To analyze the therapeutic effect of mifepristone, misoprostol and curettage on embryo development. Methods: 56 patients with embryonic development arrest diagnosed and treated in our hospital from March 2019 to March...To analyze the therapeutic effect of mifepristone, misoprostol and curettage on embryo development. Methods: 56 patients with embryonic development arrest diagnosed and treated in our hospital from March 2019 to March 2021 were selected as observation objects, and were divided into two groups according to different treatment plans. The reference group and the research group were treated with misoprostol combined with curettage, mifepristone and misoprostol combined with curettage respectively. The effects of cervical softening and dilation, success rate of one-time curettage, operation index, incidence of adverse reactions and the effects on the levels of immune function index, D- dimer and three items of thyroid function of patients in the two groups were compared. Results: compared with the reference group, the total effective rate of cervical softening and dilation in the study group was 96.43%, the success rate of one-time curettage was 100.00% higher, the time of operation, pregnancy discharge and vaginal hemorrhage were shorter, the amount of intraoperative hemorrhage was less, the levels of immune function indexes (IgA, IgM, IgG) were higher, and the values of three indexes of three items of thyroid function (TSH, FT3, FT4) and D- dimer were lower in the study group, P<0.05. There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: the combined use of mifepristone, misoprostol and curettage in patients with embryonic development arrest has significant effects on improving the cervical softening and dilation effect, increasing the success rate of one-time curettage and improving the operation condition of patients, immune function after treatment, D- dimer and three indexes of hypothyroidism.展开更多
Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colpos...Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colposcopy.Methods:This retrospective multicenter study included 4,149 patients who were referred to any one of six tertiary hospitals in China for colposcopy between January 2020 and November 2021 because of abnormal screening results.ECC data were extracted from the medical records.Univariate and multivariate logistic regression analyses were performed to identify factors that could predict HSIL+on ECC.Patients were randomly assigned to a training set or to an internal validation set for performance and comparability testing.The model was externally validated and tested in patients from two additional hospitals.The nomogram was assessed in terms of discrimination and calibration and subjected to decision curve analysis.Results:HSIL+was found on ECC in 38.8%(n=388)of cases.Our predictive nomogram included age group,cytology,human papillomavirus(HPV)status,visibility of the cervix and colposcopic impression.The nomogram had good overall discrimination,which was internally validated[area under the receiver-operator characteristic(AUC),0.839;95%confidence interval(95%CI),0.773-0.904].In terms of external validation,the AUC was 0.843(95%CI,0.773-0.912)for the consecutive sample and 0.843(95%CI,0.783-0.902)for the comparative sample.Calibration analysis suggested good consistency between predicted and observed probabilities.Decision curve analysis suggested this nomogram would be clinically useful with almost the entire range of threshold probabilities.Conclusions:This internally and externally validated nomogram can be easily applied and incorporates multiple clinically relevant variables that can be used to identify patients with occult HSIL+who need ECC.展开更多
D2 radical gastrectomy is the standard procedure for gastric cancer in the middle or upper part of the stomach. According to the latest Japanese treatment guidelines for gastric cancer, dissection of the splenic hilar...D2 radical gastrectomy is the standard procedure for gastric cancer in the middle or upper part of the stomach. According to the latest Japanese treatment guidelines for gastric cancer, dissection of the splenic hilar lymph nodes is required during the radical treatment for this condition. This study reports a D2 radical total gastrectomy employing the curettage and dissection techniques, in which the resection of the anterior lobe of transverse mesocolon, vascular denudation and splenic hilar lymph node dissection were successfully completed.展开更多
AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonida...AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.RESULTS: Thirty-three(M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo(6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty(93.8%)patients had complete resolution of the disease and two(6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.CONCLUSION: Lay open(deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate(up to 97%), doesn't require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.展开更多
