输卵管结扎术后女性生殖内分泌功能的影响

本研究以放射免疫分析测定了云南省健康对照者和１３１例输卵管结扎术受术者术后３￣＃０年血清的６种生殖激素：ＦＳＨ、ＬＨ、ＰＲＬ、Ｅ２、Ｐ、Ｔ的水平。研究结果表明，无论是卵泡期还是黄体期，与健康对照相比较，无输卵管结扎后综合征（ＰＴＬＳ）的受术者，这些激素的差异无不显著，而有ＰＴＬＳ的受术者的差异均非常显著（Ｐ〈０．０１￣０．００１）。说明输卵管地扎术可使３４％受术者的性腺轴受到干扰，对生殖内分泌功能     

输精管精索部的应用解剖

目的：为输精管结扎术、吻合术的临床应用提供形态学基础。方法：选用３０具成人男性尸体对输精管精索部进行了解剖学观测。结果：输精管精索部位于精索后方，睾丸动脉位于中央，静脉位于最前方，生殖股神经生殖支位于输精管精索部外侧。输精管精索部长左侧７．６±２．９（５０～１１．３）ｃｍ；右侧７．３±３．２（５．２～１１．０）ｃｍ。其内径左、右侧均为０．６±０．１（０．４～０．８）ｍｍ。经统计学处理（Ｐ＞０．０５）左右侧均无显著性差异。结论：在输精管结扎术、吻合术手术时应注意保护输精管外侧的生殖股神经生殖支、输精管精索部管径小、壁厚、吻合成功率高。因管径小、术后不宜安放支架，以免术后引起管腔阻塞。     

部分老年性非甲状腺疾病甲状旁腺激素测定结果的分析

应用放射免疫法对２４８你非甲关腺疾病的老年患者进行了甲状旁激素（ＰＴＨ）的测定，并与正常对照组进行了比较。结果表明：８１名健康老人血清ＰＴＨ含量明显高于正常中青年人（Ｐ〈０．０１），其中女性差异十分显著（Ｐ〈０．０１）。老年高血压、肿瘤、糖尿病、脑梗塞、慢性肾衰、肺炎与老年健康组相比差异十分显著（Ｐ〈０．０１）。提示：血清ＰＴＨ测定对于进一步了解老年人的非甲状腺疾病对ＰＴＨ分泌的调节具有重要作用。     

α—MSH对家兔ET性发热反应及脑腹中隔区AVP含量的影响

目的：研究脑腹中隔区精氨酸加压素（ＡＶＰ）在α－黑素细胞刺激素（αＭＳＨ）解热机制中的作用。方法：建立家兔ＥＴ性发热模型，观察侧脑室注射α－ＭＳＨ对家兔ＥＴ性发热反应及脑腹中隔区ＡＶＰ含量的影响。结果：（１）静脉注射ＥＴ（０３μｇ／ｋｇ）引起家兔明显的发热反应（Ｐ＜０００１），并增加脑腹中隔ＡＶＰ含量（Ｐ＜００５）；（２）静脉注射ＥＴ（０３μｇ／ｋｇ）３０ｍｉｎ后，侧脑室注射α－ＭＳＨ（２００ｎｇ／只），能明显抑制家兔发热反应，同时脑腹中隔区ＡＶＰ含量进一步显著增高（Ｐ＜０００１）；（３）侧脑室注射α－ＭＳＨ（２００ｎｇ／只）并不影响家兔正常体温，但增加脑腹中隔区ＡＶＰ含量（Ｐ＜００５）。结论：α－ＭＳＨ的解热作用可能部分是通过腹中隔ＡＶＰ增多来实现的，αＭＳＨ可能是引起发热时脑腹中隔区ＡＶＰ含量增加的一个重要因素。     

DNA损伤修复与白血病存活关系的研究

本文以自发和ＭＭＣ诱发的ＳＣＥ值为指标，分析了临床完全缓解后白血病患者ＳＣＥ值的改变。结果显示，临床完全缓解８例患者自发ＳＣＥ值与正常对照无显著差异（Ｐ＞０．０５），ＭＭＣ诱发的ＳＣＥ值两组间差异极显著（Ｐ＜０．０１）。说明患者的染色体仍有潜在的不稳定性，应继续巩固治疗。临床完全缓解４、５年以上者，自发和诱发ＳＣＥ值与正常对照均无差异（Ｐ＞０．５），提示临床缓解时间长，遗传物质相对稳定。     

