阴茎异常勃起的护理

阴茎异常勃起是指在无性欲刺激的情况下,阴茎持续的痛性勃起。其发病可无明显诱因,也可继发于各种疾病因素的刺激,如：阴茎局部损伤、神经性疾病、盆腔内肿瘤压迫、阴茎背静脉血栓性静脉炎等。此疾病在临床上较少见,现将2例围手术期的护理体会报告如下。     

脂多糖对大鼠实验性变应性鼻炎的影响

目的研究脂多糖(Lipopolysaccharide,LPS)对实验性变应性鼻炎的影响。方法SD大鼠40只随机分4组,其中,变应性鼻炎组经腹腔注射及鼻腔滴入卵清白蛋白(OVA)致敏,建立变应性鼻炎动物模型;LPS刺激组经鼻腔滴入LPS(10μg/100μL);变应性鼻炎 LPS刺激组为大鼠激发成变应性鼻炎后再以LPS滴入鼻腔。观察各组的症状变化,如喷嚏,流涕等。行常规HE及甲苯胺蓝染色观察各组鼻黏膜炎性细胞的浸润情况,并行高倍镜下嗜酸性粒细胞计数。结果①变应性鼻炎 LPS刺激组过敏症状评分高于其余各组(P<0.01);正常对照组及LPS刺激组症状评分差异无显著性(P>0.05)。②变应性鼻炎 LPS刺激组鼻黏膜中嗜酸性粒细胞计数高于变应性鼻炎组,差异有显著性(P<0.05);正常对照组及LPS刺激组鼻黏膜中嗜酸性粒细胞计数差异无显著性(P>0.05)。结论LPS刺激可以加重变应性鼻炎的症状及鼻黏膜组织的病理学改变。     

超声介入治疗常见妇科囊性炎症包块的疗效评价

目的：比较超声引导介入治疗盆腔脓肿、输卵管积脓、输卵管积液、包裹性积液及宫颈囊肿的,临床效果,了解超声引导介入治疗常见的妇科囊性炎症包块的临床价值。方法：选取我院妇科门诊2007年1月～2011年3月收治的常见妇科囊性炎症包块共108例,其中盆腔脓肿11例、输卵管积脓19例、输卵管积液43例、盆腔包裹性积液31例、宫颈囊肿4例,给予超声实时引导抽囊液、甲硝唑冲洗治疗,治疗后3个月内复查超声评价和比较疗效。结果：盆腔脓肿、输卵管积脓、盆腔包裹性积液包块均明显缩小（12／43）或消失（29／43）,治疗有效率100％;输卵管积液包块治疗有效率95％（41／43）,宫颈囊肿均痊愈。各组间比较无统计学差异（P〉O．05）。结论：超声引导介入治疗对输卵管积脓、盆腔脓肿、盆腔包裹性积液均有显著的疗效,且治疗效果无差异,值得推广应用,代替传统的非必要的手术治疗。     

超声介入治疗常见妇科囊性炎症包块的疗效评价*

摘要目的：比较超声引导介入治疗盆腔脓肿、输卵管积脓、输卵管积液、包裹性积液及宫颈囊肿的临床效果,了解超声引导介入 治疗常见的妇科囊性炎症包块的临床价值。方法：选取我院妇科门诊2007 年1 月～2011 年3月收治的常见妇科囊性炎症包块共 108例,其中盆腔脓肿11 例、输卵管积脓19 例、输卵管积液43 例、盆腔包裹性积液31 例、宫颈囊肿4 例,给予超声实时引导抽囊 液、甲硝唑冲洗治疗,治疗后3 个月内复查超声评价和比较疗效。结果：盆腔脓肿、输卵管积脓、盆腔包裹性积液包块均明显缩小 (12/43)或消失(29/43),治疗有效率100%;输卵管积液包块治疗有效率95％(41/43),宫颈囊肿均痊愈。各组间比较无统计学差异 （P>0.05）。结论：超声引导介入治疗对输卵管积脓、盆腔脓肿、盆腔包裹性积液均有显著的疗效,且治疗效果无差异,值得推广应 用,代替传统的非必要的手术治疗。     

