Objective To investigate financial burden of in-patients with hypothalamus-pituitary-adrenal gland/gonad diseases in the West China Hospital of Sichuan University, 2011, so as to provide baseline data for further research. Methods The data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital in 2011) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, initial diagnosis when the patients were discharged, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on the initial diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Results The results showed that: in 2011, 352 person-times of in-patients with hypothalamus-pituitary-adrenal gland/gonad disease as first diagnosis were hospitalized in the department of endocrinology and metabolism, of which, 139 were male and 213 were female, with mean age of 42.9±15.0 years; and b) median hospital stay was 11 days, the average cost of hospital stay for each patient was RMB 4 361.09 yuan, most of which was for lab tests, examination, and biomedicine cost. Conclusion Hypothalamus-pituitary-adrenal gland/gonad diseases are an important health problem in the department of endocrinology and metabolism in a Triple-A Hospital. Most of hospitalization costs are for lab tests, examination, and biomedicine cost.
Objective To retrospectively analyze the clinical information of a series of patients with atypical adrenal phaeochromocytoma in order to improve the diagnosis of atypical phaeochromocytoma. Methods Ninety patients diagnosed pathologically as adrenal phaeochromocytoma from January 1998 to December 2004 in the Affiliated Hospital of Inner Mongolia Medical College were included in the study. Patients with phaeochromocytoma were classified into the typical group and atypical group based on their clinical manifestations. The differences were analyzed between the two groups in terms of patient age, tumor location and maximal diameter, incidence of hypertension, and plasma catecholamine level. Results About 24.4% (22/90) of the patients with phaeochromocytoma were classified as atypical. There was no significant difference in the maximal tumor diameter between the two groups. The plasma norepinephrine level of the atypical group was significantly lower than that of the typical group (P=0.001), and the positive rate of plasma norepinephrine of the atypical group was also lower than that of the typical group (P=0.003). Conclusion Compared with typical phaeochromocytoma, atypical phaeochromocytoma is associated with a lower plasma norepinephrine level. The size of adrenal tumor cannot contribute to the diagnosis of atypical phaeochromocytoma. Based on atypical manifestations, CT examination results, and plasma catecholamine level, most atypical phaeochromocytoma should be diagnosed correctly.
ObjectiveTo explore the influence of norepinephrine on the prediction of fluid responsiveness by passive leg raising (PLR) during septic shock. MethodsForty-six septic shock patients in intensive care unit of Nanjing Drum Tower Hospital were prospectively observed from September to November 2012. Among which 36 septic shock patients were enrolled with a positive PLR test (defined by an increase in stroke volume index ≥10%). A PLR test was performed at baseline (PLR1). A second PLR test (PLR2) was performed at returning to supine position for 10 min and the dose of norepinephrine was increased to maintain MAP ≥65 mmHg for 20 min. The changes of heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),stroke volume index(SVI),index of systemic vascular resistance(SVRI),global end-diastolic volume index(GEDVI),and cardiac function index(CFI) were monitored by transpulmonary thermodilution technique (PiCCO). ResultsPLR1 significantly increased SVI by (20.54±9.63)%,CI by (20.57±9.89)%,MAP by (7.64±5.77)%,and CVP by (25.83±23.39)%. As the dose of norepinephrine increased,SVI was increased by (16.97±9.06)%,CI by (16.78±8.39)%,GEDVI by (9.08±4.47)%,MAP by (28.07±12.48)%,and CVP by (7.86±8.52)%. PLR2 increased SVI by (13.74±8.79)%,CI by (13.79±9.08)%,MAP by (2.93±5.06)%,and CVP by (13.36±14.74)%. The PLR2 and the dose increase of norepinephrine augmented SVI to a significantly lesser extent than the PLR1 performed at baseline (both P<0.05). However,SVI increased by <10% in 6 patients while the baseline PLR was positive in these patients. ConclusionIn septic patients with a positive PLR at baseline,norepinephrine increases cardiac preload and cardiac output and influences the fluid responsiveness.
