The role of the gastric antrum in the pathogenesis of reflux gastritis

The effect of antrectomy on the histopathologic changes of alkaline reflux gastritis was investigated in an effort to elucidate a possible protective role for the gastric antrum in the pathogenesis of this postgastrectomy syndrome. A canine model for reflux gastritis was utilized in 10 animals, 5 of which were antrectomized. Evaluating parameters of gastritis, parietal cell and mitotic counts, and mucosal dimensions, we found significantly more severe gastritis, parietal cell atrophy, and mucus cell hyperplasia in the antrectomized animals as compared with those which were not antrectomized. It is concluded that the gastric antrum does exert a protective effect on gastric mucosa which is chronically exposed to duodenal contents. Possible mechanisms for this protection and the pathogenesis of alkaline reflux gastritis are reviewed, and clinical implications are proposed.     

Microsurgical treatment of varicocele in outpatients using the subinguinal approach.

BACKGROUND: The aim of this study is to analyze the results of a group of patients who underwent subinguinal microsurgical varicocelectomy using local anaesthesia in one-day-surgery. METHODS: From 1997 to 1998 150 patients were selected from the whole group of patients who underwent surgical treatment for varicocele. The varicocele was always on the left side and the mean age was 27.1 years (range: 16-43). The diagnosis was based on clinical features (testicular pain or scrotal sensation), physical examination and Doppler ultrasound. Where there was infertility with abnormal semen analysis and/or patient's intolerance to the symptoms, surgery was suggested. The patients underwent varicocelectomy by sub-inguinal approach using local anaesthesia. The microsurgical technique of dissection was performed. RESULTS: All operations were performed on an outpatient basis (post-operative stay: 3-7 hours) and the operating time was 20 to 45 minutes. Follow-up was performed by physical examination, doppler ultrasound and semen analysis. Immediate and long-term complications were: 7 (4.7%) transient pain, 3 (2.0%) ecchymosis, 1 (0.7%) transient hydroceles and 1 (0.7%) permanent hydroceles, 2 (1.3%) palpable recurrence, 2(1.3%) doppler recurrence and 1 (0.7%) long-term recurrence, 0 testicular atrophy. 120/150 (80%) patients showed an improvement of semen analysis and 19/41 (46.3%) patients with infertility achieved a pregnancy with the partner. CONCLUSIONS: Microsurgical treatment of varicocele in outpatients by subinguinal approach is a safe and reliable procedure. It is performed in local anaesthesia, preserves the lymphatics, spermatic artery and vas and in our experience showed an improvement of semen analysis and pregnancy rates with minimal morbidity.     

Potential role of poly(ADP-ribose) polymerase activation in the pathogenesis of experimental left varicocele

The aim of this study was to evaluate whether the poly(adenosine diphosphate[ADP]-ribose) polymerase (PARP) pathway is activated by experimental left varicocele. Rats underwent partial ligation of the left renal vein to induce experimental varicocele, and left testes were analyzed 13 weeks after surgery. Tubule degeneration was evaluated by Johnsen score. Expression of 4-hydroxy-2-nonenal (4-HNE)-modified proteins, PARP-1, and poly(-ADP-ribose) (PAR) was detected by immunohistochemistry and Western blot. The degree of apoptosis within testes was determined by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling. Light microscopy revealed testicular damage comprising various degrees of seminiferous tubule degeneration. Germ cell apoptotic index and 4-HNE, PAR, and PARP-1 expression in germ cells increased after varicocele induction. Increased oxidative stress and PARP overactivation in testes might be important with regard to impaired testicular function associated with varicocele.     

Electroesophagogram in gastroesophageal reflux disease with a new theory on the pathogenesis of its electric changes

Background  

In view of the disturbed esophageal peristaltic activity and abnormal esophageal motility in gastroesophageal reflux disease, (GERD), we investigated the hypothesis that these changes result from a disordered myoelectric activity of the esophagus.     