胃底腺息肉的研究进展

胃底腺息肉是指胃底胃体粘膜形成的多发性广基息肉样隆起,为胃体腺上皮的增生。国内外研究均证明本病高发于40-60岁女性,年龄及性别差异显著。过去认为本病的发生与家族性腺瘤性息肉病密切相关,但近年来人们认为无家族性腺瘤性息肉病的人群也可以发生胃底腺息肉。国内外学者们研究了家族性腺瘤性息肉病、Helicobacter pylori感染、质子泵抑制剂的应用、β-连环蛋白基因变异、胆汁反流等与本病发生的相关性,有学者认为Hp感染与疾病发生成负相关,质子泵抑制剂的长期应用会导致疾病的发生,β-catenin基因突变影响了APC/β-catenin途径,从而导致胃底腺息肉的产生。目前对于疾病发生的相关危险因素及发病机制,国内外仍无定论。本文将近年来中外学者的研究加以总结并提出进一步设想。     

经利用网片的前盆底重建术治疗重度盆腔器官脱垂的临床疗效

目的:探讨经利用网片的前盆底重建术治疗重度盆腔器官脱垂的临床效果。方法:选取2013年1月-2015年3月我院妇科收治的以前中盆腔联合缺陷为主的盆底障碍性疾病患者39例(POP-Q分度III-IV度)。实施经阴道Avaulta前盆腔重建术,24例切除子宫,9例保留子宫,其中6例因中盆腔重度脱垂联合行阴道残端骶棘韧带固定术,2例合并尿失禁同时行经尿道无张力悬吊术。术后随访12-25月,根据盆腔脏器脱垂评分(POP-Q)测量及PFIQ-7评分进行客观评价及主观感受评价进行中短期的临床效果分析。结果:39例患者手术过程顺利,术后无严重并发症,POP-Q评分均较术前显著降低,客观疗效理想。术后阴道前壁及子宫、阴道穹窿脱垂等症状显著改善;到目前为止无一例复发。结论:经阴道前盆腔重建术治疗前盆腔重度盆腔脱垂为主以及合并尿失禁等复杂情况的并发症少,治愈率高,复发率低,临床效果好。     

补中益气汤联合低频脉冲电刺激促进产后盆底功能障碍的效果及血清松弛素、CTGF和MMP-1水平的影响

摘要 目的：探讨补中益气汤联合低频脉冲电刺激促进产后盆底功能障碍的效果及血清松弛素（RLX）、结缔组织生长因子（CTGF）和基质金属蛋白酶-1（MMP-1）水平的影响。方法：选取我院2022年4月到2023年4月收治的150例产后盆底功能障碍患者作为研究对象，分为观察组与对照组，各组均75例。对照组患者采取低频脉冲电刺激治疗，观察组患者采取补中益气汤联合低频脉冲电刺激治疗，对比两组患者的临床疗效，治疗前后盆底表面肌电变化情况，并分别在治疗前后应用盆腔脏器官脱垂-尿失禁性功能问卷（PISQ-12）、国际尿控协会盆腔脏器脱垂定量分析量表（POP-Q）、尿失禁问卷表简表（ICI-Q-SF）评估两组患者的性功能、盆腔脱垂程度及尿失禁情况，并对比治疗前后血清RLX、CTGF和MMP-1表达水平。结果：观察组总有效率93.33%明显高于对照组78.67%（P＜0.05）；两组患者治疗前耐力收缩（Ⅱ类肌）、持续收缩和快速收缩（Ⅰ类肌）、前静息电位、后静息电位肌电水平对比无差异（P＞0.05），治疗后观察组快速收缩（Ⅰ类肌）高于对照组（P＜0.05），静息电位与后静息电位低于对照组（P＜0.05）；两组患者治疗前PISQ-12、POP-Q和ICI-Q-SF评分对比无明显差异（P＞0.05），治疗后两组患者PISQ-12、ICI-Q-SF评分升高，观察组较对照组高，POP-Q评分均降低，观察组较对照组低（P＜0.05）；两组患者治疗前RLX、CTGF和MMP-1表达水平对比无差异（P＞0.05），治疗后两组患者RLX、CTGF和MMP-1表达水平均降低，且观察组低于对照组（P＜0.05）。结论：补中益气汤联合低频脉冲电刺激可提升产后盆底功能障碍的临床疗效，改善盆底肌表面肌电变化，改善患者性功能、盆腔脱垂程度及尿失禁情况，且能够降低血清松弛素、CTGF和MMP-1表达水平。     