目的 探讨颅内动脉瘤破裂后，患者血清促肾上腺皮质激素、甲状腺激素水平的变化情况。 方法 监测2010年3月－6月共51例动脉瘤患者术前、术后2～3、4～5 d促肾上腺皮质激素（ACTH）、甲状腺激素水平的变化情况，并对监测结果进行统计学处理。 结果 ACTH、促甲状腺激素、甲状腺素、血清游离甲状腺素在术前、术后2～3、4～5 d差异无统计学意义（P＞0.05），三碘甲状腺原氨酸（T3）、血清游离三碘甲状腺原氨酸（FT3）在术前、术后2～3、4～5 d差异有统计学意义（P＜0.05）；不同部位动脉瘤患者的T3、FT3在术前、术后2～3、4～5 d差异无统计学意义（P＞0.05）；Fisher、Hunt分级不同级别的动脉瘤患者的T3、FT3在术前、术后2～3、4～5 d差异有统计学意义（P＜0.05）。 结论 动脉瘤破裂患者的血清T3、FT3的变化水平情况，可以作为判断患者病情的轻重与预后的一项重要指标。
目的:探讨肾上腺节细胞神经瘤的CT表现特征，以提高此病CT诊断的准确性。方法:回顾性分析8例经病理确诊为节细胞神经瘤的CT表现，并与病理结果对照研究。结果:8例肿瘤边界均清晰，无周围组织和血管侵犯征象。CT平扫呈均匀稍低密度，CT值约18～35 HU，其中内有点状钙化者3例（37.5%）。CT增强扫描有轻度强化，CT值约30～45 HU。CT征象符合病理表现。结论:肾上腺节细胞神经瘤有一定的CT表现特点，多层螺旋CT扫描有助于提高肾上腺节细胞神经瘤诊断的准确性。
目的 探讨腹部手术后患者发生肾上腺皮质功能减退的临床特点及诊治方法。方法 回顾性总结分析我院自2003年1月至2006年12月期间行腹部手术8 974例患者中17例术后确诊为并发肾上腺皮质功能减退者的临床资料。结果 本组腹部手术后肾上腺皮质功能减退的发生率为0.19%（17/8 974），女性患者多于男性患者，男女之比约为1∶2； 其中55~64岁者2例，65~75岁者12例，75岁以上者3例。临床表现以嗜睡及消化道症状为主。实验室检查尿皮质醇水平降低，促肾上腺皮质激素兴奋试验阳性。1例出现肾上腺危象死亡，其余病例经激素治疗后康复。结论 腹部手术后肾上腺皮质功能减退多数病因不明确。临床以嗜睡及消化道症状为主要表现。实验室检查是确诊和激素治疗的依据。多预后良好，但发生肾上腺危象时仍可危及生命。
To quantitatively measure the α1-adrenergic receptors and select the suitable conditions of receptor-ligand binding assay. Radioligand binding analysis was used to measure the concentration of α1-adrenergic receptors, and the measuring conditions were selected, respectively. Under the selected conditions, the α1-adrenergic receptors in lier plasma membranes of 8 nonhepatopathy subjects were measured.Under such suitable conditions as ３H-prazosin concentration 0.1-2.0nmol/L, incubating temperature 37℃, reaction time 20 minutes and seperating free ligand from system with double layer of filter paper, the binding of 3H-prazosin to α1receptors from 8 nonhepatopathy subjects were saturable with a high affinity. The Bmax, Kd, RMC and Hill coefficient were 142.1±14.1 fmol per milligram of protein, 0.2382±0.0548 nM, 739.0±167.6 fmol per gram of liver and 0.90±0.03, respectively.The suitable conditions may be very important for measuring α1-adrenergic receptors in human liver plasma membranes, which should be considered in hepatopathy studies.
Ｂｙ ｐｅｒｆｕｓｉｎｇ ｌｉｖｅｒｓ ｆｒｏｍ Ｗｉｓｔａｒ ｒａｔｓ ｒｅｎｄｅｒｅｄ ｓｅｐｓｉｓ ｗｉｔｈ ａｃｕｔｅ ｏｂｓｔｒｕｃｔｉｖｅ ｃｈｏｌａｎｇｉｔｉｓ（ＡＯＣ）ｉｎ ｖｉｔｒｏ ｉｎ ａ ｎｏｎｒｅｃｉｒｃｕｌａｔｉｎｇ ｍｏｄｅ，ｗｅ ｍｅａｓｕｒｅｄ ｔｈｅ ｒａｔｅｓ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｆｒｏｍ ｓａｔｕｒａｔｉｎｇ ｃｏｎｃｅｎｔｒａｔｉｏｎ ｏｆ ｌａｃｔａｔｅ （５ ｍｍｏｌ／L) ｐｌｕｓ ｐｙｒｕｖａｔｅ （０５ ｍｍｏｌ／Ｌ） ａｎｄ ｔｈｅ ｒｅｓｐｏｎｓｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｔｏ ｇｌｕｃａｇｏｎ ａｎｄ ｅｐｉｎｅｐｈｒｉｎｅ．Ｗｅ ａｌｓｏ ｓｔｕｄｉｅｄ ｔｈｅ ＡＯＣ ｉｎｄｕｃｅｄ ａｌｔｅｒａｔｉｏｎｓ ｉｎ ｔｈｅ ｍｉｌｉｅｕ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｉｃ （ｇｌｕｃａｇｏｎ，ｅｐｉｎｅｐｈｒｉｎｅ ａｎｄ ｃｏｒｔｉｓｏｌ） ａｎｄ ｃｏｎｔｅｒｒｅｇｕｌａｔｏｒｙ （ｉｎｓｕｌｉｎ） ｈｏｒｍｏｎｅｓ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈｅ ｒａｔｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｏｆ ＡＯＣ ２４ ｈ．