Objective To compare and analyse the elective and emergency hysterectomies in obstetric practice. Meth odsA retrospective study was performed to compare elective versus emergency cesarean hysterectomies in PUMC Hos pital from January 1969 to December 1998.ResultsObstetric hysterectomies were performed on 36 patients over 30 years out of 33207 deliveries. 26 emergency cesarean hysterectomies and 10 elective hysterectomies had been done. Pla cental disorder was the main indication of emergency hysterectomy. The perinatal mortality of newborn was 179.5‰. ConclusionObstetric hysterectomy has been proved to be one of the most useful life- saving procedure for patients with postpartum hemorrhage, especially at the time of cesarean section, particularly for patients with a history of benign or malignant gynecologic tumor or irregular vaginal bleeding before pregnancy.

Objective　To evaluate the ability of a risk of malignancy index (RMI), based on a serum CA125 level, ultrasound findings and menopausal status,to discriminate a benign from a malignant pelvic mass. Methods　One hundred and forty women with a pelvic mass, 30 years or older,admitted between January 1998 and June 1999, were studied. The sensitivity,specificity and positive predictive value of serum CA125 level, ultrasound findings and the menopausal status separately and combined into the RMI,to diagnose ovarian cancer. Results　RMI was more accurate than any individual criterion in diagnosing cancer. Using a RMI cut-off level of 200 to indicate malignancy, the RMI derived from this data set gave a sensitivity of 87.3%, specificity of 84.4%, and positive predictive value of 82.1%. Conclusions　RMI is able to correctly discriminate between malignant and benign pelvic mass. It can be introduced easily into clinical practice to facilitate the selection of patients for primary surgery.

Objective To analyze the etiology and features of Pilon fractures and to explore their best operative method.Methods 92patients with pilon fracture were treated operatively and followed up between1991and 2001.According to the Ovadi a -Beals' s classification,there were 7cases of Type I fracture,12of II,30of III,26of IV,17of V.During the o peration,55patients had limited in ternal fixation with calcaneal trac-tion,18with calcaneal traction and plaster splint,10with tibial and fi bula internal fixation,9with external fixation apparatus.Results92patients were followed up for an av erage time of 53months(ranging from 4～103months).According to Mazur ' s criteria,the results of the treatm ent were rated as excellent in 42patients,good in 34,fair in 11and poor in 5.Conclusion The pilon fracture is caused by both t he force of falling from a high altitude and the force of rebounding which act in the distal end of tibia an d fibula.Limited internal fixation with calcaneal traction is a right choice of operative method to treat pilon fr actures.[

Through reviewing ancient and modern literatures,the effect evolution and disease treatment changes of Belamcanda chinensis were understood.The pharmacological experiments were used to verify its main effects.The combination of featured advantages of traditional Chinese medicine (TCM) and modern science and technology contributed to the promotion of TCM modernization.It had important significance for the development of effective components,selection of disease types in the treatment for research and development of new TCM drugs.The indication of Belamcanda chinensis was verified from textual research.The treatment of disease types by Belamcanda chinensis was verified from medical books.The treatment of disease types by Belamcanda chinensis compound was analyzed based on the Pujifang database management system.Main indications of Belamcanda chinensis were summarized.Modern pharmacological studies on anti-inflammatory mechanism of main components of Belamcanda chinensis were combined to screen animal models and investigation indexes for the preliminary verification of the efficacy of Belamcanda chinensis.The comprehensive application of classical herbal medicine books and prescription database analysis results showed that removing phlegm and relieving sore throat were the efficacy of Belamcanda chinensis,which was an important medicine in the treatment of pharyngitis and sore throat.In the modern research,serum of experimental group,IL-4 in throat tissues,as well as IgE and LTC4 level in serum and lung tissues were significantly reduced compared to the model group (P＜0.05).It was concluded that the treatment effect of Belamcanda chinensis extract to chronic pharyngitis may be through the decreasing of IgE level in serum and lung tissues,inhibiting IL-4 expression in serum and throat tissues,and the LTC4 expression in serum.

OBJECTIVETo analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis.

METHODSA retrospective study was conducted on the fertility and obstetric outcome in 153 patients with uterine malformations treated in our hospital from January 1984 to December 1998. Twenty-seven cases with other kinds of genital and/or urinary anomalies but with normal uterus during the same period were enrolled as the control group.

RESULTSThe infertility rate was 26.6% (34/128), the miscarriage rate 44.3% (86/194), premature birth rate 9.3% (18/194), abnormal fetal presentation rate 28.4% (29/102), the cesarean section rate 61.8% (63/102), and the perinatal mortality rate 11.8% (12/102).

CONCLUSIONWomen with congenital uterine malformation usually have higher incidence of infertility and complications during pregnancy and delivery. Bicornuate and septate uterus can be associated with poor obstetric outcome.

