Operated hypospadiacs: late follow-up. Social, sexual, and psychological adaptation

Thirty-four adult men operated upon for hypospadias in childhood and 36 controls were examined by interview and psychological tests. During childhood hypospadiacs had enuresis, showed shyness, and were mobbed more often than controls. Hypospadiac's sexual debut, but not the first ejaculation, was delayed. Most hypospadiacs had a satisfactory sexual life, albeit restricted to fewer partners. Socially, hypospadiacs showed normal adjustment but had less qualified professions than controls. Hypospadiacs showed a more doubtful sexual identity and greater castration anxiety combined with lesser utilization of cognitive and emotional resources than controls. Early operated hypospadiacs had a more infantile sexual identity than those operated later (less than 5 yr).

Social and sexual adjustment of men operated for hypospadias during childhood: a controlled study

In a controlled study 34 men operated on for hypospadias in childhood and 36 control subjects were interviewed concerning their sexual and social adjustment, which at the time of the interviews was shown to be virtually similar in the 2 groups. Most of the hypospadiacs had stable sexual relationships but they had been sexually less active than the controls. The sexual debut of the hypospadiacs was retarded although the age at first ejaculation was the same as for the controls. The hypospadiacs had less qualified professions compared to the controls. The results indicate the possibility of operated hypospadiacs being psychologically different from other men. Fertility seems to be equal in the 2 groups and even patients with severe forms of hypospadias reported fertility. The issue of optimal ambition in surgical repair is discussed in view of the fact that even patients with a less than perfect technical result are able to live a satisfactory sexual life.

Experimental exposure of the cat brain surface to neurosurgical irrigation fluids and air: study of blood-brain barrier damage

Different fluids used in neurosurgery were tested for the production of blood-brain barrier dysfunction by applying them to the brain surface of the cat for 3 hours. Normal saline, Ringer's solution, and Elliott's Solution B induced no obvious damage either by closed subdural perfusion or when applied to the brain surface via pledgets for 3 hours. When perfusion with Ringer's solution for 2 hours and 45 minutes was preceded by 15 minutes of exposure to air, an intense extravasation of tracer was induced in the leptomeninges. When perfusion with Ringer's solution (2 hours and 45 minutes) was followed by irrigation with 3% hydrogen peroxide (5 minutes) and then brief perfusion (10 minutes) with Ringer's solution, thrombosis of leptomeningeal vessels and extensive extravasation of tracer were found in both the leptomeninges and the cortex down to the white matter. Elliott's Solution B seemed to provide better protection against these injuries than did Ringer's solution. Thee observations demonstrate the importance of immediate protection of the exposed brain surface against air by physiological fluids and show that these fluids provide effective protection against disturbance of the blood-brain barrier for at least 3 hours. Hydrogen peroxide proved unsuitable for application to the brain surface.

Reduction of androstenedione by skin in vitro and serum levels of gonadotrophins and androgens in men with hypospadias

The reduction of 4-[1,2-3H]androstene-3,17-dione (androstenedione) in vitro by scrotal skin was measured in samples from nine men (16--34 years old) with hypospadias and from ten male control subjects. The reduction of androstenedione was also studied in axillary and upper arm skin of seven control subjects. Androstenedione was reduced to material with chromatographic characteristics of 5 alpha-androstane-3,17-dione and to 3 alpha- and 3 beta-hydroxy-5 alpha-androstan-17-one. No difference in 5 alpha-reductase activity (defined as the sum of these three metabolites formed) was found in scrotal skin from hypospadic and control men. The mean concentration of 5 alpha-dihydrotestosterone in serum from men with hypospadias was lower than that in serum from control subjects (P less than 0.01). The mean ratio of the serum concentrations of testosterone and 5 alpha-dihydrotestosterone was higher in hypospadic men than in control subjects (P less than 0.05). No differences between the two groups were found in the mean serum concentrations of LH, FSH, prolactin, dehydroepiandrosterone, androstenedione, testosterone or testosterone-binding globulin.

Formation and action of prostacyclin in the isolated human umbilical artery

The transformation of [1-14C]arachidonic acid by homogenates of human umbilical arteries was studied. The major compound formed was the stable end product of PGI2, i.e. 6-keto-PGF1 alpha (lactol form) as analyzed by gas-liquid chromatography-mass spectrometry. PGI2 was generated by incubating PGH2 with a lyophilized pig aorta microsome preparation. PGI2 concentrations around 10 ng/ml relaxed the human umbilical artery preparation significantly. Formation of PGI2 by umbilical arteries during pregnancy might be a mechanism for regulation of blood flow to the fetus.

