Endocrine Stress Response during General and Epidural Anaesthesia for Elective Caesarean Sections

In 17 patients scheduled for elective caesarean sections, the influence of general (GA, n = 9) and epidural anaesthesia (EA, n = 8) on maternal and umbilical vein blood plasma concentrations of ACTH, Cortisol, 17-α-hydroxyprogesterone (OHP) and blood glucose (BG) was studied. Mean blood pressure (MBP mmHg) and heart rate (HR beats min^-1) were also followed during the operation and Apgar scores were evaluated in all neonates. With epidural anaesthesia, an MBP of 102±6.5 mmHg and an HR of 87 ±4.9 beats min^-1 was found at hysterotomy (HT). With general anaesthesia, the corresponding values were 143 ±6.9 mmHg (P<0.01) and 108 ±6.3 beats min^-1 (P<0.05). The plasma concentration of ACTH at HT was higher during GA than during EA (P<0.01), while the plasma concentration of Cortisol during GA was higher 30 min alter HT (P<0.05). Maternal ACTH and Cortisol levels at HT were higher than umbilical vein levels, while OHP was 2–3 times higher in the umbilical vein than in maternal blood at HT. Umbilical vein Cortisol concentration was higher in the EA than in the GA group (P<0.01). With epidural anaesthesia, neonates had higher Apgar scores than with general anaesthesia (P<0.01). The increased umbilical vein Cortisol concentration with epidural anaesthesia challenged the assumption of a higher fetal stress response. The results might have a bearing on the choice of the most suitable anaesthetic method in complicated pregnancies.     

Pituitary microadenomas: Surgical results and morphological findings

Summary The results of transsphenoidal microsurgery in treating 22 patients with pituitary microadenomas are reported. Histological and ultrastructural comparative studies were performed in attempting to obtain a more accurate morphological classification of pituitary microadenomas.     

ADVANCED BREAST CANCER: RESPONSE TO HIGH DOSE ORAL MEDROXYPROGESTERONE ACETATE

We treated 105 patients with advanced breast cancer, using the progestational agent medroxyprogesterone acetate (MPA), 200 mg orally tds in a non-randomised trial. In general they were a poor risk population, since 78 had received prior endocrine therapy (21 more than one type) and 58 prior chemotherapy. Treatment was well tolerated. Side effects included weight gain, muscle cramps, fine tremor and fluid retention, but these were usually mild, resolved if the dose of drug was reduced, and only one patient stopped treatment because of toxicity. Seventeen patients died within six weeks of starting MPA, and disease progression occurred in a further 58. Nine have had stable disease for periods ranging from two to 11 months, and there were 21 who showed disease regression. Response to treatment continues in 13 of these patients, and at the time of writing the median duration of response is 10 months. Response rates were similar in pre- and post-menopausal patients. The dose of MPA was doubled to 400 mg tds in 16 patients whose disease had progressed on 200 mg tds, but no additional responses were seen in this group. Seven out of 24 (29%) patients who had not received prior endocrine therapy responded to high dose oral MPA, a response rate similar to that seen following other hormonal manipulations, but because the drug also has activity against hormone-resistant tumours and is well tolerated, it should have a role in the treatment of advanced breast cancer.     

The effects of cortisol supplementation on the metabolic and hormonal response to surgery

Summary. The role of Cortisol in determining the metabolic and hormonal changes associated with a standardized surgical operation was investigated. Twelve patients undergoing pelvic surgery were studied. Six received steroid supplementation with an infusion of hydrocortisone sodium succinate at a rate of 8 mg/h for 24 h, together with 1·5 g hydrocortisone acetate intraperitoneally at the completion of surgery, while the remainder acted as a control group. Steroid supplementation resulted in plasma Cortisol values in the range 1913–2265 nmol/1 from 4 to 24 h after the start of surgery. However, this marked hyper-cortisolaemia had no significant effects on circulating metabolites other than glucose, and did not alter plasma ACTH, GH and insulin values. The usual glycaemic response to surgery was significantly augmented by 1·0–1·5 mmol/1 in the cortisol group. We conclude that changes in substrate mobilization observed after cortisol administration in normal volunteers may not accurately predict the effects found after surgery, when catabolic hormones and other modulators such as interleukin-1 may influence metabolism.     