Abortion, Spontaneous ; etiology ; Adult ; Cesarean Section ; statistics & numerical data ; Female ; Fertility ; Humans ; Obstetric Labor, Premature ; etiology ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Retrospective Studies ; Uterus ; abnormalities

Objective To explore the pregnancy outcome and obstetric management of pregnancy and delivery after vaginal radical trachelectomy (VRT).Methods Forty-two cases of VRT from December 2003 to May 2012 in Peking Union Medical College Hospital were analyzed retrospectively.Among them ten cases got pregnant successfully.Results The average age of patient at VRT surgery was (30.6 ± 3.7) years old and average follow-up time was 29.5 months.There were 31 patients attempted conception.Ten of them got fourteen conceptions successfully.Overall conception rate was 45％ (14/31).There were four cases of first trimester abortion.Among them,two were miscarriage,two were elective abortion.There was one case of ectopic pregnancy operation and non of second trimester loss.Nine cases reached the third trimester.The total preterm delivery rate was 4/9.There were two cases delivered before 32 gestational weeks (2/9).Cesarean section was performed through a transverse incision in all of nine cases.No uterine rupture and postpartum hemorrhage occurred.All newborns had good outcomes.The average follow-up time after postpartum was 22.9 months.All cases were disease-free.Conclusions The conception rate of patients after VRT in our series is 45％.The preterm birth rate of pregnancy after VRT is higher.Routine cerclage of cervix during VRT procedure and pregnancy is not necessary.Cesarean section shortly after full term pregnancy through a transverse incision should be considered as a suitable and safe procedure.

Objective To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the Xiehe pelvic floor reconstruction surgery. Methods From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage Ⅲ to Ⅳ from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life. Results With a median follow-up of 14. 0 months (6 -28 months),twenty-three patients showed recurrent prolapse (8. 3%, 23/277), and anatomical success ( ＜ stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6. 9% (19/277). The postoperative de novo stress incontinence rate was 6. 5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P ＜0. 01 ). And there was no significant difference in the average score of PISQ before and after the surgery (76. 6 ± 15.4 versus 75.5 ± 14. 5 versus 73.6 ± 12. 6, P ＞0. 05 ), but the rate of de novo dyspareunia was 11% (9/80). Conclusions Xiehe pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.

OBJECTIVETo evaluate the ability of a risk of malignancy index (RMI), based on serum CA125 level, ultrasound findings and menopausal status, to discriminate benign from malignant pelvic mass.

METHODSOne hundred and forty women with pelvic masses, at age 30 of years or more were admitted to the Peking Union Medical College Hospital between January 1998 and June 1999. The sensitivity, specificity and positive predictive value of serum CA125 level, ultrasound findings and the menopausal status in diagnosis of ovarian cancer were evaluated separately or combined into the RMI.

RESULTSRMI was more accurate than any individual criterion in diagnosing cancer. Using an RMI cutoff level of 200 to indicate malignancy, the RMI derived from this data set gave a sensitivity of 87.3%, a specificity of 84.4%, and a positive predictive value of 82.1%.

CONCLUSIONSRMI is able to correctly discriminate malignant from benign pelvic mass. It can be introduced easily into clinical practice to facilitate the selection of patients for primary surgery.

CA-125 Antigen ; blood ; Female ; Humans ; Menopause ; Ovarian Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

Objective To measure in vivo biomechanical properties of pelvic support structures associated with uterosacral ligament suspension(ULS). Methods Ten Chinese female cadavers(death within 48 hours)without embalming were carefully dissected to expose the ligament. After dissection, ligaments were sewn according to standard ULS surgical technique. They were stretched at a steady rate to breakage during constant electronic registration of load and displacement. In vivo biomechanical properties were evaluated by a load-displacement curve. Results Ultimate load of uterosacral ligament, ring around cervix were(37.3±23.5),(49.3±28.4)N, respectively. The differences between the two groups was not significant(P>0.05). Ligament stiffness were(1.26±1.22),(1.45±0.92)N/mm, respectively. There was no significant difference between groups(P>0.05). Conclusions The uterosacral ligament, ring around cervix with sufficient strength are not easy to deform. ULS is an effective procedure for treating middle pelvic defects from a biomechanics perspective.

Objective To study the postpartum pelvic floor rehabilitation on the improvement of pelvic floor electrical physiological indexes and the prevention of female pelvic floor dysfunction in China. Methods A multicenter prospective randomized controlled study was carried out. From October 2011, postpartum women in five provinces were randomly assigned into treatment group and control group. The women in treatment group received electrical stimulation and biofeedback treatment. The women in control group performed pelvic floor muscle exercise at home. When 6 months and 12 months after delivery, comparing two groups of patients with pelvic floor electrical physiological indexes and pelvic organ prolapse quantitation measurements (POP-Q), to evaluate the effect of postpartum pelvic floor rehabilitation on the prevention of pelvic floor dysfunction. Pelvic floor impact questionnaire short form (PFIQ-7) and pelvic organ prolapse/incontinence sexual questionnaire-12 (PISQ-12) were used to evaluate the influence on quality of life and sexual life. Results Until June 2013, 324 women were participated, 124 in control group, 200 in treatment group. According to the baseline results, there was statistical significance in the results of pelvic floor electrical physiological indexes between the treatment and control groups in postpartum 6 months and 12 months; the proportion above level Ⅲ of type Ⅰ and type Ⅱ muscle fibers strength in the treatment group, it was from 41.5% (83/200) and 40.5% (81/200) to 76.3% (145/190) and 79.5% (151/190) in postpartum 6 weeks and postpartum 6 months, increased to 80.6%(58/72) and 80.6%(58/72) in postpartum 12 months, improved significantly comparing with the control group (P<0.01). According to Point Aa, treatment group and control group in the postpartum 6 weeks was (-2.2 ± 0.7) versus (-2.4 ± 0.6) cm, in postpartum 12 months (-2.5 ± 1.1) versus (-2.7 ± 0.6) cm, the improvement in treatment group was statistically significant (P<0.01). And the other points were not significantly different (P>0.05). There was no significant difference in the questionnaires in quality of life and quality of sexual life (P>0.05). Conclusion Neuromuscular electrical stimulation and biofeedback therapy in the early postpartum period could obviously improve pelvic floor electrical physiological indexes, and is beneficial to prevent the pelvic floor dysfunction.