had uterine perforation and serosal bowel injury due to extended cautery injury. Bleeding reduced considerably and a statistically significant (paired t-test, p-value <0.05) difference was observed in pre and post procedure (6 weeks, 3 months, 6 months and 1 year) bleeding scores.Conclusions: Considering advantages like shorter operative time, uterine conservation and early mobility TCRE is a procedure of choice in patients in whom hysterectomy is either technically difficult or medically contraindicated or in those who are not suitable for long term medical management.

Efficacy of vaginal Misoprostol versus transcervical Foley’s catheter and vaginal Misoprostol in induction of labor

Background: The objective is to compare the efficacy of vaginal Misoprostol versus transcervical Foley’s catheter and vaginal Misoprostol.Methods: A prospective study analyzing the comparative efficacy of intravaginal instillation of Misoprostol in two groups (tablet Misoprostol 50mg alone and combination of intracervical Foley’s catheter and tablet Misoprostol 50mg) carried out in the labour room on 300 subjects (150 subjects in each group), from May 2013 to November 2015.Results: The common gestational age at the time of induction was 36-40 weeks and the most common indication was premature rupture of membrane. In both the groups, most of the cases delivered within 12 hours. present results show that statistically significant number of cases delivered vaginally within 12 hours with the group using Misoprostol plus Foley’s catheter as compared to the group using Misoprostol alone. Cesarean section rate was 12.67% in Misoprostol group and 10.67% in Misoprostol plus Foley’s catheter group. Incidence of failure of induction was similar in both the groups. The incidence of babies with Apgar score less than 8/10 at 5 minutes and incidence of early neonatal death were similar in both the groups.Conclusions: Addition of intracervical Foley’s catheter to vaginal Misoprostol for induction of labor in subjects with unfavorable cervices reduces the Induction-Delivery interval without added side effects or complications to the mother and fetus.

Clinical Research on the Treatment of High Dose Asteroidal Valerate after Hysteroscopy Surgery on Serious Intrauterine Adhesion / 现代医院

To explore the possibility of periodic treatment of high dose asteroidal valerate (E2V) after hysteroscopy surgery on serious intrauterine adhesion. Methods The post-operative effects of periodic high-dose E2V treatment was compared with retrospective analysis on 62 cases of serious intrauterine adhesion and their clinical files. The cases were divided to 3 groups: immediate high-dose periodic treatment of E2V after hysteroscopy electric resection + contraceptive ring fitting (experiment group I), low-dose periodic treatment of E2V (experiment group II), and Irregular use of hormone treatment (control group). Results The effective rate of menstruation recovery of experiment group I and that of experiment group II are higher than control group (P＜0. 05);experiment group I is higher than experiment group II (P＜0. 05). The effective rate of Intrauterine recovery of experiment group I is higher than experiment group II and control group(P＜0. 05); the curative effect of experiment group I is higher than experiment group II (P＜0. 05). The endometrium of experiment group I is thicker than experiment group II and control group (P＜0. 05). Conclusion The use of high dose asteroidal valerate after hysteroscopy surgery on serious intrauterine adhesion, which improves the treatment effectively, is reliable and safe.

Comparison of the effect between gestrinone and levonorgestrel intrauterine system in the treatment of patients with endometrial polyps after transcervical resection of polyp / 新乡医学院学报