ｇｒｏｕｐ ｗａｓ ｓｉｇｎｉｆｉｃａｎｔｌｙ ｒｅｄｕｃｅｄ ａｎｄ ｔｈｉｓ ｒｅｄｕｃｔｉｏｎ ｃｏｕｌｄ ｂｅ ｃｏｍｐｅｎｓａｔｅｄ ｂｙ ｉｎｃｒｅａｓｅｓ ｏｆ ｇｌｕｃｏｓｅ ｐｒｅｃｕｒｓｏｒｓ，ｅｓｐｅｃｉａｌｌｙ ｌａｃｔａｔｅ ａｎｄ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｉｃ ｈｏｒｍｏｎｅｓ ｔｏ ａ ｓｅｒｕｍ ｇｌｕｃｏｓｅ ｌｅｖｅｌ ａｓ ｍｕｃｈ ａｓ ２．５ ｔｉｍｅｓ ｔｈｅ ｎｏｒｍａｌ ｗｈｉｃｈ ｉｓ ｎｅｅｄｅｄ ｉｎ ｓｔｒｅｓｓ ｒｅａｃｔｉｏｎ．Ｔｈｅ ｒａｔｅ ｏｆ ｇｌｕｃｏｎｅｏｇｅｎｅｓｉｓ ｏｆ ＡＯＣ ４８ ｈ．ｗａｓ ｆｕｒｔｈｅｒ ｄｅｃｒｅａｓｅｄ ａｎｄ ｔｈｉｓ ｄｅｃｒｅａｓｅ ｃｏｕｌｄ ｎｏｔ ｂｅ ｃｏｍｐｅｎｓａｔｅｄ ｐｒｏｂａｂｌｙ ａｓ ａ ｒｅｓｕｌｔ ｏｆ ｓｅｖｅｒｅ ｄａｍａｇｅ ｔｏ ｈｅｐａｔｏｃｙｔｅｓ． Ｔｈｅ ｒｅｓｕｌｔｓ ｉｎｄｉｃａｔｅ ｔｈａｔ ｔｈｅ ｒｅｄｕｃｅｄ ｇｌｕｃｏｓｅ ｍｅｔａｂｏｌｉｃ ｒｅｓｐｏｎｓｅ ｄｕｅ ｔｏ ＡＯＣ ｍａｙ ｐｌａｙ ａｎ ｉｍｐｏｒｔａｎｔ ｒｏｌｅ ｉｎ ｔｈｅ ｄｅｖｅｌｏｐｍｅｎｔ ｏｆ ｃｈｏｌａｎｇｉｔｉｓｉｎｄｕｃｅｄ ｄｙｓｆｕｎｃｔｉｏｎ ｏｆ ｍｕｌｔｉｐｌｅ ｏｒｇａｎｓ．
Objective To compare the vasoactive effects of norepinephrine( NE) and dopamine of different doses on isolated rabbit pulmonary and systemic arteries in septic shock. Methods Six paired pulmonary and systemic arterial rings were prepared fromsix rabbits, and matched randomly assigned into a normal group and a LPS group. The assigned groups were intervened by different doses of NE. Another six paired pulmonary and systemic arterial rings were prepared from another six rabbits. They were assigned to different groups as above and intervened by different doses of dopamine. The LPS groups were pre-incubated in RPMI mediumsupplemented with4 μg/mL LPS to simulate septic shock. The tension of arterial rings was measured and its response to NE and dopamine were studied. Results ( 1) In the normal groups, the contraction of the systemic arteries was ber than the pulmonary arteries in response to low,middle dose of NE, and high dose of dopamine ( all P lt; 0. 05) , and which was weaker in response to middle dose of dopamine and similar in response to high dose of NE( P gt;0. 05) . Both the pulmonary and systemic arteriesrelaxed in response to low dose of dopamine. ( 2) After LPS pre-incubation, the contraction of the systemic arteries was weaker than the pulmonary arteries in response to low dose of dopamine ( P lt;0. 05) , and which was similar in response to low,middle and high dose of NE, and middle, high dose of dopamine. ( 3) Comparing the LPS groups with the normal groups, the contraction in response to middle dose of dopamine increased in the systemic arteries and dreased in the pulmonary arteries ( P lt;0. 05) . Conclusions In septic shock, the vasoactive effect of different doses of NE is not different between pulmonary and systemic arteries. But middle dose of dopamine can increase the contraction of systemic arteries and decrease the contraction of pulmonary arteries.