A total of 178 patients with Sertoli cell only syndrome proved by histologic examination was investigated for the past 7 years at the infertility Clinic of Seoul National University Hospital. The size of testes ranged from 5 to 25ml with the mean of 13ml(An average normal size of Korean males: l9ml) However, testes size of greater than l5ml were found in 53.3% of the patients. Plasma FSH Levels ranged from 0.31 to 58.501U/L with a mean of 20.451U/L(Normal level of Korean males: l2.10IU/L). Plasma LH levels ranged from 1.56 to 59.75IU/L with a mean of l2.87 IU/L( Normal level of Korean males: 9.21U/L). Plasma testosterone levels ranged from 0.9 to 11.0ng/ml with a mean of 5.5ng/ml Accordingly, increased FSH levels were found in 49.4% and increased LH levels, in 25.4% of the patients. And decreased levels of testosterone levels were found in 8.9% of the patients. Stimulation tests of LH and FSH by an administration of 100ug bolus of LHRH were attempted on 3 patients. The basal FSH values were elevated over 24.l8IU/L in the 3 patients. The FSH values were increased l.8-fold 90 minutes after stimulation tests. The basal value of LH was elevated in a patient. The LH values were increased 9.l-fold 30 minutes following the stimulation tests. Leydig cell hyperplasia and peritubular fibrosis were found in 2 patients who had shown the exaggerated responses to LHRH stimulation tests. The patients with more abundant microfilament in cytoplasm and increased intercellular digitation of Sertoli cells proved by an electron microscopic examination, had the higher levels of basal FSH and LH. Therefore, the regulatory mechanism of secretion of both FSH and LH appears to be abnormal in the patients with Sertoli cell only syndrome. The karyotype evaluation revealed 46XY in 20 patients, 46XY 15S- in l patient and 46XYt(7, 14) in 1 patient of the 22 patients. Sertoli cell only syndrome seems to be heterogenous or a single process which may be in evolution at different developmental stages. Germ cell aplasia was found in 21 patients with cryptorchidism by histological examination. We could infer the more abnormal regulation of secretion of both gonadotropins (FSH and LH) in patients of cryptorchidism with germ cell aplasia than patients of Sertoli cell only syndrome without cryptorchidism.
Actin Cytoskeleton ; Cryptorchidism ; Cytoplasm ; Fibrosis ; Germ Cells ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Hyperplasia ; Infertility ; Karyotype ; Male ; Plasma ; Seoul ; Sertoli Cell-Only Syndrome* ; Sertoli Cells ; Testis ; Testosterone

BACKGROUND: Bilateral interruption of the upper thoracic sympathetic chain at T2 level represents a selective cure for essential hyperhidrosis. Following the surgical sympathectomy, significant changes in pulmonary function has been observed. Our hypothesis was that thoracic sympathectomy may increase airway resistance during mechanical ventilation and which may be attenuated by the anticholinergics. METHODS: 21 patients with essential hyperhidrosis in ASA physical status class 1 under going thoracoscopic sympathectomy, they were randomizely divided into two groups: glycopyrrolate premedication group (n=13) and non-premedication, control group (n=9). Glycopyrrolate 0.2 mg was administered 30 minutes before the induction of anesthesia. Blood pressure, heart rate, peak airway pressure, plateau pressure were measured at before and immediate after sympathectomy. Respiratory compliance and resistance were calculated. RESULTS: After thoracoscopic sympathectomy, there was significant increase in mean peak airway pressure (15 +/- 3 vs 18 +/- 3 cmH2O, P<0.05) and decrease in respiratory compliance (52 +/- 12 vs 45 +/- 10 ml/cmH2O, P<0.05) compared to baseline. However there was no significant difference between glycopyrolate premedication group and non-premedication group. Conclusion: Thoracoscopic upper dorsal sympathectomy in patients with essential hyperhidrosis causes increase peak airway pressure and decrease the compliance of respiratory system during mechanical ventilation.
Airway Resistance ; Anesthesia ; Blood Pressure ; Cholinergic Antagonists ; Compliance ; Glycopyrrolate ; Heart Rate ; Humans ; Hyperhidrosis* ; Premedication ; Respiration, Artificial ; Respiratory System ; Sympathectomy*

