Reproductive Function in Epilepsy

Summary: : The hypothalamic-pituitary-gonadal axis is a complex system within which both positive and negative feedback occur among its elements and higher brain systems. The occurrence of seizures and changes in the secretion of pituitary hormones can affect the feedback loop. Both seizures and antiepileptic drugs can affect the hypothalamic-pituitary-gonadal axis of males and females and cause changes in hormones and sexuality. Reproductive dysfunction has a social impact because of reduced fertility. Once conception occurs, live birth rates are not diminished. Prospective studies of men and women with epilepsy are needed.     

Hypothalamic-pituitary adrenal function in end-stage non-alcoholic liver disease

Abstract Patients with end-stage liver disease have significant mortality often associated with intercurrent episodes of bleeding or sepsis. Intact adrenal function is essential in such situations. In order to test the hypothesis that adrenal insufficiency might be present in severe liver disease, hypothalamic-pituitary adrenal function was evaluated in patients with end-stage liver disease awaiting transplantation. The study had a prospective, open comparative design with patients restricted to those having non-alcoholic liver disease in order to avoid the confounding direct effects of alcohol on adrenocortical function. Fifty-one consecutive patients with end-stage, non-alcoholic liver disease undergoing evaluation for liver transplantation and 40 healthy controls were studied. Patients who had used corticosteroids (n= 8) or who were unable to complete the investigations (n= 5) were excluded leaving 38 patients eligible for analysis. Adrenal function was evaluated under basal conditions by single morning measurements of plasma total and free cortisol, corticosteroid-binding globulin, dehydroepiandrosterone sulfate and by adrenal stimulation indirectly using insulin-induced (0.1 U/kg, i.v.) hypoglycaemia and/or directly by adrenocorticotrophic hormone (ACTH); 250 μg tetracosactrin, i.v.) stimulation. Compared with healthy controls, patients with liver disease had a 64% reduction in maximal increments of plasma cortisol to indirect adrenal stimulation via insulin-induced hypoglycaemia and a 39% reduction to direct adrenal stimulation by ACTH (all P < 0.001). There was a significant negative correlation between the severity of underlying liver disease as assessed by Child-Pugh scores and peak control responses to ACTH (r= -0.647, P < 0.0001) and insulin-induced hypoglycaemia (r= -0.597, P < 0.0001). Patients with liver disease also exhibited significantly blunted and delayed hypoglycaemic responses to insulin (0.1 U/kg), brisker growth hormone responses of reduced magnitude and decreased corticosteroid-binding globulin levels. Baseline morning cortisol, free cortisol and dehydroepiandrosterone sulfate levels were unchanged compared with healthy controls. Patients on spironolactone had lower basal and peak cortisol responses to ACTH and hypoglycaemia, but the reductions were unrelated to spironolactone dose. Although insulin resistance and spironolactone therapy are confounding factors, it can be concluded that hypothalamic-pituitary regulation of adrenal function is defective in end-stage non-alcoholic liver disease. It is therefore possible that functional central adrenal insufficiency might contribute to the mortality of patients with end-stage liver disease and raises the question of the need for controlled studies of adrenocortical replacement therapy during acute deteriorations (sepsis and haemorrhage) in severe hepatic disease.     

Fetal anaesthesia for intrauterine treatment

Fetal anaesthesia was performed 5 times in 1 patient to treat pleural effusions, obtain fetal blood sampling, provide albumin infusion, and establish and replace a pleuro-amniotic indwelling shunt catheter under ultrasound guidance. A maternal epidural catheter was placed and used for epidural anaesthesia for the first 4 anaesthetics. Fetal administration of pancuronium 0.15 mg·kg^?1 via the umbilical vein or 0.25 mg·kg^?1 intramuscularly was enough to produce immobilization without maternal effect. However, maternal pretreatment with intravenous diazepam and fentanyl was required for fetal sedation and analgesia, which was necessary for accurate and safe injection, and for suppression of fetal stress.     

INTRAUTERINE CANDIDA INFECTION IN PREMATURE BABY

An autopsy case of pulmonary candidiasis occurring in a neonatal girl was reported. The mycological examination of the lung taken at autopsy revealed only Candida albicans and followed by the elucidation under the microscopic sections prepared with special stains; periodic acid-Schiff and methenamine silver, in the lung, stomach, umbilical cord, and amnion. The presence of Candida vaginitis in her mother supported the concept that Candida albicans was the etiological agent of the pulmonary candidiasis.     

Nomenclature of the gonane progestins

The use of gonane nomenclature can be traced back to the early 1960s, when the first compound submitted for trial, the carbon-18 homologue of the anabolic agent Nilevar was named bisnortestosterone. However, the confusion about how this compound was named led scientists to introduce the gonane system for naming bisnortestosterones and structurally related compounds. Use of the terms gonane and estrane to classify the levonorgestrel and norethindrone families of progestins, respectively, originates from the systemic name of these compounds. Levonorgestrel is 17beta-hydroxy-17alpha-ethinyl-13beta-ethyl-4-gonen-3-one, while norethindrone is 17beta-hydroxy-17alpha-ethinyl-4-estren-3-one. The term gonane signifies that levonorgestrel and the related progestins are a separate class of steroids that differ from other steroids. Levonorgestrel and the related progestins form a structural category of 18-homologated 19-nortestosterones. Thus, it would be better to categorize levonorgestrel and the structurally related progestins such as desogestrel, norgestimate, gestodene as carbon-18-homologated 19-nortestosterones. Alternatively, it is simpler to refer to these compounds as the levonorgestrel family of progestins. In a similar manner, norethindrone and the related progestins can be referred to as the norethindrone (norethisterone) family of progestins.     

