Hormonal treatment for endometriosis associated pelvic pain.

BACKGROUND: Endometriosis is a common gynecological problem associated with chronic pelvic pain. OBJECTIVE: To evaluate the effectiveness of current hormonal treatments of endometriosis associated pain. MATERIALS AND METHODS: Randomized Controlled studies identified from databases of Medline and Cochrane Systemic Review groups were pooled. 7 RCTs were recruited for evaluation in this review. Data from these studies were pooled and meta-analysis was performed in three comparison groups: 1) Progestogen versus GnRHa; 2) Implanon versus Progestogen (injection); 3) Combined oral contraceptive pills versus placebo and progestogen. Response to treatment was measured as a reduction in pain score. Pain improvement was defined as improvement ≥1 at the end of treatment. RESULTS: There was no significant difference between treatment groups of progestogen and GnRHa (RR: 0.036; CI:-0.030-0.102) for relieving endometriosis associated pelvic pain. Long acting progestogen (Implanon) and Mirena are not inferior to GnRHa and depot medroxy progesterone acetate (DMPA) (RR: 0.006; CI:-0.142-0.162). Combined oral contraceptive pills demonstrated effective treatment of relieving endometriosis associated pelvic pain when compared with placebo groups (RR:0.321CI-0.066-0.707). Progestogen was more effective than combined oral contraceptive pills in controlling dysmenorrhea (RR:-0.160; CI:-0.386-0.066), however, progestogen is associated with more side effects like spotting and bloating than the combined contraceptive pills. CONCLUSION: Combined oral contraceptive pills (COCP), GnRHa and progestogens are equally effective in relieving endometriosis associated pelvic pain. COCP and progestogens are relatively cheap and more suitable for long-term use as compared to GnRHa. Long-term RCT of medicated contraceptive devices like Mirena and Implanon are required to evaluate their long-term effects on relieving the endometriosis associated pelvic pain.

Value of the pudendal nerves terminal motor latency measurements in the diagnosis of occult stress urinary incontinence / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Occult stress urinary incontinence may lead to de novo stress urinary incontinence after pelvic floor repair surgery. A measurement of pudendal nerve terminal motor latency can reflect the integrity of the nerves. We aimed to explore the value of pudendal nerve terminal motor latency in the diagnosis of occult stress urinary incontinence in pelvic organ prolapse patients.</p><p><b>METHODS</b>Ten patients with stress urinary incontinence (SUI group), 10 with SUI and uterine or vaginal prolapse (POP + SUI group) and 10 with uncomplicated uterine or vaginal prolapse (POP group) were evaluated for their pudendal nerve terminal motor latency using a keypoint electromyogram.</p><p><b>RESULTS</b>The amplitude of positive waves was between 0.1 and 0.2 mV. The nerve terminal motor latency was between 1.44 and 2.38 ms. There was no significant difference in the wave amplitudes of pudendal nerve evoked action potential among the three different groups (P > 0.05). The pudendal nerve latency of the SUI group, POP + SUI group and POP group were (2.9 ± 0.7) seconds, (2.8 ± 0.7) seconds and (1.9 ± 0.5) seconds respectively. The difference between the SUI group and POP + SUI group was not statistically significant (P > 0.05), whereas the difference between the SUI and POP groups and between the POP + SUI and POP groups were statistically significant (P < 0.05). There was a positive correlation between pudendal nerve latency and the severity of SUI; the correlation coefficient was 0.720 (P < 0.01).</p><p><b>CONCLUSIONS</b>Patients with SUI may have some nerve demyelination injuries in the pudendal nerve but the damage might not involve the nerve axons. The measurement of pudendal nerve latency may be useful for the diagnosis of SUI in POP patients.</p>

The epidemiology of meconium stained amniotic fluid on hospital basis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the epidemiology of meconium stained amniotic fluid pero-delivery.</p><p><b>METHODS</b>6,206 one-fetal delivery cases were divided into meconium stained amniotic fluid and normal amniotic fluid groups. Statistics were analysed on two groups using Cohort study.</p><p><b>RESULTS</b>Incidence of meconium stained amniotic fluid was 16.4%. There was no significant difference on maternal medical complication between two groups. The percentage of parity, gestational week > or = 42 weeks and big birth weight were higher in meconium stained amniotic fluid group than that in normal amniotic fluid group (P < 0.001). The average Apgar score in meconium stained amniotic fluid group was lower than that in normal amniotic fluid group (P = 0.001). The percentage of stillbirth, low birth weight and transferred newborn care unit in meconium stained amniotic fluid group were higher than that in normal amniotic fluid group (P < 0.001).</p><p><b>CONCLUSIONS</b>The relative factors on meconium stained amniotic fluid were maternal parity, gestational weeks > or = 42 weeks and big birth weight. No correlation between meconium stained amniotic fluid and maternal medical complication. Morbidity of newborn baby was higher in meconium stained amniotic fluid. Meconium stained amniotic fluid is a important clinical factor on evaluating pregnancy outcome.</p>

Serum lipid-associated sialic acid levels in gynecologic malignancies.

Significantly elevated serum concentrations of lipid-associated sialic acid (LSA) were observed in 183 patients with invasive cervical carcinoma, 31 with uterine corpus adenocarcinoma and 71 with epithelial ovarian carcinoma prior to any treatment when compared with 50 normal control women (P < 0.05). Elevated LSA levels were also observed in five women with microinvasive cervical carcinoma and in four patients with uterine corpus leiomyosarcoma (P < 0.05). By contrast there were no significant elevations of serum LSA levels in 12 cases of cervical intraepithelial neoplasia, 32 of uterine corpus leiomyoma, 52 of benign ovarian cyst and 14 of mature ovarian teratoma when compared with normal control women. If the upper limit of the normal serum LSA concentration is set at 20 mg 100 ml-1, uterine corpus malignancy was distinguished from benign uterine corpus tumor with a sensitivity of 71% and a specificity of 94%; and ovarian malignancies were distinguished from benign ovarian masses with a sensitivity of 82% and a specificity of 85%. The positive predictive values of LSA assays in uterine and ovarian masses were 93% and 85%, respectively, whilst the negative predictive values were 75% and 81%, respectively. The sensitivity of LSA assays in cervical carcinoma was 57%. The present study suggests that serum LSA assays may be useful for the detection of gyncological malignancies.

The recent development and evaluation of a medical expert system (ABVAB).

A medical expert system for the diagnosis of abnormal vaginal bleeding named as ABVAB had been reported. This paper will describe the recent development of ABVAB and its clinical evaluation. The overall testing results are quite satisfactory in spite of the limitations of time and small domain. This expert system, by using the fuzzy and certainty factor concepts, is able to handle imprecise and incomplete medical knowledge which has become informative. The paper also analyses the relative degrees of importance of the history and physical examination data in making a medical diagnosis.