丘脑底核脑深部电刺激治疗帕金森病的临床分析

目的:通过丘脑底核脑深部电刺激术治疗帕金森病,观察其肌肉僵直、静止性震颤、运动迟缓等症状的改善情况。方法:选取以丘脑底核为刺激靶点收治的帕金森病患者8例,对比手术前后患者肌强直、静止性震颤、运动迟缓等症状的改善情况,并进行UPDRS评分。结果:接受丘脑底核脑深部电刺激术治疗帕金森病6个月后,患者肌肉僵直、静止性震颤、运动迟缓等临床主症的改善上效果良好;与手术前相比,患者术后UPDRS评分均有所降低,差异具有统计学意义(P0.05);患者术后美多巴服用量显著减少,差异具有统计学意义(P0.05);患者术后没有产生永久性的并发症以及较明显的临床症状;但对大量油脂性渗出及典型面具性面容的治疗上未见明显疗效。结论:丘脑底核脑深部电刺激术治疗帕金森氏病,可以使帕金森病主要临床症状肌肉僵直、静止震颤及运动迟缓得到明显改善,显著减少美多巴服药量,具有安全可靠的疗效,对临床具有指导意义,值得临床推广应用。     

Apobec-1 加重神经源性细胞缺氧损伤并上调COX-2 的表达

目的：研究三种神经源性细胞中，缺氧条件下Apobec-1 的表达与COX-2 表达水平及细胞缺血损伤程度之间的关系。方法： 对SH-SY5Y 细胞，NG108-15 细胞和PC12细胞分别施以无氧- 无糖刺激，进而检测刺激前后细胞活力，乳酸脱氢酶(LDH)释放 量，以及Apobec-1 的表达量，以研究缺氧对Apobec-1 表达的影响。在这三种细胞中分别过表达Apobec-1，检测细胞中COX-2 蛋 白及mRNA 的水平。结果：①在三种神经源性细胞中，随着无氧- 无糖刺激时间的延长，细胞损伤程度加重，同时Apobec-1 和 ACF的表达量升高。②过表达Apobec-1 可加重无氧- 无糖刺激导致的神经细胞损伤，具体表现为细胞活力降低及LDH释放量 增加。③Apobec-1 可在此三种神经源性细胞中提高COX-2 蛋白及mRNA的水平。结论：Apobec-1 在神经源性细胞中与细胞缺氧 损伤程度及COX-2表达密切相关。     

益生菌对肝硬化自发性腹膜炎的预防及对 肝功能的影响

目的观察益生菌在肝硬化自发性腹膜炎患者中的预防效果及对肝功能的影响。方法选取福建省立医院南院2015年6月至2017年6月就诊治疗的60例肝硬化失代偿期患者为研究对象,随机平均分为对照组和益生菌组,每组30例。对照组患者采用常规保肝护肝利尿补充白蛋白治疗;益生菌组在对照组基础上加用金双歧口服,2.0g/次,3次/d,疗程3个月。比较两组患者治疗后6个月血浆内毒素(ET)、肿瘤坏死因子-α(TNF-α)、白介素6 (IL-6)、降钙素原(PCT)的水平以及肝功能指标、自发性腹膜炎(SBP)发生率和症状缓解时间的变化。结果治疗前两组患者ET、TNF-α、IL-6、PCT水平及肝功能指标比较差异无统计学意义(P0.01)。治疗后益生菌组患者ET、TNF-α、IL-6、PCT水平明显低于对照组(P0.01),肝功能指标也明显优于对照组(P0.05)。两组患者SBP发生率相比差异有统计学意义(P0.05),益生菌组患者发热缓解时间与腹部压痛缓解时间明显短于对照组(P0.05)。结论益生菌可以有效预防肝硬化失代偿期患者自发性腹膜炎的发生,改善患者肝功能并缩短发病时各症状的缓解时间。     