10年间剖宫产率及指征变化与围生儿死亡率的关系

目的：探讨剖宫产率及剖宫产指征变迁对围生儿死亡率的影响。方法：对10年间剖宫产病例资料进行回顾性分析。结果：1992－1996年剖宫产率为36．50％，显著低于1997－2001年的47．78％，两者比较，差异有极显著性（P＜0．01）。在剖宫产指征中，妊娠并发（合并）症始终处于第1位，社会因素上升为第2位，难产为第3位，胎儿窘迫为第4位。围生儿死亡率1992－1996年为17．88‰，1997-2001年为22．23‰，两者比较，差异无显著性（P＞0．05）。结论：剖宫产率升高在一定范围内降低了围生儿死亡率，但随着剖宫产率的进一步升高，围生儿死亡率并未随之下降。因此，应合理掌握剖宫产指征，降低剖宫产率。     

妊高征患者胎盘组织中FasL的表达及其意义

目的　探讨FasL在妊高征患者胎盘组织中的表达是否异常 ,进一步从免疫学角度分析妊高征的发病机制。方法　 2 0 0 1年 11月至 2 0 0 2年 7月 ,采用免疫组织化学SP法检测 2 0例正常孕妇 (对照组 ) ,6 5例妊高征患者 (妊高征组 ,其中轻度 2 2例、中度 2 0例、重度 2 3例 )胎盘组织中FasL表达强度。结果　FasL主要表达于胎盘绒毛滋养细胞 ,妊高征组胎盘绒毛滋养细胞及蜕膜组织细胞FasL表达强度明显低于对照组 (P <0 0 1,P <0 0 5 )。结论　妊高征患者胎盘组织FasL表达减少 ,母胎免疫耐受机制遭到破坏 ,引发胎盘绒毛发育不全、功能下降等一系列免疫病理改变 ,最终可能导致妊高征及其并发症的发生。     

妊娠高血压综合征患者血清sICAM-1含量测定及其在妊高征发病中的作用

目的　探讨可溶性细胞间粘附分子 1(soluble intercellular adhesion molecule- 1,s ICAM- 1)在妊娠高血压综合征 (简称妊高征 )发病中的作用。　方法　应用酶联免疫吸附法 (EL ISA)测定 6 5例妊高征患者 (妊高征组 ,包括轻度 15例 ,中度 2 4例 ,重度 2 6例 )及 2 5例同期正常妊娠孕妇(对照组 )外周血清中 s ICAM- 1的含量 ;应用化学发光酶联免疫分析法测定两组孕妇血清中白细胞介素 1(interleukin- 1,L I- 1β)及肿瘤坏死因子 (tum or necrosing factor alpha,TNF- α)含量 ;并记录新生儿体重及妊娠结局。　结果　轻、中、重度妊高征组母血清中 s ICAM- 1的含量 [(36 8.5 6± 6 2 .81) μg/L、(6 0 6 .6 3± 10 5 .0 4 ) μg/ L、(85 9.36± 2 0 0 .92 ) μg/ L]均显著高于对照组 [(2 36 .6 9± 96 .33) μg/ L](P<0 .0 5 ,P<0 .0 1,P<0 .0 1) ,中、重度妊高征组母血清中 IL- 1β及 TNF- α的含量均显著高于对照组(P<0 .0 5 ,P<0 .0 1) ;中、重度妊高征组 s ICAM- 1的水平与相应 IL- 1β及 TNF- α的水平呈显著的正相关 (r=0 .6 97,P<0 .0 1;r=0 .74 6 ,P<0 .0 1)。重度妊高征组伴胎儿生长受限 (fetal growth restric-tion,FGR)者血中 s ICAM- 1含量显著高于同组其他孕妇之含量 (P<0 .0 5 )。妊高征组     

子宫切除术后盆腔包块30例分析

目 的探讨 因 良 性 疾病 行 子 宫 切除 术 后 盆 腔包 块 形 成 的原 因 、临床 特 征 及 治疗 。 方 法 收 集 并分 析３０例 子 宫 切 除术 后 盆 腔 包 块 的 两 次 手 术 前 后 情 况 、包 块 的 性 质 、二 次 手 术 前 后 情 况 、包 块 的 性 质 、二 次 手 术方 式、治疗 效果 及 随访 结果 。 结果 ３０例 患者 在子 宫 切除 时 均保 留了 一 侧或 两侧 附 件，５３％ 病 例包 块 以 体 检或 自查 方式 发现 ，４７％ 有 症 状；大 多 数病 程长 、包 块 大、活动 差、以囊 性为 主 、用 抗 生素 治 疗 或 中药 治 疗 无 效；Ｂ超４３％ 有分 隔，ＣＡ 在 正常 范 围。７０％ 病 例与 粘 连性 囊 肿有 关，原子 宫 切除 时有 粘 连者１１例 在 本次 手术 时 均有 粘连 ，３８％ 粘 １２５连 性囊 肿于 子 宫切 除术 后６个月 内 出现 包块 ，６２％ 术 后２年内 出现 包 块，卵巢 囊肿 均 为术 后１年以 上 发现 包块 。二 次手 术时 腹腔 镜 手术 比开 腹 手术 出血 量 少，但医 疗费 用 高，平 均 住院 日及 手 术时 间差 异 无显 著 性，总复 发率２６％ 。结论 粘 连性 包 块多 数术 后２年 内 发 现 ，卵 巢 囊肿 大 多１年 以 后 发 现；保 留附 件 是 再 次形 成 包 块 中 液体 的