Presse Med
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THE "ANDROPAUSE": Also called the "male menopause" or "partial androgen deficiency of the aging male" etc., corresponds to the age at which the progressive decrease in androgen activity reaches a pathogenic threshold. Surveys made in various countries since the seventies conclude that testosterone blood levels start to decrease after the age of 25 and that 20 to more than 50% of the male population no longer benefit from optimal androgen stimulation after the age of 60. THE CONSEQUENCES OF HYPOANDROGENISM: The subsequent progressive hypoandrogenism participates in inducing the commonly-observed clinical symptoms (fatigue, morosity, weight loss, lack of interest in sexual activity); the most specific of which is the disappearance or rarification of "automatic" nocturnal or matinal erections. ⋯ A COMPLEX BIOLOGICAL DIAGNOSIS: Added to the abnormalities in production and transport of testosterone are the abnormalities in its metabolisation by the target tissues. These abnormalities are often undetected in present day blood controls and may explain the elevation in the hepatocyte of SHBG synthesis, the relative inhibition of GnRH pulses and LH secretion in the hypothalamus and the pituitary gland and, in the arterial wall (including penile vascularisation) and the prostate, some of the frequent functional and histological disorders. In current practice today, the best approximation of androgen potential is obtained by the comparison of total testosterone concentrations and SHBG, measurements that require relatively reliable standardised kits.
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Comparative Study
[Waiting time and satisfaction of patients attending the emergency surgery unit of a university hospital center].
The emergency department of a university hospital centre receives 40,000 patients per year. A study was conducted in its surgical unit to assess the existing dysfunctions and to develop corrective measures. ⋯ This study revealed the insufficient information provided on the waiting time and the reasons for this delay. The availability of a nurse to welcome and assist the patients would improve these parameters. Posters should be displayed with information on the foreseeable waiting time. During a meeting to present the results of this study, all the staff were made aware of this problem.
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Review Comparative Study
[The effect of angiotensin-converting enzyme inhibitors on the progression of chronic renal failure].
SEVERAL MECHANISMS: The progression in renal failure first implies hemodynamic mechanisms and among which angiotensin II has a central role, but also an increase in proteinuria and the induction of many inflammatory and mitogenic mediators that enhance fibrosis (TGF-beta), an effect stimulating the thrombotic mechanism. Among these factors of progression in renal failure, hypertension and proteinuria are the two major factors. Proteinuria is "nephrotoxic" and leads to glomerular and tubulo-interstitial lesions. ⋯ GLOBALLY: ACE inhibitors remain the only treatment with demonstrated long-term efficacy in the progression of chronic renal failure. However, the concept of renoprotection needs to be widened to all the factors implied in the progression of chronic renal failure, and ACE inhibitors only represent one aspect of treatment. The role of angiotensin II-receptor antagonists, alone or combined, is clearly promising.
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"PLURAL"