[Clinical significance of combined detection of thinprep cytology test and high risk human papillomavirus hybrid capture 2 assay in the screening and recurrence predication of cervical intraepithelial neoplasia].

OBJECTIVE: To evaluate the clinical significance of combined detection of TCT and HR-HPV-HC2 assay in the screening and recurrence prediction of CIN. METHODS: A total of 725 patients with suspected cervical abnormalities received TCT plus HR-HPV-HC2 detection and histopathological examinations.203 CINII-III patients received TCT and HC2 detection and histopathological examinations after treated with loop electrosurgical excision procedure or cold knife conization operation. The results of pathological examinations were gold standard. The sensitivity and specificity of TCT, HR-HPV-HC2 and TCT plus HR-HPV-HC2 were analyzed. RESULTS: The missed diagnosis and misdiagnosis rate of TCT and HC2 alone were 19.23%, 12.50% and 48.15%, 74.07% and sensitivity and specificity 90.02%, 97.01% and 51.85%, 17.76% respectively. The sensitivity, missed diagnosis rate and negative predictive value were 98.25%, 1.75% and 89.70% when TCT or HR-HPV-HC2 met the CIN diagnostic criteria. The specificity and positive predictive value were 58.95% and 72.80% when TCT and HR-HPV-HC2 met the CIN diagnostic criteria. The specificity of TCT or HR-HPV-HC2 alone was 80% for the prediction of recurrence at Month 6 postoperation. The specificity of TCT plus HR-HPV-HC2 was 98.27% for the prediction of recurrence at Month 3 postoperation and the negative predictive value was 98.75% at Month 6 postoperation. The sensitivity of TCT or HR-HPV-HC2 was 97.22% for the prediction of recurrence at Month 3/6. And the negative predictive value was 99.17% at Month 6 postoperation. CONCLUSION: The combined detection of TCT and HR-HPV-HC2 may improve the sensitivity and specificity of CIN and the predication of its postoperative recurrence.

[Value evaluation of follicle stimulating hormone and luteinizing hormone in the diagnosis of precocious puberty in girls by ROC curve analysis].

OBJECTIVE: To study the value of follicle stimulating hormone (FSH), luteinizing hormone (LH) and LH/FSH ratio in the diagnosis of precocious puberty in girls by ROC curve analysis. METHODS: Gonadotropin-releasing hormone (GnRH) stimulation test was performed on 220 girls with pseudo-sexual precocity and 61 girls with true sexual precocity. Blood LH and FSH levels were measured before and after 30 and 60 minutes of taking the GnRH test. The ratio of LH to FSH was calculated. Sensitivity and best point for the diagnosis of precocity according to LH, FSH and LH/FSH ratio were analyzed by ROC curve analysis. RESULTS: The area under the ROC curve was 0.90 and 0.95 according to LH level and LH/FSH ratio respectively for the diagnosis of precocity. The best point for diagnosis by LH was 10.15 IU/L, with a sensitivity of 0.92 and specificity of 0.89. The best point for diagnosis by LH/FSH ratio was 0.60, with a missed diagnosis rate of 6.0% and specificity of 0.91. When true sexual precocity was diagnosed based on one index between LH>10.15 IU/L and LH/FSH ratio>0.60, sensitivity was 0.97 and specificity was 0.94. When the diagnosis of true sexual precocity was diagnosed based on both LH>10.15 IU/L and LH/FSH>0.60, sensitivity was 0.85 and specificity was 1.00. CONCLUSIONS: True sexual precocity can be diagnosed when both LH>10.15 IU/L and LH/FSH ratio>0.60. Only one of the two indexes for the diagnosis of true sexual precocity is presented, further observation is necessary to decrease missed diagnosis and misdiagnosis.

[The operative treatment of Ruedi II-III Pilon fractures with the ventr-lateral approach].

OBJECTIVE: To investigate the effects of the ventralateral approach in treating severe Pilon fracture. METHODS: From February 2002 to March 2008, 63 patients with Ruedi II-III Pilon fractures were treated with the ventralateral approach, including 36 males and 27 females with an average age of 37 years ranging from 19 to 71 years. The mean time from injury to operation was 8 days (ranged for 2 h-19 d). According to the Ruedi classification system, type II was 32 cases (6 cases of them combined with soft tissue lesion, 4 with open fracture) and type III was 31 cases (9 cases of them combined with soft tissue lesion, 8 with open fracture). The clinical effects were evaluated according to Helfet criteria and the complications were observed including condition of wound healing, infection, bone union, deformity union, motion of the ankle, the degree of the pain and so on. RESULTS: The first intention achieved in 59 cases, the delayed healing in 4 cases. Stiffness of the ankle was found in 5 cases because of bone disunion. All patients were followed up from 8 to 31 months with an average of 15.3 months. The ranging in bone healing time was from 8 to14 weeks with an average of 10 weeks. According to the Helfet criteria, 28 cases obtained excellent results, 30 good, 5 poor. CONCLUSION: The operative treatment of Ruedi I-III Pilon fractures with the ventralateral approach can obtain satisfactory results and avoid complications effectively.

[Endourethral surgery for 46 cases of the complicated urethra stenosis and urethratresia].

OBJECTIVE: To evaluate the endourethral surgery for the complicated urethra stenosis and urethratresia. METHODS: The endourethral surgery, such as internal urethrotomy transurethral scar electrosectomy or transurethral scar plasmakinetic bipolar electrocautery (PKR) or transurethral laser cicatrectomy, were carried out in 46 cases suffering from the complicated urethra stenosis and urethratresia. RESULTS: The curative rate in this series being achieved by once and twice or three times'operation were 80.43% (39/46) and 13.04% (6/46) respectively. Three cases of treatment failure were caused by long-segment stricture and urethratresia or severe malposition of the urethral proximal and distal to a narrow-caliber area or post-operation infection. Thirty-nine cases have been followed up for 6 to 84 months. Satisfactory voiding has been achieved in all patients. CONCLUSION: Endoscopic surgery was believed to be a safe and efficient therapeutic choice for the complicated urethra stenosis and urethratresia. The success of the treatment depends on understanding the length of the stricture before operation, resecting completely the scar tissue with electric or PKR or laser technique during the process, preventing infection and managing appropriately the urethral catheterization after operation.