The effects of an anabolic steroid and peripherally administered intravenous nutrition in the early postoperative period

Sixty patients undergoing colorectal surgery for malignancy were randomized to receive the anabolic steroid stanozolol (n = 30) or to a control group (n = 30). Patients were further randomized to receive on the first 4 postoperative days a) a standard dextrose-saline regimen (DS), b) an amino acid regimen (AA), or c) a glucose-amino acid-fat regimen (GAF) via a peripheral vein. Fat and carbohydrate oxidation rates were calculated pre- and postoperatively using indirect calorimetry. Postoperative nitrogen balance (NB) in patients receiving amino acids was significantly improved (p less than 0.02) by the administration of stanozolol. Fat and carbohydrate oxidation rates were not significantly affected by stanozolol. Patients in the stanozolol and control AA groups showed a fall in carbohydrate oxidation (p less than 0.01) and a rise in fat oxidation (p less than 0.05) postoperatively, whereas no significant changes in fat and carbohydrate oxidation occurred in the two DS and two GAF groups. Cumulative NB for the first 4 postoperative days was significantly better (p less than 0.01) in the two AA groups than in the two DS groups, due to an improved NB in the two AA groups on the 1st and 2nd days only. Cumulative NB in the two GAF groups was significantly better (p less than 0.01) than in all the other groups. This study shows that stanozolol improves postoperative NB in patients receiving amino acids alone, whereas the provision of a more complete nutritional regimen containing glucose, amino acids, and fat results in a positive NB unaffected by stanozolol.     

Sexual functioning of male anabolic steroid abusers

The effects of anabolic steroid use on male sexual behavior were assessed using a structured clinical interview administered to male body builders currently using steroids, and to two comparison groups (body builders with a past but not current history of steroid use, and a group of natural body builders who had never used steroids). Current anabolic steroid users had a significantly higher coital and orgasmic frequency than did comparison athletes. They also reported a significantly higher incidence of erectile difficulties during the past month. Beliefs concerning the sexually stimulating effects of steroids did not correlate with the frequencies of specific sexual behaviors. The data support the contention that anabolic steroids, as androgenic compounds, enhance sexual desire.     

Alpha-ketoglutarate-supplemented enteral nutrition: effects on postoperative nitrogen balance and muscle catabolism

Enteral feeding in the early postoperative phase may improve gut integrity and reduce infectious complications after trauma and surgery. The aim of the current study was to evaluate the feasibility of alpha-ketoglutarate enrichment of enteral feeding and the effect on protein metabolism after major surgery.Patients undergoing elective abdominal surgery were randomly allocated to receive a standard whole-protein-based enteral nutrition solution (n = 9) or an isonitrogenous, isocaloric solution enriched with alpha-ketoglutarate (n = 11) for 5 d postoperatively. The nutritional goals by day 4 were 25 kcal and 0.17 g of nitrogen, respectively, per kilogram of body weight every 24 h. Standard blood analysis, including prealbumin and C-peptide, was performed preoperatively and on days 1, 3, and 6. Urine was collected daily for nitrogen and 3-methylhistidine analyses.Due to restricted tolerance to enteral feeding, the nitrogen delivery reached only 0.10 g of nitrogen per kilogram of body weight. Transthyretin decreased by 25% in both groups, and albumin decreased significantly in the enriched group compared with the standard nutrition. There were no significant differences in nitrogen balance, excretion of 3-methylhistidine, or clinical outcome between groups.Enrichment of a whole-protein-based formula with alpha-ketoglutarate did not improve protein metabolism or decrease muscle catabolism after major abdominal surgery.     

重组人生长激素对消化道术后病人氮平衡作用的研究

目的了解重组人生长激素(rhGH)对手术后病人氮平衡的影响。方法在肠全外营养(TIN)的基础上，加用rhGH治疗消化道大中型手术后10例病人，并与同期仅用TPN治疗的10例病人做对照研究。结果1．2组病人均未获得正氮平衡，但GH组氮平衡明显改善；术后5天累积氮平衡GH组显高于对照组。2．术后3天、5天，累积尿氮的排出，对照组较GH组高，二差别有显统计学意义。3．术后1天引流氮的排出、术后3天累积引流氮的排出及平均每天引流氮的排出，GH组均较对照组低，但无显的统计学意义。结论在低氮和低热的基础上，rhGH能减轻术后病人的负氮平衡。主要是通过减少尿氮的排出而达到节氮效果，rhGH对引流氮影响不大。     

