Experimental and immunohistochemical studies on the possible role of parathyroid hormone in uraemic pruritus

Secondary hyperparathyroidism has been suggested as a cause of itching in chronic renal failure. The aim of the present study was to evaluate the possible role of parathyroid hormone (PTH) in pruritus affecting patients undergoing maintenance haemodialysis. In agreement with our previous findings, patients with pruritus had significantly (P less than 0.01) higher serum levels of PTH fragment 53-68 (m-PTH53-68) than patients without pruritus, 47.7 +/- 40.0 and 23.4 +/- 17.1 micrograms l-1 respectively. Serum concentrations of other substances including calcium, phosphate and magnesium did not differ between the two groups of patients. Intradermal injections of human PTH1-34 and PTH44-68 failed to evoke any acute or delayed cutaneous reactions in either patients or controls. Immunohistochemical investigations of skin biopsies from uraemic patients using several different antibodies against PTH were negative. Thus, the present results do not support PTH as a peripheral mediator of uraemic itching.     

The effect of hysterectomy on ano-rectal physiology

Hysterectomy is associated with severe constipation in a subgroup of patients, and an adverse effect on colonic motility has been described in the literature. The onset of irritable bowel syndrome and urinary bladder dysfunction has also been reported after hysterectomy. In this prospective study, we investigated the effect of simple hysterectomy on ano-rectal physiology and bowel function. Thirty consecutive patients were assessed before and 16 weeks after operation. An abdominal hysterectomy was performed in 16 patients, and a vaginal procedure was performed in 14. The parameters measured included the mean resting, and maximal forced voluntary contraction anal pressures, the recto-anal inhibitory reflex, and rectal sensation to distension. In 8 patients, the terminal motor latency of the pudendal nerve was assessed bilaterally. Pre-operatively, 8 patients were constipated. This improved following hysterectomy in 4, worsened in 2, and was unchanged in 2. Symptomatology did not correlate with changes in manometry. Although, the mean resting pressure was reduced after hysterectomy (57 mmHg– 53 mmHg, P = 0.0541), the maximal forced voluntary contraction pressure was significantly decreased (115 mmHg – 105 mmHg, P = 0.029). This effect was more pronounced in those with five or more previous vaginal deliveries (P = 0.0244, n = 9). There was no significant change in the number of patients with an intact ano-rectal inhibitory reflex after hysterectomy. There was no change in rectal sensation to distension, and the right and left pudendal nerve terminal motor latencies were unaltered at follow-up. Our results demonstrate that hysterectomy causes a decrease in the maximal forced voluntary contraction and pressure, and this appears to be due to a large decrease in a small group of patients with previous multiple vaginal deliveries. Accepted: 10 February 1998     

Tuberculous anal ulcer

Two patients with anorectal tuberculosis, without prior or concurrent knowledge of active pulmonary infection with mycobacteria, are described. Anal fissure in an unusual location which is slow to heal should have a biopsy performed, with appropriate stains and cultures carried out, to rule out tuberculous disease. Chemotherapy is then highly effective for ulcerative perianal tuberculosis     

主灶切开挂线支管旷置加中药坐浴治疗高位复杂性肛瘘临床研究

目的：观察主灶切开挂线、支管旷置加中药坐浴治疗高位复杂性肛瘘的临床疗效。方法：74例高位复杂性肛瘘患者随机分为对照组36例和治疗组38例。治疗组采用主灶切开挂线、支管旷置加中药坐浴疗法,对照组采用切开挂线加PP水坐浴。观察两组治愈率、复发率、疼痛程度、持续时间、平均疗程及肛门功能。结果：两组近期治愈率均100%;一次性治愈率治疗组为97.4%,对照组为91.6%,两组一次性治愈率比较,差异有统计学意义（ P<0.05）。随访2 a,治疗组复发率为2.6%,对照组为8.3%,两组比较,差异有统计学意义（P<0.05）。治疗组疼痛程度、持续时间、平均疗程及肛门功能评价均优于对照组（P<0.05）。结论：主灶切开挂线、支管旷置加中药坐浴疗法治疗高位复杂性肛瘘,既有愈合快、复发率低、瘢痕小等优点,又能保护肛门括约肌功能。     

