International Journal of Fertility and Womens Medicine最新文献

Breast feeding has been shown to enhance the development of the immune system of the newborn as well as provide protection against enteric and respiratory infections. It has been suggested that implementation of breast feeding programs has the potential to save hundreds of thousands of lives worldwide. Human milk is a bodily fluid which, apart from being an excellent nutritional source for the growing infant, also contains a variety of immune components such as antibodies, growth factors, cytokines, antimicrobial compounds, and specific immune cells. These help to support the immature immune system of the newborn baby, and protect it against infectious risks during the postnatal period while its own immune system matures. This article reviews some of the factors in human breast milk that give it these important properties.

Objective: Postoperative pain management is important, especially in cancer patients. We describe our experience with the application of a locally placed continuous local anesthetic-releasing catheter for wound pain reduction after mastectomy for breast cancer.

Materials and methods: Retrospective evaluation of a continuous series of 41 patients at Fayette Medical Center, AL, USA, receiving an anesthetic-releasing catheter from January 2000 until June 2004. We used a pain management system with 270 ml volume of 0.25% Sensorcaine (bupivacaine and epinephrine) and a release rate through dual catheter ends of 2 ml/h each, lasting for approx. 67.5 h post op.

Results: 41 patients, age 67.0 (42-84) years, height 164.5 (152.4-177.8) cm, weight 71.1 (45.4-129.4) kg were treated after mastectomies (n=43; two bilateral) for breast cancer (n=30) and carcinoma in situ (CIS) (n= 11) with a local anesthetic wound catheter (n=43). The following procedures were performed: 31 modified radical mastectomies, 10 simple mastectomies and 2 simple mastectomies with sentinel lymph nodes. Intraoperative application of such a catheter system took less than 3 minutes. No intra- or postoperative complication or infection occurred within a follow up time of 30.3 months (0.2-52.4).

Conclusion: Application of this temporary anesthesia catheter after mastectomy is easy and safe and reduces postoperative pain.

Skin-sparing mastectomy (SSM) with nipple areola complex (NAC) preservation appears to be oncologically safe, provided the tumor is not close to the nipple and a frozen section protocol for the retroareolar tissue is followed.

Background: The purpose of this study was to identify correlates of HER2 status for patients with bilateral breast cancer.

Methods: Data were collected prospectively in our institutional review board approved patient registry for all patients with asynchronous (ABBC) and synchronous (SBBC) bilateral infiltrating breast cancer whose HER2 assays were performed at our laboratory using FISH. Data were analyzed using the Wilcoxon rank sum and Chi-square test.

Results: Data were available for 98 tumors in 49 patients. Patients diagnosed with SBBC were more likely to be white (P = 0.023); to have bilateral HER2 non-amplified tumors (P = 0.022) and to be older at diagnosis (P = 0.025) compared to those with ABBC. Patients with one HER2 amplified tumor were likely to have at least one tumor be hormone receptor negative and to have ABBC.

Conclusions: Only 16% of patients in this study had one tumor that was HER2 amplified; no patient had bilateral HER2 amplified tumors.

Gynecomastia is a common condition characterized by a benign proliferation of the glandular component of the male breast. It is thought to be due to an increase in the ratio of estrogen to androgen activity. The present article reviews the pathogenesis, clinical features, and contemporary treatment of gynecomastia.

Although further research is required, epidemiological evidence indicates that breast cancer risk is increased by 40% among flight attendants. Female flight attendants and women who fly frequently should be informed of this potential increase in risk and be encouraged to participate in appropriate breast cancer screening programs.

Fractures can be a devastating outcome of osteoporosis, a disease that disproportionately affects postmenopausal women. Once a patient sustains a fragility fracture, the risk of future fractures quickly increases, providing compelling rationale for identifying patients at risk and initiating treatment that works rapidly. Comprehensive risk assessment beyond bone mineral density measurement is needed to identify women for further clinical assessment and intervention. Effective management of osteoporosis can improve the long-term health of postmenopausal women with osteoporosis. A number of oral therapies have demonstrated a rapid onset of fracture risk reduction. Risedronate has shown significant reductions in vertebral and nonvertebral fracture risk after 6 months and alendronate after 1 year of therapy. Teriparatide also has demonstrated both vertebral and nonvertebral fracture efficacy and should be considered an effective therapeutic

Introduction: Recent clinical trials have caused physicians to reconsider the use of hormone therapy (HT). Low-dose therapy has been proposed for those patients who tolerate standard doses poorly.

Objective: to evaluate low-dose and ultra low-dose estrogen therapy (ET) for vasomotor symptom control.

Materials and method: Thirty five healthy postmenopausal women with moderate to severe climacteric symptoms were recruited. Symptoms were evaluated at baseline and three months after the beginning of treatment by a modified Kupperman's index (KI). Endometrial thickness was assessed with pelvic ultrasonography. Patients were randomly assigned to one of these therapies: I) Esterified conjugated estrogens (ECE) 0.156 mg/day (ultra low-dose) (n = 18) or II) ECE 0.312 mg/day (low-dose) (n = 17) for 12 weeks. Statistical analysis was done with student's t test for independent and paired samples.

Results: In groups I and II, the abandon rate was 33.3% and 47.0%, respectively. No differences were found among the groups in general data nor in KI. The KI at the end of the study was 47.8+/-37.9 and 48.9+/-33.2 for group I and group II, respectively, for a mean decrease of 32.1% and 37% without differences between the groups. When comparing each group separately, KI decreased in group 1, but without statistical significance. In group II there was significant decrease in KI. Endometrial thickness increased from 2.5+/-1.0 to 4.2+/-1.7 mm in group I, and from 3.5+/-1.3 to 6.0 +/-1.4 mm in group II.

Conclusion: low dose and ultra-low dose ET were useful in decreasing climacteric symptoms.

Objective: To compare the outcomes of conventional IVF and ICSI on sibling oocytes.

Design: Retrospective analysis.

Methods: Performance of ICSI on part of the oocytes and IVF on the remaining portion during the same cycle (sibling oocytes).

Patients: 135 couples (141 cycles) with male subfertility or with idiopathic infertility.

Results: Globally, the fertilization rate was not different between the ICSI and IVF, however, in patients with severe teratospermia, it was higher after ICSI (56.2 vs. 44.2 %, p<0.05). The fertilization failure rate was higher in the IVF group than in the ICSI group, globally, (12.1 % vs 2.8 %, p = 0.005), as well in patients with severe teratospermia. In the latter group, a higher number of top quality embryos were obtained after ICSI than after IVF. Of 57 cycles with severe teratospermia, only ICSI-embryos were transferred in 24, while only IVF-embryos were transferred in 11, resulting respectively in 8 and 3 clinical pregnancies.

Conclusion: This study underscores that ICSI is useful in patients with teratospermia. Nevertheless, considering the chances of obtaining a successful fertilization after IVF and lower risk of chromosomal aberrations, we recommend performing both IVF and ICSI on sibling oocytes during the first treatment cycle in patients with teratospermia.

The coexistence of endometriosis and Turner's syndrome is extremely rare, and therefore poses certain questions on the mechanisms of endometriosis. We present a case of a 27-year-old woman with Turner's syndrome [(46, X(x) (q10); 45X], primary amenorrhea and menopausal hormonal profile in which peritoneal endometriosis was revealed laparoscopically.