Male hypospadias, 625 cases, associated malformations and possible etiological factors

Records from 625 patients with hypospadias have been reviewed, with reference to associated malformations. Cryptorchidism was found to be the most common associated malformation and was present in 6% of cases with hypospadias. The highest incidence of cryptorchidism was found in the more severe forms of hypospadias. Other concomitant genital malformations, such as bifid scrotum, hypoplasia of penis and remnants of the Müllerian system showed the same pattern. The recorded incidence of bifid scrotum and hypoplasia of the penis was 4% and 8% respectively. A high incidence of abnormalities in the lower urinary tract was found; 50% of 84 patients investigated. The hypothesis of hypospadias being a result of testicular hormone insufficiency is discussed.

Structure and quantitative determination of the major urinary metabolite of thromboxane B2 in the guinea pig

2,3-Dinor-thromboxane B2 was the major urinary metabolite of thromboxane B2 in the guinea pig. The structure was assessed mainly by mass spectrometric analysis of a number of derivatives of the metabolite and by chemical degradation by oxidative ozonolysis. A method for quantitative determination of 2,3-dinor-thromboxane B2 in guinea pig urine based on multiple ion analysis and octadeuterated 2,3-dinor-thromboxane B2 as internal standard was developed. The basal excretion of the metabolite was 65 +/- 36 (S.D.) ng/kg x 24 h (n = 19; range 19--140 ng). This level corresponded to an endogenous synthesis of 543 +/- 300 ng of TXB2. No increase in the excretion was seen after anaphylaxis, in contrast to what has earlier been reported for PGF2 alpha.

A method for measurement of platelet regeneration in man

Platelet suspensions obtained at different time intervals following a single dose of oral aspirin were incubated with [1-(14)C]-arachidonic acid and the amount of [1-(14)C]thromboxane B2 formed was determined by a double isotope technique. Since aspirin is an irreversible inhibitor of platelet cyclooxygenase and since circulating platelets do not synthesize cyclooxygenase the rate of reappearance of active cyclooxygenase determined in this way was a measure of the rate of regeneration of functioning platelets. In two subjects the regeneration half-times were 4.2 and 4.8 days.

Metabolism of androstenedione in skin and serum levels of gonadotrophins and androgens in prepubertal boys with hypospadias

The metabolism of 4-[1,2-3H]androstene-3,17-dione in the prepuce, axillary skin and skin from the arm was investigated in 27 boys operated for phimosis (controls) and 13 unselected boys with hypospadias (a congenital defect of the male urethra). In all types of skin investigated, androstenedione was metabolized to 5alpha-androstane-3,17-dione, 3alpha-hydroxy-5alpha-androstan-17-one, 3beta-hydroxy-5alpha-androstan-17-one and testosterone. Conversion to testosterone was found in the prepuce of two out of 11 boys with hypospadias. Mild forms of hypospadias in the age group 1--4 years had a higher level of 5alpha-reductase activity in the prepuce than controls in the same age group (P less than 0.05); no such differences were found in the few severe cases of hypospadias in this group. No other differences in 5alpha-reductase activity were found between hypospadic boys and controls. The ratio of 5alpha-reductase activity in the prepuce: 5alpha-reductase activity in skin from the arm was significantly higher (P less than 0.05) in hypospadic boys than in controls in the age group 1--4 years. Serum levels of LH and FSH were the same in normal and hypospadic boys but the concentration of prolactin in the serum was lower in boys with hypospadias compared with control subjects in the age group 1--4 years (P less than 0.005). No differences were found in serum concentrations of androstenedione, testosterone, oestradiol and testosterone-binding globulin.

Thromboxane A2 and prostaglandin H2: potent stimulators of the swine coronary artery

Thromboxane A2 was generated by incubation of arachidonic acid with a suspension of human platelets. The filtrate contained 266 +/- 46 ng/ml (n=10) of thromboxane A2 and 25 ng/ml or less of prostaglandin endoperoxides (prostaglandins G2+H2). Thromboxane A2 was 2-10 times more potent than prostaglandin H2 and 9-102 times and 26-308 times more potent than prostaglandins E2 and F2alpha, respectively, in causing contractions of the superfused swine coronary artery.

