Poly (vinyl alcohol)/Silk Fibroin/Ag NPs composite nanofibers for bone tissue engineering.

In this work, electrospinning was used for the preparation of composite nanofibrous scaffold, of polyvinyl alcohol (PVA), silk fibroin (SF) extract of Bombyx mori cocoons and silver nanoparticles (Ag NPs), as a substrate for bone tissue engineering. The PVA pristine was prepared at a concentration of 10% wt. The composite nanofibers scaffolds of PVA was prepared with silk fibroin and silver nanoparticles, in relation of PVA: SF (90:10) (v/v) respectively. The formation and presence of AgNPs was confirmed by ultraviolet-visible spectroscopy (Uv-vis). The diameter distribution of the nanofibers was narrow by SEM using Image J software. The chemical composition was determined by FTIR spectra. The wettability was determined using water contact angle. The results showed the average nanofiber diameter of PVA10 pristine was 108.18 nm and to PVA10/SF/Ag NPs was 106.62 nm, no significant changes were noted in the mean diameter, but there were changes in its morphology. The average nanofiber diameter increase with the concentration of PVA at PVA15/SF/Ag NPs was 189.12 nm to PVA18/SF/Ag NPs was 224,23 nm. FTIR spectra indicated characteristic absorption peaks related to the chemical structure of PVA, fibroin and Ag NPs, it demonstrated good interactions between them, caused by strong intermolecular hydrogen bonds. The contact angle of the scaffolds PVA 10%wt decrease with the incorporation of fibroin and show hydrophilic characteristics. The achievements indicate the potential of the nanofibers of PVA15/SF/Ag NPs as a possible substitute for bone tissue engineering.Clinical Relevance-This establishes a possible substrate of PVA/SF/Ag NPs that exhibit desired properties such as porosity and high surface area to volume ratio for bone tissue engineering.

Characterization of polycaprolactone/rGO nanocomposite scaffolds obtained by electrospinning.

The incorporation of nanoparticles inside polymeric matrices has led to the development of multifunctional composites necessary to repair human tissues. The addition of nanoparticles may improve the properties of the composite materials such as surface area, mechanical properties, flexibility, hydrophilicity, electrical conductivity, etc. These properties can help in cellular growth, proliferation and/or differentiation. In this work, scaffolds of polycaprolactone (PCL) and reduced graphite oxide (rGO) were built by electrospinning technique. The ratios of rGO/PCL employed were 0.25, 0.5, 0.75 and 1 wt%. Two different voltage setup (10 and 15 kV) and distance of 10 cm were used for electrospinning. Thermal, mechanical, morphological, electrical, porosity and absorption water tests were made to the scaffolds. Samples electrospun at 10 kV with rGO showed improvement in mechanical properties with an increase of 190% of Young's Modulus in comparison with sample without rGO. Furthermore, samples electrospun at 15 kV showed an important deterioration with the addition of rGO but had an increase in the electrical conductivity and porosity. Overall, the addition of 0.75 and 1 wt% of rGO led to a detriment on properties due to formation of aggregates. The voltage on the electrospinning process plays a very important role in the final properties of the nanocomposites scaffolds of PCL-rGO.

Oral mucositis in paediatric acute lymphoblastic leukemia patients receiving methotrexate-based chemotherapy: case series.

AIM: Oral mucositis (OM) is a painful and inflammatory ulcerative lesion occurring as an adverse effect during chemotherapy in children with acute lymphoblastic leukemia (ALL). This condition may cause significant systemic anomalies such as malnutrition, opportunistic infections, and delay in the chemotherapy course. This report aims to describe a case series of 11 ALL patients treated with methotrexate as chemotherapy agent. CASE SERIES: Each patient was carefully followed-up and orally examined for 14 days after their chemotherapy session. OM occurred in all children. Then, the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) management protocol for OM was applied to them. The mean time of the lesion total resolution was 3.7 days. CONCLUSIONS: It is necessary to emphasise the importance of early detection of OM through a close clinical oral examination of children and adolescents with ALL undergoing methotrexate chemotherapy. Pain/infection control and the maintenance of good levels of oral hygiene are fundamental during the management of OM. Therefore, paediatric dentists need to be part of the oncology care team, and thus contributing and helping with ALL treatment.