急性脑死HPA轴激素与胰腺内分泌变化的研究

目的：研究急性脑梗死（ＡＣＩ）下丘脑－垂体－肾上腺（ＨＰＡ）轴激素与胰腺内分泌的变化，以探讨其发病机理。方法：采用施放免疫分析法（ＲＩＡ）分别对１５１例ＡＣＩ患者进行ＣＲＨ（促肾上腺皮质激素释放激素）、ＡＣＴＨ（促肾上腺皮质激素）、ＣＳ（皮质醇）、ＩＮＳ（胰岛素）及ＧＬＣ（胰高血糖素）入院时始发状态血液检测，并与６０例年龄相仿健康人组作对照。结果：ＡＣＩ者轴激素显著高于健康正常人组（Ｐ〈０．０１～     

儿童正中神经刺激的体感诱发电位正常值及其特点

对３０例８～１４岁健康儿童，在Ｃ＿７处体表及对侧大脑皮层相应体感区（Ｃ＿３或Ｃ＿４）记录正中神经刺激诱发的体感诱发电位（ＳＥＰ＿ｓ）。测定了短潜伏期ＳＥＰ＿ｓ各波峰潜伏期及波间期，计算了自腕部到Ｅｒｂ点和腕部到Ｃ＿７段的外周神经传导速度。上述各指标两侧值均无显著差异。回归分析表明，各波峰潜伏期与身高（或臂长）呈正线性相关（ｒ＝０．６０～０．７１，Ｐ＜０．０１～０．０５），但与年龄、体重无关；各波间期与身高、年龄、体重均无相关关系。故ＳＥＰ＿ｓ各波峰潜伏期正常值应按它与身高（或臂长）的直线回归方程确定。     

早熟素—Ⅱ对长角血蜱生殖的影响

用长角血蜱饱血后３ｄ雌虫，点滴不同剂量的早熟素Ⅱ（Ｐ－Ⅱ），研究其对蜱生殖的影响。发现５μｇ／蜱剂量对产卵力和所产出的卵的孵化率无明显的影响２０、１００和２５０μｇ／蜱则与对照相比差异极显著（Ｐ＜０．００１）；同时研究了激素对Ｐ－Ⅱ（２０μｇ／蜱）生殖抑制的影响，发现５０μｇ／蜱ＪＨ类似物（ＪＨＡ）——法尼醇能解除Ｐ－Ⅱ生殖的抑制作用；５０μｇ／蜱法尼醇与２０μｇ／蜱２０－羟基蜕皮酮（２０－Ｅ）组合次之，２０－Ｅ单独处理则无解除作用     

脑血管疾病患者体液中SOD,MDA含量测定

本文对６７例脑卒中（脑梗塞４２例、脑出血２５）病人血清、红细胞、脑脊液、尿进行了超氧化歧化酶（ＳＯＤ）、丙二醛（ＭＤＡ）的含量测定。以３４名正常人相同样品作对照。结果：脑卒中患者各标本中ＳＯＤ的含量显著低于对照组（Ｐ〈０．０５￣０．０１），ＭＤＡ含量显著高于对照组（Ｐ〈０．０５）￣０．０１）；脑卒中急性期ＳＯＤ含量低于恢复期，ＭＤＡ含量高于恢复期，具有显著差异（Ｐ〈０．０５）；且脑出血患者血清、红     

摘除小鼠颌下腺其附睾内精子数的变化

为观察１４周龄雄性昆明种小白鼠施行颌小腺摘除后１～６周附睾内成熟精子数量的变化，取小鼠４８只，随机分成１２组，其中６组行颌下腺摘除手术，其余为对照。结果表明，颌下腺摘除后第４周开始，附睾内精子数量呈显著减少趋势，第５和第６周的精子数分别为０．５６±０．２６×１０７和０．５０±０．１３×１０７，与对照相比分别有显著差异（Ｐ＜０．０５）和非常显著差异（Ｐ＜０．０１）。摘除颌下腺手术后５周内小鼠的体重与对照相比无显著变化，但第６周的体重下降有明显的统计学差异（Ｐ＜０．０１）。     

Ectopic pregnancy after tubal sterilization

We report 13 cases of ectopic pregnancy following tubal ligation out of 287 ectopic pregnancies seen during a six year period (1984-1989). These findings suggest that tubal sterilization does not invariably confer infertility. Ectopic pregnancy must not be disregarded in women who have undergone tubal ligation, especially if two or more years have elapsed since the sterilization.     

