Antiandrogenic effect of spirolactones: mechanism of action.

Spirolactones are aldosterone antagonists which inhibit the binding of aldosterone to the renal mineralocorticoid receptor. These molecules also possess an antiandrogenic effect which could be due, among other possibilities, to a peripheral antagonism of androgens. This hypothesis has been tested in the present study. From in vivo experiments, spironolactone K+ canrenoate appear to inhibit the binding of [3H]5alpha-dihydrotestosterone [3H]DHT to the cytosolic and nuclear receptor of the rat ventral prostate. The doses used are in the same range as those used for demonstrating the antimineralocorticoid effect of these molecules. In vitro incubations and in vitro displacement studies show that spironolactone and K+ canrenoate are respectively about 20 and 100 times less effective than DHT in displacing 50 percent of 5 times 10- minus 10 M [3H]DHT from its receptor. Spirolactones are also able to compete with [3H]DHT for the specific 8 S cytosolic receptor. Neither spironolactone nor K+ canrenoate decreases prostatic 5alpha-reductase activity, even at a concentration as high as 10- minus 5 M. It seems likely that spirolactones, besides their action on testosterone biosynthesis, exert their antiandrogenic activity via a peripheral androgen antagonism.

Laparoscopic treatment of tubal pregnancy.

Seventeen tubal pregnancies were treated successfully with a laparoscopic procedure over the past four years. Four different laparoscopic techniques were used: salpingectomy, partial salpingectomy (midtube resection), fimbrial expression, and salpingotomy. "Preventive hemostasis" using vasopressin has made salpingotomy our treatment method of choice. Ruptured tubal pregnancy was not considered a contraindication to laparoscopic treatment. Four of the six women who were trying to conceive and were followed for longer than six months have had documented intrauterine pregnancies; one woman subsequently developed a contralateral tubal pregnancy which was treated by laparoscopic salpingotomy. Tubal ectopic pregnancy, even in the presence of rupture, can be managed effectively by a variety of laparoscopic techniques with benefits including minimal incision, short hospitalization, early return to full activity, and in many cases, a patent tube.

[Factors that affect the medical recuperation and socio-occupational rehabilitation of pulmonary tuberculosis patients (I)]. / Factorii care influenteaza recuperarea medicala si reinsertia socio-profesionala la bolnavii cu tuberculoza pulmonara (Nota I).

Investigations were carried out in a group of patients serving as a rehabilitation model, considered the best and the most worth being adopted. The group was made up of 100 patients with pulmonary tuberculosis, recorded during the last 5 years, recently stabilized and included in the group II of dispensary care and in the card index "surveillance", who are re-employed and work in various enterprises in the Capital; as regards the solving of these cases, they are at the opposite pole with respect to chronic patients (100 cases), with whom they are continuously put in contrast. The elements with a positive value regarding the most rapid health restoration, as well as the ways of re-employment were studied. The results of medical rehabilitation depend on the early detection of the disease, on a treatment correctly applied, on the patients' cooperation, on the chemoresistance and drug intolerance, on the presence or absence of associated non-invalidating diseases, on age (results are better in young patients), on sex, on the professional activities a.s.o. The most important causes of an unsatisfying socio-professional rehabilitation and of a partial maladjustment were related to the performance of activities in departments with various bronchopulmonary irritants, to weight lifting and carrying, to a prolonged upright posture to additional professional efforts, to the insufficient granting of the initially shorter programme a.s.o.(ABSTRACT TRUNCATED AT 250 WORDS)

Guidance for the evaluation, risk assessment and control of chemical embryo-fetotoxins.

The recognition, evaluation, and control of embryotoxins in the workplace are toxicologically and administratively complex and present challenging circumstances to the occupational health professional and to the workplace manager. Accommodating the expectations of society and complying with existing laws and regulations make this complex problem even more difficult. By carefully applying the same toxicological considerations and control measures as are used for other chemicals which present different toxic hazards, exposures of susceptible persons to embryotoxins can be prevented or maintained at safe levels without unnecessary restriction of the opportunity for meaningful employment for any class of persons.