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Jing-he Lang

Publications and source records attributed to Jing-he Lang.

At least 55 records · Page 3Linked to original sources
PubMed2005

Clinical analysis of primary malignant melanoma of the cervix.

OBJECTIVE: To investigate the clinical and pathological characteristics of primary cervical malignant melanoma, and its prognosis. METHODS: The clinical and pathological data of four patients with primary malignant melanoma of the cervix were analyzed retrospectively. Nerve tissue protein S-100 and monoclonal antibody to melanoma (HMB-45) were measured in all cases by immunohistochemical method. All four patients received radical hysterectomy. Three of them received chemotherapy preoperation or postoperation, and one of them received biotherapy with interferon-gamma and interleukin-2 at the same time. All the cases were followed up. RESULTS: The average age of four patients was 45 years. Clinical symptoms presented with irregular vaginal bleeding, postcoital bleeding, or increase of vaginal discharge. Gynecologic examination showed polypus papilla cauliflower-shaped or nodulated black-brown or black-blue mass on the cervix. All the four cases were pathologically diagnosed with cervical malignant melanoma. S-100 and HMB-45 were positive in all patients. Two patients died at 6 and 41 months postoperation, respectively. The other two patients survived for 3.5 and 7 years postoperation, respectively. CONCLUSIONS: S-100 protein and HMB-45 play very important roles in the diagnosis of primary malignant melanoma of cervix. Radical hysterectomy, chemotherapy combined with dimethyl triazemo imidazole carboxamide and biological therapies may improve the prognosis of the primary malignant melanoma of cervix if the disease could be diagnosed in an early stage.

Adult↗
PubMed2005

[Lymphadenectomy in the treatment of malignant ovarian germ cell tumor].

OBJECTIVE: To evaluate the impact of lymphadenectomy on the relapse and survival of malignant ovarian germ cell tumor (OGCT). METHODS: The clinical data of 102 OGCT cases treated in Peking Union Medical College Hospital from June 1980 to June 2003 were analyzed retrospectively. All the data about lymphadenectomy during primary and secondary surgery were collected, and other factors related to prognosis were also collected at the same time. Chi-squared test was applied in the univariate analysis related to relapse of disease. Cox model was applied in multivariate analysis related to relapse and survival of disease. RESULTS: Pelvic and paraaortic lymph node metastasis was not significantly related to prognosis in primary and secondary treated patients. Lymphadenectomy showed no significant impact on disease relapse and survival. In the primary treatment, International Federation of Gynecology and Obstetrics (FIGO) staging, chemotherapy regimen, residual tumor and lymphadenectomy were the significant factors related to the relapse. After being stratified for the chemotherapy regimen, lymphadenectomy was not significantly related to the relapse in bleomycin +etoposide +cisplatin or cisplatin +vincristine +bleomycin regimen group, and lymphadenectomy could prevent relapse in no chemotherapy or other chemotherapy regimen group. In relapsed patients, only residual tumor was significantly related to survival time after relapse. CONCLUSIONS: Pelvic lymph node metastasis is not the significant risk factor related to prognosis. Lymphadenectomy may have a beneficial effect on survival, although such effect is not significant. Although lymphadenectomy provides important information for prognosis, they provide little benefit to those patients already requiring chemotherapy based on the original operative findings. Lymphadenectomy should be performed to primary or relapsed patients by an expert surgical team.

Adolescent↗
PubMed2004

[Clinical characteristics of abdominal wall endometrioma and its recurrence-related factors].

OBJECTIVE: To analyze the clinical characteristics, and treatment, recurrence-related factors of abdominal wall endometriomas (AWE). METHODS: Fifty-seven cases of AWE treated at Peking Union Medical College Hospital from 1983 to 2002 were reviewed. RESULTS: The incidence of AWE was 1.04% (57/5478) in patients with endometriosis after surgical treatment. It was 0.046% in patients undergoing cesarean section in the same period. Of 57 cases with AWE, 56 had low-abdominal operation previously and one was primary umbilicus endometrioma. Fifty-five cases of AWE were secondary to cesarean section. The latent period of AWE was positively correlated to patient's age at onset (P < 0.001). Fifty-five cases received surgical treatment while 2 were given medical treatment. Follow-up duration was 1.1 - 235 months. Five cases recurred and one was transformed to malignancy. The recurrence was correlated to the size and depth of the lesions. CONCLUSIONS: AWE could be diagnosed prior to operation according to its typical clinical manifestations. Ultrasonic examination may be valuable for the diagnosis of atypical cases. Surgical treatment is effective. A complete excision with clear margin is very important to prevent recurrence.