Objective To compare the clinical effect between gestrinone and levonorgestrel intrauterine system in the treatment of patients with endometrial polyps after transcervical resection of polyp (TCRP).Methods A total of 225 endometrial polyps patients underwent TCRP were selected from January 2014 to January 2017 in Zhengzhou Central Hospital.The patients were divided into group A,B and C according to the postoperative treatment,75 cases in each group.The patients in group A were treated with gestrinone from the fifth day after operation.The patients in the group B were treated with levonorgestrel intrauterine system at the 3-5 days of the first menstruation after operation.The patients in group C were not given any treatment after operation.All patients were followed up for 6 months.The endometrial thickness,the recurrence of endometrial polyps and the improvement of abnormal uterine bleeding of patients in the three groups were observed.Results The recurrence rate of endometrial polyps in group A,B and C was 16.00％ (12/75),1.33％ (1/75) and 38.67％ (29/75) respectively;the improvement rate of abnormal uterine bleeding was 92.00％ (69/75),86.67％ (65/75) and 88.00％ (66/75) respectively.The recurrence rate of endometrial polyps in group A and B was significantly lower than that in group C (x2 =9.700,32.667;P ＜ 0.05),and the recurrence rate of endometrial polyps in group B was significantly lower than that in group A (x2 =10.191,P ＜ 0.05).There was no significant difference in the improvement rate of abnormal uterine bleeding among the three groups (x2 =1.170,P ＞ 0.05).There was no significant difference in endometrial thickness among the three groups before and one month after operation (P ＞ 0.05).Three months after operation,the endometrial thickness in group A and B was significantly less than that in group C (P ＜ 0.05),but there was no significant difference in endometrial thickness between group A and B (P ＞ 0.05).Six months after operation,the endometrium thickness in group B was significantly less than that in group A and C (P ＜ 0.05),but there was no significant difference in endometrial thickness between group A and C (P ＞ 0.05).Conclusion Gestrinone and levonorgestrel intrauterine system assisted TCRP for endometrial polyps can significantly reduce the recurrence rate of endometrial polyps,inhibit endometrial hyperplasia,and the effect of levonorgestrel intrauterine system is better than that of gestrinone.

Clinical Efficacy of Cold Knife Conization and Transcervical Resection of Cervical Lesionin the Treatment of Cervical Intraepithelial Neoplasia Ⅱ, Ⅲ / 实用妇产科杂志

Objective:To compare the clinical efficacy of cold knife conization and transcervical resection of cervical lesion in the treatment of cervical intraepithelial neoplasia(CIN) Ⅱ,Ⅲ.Methods:The clinical data of 62 patients with CIN Ⅱ,Ⅲ underwent cold knife conization(CKC group) and 114 underwent transcervical resection of cervical lesion(TCRC group)in Zhujiang Hospital Southern Medical University from Jan 1 st 2010 to Jun 1 st 2014 were collected.The patients' age,pregnant frequency,mean operative time,preoperative pathological grading,blood loss during the operation and after the operation,positive resected margin,cervical stenosis and recurrence were compared between the two groups.Results:There was no difference on the patients age,pregnant frequency and preoperative pathological grading between the two groups(P ＞ 0.05).The mean blood loss during the operation (14.16 ± 14.10 ml)and the mean hospital stays(5.73 ± 1.43 days)of CKC group were significantly different from those of TCRC group(29.80 ±20.55 ml,4.75 ±1.23 days) (P＜0.05).There was no statistical difference on the mean operation time,postoperative vaginal bleeding rate,rate of positive resected margin,cervical stenosis rate and recurrence rate between CKC group and TCRC group (33.15 ± 11.42 min vs 33.18 ±14.61 min,33.9％ vs 21.1％,3.2％ vs 5.3％,4.8％ vs 4.4％,4.8％ vs 3.5％,respectively) (P＞0.05).The concordance rate of pre-operation and post operation pathological results of CKC group and TCRC group was 74.2％ (46/62) and 72.8％ (83/114) respectively,both kappa values were ＜ 0.75.Conclusions;Both CKC and TCRCT are safe as well as effective in the treatment of high-grade cervical intraepithelial neoplasia.Compared with CKC,TCRC has the advantage of short hospital stay,while much intraoperative blood loss,which calls for intraoperative attention.