MRI dedicated to bones and joints: what are their market shares in terms of number of patients in private practice in France?

PURPOSE: The French government plans to install MRI facilities dedicated to musculoskeletal indications. We have analyzed the use of imaging investigations in the community to assess their market share. MATERIALS AND METHODS: We undertook a retrospective analysis of all reimbursements during the year 2012 by the French Social Plan for Independent Workers for 4 imaging methods for a musculoskeletal indication (MRI, CT scan with or without opacification and contrast-enhanced conventional radiography). RESULTS: Three hundred and thirty-two thousand eight hundred and ninety-three beneficiaries were included. The following investigations were used: MRI 12659 investigations; CT scan without direct opacification 7392; CT scan with direct opacification 1271; contrast-enhanced conventional radiography 1187. Of those beneficiaries who underwent investigations of the spine, 39.91% had MRI alone, 8.62% had both MRI and one of the other investigations and 51.46% did not have MRI. The corresponding figures for beneficiaries undergoing lower limb investigations were 79.57%, 4.53% and 15.90% and those for beneficiaries undergoing upper limb investigations were 35.49%, 6.56% and 57.94% respectively. CONCLUSION: In terms of the numbers of investigations, our results show that in France MRI dedicated to musculoskeletal indications has a wide market share for the spine, upper and lower limbs.

Influencia de la formación académica del personal de enfermería en la calidad del cuidado brindado a pacientes adultos hospitalizados / Influence of the academic training of nurses in the quality of care provided to hospitalized adult patients

Introducción. La formación académica inicial del personal profesional de enfermería parte de dos niveles: técnico o licenciatura; ambas llegan a la práctica institucional a ejercer funciones similares o equivalentes; quedando de lado las características distintivas de ambas formaciones. En el ámbito teórico se encuentran diferencias como el tiempo de permanencia, los créditos alcanzados y sobre todo, los perfiles de egreso. En el ámbito práctico, las relaciones, los objetivos y el ambiente laboral en general es idéntico. Material y métodos. El universo de estudio estuvo compuesto por personal de enfermería del turno matutino y vespertino de un hospital regional público. Se observaron 90 enfermeras que realizaron la administración de medicamentos por vía intravenosa realizado por el personal mencionado, se encuestó a igual número de pacientes sobre la satisfacción de la atención a cargo de la enfermera que el investigador observó, y por último, se aplicó una encuesta al personal observado y evaluado respecto a sus antecedentes de formación académica. Resultados. Se aplicó un instrumento a 65 integrantes del personal de nivel técnico y 25 de nivel licenciatura en ambas categorías se observaron por parte del investigador porcentajes bajos en la realización adecuada de las actividades correspondientes a la administración de medicamentos intravenosos, como lavado de manos (17.8%) del total, entre otros; no se encontraron diferencias significativas entre ambas categorías. Por otro lado, en lo referente a la satisfacción del paciente los usuarios evalúan la calidad de la atención recibida, aquí se encontraron diferencias estadísticamente significativas en ítems como atención individualizada (p=0.023) y que el personal contesta con rapidez el botón de llamada (p=0.008) favoreciendo al personal de nivel técnico en esta dimensión. Discusión. Al conjuntar los resultados de ambas dimensiones (técnica y humana) se observa un bajo nivel de cumplimiento por lo que es viable aseverar que la formación no es una variable única que de manera unilateral pueda determinar la calidad del cuidado. Conclusiones. En base a los resultados y comparándolo con la información de la revisión sistemática es posible afirmar que los resultados son similares, sin favorecer a alguna formación académica en particular, por lo que es importante considerar en este sentido la revisión de otras dimensiones al respecto. Palabras clave: formación académica, personal, calidad de cuidado, influencia.