CEUS诊断精索静脉曲张侧支反流

目的 探讨CEUS诊断精索静脉曲张(VC)侧支反流的临床意义.方法 对60例单纯左侧VC患者行精索静脉CEUS,观察是否存在开放侧支血管,并用Doppler检测反流情况.根据造影结果将60例VC患者分为无侧支组(A组)和有侧支组(B组).造影完成后对全部患者行精索内静脉高位结扎术,并于术前及术后6个月检查精液质量、睾丸大小、术后复发及配偶受孕情况,以评价治疗效果.结果 A组41例(41/60,68.33％),B组19例(19/60,31.67％).B组27支侧支血管开放,其中13例18支侧支血管检测出反流频谱.术后6个月复查,两组患者的左侧睾丸体积较术前均有所增大(P＞0.05);与术前比较,术后A组精液质量较B组有明显改善(P＜0.05);术后A组无复发病例,B组5例复发;A组7例、B组2例的配偶受孕成功.结论 精索内静脉高位结扎术对无开放侧支血管VC的治疗效果好于有开放侧支血管者.侧支反流是术后VC复发的主要原因.CEUS可于术前诊断阴囊段及腹股沟段VC合并侧支反流,为外科选择治疗方案提供依据.     

The role of reactive oxygen species and apoptosis in the pathogenesis of varicocele in a rat model and efficiency of vitamin E treatment

We investigated role of reactive oxygen species (ROS) and apoptosis in the pathogenesis of infertility in experimental model of varicocele. The protective effect of vitamin E was also examined. Three groups of rats were constructed as the first group had sham operation, experimental varicoceles were established by partial ligation of the left renal vein in later two groups. Third group had received vitamin E. Production of ROS was determined by chemiluminescence assay (CL). The in situ end labelling technique was utilized to investigate apoptosis. Tissue vitamin E levels were measured by high performance liquid chromatography. The differences between luminol enhanced CL levels of groups were not statistically significant. However, the difference between CL levels of lucigenin probe in left testicles of sham and varicocele groups were statistically significant ( p = 0.0007). Similarly, the results of the third group receiving vitamin E significantly differed from the varicocele group ( p = 0.0025). The difference of apoptotic index was also statistically significant between sham and varicocele groups ( p = 0.0038). Although the values of apoptotic index detected in the vitamin E group were lower compared with the varicocele group, the difference was not significant. This study proposes that ROS production and apoptosis in the testicles were induced with experimental varicocele. Vitamin E had a protective role. An increased rate of apoptosis with experimental varicocele suggests a molecular alteration, which may involve ROS overproduction as the triggering mechanism. Consequently, this study indicates an association between varicocele and infertility at molecular level through stimulation of ROS and apoptosis.     

胃食管反流病发病机制研究进展

胃食管反流病（GERD）是指上消化道内容物反流进入食管引起的疾病,患者可以出现食管内及食管外症状,如胸部烧灼感（烧心）、反流、顽固性的咳嗽等。GERD的发病机制与抗反流屏障功能下降、反流物的攻击作用、幽门螺杆菌（Hp）感染、Cajal间质细胞（ICC）数量减少或功能障碍、内脏敏感性增高等有关。     

The role of the functional interrelation of the adrenals and testes in the pathogenesis of sterility in patients with left-sided varicocele

Selective renal phlebography, phlebotonometry, selective analysis of the blood from the renal veins and vena cava inferior for the activity of plasma renin, catecholamines, prostaglandins E2, pO2 and pCO2, peripheral blood analysis for levels of progesterone, androstendione, testosterone, ACTH, ACTH-tolerance test, orchidometry, ejaculate microscopy, evaluation of seminal plasma testosterone, trochanter index and parameters of sexual maturation were performed during the treatment of 70 patients with left varicocele. Based on the results the authors concluded that not only the left testicle, but the left adrenal was involved in the course of organic renal venous hypertension. A significant feedback correlation was revealed between the peripheral blood progesterone and the left kidney venous pressure (r = -0.50, p less than 0.01) and between the peripheral blood progesterone and the number of motile spermatozoa in the ejaculate (r = -0.31, p less than 0.05). Pathogenesis of organic renal venous hypertension and spermatogenesis failure were supplemented by the conclusion that the left adrenal central vein was the first to involve into the compensation of venous hypertension. Retrograde alterations in the direction of the blood flow in the left adrenal central vein resulted in the abnormal stimulation of steroidogenesis in the cortical layer. The excessive production of antiandrogenic steroid hormones by the left adrenal gland was a cause of spermatogenesis damage in both testicles. The blockage of the left adrenal androgenic hormones of the hypothalamo-hypophyseal system can deteriorate the process.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of hemorrhoids in the pathogenesis of recurrent bacteriuria with a new approach for treatment

