53 patients from a mainly climacteric population were treated monthly with 200 mg dehydro-epiandrosterone (DHEA) oenanthate or with 1 ampoule Gynodian-Depot®. Pronounced adiposity was present in 15 of these cases. Hormonal variables were determined before the treatment and during the depot effect of the preparations in order to study the principle which supports the oestrogenic influence and any weight-reducing influence under administration of DHEA. The elimination of lowpolar oestrogens increased considerably in 4 out of 13 post-menopausal cases treated with DHEA. This effect is probably indirect and presupposes intact ovaries. The incorporation of exogenous DHEA into the excretion of 17-ketosteroids and of 17-ketogenic steroids, such as those of androsterone + aethiocholanolone, depends on the size of the initial pool inasmuch as it is higher in small initial pools than in saturated pools - the size of the pool being age-dependent.
An average weight loss of >1 kg/mth was observed under DHEA treatment in 7 out 15 adipose cases. In comparison to the other 8 adipose cases, these 7 were younger and therefore also displayed higher values for 17-ketosteroids and their individual fractions. These circumstances appeared to explain why the administration of DHEA resulted in higher levels of free plasma DHEA which, in contrast to the cases without loss of weight, also resulted in an increase of renal DHEA-sulphate clearance. It was concluded from the findings that this is the explanation for the catabolic effect of exogenous DHEA.
Post-menopausally increased FSH and LH fractions were markedly suppressed in about half of the determinations after Gynodian-Depot administration, the findings indicating that DHEA is probably involved in suppression of the LH fraction. 相似文献
We report a case of infectious endocarditis in a 77-year-old woman who was undergoing maintenance hemodialysis therapy, and
who was also having a prosthetic aortic valve replacement. The disease resulted from a local skin infection at the needle
puncture site of the arteriovenous fistula. Ampicillin-resistant Staphylococcus aureus was the causal organism. Surgical treatment could not be performed because of associated intracranial hemorrhage due to septic
embolism. In spite of intensive treatment with several antibiotics, a ventricular septal abscess just beneath the prosthetic
aortic valve progressed to form a ventricular septal fistula. The resultant intracardiac left-to-right shunt led to refractory
congestive heart failure. The patient finally died of heart failure. The formation of a ventricular septal fistula is considered
to be a rare and extraordinary complication of infectious endocarditis in a hemodialysis patient with aortic valve replacement.
Received: July 25, 2001 / Accepted: November 3, 2001 相似文献
The author reports a complicated recurrence of genital tract fistula. The initial vesicovaginal fistula resulted from obstructed
labor, which was subsequently surgically managed without success. The patient had a recurrent vesicovaginal fistula that was
formed by the erosion of vesical stones through the anterior endopelvic fascia into the vagina. The stones eventually eroded
into the rectum, resulting in the formation of a complex vesicovaginal and rectovaginal fistula. 相似文献
Esophageus or gaster resection in patients with malignant disease is still a treatment of choice. It is obvious that each surgical procedure in these patients carries some possibility of complications. Esophageo-gastric or esophageo-jejuno anastomosis has a 4-27% frequency of fistula occurrence. All these result in 65% mortality in cases of poorer prognosis. The aim of this paper is not to present all types of complications but to objectively analyse the usefulness of the covered stent placement in the treatment of anastomotic fistulas. We present six patients who were treated for postoperative fistula of esophageo-gastric anastomosis (1 case) or esophageo-jejuno anastomosis (5 cases). All patients were treated with stapler suture for digestive tract reconstruction after malignancy removal during the primary surgical procedure. Signs and symptoms of suture leak between 5-8 days post-surgery were observed. Conservative therapy was not effective. Thus a new method of treatment was employed - covered stent placement. The procedure was performed under X-ray control. In all treated patients there was change for the better and quick reduction of secretion from the fistulas was observed. All patients were discharged from the department after several days and all had survived at 30 days follow-up. Covered esophageal stent placement seems to be a safe and promising method of treatment for patients with anastomotic fistula which significantly reduces mortality and improves quality of live. Our experiences confirms that of other investigators. 相似文献
Background Surgical procedures enhance production of pro- and anti-inflammatory cytokines and angiogenic factors that play a pivotal
role in the immunological response to surgical trauma and take part in the pathogenesis of tumor growth and adhesions formation.
The purpose of the study was to access the influence of low-pressure CO2 pneumoperitoneum on the inflammatory and angiogenic responses during the postoperative period after laparoscopy.
Methods The study group consisted of 40 patients, operated on due to cholelithiasis using standard-pressure (n = 20) and low-pressure (n = 20) CO2 pneumoperitoneum. Serum concentration of interleukin (IL)-6, IL-8, IL-10, vascular endothelial growth factor (VEGF)-A, and
endostatin were measured before and at 6, 24, and 48 h after surgery with commercially available enzyme-linked immunosorbent
assay (ELISA).
Results Concentrations of IL-6 increased significantly after the operations in both groups. No differences were observed between the
groups in regards to IL-6, IL-8, and IL-10 levels. Concentrations of VEGF-A measured at 6 and 48 h were significantly lower
in patients who underwent laparoscopies performed with low-pressure pneumoperitoneum. No significant variations were observed
in endostatin serum concentration. Concentrations of the studied parameters were not influenced by duration of surgery or
by age, gender, or body mass index (BMI) of the patients.
Conclusions The results obtained in our study do not show any significant differences between studied operative procedures with regards
to systemic inflammatory response. Changes in the concentrations of VEGF-A and endostatin observed in the studied population
may suggest this technique is more favorable with regards to angiogenesis process intensity, along with all its consequences
and implications. 相似文献
Perianal mucinous adenocarcinoma is a rare tumour which may be associated with long‐standing chronic perianal sepsis. Early diagnosis is challenging and is based on a high index of clinical suspicion and specific histological features. Definitive treatment is surgical, in the form of an abdomino‐perineal resection. We hereby describe a case of a perianal mucinous adenocarcinoma arising from long‐standing recurrent perianal fistula and complement this with a brief review of the literature pertaining in particular to the management of this condition. 相似文献