Introduction. The initial academic training professional nurses from two levels: technical or degree; reach both institutional practice to exercise functions similar or equivalent; leaving out features of both formations. At the theoretical level differences are found from the residence time credits earned and above all, in the graduate profiles. In practical terms, relationships, objectives and the overall feel is identical. Material and methods. The study group consisted of nurses of the morning and afternoon shift of a Regional Hospital. 90 procedures for medication administration were observed intravenously, were surveyed equal numbers of patients on satisfaction of care by nurse researcher noted, and finally, a survey was applied to the observed staff and evaluated by patients about their history of education. Results. 65 instruments to staff technical level undergraduate and 25 were applied in both categories were observed by the researcher low percentages in the proper performance of the activities under the administration of intravenous medications, such as hand washing (17.8 % ) of the total , among others, it is noteworthy that no significant differences were found between the two categories . Furthermore, with regard to patient satisfaction users assess the quality of care received , here statistically significant differences were found in items such as individual attention (p = 0.023 ) and the staff quickly answered the call button ( p = 0.008 ) favoring technical level staff in this dimension. Discussion. By bringing together the results of both dimensions (technical and human) a low level of compliance with what is feasible to assert that training is not a single variable can unilaterally determine the quality of care is observed. Conclusions. Based on the results and comparing it with information from the systematic review we can conclude that the results are similars, so it is important to consider in this regard the review of other aspects about it. Keywords: academic training, staff, quality of care, influence.

Prevention of congenital rubella and congenital varicella in Europe.

Despite the availability of safe and efficacious vaccines, cases of congenital rubella and varicella syndrome still occur in Europe. As of 2004, several countries had high proportions of women of childbearing age that were susceptible to rubella and varicella virus infection.

Vacuum phenomenon in the temporomandibular joint: a clinical, computed tomography and magnetic resonance case report.

A 28-year-old woman presented with a history of clicking and mandibular clenching. She was studied clinically and with axial and coronal CT. The patient was going through a tense emotional period and reported tightening of her teeth (clenching); she was under psychological and neurological treatment for depression including pharmacological therapy. She presented slight pain only at maximum mouth opening at the right temporomandibular joint (TMJ) and in the lateral pole on palpation; there was no coincidence between initial and maximal interocclusal contacts because of premature dental contacts. She showed occlusal group function in the right side and canine guidance in the left side with a right contact of balance, local muscular pain in the right deep masseter muscle and in the superior and middle portion of the right trapezium on palpation. On CT, a spherical area of 3 mm diameter with an average density of -647 HU (SD+/-4.7) was found in the upper and posterior area of the lower space of the right TMJ, together with a thicker lower synovial tissue. This observation was confirmed by MRI. Like other joints, the TMJ could present vacuum phenomenon images inside synovial tissue in the presence of degenerative disease. It is important for radiologists to recognize this rare entity.

El reto para la salud pública de los Objetivos de Desarrollo del Milenio: un enfoque desde la epidemiología política / The challenge to public health of the Millenium Development Goals: an approach from political epidemiology

Los Objetivos de Desarrollo del Milenio, y dentro de éstos las Metas del Milenio, constituyen un plan operativo para la consecución de logros básicos dirigidos al alcance de la salud, la erradicación de la pobreza y el cumplimiento de los derechos humanos fundamentales. Sus ámbitos de acción representan un punto de entrada histórico para una eventual política social a escala mundial, donde la intervención intersectorial es imprescindible para la eficacia de ésta. La salud pública, por su naturaleza multidisciplinar, junto a la epidemiología política, constituyen herramientas útiles para contribuir a incrementar el conocimiento científico en el ámbito de la salud con relación a los Objetivos de Desarrollo del Milenio. A pesar de la oportunidad que constituye este acuerdo internacional, se ha profundizado poco acerca de las dificultades, fundamentalmente políticas para su consecución. Por lo tanto, es necesario un cambio conceptual y metodológico basado en pasar de preguntarnos acerca de los determinantes socials de la salud a cuestionarnos acerca de los determinantes politicos de los propios determinantes sociales. Esto supondría no sólo elaborar una taxonomía de las injusticias, sino encontrar puntos de entrada efectivos en las instituciones derivadas del poder político para aminorarlas (AU)