Effects of an anabolic steroid (metandienone) on spermatogenesis

The purpose of this study was to evaluate the effect of daily administration of an anabolic steroid, metandienone, on spermatogenesis. Fifteen well-trained male athletes were prescribed orally 15 mg of metandienone for two months. Semen specimens before, after one month and after two months use of metandienone were studied. The sperm density per ml decreased 46% and 73%, respectively, the latter value being highly pathologic (25 ± 22 × 10 ° /ml). Three of the subjects became azoospermic and one of them had only 1 million sperms/ml after two months use of the drug. The percentage of motile cells decreased in two months about 30%. The percentage of sperms with normal configuration decreased significantly both in one and two months, from 73 ± 8% to 65 ± 5% and 42 ± 23%, respectively. The percentage of sperms with amorphous head increased about 100% during two months use of metandienone. Other kinds of anomalies in the sperms also increased significantly. The “fertility index” increased in two months to a value which is highly pathological. Acid phosphatase activity in semen decreased significantly during two months use, while fructose concentration changed significantly only after one month use of metandienone, but not after two months use. Metandienone is a sperm-suppressive agent, but it also has other effects on the quality of the semen. The changes were, however, reversible.     

Nitrogen sparing effect of Ornicetil in the immediate postoperative state clinical biochemistry and nitrogen balance

The salt complex of alpha-ketoglutarate and ornithine, L(+)ornithine alpha-ketoglutarate - ORNICETIL (OR) - is able to bind six amino groups per molecule without enzymatic intervention. The present study was undertaken to determine whether intravenous administration of OR together with total parenteral nutrition (TPN) has a beneficial effect on nitrogen utilization in the immediate postoperative phase. Thirteen patients were investigated after major abdominal operations (resection of colon or rectum). All patients received TPN for 5 days postoperatively. Energy (165 kJ/kg BW) was given as fat (Intralipid 20%) and carbohydrate (Glucose 20%). Seven patients (controls) received 0.15 g amino acid (AA)-N/kg BW (Vamin). Six patients had an isonitrogenous regimen but with 2.5 g AA-N being replaced by Ornicetil (OR group). The excretion of urea, creatinine, ammonia, 3-methyl-histidine (3-MeHis) and total-N was determined throughout the study and the daily nitrogen balance was calculated. Blood samples were drawn serially before and after surgery for routine clinical biochemistry. The day-to-day nitrogen balance was significantly better when OR was given. Urea excretion was significantly reduced, and the urinary ammonia losses in the OR group were one third of those in the control group. In the control group 3-MeHis correlated negatively with the nitrogen balance. The regression line obtained, y = 265 - 21.6 x (p < 001), and the calculated correlation coefficient, r = 0.87 (p < 0.001), were highly significant. In contrast, no correlation could be demonstrated between 3-MeHis output and nitrogen balance in the OR group (r = 0.18, N.S.). The results indicate better postoperative nitrogen economy in the OR group than in the control group. Stimulation of insulin and growth hormone secretion may be contributing factors in the better nitrogen utilization. The increased ammonia excretion postoperatively in the control group was completely abolished when OR was given simultaneously with decreased urea formation, suggesting a product inhibition of arginase in the liver cytosol and also indicating that amino groups generated by the enhanced gluconeogenesis were trapped by OR owing to stimulated transamination in peripheral muscle tissues. The significant negative correlation between 3-MeHis excretion and nitrogen balance in the control group strongly indicates a correlation between net protein catabolism and increased postoperative muscle protein breakdown. In contrast, the total absence of correlation between nitrogen balance and 3-MeHis excretion in the OR group suggests a diminished (or zero) net muscle protein breakdown.     

Social capital: implications from an investigation of illegal anabolic steroid networks

Numerous studies have linked the constructs of social capital with behaviours that are health enhancing. The factors of social trust, social cohesion, sense of belonging, civic involvement, volunteer activity, social engagement and social reciprocity are all associated with social capital and their existence is often linked with communities or settings where health enhancement is high. Utilizing an interpretive perspective, this paper demonstrates how the existence of social capital may enhance the transition into drug use, the experience of using an illegal drug and decrease the risk of detection. It highlights how social capital may contribute to behaviours which are not health enhancing. Using a variety of data, including participant observation of 147 male anabolic steroid users and 98 semi-structured in-depth interviews with male anabolic steroid users, dealers and distributors it was found that social capital facilitated the operation of the illegal anabolic steroid distribution network. The subcultural norms and social trust that existed within the network allowed anabolic steroid dealers to sell the drug to others with reduced risk of detection. It is argued that social capital facilitates the distribution of illegal anabolic steroids and that social capital is a non-discriminatory concept, that may enhance both negative and positive health-related behaviours.     