A randomized controlled trial study on the appropriate time of replacing drainage bags after trans-cervical resection of adhesion / 中华护理杂志

Objective To investigate the appropriate time of replacing drainage bags after trans-cervical resection of adhesion(TCRA) surgery.Methods Totally 156 patients underwent TCRA were randomly divided into three groups:Group A,the drainage bags were replaced daily;Group B,the drainage bags were replaced every 3 days;Group C,the drainage bags were never replaced.The drainage bags were removed on the 6th day after TCRA for all groups.Bacterial culture results from the balloon surface of drainage bag,outer cervical orifice,and the connector of drainage bag for 3 groups were observed.The positive rates of bacterial cultures were analyzed statistically.Results The bacterial culture results from the drainage bag connector of 3 groups indicated that the positive rate of Group C was significantly lower than that of other two groups(P＜0.05).The bacterial culture from the drainage bag balloon surface also indicated the same result,but the result did not showed statistically significant difference(P＞0.05).There was no statistically significant difference in the culture result firom outer cervical orifice and the volume of drainage fluid within three groups(P＞0.05).Conclusion It is indicated that the patient may enjoy a lower rate of bacterial infection without replacing any drainage bags connected to balloon drainage tubes placed after TCRA within 6 days.We suggest that the intrauterine drainage hags may be kept without replacement until direct removing the drainage tube on day 6 after TCRA.

Prospective study of the treatment of adenomyosis by combining hysteroscopic transcervical resection of endometrium with levonorgestrel-releasing intrauterine system / 上海交通大学学报（医学版）

Objective · To explore the clinical application value of hysteroscopic transcervical resection of endometrium (TCRE) combined with levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods · A total of 112 cases of adenomyosis patients were divided randomly into the combination group and Mirena group. The combination group (56 cases) was treated by TCRE endometrium endometrial resection, assisted Mirena treatment after operation. Mirena group (56 cases) was treated by Mirena only. The follow-up lasted 36 months after treatment, including measures of the volumes of menstrual bleeding, hemoglobin levels, dysmenorrhea scores, uterine volume, serum CA125 levels and incidences of complications.Results · The median follow-up duration was 42 months, and the three-year follow-up rate was 73.21% for the combination group and 50% for the Mirena group. After surgery, the volumes of menstrual bleeding of patients in 3-36 months decreased significantly, with an increase in hemoglobin level and a decrease in serum CA215 level and dysmenorrhea scores. Compared with their situations before surgery, the difference was significant (P<0.05). A comparison of uterine volume before and after surgery showed that there is a significant decrease in the uterine volume in both groups in6-12 months after surgery (P<0.05).Twenty-four months after surgery, it shows thatthe combination group has a much more significant decrease in uterine volume [(171.3±34.8) mm3] than Mirena group [(213.7±38.6) mm3] (P<0.05). The hysterectomy rate in Mirena group was significantly higher than that in the combination group (12.50% vs 5.36%); the ring expulsion rate was 16.07% in Mirena group and 5.36% in the combination group, and the break through bleeding happeningrate was 8.93% in Mirena group and 3.57% in the combination group. After 36 months an irregular small amount of vaginal bleeding rate was 62.25% in Mirena group, while it was only 12.50% in the combination group. There was significant differencewhen comparing above indices between two groups (P<0.05). There was no obvious differences in most common side effects of both groups. Conclusion · HysteroscopicTCRE combined with Mirena reduces significantly the irregular menstrual bleeding caused by merely applying Mirena. It has a prominent clinical efficacy and can be an effective approach in treatment of adenomyosis.

Efficacy of Foley balloon combining with uterine adhesions to prevent the recurrence of intrauterine adhesions after resection of intrauterine adhesions / 中国内镜杂志

Objective To observe the efficacy of Foley balloon combining with uterine adhesions to prevent the recurrence of intrauterine adhesions after resection of intrauterine adhesions.Methods Patients underwent resection of intrauterine adhesions were randomized into two groups. 30 patients in control group underwent the therapy of uterine adhesions to prevent the relapse intrauterine. On the other hand, the study group with 30 patients were placed Foley balloon for 5 ~ 7 days and combined with the therapy of uterine adhesions to intervention for 1 ~ 2 weeks. All patients were followed-up for 1 ~ 2 months, and the result of the intrauterine adhesion were assessed by hysteroscopy.Results The rate of the relapse in control group was 3.33%; the study group had the same result (the rate was 3.33%). There was no difference between these two groups.Conclusions The rate of recurrent intrauterine adhesions is no different between the control group of only use therapy of uterine adhesions and replacement of Foley balloon combining with therapy of uterine adhesions as intervention.