A new operating programme was designed by us, based on keeping the whole limb in 1988. A successful operation on one patient with this new method was achieved on Dec. 17 in the same year at the First Teaching Hospital...A new operating programme was designed by us, based on keeping the whole limb in 1988. A successful operation on one patient with this new method was achieved on Dec. 17 in the same year at the First Teaching Hospital, Xi'an Medical Nniversity. Firstly, the internal tumor tissue was resected and curstted thoroughly, and the osseous shell was kept to attach to the normal bone tissue. Then, a plastic bag was used to encase the osseous shell in, deactivation was done with 95 per cent alcohol. the remainder osseous shell was used as a support, a pulp canal steel needle was inserted into it, and the bone cement was filled up in. In this way, a ' prosthesis' in pulp canal was formed, which was not only firm, reliable, less expensive convenient for drawing material, and satisfactory for achieving the goal of treating the tumor and keeping the limb, but also easy to move for the patient and to recover the function of the limb rapidly after operation because of not amputating the normal bone tissue and partly keeping the continuity of it. Now 25 cases have been treated with this new method, and in 90 per cent patients, the limbs have been preserved.展开更多
BACKGROUND Uterine rupture is a serious obstetric emergency,a severe event,and a serious threat to maternal and fetal life.It is a rare and not well characterized by the fact that multiple operations of uterine caviti...BACKGROUND Uterine rupture is a serious obstetric emergency,a severe event,and a serious threat to maternal and fetal life.It is a rare and not well characterized by the fact that multiple operations of uterine cavities contribute to uterine rupture during pregnancy.Atypical uterine rupture is easily misdiagnosed as other obstetric or surgical diseases.In current guidelines,abdominocentesis is a contraindication for late pregnancy.Therefore,the cases presented in this report provide new ideas for clinical diagnosis and treatment of uterine rupture.CASE SUMMARY Case 1,a 34-year-old woman(gravida 5,para 2),32 wk and 4 d of gestation,presented with acute upper abdominal pain for 8 h with nausea and vomiting.Computed tomography(CT)revealed pelvic and abdominal effusion.We extracted 3 mL unclotted blood from her abdominal cavity.An emergency caesarean section was performed.A uterine rupture was found,and the fimbrial portion of the left fallopian tube was completely adhered to the rupture.The prognosis of both the mother and the infant was good.Case 2,a 39-year-old woman(gravida 10,para 1)at 34 wk and 3 d of gestation complained of persistent lower abdominal pain for half a day.Her vital signs were normal.CT revealed a high probability of pelvic and abdominal hemoperitoneum.We extracted 4 mL dark red blood without coagulation.An emergency laparotomy was performed.Uterine rupture was identified during the operation.Postoperative course in both the mother and infant was uneventful.CONCLUSION For pregnant women in the second or the third trimester with persistent abdominal pain,abdominal effusion,fetal distress and even fetal death,the possibility of uterine rupture should be highly suspected.CT can identify acute abdominal surgical or gynecological and obstetric diseases.Abdominocentesis is helpful for diagnosing and clarifying the nature of effusion,but its clinical value need to be confirmed by further clinical studies.展开更多
Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post...Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post pregnancy related dilatation and curettage managed successfully by laparoscopic small bowel resection and primary anastomosis.展开更多
Objective: to explore the significance of combined guided bone regeneration technique on the basis of jaw cyst curettage in the treatment of patients with odontogenic jaw cyst to improve the treatment quality of patie...Objective: to explore the significance of combined guided bone regeneration technique on the basis of jaw cyst curettage in the treatment of patients with odontogenic jaw cyst to improve the treatment quality of patients. Methods: the project started in October 2020 and the project ended in January 2022. The data composition of the project were all confirmed patients in our hospital, with a total of 54 cases. The project was divided into the general group and the study group, with 27 cases in each group. The treatment parameters, changes in jaw height and width after surgery, treatment efficiency and surgical treatment indexes of the two groups were compared. Results: compared with other groups, the volume and area of cysts in the study group changed more significantly, and the bone mineral density of the patients increased more than that in the general group. Comparing the changes of jaw height and width, the parameters of the study group were higher than those of the conventional group. The number of patients in the study group who showed significant improvement in treatment was larger, and the total effective rate was significantly higher than that in the general group. Compared with the surgical treatment, although the treatment time and blood loss of the study group were more, the incidence of postoperative complications and recurrence rate were lower than those of the general group (P≤0.05). Conclusion: for the patients with odontogenic jaw cyst, the application of combined therapy is of positive significance in improving the disease pathological changes of the patients, improving the overall recovery quality, and reducing the influence of disease complications and recurrence rate.展开更多
