Selection of surgical methods for uterine fibroids

1. Transabdominal surgery or laparoscopic surgery Hysteromyomectomy is suitable for young patients who have fertility requirements and want to retain the uterus. Laparoscopy or laparotomy mainly depends on the technique of the operator and the condition of fibroids. For multiple fibroids, the diameter of fibroids is greater than 10cm, and special sites such as cervical fibroids have a history of surgery that is suspected of severe pelvic adhesions. Open surgery may be considered unless the evil is possible. For large fibroids, a large number, no fertility requirements, and suspected malignant transformation can be done with uterus. 2. Hysteroscopy surgery Type 0 submucosal fibroids, type Ⅰ submucosal fibroids, type II submucosal fibroids are less than 5cm in diameter, the uterine volume is less than 8-10 weeks in size, and the uterine cavity is less than 12cm deep. Microscopic surgery. 3. Transvaginal surgery The main choice for transvaginal fibroids removal is married patients. The number of fibroids is less than 2cm and the diameter of fibroids is less than 6cm. Cervical fibroids or fibroids in the lower uterus can be used for pelvic organ prolapse simultaneously. .

Talk about the interpretation of the semen routine report-Chen Guang, Dongguan Guangji Hospital

&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. Outpatients often encounter patients asking for a semen report and don’t know how to look at it. Today, I will talk to you about the interpretation of the semen report. The regular report of semen mainly looks at the following indicators: Liquefaction time: refers to the time required for the semen to change from jelly to liquid. Under normal circumstances, the liquefaction time should be completed within 30 minutes. If it fails to liquefy after more than 60 minutes, it is regarded as abnormal. The report shows no liquefaction or the addition of liquefying agent. Abnormal liquefaction may indicate prostatitis. The hazard of non-liquefaction: The sperm is wrapped in seminal plasma, and the sperm cannot run out and cannot combine with the egg, causing infertility. Sperm concentration: refers to the number of sperm per ml of semen. The most important indicator. &nbsp.&nbsp.&nbsp. The normal reference value is 15 million/ml, natural pregnancy is better than 20 million/ml. Less than 15 is called oligozoospermia, less than 10 is moderate oligozoospermia, less than 5 is severe oligozoospermia, and less than 2 is a report of oligozoospermia. At this time, the vitality is not measured. Too few systems cannot count vitality. At this time the vitality test is of little significance. No sperm can be seen under conventional microscope. Centrifugal sperm is called latent sperm disease. Centrifugal sperm is called azoospermia. Sperm vitality: refers to the ability of sperm to move forward. &nbsp.&nbsp.&nbsp. The forward movement sperm percentage (PR) reference value is 32%. Less than 32 is asthenozoospermia, less than 20 is moderate asthenozoospermia, less than 10 is severe asthenozoospermia, and less than 1 is extreme. The lower the vitality, the lower the fertility. Total vitality refers to the percentage of motor sperm, the reference value is 40%, and refers to the sum of the percentage of forward sperm + non-forward sperm. There is also an indicator for the total number of forward movement sperm. The male reproductive physicians use it to determine which type of assistive method to choose. Generally, if it is greater than 5 million, artificial insemination can be considered (excluding the female factor). If it is less than 2 million, second-generation test tube assistance is recommended. Education. Sperm morphology: refers to whether the sperm has abnormalities and abnormal appearance. &nbsp.&nbsp.&nbsp. mainly depends on the percentage of normal sperm. The reference value is 4-100, less than 4%. It is malformed sperm disease, less than 3 is moderate, less than 2 is severe, and less than 1 is extreme. Most of the morphological abnormalities are head defects, which may be abnormal or missing sperm acrosome development, which affects the fertilization ability of sperm and affects pregnancy. Sperm malformation has no direct relationship with fetal malformation. Mainly look at the above four indicators, other indicators such as color, generally milky white, if it is red consider blood sperm, yellow means inflammation may be present. The amount of semen, normally 1.5-6ml, may cause obstruction of the vas deferens or abnormal ejaculation. The pH of semen pH is normally 7.2-8.0, less than 7 may have chronic genital tract inflammation or ejaculatory duct obstruction, and more than 8 may have acute genital tract inflammation.

What are the criteria for evaluating the efficacy of myelodysplastic syndrome?