Assessing tubal patency with transvaginal salpingosonography after the reversal of tubal ligation for female sterilization

The objective of this study was to assess tubal patency usingtransvaginal salpingosonography (TSSG) among women treated bytubal ligation after sterilization and to compare these resultswith those obtained using X-ray hysterosalpingography (HSG).Twenty-one healthy women were recruited. Air was used as a contrastmedium in TSSG and Omnipaque® as a water-soluble contrastmedium in the HSG examination. All women underwent at leastone TSSG. If the woman did not become pregnant during the follow-upor had a miscarriage or tubal pregnancy, she was re-examinedwith a second TSSG and the results were compared with thoseof HSG undertaken during the same menstrual cycle. Because ofthe high pregnancy rate the final number of patients was reducedto 10. The observed agreement between the two TSSGs was 70%,which was low compared with our earlier results. The kappa coefficientwas only 0.41. The sensitivity of TSSG for the detection oftubal occlusion was 54%. This can be explained by the fact thatthe mean time interval between the two TSSGs was long (5.5 months)and results were not therefore comparable or repeatable. Wecan conclude that the women with patent tubes became pregnantafter the first TSSG while the women taking part in the secondTSSG had impaired tubal function. There were more occluded tubesobserved in the second TSSG than in the first. An analysis comparingthe second TSSG with HSG produced better results. The observedagreement was 84%, kappa coefficient 0.67, demonstrating a goodreproducibility of TSSG; the sensitivity of TSSG for the detectionof tubal occlusion was 83%, specificity 85%, positive predictivevalue 91% and negative predictive value 75%. Thus, TSSG shouldbe regarded as a reliable, rapid, safe and inexpensive methodfor testing tubal patency after reversal of tubal ligation forsterilization. It also allows simultaneous scanning of the uterinecorpus, endometrium and ovaries and may have a clearing actionon occluded tubes. TSSG can thus replace X-ray HSG in the primaryevaluation of tubal status, even in this special group of patients.     

Prediction of endometriosis with serum and peritoneal fluid markers: a prospective controlled trial

BACKGROUND: The objective of this prospective controlled trial was to investigate the ability of a group of serum and peritoneal fluid (PF) markers to predict, non-surgically, endometriosis. METHODS AND RESULTS: Serum and PF samples were obtained from 130 women while undergoing laparoscopy for pain, infertility, tubal ligation or sterilization reversal. Concentrations of six cytokines [interleukin (IL)-1beta, IL-6, IL-8, IL-12, IL-13 and tumour necrosis factor (TNF)-alpha] were measured in serum and PF, and reactive oxygen species (ROS) in PF, and levels were compared among women who were allocated to groups according to their post-surgical diagnosis. Fifty-six patients were diagnosed with endometriosis, eight with idiopathic infertility, 27 underwent tubal ligation or reanastomosis (control group) and 39 were excluded due to bloody PF. Only serum IL-6 and PF TNF-alpha could be used to discriminate between patients with and without endometriosis with a high degree of sensitivity and specificity (P < 0.001). A threshold of 15 pg/ml PF TNF-alpha provided 100% sensitivity and 89% specificity (positive likelihood ratio of 9.1 and negative likelihood ratio of 0). A threshold of 2 pg/ml for serum IL-6 provided a sensitivity of 90% and specificity of 67% (positive likelihood ratio of 2.7 and negative likelihood ratio of 0.14). CONCLUSIONS: By measuring serum IL-6 and PF TNF-alpha, it was possible to discriminate between patients with endometriosis and those without. Before these markers can be used as a non-surgical diagnostic tool, these data should be verified in a larger study.     

