子宫内膜异位症引起的盆腔疼痛的诊断和治疗

子宫内膜异位症(endometriosis,EMT)是妇科最常见的疾病之一,且发病率呈逐年上升趋势,盆腔疼痛是它常见的症状之一,其发病机制尚未明确,易复发,成为妇科研究的热点和难点.随着对EMT引起盆腔疼痛的发病机理的不断认识,其诊治也相应得到完善和发展.本文从哲学的角度以认识和实践等观点对EMT引起盆腔疼痛的诊断和治疗进展进行综述,以助于临床诊治.     

子宫内膜异位症的诊断和治疗进展

子宫内膜异位症(endometriosis,EMT)是妇科最常见的疾病之一,是引起痛经、月经不调、不孕等证状的重要原因,发病率呈逐年上升趋势,严重危害妇女的身心健康,影响患者的生活质量。其发病机制不清,疗效差,易复发,一直是妇科研究的热点和难点。多年来随着对EMT发病机制的不断认识,使EMT的诊治得到了进一步的完善和发展。从哲学的角度以认识和发展的观点对子宫内膜异位症的诊断和治疗进展进行综述,以有助于临床上的诊治。     

子宫内膜异位症的诊断和治疗进展

子宫内膜异位症(endometriosis,EMT)是妇科最常见的疾病之一,是引起痛经、月经不调、不孕等证状的重要原因,发病率呈逐年上升趋势,严重危害妇女的身心健康,影响患者的生活质量.其发病机制不清,疗效差,易复发,一直是妇科研究的热点和难点.多年来随着对EMT发病机制的不断认识,使EMT的诊治得到了进一步的完善和发展.从哲学的角度以认识和发展的观点对子宫内膜异位症的诊断和治疗进展进行综述,以有助于临床上的诊治.     

腹腔镜手术治疗子宫内膜异位症的临床价值

子宫内膜异位症是妇科常见病、多发病之一,可引起痛经、慢性盆腔痛、性交痛和不孕等症状,严重影响育龄期妇女的身心健康和生活质量,日益受到人们的关注。以人为本,微创手术是当代医学的模式之一。本文从哲学的角度出发、以辩证的观点对腹腔镜手术治疗子宫内膜异位症的临床价值进行综述。     

腹腔镜手术治疗子宫内膜异位症的临床价值

子宫内膜异位症是妇科常见病、多发病之一,可引起痛经、慢性盆腔痛、性交痛和不孕等症状,严重影响育龄期妇女的身心健康和生活质量,日益受到人们的关注。以人为本,微创手术是当代医学的模式之一。本文从哲学的角度出发、以辩证的观点对腹腔镜手术治疗子宫内膜异位症的临床价值进行综述。     

慢性前列腺炎/慢性盆腔疼痛综合征患者前列腺组织相关免疫学改变及意义

慢性前列腺炎/慢性盆腔疼痛综合征是以排尿异常及慢性盆腔疼痛为主要症状的一类综合征.其病因、发病机制及病理生理学改变还不十分清楚.最新研究表明,其与自身免疫性疾病类似,并与体液免疫有关,过程中有多种细胞因子参与,本文就慢性前列腺炎患者前列腺组织相关免疫学改变及其意义进行综述.     

异位妊娠诊治的临床思考

异位妊娠是妇产科常见急症之一,也是目前早期妊娠妇女死亡的首要原因。其检查方法多种,治疗也趋于多样化。在异位妊娠的诊治中,我们应从整体上认识了解患者,掌握疾病的发展变化,作出最佳的诊治方案,并随时根据病情发展变化,对诊治方案做出相应的合理的改变。     

妇科恶性肿瘤合并静脉血栓栓塞的研究进展

静脉血栓栓塞(venous thromboembolism,VTE)是妇科恶性肿瘤的常见并发症之一,与患者的病死率升高密切相关。患者自身状态、肿瘤的类型、分期及手术、放化疗等治疗手段均可构成VTE的危险因素。但目前尚缺乏专门针对妇科恶性肿瘤合并VTE的临床实验数据以及预防和诊治指南。     

妇科恶性肿瘤合并静脉血栓栓塞的研究进展

静脉血栓栓塞(venous thromboembolism,VTE)是妇科恶性肿瘤的常见并发症之一,与患者的病死率升高密切相关.患者自身状态、肿瘤的类型、分期及手术、放化疗等治疗手段均可构成VTE的危险因素.但目前尚缺乏专门针对妇科恶性肿瘤合并VTE的临床实验数据以及预防和诊治指南.     

