A successful conception by a shift from human menopausal gonadotropin therapy to therapy with recombinant human follicular-stimulating hormone for the treatment of male hypogonadotropic hypogonadism

Stimulatory therapy with gonadotropins effectively induces spermatogenesis and increases the chances of successful reproduction. However, the optimal treatment modality and schedule, and required duration of treatment have not been determined. A 27-year-old man presented with erectile and ejaculatory disorder. Endocrinological examinations revealed isolated luteinizing hormone-releasing hormone (LHRH) deficiency of the hypothalamus, resulting in hypogonadotropic hypogonadism. No causative abnormality was detected in imaging studies. Having a diagnosis of adult-onset hypogonadotropic hypogonadism, the patient received pulsatile subcutaneous human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG). Hypogonadism did not improve with hCG/hMG combination therapy. He was successfully treated with the replacement therapy from hMG into recombinant human follicular-stimulating hormone (rhFSH) for induction of spermatogenesis, along with pregnancy in the female partner.     

Cancer of the Colon and Disseminated Intravascular Coagulation

Disseminated intravascular coagulation may occur as a complication of a rapidly growing tumor or Gram-negative septicemia. Coagulation tests, particularly the test for fibrin split products, are helpful in detecting this insidious disease process. Heparin is the treatment of choice, but a good prognosis often hinges on successful management of the primary disease.     

Treatment of type 2 diabetes

PREVIEW

Early initiation of therapy to decelerate the decline in beta cell function and achieve low hemoglobin A_1c levels is advantageous in patients with type 2 diabetes. In this first of two articles on treatment of type 2 diabetes, the authors share their experience in optimizing therapy and advocate fixed-dose oral combinations because of lower cost, improved efficacy, better compliance, and fewer side effects. The second article (on page 15) looks at the use of injection therapy when oral therapy is not enough.     

Neonatal nutrition

Using propranolol or lidocaine as an antiarrhythmic agent takes keen clinical judgment if optimal efficacy is to be obtained at minimal risk. Serious adverse effects of propranolol are cardiac, while those of lidocaine are usually dose-related and most often involve the central nervous system.     

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。