Clinical Analysis of 12 Cases of Intrauterine Re-adhesions Treated with Transcervical Resection of Adhesion / 中国微创外科杂志

Objective To study the clinical characteristics of intrauterine re-adhesions treated by transcervical resection of adhesion (TCRA). Methods Between January 2012 and January 2015, 12 patients with intrauterine re-adhesions after TCRA in other hospitals had fertility requirements , including 10 cases of severe intrauterine adhesions and 2 cases of moderate intrauterine adhesions .In our hospital , the 12 patients underwent laparoscopic exploration and TCRA .After operation the patients were treated with artificial cycle therapy for 3 months and then underwent hysteroscopic examination . Results In the operation, the remaining of 50%endometrium was found in 1 case, the remaining of 30%endometrium was found in 1 case, and the remaining of 20%endometrium in 9 cases.Only petechial and patchy residual endometrial islands were found in 1 case.Uterine dysplasia was found in 3 cases.Re-examinations of hysteroscopy 3 months after surgery showed 4 cases of uterine cavity normal recovery , 6 cases of moderate intrauterine adhesions, and 2 cases of mild intrauterine adhesions .Follow-up for 18-42 months (mean, 28.5 months) in the 12 cases showed 2 cases of term pregnancy and 1 case of spontaneous abortion .The other 9 patients had no pregnancy , 3 of which withdrew the treatment and 6 of which underwent further treatment . Conclusions Patients with intrauterine re-adhesions usually have seriously damaged endometrium and poor recovery .We suggest that TCRA should be completed by experienced professionals to reduce the residual endometrial destruction , so as to improve the treatment outcomes of intrauterine adhesions .

Influencing factors analysis of the postoperative pregnancy in patients with uterine septum / 中国内镜杂志

Objective To analyze the impact of uterine septum on pregnancy and influencing factors on postopera-tive pregnancy. Methods 125 patients with septate uterus and bearing requirement who underwent TCRS were fol-lowed up to assess fertility outcome. The clinical data was retrospectively analyzed. Results Spontaneous abortion rate was 70.40%and 19.39%, live birth rates was 10.40%and 72.45 %in preoperation and postoperation respec-tively. The difference was statistically significant ( < 0.05). Spontaneous abortion rate in older than 35 years old group was significantly higher than that in younger than 35 years old group, but live birth rate was lower. There was no significant difference in different times of operation in uterine cavity, number of abortion and septum length and so on. Conclusions TCRS can significantly improve pregnancy outcome. The age has influence on postoperative pregnancy outcome. Abortion numbers, septum length, septal base width, intrauterine device (IUD) and hormone re-placement therapy (HRT) may have no effects.

Preventing Effect of Different Dosages of Progynova in Intrauterine Adhesions After TCRS Under Laparoscope / 医药导报