子宫内膜干细胞与子宫内膜异位症的治疗

子宫内膜异位症（EMs）是妇科最常见的疾病之一,引起痛经、月经不调、不孕等,严重危害妇女的身心健康,影响患者生活质量。其发病率逐年升高,发病机制不清,疗效差,一直是困扰妇科医生的难题之一。最近提出的子宫内膜干细胞（SC）学说认为EMs起源于SC,EMs病灶的维持和发展是子宫内膜SC不断更新和分化的结果。因此,治疗的关键应是针对子宫内膜SC,通过靶向子宫内膜SC及其异常调节的信号转导通路来治疗EMs。这对传统的治疗方式提出了巨大的挑战,也为有效的根治EMs开辟了新的思路。     

腹腔镜在盆腔炎中的应用

急性盆腔炎发病率高,并发症多,是常见妇科急腹症之一,而早期明确诊断和及时处理是治疗成功的关键。本文初步探讨了腹腔镜作为一种检查和治疗的手段在急性盆腔炎的应用价值,结果提示其具有较好的临床应用价值。     

剖宫产术后盆腔血肿6例临床分析

本文探讨剖宫产术后盆腔血肿形成的原因、早期诊断、治疗及预防措施。对我院2010年3月～2011年4月1800例剖宫产术后发生盆腔血肿的6例患者资料进行回顾性分析,盆腔血肿发生率为0．33％,均通过B超检查确诊,3例保守治疗,3例在B超下穿刺治疗,均治愈。剖宫产后盆腔血肿的形成有多种原因,多在术后一周左右B超检查确诊。早...     

Chronic pelvic pain: A meta-analytic review

Abstract

Chronic pelvic pain (CPP) in women of reproductive age is a common complaint; for many women no identifiable pathology can be found. Research has suggested that women who have chronic pelvic pain without obvious pathology differ on a range of psychological characteristics, such as anxiety and depression, compared with those with identified pathology. A meta-analysis of 22 studies was undertaken to clarify these issues. Results showed that there were no significant differences on a range of psychological variables between women who were identified, via laparoscopy and clinical judgement, as having organic disorders and those who were not so identified. When women with chronic pelvic pain were compared with pain-free groups a profile of elevated depression, anxiety, neuroticism and psychopathology was found which is consistent with findings from studies of other painful conditions.     

Antidepressants and cognitive-behavioral therapy for symptom syndromes

Somatic symptoms are common in primary care and clinicians often prescribe antidepressants as adjunctive therapy. There are many possible reasons why this may work, including treating comorbid depression or anxiety, inhibition of ascending pain pathways, inhibition of prefrontal cortical areas that are responsible for "attention" to noxious stimuli, and the direct effects of the medications on the syndrome. There are good theoretical reasons why antidepressants with balanced norepinephrine and serotonin effects may be more effective than those that act predominantly on one pathway, though head-to-head comparisons are lacking. For the 11 painful syndromes review in this article, cognitive-behavioral therapy is most consistently demonstrated to be effective, with various antidepressants having more or less randomized controlled data supporting or refuting effectiveness. This article reviews the randomized controlled trial data for the use of antidepressant and cognitive-behavior therapy for 11 somatic syndromes: irritable bowel syndrome, chronic back pain, headache, fibromyalgia, chronic fatigue syndrome, tinnitus, menopausal symptoms, chronic facial pain, noncardiac chest pain, interstitial cystitis, and chronic pelvic pain. For some syndromes, the data for or against treatment effectiveness is relatively robust, for many, however, the data, one way or the other is scanty.     