BACKGROUND: Positive end expiratory pressure (PEEP) ventilation is well established as an integral part of the management of patients with the acute lung injury. PEEP is a key element in the treatment of hypoxemia resulting from pulmonary edema. Pulmonary capillary pressure (Pcap) is the most important factor influencing lung edema formation, and an understanding of how Pcap is altered by variations of PEEP or pulmonary arterial occlusion pressure (PAOP) is important to improve the treatment of acute lung injury patients. This study was performed to evaluate the effects of PEEP on the pulmonary capillary pressure in acute lung injury patients. METHODS: This was a prospective study of 11 acute lung injury patients. The effect of PEEP on pulmonary circulation at four different levels (0,4,8, and 12cm H2O) was analyzed. Pcap was estimated visually at bed side with Swan Ganz catheters. The pulmonary vasculature was analyzed by calculating the pressure difference at the arterial and venous parts of the circulation. RESULTS: As PEEP increased from 0 to 12 cm H2O, the mean puhnonary arterial pressure (PAP) and Pcap increased respectively from 22.7 ± 7.4 to 25.3 ± 7.3 mmHg and 15.3 ± 3.3 to 17.8 ±3.2 mmHg (p<0.05). Similarly, PAOP increased from 9.8 ± 2.1 to 12.8 ± 2.1 mmHg and the central venous pressure increased from 6.1 ± 1.6 to 9.3 1: 2.3 mmHg(p<0.05). However, the pressure gradient at the arterial (PAP-Pcap) and venous (Pcap-Pcwp) part of pulmonary circulation remained unchanged at all evaluated PEEP levels. CONCLUSION: Although Pcap increasoo gradually with increased PEEP, the pressure gradient at the arterial and venous part of the pulmonary vasculature remained unchanged at all evaluated PEEP levels in acute lung injury patients.
Acute Lung Injury* ; Anoxia ; Arterial Pressure ; Capillaries* ; Catheters ; Central Venous Pressure ; Edema ; Humans ; Lung ; Positive-Pressure Respiration* ; Prospective Studies ; Pulmonary Circulation ; Pulmonary Edema ; Ventilation

BACKGROUND: Despite the importance of burn-induced encephalopathy, cerebral hemodynamics after burn injury and during resuscitation remains undefined. The aim of our study was to evaluate the effects of a large cutaneous burn injury on the cerebral circulation. METHODS: Anesthetized sheep(n=8) were prepared with vascular catheters, a urinary catheter and a Richmond bolt for intracranial pressure monitoring. A scald injury was inflicted on 70% of total body surface area with hot water. Resuscitation was started 30 minutes after scald with Ringer's lactate to restore and then maintain baseline oxygen delivery. Resuscitation maintained blood pressure, cardiac output and urine output at normal levels. Brain blood flow was measured with colored microspheres. RESULTS: During resuscitation intracranial pressure rose slowly from 10.6+/-1.5 to 17.0+/- 4.0 mmHg(P<0.05) and cerebral perfusion pressure was reduced from 86.4+/- 6.8 to 64.1+/- 2.8 mmHg(P<0.05). During early resuscitation cerebrovascular resistance declined to maintain brain blood flow and oxygen delivery at baseline or better. After 6 hours, cerebrovascular resistance was inappropriately increased during a period of reduced cerebral perfusion pressure which resulted in brain blood flow being half the baseline levels. CONCLUSIONS: These data suggest that autoregulation maintains brain blood flow immediately after burn shock and early resuscitation, but autoregulation may be less effective as burn resuscitation proceeds.
Blood Pressure ; Body Surface Area ; Brain ; Burns* ; Cardiac Output ; Hemodynamics ; Homeostasis ; Intracranial Pressure ; Lactic Acid ; Microspheres ; Oxygen ; Perfusion ; Resuscitation* ; Shock ; Skin ; Urinary Catheters ; Vascular Access Devices ; Water