The Millennium Development Goals, and within these the Millennium Targets, constitute a working plan that strives to achieve basic goals within the field of health, eradicate poverty, and ensure compliance with basic human rights. Its scope of action represents a historic breakthrough as a step toward a possible global social policy, in which cooperation between the different sectors is essential for its efficiency. Due to its multidisciplinary nature, public health, as well as political epidemiology, can be used to help increase scientific knowledge in the field of health with respect to the Millennium Development Goals. Despite the opportunity that this international agreement provides, insufficient in-depth study has been carried out on the potential –mainly political– difficulties that could arise during its implementation. Therefore, a conceptual and methodological change is required so that concern does not simply center on social determinants of health but instead takes into consideration the political reasons behind them. To reduce inequality, not only must injustice be classified but effective ways must also be found to encourage institutions with political power to take part in this initiative (AU)

[The challenge to public health of the Millenium Development Goals: an approach from political epidemiology]. / El reto para la salud pública de los Objetivos de Desarrollo del Milenio: un enfoque desde la epidemiología política.

The Millennium Development Goals, and within these the Millennium Targets, constitute a working plan that strives to achieve basic goals within the field of health, eradicate poverty, and ensure compliance with basic human rights. Its scope of action represents a historic breakthrough as a step toward a possible global social policy, in which cooperation between the different sectors is essential for its efficiency. Due to its multidisciplinary nature, public health, as well as political epidemiology, can be used to help increase scientific knowledge in the field of health with respect to the Millennium Development Goals. Despite the opportunity that this international agreement provides, insufficient in-depth study has been carried out on the potential -mainly political- difficulties that could arise during its implementation. Therefore, a conceptual and methodological change is required so that concern does not simply center on social determinants of health but instead takes into consideration the political reasons behind them. To reduce inequality, not only must injustice be classified but effective ways must also be found to encourage institutions with political power to take part in this initiative.

Use of sensory-evoked potentials recorded from the human occiput for intraoperative physiologic monitoring of the spinal cord.

STUDY DESIGN: This is a report of a prospective case series. OBJECTIVE: The purpose of this study was to determine whether evoked potential activity recorded from occipital scalp electrodes in humans is similar to that recorded in animals, and to evaluate the independence of this activity from the classical somatosensory-evoked potential. SUMMARY OF BACKGROUND DATA: Intraoperative somatosensory-evoked potentials can be of limited usefulness in predicting spinal cord injury because they are transmitted primarily through the dorsal columns, and therefore do not reflect integrity of important ventral pathways. It recently has been shown in animal studies that a sensory-evoked potential recorded from the cerebellum is mediated via ventral tracts and is useful as an adjunct to the somatosensory-evoked potential in spinal cord monitoring. METHODS: Twenty-five patients undergoing spinal or posterior fossa surgery were consecutively entered into the study. Evoked responses were recorded transcranially from over the cerebellar hemispheres and from the vertex. Recordings were made directly from the surface of the cerebellar hemispheres in seven of these patients. RESULTS: Waveforms could be recorded and reproduced in all but one of the patients. The overall appearance of the occipital recordings was similar to the appearance of responses obtained in animals. The mean latency of the first negative peak recorded from the ipsilateral occiput was 33.0 msec (standard deviation, 3.7 msec) compared with 52.4 msec (standard deviation, 6.1 msec) for the somatosensory-evoked potential. In addition, the amplitude of this response (0.35 microV; standard deviation, 0.20 microV) was independent of the amplitude of the somatosensory-evoked potential (0.76 microV; standard deviation, 0.69 microV). In five cases, one evoked potential could be recorded in the absence of the other. Recordings from the surface of the cerebellum were of the same morphology, but of greater amplitude than the transcranial recordings. CONCLUSION: Evoked responses can be reliably recorded from over the occiput and show characteristics independent of the classical somatosensory-evoked potential. These responses are very similar to the cerebellar-evoked potential recently characterized in animals and may provide a method for assessing the physiologic integrity of the ventral tracts of the spinal cord in humans.