Unexplained chest pain: a review of psychological conceptualizations and treatment efficacy

This review critically considers psychological theories and models used to understand unexplained chest pain, and efficacy of treatment strategies. It discusses the strengths and limitations of current perspectives, and highlights implications for future research and interventions. A comprehensive range of literature examining unexplained chest pain, and published over the last three decades, was thus reviewed finding that, although unexplained chest pain has been examined as a psychological phenomenon for over 100 years, explanatory models have emerged only in the last two decades. Neither psychophysiological nor psychodynamic models have been significantly advanced. Only cognitive-behavioural models have been explicitly derived to explain and manage the condition, and require further refinement to address conceptual and methodological limitations. Studies assessing treatment efficacy suggest cognitive-behavioural therapy as a first-line therapy, but have failed to establish whether the approach is acceptable and effective in routine care. Comprehensive psychological understanding of unexplained chest pain, and its management, is therefore developing but is far from complete. Cognitive-behavioural interventions show promise but are likely to be enhanced by greater theoretical clarity and understanding of resistance to their implementation.     

Tele-pain management: use of videoconferencing technology in the delivery of an integrated cognitive-behavioral and physical therapy group intervention

Chronic pain has been recognized as a highly prevalent problem, and interdisciplinary treatments have been shown to be effective in the treatment of chronic pain. An integrated cognitive-behavioral and physical therapy group protocol has been developed and then implemented at remote sites using videoconferencing technology to provide pain management for veterans. The treatment model is summarized and recommendations are made for addressing challenges in implementing this type of treatment via videoconferencing.     

慢性乙型肝炎诊治现状中值得注意的几个问题

慢性乙型肝炎已成为目前我国最为重要的危害人类健康的传染病之一,其防治刻不容缓。由于缺乏特效药,在诊治中存在一些问题,需科学引导。     

Mesothalamic discharge in a chronic pain,allergy and fluid retention syndrome (case report)

A 32-year-old woman was bedridden for a year because of chronic pain and headaches. She had insomnia, depression, suicidal thoughts and a severe chemical allergy. She had been on steroid therapy for two years and became Cushingoid with striae in the arm pits, groins and abdomen. However, she had no hypertension, nor the buffalo fat and hirsutism. She was very edematous, with a weight gain from 112 to 180 lbs. The fluid retention did not conform to the syndrome of inappropriate antidiuretic hormone. Studies revealed abnormal scalp EEG discharges and high-voltage seizure discharges in the posterior thalamus. Electrothalamic stimulation suppressed the thalamic discharges and relieved the patient’s pelvic pain and headaches. After one month of several thalamic stimulations per day, she was able to get out of bed and ambulate. In addition, the patient no longer was edematous and was tolerating perfumes and floor detergents. Steroids were progressively reduced without complications of withdrawal. She went from a completely steroid dependent state to independent during the first 1-1/2 yrs of thalamic stimulation. With continued thalamic stimulation she has done well for 8-1/2 yrs, weighs 112 lbs, keeps house and drives a car. It’s speculated the illness is a chronic pain multiple system syndrome predominantly due to mesothalamic discharges and body infirmities. The mesothalamic discharge implicated neural networks, which represent biologic systems, i.e. pain, sleep, fluid retention, etc. Therapeutic stimulation attenuates the discharges and the neural networks return to their normal set points of homeostasis.     

Somatoforme Schmerzstörung am Beispiel des chronischen Unterbauchschmerzes der Frau

In this review we discuss the psychological dimension of chronic pelvic pain in women. We give an overview of the psychopathology of the disease. The psychosomatic correlations of this complex syndrome are discussed. The diagnostic criteria of somatoform pain disorder are relevant for a large number of patients. The psychotherapeutic approaches are described. Psychosomatic knowledge is very helpful in the management of chronic pelvic pain in women. It helps to avoid unnecessary operations and contributes to a satisfying doctor-patient-relationship.     

关于糖尿病的几点认识

糖尿病及其并发症严重影响了人类的健康。随着科学技术的不断发展,人们对糖尿病 的认识逐步加深。目前关于糖尿病的命名、诊断分型标准和治疗原则在临床工作中逐渐显露 出其不足之处,这势必会影响人们对于糖尿病的进一步研究。本文从糖尿病的命名、诊断、 分型、治疗和糖尿病研究等方面发表了作者的看法,旨在引起大家的思考。