Pre-emptive lidocaine inhibits arterial vasoconstriction but not vasopressin release induced by a carbon dioxide pneumoperitoneum in pigs

Background. We assessed the preventive effects of i.v. or i.p.lidocaine administration on increases in vascular resistanceproduced by carbon dioxide pneumoperitoneum and related thisto vasopressin release. Methods. Carbon dioxide pneumoperitoneum (14 mm Hg intra-abdominalpressure) was performed in 32 anaesthetized young pigs and monitoredusing a pulmonary artery catheter. Animals received lidocaine0.5% (0.5 mg kg^–1) i.v. (n=9) or 2 ml kg^–1 i.p.(n=9) or saline (n=5) 15 min before the pneumoperitoneum andwere compared with a control group (n=9). Results. I.V. and i.p. lidocaine inhibited increases in meansystemic vascular resistance induced by the pneumoperitoneum[2109 (SD 935) and 2282 (895), respectively, vs 3013 (1067)dyne s^–1 cm^–5 in the control group]. Cardiac outputwas increased. Plasma lidocaine concentrations were threefoldhigher after i.p. administration than after i.v. administration.After pneumoperitoneum insufflation, plasma lysine-vasopressinconcentrations increased in all groups (control 74%, saline65%, i.p. lidocaine 57%, i.v. lidocaine 74%). Conclusions. I.V. and i.p. lidocaine blunted systemic vascularresponses to carbon dioxide pneumoperitoneum in pigs, but withoutinfluencing vasopressin release. Br J Anaesth 2003; 90: 343–8     

Androgen and estrogen receptors in the human corpus cavernosum penis: immunohistochemical and cell culture results

Despite the central and peripheral effects of androgens on the nervous system, the local effects of androgens in the corpus cavernosum penis and their importance for erectile function is still unclear. In this study corpus cavernosum biopsies of eight adult potent patients, aged 19–63 years, undergoing penile deviation surgery (group A) and 12 patients undergoing male-to-female transsexual surgery (group B) were immunostained for nuclear androgen and estrogen-alpha receptors. Additionally, primary corpus cavernosum endothelial cell cultures were obtained from six transsexual patients and exposed to testosterone, dihydrotestosterone, estradiol and progesterone likewise for 7 days. Total cell count was performed and cell metabolic activity was measured by a tetrazolium salt-based assay. Androgen and estrogen-alpha receptors were detected in stromal as well as in endothelial cells. Of all cell nuclei, 74.9% (SD 16.4) in group A and 63.5% (SD 17.1) in group B were positively stained for androgen receptors. The respective percentage of estrogen receptors was 11% (SD 9.5) and 21.2% (SD 12.6). An age-dependent difference in receptor distribution was not observed in either group. In the cell culture system only cultures exposed to testosterone and dihydrotestosterone showed a dose-dependent increase of cell metabolic activity compared to the cultures supplemented with estradiol and progesterone. The significant and age-independent high androgen and low estrogen-alpha receptor distribution found in both groups suggests a possible peripheral effect of androgens at the level of the corpus cavernosum penis in adult humans. This is supported by the observed effect of testosterone and dihydrotestosterone on cell count and endothelial cell metabolism in our cell culture system. The role of estrogens remains unclear.     

月经周期中内源性大麻素与性激素和促性腺激素的相关性研究分析

目的分析月经周期中不同时期正常女性血浆中N-花生四烯酸氨基乙醇(AEA)的水平变化及其与性激素和促性腺激素的相关性。方法选择2015年5~10月因输卵管梗阻或男方因素到本院生殖医学科就诊并欲行IVF助孕、月经周期和排卵正常的育龄妇女为研究对象。根据实验目的分为横断面研究组(79例)和纵向研究组(10例),检测AEA在两组女性月经周期中不同时期的变化,以及AEA与FSH、LH、E2、P之间的相关性。结果横断面研究组中早卵泡期、晚卵泡期、排卵期和黄体期AEA水平分别为(9.71±0.86)ng/ml、(10.61±1.05)ng/ml、(12.24±0.73)ng/ml和(7.46±0.71)ng/ml。排卵期AEA水平最高,黄体期最低(P0.05)。纵向研究组4个时期AEA水平分别(8.76±0.91)ng/ml、(11.61±1.28)ng/ml、(13.85±1.18)ng/ml、(8.50±1.08)ng/ml,排卵期AEA水平最高,黄体期最低(P0.05)。横断面研究组和纵向研究组各个时期的AEA水平比较均无显著性差异(P0.05)。AEA与FSH、LH、E2之间存在显著的正相关(P0.05),与P水平则无显著相关性(P=0.067)。结论正常女性血浆内AEA的浓度随月经周期的变化而变化,且与性激素和促性腺激素呈明显相关。但AEA与FSH、LH、E2、P之间的具体作用机制,有待进一步研究。     