Background Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few inst...Background Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide, Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development, We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.Methods Altogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transecsion laparoscopic Peng＇s multifunctional operative dissector （LPMOD） was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1.Results Laparoscopic operation was completed in 57 patients. Two patients （3.4%） had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients （3.4%）, and there was no pedoperative death.Conclusion Laparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.展开更多
Background Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage Ⅰ endometriod adenocarcinoma. However, there is an inconsistency of tumor g...Background Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage Ⅰ endometriod adenocarcinoma. However, there is an inconsistency of tumor grade between preoperative curettage and final hysterectomy specimens, and its associated factors are poorly understood. This study aimed to evaluate the accuracy of tumor grade by preoperative curettage so as to achieve a better stratified management for clinical stage Ⅰ endometriod adenocarcinoma. Methods Clinical data of totally 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent preoperative curettage and primary surgery were retrospectively collected. Compared with final hysterectomy specimens, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of tumor grade by preoperative curettage were calculated and their associations with clinicopathologic parameters, including age, status of menopause, position of uterus, location and size of lesion, histological grade, depth of myometrial invasion, cervical invasion, extrauterine spread, peritoneal cytology, metastasis to retroperitoneal lymph node, serum CA125 level, and hormone receptor status, were analyzed. Results In final hysterectomy specimens, 139 of 259 grade 1 patients by curettage were upgraded to grade 1 or 2; 31 of 296 grade 2 were upgraded to grade 3, with a significantly discrepant rate of 40.9% （281/687） and an upgraded rate of 24.7% （170/687）. The specificity and negative predictive value for grade 3 were 90.7% and 89.9%, while the sensitivity and positive predictive value for grade 1 were 67.1% and 40.9%, respectively. Conclusions Preoperative tumor grade by curettage does not accurately predict final histological results, especially in those classified as grade 1. Complete surgical staging seems to be necessary for clinical stage Ⅰ endometriod adenocarcinoma.展开更多
Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situat...Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situation.An elderly post-loop electrosurgical excision procedure woman,who had undergone a colposcopy 4 months before,went for her follow-up and abnormal cytology was found,and both the ECC and punch biopsy showed negative results.Then,a second ECC was performed,which led to the diagnosis of a high-grade squamous intraepithelial lesion.This case report shows that ECC is useful for diagnosing elderly women with Type 3 squamocolumnar junction.展开更多
Cherubism is a rare disease characterized by significant loss of medullary bone which is replaced by excessive amounts of fibrous tissue growth within the mandible and maxilla. We present a case of a 4-year-old boy wi...Cherubism is a rare disease characterized by significant loss of medullary bone which is replaced by excessive amounts of fibrous tissue growth within the mandible and maxilla. We present a case of a 4-year-old boy with a rapidly enlarging mandible and maxilla, causing significant change in the facial contour, malocclusion and phonation difficulties. He was treated with aggressive tumor curettage, lateral mandibular cortex osteotomies with medial repositioning. This allowed obliteration of the enlarged medullary space and restoration of the normal mandibular anatomy. At 12 months postoperatively, the patient had significant improvement in facial contour, normal outward appearance, and stable dentition.展开更多
Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these pa...Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method.展开更多
BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management o...BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management of HCSP.No universal treatment protocol has been established when IUP is desired to be preserved.CASE SUMMARY We report a case of HCSP at 8+wk gestation in a 34-year-old woman with stable hemodynamics.A two-step intervention was applied.Selective embryo aspiration was performed first,and surgical removal of ectopic gestational tissue by suction and curettage was performed 2 d later.Both steps were performed under ultrasound guidance.The patient had an uneventful course,and a healthy baby was delivered at 34+6 wk gestation.CONCLUSION Selective embryo aspiration followed by suction and curettage was successful in the preservation of IUP in the management of HCSP.This approach is an alternative option for HCSP in the first trimester when the IUP is desired to be preserved.展开更多