Abdominal Wall↗
PubMed2004

[Temporal and spatial expression of estrogen activity-related molecules in eutopic endometrium of adenomyosis].

OBJECTIVE: The aim of this study was to demonstrate the temporal and spatial expression of estrogen receptor (ER), 17beta-hydroxysteroid dehydrogenase (17beta-HSD) in uterine endometria and the endometrial-myometrial interface (EMI) of adenomyosis and the effects of estrogen activity-related molecules on the occurrence of adenomyosis. METHODS: Thirty-three cases of normal endometria (and myometrial) and eighteen cases of endometria (and myometrial) with adenomyosis were collected. Immunohistochemical assay was performed to locate the ERalpha, ERbeta, 17beta-HSDI and 17beta-HSDII in endometria and EMI. RESULTS: The ERalpha positive cell number in glandular epithelial cells at the early proliferative phase increased evidently in adenomyosis (90%), while it was 60% in normal endometria. We found ERalpha signal in cytoplasm in glandular epithelial cells of adenomyosis endometria as well as in nucleus. Compared with normal endometrium (early proliferative phase: +; late proliferative phase: ++; late secretory phase: +), eutopic endometrium with adenomyosis exhibited a higher level of 17beta-HSDI (early proliferative phase: ++; late proliferative phase: +++; late secretory phase: ++). The intensity of 17beta-HSDIIin glandular epithelial cells of eutopic endometrium with adenomyosis (early proliferative phase: +++; secretory phase: ++++) was also higher than that of normal endometrium (early proliferative phase: - approximately ++; secretory phase: +++). Higher intensities of ERalpha, ERbeta and 17beta-HSDIand lower intensities of 17beta-HSDII were observed in EMI than in the eutopic endometrium of adenomyosis. CONCLUSIONS: The elevation of ERalpha positive cell number, 17beta-HSDI level as well as the insufficient compensation of 17beta-HSDII in eutopic endometrium with adenomyosis and the change in expression pattern of ERalpha, ERbeta, 17beta-HSDI and 17beta-HSDII in EMI lead to the local enhancement of estrogen effect, which would promote cell proliferation.

17-Hydroxysteroid Dehydrogenases↗
PubMed2004

[Study of neural expression in vaginal mucosa of patients with urinary stress incontinence].

OBJECTIVE: The aim of our study was to investigate the histological changes of vaginal mucosa innervation in stress urinary incontinence (SUI), to determine the alteration that contributed to them. METHODS: Biopsy specimens of anterior vaginal wall were obtained from 56 subjects during operation, which belonged to one of the 3 groups: SUI (15 cases), POP (23 cases) and asymptomatic control (15 cases). Using immunohistochemical method we could semiquantitatively determine the expression of neurofilament (NF) in vaginal mucosa as the distribution of the nerve terminals. RESULTS: There were brown-stained nerve fibers in the lamina propria. According to the expression staging (-, +, ++, +++), the number of patients was 6, 5, 4, 0 cases in SUI group, 17, 5, 1, 0 cases in POP group, and 3, 2, 4, 6 cases in control group, respectively. There was significant difference between SUI group and control group in the expression of NF (P < 0.05) and the expression of nerve fiber had no correlation with the clinical severity and leak point pressure (LPP) in SUI group (P > 0.05). The expression of NF in POP group was also weaker than control. CONCLUSION: The SUI group had a significant less total innervation of vaginal mucosa than asymptomatic controls, which may contribute to the pathogenesis of SUI.

Aged↗
PubMed2004

[Clinical analysis of endometrial carcinoma patients aged 45 years and younger].