On the formation and effects of thromboxane A2 in human platelets

Incubation of arachidonic acid and prostaglandin G2 with a suspension of human platelets led to formation of an unstable (t1/2, 41+/-7 s) compound, thromboxane A2. Thromboxane A2 induced irreversible aggregation of washed platelets and of platelets in platelet-rich plasma and caused release of serotonin and ADP from platelets in platelet-rich plasma.

Thromboxanes: a new group of biologically active compounds derived from prostaglandin endoperoxides

An unstable [t1/2 at 37 degrees = 32 +/- 2 (SD) sec] intermediate, thromboxane A2, was detected in the conversion of prostaglandin G2 into 8-(1-hydroxy-3-oxopropyl)-9,12L-dihydroxy-5,10-heptadecadienoic acid (thromboxane B2) in platelets. The intermediate was trapped by addition of methanol, ethanol, or sodium azide to suspensions of washed human platelets incubated for 30 sec with arachidonic acid or prostaglandin G2. The structures of the resulting derivatives demonstrated that the intermediate possessed an oxane ring as in thromboxane B2 but lacked its hemiacetal hydroxyl group. Additional experiments using 18O2 or [2H8]arachidonic acid in the formation of thromboxane B2 and CH3O2H for the trapping of thromboxane A2, together with information on the t1/2 of the intermediate, indicated the presence of an oxetane structure in thromboxane A2. Incubation of arachidonic acid or prostaglandin G2 with washed platelets led to formation of an unstable factor that induced irreversible platelet aggregation and caused release of [14C]serotonin from platelets that had been incubated with [14C]serotonin. The properties and the mode of formation of this factor indicated that it was identical with thromboxane A2. Furthermore, evidence is presented that the more unstable and major component of rabbit aorta contracting substance (RCS) formed in platelets and guinea pig lung is also thromboxane A2.

Prostaglandin endoperoxides IX. Characterization of rabbit aorta contracting substance (RCS) from guinea pig lung and human platelets

Material causing contraction of the isolated rabbit aorta (rabbit aorta contracting substance, RCS) was released from guinea pig lung following perfusion with arachidonic acid and from human blood platelets after addition of thrombin to induce aggregation. Prostaglandin endoperoxides (prostaglandins G2 and/or H2) were found both in the perfusate of guinea pig lung (1-3 ng/ml) and in the medium collected after platelet aggregation (13-37 ng/ml). The contractile response of the isolated rabbit aorta to the pure prostaglandins G2 and H2 was also determined. These data combined with the quantitative analyses of the endoperoxides released from the lungs and platelets showed that only a minor part of the rabbit aorta contracting activity was due to the prostaglandin endoperoxides. The major part of the activity consisted of very unstable material. The half life of this material was about 30 s at 37 degrees whereas at this temperature the prostaglandin endoperoxides had a half life of about 5 min.

Physiological role of an endoperoxide in human platelets: hemostatic defect due to platelet cyclo-oxygenase deficiency

The endoperoxide prostaglandin G2 (PGG2) induced platelet aggregation as well as the platelet release reaction (release of ADP and serotonin) when added to human platelet-rich plasma. Formation of a metabolite of PGG2 [8-(l-hydroxy-3-oxopropyl)-9,12L-dihydroxy-5,10-heptadecadienoic acid] and a lipoxygenase product [12L-hydroxy-5,8,10,14-eicosatetraenoic acid] accompanied the release reaction caused by aggregating agents such as collagen, ADP, epinephrine, and thrombin. Indomethacin inhibited the release reaction and PGG2 formation induced by these agents but had no effect on PGG2-induced release reaction. The aggregating effect of PGG2 was abolished by furosemide, which is a competitive inhibitor of ADP-induced primary aggregation. These data indicate that the aggregating effect of PGG2 is due to release of ADP and that PGG2 synthesis is required for induction of the release reaction by various aggregating agents. A subject with a hemostatic defect due to abnormal release mechanism [decreased aggregation with epinephrine (second wave) and collagen and normal platelet ADP] had a deficiency of the cyclo-oxygenase that catalyzes formation of PGG2. Normal aggregation and release reaction were obtained with added PGG2. Ii is concluded that the endoperoxide (PGG2) is essential in normal hemostasis because of its role in initiating the release reaction required for aggregation by collagen and the second wave of aggregation caused by, e.g., ADP.