The male patient with obesity undergoing metabolic and bariatric surgery: changes in testosterone levels correlate with weight loss after one-anastomosis gastric bypass and Roux-en-Y gastric bypass

BackgroundMale obesity secondary hypogonadism (MOSH) is a common disease among men with obesity and can be associated with metabolic syndrome and a variety of metabolic problems ultimately leading to androgen deficiency. Metabolic and bariatric surgery is a well-established treatment option associated with significant weight loss and reduction in metabolic co-morbidities.ObjectivesTo evaluate the impact of surgery on plasma levels of sexual hormones and their effect on weight loss comparing 2 surgical methods (one-anastomosis gastric bypass [OAGB] and Roux-en-Y gastric bypass [RYGB]) in male patients with obesity.SettingUniversity hospital, Austria.MethodsPatients undergoing OAGB and RYGB between 2012 and 2017 were analyzed retrospectively. Follow-up in this study was up to 24 months. Systemic levels of sexual hormones (luteinizing hormone [LH]), follicle stimulating hormone [FSH], total testosterone [TT], sexual hormone binding globin [SHBG], 17 beta-estradiol [17bE], androstenedione [AS]) were retrieved at each visit. A linear mixed model was used to assess the correlation between changes in testosterone levels and percent excess weight loss (%EWL).ResultsIn 30.8% of all patients, MOSH was present preoperatively. A significant increase of TT was observed postoperatively that led to a complete resolution of hypogonadism within the period observed. Bioavailable testosterone (bTT) and FSH levels significantly increased each month of follow-up after surgery (all P < .01). Levels of 17bE did not change significantly after surgery. The overall change of TT, comparing preoperative and 1-year postoperative TT levels (ΔTT), significantly correlated with %EWL. Changes in TT levels were not affected by the choice of surgical method.ConclusionsSerum plasma testosterone levels rise significantly after metabolic and bariatric surgery in male patients. The change of testosterone levels seems to play a role in continued weight loss after surgery. This is true irrespective of the surgical method used.     

肝移植受者围手术期甲状腺激素水平对预后的影响

目的 探讨肝移植受者围手术期甲状腺激素水平对预后的影响.方法 采用放射免疫法检测82例原位肝移植受者和20例健康对照者血清中总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)以及促甲状腺激素(TSH)的水平;观察受者术后肝功能和存活情况,并分析甲状腺素水平的变化对肝功能和死亡率的影响.结果 肝移植受者术前TT3和TT4水平明显低于健康对照者,且受者的甲状腺激素水平随肝功能水平降低而显著下降.术后2周内有72例受者甲状腺激素水平恢复正常,其中7例死亡,死亡率为9.7%;有10例甲状腺激素水平未恢复正常,其中5例死亡,死亡率为50%,两组死亡率的比较.差异有统计学意义(P<0.05).结论 肝移植术前甲状腺激素水平的降低与肝功能损害程度呈正相关;甲状腺激素水平可作为判断肝移植预后的指标.     

腹腔镜直肠癌根治术中保护盆腔植物神经的体会

目的:探讨腹腔镜直肠癌根治术中显露及保护盆腔植物神经对患者术后性功能和排尿功能的影响。方法:回顾分析2005年5月至2008年3月我院为11例男性直肠癌患者施行腹腔镜全直肠系膜切除术(total mesorectal excision,TME)的基础上保留盆腔植物神经(pelvic autonomic nervepreservation,PANP),降低术后排尿及性功能障碍发生率的临床资料。结果:患者术后勃起功能障碍发生率9.09%,射精功能障碍发生率18.18%,近期排尿障碍发生率9.09%。结论:腹腔镜TME基础上行PANP与传统开腹TME基础上行PANP相比,术中能更清晰地显露盆腔植物神经并予以保护,减少了术后排尿和性功能障碍的发生。     