4019例妇科门诊不同症状患者阴道微生态状况分析

目的探讨妇科门诊不同症状患者的阴道微生态状况。方法回顾性分析2011年11月至2012年9月西安交通大学医学院第一附属医院妇科门诊因不同症状就诊患者的阴道微生态评价（菌群的密集度、多样性、优势菌、病原菌、AV评分、Nugent评分及五项菌群功能及炎症反应指标）检测结果。结果4019例被检查者平均年龄为33．56岁。其中阴道微生态正常占n70％（28／4019）;阴道微生态失调者占99．30％（3991／4019）;后者包括未明确感染的阴道微生态失调患者占66．36％（2667／4019）;明确感染的阴道微生态失调患者占32．94％（1324／4019）;其中外阴阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）患者占24．33％（978／4019）;需氧菌陛阴道炎（aerobic vaginitis,AV）患者占3．11％（125／4019）;细菌性阴道病（bacterial vaginosis,BV）患者占3．14％（126／4019）;滴虫阴道炎（trichomonas vaginitis,TV）患者占5．15％（207／4019）;混合感染患者占8．31％（110／1324）。优势菌群异常患者占54．32％（2183／4019）。结论妇科门诊中未明确感染的阴道微生态失调患者构成比最高;在明确感染的患者中外阴阴道假丝酵母菌病构成比最高;因此阴道微生态评价成为阴道感染性疾病诊断首选检测方法,在临床诊疗实践中具有重要意义。     

Monilial and Trichomonal Vaginitis—Topical Treatment with Povidone-Iodine Preparations

A regimen of treatment for vaginitis combining the use of a povidone-iodine solution for swabbing, a povidone-iodine vaginal gel for application at night and a povidone-iodine douche for use in the morning, was evaluated in 93 courses of treatment in 87 patients with monilial or trichomonal vaginitis or a combination of both.In monilial vaginitis, symptoms were cleared and negative laboratory results obtained in one to three weeks in all 74 courses of treatment. These results were obtained within one week in 52 cases and within two weeks in another 17.In four of five patients with trichomonal vaginitis, symptoms were cleared within three weeks. In the fifth, negative laboratory results were obtained but a mild discharge persisted at the end of the fourth week.In 14 courses for combined infections, symptoms were cleared within three weeks in 13, and the pathogens were absent in those patients within four weeks. In one patient the disease did not respond.     

A biomechanical model to assess the contribution of pelvic musculature weakness to the development of stress urinary incontinence

A biomechanical model of the female pelvic support system was developed to explore the contribution of pelvic floor muscle defect to the development of stress urinary incontinence (SUI). From a pool of 135 patients, clinical data of 26 patients with pelvic muscular defect were used in modelling. The model was employed to estimate the parameters that describe the stiffness properties of the vaginal wall and ligament tissues for individual patients. The parameters were then implemented into the model to evaluate for each patient the impact of pelvic muscular defect on the vaginal apex support and the bladder neck support, a factor that relates to the onset of SUI. For the modelling analysis, the compromise of pelvic muscular support was demonstrated to contribute to vaginal apex prolapse and bladder neck prolapse, a condition commonly seen in SUI patients, while simulated conditions of restored muscular support were shown to help re-establish both vaginal apex and bladder neck supports. The findings illustrate the significance of pelvic muscle strength to vaginal support and urinary continence; therefore, the clinical recommendation of pelvic muscle strengthening, such as Kegel exercises, has been shown to be an effective treatment for patients with SUI symptoms.     

