VARICOCELE IS ASSOCIATED WITH ELEVATED SPERMATOZOAL REACTIVE OXYGEN SPECIES PRODUCTION AND DIMINISHED SEMINAL PLASMA ANTIOXIDANT CAPACITY

PURPOSE: Because varicocele is seen often in infertile men and oxidative stress has been implicated in sperm dysfunction, we assessed spermatozoal reactive oxygen species and seminal total antioxidant capacity in men with and without varicocele. MATERIALS AND METHODS: Levels of reactive oxygen species and total antioxidant capacity were measured in the semen of 21 infertile men with varicocele, 15 men with incidential varicocele and 17 normal donors without varicocele (controls). Men with leukocytospermia (more than 1 x 10(6) white blood cells per ml.) were excluded from study. Reactive oxygen species were measured in washed spermatozoa with a luminol dependent chemiluminescence assay. Total seminal antioxidant capacity was measured with an enhanced chemiluminescence assay, and the results were expressed as trolox equivalents. Sperm characteristics were assessed with a computer assisted semen analyzer, and sperm morphology was assessed using World Health Organization and Kruger's strict criteria. RESULTS: Patients with varicocele had significantly higher reactive oxygen species levels than controls (p = 0.02). Reactive oxygen species levels did not differ significantly between infertile and men with incidental varicocele. Total antioxidant levels were significantly lower among men with varicocele (p = 0.02) and those with incidental varicocele compared to controls (p = 0.05). Reactive oxygen species and total antioxidant capacity levels did not correlate in any group. CONCLUSIONS: Our results suggest that elevated reactive oxygen species and depressed total antioxidant capacity levels are associated with varicocele. These changes may be related to functional sperm abnormalities and infertility seen commonly in these patients. These findings support a possible rationale for controlled clinical trials of antioxidant supplementation in infertile men with varicocele.     

PATIENT CHARACTERISTICS ASSOCIATED WITH VASECTOMY REVERSAL

PURPOSE: More than 30 million couples throughout the world are using vasectomy as a method of birth control. It is estimated that up to 6% of men who undergo voluntary sterilization will eventually request reversal, despite the high cost and relatively low success rate of the procedure. We identified characteristics that predict which vasectomy patients may request reversal. We also examined the cost and effectiveness of pre-vasectomy sperm cryopreservation followed by intrauterine insemination as an alternative method of achieving pregnancy. MATERIALS AND METHODS: We reviewed medical charts of 365 patients who underwent vasectomy and 290 who underwent vasectomy reversal between 1990 and 1997. Data were collected on patient age at the time of vasectomy, religion, occupation, wife employment status, number of marriages, number of children, reason for reversal, and number of years between vasectomy and reversal. Based on previously reported values, pregnancy rates and cost per successful pregnancy were estimated for vasectomy reversal surgery, and compared with a calculated cost per pregnancy for sperm cryopreservation and intrauterine insemination. RESULTS: Patient factors significantly associated with increased vasectomy reversal included younger age at time of vasectomy (p < 0.001) and a wife who worked outside the home (p < 0.001). Vasectomy reversal occurred 12.5 times more often (95% confidence interval [CI] 7.6 to 20.7) in men who underwent vasectomy in their 20s than in men who were older. Men whose wives were not employed requested reversal 0.48 times as often (95% CI 0.33 to 0.71) as those whose wives worked. Men who were younger at vasectomy tended to wait longer before reversal (median 10 years) than other patients (p < 0.001). At 10 years our calculated pregnancy rates and cost per pregnancy were 44% and $12,727 for vasectomy reversal, and 41% and $9,512 for intrauterine insemination with banked sperm (3 attempts). CONCLUSIONS: Patients who requested vasectomy reversal most often chose voluntary sterilization at a younger age. We believe that younger men should be given better pre-vasectomy counseling. However, the success rate and cost-effectiveness of sperm cryopreservation before vasectomy, with subsequent intrauterine insemination, may make this nonsurgical alternative desirable for younger couples who choose vasectomy even when properly informed about reversal rates.     

