超声在诊断卵巢黄体破裂中的应用

目的探讨超声对卵巢黄体破裂的诊断价值。方法回顾性分析35例经超声诊断卵巢黄体破裂的声像特点及临床表现。结果35例均有不同程度的腹盆腔积液。24例手术治疗并病理证实,11例保守治疗,超声表现为盆腔积液,卵巢囊肿,附件区包块。结论超声对卵巢黄体破裂的早期快速诊断和制定治疗方案及愈后,有极其重要价值和意义。     

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。     

彩色多普勒超声监测卵巢过度刺激综合征的临床应用价值

目的探讨彩色多普勒超声监测卵巢过度刺激综合征的临床应用价值。方法选择2015年8月~2016年8月我院收治的70例卵巢过度刺激综合征患者为研究对象,根据诊断方法不同分为观察组和对照组各35例,其中观察组患者接受彩色多普勒超声诊断,对照组接受实验室检查,比较两组诊断准确率。结果观察组患者彩色多普勒超声诊断结果为轻度15例、中度10例、重度10例,随访6个月,妊娠成功率分别为100.00%、60.00%、50.00%。两组均以临床确诊结果为标准评价诊断准确率,观察组诊断准确率100.00%明显高于对照组的51.43%,组间比较差异有统计学意义(P0.05)。结论彩色多普勒超声监测卵巢过度刺激综合征具有较高的临床应用价值,有利指导临床用药干预,提高了妊娠成功率,提高预后,值得推广使用。     

超声造影联合声辐射力脉冲成像鉴别诊断盆腔肿物的价值

目的:评价超声造影及声辐射力脉冲成像技术在诊断及鉴别诊断盆腔良恶性肿块性质中的优越性。方法:分析术前超声造影及声辐射力脉冲成像技术在48例盆腔肿块中的检查结果,探讨两种技术对于肿块性质判定的应用价值。结果:48例中,良性肿块28例,恶性肿块20例。超声造影、声辐射力脉冲成像技术与常规超声相比,诊断的敏感性、特异性、漏诊率、误诊率、诊断准确性等指标均有统计学差异(P0.05),两者联合应用组与常规超声组相比上述指标的统计学差异更加明显(P0.01),超声造影技术和声辐射力脉冲成像技术在判断肿块良恶性方面诊断的敏感性、特异性、漏诊率、误诊率、诊断的准确性没有统计学差异(P0.05);超声造影与声辐射力脉冲成像对盆腔良恶性肿块定性诊断与病理诊断具有一致性,两者联合具有更好的一致性(Kappa=0.8362,0.7126,0.9241)。良恶性盆腔肿块中,实性为主者ARFI值均高于囊实混合性者;实性为主和囊实混合性的恶性盆腔肿块ARFI值均高于良性盆腔肿块,差异有统计学意义(均P0.05)。结论:实时超声造影联合声辐射力脉冲成像技术较常规超声更具优势,可提高盆腔肿物诊断及鉴别诊断的准确性。     

出血性输卵管炎32例临床分析

目的:提高对出血性输卵管炎的认识,采取正确的诊疗方法,减少误诊率。方法:对我院1996年5月至2009年10月收治的32例出血性输卵管炎患者的临床资料进行系统性回顾分析。结果:32例出血性输卵管炎患者中仅4例正确诊断,24例误诊为宫外孕,2例误诊为卵巢黄体破裂,1例误诊为子宫肌瘤蒂扭转,1例误诊为阑尾炎,误诊率高达87.5%。结论:应综合分析患者的病因、临床特点和实验室及辅助检查结果,掌握出血性输卵管炎的诊断要点,减少不必要的手术治疗。     

超声对女婴幼儿腹股沟疝伴卵巢嵌顿的早期诊断及鉴别

目的探讨超声对女性婴幼儿腹股沟疝伴卵巢嵌顿的早期诊断及鉴别。方法分析经手术证实的女婴腹股沟疝伴或不伴卵巢嵌顿患者的二维及彩色多普勒超声图像特征。结果超声诊断的28例病例中,12例卵巢嵌顿超声表现为典型的卵巢声像图,1例卵巢坏死超声表现为混合性肿块。结论超声检查女性婴幼儿斜疝伴卵巢嵌顿的诊断符合率高,应作为首先检查方法之一。     