Objective To analyze retrospectively the utility of uterine arterial embolization （UAE） for cesarean scar pregnancy （CSP）.Methods Fifty-one women with CSP were pretreated with UAE before dilatation ＆ curettage （...Objective To analyze retrospectively the utility of uterine arterial embolization （UAE） for cesarean scar pregnancy （CSP）.Methods Fifty-one women with CSP were pretreated with UAE before dilatation ＆ curettage （D＆C）. Indexes such as blood loss volume, operation-associated complications, serum hCG level ultrasound imaging and hospitalization cost were analyzed.Results Thirty-eight women accepted D＆C following UAE （group A）, 10 patients had medicine （3 took trichosanthin injection, 7 took MTX injection） before UAE and D＆C （group B）. Uterine packing following emergency UAE were performed in another 3 women due to severe hemorrhage during direct curettage without pretreatment （group C）. There were no statistically significant differences between group A and group B about the serum fl-hCG level resolution time and the blood loss in the opertation. Patients had shorter duration of hospital stay （P〈0.01） and cheaper cost of hospitalization （P〈0.05） of group A than group B.Conclusion Pretreatment with UAE before curettage is safe and effective in terminating CSP, reducing hospitalization cost. UAE followed by curettage is recommended to medical facilities where UAE is available.展开更多
BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dyspl...BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.展开更多
Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not ...Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not available in low and middle-income countries due to the complex challenges of patient delay and lack of access to healthcare, physician shortages, and the lack of ancillary services such as pathology and radiology. This paper reviews current training statistics, the international literature on minor gynecologic surgery and training strategies. Methods: PubMed searches using MESH terms cone biopsy, dilation and curettage, and loop electrosurgical excision procedure were performed. Statistics of minor surgical procedures among US Obstetrics and Gynecology Residency programs were tabulated. We then searched for data of training programs and surgical statistics in low resource countries. Results:Dilation and curettage is the most common minor gynecologic procedure in the United States but is performed with significantly lower frequency in low and middle-income countries. The most common procedure for the treatment of preinvasive disease was cryotherapy followed by loop electrosurgical excision procedure. There was no information about minor surgical procedures performed in hospitals in low and middle-income countries. Statistics from four-year American training programs showed an average of 209 minor cervical procedures performed annually. Conclusion: Expertise in minor gynecologic procedures is vital and requires the development of both adequate training programs and local medical infrastructure. Strategies for training in minor surgery for providers in low and middle-income countries include online curriculums, mentored relationships with senior physicians, and simulation models.展开更多
The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined cli...The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.展开更多
There have been not many reports on the result of intralesional excision for giant cell tumors (GCTs) of the great trochanter and femoral neck because of its rarity. The authors present the case of a 35-year-old femal...There have been not many reports on the result of intralesional excision for giant cell tumors (GCTs) of the great trochanter and femoral neck because of its rarity. The authors present the case of a 35-year-old female patient managed with intralesional curettage and filling the defect with autologous bone graft from iliac crest. An appoint of three doses of Denosumab was done postoperatively. The article discusses the clinical aspects and surgical treatment, and the benefits of Denosumab. This report aimed to demonstrate the possibility to perform curetage for giant cell tumor of the hip even the recommandation for this location is wide resection and endoprothesis fixation.展开更多
文摘To analyze the therapeutic effect of mifepristone, misoprostol and curettage on embryo development. Methods: 56 patients with embryonic development arrest diagnosed and treated in our hospital from March 2019 to March 2021 were selected as observation objects, and were divided into two groups according to different treatment plans. The reference group and the research group were treated with misoprostol combined with curettage, mifepristone and misoprostol combined with curettage respectively. The effects of cervical softening and dilation, success rate of one-time curettage, operation index, incidence of adverse reactions and the effects on the levels of immune function index, D- dimer and three items of thyroid function of patients in the two groups were compared. Results: compared with the reference group, the total effective rate of cervical softening and dilation in the study group was 96.43%, the success rate of one-time curettage was 100.00% higher, the time of operation, pregnancy discharge and vaginal hemorrhage were shorter, the amount of intraoperative hemorrhage was less, the levels of immune function indexes (IgA, IgM, IgG) were higher, and the values of three indexes of three items of thyroid function (TSH, FT3, FT4) and D- dimer were lower in the study group, P<0.05. There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: the combined use of mifepristone, misoprostol and curettage in patients with embryonic development arrest has significant effects on improving the cervical softening and dilation effect, increasing the success rate of one-time curettage and improving the operation condition of patients, immune function after treatment, D- dimer and three indexes of hypothyroidism.