精浆催乳素浓度与精子计数、活动率的关系

对107例男性进行精液分析并测定其精浆催乳素(PRL)浓度,精子活动率和精子密度正常男性的精浆PRL为11.53±5.36ng/ml,与精子活动率正常而少精子的男性相比(13.06±4.62ng/ml),两组间无显著性差异(t=0.91,t>0.2);而精子密度正常、正常精子活率组和低活率组相比,低活率组的精浆PRL水平(17.24 ±5.86ng/ml)明显增高(t=4.15,P<0.001).相关分析表明精浆PRL与精子活动率呈负相关(r=-0.38,P<0.001);与精子密度亦呈负相关(r=-0.37,P<0.001).49例受试者取精液前抽血测定血清PRL水平,精浆PRL水平与血清PRL无关(r=0.204,P>0.1).     

INCREASED CARBON DIOXIDE PRODUCTION IN TWO PATIENTS WITH MALIGNANT HYPERPYREXIA AND ITS CONTROL BY DANTROLENE

Two patients with successfully treated malignant hyperpyrexiaare reported. Carbon dioxide output, calculated from the respiratoryminute volume and P_CO2 was found to be greatly increased inboth patients. In the patient who received dantrolene 7.5 mgkg^–1 the carbon dioxide output decreased rapidly to normalvalues, whereas in the other patient carbon dioxide output remainedincreased for several hours.     

LOW VENTILATORY RESPONSE TO CARBON DIOXIDE NOT ASSOCIATED WITH INCREASED DEPRESSION BY MORPHINE

Ventilation (E), end-tidal (P')_co2 mixed venous Pco₂ (P_co2andthe ventilatory response to carbon dioxide (E/Pco₂) were measured before and within 90 min asgtermorphine 0.15 mg kg^–1 i.m. given to 17 adult patientsundergoing elective surgery under general anaesthesia. The hypothesisthat pastients with a low ventilastory response to carbon dioxideare more susceptible to the ventilatory depressant effecstsof morphine was tested. Morephine induced increases in PE'_co2andP_co2 were not correlasted witheither the slope or the position of the preinjection responseto carbon dioxide. Mean E/Pco₂was depressed after morphine (P <0.05), but individual responsesvaried widely. Seven pastients whose control E/Pco₂ was 9.9 litre min^–1kPa^–1 or lessdecreased E/Pco₂ after morphine.In four patients, E/Pco₂ increasedafter morphine; however, in each case, PE'co₂ and Pco₂ increased also. Morphine disphine displaced thecarbon dioxide response to the right (P < 0.001) but no correlationwas found between either the magnitude of the displacement orchange in slope and control E/Pco₂.The results suggest that patients with a low value for E/Pco₂ are not more susceptible tothe ventilatory depressant action of morphine.     

钙超载与氧自由基：镉致离体肾小管上皮细胞损伤中的作用及联系

钙超载与氧自由基机制是细胞发生损伤的两大重要分子学机制。本文以离体肾小管上皮细胞为研究对象，重金属隔为损伤因素，着重探讨了镉致肾小管损伤中钙超载及氧自由基双重损伤机制的各自作用及联系，此外，尚观察了中药三七皂甙对上述机制的可能影响。结果发现，当镉与肾小管上皮细胞共同孵育后，［Ｃａ＾＋＋］ｉ及脂质过氧化代谢产物明显升高，氧自由基清除酶活力下降，提示钙超载机制及氧自由基机制共同参与了镉致肾小管上皮细胞     

PREDICTED AND MEASURED OXYGEN CONCENTRATIONS IN THE CIRCLE SYSTEM USING LOW FRESH GAS FLOWS WITH OXYGEN SUPPLIED BY AN OXYGEN CONCENTRATOR

An oxygen concentrator based on a zeolitic molecular sieve hasbeen used to supply piped oxygen in a District General Hospital;such oxygen contains 5% argon. If concentrator oxygen is usedin the closed circuit, argon accumulates. The present investigationdefines the extent and time course of argon accumulation inpartially and fully closed breathing systems. A theoreticalmodel is presented which predicts the extent and rate of inertgas accumulation. The predictions have been tested in a volunteerunder laboratory conditions and in five anaesthetized patients.It is recommended that concentrator oxygen may be used for lowflow anaesthesia of indefinite duration, provided the freshoxygen flow to the circuit is at least twice the oxygen consumption.If the circuit is totally closed, periodic opening of the circuitis necessary.     