Involvement of corticotropin-releasing hormone and endogenous opioid peptides in prolactin-suppressed gonadotropin-releasing hormone release in vitro.

Corticotropin-releasing hormone (CRH) has been shown capable of inhibiting hypothalamic gonadotropin-releasing hormone (GnRH) release through activation of an endogenous opioid peptide (EOP)-dependent mechanism. Recently, we have shown that prolactin (PRL) stimulates CRH release and inhibits GnRH release by hypothalami explanted from male rats. Thus, the present study was undertaken to investigate whether the inhibitory effect of PRL on GnRH release in vitro is mediated by CRH and/or EOP. To this aim, the release of GnRH in response to PRL was evaluated in presence of CRH9-41 alpha-helical (CRH-9-41), a CRH receptor antagonist, and/or naloxone (NAL), a nonselective opioid receptor antagonist, using a static hypothalamic organ culture system which enabled us to evaluate immunoreactive GnRH (iGnRH) release from individually incubated longitudinally halved hypothalamic. As previously shown, PRL at the concentration of 100 nmol/l inhibited basal iGnRH release by about 35%. CRH9-41 or NAL overcame the inhibitory effect of PRL on iGnRH release in a concentration-dependent fashion. The simultaneous co-incubation with both antagonists was not more effective than each single antagonist. CRH9-41 did not have any effect on basal iGnRH release whereas NAL, as previously reported, increased it. In addition, PRL at the concentration of 100 nmol/l stimulated basal hypothalamic beta-endorphin (beta-EP) release. In conclusion, these data show that antagonism to CRH receptors counteracts the suppressive effects of PRL upon GnRH release and that PRL is able to stimulate hypothalamic beta-EP release in vitro.

Relationship of inhibin serum level to bioactive and immunoreactive FSH in oligospermic and azoospermic patients.

The purpose of the study described here was to evaluate the relationship between inhibin (INH) and bioactive FSH (B-FSH) or immunoreactive FSH (I-FSH) in oligoazoospermic patients. To accomplish this, the authors measured serum levels of INH, I-FSH, B-FSH, LH and testosterone (T) in 98 male patients attending the andrology Centre at Malphighi Hospital (Bologna) for infertility workup. On the basis of the mean sperm concentration, patients with sperm output > or = 4 x 10(7) ml-1 (n = 30) formed the control group (group A), whereas oligozoospermic patients were divided arbitrarily into three groups. Sperm concentrations for these groups ranged as follows: B, 2-4 x 10(7) ml-1 (n = 14); C, 5 x 10(6)-2 x 10(7) ml-1 (n = 18); D, < 5 x 10(6) ml-1 (n = 17). In addition, the authors studied a group of patients with possible non-obstructive azoospermia (n = 19, group E), confirmed in 16 of them through testicular biopsy. There were no significant differences in serum levels of LH and T among groups. However, azoospermic patients had a significant reduction of the T/LH ratio. Similarly, B-FSH and B/I-FSH ratios were significantly elevated only in group E. INH serum levels did not show any appreciable changes among groups and in azoospermic patients INH correlated significantly and in a positive manner with I-FSH serum levels and negatively with B/I-FSH and T/LH ratios. Within the azoospermic patient group no consistent relationship was evident between INH serum concentration and various degrees of spermatogenetic arrest.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of cholecystokinin octapeptide on the hypothalamic-pituitary-adrenal axis function and on vasopressin, prolactin and growth hormone release in humans.