Objective To explore the effect of different dosages of progynova in preventing intrauterine adhesions after transcervical resection of septum ( TCRS) under laparoscope. Methods Clinical data of 213 TCRS patients under laparoscope were retrospectively analyzed, and these cases were divided into four groups according to the dosages of progynova. Except for group A (n=26), group B, C, D were given 4,6,8 mg.d-1 of progynova.Endometrial thickness, menstrual blood volume, incidence rates of residual septal and intrauterine adhesions, rate of adverse effect, pregnancy rate after operation and rate of spontaneous abortion were compared among the four groups. Results The incidence rate of residual septal in group A, B, C, D was 11.5%, 6.9%, 6.0% and 6.3%, respectively.Incidence rate of intrauterine adhesions after operation was 46.2%, 12.5%, 9.0% and 4.2%, respectively.The pregnancy rate in group A, B, C and D was 30.8%, 59.7%, 58.2% and 60.4%, respectively. There were significant differences between group A and the other groups(all P<0.05).The high dose of progynova(8 mg.d-1) significantly increased endometrial thickness ( P<0. 05 ) and menstrual blood volume ( P<0. 05 ) . But the incidence rates of gastrointestinal tract reaction, hepatic damage and vaginal spotting in the high dose group of progynova increased obviously( P<0.05) . Conclusion Progynova is a safe and effective drug in preventing intrauterine adhesions after TCRS. It can effectively prevent intrauterine adhesions, increase pregnancy rate and improve pregnant outcome.

Clinical use of misoprostol for cervical ripening before transcervical procedures in non pregnant women: a randomized comparison of vaginal and sublingual administrations.

Background: Endometrial sampling techniques like endometrial biopsy, Fractional curettage, Dilatation & curettage and hysteroscopy are the common gynaecological outpatient transcervical diagnostic procedures for various clinical conditions. Complications encountered during these procedures are often due to difficulties in cervical dilatation. The incidence of these complications can be reduced if cervix is ripened before the procedures. The aim of the present study was to evaluate the efficacy of 400mcg of misoprostol administered vaginally or sublingually for cervical ripening before transcervical gynaecological diagnostic procedures in both pre and post-menopausal women. Methods: Non pregnant pre and post-menopausal women scheduled for transcervical diagnostic procedures were assigned by computerized randomization to receive 400 mcg of misoprostol, administered either sublingually or vaginally 3-4 hours prior to the procedure. The primary outcome in this study was the pre procedural cervical width as measured by the largest number of Hegar dilators. The side effects related to misoprostol and complications associated with the procedure if any also noted. Results: Patients were randomized to receive sublingual (50) or vaginal (50) misoprostol. The two groups were comparable in terms of age, BMI (body mass index), parity, menopausal status and indications for diagnostic procedures. The mean cervical dilatation in sublingual group was 7.28 ± 2.21 mm and it was 6.57 ± 2.24 mm in vaginal group which was statistically similar among the groups. There were no complications associated with the procedure. Side effects were also comparable among the groups. Conclusion: Even though we found sublingual route is an effective alternate to vaginal administration of misoprostol for cervical ripening before transcervical diagnostic procedures like endometrial biopsy, fractional curettage and dilatational curettage in non pregnant pre and post-menopausal women especially when women feel uncomfortable with vaginal route. However, the optimal dose and time interval remains to be identified. It needs larger randomized control trials are required to prove clinical significance if any.

Clinical observation on hysteroscopic transcervical resection of endometrium combined with levonorgestrel-re-leasing intrauterine system in treatment of adenomyosis / 局解手术学杂志

Objective To observe the effects of hysteroscopic transcervical resection of endometrium combined with levonorgestrel-relea-sing intrauterine system in the treatment of adenomyosis. Methods Clinical data of 62 cases with adenomyosis from January 2009 to January 2011 were randomly divided into 2 groups with 31 cases each. The observation group was given hysteroscopic transcervical resection of endo-metrium ( TCRE) combined with levonorgestrel-releasing intrauterine system( LNG-IUS) ,the control group was given LNG-IUS. All patients were followed up in 0,1,3,6,12 months after treatmenting with LNG-IUS. The menstrual blood volume,score of VAS,volume of uterus, CA125 and the levels of serum reproductive hormone were analyzed before treatment and after treatment. Results After the therapy,the cur-ative effects of controlling menorrhea were improved and the the observation group was significantly better than the control group(P0. 05). Conclusion It is exact effect to treat adenomyosis by TCRE combined with LNG-IUS,which can prevent dripping bleeding induced by application of LNG-IUS effectively.