The relationship of endocrine cells, dysplasia and carcinoembryonic antigen in Barrett''s mucosa to adenocarcinoma of the oesophagus

This study was undertaken to assess the prevalence and characteristic hormonal profile of endocrine cells in Barrett's mucosa and to determine to what extent this profile was shared by endocrine cells of adenocarcinomas arising therefrom. In addition, lower oesophageal carcinomas, not associated with columnar metaplasia, were examined to see if they exhibited a different hormonal profile. The patients studied comprised 43 who had had multiple oesophageal biopsies. 35 who had had oesophagogastric resection for adenocarcinoma arising in Barrett's mucosa and 26 in whom the resection showed no metaplastic epithelium adjacent to tumour. Argyrophil cells were present in 90% of biopsies and resections of Barrett's mucosa combined, irrespective of the histological type of metaplastic epithelium. By immunocytochemistry the most frequently identified substance in mucosal endocrine cells was serotonin (82%) followed by somatostatin (54%), secretin (22%) and pancreatic polypeptide (17%). Gastrin, bombesin, cholecystokinin, ACTH and substance P were not identified in metaplastic mucosa in any case. The difference in expression of serotonin by endocrine cells of tumours arising in Barrett's mucosa (31%) and those not (3.8%) was statistically significant (P less than 0.0186). Carcinoembryonic antigen (CEA) was demonstrated in 60% of oesophageal carcinomas, both endocrine positive and endocrine negative. Focal CEA expression was seen in 4.6% of biopsies and 14% of Barrett's mucosa adjacent to tumour. These results indicate a higher prevalence of endocrine cells in Barrett's mucosa than hitherto documented and suggest that serotonin may be a useful marker in distinguishing between primary oesophageal and putative gastric cancers at the gastro-oesophageal junction. The identification of CEA in oesophageal columnar epithelium is of little value in predicting the development of malignancy.     

80m氦氧饱和-100m巡回潜水前后内分泌的变化

80m氦氧饱和—100m巡潜作业是我国饱和潜水技术由实验室模拟试验进入海上作业的首次实践。本文通过对潜水员氦氧饱和潜水前后诸项内分泌指标测定,发现GH、LH/FSH、F、17-OHCS、17-KS均较潜水前显著增高。引起上述变化的主要因素是机体对水下环境的各种物理、化学、生物因素,特别是静水压、高气压下各种气体分压及环境低温等所产生的生理和心理方面的应激性反应,进而说明潜水员进入高压环境后出现的心率减慢、心律紊乱和ST-T段的可逆性改变亦是上述应激反应的结果。     

~(153)Sm EDTMP combined with endocrine therapy for treatment of prostatic cancer bone metastasis

~(153)Sm EDTMP combined with endocrine therapy for treatment of prostatic cancer bone metastasis     

应激对女性生殖内分泌疾病影响的研究进展

躯体和心理应激均能抑制或损害女性生殖内分泌功能.该文就近几年应激对女性月经、经前期综合征,女性生育能力及围绝经期综合征、高泌乳素血症等生殖内分泌疾病影响的研究作以综述.     

低铅染毒对大鼠脂质过氧化作用的影响

目的 探讨长期低铅染毒对大鼠内分泌脂质过氧化作用及超氧化歧化酶活性的影响。方法 将40只大鼠随机分成4组，分别给予含有不同剂量的铅饲料8周，测定并分析大鼠染毒后血中、甲状腺、胰腺组织中的铅含量、MDA、T-SOD、CAT、GSH-Px含量，并进行相关分析。结果 各组血铅随染铅剂量升高而升高；甲状腺、胰腺组织中的MDA含量随染铅剂量升高而升高，并与血铅浓度呈正相关；而甲状腺、胰腺组织中的T-SOD和GSH-Px含量随染铅剂量升高而下降，并与血铅浓度呈负相关；甲状腺、胰腺组织中的CAT与染铅剂量无关。结论 慢性铅中毒增强机体的脂质过氧化作用，降低机体抗氧化酶系活力，可能参与了体内某些内分泌功能和组织学的损害机制。     

氟对雄性大鼠生殖系统的内分泌干扰作用研究

目的　探讨高氟对雄性大鼠生殖系统的内分泌干扰作用。方法　给予雄性Wister大鼠含氟化钠 15 0mg/l的水 10周后 ,检测其精子计数、活动率、畸形率 ,测定睾丸、附睾生化标志酶和性激素 ,观察睾丸组织病理改变。结果　染毒组精子计数、活动率下降 ,畸形率升高 ,血清睾酮、促黄体生成激素下降 ,较对照组差异有统计学意义 (P <0 .0 5 ) ,睾丸组织有明显的病理学改变。结论　长期接触高浓度的氟对雄性生殖系统有明显的内分泌干扰作用