BACKGROUND AND OBJECTIVE: Controlled mechanical ventilation(CMV) with positive end expiratory pressure(PEEP) is frequently employed in the treatment of critically ill patients in the surgical intensive care unit. CMV with PEEP can impair many hemodynamic parameters such as a decrease in cardiac index. These hemodynamic changes may lead to vital organ dysfunctions such as oliguria. The purpose of this current study is to examine the effect on the hemodynamic and renal function of positive end expiratory pressure. MATERIALS AND METHODS: The study is performed in 10 patients treated with PEEP. Starting with no PEEP and then adding 4cmH2O of PEEP in 2 hrs interval till 12cmH2O of PEEP is reached. At each procedure, the hemodynamic parameters, urine output, creatinine clearance, fractional excretion of sodium are measured. RESULTS: The mean arterial pressure was decreased from 102.2+/-5mmHg(mean+/-SEM) at 0cmH2O of PEEP to 91.6+/-5.4mmHg at 12cmH2O of PEEP(P<0.05). The cardiac index decreased from 4.21+/-0.21L/min/m2 at 0cmH2O of PEEP to 3.59+/-0.14L/min/m2 at 8cmH2O of PEEP(P<0.01) and 3.25+/-0.12L/min/m2 at 12cmH2O of PEEP(P<0.01). Urine output decreased from 1.61+/-0.21ml/hr/kg at 0cmH2O of PEEP to 1.21+/-0.19ml/hr/kg at 8cmH2O of PEEP(P<0.05), 0.85+/-0.13ml/hr/kg at 12cmH2O of PEEP(P<0.01). Creatinine clearance decreased from 114.9+/-3.36ml/min at 0cmH2O of PEEP to 97+/-5.28ml/min at 8cmH2O of PEEP(P<0.01) and 80.2+/-3.11ml/min at 12cmH2O of PEEP(P<0.01). The pulmonary capillary wedge pressure, fractional excretion of sodium were unchanged. CONCLUSION: CMV with 8cmH2O of PEEP significantly affected the hemodynamic and renal function. At 12 cmH2O of PEEP, the changes in urine output and renal function may be affected more by hemodynamic changes than hormonal changes.
Arterial Pressure ; Creatinine ; Critical Illness ; Hemodynamics* ; Humans ; Critical Care ; Oliguria ; Positive-Pressure Respiration ; Pulmonary Wedge Pressure ; Sodium

Controlled mechanical ventilation (CMV) with positive and expiratory pressure (PEEP) is often used to improve the pulmonary gas exchange in patients with acute respiratory distress syndrome. However, this ventilatory technique may induce hemodynamic and hormonal changes which may lead to vital organ dysfunction, such as oliguria. Low dose dopamine, acting as a dopaminergic receptor agonist, may improve vital organ perfusions, i.e. renal, mesenteric and coronary perfusions. The purpose of this current study was to evaluate the effects of low dose dopamine on renal function and hemodynamic change during controlled mechanical ventilation with PEEP. The study was performed on 10 patients treated with PEEP in the surgical intensive care unit. Starting with 0 cmH2O of PEEP and adding 4 cmH2O of PEEP at 4-hour intervals until it reached 12 cmH2O of PEEP, dopamine, 2 ug/kg/min, was selectively, administered, intravenously during the last two hours of each four hour intervals. Following each procedure, hemodynamic parameters, urine output, creatinine clearance and fractional excretion of sodium were measured. The cardiac index and mean arterial pressure had both decreased, but the mean pulmonary arterial pressure was increased at 12 cmH2O of PEEP compared with 0 cmH2O of PEEP in both groups with and without low dose dopamine. The main result of this study was that low dose dopamine attenuated the decrease of the cardiac index, urine output and creatinine clearance induced by mechanical ventilation with PEEP at 12 cmH2O.
Adult ; Aged ; Dopamine/therapeutic use ; Dopamine/administration & dosage* ; Dose-Response Relationship, Drug ; Female ; Hemodynamics/drug effects ; Human ; Kidney/physiopathology* ; Kidney/drug effects* ; Male ; Middle Age ; Positive-Pressure Respiration*

BACKGROUND: Increasing degrees of medullary hyperemia induced by ischemia reperfusion injury were associated with renal dysfunction. A possible mechanism may be that ischemia causes alterations in the structure and function of vascular membranes which leads to an aggregation of red blood cells in the medullary vessel. It has been shown that heparin prevents postischemic endothelial cell dysfunction. Aim of this study was to evaluate heparin effects on renal hyperemia induced by ischemia reperfusion injury. METHOD: In this study, fifteen rabbits were randomized to either heparin treatment group(500 IU/kg IV bolus 10 minutes before renal artery occlusion, n=8) or control group(n=7). One side kidney underwent 60 minutes ischemia only by clamping renal pedicle and after that kidney tissue sample was obtained for histologic evaluation. The other side of kidney were permitted 60 minutes ischemia following 60 minutes reperfusion and after that kidney tissue sample was obtained for histologic evaluation. RESULTS: There was significant difference in the degree of congestion(2.6+/-0.2 vs 1.1+/-0.3, P<0.05) between outer medulla of control and heparin treatment group. CONCLUSION: Heparin significantly attenuated outer medullary congestion induced ischemic injury.
Constriction ; Endothelial Cells ; Erythrocytes ; Estrogens, Conjugated (USP) ; Heparin* ; Hyperemia ; Ischemia* ; Kidney ; Membranes ; Rabbits ; Renal Artery ; Reperfusion Injury ; Reperfusion*