POSTOPERATIVE MULTIPLE ORGAN DYSFUNCTION SYNDROME ASSOCIATED WITH GUT MUCOSAL HYPOPERFUSION, INCREASED NEUTROPHIL DEGRANULATION AND C1-ESTERASE INHIBITOR DEPLETION

We have examined the relationship between gut mucosal perfusion,as determined by gastric intramucosal pH (pHi), changes in plasmaneutrophil elastase concentrations and components of the contactsystem during elective major surgery and related these findingsto patient outcome. Of the 26 patients studied, 16 developedgut mucosal hypoperfusion (pHi<7.32) by the end of surgery;four of these developed multiple organ dysfunction syndrome;three of these died. In this group there was a significant increasein neutrophil elastase (P<0.005) and significant reductionsin plasma components of the contact system from immedi atelybefore surgery to 24 h later. Ten patients maintained gut mucosalperfusion (pHi     

RHABDOMYOLYSIS, MYOGLOBINURIA AND HYPERPYREXIA CAUSED BY SUXAMETHONIUM IN A CHILD WITH INCREASED SERUM CREATINE KINASE CONCENTRATIONS

Rhabdomyolysis, myoglobinuria, hyperpyrexia, muscle weaknessand stiffness occurred in a 4-yr-old boy after halothane anaesthesiaand a single dose of suxamethonium. Neurological examinationof the patient and his mother revealed no physical abnormalityalthough in both the serum creatine kinase and lactic dehydrogenaseconcentrations were increased. McArdle's disease was excludedby a normal response to an ischaemic work test.     

PORTAL VEIN THROMBOSIS ASSOCIATED WITH RECTAL BLEEDING: NON-INVASIVE DIAGNOSIS AND FOLLOW UP BY ULTRASOUND

A 65 year old woman presented with a sudden onset of abdominal pain and bright rectal bleeding. Shortly after admission a diagnosis of partial portal vein thrombosis was made by ultrasonography. This thrombosis appeared to be the first sign of a previously unsuspected hypercoagulable state due to polycythaemia rubra vera. Ultrasound proved useful in confirming complete resolution of the portal system thrombosis in response to conservative therapy.     

臀肌挛缩合并骨盆倾斜肢体不等长的修复

目的 探讨臀肌挛缩合并骨盆倾斜肢体不等长的发病机制、诊断和治疗方法。方法 回顾性分析1990年1月～2004年12月收治的132例臀肌挛缩合并骨盆倾斜双下肢不等长患者的临床特点并随访其疗效。其中男73例，女59例，年龄5～26岁，平均11岁。均表现为不对称性臀肌挛缩，单侧37例，双侧95例。明显跛行89例，明显双下肢不等长78例；X线片示骨盆倾斜97例，股骨颈干角增大11例。采用经大转子后外侧纵弧形切口行臀肌松解术配合双下肢皮肤牵引及运动锻炼治疗。结果 术后双下肢相对长度等长118例，相差0．5～1．5cm 13例，相差3cm 1例。综合治疗后获随访3个月～14年，根据刘国辉等疗效评定标准，优118例，良13例，差1例，治愈率99．2％。结论 臀肌挛缩合并骨盆倾斜双下肢不等长是双下肢臀肌挛缩程度不对称的结果。采用大转子后外侧纵弧形切口行臀肌松解术配合双下肢皮肤牵引、运动锻炼是治疗臀肌挛缩合并骨盆倾斜双下肢不等长的一种有效方法。     

输精管结扎干扰前列腺增生过程的机制探讨——精浆睾酮双氢睾酮的放射免疫测定

本文应用放射免疫测定的方法检测了13例输精管结扎后(平均15.3年,平均年龄50岁)的男性精浆双氢睾酮和睾酮的浓度,另取同年龄组男性13例作为对照。结果表明,精浆睾酮在结扎组(374.54p/ml)和正常对照组(315.64Pg/ml)中没有明显差异,而结扎组精浆中双氢睾酮(46.21pg/ml)却明显低子对照组(184.27pg/ml(p<0.01)。作者认为,输精管结扎对精浆DHT有长期影响,这可能是其对前列腺增生过程产生抑制作用的原因之一。