西沙比利对不同透析方式患者的消化道症状及胃肠激素影响研究

目的:研究西沙必利对HD和PD患者消化道症状及胃肠激素的影响。方法:选取透析患者120例作为研究对象,同期选择40位健康人作为对照组,在给予基础疾病的常规治疗基础上加用西沙必利治疗,对比血清生长抑素（SS）、胃动素（MOT）及血管活性肠肽（VIP）水平,以及消化道症状、胃肠激素和部分生化指标的变化。结果:治疗后,HD组和PD组患者消化道症状评分显著低于治疗前（P＜0.05）,治疗后PD组在腹胀和便秘症状得分仍高于HD组;HD组和PD组治疗前后SS和VIP无显著变化（P＞0.05）,MOT显著下降（P＜0.05）;PD组和HD组治疗前后BUN、Scr、Hb和kt/v对比无显著差异（P＞0.05）,而PD组ALB水平治疗后较治疗前升高（P＜0.05）。研究组胃肠激素水平明显高于健康对照组。结论:透析患者都普遍存在消化道症状,且存在明显的胃肠激素蓄积,在常规基础疾病治疗的基础上加用西沙必利可以改善其消化道症状效果,同时降低患者血清胃动素含量。     

补肾活血祛痰方在女性生殖障碍中的应用及对HAMD的影响

目的 探讨补肾活血祛痰方在女性生殖障碍中的应用及对HAMD的影响。方法 选取2018年5月～2019年8月在我院接受生殖障碍治疗的女性患者98例为研究对象,按随机数字法分为对照组和研究组,每组49例,对照组应用常规治疗,研究组应用补肾活血祛痰方治疗,对比两组患者在治疗后的效果及HAMD的影响。结果研究组患者治疗后PRL、T、LH以及FSH各项性激素改善的水平均优于对照组(P0.05)。研究组患者治疗后受孕率高于对照组(P0.05)。研究组患者治疗后各个时段HAMD评分改善均优于对照组(P0.05)。结论 女性生殖障碍的治疗过程当中,补肾活血祛痰方的治疗取得了理想的效果,临床应当进一步推广应用。     

系统性红斑狼疮患者不同性别临床特征的对比研究

目的对比确诊为系统性红斑狼疮(Systemic lupus erythematosus,SLE)的患者中不同性别的临床特征及其治疗效果、预后的差异。方法选取中国人民解放军联勤保障部队第九四〇医院风湿免疫科从2005年1月～2014年1月住院期间所有的SLE患者进行回顾性研究。观察患者的发病年龄、发病特点,分析系统性红斑狼疮患者不同性别的临床表现、对各脏器功能的损害程度、实验室差异、经药物治疗后的效果及生存率的差异。结果回顾性分析发现,男性SLE狼疮患者生存率低于女性患者(P0.05),激素及免疫抑制剂的使用明显高于女性(P0.05)。男性SLE患者脱发及盘状红斑的发生率较女性患者低(P0.05)。但女性患者白细胞减少及自身抗体阳性率更为突出(P0.001)。在疾病终末期需要透析的狼疮肾炎患者中,男性患者的风险明显高于女性患者(OR,3.98;95%置信区间,1.07～14.97)。男性与女性的SLICC/ACR DI(分别为1.55±0.26和1.03±0.42,P=0.028)。结论通过回顾性分析,本研究进一步证实,在系统性红斑狼疮患者中,男性狼疮性肾病的发生率比女性患者更高、损害程度比女性患者更为严重,男性一旦确诊SLE,总体预后及生存率较女性差。     

保留子宫动脉筋膜内子宫切除术式探讨

目的探讨应用保留子宫动脉筋膜内子宫切除术治疗子宫良性病变的实用性。方法对56例子宫良性病变需行子宫切除者进行保留子宫动脉筋膜内子宫切除术，分别测定手术前、后血清性激素水平（研究组）；选择同期行全子宫切除术48例（对照组）作为对照组，比较二组术中出血量、手术时间等。结果研究组手术前后血清性激素水平无明显改变，提示此术式对卵巢功能无影响，术中出血量、手术时间与对照组无差异。结论保留子宫动脉筋膜内子宫切除术是治疗子宫肌瘤等良性病变可供选择的好的手术方法。