Cholecystokinin (CCK), a gastrointestinal (GI) hormone, is also present in structures of the central nervous system such as cortex, hippocampus, amygdala, olfactory tubercle and in regions involved in the regulation of the pituitary function. Although a number of studies have evaluated the effects of CCK on hypothalamic-pituitary-adrenal (HPA) axis function and on arginine vasopressin (AVP), prolactin (PRL) and growth hormone (GH) plasma levels in the laboratory animal, its role in humans has not been explored. Hence, we examined the effects of the exogenous administration of this GI hormone on corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol, AVP, PRL and GH plasma levels in humans. To accomplish this, graded doses (0, 50, 140 and 420 ng/kg) of sulfated CCK octapeptide (CCK-8), the full biologically active peptide, were infused intravenously to healthy men in 30 min. Blood samples were collected 30 min and immediately before the infusion was started (baseline) and 15, 30, 45, 60 and 90 min thereafter. CRH, ACTH, and AVP were extracted from plasma proteins using cartridges of SepPak C18. These hormones and cortisol were measured by radioimmunoassay whereas PRL and GH were measured by immunoradiometric assay. CCK-8 increased plasma ACTH and cortisol levels only at the dose of 420 ng/kg, whereas it had no detectable effect on plasma CRH levels. It increased also plasma AVP levels at the doses of 140 and 420 ng/kg. However, this effect reached the statistical significance only at the highest dose tested. CCK-8 stimulated PRL and GH release in a dose-dependent fashion. The lowest stimulatory dose was 140 ng/kg for both hormones.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of selective serotonin agonists on basal, corticotrophin-releasing hormone- and vasopressin-induced ACTH release in vitro from rat pituitary cells.

The present study was undertaken to evaluate the serotonin (5-HT) receptor subtype(s) by which 5-HT acts on the pituitary to stimulate ACTH secretion. We tested the effects of the 5-HT1A receptor agonist 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT), the 5-HT1C receptor agonist metachloro-phenylpiperazine (m-CPP), which also binds to other 5-HT receptors with lower affinity, and the 5-HT2/1C receptor agonist 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) on basal, corticotrophin-releasing hormone (CRH) and arginine vasopressin (AVP)-stimulated ACTH release from primary rat anterior pituitary cell cultures. 5-HT, 8-OH-DPAT and DOI significantly increased basal ACTH release, an effect which was antagonized by 5-HT receptor antagonists. 5-HT and DOI were effective at nanomolar concentrations whereas 8-OH-DPAT was effective at higher concentrations. 5-HT, 8-OH-DPAT (both at 10 nmol/l) and DOI (at higher concentrations) blunted the stimulatory effect of CRH. The suppressive effects of 8-OH-DPAT and DOI on CRH-stimulated ACTH release were antagonized by (-)propranolol, a beta-adrenergic receptor antagonist which binds the 5-HT1A receptor with elevated affinity, and ketanserin, a 5-HT2 receptor antagonist respectively. 5-HT, 8-OH-DPAT and DOI showed additive stimulatory effects with AVP but only at the highest concentration tested, whereas m-CPP potentiated AVP-induced ACTH release at concentrations of 1 nmol/l or more. This effect was antagonized by metergoline, a non-selective 5-HT receptor antagonist and mianserin, an antagonist which binds the 5-HT1C receptor with elevated affinity.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of acetylcarnitine treatment in oligoasthenospermic patients.

Acetylcarnitine (AC), present in human spermatozoa and seminal fluid, plays an important role in sperm metabolism. To further investigate the effect of AC on sperm quality, AC (4 g/day) was given to 20 patients with idiopathic oliogasthenospermia for 60 days. AC had no effects on sperm density and total motility, but it did significantly increase progressive sperm motility (mean +/- SEM: 21.7 +/- 3.2% vs 38.2 +/- 4.7). The increment in sperm motility was sustained ( > or = 40%) in 12 patients (mean increment 2.7 fold). This parameter returned to basal value 4 months after therapy discontinuation. Five pregnancies occurred during treatment and only 2 during the 4 months follow-up ensuing therapy discontinuation.

Limited clinical usefulness of plasma corticotropin-releasing hormone, adrenocorticotropin and beta-endorphin measurements as markers of lung cancer.