The First Isolation of Cryptococcus neoformans from Eucalyptus Trees in South Aegean and Mediterranean Regions of Anatolia in Turkey despite Taurus Mountains alkalinity

Between April 2001 and April 2002 were studied 106 women with a clinical diagnosis of vaginal candidiasis seen at the Gynecology and Obstetrics Ambulatory of the Hospital das Clínicas da Universidade Federal de Goiás. The patients were assessed on two occasions, before starting treatment with itraconazole or fluconazole (initial visit) and 14 days after treatment (return). At two visits the signs and symptoms were recorded and vaginal secretion was collected. According to the clinical evaluation, itraconazole was effective in 64.3%, while fluconazole was effective in 71.0% of the patients. The mycological cure rates (negative culture) in the return were 64.3% for the patients treated with itraconazole and 78.9% for the patients treated with fluconazole. The MICs of itraconazole and fluconazole for 80 Candida isolates were determined by Etest method. We investigated the correlation between in vitro susceptibility (Susceptible, Susceptibility Depending Dose and Resistant) to itraconazole and fluconazole with clinical outcome of the patients. The success rates were 63.9% for itraconazole and 90.6% for fluconazole in the susceptible category, 100.0% for both drugs in the susceptible dose dependent category, and 0.0% for both drugs in the resistant category. Our results showed there were a positive correlation between in vitro susceptibility test results with clinical outcome in vaginal Candida infections and that both drugs might be one choice in the treatment of vaginal candidiasis.     

Population-based genetic epidemiologic analysis of Chlamydia trachomatis serotypes and lack of association between ompA polymorphisms and clinical phenotypes

Chlamydia trachomatis is the leading cause of bacterial sexually transmitted diseases worldwide. Urogenital strains are classified into serotypes and genotypes based on the major outer membrane protein and its gene, ompA, respectively. Studies of the association of serotypes with clinical signs and symptoms have produced conflicting results while no studies have evaluated associations with ompA polymorphisms. We designed a population-based cross-sectional study of 344 men and women with urogenital chlamydial infections (excluding co-pathogen infections) presenting to clinics serving five U.S. cities from 1995 to 1997. Signs, symptoms and sequelae of chlamydial infection (mucopurulent cervicitis, vaginal or urethral discharge; dysuria; lower abdominal pain; abnormal vaginal bleeding; and pelvic inflammatory disease) were analyzed for associations with serotype and ompA polymorphisms. One hundred and fifty-three (44.5%) of 344 patients had symptoms consistent with urogenital chlamydial infection. Gender, reason for visit and city were significant independent predictors of symptom status. Men were 2.2 times more likely than women to report any symptoms (P=0.03) and 2.8 times more likely to report a urethral discharge than women were to report a vaginal discharge in adjusted analyses (P=0.007). Differences in serotype or ompA were not predictive except for an association between serotype F and pelvic inflammatory disease (P=0.046); however, the number of these cases was small. While there was no clinically prognostic value associated with serotype or ompA polymorphism for urogenital chlamydial infections except for serotype F, future studies might utilize multilocus genomic typing to identify chlamydial strains associated with clinical phenotypes.     

Chlamydia trachomatis infections in women with urogenital symptoms.

Chlamydia trachomatis was isolated from 30 to 100 women attending a family physician''s office with dysuria, frequency or vaginal discharge, compared with 2 of 30 asymptomatic women. Multiple infections were common: C. trachomatis coexisted with Gardnerella vaginalis, Candida albicans, Trichomonas vaginalis or a bacterial cause of urinary tract infection in 15 patients. C. trachomatis was isolated alone from 15 symptomatic women. The source of the positive culture was not always the site of symptoms. C. trachomatis was isolated from both the cervix and the urine of 9 patients, either simultaneously or sequentially. The probability of finding a chlamydial infection was 30% in young women with vaginal discharge alone, 33% in those with dysuria and frequency alone and 53% in those with abdominal or pelvic pain in addition to lower urogenital tract symptoms.     

细菌性阴道病及其 合并盆腔炎患者的阴道菌群分析

目的对比细菌性阴道病及其合并盆腔炎患者与健康个体的阴道菌群,分析阴道菌群的结构,为确定该疾病的特征细菌及研究致病机制奠定基础。方法采用临床Amsel标准筛选的17例细菌性阴道病患者、13例细菌性阴道病合并盆腔炎患者和52例健康者,使用无菌拭子采集阴道后穹窿分泌物以提取细菌基因组DNA。采用PCR技术扩增上一步得到的16S rRNA片段,而后将扩增产物通过变形梯度凝胶电泳(DGGE)分离以得到阴道细菌种属结构图谱,应用Quantity One软件进行聚类分析,应用凝胶测序法进行特异条带分析。检测16S rRNA基因,具体研究样品中的物种分类。结果细菌性阴道病及其合并盆腔炎患者的阴道菌群的构成与健康者相比较具有显著性差异。其中,Firmicutes等菌门细菌减少,Actinobacteria等菌门细菌增多;G.vaginallis、P.vaginallis等厌氧菌数量均增加,L.crispatus、L.iners等益生菌数量均有减少。结论细菌性阴道病及其合并盆腔炎患者的生殖道内的合并感染改变了阴道内的原有微生态平衡。两组疾病组患者的阴道菌群构成相比于健康对照组变化明显。     

