Steroid receptors in the pathogenesis of chronic subdural hematoma

Chronic subdural hematoma (CSDH), located between the dura mater and the arachnoid and usually characterized by a well-vascularized external capsule (HEM), has a higher incidence in male patients with elevated urinary estrogens than in female patients. In an attempt to increase our understanding of the physiopathogenesis of CSDH, total estrogen receptor (ER) was measured in HEM specimens from four male patients by a sodium thiocyanate exchange assay and cytosol progesterone receptor (PRc) in three specimens by a dextran-coated charcoal adsorption assay. Although no nuclear ER could be detected, ERc and PRc were found in all three specimens examined. The presence of ER in a mesenchymal tissue like HEM could suggest that, in addition to inducing vascular changes, estrogens might act directly on HEM through a receptor-mediated mechanism more pronounced in men than in women, whose vascular network is adapted to high estrogen values.

Hormones and tumours in central nervous system (CNS): steroid receptors in primary spinal cord tumours

On the basis of the studies reported on steroid receptors in brain tumours, cytoplasmic and nuclear estrogen (ER) and progesterone (PR) receptors have been examined in forty primary spinal cord tumours: fifteen neurinomas, three neurofibromas, nine meningiomas, nine ependymomas, two astrocytomas, one oligodendroglioma and one hemangiopericytoma with the exchange method in the presence of sodium thiocyanate for ER and using the synthetic progestin R5020 for PR. Regardless the type of the tumour, ER have been detected with a higher incidence in male than in female patients (78% versus 59%). PR had the same incidence in male and in female patients. The neurinoma was the oncotype more constantly provided with steroid receptors: nuclear ER, in fact, has been found with an incidence of 75% in male and of 43% in female patients. This oncotype is usually provided in both sexes with PR. Ependymomas is spinal tumour with the highest incidence of cytosol ER both in male and in female patients. On the basis of the above results reported it can be assumed that hormonal factors might be involved in the occurrence as well as in the growth of spinal cord tumours. Therefore it can be hypothesized that hormonal treatment might favourably be used as an adjuvant therapy in some selected patients with receptor positive spinal tumours.

[Value of differential cytology in the diagnosis of preclinical forms of cervix uteri cancer]

The value of "differential cytology" in the diagnosis of preclinical carcinoma of the cervix uteri was assessed from serial sections of operative specimens in a series of 452 patients. Although not absolute, this value was found to be considerable. Used to supplement colposcopy-guided biopsy, it makes it possible to decide on the therapeutic approach (notably simple destruction by laser) without having recourse to conization. However, the results are only valid for the team which presents them, and before deciding to treat intra-epithelial carcinomas by laser destruction, each team must perform the same "quality control".

Is 3 alpha-androstanediol a marker of peripheral hirsutism?

The behaviour of 5 alpha-reduced metabolites of testosterone, dihydrotestosterone1, 3 alpha-androstanediol and 3 beta-androstanediol, was studied in 36 hirsute women: Group I: 24 patients with high plasma levels of testosterone, androstenedione and/or dehydroepiandrosterone sulphate and Group II: 12 patients with normal plasma concentrations of these steroids. Testosterone and its 5 alpha-reduced metabolites were determined by radioimmunoassay after chromatographic separation on celite 535 microcolumns. Plasma 3 alpha-androstanediol was found to be elevated both in Group I (26.9 +/- 10.8 SD ng/100 ml) and in Group II patients (23.2 +/- 10.5 SD ng/100 ml). 3 beta-Androstanediol and dihydrotestosterone, on the contrary, were elevated in only a few cases: in 6 cases in Group I and in 2 and in 1 case, respectively, in Group II. The finding of high plasma 3 alpha-androstanediol levels in hirsute women, with normal values of the other androgens, may be an index of hirsutism of peripheral origin, since this steroid is produced almost exclusively in the extraglandular compartment.

Spermatic and peripheral oestradiol levels in patients affected by azoospermia due to seminiferous tubular damage

Plasma levels of testosterone, androstenedione and oestradiol were determined in the spermatic venous blood of both testes of 17 patient affected by azoospermia due to tubular damage (Group I). The results were compared with those found in 5 patients affected by azoospermia of obstructive origin and 5 patients with an inguinal hernia (Group II). Mean spermatic levels of testosterone and androstenedione were not significantly different in the two groups, while the mean (+/- SE) oestradiol spermatic level was significantly higher in patients of Group I (5.02 +/- 0.75 nM/l vs. 2.20 +/- 0.365 nM/l; P less than 0.05). Moreover, while the testosterone/androstenedione and the androstenedione/oestradiol ratios were not significantly different in the two groups, the mean (+/- SE) testosterone/oestradiol ratio was significantly lower in patients of Group I (552.71 +/- 80.94 vs. 939.86 +/- 129.45; P less than 0.025). Peripheral testosterone and androstenedione mean levels were not significantly different between the two groups while the mean peripheral oestradiol level (+/- SE) was significantly higher in Group I (0.107 +/- 0.021 nM/l vs. 0.038 +/- 0.05 nM/l; P less than 0.025). Peripheral oestradiol was not significantly related to peripheral FSH, nor to spermatic oestradiol in both groups. These results suggest the possibility that oestradiol may be involved in the pathogenesis of some cases of male infertility.