Chlamydia trachomatis infection increases fallopian tube PROKR2 via TLR2 and NFκB activation resulting in a microenvironment predisposed to ectopic pregnancy

Chlamydia trachomatis and smoking are major risk factors for tubal ectopic pregnancy (EP), but the underlying mechanisms of these associations are not completely understood. Fallopian tube (FT) from women with EP exhibit altered expression of prokineticin receptors 1 and 2 (PROKR1 and PROKR2); smoking increases FT PROKR1, resulting in a microenvironment predisposed to EP. We hypothesize that C. trachomatis also predisposes to EP by altering FT PROKR expression and have investigated this by examining NFκB activation via ligation of the Toll-like receptor (TLR) family of cell-surface pattern recognition receptors. PROKR2 mRNA was higher in FT from women with evidence of past C. trachomatis infection than in those without (P < 0.05), and was also increased in FT explants and in oviductal epithelial cell line OE-E6/E7 infected with C. trachomatis (P < 0.01) or exposed to UV-killed organisms (P < 0.05). The ability of both live and dead organisms to induce this effect suggests ligation of a cell-surface-expressed receptor. FT epithelium and OE-E6/E7 were both found to express TLR2 and TLR4 by immunohistochemistry. Transfection of OE-E6/E7 cells with dominant-negative TLR2 or IκBα abrogated the C. trachomatis-induced PROKR2 expression. We propose that ligation of tubal TLR2 and activation of NFκB by C. trachomatis leads to increased tubal PROKR2, thereby predisposing the tubal microenvironment to ectopic implantation.     

Human endometrial perfusion after tubal occlusion

We examined variations in human endometrial microvascular perfusion across one menstrual cycle in women who had undergone tubal ligation and did not report unusual menstruation. Endometrial red blood cell flux was monitored by laser Doppler fluxmetry via a fibreoptic probe atraumatically inserted transvaginally into the uterus of each of 13 conscious volunteers. The observations obtained have been compared with those previously reported from a matched control group of women [B.J.Gannon et al., Hum. Reprod., 12, 132-139 (1997)]. Women who had undergone tubal occlusion for sterilization exhibited greater endometrial perfusion during menstruation (cycle days 0-5), at the time of ovulation (cycle days 13-16) and in the late secretory phase (cycle days 23-28) than occurred in controls. In addition, vasomotion in the study group was lower than that in controls in the early and late secretory phase (cycle days 17-22 and 23-28). Tubal occlusion appeared to alter endometrial perfusion. It is possible that the reported menstrual changes in women following tubal ligation are a consequence of altered endometrial perfusion; a possible causative relationship is discussed.      

Peritoneal fluid leptin is associated with chronic pelvic pain but not infertility in endometriosis patients

BACKGROUND: Leptin influences the proinflammatory immune responses and has angiogenic activity in vitro and in vivo. The objective of this study was to evaluate the peritoneal fluid levels of leptin in patients with endometriosis and idiopathic infertility and compare them with a control group of tubal ligation/reanastomosis patients. METHODS: In this observational, prospective controlled study, peritoneal fluid from 108 women was obtained while they underwent laparoscopy for pelvic pain, infertility, tubal ligation or sterilization reversal. We measured the concentration of leptin in the peritoneal fluid and compared the levels among women who were divided into groups according to their post-surgical diagnosis. Sixty patients were diagnosed with endometriosis, 10 with idiopathic infertility and 38 had undergone tubal ligation or reanastomosis (control group). RESULTS: Peritoneal fluid leptin was significantly higher in endometriosis 14.62+/-9.79 (mean+/-SD) ng/ml compared to idiopathic infertility [0.92+/-1.57 ng/ml (P=0.0007)] and to controls [0.78+/-1.94 ng/ml (P<0.0001)]. Leptin levels were positively correlated with the stage of endometriosis (r=0.45; P=0.03), and with pelvic pain in endometriosis patients (r=0.49; P=0.001). Peritoneal fluid leptin levels in patients with idiopathic infertility were comparable to controls. CONCLUSIONS: Higher levels of leptin were observed in peritoneal fluid of patients with endometriosis compared to those without the disease. These data suggest that the proinflammatory and neoangiogenic action of leptin may contribute to the pathogenesis of endometriosis. Moreover, leptin may play a role in endometriosis-associated pain.     