Prevention of postoperative pulmonary complications by preoperative training

Postoperative pulmonary complications are the main cause of morbidity and mortality after surgery. A likely explanation is dysfunction of the respiratory muscles, in particular the diaphragm, which results in rapid, shallow breathing and ultimately-in closing of the airways, atelectasis and hypoxaemia. Breathing exercises in the perioperative period, despite a good rationale, were in general not found to be effective. A promising new approach is specific training of inspiratory muscles. A randomized clinical trial, published in this issue of the journal, found this to be effective in patients at increased risk for postoperative complications who underwent cardiac surgery.     

Impact of preoperative weight loss on postoperative morbidity

Clinical observations in developing countries and experimental studies in animals suggest that preoperative weight loss adversely affects postoperative morbidity. Since it is not clear whether these findings can be applied to surgical series in European countries, we have studied 106 surgically-treated patients with inflammatory bowel disease. Patients were divided into three groups according to the degree of preoperative weight loss. The groups were well matched in all other respects. Postoperative morbidity was monitored independently. The outcome in all three groups was similar so that in these patients, at least, preoperative weight loss did not adversely affect the postoperative outcome.     

蛋白质丢失与氮平衡监测

对伴有中、重度营养不良肝胆病患者在手术前、后实施肠外营养(PN)247例次,在实施中的氮平衡监测体会和方法。认为只要每天认真监测氮平衡,及时调整全营养混合液(TNA)成分和非蛋白质热卡与氮的比例,维持内环境稳定,一般3～5天即可纠正负氮,达到正氮平衡,并取得满意疗效。     

对胃肠道恶性肿瘤病人手术前后营养状况的研究

目的:调查胃肠道恶性肿瘤病人手术前后的营养状况及其变化。方法:采用方便取样法选取拟行根治术的胃肠道恶性肿瘤病人202例,在入院48 h内评估病人的营养状况和营养风险状况,并在出院时再次评估其营养状况,记录病人住院期间的营养支持状况及其在入院初和出院时的消化系统症状、进食状况。结果:入院时,140例(69.3%)病人至少有1项指标提示有营养不足或有营养风险。出院时,除肱三头肌皮皱厚度外,其余各项营养指标均显著低于入院时(P<0.01)。病人的营养支持以PN为主,手术前、后营养支持时间≥5 d的病人分别为2.0%和71.3%;入院时及出院时,分别有76.2%和93.4%的病人存在1项或多项消化系统症状。出院时,99.5%的病人进食状况为流食/半流食。结论:胃肠道恶性肿瘤病人术前营养不足和营养风险的发生率较高,且术后营养状况进一步恶化。     

Severe nephrotic syndrome in a young man taking anabolic steroid and creatine long term

Anabolic steroids and creatine supplementation is one of the current abuse used by body builders. It is less known that this combination beside of many deleterious effects may also cause renal damage. Authors report a case of diffuse membranoproliferative glomerulonephritis type I in a 22-year-old man who had been taking continuously methandion in a large quantity and 200 grams of creatine daily, and was sent to the outpatient nephrologic unit with typical clinical signs of nephrosis syndrome. They also call attention to the role of the continuously consumed creatine in the renal failure.     

宫外生长迟缓早产儿氮平衡变化

目的　观察住院期间宫外生长迟缓（EUGR）早产儿氮平衡的变化规律。方法　选择2014年5至10月入住扬州大学医学院附属淮安市妇幼保健院新生儿医学中心的出生胎龄＜32周且出生后24 h内入院的小早产儿（VP）64例,根据是否符合EUGR诊断标准分为EUGR组（18例）和非EUGR组（46例）。采用凯氏测氮法分别测定所有VP出生后第1、7、14、28天尿液中的尿素氮水平。分别计算和比较两组早产儿在各个时间点的氮平衡值。结果　两组VP出生后第1、7、14、28天的氮平衡值均呈负值,且氮平衡值随着日龄的增加呈上升