Minoxidil and male-pattern alopecia: a potential role for a local regulator of sebum secretion with vasoconstrictive effects?

Regulation of the hair cycle takes place at the pilo-sebaceous unit with the sebaceous gland as a sex hormone-dependent part. Although minoxidil stimulates proliferation of follicular cells and activation of prostaglandin endoperoxide synthase-1, it was suggested that other mechanisms, such as an increase in the local blood flow, might mediate the drug effect on hair growth. If that is the case, it is possible that minoxidil counteracts some vasoconstrictive mediator of male-pattern alopecia. This hypothetical vasoconstrictive mediator X would have to meet some criteria: (I) vasoconstriction both in the general circulation and in the hair-growing skin; (II) local vasoconstrictive activity in the hair growing skin should be related to the circulating testosterone level; (III) only an increase in the local mediator X activity causes male-pattern alopecia, since hypertensive patients are not balder than expected. The sebaceous gland is a possible place of the mediator X secretion since it is a sex-hormone-dependent part of the pilo-sebaceous unit. ET-1 might be a suitable candidate for the mediator X, since male hormones raise ET-1 plasma levels and female hormones lower them. The speculation presented here is that ET-1, beside vasoconstriction in the general circulation, might also regulate the sebum secretion, by triggering contractions of the myoepithelial cells. This hypothetical mechanism would normally remain confined to the sebaceous gland. During puberty, sex hormones stimulate growth of sebaceous glands in both sexes. In women hypertrophied sebaceous glands under estrogen control would not increase its ET-1 content, while in men, testosterone would increase ET-1 secretion that might affect the neighboring arterioles. Induced vasoconstriction might reduce the hair growth and promote hair loss. If ET-1 plays the described role, then an ET-1 antagonist, i.e. bosentane, should also have some hair-growing properties.

Changes in vitamin E concentration after surgery and anesthesia.

UNLABELLED: The aim of this randomized study was to examine changes in vitamin E concentration in female subjects (age 30-60, ASA I) after cholecystectomy and halothane (N = 16) or isoflurane (N = 16) anaesthesia. Vitamin E concentration was measured two days before, and then one, five and twenty-four hours and four days after surgery. High-pressure liquid chromatography was used for its determination. Simultaneously activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyltransferase (GGT) were determined. STATISTICAL ANALYSIS: ANOVA, Tukay HSD test. The research has been accepted by the Drugs Committee of the Karlovac County Hospital. Preoperative vitamin E concentrations in the halothane group were 8.69 +/- 2.35 micrograms/L, median 8.67 micrograms/L and in the isoflurane group 9.43 +/- 2.4 micrograms/L, median 9.08 micrograms/L. Statistically lower vitamin E concentrations compared with preoperative values were noted one hour (P < 0.05), 5 hours (P < 0.01), 24 hours (P < 0.01), as well as 4 days (P < 0.01) after the operation. The lowest vitamin E concentrations were noted 24 hours after the operation with statistically insignificantly higher values in the isoflurane group (halothane group 5.98 +/- 2.08 micrograms/L, isoflurane group 6.58 +/- 1.51 micrograms/L). Analyzing enzyme (ALT, AST and GGT) pre- and postoperative values, no statistically significant differences between the investigated groups and during the time were observed. Statistically significant differences were found between individual measurement times, with no statistical significance of the differences between the halothane and isoflurane groups. It seems that neither the difference in halothane and isoflurane biotransformation nor their distinct effect on perfusion of some organs are the determining factors in post-operative changes in vitamin E concentration.

[War injuries of the arteries]. / Ratne ozljede arterija.

The experience with military vascular injuries in the recent war in Crotia is reviewed. From April 1991 to October 1995, 197 wounded persons with 231 injuries of arteries were admitted to the University Hospital Rebro. The most common injuries were of lower extremity arteries (54.5%), and the most frequent method of repair was revascularisation with saphenous vein graft interposition. Fasciotomies were performed in 34% because of frequent associated injuries of bones (34.5%) and veins (46.7%). In 20.7% casualties pseudoaneurysms and arteriovenous fistulas were found. Postoperative thrombosis (9%) was a consequence of local infection, massive necrosis and sepsis. Amputation rate was 7.7%, and mortality 5.3%. These results are very satisfactory in comparison with the results in literature. This is a result of good organization of our war surgical service: rapid transportation of wounded persons to convenient surgical centres and high surgical skill.

[Epidural anesthesia in vascular surgery in patients with chronic obstructive lung disease]. / Epiduralna anestezija u vaskularnoj kirurgiji u bolesnika s kronicnom opstruktivnom bolesti pluca.

Epidural anaesthesia was determined in 29 patients with chronic obstructive pulmonary disease. Lidocaine 2% for vascular procedures such as embolectomy from the arteriae femoralis and arteriae poplitea was used as an anesthetic in 12 patients and 0.5% bupivacaine for aortobitemoral or femoropopliteal bypass in 17 patients. Thus possible complications in patients with obstructive chronic pulmonary disease were avoided as well as prolonged mechanical ventilation and endotracheal intubation. With the postoperative application of local anesthetic through a catheter into the epidural space, spontaneous breathing and good analgesia was achieved. Preoperatively all patients were administered bronchodilators, expetorants and they stopped smoking.

[Sepsis in surgery patients]. / Sepsa u kirurskih bolesnika.