基金supported by CAMS Innovation Fund for Medical Sciences(No.CAMS 2021-I2M-1-004)。
文摘Objective:This study aimed to develop a nomogram that can predict occult high-grade squamous intraepithelial lesions or worse(HSIL+)and determine the need for endocervical curettage(ECC)in patients referred for colposcopy.Methods:This retrospective multicenter study included 4,149 patients who were referred to any one of six tertiary hospitals in China for colposcopy between January 2020 and November 2021 because of abnormal screening results.ECC data were extracted from the medical records.Univariate and multivariate logistic regression analyses were performed to identify factors that could predict HSIL+on ECC.Patients were randomly assigned to a training set or to an internal validation set for performance and comparability testing.The model was externally validated and tested in patients from two additional hospitals.The nomogram was assessed in terms of discrimination and calibration and subjected to decision curve analysis.Results:HSIL+was found on ECC in 38.8%(n=388)of cases.Our predictive nomogram included age group,cytology,human papillomavirus(HPV)status,visibility of the cervix and colposcopic impression.The nomogram had good overall discrimination,which was internally validated[area under the receiver-operator characteristic(AUC),0.839;95%confidence interval(95%CI),0.773-0.904].In terms of external validation,the AUC was 0.843(95%CI,0.773-0.912)for the consecutive sample and 0.843(95%CI,0.783-0.902)for the comparative sample.Calibration analysis suggested good consistency between predicted and observed probabilities.Decision curve analysis suggested this nomogram would be clinically useful with almost the entire range of threshold probabilities.Conclusions:This internally and externally validated nomogram can be easily applied and incorporates multiple clinically relevant variables that can be used to identify patients with occult HSIL+who need ECC.
文摘D2 radical gastrectomy is the standard procedure for gastric cancer in the middle or upper part of the stomach. According to the latest Japanese treatment guidelines for gastric cancer, dissection of the splenic hilar lymph nodes is required during the radical treatment for this condition. This study reports a D2 radical total gastrectomy employing the curettage and dissection techniques, in which the resection of the anterior lobe of transverse mesocolon, vascular denudation and splenic hilar lymph node dissection were successfully completed.
文摘AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.RESULTS: Thirty-three(M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo(6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty(93.8%)patients had complete resolution of the disease and two(6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.CONCLUSION: Lay open(deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate(up to 97%), doesn't require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.
文摘A new operating programme was designed by us, based on keeping the whole limb in 1988. A successful operation on one patient with this new method was achieved on Dec. 17 in the same year at the First Teaching Hospital, Xi'an Medical Nniversity. Firstly, the internal tumor tissue was resected and curstted thoroughly, and the osseous shell was kept to attach to the normal bone tissue. Then, a plastic bag was used to encase the osseous shell in, deactivation was done with 95 per cent alcohol. the remainder osseous shell was used as a support, a pulp canal steel needle was inserted into it, and the bone cement was filled up in. In this way, a ' prosthesis' in pulp canal was formed, which was not only firm, reliable, less expensive convenient for drawing material, and satisfactory for achieving the goal of treating the tumor and keeping the limb, but also easy to move for the patient and to recover the function of the limb rapidly after operation because of not amputating the normal bone tissue and partly keeping the continuity of it. Now 25 cases have been treated with this new method, and in 90 per cent patients, the limbs have been preserved.
基金We would like to thank these two patients for allowing us to share their cases and using their picture and we are also grateful to all of our team members who were involved in the management of the cases。
文摘BACKGROUND Uterine rupture is a serious obstetric emergency,a severe event,and a serious threat to maternal and fetal life.It is a rare and not well characterized by the fact that multiple operations of uterine cavities contribute to uterine rupture during pregnancy.Atypical uterine rupture is easily misdiagnosed as other obstetric or surgical diseases.In current guidelines,abdominocentesis is a contraindication for late pregnancy.Therefore,the cases presented in this report provide new ideas for clinical diagnosis and treatment of uterine rupture.CASE SUMMARY Case 1,a 34-year-old woman(gravida 5,para 2),32 wk and 4 d of gestation,presented with acute upper abdominal pain for 8 h with nausea and vomiting.Computed tomography(CT)revealed pelvic and abdominal effusion.We extracted 3 mL unclotted blood from her abdominal cavity.An emergency caesarean section was performed.A uterine rupture was found,and the fimbrial portion of the left fallopian tube was completely adhered to the rupture.The prognosis of both the mother and the infant was good.Case 2,a 39-year-old woman(gravida 10,para 1)at 34 wk and 3 d of gestation complained of persistent lower abdominal pain for half a day.Her vital signs were normal.CT revealed a high probability of pelvic and abdominal hemoperitoneum.We extracted 4 mL dark red blood without coagulation.An emergency laparotomy was performed.Uterine rupture was identified during the operation.Postoperative course in both the mother and infant was uneventful.CONCLUSION For pregnant women in the second or the third trimester with persistent abdominal pain,abdominal effusion,fetal distress and even fetal death,the possibility of uterine rupture should be highly suspected.CT can identify acute abdominal surgical or gynecological and obstetric diseases.Abdominocentesis is helpful for diagnosing and clarifying the nature of effusion,but its clinical value need to be confirmed by further clinical studies.