彩色多普勒超声对盆腔瘀血综合征的诊断价值及与临床因素的相关性研究

目的:探讨盆腔瘀血综合征患者彩色多普勒超声的影像学特征及与临床因素的相关性。方法:对112例盆腔瘀血综合征患者行彩色多普勒超声检查,按超声诊断分级Ⅰ级、Ⅱ级、Ⅲ级分为62例、27例、23例,观察彩色多普勒超声的影像学特征,分析静脉内径与病程的相关性,并分析超声诊断分级与临床症状积分、体质量指数(BMI)、妊娠次数、既往工作站立时间的相关性。结果:不同超声诊断分级患者的静脉内径、静脉丛范围和静脉流速差异具有统计学意义(P<0.05)。静脉内径与病程呈正相关(P<0.05),超声诊断分级与临床症状积分、妊娠次数、既往工作站立时间呈显著正相关(P<0.05),与BMI呈负相关(P<0.05)。结论:彩色多普勒超声对盆腔瘀血综合征具有特异性的诊断价值,超声诊断分级、静脉内径与临床因素存在一定的的关联性。     

异位妊娠早期超声的临床诊断分析

目的:评价超声在异位妊娠早期诊断中的应用价值,总结诊断经验。方法:回顾性分析确诊的早期异位妊娠超声诊断临床资料。结果:输卵管妊娠73例(89.02%),非输卵管妊娠9例(10.98%);胚囊类30(36.59%)例,实性包块30(36.59)例,不均质包块13(15.85%)例;伴有盆腔积液12例;确诊68(82.93%)例,漏诊4(4.88%)例;第1次、第2次、第3次诊断,阴道超声符合率90.91%、92.00%、100.00%,腹部超声诊断符合率58.33%、88.61%、98.65%;典型征象心血管搏动占13.41%、胚芽反射21.95%、双环征23.17%,不典型征象囊实性包块43.90%、积液14.63%、散在性包块9.76%。结论:异位妊娠早期超声征象多不典型,腹部超声诊断符合率较低,应尽量应用阴道超声,多次诊断,有助于提高诊断符合率;早期孕囊多表现为囊实性包块,若位置敏感,应提高警惕,详细确诊。     

彩色多普勒超声监测下介入治疗盆腔脓肿的临床疗效及安全性研究

目的探讨盆腔脓肿患者在彩色多普勒超声监测下行介入治疗的临床效果及安全性。方法选择2013年9月～2017年9月在我院诊治的88例盆腔脓肿患者为研究对象,按随机方法分为对照组和实验组各44例,对照组实施传统手术治疗,实验组在彩色多普勒超声监测下行介入治疗,观察比较两组患者的治疗效果。结果两组患者的住院时间、症状消失时间、白细胞恢复时间、体温恢复时间比较,实验组各项指标均优于对照组,差异均有统计学意义(P0.05)。结论彩色多普勒超声监测下行介入治疗盆腔脓肿的效果显著,具有临床应用价值。     

Detection of unsuspected ovarian pregnancy by wedge resection

Five follicular ovarian implantations occurred among 200 ectopic pregnancies encountered during a 14-year period. Abortions from impregnated follicles may cause hemoperitoneum more often than is generally suspected. Wedge resection or cystectomy to ensure hemostasis provides tissue for histological examination, without which ruptured ovarian pregnancy may masquerade as rupture of a corpus luteum with hemorrhage (“ovarian apoplexy”). Including patients reported here, IUCD users have within the past five years accounted for about 10% of all ovarian pregnancies recorded in English.     

Ultrasonic detection of the conceptus and characterization of intrauterine fluid on days 10 to 22 in heifers

Nonbred and pregnant heifers were examined ultrasonically on alternate days from Days 10 to 22 in three experiments. The goal was to define criteria that could be used for identification of the early conceptus. The location and size of circular and elongated nonechongenic structure (apparently free intrauterine luminal fluid) were recorded (Experiment 1). On Day 12, there was a significantly greater number of circular nonechogenic structures in the ovarian half of the uterine horn ipsilateral to the corpus luteum in pregnant heifers than in nonbred heifers (means, 5.1 vs 3.5). Therefore, the embryonic vesicle was apparently detected on Day 12, but was not distinguished from circular nonechogenic structures representing free luminal fluid. The number of circular nonechogenic structures decreased after Day 14, with a corresponding increase in elongate nonechogenic structures associated with luteal regression (nonbred heifers) or elongation of the blastocyst (pregnant heifers). On Day 16, there were more elongated than circular nonechogenic structures in pregnant heifers than in nonbred heifers. In nonbred heifers, there was no evidence of a local utero-ovarian relationship between the amount of intrauterine luminal fluid and the location of either the corpus luteum or the next ovulatory follicle. Uterine luminal fluid in each horn increased several fold between Days 16 and 18 in nonbred heifers; there was significantly more lumina fluid in nonbred than in pregnant heifers on Days 18 and 20. In pregnant heifers, intrauterine luminal fluid area increased first in the ovarian end of the uterine horn ipsilateral to the corpus luteum; this was apparently due to detection of the elongating blastocyst. The length of the longest specular reflector on the endometrial surface of the uterine lumen increased over Days 10 to 22 in nonbred and pregnant heifers, but was not a useful criterion for detection of the conceptus (Experiment 2). The accuracy of a 7.5 MHz transducer for pregnancy diagnosis was not greater than a guess (50%) before Day 16 (Experiment 3). Results indicated that early pregnancy diagnosis in heifers was confounded by the presence of intrauterine fluid.     