Seminal plasma levels of testosterone and 5 alpha-dihydrotestosterone in azoospermic patients

Testosterone (T) and 5 alpha-dihydrotestosterone (DHT) have been measured in seminal plasma of sixteen azoospermic patients with tubular damage (germinal cell arrest or Sertoli cell only syndrome) and five patients affected by azoospermia of obstructive origin. In both groups T values were not significantly different from controls, while DHT was significantly lower in patients affected by azoospermia of obstructive origin.

Treatment and follow-up of patients with infertility due to spermagglutinins

A therapeutic trial based on pharmacologically induced azoospermia followed by the administration of corticosteroids was carried out in 48 patients with infertility due to spermagglutinins. Three types of responses were observed: type A, no modifications in the blood and spermagglutinating (SA) titer (19 cases); type B, disappearance or significant decrease in SA titer during treatment, with return to normal values upon resumption of spermatogenesis (7 cases); and type C, disappearance or significant decrease in SA titer for at least 1 year after stopping treatment (22 cases). Within the 1st year after stopping therapy only men who responded in type C fashion were able to impregnate partners, three pregnancies ended in abortion and nine in normal births.

Diurnal 18-hydroxy-11-deoxycorticosterone pattern in human stable hypertension

Diurnal 18-hydroxy-11-deoxycorticosterone (18-OH-DOC) pattern was studied with RIA technique in 33 hypertensive patients in supine position and on normal sodium diet. The compound was evaluated every 2 h from 0800-2000 h. Simultaneously, plasma aldosterone and cortisol were measured. Abnormal 18-OH-DOC behavior was observed in only 2 out of 4 patients with Cushing's disease, while sporadic and slight elevations, synchronous with F, were seen in 5 out of 24 stable essential hypertensive patients [1 with normal plasma renin activity (PRA), 1 with low PRA, and 3 with high PRA]. 18-OH-DOC was normal in 2 cases of hypertension due to renal artery stenosis, in 1 patient with nephrosclerosis, and in 1 patient with horseshoe kidney. From these results, 18-OH-DOC does not seem to play an important pathogenetic role in stable essential hypertension, considering also the low mineralocorticoid activity of the compound.

Arginine evaluation to verify sperm maturation in man

A modified version of Sakaguchi's histochemical reaction is proposed for the evaluation of arginine content in spermatozoa as an index of sperm maturation. Results obtained with this procedure, compared with DNA and basic nuclear proteins determinations in the sperm cells from normal subjects and from patients with oligospermia, appear to confirm the usefulness of this technique.

Influence of hyperprolactinaemia due to metoclopramide on gonadal function in men

Five clinically normal male volunteers were given metoclopramide, 10 mg t.d.s. for 6 weeks. During treatment prolactin concentrations were elevated (over 50 ng/ml) in all. LH, FSH, testosterone and cortisol concentrations were not altered. No change was observed in LH or FSH responses to LHRH testing 4 weeks after the beginning of therapy, compared with pre-treatment values. A reduction in seminal volume and total sperm count were observed in each subject. Four noticed a decrease in libido and three lost spontaneous erections. While the metoclopramide-induced hyperprolactinaemia could be the cause of the observed changes in semen and erectile activity, it is possible that this dopamine receptor blocking drug might directly affect central or peripheral mechanism of erection, the testes or accessory organs.

Simultaneous estimation of four plasma androgens before and after dynamic tests in women with hirsutism: correlation with long-term therapy

Concentrations of testosterone, delta4-androstenedione, dihydrotestosterone and delta5-androstenediol were measured in 12 patients affected by hirsutism associated with menstrual disorders. Testosterone was elevated in 9 cases, in whom high levels of delta4-androstenedione and dihydrotestosterone was found, and normal in 3 cases, 2 of which presented high values of dihydrotestosterone and one high levels of delta5-androstenediol. In some hirsute females therefore, other androgens, such as dihydrotestosterone and delta5-androstenediol, play a role in the pathogenesis of hirsutism. Dexamethasone and estrogen progestin combinations were administered for dynamic tests, and results in most cases provided useful information in the selection of suitable long-term therapy.

[Surgical anatomy of the peritoneal fringes at the level of the terminal ileal loop]

The Authors give a detailed picture of the peritoneal fringe of the terminal ileum. With the help of an iconography they describe the possible anatomical variations according with the surgical possibilities.