OBJECTIVE: To retrospectively analyze the clinical characteristics and outcomes of endometrial carcinoma patients aged 45 years and younger. METHODS: Fifty-two cases of endometrial carcinoma aged 45 years and younger were treated in Peking Union Medical College Hospital. They were further divided into group A (35 years of age and younger) and group B (older than 35 years). Clinical data of these patients were reviewed and the two groups were compared. RESULTS: Patients aged 45 years and younger accounted for 12.7% of all the endometrial carcinoma cases. About 50% of the patients were nulliparous, infertile or had irregular menstruation and endometrial hyperplasia, 29% were obese, 23% had polycystic ovaries. Eighty-three percent of the patients were stage [International Federation of Gynecology and Obstetrics (FIGO), 1988]. Group A had more polycystic ovaries and atypical endometrial hyperplasia than group B (53% vs 9%, 59% vs 26% respectively, P < 0.05). All group A patients were stage I endometrial carcinoma. In group B, 26% had high risk factors, and compared with group A, FIGO stage was higher (P < 0.05). Operation was the main treatment. Two patients were treated successfully with conservative high dose progestin. Two patients relapsed. CONCLUSIONS: There were high incidences of infertility, irregular menstruation, endometrial hyperplasia, obese and polycystic ovaries in patients aged 45 years and younger, indicating the relationship between endometrial carcinoma and estrogen. Most patients, especially those younger than 35 years, were stage I with few risk factors and good prognosis. Conservation of fertility and ovarian function should be considered in these patients.

Adenocarcinoma↗
PubMed2004

[Comparative analysis of laparoscopic surgery and laparotomy for early stage endometrial cancer].

OBJECTIVE: To evaluate the feasibility of laparoscopic surgical treatment of early stage endometrial cancer. METHODS: From January 1998 to August 2003, 24 endometrial cancer cases treated by laparoscopy were analyzed as the study group. And 41 endometrial cancer cases treated by laparotomy during the same period were randomly selected as the control group. The two groups were compared in terms of the clinic data of perioperative periods. RESULTS: The clinicopathological characteristics before operation between both groups were similar. The mean operating time in the laparoscopy group (97 minutes) was significantly shorter (P < 0.001) than that in the laparotomy group (134 minutes). The blood loss during the operation in the laparoscopy group (163 ml) was fewer than that in the laparotomy group (259 ml). The numbers of the lymph nodes resected between the two groups were similar. The rate of complications in the laparoscopy group was lower than that in the laparotomy group. The laparoscopy group had shorter hospitalization (6.3 days) than that of the laparotomy group (9.6 days, P < 0.01). The pathological type and International Federation of Gynecology and Obstetrics (FIGO) stage between the two groups were similar. One case had recurrence and 1 case died in the control group but there was no such case in the laparoscopy group. The survival rate of the study group was 100% and that of the control group was 97% (P > 0.05). CONCLUSION: Laparoscopic surgery is feasible and safe in treatment of early stage endometrial cancer, and the clinic value should be confirmed by multicenter randomized clinic trial.

Aged↗
PubMed2004

[Ureteral injury in gynecologic laparoscopies].

OBJECTIVE: To investigate the ureteral injury in gynecological laparoscopies and discuss its diagnosis, treatment and prevention. METHODS: Ureteral injury in gynecological laparoscopies during the past 13 years was reviewed retrospectively. The clinical features of initial operations including the types of disease, uterine size, pelvic adhesion, operative procedures and the methods of diagnosis, treatment and prognosis of ureteral injury were studied. RESULTS: There were 8 ureteral injuries (0.14%) in 5 541 gynecological laparoscopies with seven in laparoscopically assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) (0.45%) and one in non-LAVH (0.03%). The main gynecological disorders included adenomyosis, endometriosis and leiomyoma. All patients had pelvic adhesions and 4 had previous pelvic operations. Uterine enlargement was found in 7. Patients presented increased vaginal drainage, flank pain, increased volumes of vaginal discharge, nausea and vomiting, fever, edema, or peritonitis from 0 to 13 days postoperatively. Ureteral injuries were mainly diagnosed via excretory urogram (IVP). The sites of injury were near the inferior margin of the sacroiliac joint in two women and at the inferior part of ureter (near the uterine vessel, uterosacral ligament and ureterovesical junction) in 6. Two patients whose injuries were found soon after operation received ureteral repair by laparotomy successfully. Two of the six patients whose injuries were found several days later were treated with internal ureteral stenting successfully, the other four failed with ureteral stenting and received ureteral repair by laparotomy. Outcomes were good in all cases. CONCLUSIONS: Ureteral injury is an uncommon and severe complication in gynecological laparoscopies. Symptoms like abnormally increased drainage, fever, flank pain, abnormal vaginal discharge and peritonitis after operation should be paid attention to and ureteral injury be considered. Surgical repair is the primary treatment.