Physiological and immunocytochemical evidence for a new concept of blood flow regulation in the corpus luteum

To explain the high rate of blood flow in the corpus luteum, we hypothesize that luteal blood vessels offer minimal resistance to flow and are incapable of vasomotion. This hypothesis was tested in rabbits at mid-pseudopregnancy by measuring blood flow in the corpus luteum and ovarian stroma with tracer-labeled microspheres at three levels of arterial blood pressure, which was manipulated by constricting the aorta above the ovarian artery. In addition, the distribution of vascular smooth muscle in the ovary was evaluated with morphological and immunocytochemical techniques. Decreases in arterial pressure were paralleled by reductions in blood flow in the corpus luteum, whereas ovarian stromal blood flow was unchanged. Consistent with our hypothesis, there was no change in the low level of vascular resistance offered by blood vessels in the corpus luteum, supporting the view that they are maximally dilated and incapable of autoregulation. Morphologically, the vessels within the corpus luteum appeared as large sinusoidal capillaries without smooth muscle, providing an anatomical explanation for the lack of vasomotor control demonstrated physiologically. The absence of vascular smooth muscle was confirmed with immunocytochemistry using an antibody against the muscle-specific intermediate filament, desmin. The fluorescein-labeled antibody decorated arteries and arterioles within the ovarian stroma and near the capsule of the corpus luteum, but did not decorate vessels in the corpus luteum of pseudopregnancy, providing additional evidence that the vessels of the corpus luteum lack the smooth muscle investment necessary to change vascular caliber. From these findings, we have proposed a novel scheme to explain intraovarian blood flow regulation. Vascular resistance in the ovarian stroma, as in most tissues, is acutely regulated by dilation or constriction of intratissue arterioles. In contrast, vascular resistance within the corpus luteum is modeled as a relatively invariable parameter, fixed at a low level by the morphological characteristics of the luteal vasculature. Therefore, the corpus luteum operates on a linear (maximally "vasodilated") pressure-flow curve, does not actively regulate intratissue blood flow, and is subject to acute regulation of perfusion only through changes in extra-luteal vessels.     

Catecholaminergic regulation of ovarian function in mammals: current concepts

A review of the rapidly accumulating data in the literature continues to support the notion that catecholamines regulate ovarian function, and extends the complexity of catecholaminergic effects on the ovary via interactions with pituitary and adrenal hormones. It is clear that catecholamines affect growth and differentiation of ovarian follicles, but their role in follicular rupture during ovulation and in corpus luteum function remains unclear. The effects of catecholamines (mediated by membrane receptors) on ovarian function probably should be considered paracrine but classic endocrine regulation of ovarian function cannot be ruled out. Myogenic tonus of ovarian vasculature appears to be regulated by catecholamines, and estrogens may enhance adrenergic receptors in ovarian smooth muscle cells.     

Microvascular endothelial cells of the corpus luteum

The cyclic nature of the capillary bed in the corpus luteum offers a unique experimental model to examine the life cycle of endothelial cells, involving discrete physiologically regulated steps of angiogenesis, blood vessel maturation and blood vessel regression. The granulosa cells and theca cells of the developing antral follicle and the steroidogenic cells of the corpus luteum produce and respond to angiogenic factors and vasoactive peptides. Following ovulation the neovascularization during the early stages of corpus luteum development has been compared to the rapid angiogenesis observed during tumor formation. On the other end of the spectrum, the microvascular endothelial cells are the first cells to undergo apoptosis at the onset of corpus luteum regression. Important insights on the morphology and function of luteal endothelial cells have been gained from a combination of in vitro and in vivo studies on endothelial cells. Endothelial cells communicate with cells comprising the functional unit of the corpus luteum, i.e., other vascular cells, steroidogenic cells, and immune cells. This review is designed to provide an overview of the types of endothelial cells present in the corpus luteum and their involvement in corpus luteum development and regression. Available evidence indicates that microvascular endothelial cells of the corpus luteum are not alike, and may differ during the process of angiogenesis and angioregression. The contributions of vasoactive peptides generated by the luteal endothelin-1 and the renin-angiotensin systems are discussed in context with the function of endothelial cells during corpus luteum formation and regression. The ability of two cytokines, tumor necrosis factor alpha and interferon gamma, are evaluated as paracrine mediators of endothelial cell function during angioregression. Finally, chemokines are discussed as a vital endothelial cell secretory products that contribute to the recruitment of eosinophils and macrophages. The review highlights areas for future investigation of ovarian microvascular endothelial cells. The potential clinical applications of research directed on corpus luteum endothelial cells are intriguing considering reproductive processes in which vascular dysfunctions may play a role such as ovarian failure, polycystic ovary syndrome (PCOS), and ovarian hyperstimulation syndrome (OHSS).     