The aim of the study was to determine therapeutic possibilities in surgical patients with sepsis following gunshot wounds of the abdomen and lower extremities. Thirty patients who underwent repeated surgical procedures in general or peridural anesthesia were analyzed. Eleven patients developed ARDS, of which 7 also had acute renal insufficiency and required hemodialysis. Mechanical ventilatory support and PEEP therapy were instituted. In 4 cases, alprostidil at a dosage of 0.1 microgram/kg body weight/min over 2 days was given. Empirical use of antibiotics was at the beginning of the therapy carried out by penicillin, gentamicin and metronidazole and later according to the antibiogram. One patient presented with spinal meningitis after the insertion of peridural catheter.

[The effect of propofol anesthesia with and without the use of opioid analgesia on cardiorespiratory stability in patients]. / Ispitivanje anestezije propofolom s primjenom i bez primjene opioidnih analgetika na kardiorespiracijsku stabilnost bolesnika.

The possibility of use of propofol as an anesthetic induction agent was studied in 147 patients who were scheduled for trauma, abdominal, plastic and proctologic surgery. The patients were divided into 4 groups. Group I consisted of 39 patients who had anesthesia induced with propofol alone for outpatient operations. There was neither the decrease in blood pressure nor respiratory depression. Group II comprised 71 patients. These patients had anesthesia induced with a combination of propofol and alfentanil. They were breathing spontaneously. In this group, the decrease in blood pressure was seen in 20 patients (28%), and respiratory depression in 61 patients (85.9%). The Group III was composed of 30 patients who were assigned to the propofol and fentanyl for total intravenous induction combined with nitrous oxide-oxygen and pancuronium bromide for a maintenance of anesthesia. The patients were mechanically ventilated. The decrease in blood pressure occurred in 9 of these patients (30%). In Group IV in which a combination of propofol and talamonal were used because of a prolonged ventilation of patients by means of a respirator, 2 of 7 (28.6%) patients had the decrease in blood pressure. The study demonstrates that propofol as an anesthetic induction agent my be used for a great number of diagnoses and that it is very important to take into account the duration of surgical procedure and the stress of surgery, because if propofol is combined with narcotic analgetics the respiratory depression will appear in a high percentage.

[High colonic-vaginal fistulas]. / Visoke kolovaginalne fistule.

In this paper, the authors present the definition, etiology, clinical features, diagnosis and preparations for the surgical treatment of colovaginal fistulas. A ten year experience with 11 female patients with colovaginal fistulas divided according to the causes is reviewed. The fistulas commonly resulted from the surgical treatment, radiotherapy, parturition injuries and Crohn's disease. In the discussion, each group is evaluated with respect to the therapeutic procedure giving some general remarks on this rare clinical condition. Besides the surgical treatment of the fistula, in most cases, the contemporary colostomy is required.

[Anesthesiology problems in injuries of the retroperitoneum]. / Anestezioloski problemi kod ozljeda retroperitoneuma.

Patients with injured retroperitoneum present a great problem because of difficulties arising in their diagnosis and treatment. The aim of our work was to indicate the approach to such patients for the purpose of establishing the timely diagnostic and adequate treatment. The methods: Polytraumatized patients with retroperitoneal injuries were investigated, who during their treatment had the following complications: hemolysis, disseminated intravascular coagulation, and renal insufficiency. The results indicate the importance of the correct and timely diagnosis and adequate treatment which should, besides operation, also include the prevention of the irreversible phase of the shock, being aware that the body, when being in the state of anoxic molecular cell disease, with disturbed glucose, protein and fat metabolism, cannot function normally to decompose drugs, blood, blood derivates and anaesthetics. Therefore, the reactions of the body during abundant blood transfusions and disturbed process of blood coagulation aggravate the process of treatment. In conclusion, we should emphasize, that, in patients with a retroperitoneal injury, together with all the accessible medical techniques for diagnosing the disease, clinical observation remains the most reliable diagnostic method.

[Anesthesia in patients with varicose syndrome]. / Anestezija bolesnika s varikoznim sindromom.

Pain in the muscles and the feeling of tension in the lower legs along the varicose veins brings many patients, especially women to an operation, usually after previous attempts of conservative treatment. The aim of the work was to present the choice of analgesia for the operation of the veins of the lower limbs with the control of the post-operative analgesia. The methods included two groups of patients. One group received halothane inhalation anaesthesia in combination with nitrous oxide and oxygen, and the other ketamine hydrochloride anaesthesia applied intravenously. Postoperative pain was graded as strong, medium, mild, and painfree state. The pain intensity was assessed for each patient by the hours, and by multiplying the obtained score by the number of patients, we got the total pain scores. The pain relief 1, 2, 3, and 4 hours after the administration of propoxiphen napsilate with paracetamol was calculated according to the formula: Br = Bo-B1 (2,3,4). As compared to the placebo, we got p.o.05 in favour of the active substance after ketamine hydrochloride anaesthesia. The results have shown that postoperative pain was much lower in the group of patients who had ketamine hydrochloride anaesthesia, what together with increased oxygen saturation during anaesthesia leads to the conclusion that this anaesthesia is appropriate for operations on the veins of the lower limbs because it ensures postoperative analgesia and oxygenation without oxygen inhalation. This is important because in the region attacked by varicosity the tissue metabolism is disturbed, oxygenation decreased and the values of pCO2 increased, frequently followed by skin atrophy, lower limb edema and lymphostasis.