A new approach for the pathogenesis and treatment of recurrent bacteriuria is presented. Ten patients with recurrent bacteriuria were studied. Episodes started 3-8 years prior to presentation. Different antimicrobial therapy and surgical procedures had no influence on the recurrence of infection. Urinary tract investigations were normal except for bladder neck and urethral congestion in all patients. Urine cultures identified Escherichia coli in all episodes of each individual and were identical to those of anal flora. All patients had hemorrhoids and 3 had chronic cervicitis. An etiological concept for recurrent bacteriuria is put forward. Hemorrhoids are considered to be the source of recurrent infection, the E. coli being transmitted to the genitourinary organs through the rectogenital veins. Treatment of hemorrhoids and rectogenital vein obliteration resulted in the disappearance of bacteriuric episodes during a follow up period of 1.5-6 years. Urine cultures remained free. Chronic cervicitis is cured.     

A new approach to the surgical treatment of reflux oesophagitis.

The rationale of combining proximal gastric vagotomy with Nissen fundoplication in the treatment of reflux oesophagitis due to hiatus hernia is discussed. The application of this procedure in 12 cases over a period of 4 years is described and the results, with a follow-up of 13--48 months, are reported. Ten of the 12 patients have been completely relieved of their symptoms and one has been significantly improved.     

Treatment of varicocele using a microsurgical technic

We operated on 34 patients with varicocele employing microsurgical anastomosis. A direct anastomosis of veins of varicocele with the saphenous vein was performed in 29 patients. Microsurgical spermaticoepigastric anastomosis was performed in 5 patients. The distal stump of the epigastric vein was end-to-end anastomosed with the spermatic vein in one case of type 2 varicocele. Clinical results were satisfactory with varicocele disappearing 33 times out of 34 cases. The shunt between a high regimen pressure with a lower one improve the venous drainage of the testis. These new techniques must be selected according to the pathogenic mechanism of varicocele.     

Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair

Context

Varicocele is a common condition, found in many men who present for infertility evaluation.

Objective

To assess the effect of varicocelectomy on male infertility.

Evidence acquisition

A literature search was performed using Embase and Medline. Literature reviewed included meta-analyses and randomized and nonrandomized prospective (controlled and noncontrolled) studies. In addition, a new meta-analysis was performed.

Evidence synthesis

Four randomized controlled trials reporting on pregnancy outcome after repair of clinical varicoceles in oligozoospermic men were identified. Using the random effect model, the combined odds ratio was 2.23 (95% confidence interval [CI], 0.86-5.78; p = 0.091), indicating that varicocelectomy is moderately superior to observation, but the effect is not statistically significant. We identified 22, 17, and 5 prospective studies reporting on sperm concentration, total motility, and progressive motility, respectively, before and after repair of clinical varicocele. The random effect model combined improvement in sperm concentration was 12.32 million sperm per milliliter (95% CI, 9.45-15.19; p < 0.0001). The random effect model combined improvement in sperm total and progressive motility were 10.86% (95% CI, 7.07-14.65; p < 0.0001) and 9.69% (95% CI, 4.86-14.52; p = 0.003), respectively. These results indicate that varicocelectomy is associated with a significant increase in sperm concentration as well as total and progressive motility. Prospective studies also show that varicocelectomy reduces seminal oxidative stress and sperm DNA damage as well as improving sperm ultramorphology. Studies indicate that a microsurgical approach to a varicocele repair results in less recurrence and fewer complications than other techniques.

Conclusions

Although there is no conclusive evidence that a varicocele repair improves spontaneous pregnancy rates, varicocelectomy improves sperm parameters (count and total and progressive motility), reduces sperm DNA damage and seminal oxidative stress, and improves sperm ultramorphology. The various methods of repair are all viable options, but microsurgical repair seems to be associated with better outcomes.     

Anatomy of the spermatic venous plexus (pampiniform plexus) in men with and without varicocele: intraoperative venographic study.

Venous anatomy of the testis was reexamined by retrograde spermatic venography during surgery in 17 men with and in 11 without a varicocele. The route of venous drainage of the testis was the internal spermatic vein and the external pudendal vein. The cremasteric and vasal veins were smaller collaterals. There was no cross communication between the right and left spermatic venous systems in the scrotal, retropubic or pelvic areas. In men with a varicocele the spermatic venous plexus was formed of numerous venous sinuses and large dilated veins.