Morphological changes of the ovary and hormonal changes through the ovarian cycle of the common marmoset (Callithrix jacchus)

Laparoscopic observations of morphological changes of the ovary during the ovarian cycle in conjunction with radioimmunoassay of serum progesterone and estradiol-17β was investigated as a method of monitoring the ovarian cycle in the common marmoset. In the common marmoset, plural follicles first appeared in each ovary five days prior to ovulation. At three to four days prior to ovulation one or two follicles developed into translucent blisters on the surface of the ovary. As the follicles filled with follicular fluid, they became larger and clearer until one to two days prior to ovulation, at which time they formed well defined, transparent bubbles protruding from the surface of the ovary. After ovulation, the ovulation point could be detected at the center of the follicle, sometimes surrounded by a corpus of engorged blood vessels. Ovulations of the plural follicles were not simultaneous, and due to the time lag ovulations took at least 12 to 20 hrs in four out of seven animals examined. After two to five days of ovulation the corpus hemorragicum, a bright red protrusion made of tissue and blood disrupted by ovulation, was found. Subsequently, the color of the formatted corpus luteum changed from dark-red to yellow then to yellow white. While the corpus luteum remained reddish in color serum progesterone was maintained at as high levels as in the luteal phase. There was no mature follicle or corpus luteum in subordinate female ovaries.     

The identification of novel ovarian proteases through the use of genomic and bioinformatic methodologies

Proteolytic activities are essential for follicular growth, ovulation, as well as for luteal formation and regression. Using suppression subtractive hybridization (SSH), a novel mouse ovary-selective gene (termed protease serine 35, Prss35) was identified. Analysis of the mouse genome database using the Prss35 sequence led to the identification of a homologous protease (protease serine 23, Prss23). PRSS35 possesses general features that are characteristic of serine (Ser) proteases, but is unique in that the canonical Ser that defines this enzyme family is replaced by a threonine (Thr). In contrast, PRSS23 possesses the standard catalytic Ser typical for this family of proteases. As determined by real-time polymerase chain reaction (PCR), the Prss35 mRNA levels increased around the time of ovulation and remained elevated in the developing corpus luteum. Steroid ablation/replacement studies demonstrated progesterone-dependent regulation of Prss35 gene expression prior to follicle rupture. Prss35 gene expression was localized to the theca cells of pre-antral follicles, the theca and granulosa cells of pre-ovulatory and ovulatory follicles, as well as to the developing corpus luteum. In contrast, Prss23 mRNA levels decreased transiently after ovulation induction and again in the postovulatory period. Prss23 gene expression was noted primarily in the granulosa cells of the secondary/early antral follicles. PRSS35 and PRSS23 orthologs in the rat, human, rhesus macaque, chimpanzee, cattle, dog, and chicken were identified and found to be highly homologous to one another (75-99% homology). Collectively, these results suggest that the PRSS35 and PRSS23 genes have been conserved as critical ovarian proteases throughout the course of vertebrate evolution.     

Ascorbic acid in buffalo ovary in relation to oestrous cycle.

Concentration of ascorbic acid was determined in different parts of buffalo ovary at four different stages of oestrous cycle viz. early luteal, mid luteal, late luteal and follicular. The stages were decided from the physical and morphological examinations of corpora lutea. The ovary was dissected in three components viz. corpus luteum, follicular fluid and ovarian stromal tissue for ascorbic acid assay. Corpus luteum showed significant change in concentration of ascorbic acid with the advancement of oestrous cycle, value being highest in late- luteal stage. Follicular fluid and ovarian stromal tissue did not show significant changes in ascorbic acid at any stage of the oestrous cycle. Small follicles, irrespective of the stage of oestrous cycle had, however, significantly higher ascorbic acid content than large follicles.