The level of endothelin-like immunoreactivity in seminal fluid correlates positively with semen volume and negatively with plasma gonadotrophin levels

OBJECTIVE The newly discovered vasoactive peptides, endothelin 1, 2 and 3, and their receptors are widely distributed in various non-vascular tissues. Recent studies have suggested the presence, as well as possible regulatory roles, of endothelins at several levels of the pituitary-gonadal axis. We determined the level of endothelin-like immunoreactivity in the seminal fluid and examined its possible correlation with routine semen parameters or plasma levels of FSH, LH or testosterone. DESIGN Prospective study in a tertiary care centre. PATIENTS Ninety-one men attending infertility clinics for male factor, female factor or both. MEASUREMENTS Endothelin-like immunoreactivity was determined in seminal fluid using two radioimunoassays, ET1–21 that measures endothelin and ET-1,2 that measures both endothelin and big endothelin. In addition, the levels of FSH, LH and testosterone as well as routine semen parameters were determined. RESULTS Sperm density ranged from 0 to 315 times 10⁸ with a mean (±SD) of 28.5 times 10⁸ (±48 times 10⁸) sperm/ml and the percentage of motile sperm ranged from 0 to 85% with a mean of 16% (±20.5%). Mean levels of FSH (n = 33), LH (n = 35) and testosterone (n = 35) were 6.4 ± 4.9 IU/I, 3.5 ± 2.8 IU/I and 21 ± 9.4 nmol/l, respectively. Mean ET1-21 level (n = 91) was 81 ± 16.5 pmol/l, and mean ET-1,2 level (n = 33) was 630.5 ± 143 pmol/l. There were significant correlations between the levels of ET1–21 and ET-1,2 (r = 0.37, P = 0.04), ET1–21 and FSH (r = ?0.5, P = 0.006), ET1–21 and LH (r = ?0.46, P = 0.01), and ET1–21 level and semen volume (r = 0.23, P = 0.03). Mean level of ET1–21 or ET-1,2 was significantly lower in patients treated empirically with clomiphene citrate or gonadotrophins (n = 34) compared to untreated (n = 52) patients (P = 0.04). CONCLUSIONS We conclude that in human seminal fluid (1) endothelin-like immunoreactivity that is specific for active endothelin (ET1–21) represents about 13% of the total immunoreactivity; (2) inactive big endothelin or its N-terminal derivative(s) may account for most of the immunoreactivity; (3) the production/secretion of endothelin may be inhibited by LH and/or FSH; and (4) endothelin level correlates positively with seminal fluid volume.     

Continuous monitoring of mixed venous oxygen saturation in hemodynamically unstable patients

A balloon-tipped catheter has recently become available which, when placed in the pulmonary artery, in addition to enabling the usual measurements of pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac output by thermodilution, measures mixed venous oxygen saturation (SvO2) by spectrophotometry. Unlike the measurement of cardiac output by thermodilution, which is done intermittently, the continuous measurement of SvO2 is an effective method of monitoring hemodynamically unstable patients, since changes in cardiac output will immediately become apparent via a corresponding change in SvO2. This is of particular benefit in patients in whom knowledge of the immediate effects of therapy is important. It is also of value in assessing the time of onset of action and duration of action when a cardioactive drug is given to increase cardiac output. We suggest that monitoring SvO2 will provide an earlier indication of the effect of both diagnostic and therapeutic interventions and, therefore, will improve our management in such patients.     

Psychological distress among workers caring for the elderly

The GHQ-30 was used to assess psychological disturbance among staff working in four long-stay wards, four homes for the elderly mentally infirm, four elderly persons' homes and four private nursing homes. Rates of disturbance were consistent across all 16 units. Rates of CGHQ caseness were low, compared with published findings from a representative UK community sample. A strong relationship was demonstrated between staff psychological disturbance and aggression from residents over the last week. Disturbed staff were more likely to perceive a lack of support at work, and to report 'shouting back' at aggressive residents. No relationship was found between rates of disturbance and a range of demographic and work-related factors. Implications for service provision and future research are discussed.     

MRI of optic nerve and postchiasmal visual pathways and visual evoked potentials in secondary progressive multiple sclerosis

We studied the relationship between abnormalities shown by MRI and functional disturbances in the visual pathway as assessed by the visual evoked potential (VEP) in 25 patients with established multiple sclerosis (MS); only 4 of whom had a history of acute optic neuritis. Optic nerve MRI was abnormal in 19 (76 %) and is thus useful in detecting subclinical disease. Optic nerve total lesion length and area on the STIR sequence was found to correlate significantly with prolongation of the VEP latency. This may reflect a predominantly demyelinating rather than inflammatory origin for the signal change in the optic nerve. Received: 21 July 1997 Accepted: 1 April 1998     

The spectrum of right ventricular involvement in inferior wall myocardial infarction: a clinical, hemodynamic and noninvasive study

The clinical experience with 37 patients with acute transmural inferior wall myocardial infarction who were assessed for evidence of right ventricular involvement is reported. On the basis of currently accepted hemodynamic criteria, 29 patients (78%) had evidence suggestive of right ventricular infarction. However, only 5 (20%) of 25 patients demonstrated right ventricular uptake of technetium pyrophosphate on scintigraphy. Two-dimensional echocardiography or isotope nuclear angiography, or both, were performed in 32 patients; 20 studies (62%) showed evidence of right ventricular wall motion disturbance or dilation, or both. Twenty-one patients demonstrated a late inspiratory increase in the jugular venous pressure (Kussmaul's sign). The presence of this sign in the clinical setting of inferior wall myocardial infarction was predictive for right ventricular involvement in 81% of the patients in this study. It is suggested that right ventricular involvement in this clinical setting is common and includes not only infarction but also dysfunction without detectable infarction, which is likely on an ischemic basis.     

Oral session 3 — Cerebrovascular disorders (1)

Oral Sessions

Oral session 3 — Cerebrovascular disorders (1)     

Solitary fibrous tumour of the spinal cord

We report an intramedullary primary solitary fibrous tumour of the cervical spinal cord in a 33-year-old man. The tumour predominantly consisted of monomorphic spindle cells with a storiform pattern. MRI demonstrated an inhomogeneously enhancing cervical intramedullary tumour. The patient was well without recurrence 18 months after surgery. Received: 19 July 1999/Accepted: 6 November 1999     

Spontaneous intracranial hypotension

PURPOSE: To describe a patient with classic presentation of spontaneous intracranial hypotension and subsequent improvement with targeted epidural blood patch. METHODS: Report of one case and review of the literature. RESULTS: Examination of cerebrospinal fluid after lumbar puncture disclosed a reduced opening pressure, an increased level of protein, and lymphocytic pleocytosis. Magnetic resonance imaging of the brain with gadolinium showed diffuse enhancement of the pachymeninges, no evidence of leptomeningeal enhancement, and chronic subdural fluid collection. Radionuclide cisternography demonstrated reduced activity over the cerebral convexities, early accumulation of radiotracer in the urinary bladder, and direct evidence of leakage at the cervicothoracic junction (C7-T1). Clinical, laboratory, and radiologic features were consistent with the diagnosis of spontaneous intracranial hypotension. Therapy with a targeted epidural blood patch resulted in the rapid resolution of symptoms. CONCLUSIONS: In this report, we describe a classic case of spontaneous intracranial hypotension in a 63-year-old man with an initial presentation of postural headaches, blurred vision, pain in the left eye, diplopia on left gaze, and neck soreness.