陈旧性肛裂手术两种麻醉方法效果比较

为了为陈旧性肛裂手术患者寻求一种安全有效的麻醉方法,对122例陈旧性肛裂患者分别在骶管麻醉（治疗组,62例）或局部麻醉（对照组,60例）下行手术治疗,跟踪观察麻醉止痛效果和肛门松弛效果。结果显示,（1）麻醉止痛效果：治疗组显效59例（95．2％）,有效3例（4．8％）,无效0例;对照组显效21例（35．0％）,有效39例（65．0%）,无效0例;治疗组显效率明显高于对照组,P〈0．05。（2）麻醉后肛门松弛效果：治疗组显效59例（95．2％）,有效3例（4．8％）,无效0例;对照组显效15例（25．0％）,有效39例（65．0％）,无效6例（10．0％）;治疗组显效率明显高于对照组,P〈0．05。结果表明,陈旧性肛裂患者骶管麻醉下手术安全可靠,止痛效果和肛门松弛效果好。     

创愈洗剂和贴剂在混合痔术后的应用

为观察创愈洗剂和贴剂在混合痔术后换药的临床疗效,将215例混合痔术后患者分为治疗组和对照组进行疗效观察。结果显示,治疗组在抗炎、镇痛、消肿、止血、促进创口愈合等方面优于对照组。创愈洗剂和贴剂可缩短创口愈合时间,治疗组和对照组优良率分别为72％和54％（P〈0．01）;止痛效果优良率分别为93．8％和76．5％（P〈0.01）。     

滴虫净洗剂的制备及临床应用

目的：介绍滴虫净洗剂的制备及临床应用。方法：根据临床验方自制滴虫净洗剂,并建立了性状、鉴别、检查质控项目,应用薄层色谱法对主要药物进行鉴别;临床用于治疗滴虫性阴道炎。结果：制荆可控,临床有效率96％。结论：滴虫净洗剂纽方合理,疗效满意。     

MicroRNA-15b is induced with E2F-controlled genes in HPV-related cancer

Background:

MicroRNAs (miRNAs) are important regulators of cellular processes and are found to be deregulated in many cancers. We here analysed the miRNA expression in anal carcinomas. In a previous study, we found that our anal carcinoma tumours were divided into two groups based on the expression of E2F-regulated genes. Therefore, we searched for miRNAs that could reproduce this grouping.

Methods:

A global screen of the miRNA population was performed using real-time quantitative PCR (RT–qPCR) array methods and differentially expressed miRNAs were identified. Real-time–qPCR was used to verify the expression levels of selected miRNAs and genes in a larger collection of biopsies. A siRNA-mediated knockdown of human papilloma virus (HPV)16 E7 in a cervical cell line was performed to assess the effect of E7 on miR-15b.

Results:

The grouping of tumours into two groups based on the expression of E2F-controlled genes was confirmed in a larger collection of anal carcinoma tumours. The expression of miR-15b was shown to be highly correlated with that of five selected E2F-induced genes (CCNA2, CCNB1, CCNB2, MSH6 and MCM7). A knockdown of HPV16 E7 resulted in decreased levels of miR-15b in Ca Ski cells.

Conclusion:

MiR-15b expression correlates with E2F-regulated genes in anal carcinoma and appears to be part of the E2F-regulatory network.     

What harm does a second delivery to the pelvic floor?

Objective

To compare the pelvic floor function of primiparous women to women after a second delivery regarding symptoms of urinary and anal incontinence, anal sphincter ruptures and bladder-neck mobility.

Methods

A questionnaire evaluating symptoms of urinary and anal incontinence was used in nulliparous women before and 27 months after childbirth. Furthermore these symptoms were correlated with functional changes of the pelvic floor based on a careful gynecologic examination as well as perineal and endoanal ultrasound.

Results

112 nulliparous women were included, 49 women returned for follow-up on average 27 months (SD 4.4 months) after the first delivery. 39 women (group A) had just one delivery, 10 women (group B - 10/49) had had a second delivery. Apart from levator ani muscle strength, no significant difference between pelvic floor function of group A vs group B was demonstrable. Furthermore, we could show no significant difference for symptoms of urinary (11 (28.2%) vs. 5 (50.0%)) and anal incontinence (14 (35.9%) vs. 4 (40.0%)) between both groups. However, we found a lasting increase of stress urinary and anal incontinence as well as overactive bladder symptoms after one or more deliveries. The position of the bladder neck at rest was lower in both groups compared to the position before the first delivery and bladder neck mobility increased after one or more deliveries.

Discussion

Our study shows several statistically significant changes of the pelvic floor function even on average 27 months after delivery, but a subsequent delivery did not compromise the pelvic floor any further.