Leukemia inhibitory factor (LIF) is immunohistochemically localized in tubal ectopic pregnancy

Leukemia inhibitory factor (LIF) is essential for implantation of the embryo in the endometrium. It is not clear whether the blastocyst requires expression of LIF for implantation into tissues other than endometrium. Immunohistochemical localization of LIF was performed in the fallopian tube of 20 women with ectopic pregnancies, 7 women with normal pregnancies and 20 healthy non-pregnant women. Fallopian tubes were evaluated from specimens taken during tubal ligation in normal pregnancies and non-pregnant fertile women or at operation for tubal surgery in ectopic pregnancies. Biopsies were assayed by immunohistochemistry. Semi-quantitative immunohistochemical reaction scores (IRS) were used for immunohistochemical analyses. Immunolabeling of LIF was detected in the surface epithelium and stroma of fallopian tubes in all subjects. IRS score in the epithelium and stroma of non-pregnant women and women with intrauterine pregnancy were similar (p>0.05). However, women with ectopic pregnancy had significantly increased labeling of LIF compared to others (p<0.05). Immunohistochemical labeling of LIF in the fallopian tube was found to be increased in ectopic pregnancies compared to non-pregnant and healthy pregnant controls. This may indicate a role of LIF in the ectopic implantation of embryos.     

Colour Doppler hysterosalpingosonography: a simple and potentially useful method to evaluate Fallopian tubal patency

The diagnostic efficacy of colour Doppler hysterosalp-ingosonographyto evaluate Fallopian tubal patency was studied in 17 women.Of the 17 women, 12 were infertile and the remaining five werefertile and requested elective tubal ligation. Colour Dopplersonography was performed using the transabdominal approach 1–4weeks after diagnostic laparoscopy during infertility work-upin the former, and 1–2 weeks after bilateral isthmic tuballigation in the latter group. Sterile saline was used as thecontrast agent. Laparoscopic chromopertubation was consideredas the gold standard. The sensitivity and specificity of colourDoppler sonography were found to be 93 and 83%, respectively.A kappa value of 0.73 reflected good clinical agreement betweenthe two techniques. Colour Doppler hysterosalpingosono-graphyis concluded to be a relatively accurate and simple procedureto test tubal patency. The other advantages include absenceof radiation and avoidance of potential allergic reactions toiodinated contrast agents employed for hystero-salpingography.However, the inability to delineate the inner architecture ofthe genital canal and to determine the exact location of tubalobstruction, when present, remain the disadvantages of thistechnique.     

Arnold‐Chiari type 1 malformation in Potocki–Lupski syndrome

Potocki–Lupski syndrome (PTLS) is a genetic disorder that results from an interstitial duplication within chromosome 17p11.2. Children with PTLS typically present with infantile hypotonia, failure to thrive, and global developmental delay with or without major organ system involvement. Systematic clinical studies regarding growth, cardiovascular disease, and neurocognitive profiles have been published; however, systematic evaluation of central nervous system structure by magnetic resonance imaging (MRI) of the brain has not been reported. Herein, we describe three patients with PTLS who were found—in the course of routine clinical care—to have a type 1 Arnold‐Chiari malformation (CM‐1). This finding raises the question of whether the incidence of CM‐1 is increased in PTLS, and hence, if an MRI of the brain should be considered in the evaluation of all patients with this chromosomal duplication syndrome.     

Measurement of serum CA-125 concentrations does not improve the value of Chlamydia trachomatis antibody in predicting tubal pathology at laparoscopy

Chlamydia antibody testing (CAT) has been used to predict tubal pathology associated with Chlamydia infection, the leading cause of pelvic inflammatory disease (PID). Tubal pathology not related to C. trachomatis is unlikely to be identified by CAT alone. A correlation between serum CA-125 concentrations and the severity of adnexal inflammation during acute PID was demonstrated. The objectives of this study were to determine the prevalence of C. trachomatis infection in an Asian infertile population and to assess the role of a combination of serum CA-125 and CAT in the prediction of tubal pathology as shown by laparoscopy. A total of 110 consecutive women attending an infertility clinic for work-up were recruited. Blood was taken for CAT and CA-125 on the day of hospital admission and an endocervical swab was taken for culture of C. trachomatis prior to laparoscopy. Two (1.8%) women had C. trachomatis found in the endocervix and 28 (25.5%) women had CAT of > or = 1:32. Serum CA-125 concentrations were > 35 IU/ml in 11 (10%) women. The discriminative capacity of CAT in the diagnosis of tubal pathology including both proximal and distal obstruction was not improved by measuring serum CA-125, regardless of the threshold values of serum CA-125 concentration.