Oral contraceptives alone and with spironolactone increase sCD40 ligand in PCOS patients

Background  

The present study was designed to determine the effect of oral contraceptives (OCP) and OCP plus spironolactone (Sp) on plasma soluble CD40L levels in polycystic ovary syndrome (PCOS) patients.     

老年男性勃起功能及迟发性性腺功能减退症状与下尿路症状严重性的关系

本文旨在研究土耳其爱琴海地区的老年男性下尿路症状（LUTSs）、勃起功能障碍（ED）和有症状的迟发性性腺功能减退症（SLOH）三者间的关系。符合以下标准的500名男性患者被纳入该研究：40周岁以上；过去6个月内有稳定的性关系；在六个泌尿外科诊所之一进行过就诊登记。每位患者均行血清PSA、睾酮水平及尿流率的检测，并填写国际前列腺症状评分和生活质量评分（IPSS-QoL）量表、国际勃起功能指数（IIEF）问卷和老年男性症状（AMS）量表。在所有的研究对象中，23．9％的患者有轻度LUTSs，53．3％有中度LUTSS，22．8％有重度LUTSS。每组间总睾酮水平无明显差异。除此之外，69．6％的病人患有ED，且ED的发生率与LUTS严重性呈正相关。71．2％的患者出现SLOH（AMS〉27），且IPSS评分越高，严重的性腺功能减退症状的发生率也越高。相关性分析显示以上三种问卷分数之间有显著关联。总之，LUTS严重性是ED和SLOH的非年龄依赖性危险因素，LUTS严重性和SLOH症状之间似乎有显著的相关性，但还需要从病因学和生物学角度进行深入阐明。     

Left atrial function as a predictor of haemodynamic response in patients with mitral stenosis: a dobutamine stress echocardiographic study

OBJECTIVE: The mechanisms of the different haemodynamic and clinical responses to dobutamine infusion in mitral stenosis (MS) are not clearly established. The aim of this study was to evaluate the relation between left atrial (LA) function and haemodynamic response in patients with MS during dobutamine infusion. METHODS AND RESULTS: Forty-two consecutive moderately symptomatic patients (33 women, 9 men; mean age 46+/-9, range from 26 to 66), New York Heart Association (NYHA) class II with MS (mean mitral valve area 1.7+/-0.1 cm2) were evaluated with dobutamine stress echocardiography. Haemodynamic measurements were obtained at rest and during peak dobutamine infusion. LA fractional shortening at rest was used as an index of global LA function. Group I consisting of patients with significantly elevated pulmonary artery pressure (> 60 mm Hg) and mean transmitral gradient (> 15 mm Hg) at peak dobutamine infusion were defined as haemodynamically serious MS. Group II consisted of the remaining 30 patients whose haemodynamic data were below these levels. While baseline haemodynamic parameters and mitral valve characteristics were not different between the two groups, LA fractional shortening was significantly lower (18.9+/-2.8 vs. 32.3+/-5.1%, p<0.0001) and left atrial dimension was significantly larger in group I (49.7+/-2.3 mm vs 43.6+/-5.3 mm, p<0.0001). Left atrial fractional shortening was negatively correlated with the increase in mean transmitral gradient (r:-0.58, p<0.01). When the patients were divided using a LA fractional shortening level of 25% as the cut-off point, we observed that the patients with low LA fractional shortening had a greater increase in mean transmitral gradient (7.3+/-3.1 mm Hg vs. 4.6+/-1.4 mm Hg), p = 0.005) and pulmonary artery pressure (22.4+/-3.5 mm Hg vs. 16.1+/-8.5 mm Hg, p = 0.001) compared to the patients with high LA fractional shortening. Based on these haemodynamic results, management was changed in 12 patients (28%): 5 underwent percutaneous mitral balloon commissurotomy and 7 received intensive medical treatment. CONCLUSIONS: The present study demonstrates that haemodynamic response during dobutamine stress echocardiography correlates with LA fractional shortening in patients with MS. The evaluation of left atrial function at rest in patients with ambiguous symptoms and mild mitral stenosis may be useful in clinical decision making. Atrial dysfunction at rest may predict the haemodynamic response during stress echo in these patients.     

Late results of combined percutaneous balloon valvuloplasty of mitral and tricuspid valves

Although combined mitral and tricuspid stenosis are rarely seen in patients with rheumatic heart disease, when both exist together, combined percutaneous balloon valvuloplasty can be an alternative to surgical treatment in suitable cases. We present the immediate and late follow up results of 12 patients with rheumatic tricuspid and mitral stenosis treated with combined percutaneous balloon valvuloplasty. Twelve patients (11 female, 91.7%; 1 male, 8.3%) with a mean age of 35.3 ± 6.4 years were enrolled in the study. The patients were followed up for 38.8 ± 12.6 months. The mitral valve area increased from 1.2 ± 0.2 cm² to 2.3 ± 0.2 cm² (P < 0.01) and on follow up the mitral valve area did not differ significantly (2.2 ± 0.2 cm²; P > 0.05). The tricuspid valve area increased from 1.6 ± 0.3 cm² to 3.2 ± 0.2 cm² (P < 0.01) and on follow up the tricuspid valve area did not differ significantly (3.1 ± 0.2 cm²; P > 0.05). Two patients (16.6%) had tricuspid restenosis and tricuspid re-valvuloplasty. One other patient (8.3%) was referred to surgery 14 months after the procedure secondary to severe tricuspid regurgitation. In conclusion, this study demonstrates a sustained benefit on late follow up after combined percutaneous balloon valvuloplasty of mitral and tricuspid valves and confirms the efficacy and safety of the procedure as an alternative to surgery in selected cases of combined mitral and tricuspid stenosis. Cathet. Cardiovasc. Diagn. 45:246–250, 1998. © 1998 Wiley-Liss, Inc.     

Scintigraphy in the detection of gastro-oesophageal reflux in children with caustic oesophageal burns: a comparative study with radiography and 24-h pH monitoring

Background: Caustic injury of the oesophagus not only causes luminal narrowing but is also responsible for longitudinal contraction, resulting in gastro-oesophageal reflux (GOR), which leads to failure of conventional therapy. Therefore, the development of GOR should be investigated periodically to direct appropriate management of these patients. Purpose: To determine the ability of scintigraphy to detect GOR in children with caustic oesophageal strictures in comparison with barium study and 24-h pH monitoring. Materials and methods: Seventeen children with caustic oesophageal injury underwent scintigraphy, an upper GI barium study and 24-h pH monitoring within the same week. Five patients were also investigated post-operatively for the assessment of surgical outcome after antireflux surgery. Results: On the whole, there was good correlation (r = 0.78, P < 0.00 l) between scintigraphy and 24-h oesophageal pH monitoring. Scintigraphy detected all but one (9/10) refluxing patients and also correctly identified all (7/7) non-refluxing patients. Barium studies demonstrated 6 out of 10 refluxing patients. There were no false-positive barium studies in non-refluxing patients. Post-operative studies demonstrated no evidence of GOR in surgically treated patients. Conclusions: Our results indicate that, by comparison with barium studies, scintigraphy is useful in the detection of GOR in cases with caustic oesophageal strictures and may be used as a screening modality for those under clinical follow-up. Received: 25 January 2000 Revised: 26 June 2000 Accepted: 5 March 2001