文摘Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post pregnancy related dilatation and curettage managed successfully by laparoscopic small bowel resection and primary anastomosis.
文摘Objective: to explore the significance of combined guided bone regeneration technique on the basis of jaw cyst curettage in the treatment of patients with odontogenic jaw cyst to improve the treatment quality of patients. Methods: the project started in October 2020 and the project ended in January 2022. The data composition of the project were all confirmed patients in our hospital, with a total of 54 cases. The project was divided into the general group and the study group, with 27 cases in each group. The treatment parameters, changes in jaw height and width after surgery, treatment efficiency and surgical treatment indexes of the two groups were compared. Results: compared with other groups, the volume and area of cysts in the study group changed more significantly, and the bone mineral density of the patients increased more than that in the general group. Comparing the changes of jaw height and width, the parameters of the study group were higher than those of the conventional group. The number of patients in the study group who showed significant improvement in treatment was larger, and the total effective rate was significantly higher than that in the general group. Compared with the surgical treatment, although the treatment time and blood loss of the study group were more, the incidence of postoperative complications and recurrence rate were lower than those of the general group (P≤0.05). Conclusion: for the patients with odontogenic jaw cyst, the application of combined therapy is of positive significance in improving the disease pathological changes of the patients, improving the overall recovery quality, and reducing the influence of disease complications and recurrence rate.
基金the Foundation of Science and Technology Bureau of Zhejiang Province(No.2003C33055)
文摘Background Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide, Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development, We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.Methods Altogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transecsion laparoscopic Peng＇s multifunctional operative dissector （LPMOD） was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1.Results Laparoscopic operation was completed in 57 patients. Two patients （3.4%） had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients （3.4%）, and there was no pedoperative death.Conclusion Laparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.
文摘Background Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage Ⅰ endometriod adenocarcinoma. However, there is an inconsistency of tumor grade between preoperative curettage and final hysterectomy specimens, and its associated factors are poorly understood. This study aimed to evaluate the accuracy of tumor grade by preoperative curettage so as to achieve a better stratified management for clinical stage Ⅰ endometriod adenocarcinoma. Methods Clinical data of totally 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent preoperative curettage and primary surgery were retrospectively collected. Compared with final hysterectomy specimens, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of tumor grade by preoperative curettage were calculated and their associations with clinicopathologic parameters, including age, status of menopause, position of uterus, location and size of lesion, histological grade, depth of myometrial invasion, cervical invasion, extrauterine spread, peritoneal cytology, metastasis to retroperitoneal lymph node, serum CA125 level, and hormone receptor status, were analyzed. Results In final hysterectomy specimens, 139 of 259 grade 1 patients by curettage were upgraded to grade 1 or 2; 31 of 296 grade 2 were upgraded to grade 3, with a significantly discrepant rate of 40.9% （281/687） and an upgraded rate of 24.7% （170/687）. The specificity and negative predictive value for grade 3 were 90.7% and 89.9%, while the sensitivity and positive predictive value for grade 1 were 67.1% and 40.9%, respectively. Conclusions Preoperative tumor grade by curettage does not accurately predict final histological results, especially in those classified as grade 1. Complete surgical staging seems to be necessary for clinical stage Ⅰ endometriod adenocarcinoma.
基金Shanghai Medical Center of Key Programs for Female Reproductive Diseases(No.2017ZZ01016).
文摘Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situation.An elderly post-loop electrosurgical excision procedure woman,who had undergone a colposcopy 4 months before,went for her follow-up and abnormal cytology was found,and both the ECC and punch biopsy showed negative results.Then,a second ECC was performed,which led to the diagnosis of a high-grade squamous intraepithelial lesion.This case report shows that ECC is useful for diagnosing elderly women with Type 3 squamocolumnar junction.
