青春发育期男孩尿液中睾酮及精子的检查

本文对１６４例１０－１４岁中学生进行两年纵向随访，调查晨尿中出现精子的阳性率，及连续６天精尿的阳性频数。又以放射免疫法测定同期晨尿中睾酮含量，结果其浓度与相同个体同日的血清睾酮浓度呈正相关。     

多聚酶链反应检测尿中结核杆菌的临床意义

应用多聚酶链反应（ＰＣＲ）对８６例患者（１０例经病理诊断为肾结核，６９例可疑肾结核，７例单纯附睾结核）和３０例健康对照者进行连续２日晨尿结核菌检测。１０例肾结核患者检出均阳性；可疑肾结核者第一次检出９例，第二次为６例；７例附睾结核者两次无一阳性；对照组有１例二次检查均为阳性。认为ＰＣＲ对尿中结核杆菌检出率高、准确、快速，值得在临床上推广应用。     

中老年男性下尿路症状的流行病学调查

为了了解下尿路症状在中、老年男性中的流行情况，用附加了二个症状问题的ＳＬ问卷对８７１名５２～７４岁的男子作回顾性调查，对调查结果作了年龄分组分析。结果发现：平均ＩＰＳＳ总分为４．９３分，无症状者为１２．２％，轻症者为６４．７％，中度症状者为１９．６％，重症者为３．５％。夜尿者占７２．３％，尿终滴沥占５４．４％，而症状中分值＞３分者尿终滴沥占２５．６％，夜尿占１４．６％，平均ＱＯＬ为１．７４，ＱＯＬ为０～２、３、４～６的比例分别为５２．７％、４６．０％、１．３％。ＱＯＬ与ＩＰＳＳ的相关性较好（ｒ＝０．６２），与梗阻症状群的相关性（ｒ＝０．５７）优于与刺激症状的相关性（ｒ＝０．４４）。中重度症状者中有７２．０％的人未进行治疗。     

血浆睾酮水平测定在评价男性性欲减退中的临床意义

为了研究勃起功能障碍患者的血浆睾酮水平与性欲之间的关系，作者回顾性研究了１９９７年４月～１９９８年１月间１８０例勃起功能障碍患者的临床资料。性欲状况用《简要性功能调查问卷》进行评价，同时测定了血浆总睾酮及游离睾酮水平。其中，资料完整者１０８例，年龄３３～７９岁，平均（５９－５±１０．２）岁。按性欲强弱分为３组：性欲减退者５５例（５０－９％），性欲适中者３８例（３５－２％），性欲高亢者１３例（１３－９％）。３组间的平均性欲、性焦虑及总性功能评分差异有显著性（Ｐ＜０－００１）。３组平均血浆总睾酮水平…     

肾病综合征出血热并发肾破裂的诊断与治疗(附5例报告)

肾病综合征出血热（ＨＦＲＳ）并发肾破裂临床少见，易误诊。我院１９８５年４月～１９９７年１１月收治ＨＦＲＳ并发肾破裂５例，现报告如下。１　临床资料本组５例，男４例，女１例，年龄２７～５３岁，平均４０．５岁。均因发热、头痛、少尿等症状以ＨＦＲＳ收住传染科。免疫荧光测定均为阳性。住院６～１１ｄ（发病后８～１５ｄ）突然腰痛加重，伴腹痛、大汗淋漓、面色苍白或昏厥，血压下降〔６４／３３ｍｍＨｇ～７８／４８ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）〕，经外科急会诊作腹腔穿刺抽出不凝固淡血性液４例，凝固血性液１例…     

经胆囊管探查胆总管应用价值的探讨

目的 探讨经胆囊管探查胆总管的适应征、方法和应用价值。方法 距胆总管０．５～１ｃｍ切断胆囊管，除去胆囊，血管钳提起管腔边缘，插入弯成弧形的探条探查胆总管。如探条受阻，以探条为引导，触摸探条尖端附近，有助于鉴别结石、肿瘤或炎性狭窄。结果 ５１例胆囊结石，探查３６例，阳性７例（１９．４％），其中有探查指征６例，阳性４例（６６．６）；无探查指征３０例，阳性３例（１０％）。结论 经胆囊管探查胆总管无创、便捷，能准确发现胆总管病变，凡胆囊管径〉０．３ｃｍ者，应采用该法探查。     

肾移植术后尿漏成因及防治：附39例报告

我院自１９７８年４月至１９９４年７月共行肾移植手术６３８例次，３９例（６．０％）出现不同程度尿漏，我们对尿漏的成因及防治进行分析：与手术直接相关者２１例，占５３％（３．３％）；感染所致者１３例，占３３％（２．０％）；其它原因所致者５例，占１３％（０．７％）。手术是引起尿漏的主要原因，随着手术方法的改进和提高，以及预防性应用抗感染治疗。尿漏的发生率明显下降（Ｐ〈０．０１），尿漏的治疗主要根据尿漏程度     

鲁藤巴赫综合征的外科治疗

鲁藤巴赫综合征的外科治疗赵希武，杨耀晨，张显清１９８４．４～１９９２．１我们手术治疗７例鲁藤巴赫综合征（Ｌｕｔｅｍｂａｃｈｅｒ＇ｓｓｙｎｄｒｏｍｅ）病人。现报道并讨论如下：临床资料本组病人中男１例，女６例。年龄６～３６岁。其中心功能ＩＩ级者１例，ＩＩ...     

女性酒渣鼻患者血清睾酮、二醇和月经的关系

为了探讨女性酒渣鼻患者血清睾酮、雌二醇水平及月经周期改变情况，作者用放射免疫分析法测定了２５例患者及２０例正常对照者血清睾酮及雌二醇水平，并调查了２５０例患者及１００例正常对照者月经周期变化情况。结果显示，患者血清中睾酮的平均值为５．２７ｎｍｏｌ／Ｌ，明显于对照组（ｔ＝２．９１，ｐ＜０．０１）。雌二醇平均值为５７４．６ｎｍｏｌ／Ｌ，与对照组无明显差异（ｔ＝０．１１，ｐ＞０．０５）。患者月经紊乱率为６９．６％，明显高于对照组（χ２＝３５．５５，ｐ＜０．０１）。可见，女性酒渣鼻患者血清睾酮升高，雌二醇正常，且多伴月经周期紊乱。     

切除颌下腺对大鼠睾酮和精子顶体酶活力的影响

本实验对大鼠切除颌下腺３０和４８天时，睾丸和附睾重量、血清睾酮水平及精子顶体酶活力进行了观察。结果显示：（１）切除颌下腺的实验组，睾丸和附睾重量明显低于对照组（Ｐ＜０．０５，Ｐ＜０．０１），睾丸脏器系数也明显降低（Ｐ＜０．０１），但附睾脏器系数无明显降低（Ｐ＞０．０５）；（２）血清睾酮水平３０天时实验组略低于对照组，４８天时为２．４１ｎｍｏｌ／Ｌ，明显低于对照组的４．４９ｎｍｏｌ／Ｌ（Ｐ＜０．０１）；（３）实验组的精子顶体酶活力分别为７．１９和６．００ｍＵ／ｍｌ明显低于对照组（Ｐ＜０．０１）分别降低了５５．１％和６１．１％。结果表明表皮生长因子（ＥＧＦ）参与了调节睾酮的分泌，并能影响精子顶体酶活力以及睾丸和附睾的重量。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.