Adult↗
PubMed2004

[Effect of different surgical approaches on quality of life and cost-consequence].

OBJECTIVE: To evaluate the effects of total abdominal hysterectomy (TAH), laparoscopic hysterectomy (LH) and transvaginal hysterectomy (TVH) on quality of life, cost and health care utilization. METHODS: A study of women who underwent elective hysterectomy was performed to assess the effect of operations on quality of life using WHO quality of life-bref before operation, at the 4th, 14th and 28th day after operation, respectively. The data of total cost and health care utilization were also analyzed. RESULTS: The score of quality of life at the 4th day after operation in TVH patients was significantly higher than that in TAH patients (93 +/- 6 vs 81 +/- 11, P < 0.01). There was no significant difference in this score between TVH and LH, and between LH and TAH patients. However, at the 14th and 28th after operation, the scores in both TVH and LH patients were significantly higher than that in TAH patients (95 +/- 7 and 96 +/- 7 vs 85 +/- 9, P < 0.001 and 0.001; 96 +/- 10 and 98 +/- 7 vs 87 +/- 10, P < 0.01). There was no significant difference in the total costs among three groups. The better health care utilization was in LH and TVH patients, and the worse in TAH patients. CONCLUSIONS: The effect of LH and TVH on quality of life and health economics is similar, and appears to be superior than that of TAH.

Adult↗
PubMed2004

[Study of morphological changes in levator ani muscle of patients with stress urinary incontinence or pelvic organ prolapse].

OBJECTIVE: To investigate the morphological characteristics of levator ani muscle in patients with stress urinary incontinence (SUI) or pelvic organ prolapse (POP) and to explore whether the alterations could contribute to pathogenesis of the diseases. METHODS: Biopsy specimens of levator ani muscle were obtained from 15 patients with SUI, 19 patients with POP and 3 asymptomatic controls with rectal cancer during operation. The structure of levator ani muscle was examined with routine histological techniques: HE staining, modified Gomori trichrome staining, NSE staining, ACP staining, and adenosine triphosphatase (ATPase) staining. RESULTS: There was no significant difference in age, parity, menopausal time, disease severity and leak point pressure between SUI patients with or without muscle fibers (P > 0.05). The muscular fiber density of levator ani muscles in SUI and POP groups was decreased, fibers were arranged in disorder and separated by large quantities of dense connective tissues with infiltrating inflammatory cells. The muscle fiber fascicles showed obvious grouped denervative atrophy, fiber type grouping and angular in shape. And also there was myopathic degeneration such as centrally located nuclei, peripheral phagocytosis and vacuolated necrosis. CONCLUSIONS: There are both neurogenic and myopathic alterations in levator ani muscle's structure in patients with SUI and POP. The presence of both acute and chronic abnormalities indicates that the weakness of pelvic floor is a consequence of prolonged denervation.

Aged↗
PubMed2004

[Relationship of cyclooxygenase 2 expression and chemotherapy response and prognosis in human ovarian carcinoma].