Management of vaginal dryness and dyspareunia in estrogen sensitive cancer patients

Cancer patients suffer from vaginal dryness and dyspareunia earlier and longer than the general population, with more severe and distressing symptoms. Life-style advices are the first step and vaginal lubricants can be tried, but they can't completely relieve atrophic symptoms. The most effective therapy is use of vaginal estrogens, but compliance and management are particularly difficult in estrogen sensitive cancer patients because of their systemic absorption. Compliance can be improved if they are begun at a very low dose and gradually increased until the lowest effective dose is reached. Promestriene only possesses an intramucosal effect, it can be used at very low doses in cancer patients suffering from urogenital symptoms.     

A comparative multi-centre study of the efficacy of propolis, acyclovir and placebo in the treatment of genital herpes (HSV).

Ninety men and women with recurrent genital HSV type 2 participated in a randomized, single-blind, masked investigator, controlled multi-centre study comparing the efficacy of ointment of Canadian propolis containing natural flavonoids with ointments of acyclovir and placebo (vehicle) on healing ability and capacity to remedy symptoms. Thirty individuals were randomized to each group. Treatment was intended to start in the blister phase. All participants had HSV type 2 isolated, confirmed by serum immunoglobulin levels. The participants were examined on the 3rd, 7th and 10th days of treatment by gynaecologists, dermatovenerologists or urologists at seven different medical centres. Apart from clinical symptoms the number and size of the herpetic lesions were noted. At each examination the lesions were classified into four stages: vesicular, ulcerated, crusted and healed. The study ointments were applied to affected areas four times daily. In women with vaginal or cervical lesions a tampon with the appropriate ointment was inserted four times daily for 10 days. Endpoint variables were healing time and time until loss of symptoms. RESULTS: On Day 10, 24 out of 30 individuals in the propolis group had healed. In the acyclovir group 14 out of 30 and in the placebo group 12 out of 30 had healed. (p = 0.0015). The healing process appeared to be faster in the propolis group. In the propolis group 15 individuals had crusted lesions on Day 3 compared to 8 individuals in the acyclovir group and none in the placebo group (p = 0.0006). On Day 7, 10 participants in the propolis group, 4 in the acyclovir group and 3 in the placebo group had healed. At the initial examination all patients had local symptoms and 28% general symptoms. At Day 3, 3 patients in the propolis group had local symptoms compared to 8 and 9 in the acyclovir and placebo groups respectively. Of the women, 66% had vaginal superinfections of microbial pathogens at the initial examination. In the acyclovir and placebo groups no change in the vaginal flora was found following treatment whereas in the propolis group the incidence of superinfection was reduced by 55%. (p = 0.10 n.s.). CONCLUSION: An ointment containing flavonoids appeared to be more effective than both acyclovir and placebo ointments in healing genital herpetic lesions, and in reducing local symptoms.     

Diffuse peritonitis and chronic ascites due to infection with Chlamydia trachomatis in patients without liver disease: new presentation of the Fitz-Hugh-Curtis syndrome.

Two women were admitted for increasing abdominal pain, vaginal discharge, and severe or moderate chronic ascites. Diffuse peritonitis without evidence of liver disease was found in both cases, and in one the ascites and vaginal discharge contained Chlamydia trachomatis. Both patients responded to doxycycline, and this and the laboratory findings pointed strongly to C trachomatis as the aetiological agent. C trachomatis may cause severe peritoneal infections with chronic ascites formation in the absence of liver disease in women with the Fitz-Hugh-Curtis syndrome. Prompt diagnosis and antibiotics lead to rapid cure.