About the efficacy of myelodysplastic syndrome (MDS) is mainly divided into complete remission and partial remission. The criteria for complete remission involve bone marrow BM, peripheral blood PB, and hematological HI. Myelodysplastic syndrome has been used for a while, how to see the effect of treatment? [Complete remission] The manifestation in the bone marrow is as follows: the proportion of primitive cells is less than five percent (high, low and medium are not equal), the symptoms of cell maturity in various lines, and no morphological manifestations of developmental abnormalities. Symptoms of voluntary sensation: no obvious symptoms of discomfort. Peripheral blood is manifested as: hemoglobin greater than 110, neutrophils greater than or equal to 1.5, platelets greater than or equal to 100, blood cells without primitive cells, blood cells without abnormal performance. The standard prerequisite for a complete remission of the blood picture is that the patient can maintain the hemopoietic growth factor for 2 months. [Partial remission] Similar to the indication of complete remission, the blood cells in the bone marrow are reduced by half or more than before. Or the FAB subtype is changed to a lighter subtype, for example, patients with intermediate risk may return to low-risk MDS status through treatment. Which is regardless of the degree of nucleated cell proliferation and abnormal development. [Hematology improvement] Hematology improvement mainly depends on red blood cells, hemoglobin, platelets, neutrophils, etc. The premise is the same as the relief strength of the peripheral blood elephant, and the improvement value needs to be maintained for at least two months without the treatment of cytotoxic drugs. Erythroid-less than 110 before effective treatment, increased by 20 after treatment, dependent on blood transfusion before treatment, and detached from blood transfusion before treatment; less than 110 before effective treatment, increased by 10-20 after treatment, dependent on blood transfusion before treatment, blood transfusion requirements after treatment 50% reduction. Plate-Significant effect value is less than 100, increased by 30 or more after treatment, dependent on platelet transfusion before treatment, detached from platelet transfusion after treatment, and the value situation remains stable; value before effective treatment is less than 100, increased by 50% or more after treatment More, the net added value is greater than 10, but less than 30. Granules-less than 1.5 before markedly effective treatment, at least an increase of 100% or a net increase of less than or equal to 0.5 after treatment; a value of less than 1.5 before effective treatment, at least a 100% increase after treatment, but a net increase of less than 0.5 In summary, all the criteria for efficacy must be based on an appropriate period after treatment, such as less than or equal to one month, separated by at least one week, with two consecutive measurements to determine. For example, the erythroid% is less than 50% of nucleated cells, and the percentage of primitive cells is calculated according to nucleated cells. If the erythroid% is less than or equal to 50% of the nucleated cells, the original cell percentage is calculated according to non-erythroid cells. In addition, if it is considered to be caused by the effect of treatment, mild megaloblastic changes may be allowed, but other morphological abnormalities that existed before treatment cannot be allowed. If you have any questions about this article or the disease, please feel free to follow us on WeChat and search more: gsby120

Farewell: Under what circumstances do patients with aplastic anemia require blood transfusion?

The purpose of Xiebeilu’s studio WeChat add369456 blood transfusion is to correct anemia, supplement platelets, improve coagulation function and supplement coagulation factors. The operation during blood transfusion needs to be reasonable and standardized. Observe the patient’s response closely during blood transfusion. To prevent adverse reactions. For patients with aplastic anemia, blood transfusion is for emergency adjuvant therapy and cannot be used as the main treatment method. Indications for transfusion in anemia patients with aplastic anemia are that red blood cells can be transfused when the hemoglobin is less than 70g / L and the hematocrit is less than 0.21g during acute blood loss, and when the anemia hemoglobin is less than 60g / L and the hematocrit is less than 0.1g in patients with chronic aplastic anemia Red blood cells can be infused. The platelet transfusion pointer needs platelet transfusion when the acute blood loss is that the platelet is less than 50×10 ^ 9 / L and there is a clear bleeding tendency. Or in the case of platelet dysfunction, it is not necessary to look at the platelet count to determine the platelet transfusion according to the bleeding situation. The platelet transfusion for non-acute blood loss is that when the platelet is less than 50×10 ^ 9 / L, you need to apply for transfusion immediately. If the platelet is 10-50×10 ^ 9 / L, the platelet transfusion is determined according to the bleeding tendency and the condition of the disease. Therefore, what needs to be done before blood transfusion is that for patients with first blood transfusion or multiple blood transfusions, anti-allergic drugs are generally taken orally or intramuscularly to prevent possible transfusion reactions. If a large amount of blood transfusion is performed, the recipients are generally given calcium gluconate etc. to fight some anticoagulant substances in the blood. If there is an adverse reaction to emergency blood transfusion, stop blood transfusion immediately; keep the venous passage unobstructed or slow down the blood transfusion rate; observe the patient’s reaction closely; physical hypothermia can be given to those with high fever; if the body temperature is too low, the blood should be warmed, and the temperature should be controlled at 32 degrees Celsius (cut Do not exceed 38 degrees Celsius); the patient keeps warm properly, warms the blood transfusion limbs, eliminates venous vasospasm, and avoids affecting blood transfusion speed; if breathing is difficult, oxygen can be inhaled first, and tracheotomy may be performed in severe cases. & nbsp. As long as the blood transfusion reaction is properly handled in a timely manner, serious sequelae are rarely left over later. If it is not treated in time, it may lead to serious complications such as kidney failure and even death. Blood transfusion is not the fundamental method of treatment. It is very important to find a suitable method for patients. Symptomatic treatment can reduce the pain and stabilize the patient’s condition.

Look! When did the size of the male penis widen?

Look! When did the size of the male penis widen? The baby’s penis is formed in the first trimester and grows and develops in the second and third trimesters. It grows and develops under the combined action of growth hormone, gonadotropin and testosterone secreted by the pituitary gland. If the testosterone is insufficiently secreted during the 6th to 9th month of pregnancy and the fetal penis develops at a slower rate than normal, it will be smaller at birth. In addition, the lack of androgen receptors can also cause small penis. Idiopathic small penis of unknown cause accounts for about 20% of the total number of small penis cases. So, in the infant stage, how long is a small penis? Generally speaking, if the length is less than 1 cm when pulling, we think it is a small penis. Before 9 years of age, if it is less than 3 cm, it can be determined to be abnormal. Small penis is often combined with many developmental deformities, so if parents find that their child has signs of small penis, they should take the child to the hospital for treatment as soon as possible.