OBJECTIVE: To investigate the relationship between expression of cyclooxygenase 2 (COX-2) and chemotherapy response and prognosis of patients with ovarian carcinoma. METHODS: The expression of COX-2 was detected by immunohistochemistry in ovarian carcinoma tissues. Correlations between COX-2 and clinicopathological markers, therapeutic effect and prognosis of the patients with ovarian carcinoma were analyzed by chi(2) test, Kplan-Meire and Cox model. RESULTS: COX-2 positive rate of 70 ovarian carcinomas was 60%. Expression of COX-2 was correlated with lymph nodes metastasis only (P = 0.001). There was no correlation between COX-2 and pathohistological types, clinical stage, pathohistological grade, age at diagnosis (P = 0.397, 0.094, 0.275, 0.394). In patients whose serum CA(125) level did not drop to normal after two courses of chemotherapy, the COX-2 positive rate (76%) was significantly higher than in those whose serum CA(125) level decreased obviously (51%, P = 0.042). The positive rate was also higher in patients with recurrent diseases (67%) than in those without recurrence (46%, P = 0.062). In univariate survival analysis, the expression of COX-2 was associated with a significantly reduced median survival time (P = 0.029). In multivariate survival analysis, COX-2 was an independent prognostic factor for poor survival (P = 0.036). CONCLUSION: COX-2 expression is correlated with poor chemotherapy response and prognostic outcome. It is an independent prognostic factor of ovarian carcinoma.

Adult↗
PubMed2004

[Epithelial ovarian tumors in adolescence: a study of clinical features and treatment].

OBJECTIVE: To study the clinical feature, diagnosis and treatment of epithelial ovarian tumors in adolescent patients. METHODS: A retrospective analysis was performed on 29 patients of epithelial ovarian tumors between the age of 13 and 19 during the period of 1983 - 2002 in Peking Union Medical College Hospital. Twenty of the cases were with benign tumors, four with borderline, and five with malignant tumors. RESULTS: The average age was 16.5 years old. The majority of patients presented with abdominal pain, abdominal distention and a large pelvic mass. The histological types included mucinous tumor in twenty-two cases, serous tumor in six, and endometroid tumor in one case. Among the nine cases with borderline or malignant tumors, eight were at stage I and one at stage IIIc. Of benign tumor group, an abdominal unilateral salpingo-oophorectomy was performed on nine cases. A laparoscopic cystectomy was undertaken in 11 patients. The nine cases with borderline or malignant tumors underwent cytoreductive surgery and comprehensive staging surgery; fertility was preserved for eight of them. A cisplatin combined chemotherapy was given to four patients with malignant tumors. All of the patients were without evidence of disease recurrence during the follow-up. CONCLUSIONS: The incidence of epithelial ovarian tumors during adolescence increases with age. Mucinous tumor is the most common histological type in adolescent patients. A laparoscopic cystectomy could be considered for most benign patients. The therapeutic strategy should be individualized, and surgical approach should consider both cure and preservation of fertility in malignant cases.

Adolescent↗
PubMed2004

[Study on estrogen receptor around levator ani muscle for female stress urinary incontinence].

OBJECTIVE: To explore the relationship between estrogen receptor and the occurrence of stress urinary incontinence (SUI) through analysis on estrogen receptor (ER) around levator ani muscle. METHODS: The biopsy specimens around levator ani muscle were obtained from 31 subjects undergoing total vaginal hysterectomy (TVH), laparoscopic assistant hysterectomy (LAVH) and tension-free vaginal tape (TVT) procedures, who were assigned in to control, pelvic organ prolapse (POP) and SUI groups. The histological structures around levator ani muscle were examined with routine HE staining. ER in structures around levator ani muscle was evaluated by immunohistochemical staining. RESULTS: ER positive staining rate in levator ani muscle and surrounding tissues was 6.7% among total samples. ER positive staining located in nuclei of connective tissue, smooth muscle and small nerve cells. The positive rate in connective tissue, smooth muscle and small nerve cells was 1.4%, 4.7%, 5.7% in control group, 1.1%, 2.8%, 2.7% in SUI group and 4.1%, 9.5%, 11.6% in POP group, respectively. It was significantly lower in SUI group than that in control group (P < 0.01), and POP group (P < 0.01). CONCLUSIONS: There is close relationship between degeneration of pelvic support construction and deficiency in ER around levator ani muscle. ER positive staining in SUI group was significantly lower than that in POP group, suggesting that decrease of ER around levator ani muscle in POP might lead to the occurrence of SUI.

Adult↗