We measured plasma corticotropin-releasing hormone (CRH), ACTH, beta-endorphin (beta-EP), and cortisol levels as possible tumor markers in a sequence of 103, randomly selected, patients with lung cancer but without the ectopic Cushing's syndrome and in 72 age- and sex-matched controls. Plasma CRH levels of cancer patients were similar to those of controls both in patients sampled in the morning or in the afternoon. On the other hand, plasma ACTH levels of cancer patients were significantly higher than control patients both in the morning and in the afternoon and showed a preserved circadian rhythm. However, about 35% of cancer patients sampled in the morning and about 60% of those sampled in the afternoon had ACTH levels within the 95% confidence interval (CI) of controls. Also plasma beta-EP levels were more elevated in cancer patients than controls in the morning but about 33% of them and about 80% of those sampled in the afternoon had beta-EP levels within the 95% CI of controls. Despite the higher plasma ACTH levels, cancer patients had cortisol plasma levels similar to controls with preserved circadian rhythm. In conclusion, although mean plasma ACTH and beta-EP were higher in patients affected by lung cancer, their measurements, as well as those of CRH, have practically no diagnostic value. Perhaps measurement of ACTH levels in the bronchial lavage may be more helpful.

Therapy with human chorionic gonadotrophin alone induces spermatogenesis in men with isolated hypogonadotrophic hypogonadism--long-term follow-up.

The effects of long-term (14-120 months) hCG-treatment of 17 male patients affected by isolated hypogonadotrophic hypogonadism (IHH) on testicular volume, plasma testosterone levels, and sperm concentration were assessed. Mean testicular volume increased from 3.8 +/- 0.2 (Mean +/- SEM) ml to a maximal of 14.9 +/- 1.1 ml after 22.2 +/- 2.3 months of hCG treatment. Maximal testicular volume correlated positively with the volume recorded before the patients had undergone any previous treatment. Testicular growth was also analysed by sorting the patients into two sub-groups according to whether their initial testicular volume was less than 4 ml (small testis subset, STS) or greater than or equal to 4 ml (large testis subset, LTS), supposedly indicating complete or partial gonadotrophin deficiency, respectively. Testicular volumes in the LTS group were always greater than those of the STS. Plasma testosterone levels reached adulthood values during hCG treatment and no statistically significant difference was detected between LTS and STS patients with IHH. Thirteen patients (70%) became sperm-positive during treatment with hCG alone; five out of eight (60%) were STS patients and eight out of nine (90%) were LTS. In addition, LTS patients always had a greater sperm output than did STS patients. Sperm concentration correlated positively with maximal testicular volume, but not with patient age, length of treatment, or initial testicular volume. The administration of hMG to eight of these patients caused an increase in testicular volume in two patients but the mean volume was not statistically different from that recorded at the end of treatment with hCG alone. Similarly, sperm concentration improved in three patients but again it did not differ significantly from that achieved in the course of hCG treatment. It is noteworthy that one patient became sperm-positive after the addition of hMG to his therapeutic regimen. Among sperm-positive patients attempting conception, seven out of 10 succeeded, two of whom were from the STS group. In summary, this study indicates that hCG alone is an effective treatment to induce complete spermiogenesis in IHH patients regardless of their initial testicular volume. However, a number of IHH patients may benefit from the addition of hMG in terms of testicular volume, sperm output, and pregnancy outcome.

Role of peripherally infused angiotensin II on the human hypothalamic-pituitary-adrenal axis.

Although angiotensin II (AII), a potent vasoconstrictor agent, has been reported to stimulate the hypothalamic-pituitary-adrenal (HPA) axis of laboratory animals, its role in the regulation of this axis in humans appears to be controversial. To examine this question, AII (Val5-AII amide) was infused intravenously into 19 male normal volunteers at the doses of 0, 1, 3.3 and 10 ng/kg/min for 30 min. AII had no effect on plasma ACTH, cortisol, corticotrophin-releasing hormone, arginine vasopressin, and atrial natriuretic factor concentrations, nor did it increase systolic or diastolic arterial blood pressure. On the other hand, AII caused a dose-dependent increase of plasma aldosterone concentrations, suggesting that the doses and the mode of AII infusion were effective. Thus, our data show that peripherally infused AII has no detectable effect on the HPA axis function in humans, at doses capable of stimulating plasma aldosterone secretion, its specific target hormone.