Bezoars are not uncommonly found during upper gastrointestinal investigations (UGI), are known to be associated with conditions causing stasis changes in gastrointestinal tract. We described here a curious presentation of an oropharyngea bezoar associated with medication and tube feeding. Only few cases of regurgated esophageal bezoar have been reported. A 54 years old man with amyotropic lateral sclerosis required ventilatory support. Nasogastric tube was placed, enteral feeding with special liquid diet (Geenvia TF) was begun. In addition, almagate was given via the feeding tube. Tracheotomy was done for long term mechanical ventilation support. On the 10th day of ICU stay, he complained of foreign body sensation in oral cavity. We could find a white brown colored 15cm solid mass in deep oropharynx. Some factors including sucralfate and the peripheral neuropathy have been suspected to be ascribed forming the esophageal bezoar. Gastrointestinal motility was decrease in patients with peripheral neuropathy. In this case, aluminum hydroxides, one of the aluminium substance like sucralfate, was given to the patient with the peripheral neuropathy. From this experience, we became to know that it is necessary to use the aluminium compound anti-ulcer drug with caution in the patients with the gastrointestinal depression.
Aluminum ; Amyotrophic Lateral Sclerosis* ; Bezoars* ; Depression ; Diet ; Enteral Nutrition ; Foreign Bodies ; Gastrointestinal Motility ; Gastrointestinal Tract ; Humans ; Hydroxides ; Middle Aged ; Motor Neuron Disease ; Mouth ; Oropharynx ; Peripheral Nervous System Diseases ; Respiration, Artificial* ; Sensation ; Sucralfate ; Tracheotomy ; Ventilation

Oxygen therapy is clear benefit in the treatment of tissue hypoxia, but high concentrations and long term exposures of oxygen carry the risks of detrimental physiologic changes and tissue damages. Tissue damages involve decreased surfactant production,alveolar edema, and alveolar hemorrhage. In spite of these damage, diagnosis of oxygen toxicity is difficult in many clinical settings. In this study, we measured lung compliance to evaluate the oxygen toxicity in 60 white rat of 100-150 g body weight Rats were divided into 6 groups. Group I was control graup, exposed to room air, group II -group V were exposed to 100% oxygen, group II for 24 hours, group IlI for 48 hous, group IV for 72 hours, and group V for 96 hours. Group VI was exposed to oxygen in serial as 30% oxygen for 24 hours, 60% oxygen for 24 hours and then 100% oxygen for 96 hours. After oxygen exposure we obseved changes of lung compliance and pathologic findings, compliance of group V was 15.94 mL/cmH2O significantly lower than that of eontrol group (p<0.05) and lung weight of group V was 2.16 g/100 g heavier than the other groups (p<0.05). Although we found oxygen tolerance was developed in group V, we could not differentiate the degree of pathologic damage cauesd from oxygen toxicity by pathologic findings. We concluded that the measurement of lung compliance is valuable in diagnosis of oxygen toxicity and thus in reducing lung damages.
Animals ; Anoxia ; Body Weight ; Compliance ; Diagnosis ; Edema ; Hemorrhage ; Lung Compliance* ; Lung* ; Oxygen* ; Rats*

Oxygen therapy is clear benefit in the treatment of tissue hypoxia, but high concentrations and long term exposures of oxygen carry the risks of detrimental physiologic changes and tissue damages. Tissue damages involve decreased surfactant production,alveolar edema, and alveolar hemorrhage. In spite of these damage, diagnosis of oxygen toxicity is difficult in many clinical settings. In this study, we measured lung compliance to evaluate the oxygen toxicity in 60 white rat of 100-150 g body weight Rats were divided into 6 groups. Group I was control graup, exposed to room air, group II -group V were exposed to 100% oxygen, group II for 24 hours, group IlI for 48 hous, group IV for 72 hours, and group V for 96 hours. Group VI was exposed to oxygen in serial as 30% oxygen for 24 hours, 60% oxygen for 24 hours and then 100% oxygen for 96 hours. After oxygen exposure we obseved changes of lung compliance and pathologic findings, compliance of group V was 15.94 mL/cmH2O significantly lower than that of eontrol group (p<0.05) and lung weight of group V was 2.16 g/100 g heavier than the other groups (p<0.05). Although we found oxygen tolerance was developed in group V, we could not differentiate the degree of pathologic damage cauesd from oxygen toxicity by pathologic findings. We concluded that the measurement of lung compliance is valuable in diagnosis of oxygen toxicity and thus in reducing lung damages.
Animals ; Anoxia ; Body Weight ; Compliance ; Diagnosis ; Edema ; Hemorrhage ; Lung Compliance* ; Lung* ; Oxygen* ; Rats*