文摘Cherubism is a rare disease characterized by significant loss of medullary bone which is replaced by excessive amounts of fibrous tissue growth within the mandible and maxilla. We present a case of a 4-year-old boy with a rapidly enlarging mandible and maxilla, causing significant change in the facial contour, malocclusion and phonation difficulties. He was treated with aggressive tumor curettage, lateral mandibular cortex osteotomies with medial repositioning. This allowed obliteration of the enlarged medullary space and restoration of the normal mandibular anatomy. At 12 months postoperatively, the patient had significant improvement in facial contour, normal outward appearance, and stable dentition.
文摘Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method.
基金Supported by Zhejiang National Science Foundation,No.LGF20H04001Zhejiang Bureau of Traditional Chinese Medicine,No.2017ZA092.
文摘BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management of HCSP.No universal treatment protocol has been established when IUP is desired to be preserved.CASE SUMMARY We report a case of HCSP at 8+wk gestation in a 34-year-old woman with stable hemodynamics.A two-step intervention was applied.Selective embryo aspiration was performed first,and surgical removal of ectopic gestational tissue by suction and curettage was performed 2 d later.Both steps were performed under ultrasound guidance.The patient had an uneventful course,and a healthy baby was delivered at 34+6 wk gestation.CONCLUSION Selective embryo aspiration followed by suction and curettage was successful in the preservation of IUP in the management of HCSP.This approach is an alternative option for HCSP in the first trimester when the IUP is desired to be preserved.
文摘Objective To analyze retrospectively the utility of uterine arterial embolization （UAE） for cesarean scar pregnancy （CSP）.Methods Fifty-one women with CSP were pretreated with UAE before dilatation ＆ curettage （D＆C）. Indexes such as blood loss volume, operation-associated complications, serum hCG level ultrasound imaging and hospitalization cost were analyzed.Results Thirty-eight women accepted D＆C following UAE （group A）, 10 patients had medicine （3 took trichosanthin injection, 7 took MTX injection） before UAE and D＆C （group B）. Uterine packing following emergency UAE were performed in another 3 women due to severe hemorrhage during direct curettage without pretreatment （group C）. There were no statistically significant differences between group A and group B about the serum fl-hCG level resolution time and the blood loss in the opertation. Patients had shorter duration of hospital stay （P〈0.01） and cheaper cost of hospitalization （P〈0.05） of group A than group B.Conclusion Pretreatment with UAE before curettage is safe and effective in terminating CSP, reducing hospitalization cost. UAE followed by curettage is recommended to medical facilities where UAE is available.
基金The Scientific Program of the Health and Family Planning Commission of Hunan Province,China,No.C20190940The Science and Technology Planning Project of Huaihua,China,NO.2021R3117。
文摘BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.
文摘Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not available in low and middle-income countries due to the complex challenges of patient delay and lack of access to healthcare, physician shortages, and the lack of ancillary services such as pathology and radiology. This paper reviews current training statistics, the international literature on minor gynecologic surgery and training strategies. Methods: PubMed searches using MESH terms cone biopsy, dilation and curettage, and loop electrosurgical excision procedure were performed. Statistics of minor surgical procedures among US Obstetrics and Gynecology Residency programs were tabulated. We then searched for data of training programs and surgical statistics in low resource countries. Results:Dilation and curettage is the most common minor gynecologic procedure in the United States but is performed with significantly lower frequency in low and middle-income countries. The most common procedure for the treatment of preinvasive disease was cryotherapy followed by loop electrosurgical excision procedure. There was no information about minor surgical procedures performed in hospitals in low and middle-income countries. Statistics from four-year American training programs showed an average of 209 minor cervical procedures performed annually. Conclusion: Expertise in minor gynecologic procedures is vital and requires the development of both adequate training programs and local medical infrastructure. Strategies for training in minor surgery for providers in low and middle-income countries include online curriculums, mentored relationships with senior physicians, and simulation models.
文摘The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.
文摘There have been not many reports on the result of intralesional excision for giant cell tumors (GCTs) of the great trochanter and femoral neck because of its rarity. The authors present the case of a 35-year-old female patient managed with intralesional curettage and filling the defect with autologous bone graft from iliac crest. An appoint of three doses of Denosumab was done postoperatively. The article discusses the clinical aspects and surgical treatment, and the benefits of Denosumab. This report aimed to demonstrate the possibility to perform curetage for giant cell tumor of the hip even the recommandation for this location is wide resection and endoprothesis fixation.
