Human chorionic gonadotropin treatment of nonorganic erectile failure and lack of sexual desire: a double-blind study

Forty-five cases of nonorganic failure (n = 39) or lack of sexual desire (LSD, n = 6) were treated for one month, either with human chorionic gonadotropins (HCG, 5,000 IU I.M. twice per week) or with placebo using a double-blind method. HCG gave better results than placebo (47% vs 12%, p less than 0.05) and improved a higher number of sexual parameters (6/7) than placebo (2/7). HCG effect on sexual behavior did not correlate with the increase in plasma testosterone level: it seems HCG is a useful option in sexologic treatment of erectile failure and LSD.

[Mechanisms of diabetic impotence. 25 cases]

Twenty-five impotent diatetics were investigated by means of nocturnal penile tumescence monitoring, hormone determinations, penile blood pressure measurement, artificial erection test and dynamic cavernosography, bulbocavernous reflex latency time measurement and cortical evoked responses from pudendal nerves. Sexological treatment was then attempted for a better evaluation of the psychogenic element. Penile blood pressure was also measured in 15 non-impotent diabetics and was found to be abnormal as often as in impotent diabetics. The results as a whole demonstrated that impotence was predominantly psychogenic in 9 cases, predominantly organic in 12 cases and mixed psychogenic and organic in 4 cases. Diabetic impotence is often due to several causative factors, as was the case in 12 of our patients. The factors most frequently responsible were psychological (present in 13 cases), neurological (present in 12 cases) and vascular factors (arterial abnormalities in 7 cases, "venous leakage" in 4 cases). Endocrine abnormalities were observed in only 2 cases.

Venous incompetence: critical study of the organic basis of high maintenance flow rates during artificial erection test

We tested whether the necessity for high flow rates of saline to maintain an artificial erection actually corresponds to an organic abnormality able to induce impotence as claimed recently. A total of 56 patients with presumed vascular impotence and 13 with typical psychogenic impotence underwent dynamic cavernosography followed by the artificial erection test. The former 56 patients also underwent bilateral selective internal iliac arteriography. A severely elevated maintenance flow rate (more than 120 ml. per minute) was found in 19 of the 56 patients with vascular and none of the 13 with psychogenic impotence, while a moderately elevated maintenance flow rate (80 to 120 ml. per minute) was found in 11 and 3, respectively. In most cases a severely elevated maintenance flow rate was associated with arterial (16 patients) or neurological abnormalities able to disturb erection. However, a severely elevated maintenance flow rate seemed to correspond to an organic abnormality able to induce impotence or to worsen erectile failure induced by other organic factors. Indeed, we found no severely elevated maintenance flow rates among our 13 patients with psychogenic impotence and the nocturnal penile tumescence test was normal in only 1 of 12 tested patients, although 7 had no other organic impairment sufficient to induce impotence (only moderate arterial stenoses in 4). In addition, sexual treatment succeeded in only 1 of the 13 patients, while our success rate is 43 per cent among patients with arterial impotence exclusively and this treatment succeeded in 6 of 10 patients with a moderately elevated maintenance flow rate. On the contrary, a moderately elevated maintenance flow rate does not seem to correspond to a genuine organic abnormality able to induce impotence. Indeed, we found it in 3 of 13 patients with psychogenic impotence, and every patient with a moderately elevated maintenance flow rate and normal arteries had a normal nocturnal penile tumescence test or was cured by sexual therapy. In conclusion, a maintenance flow rate exceeding 120 ml. per minute seems to reveal a genuine venous incompetence but in most cases this abnormality is only the cofactor of an arterial obstruction.

[Instrumental dilation and transparieto-hepatic cholangioscopy for stenosis of a choledocho-duodenal anastomosis with gallstone formation]

A 94-year old woman presented with gallstone formation above a stenotic choledoco-duodenal anastomosis, responsible for episodes of cholangitis. After percutaneous biliary tract drainage, the anastomosis was dilated with an angioplasty catheter. As several stones persisted despite washing out, percutaneous cholangioscopy was performed. To introduce a small fibroscope into the biliary canals, transhepatic dilation up to 28 F was necessary. The last stones were pushed into the duodenum with the endoscope. Freedom of the biliary tract and patency of the anastomosis were ascertained.

Is intracavernous injection of papaverine a reliable screening test for vascular impotence?

To determine whether intracavernous injection of papaverine can discriminate vascular versus psychogenic impotence 80 mg. papaverine were injected intracorporeally into 27 impotent patients without any hormonal or neurological abnormality. The patients also underwent dynamic cavernosography, the artificial erection test and selective internal iliac arteriography. In addition, 21 of the patients underwent nocturnal penile tumescence monitoring. The response to intracavernous papaverine injection was noted as positive (fully rigid erection), intermediate or negative (soft or absent erection). Among 14 patients with severe arterial lesions and/or severe venous leakage the response was negative in 11 and positive in none. Among the remaining 13 patients (moderate or absent vascular abnormalities) the response was positive in 4 but negative in 4. Of 15 patients with an abnormal nocturnal penile tumescence test the response to intracavernous papaverine injection was negative in 12 and positive in none. However, of 6 patients with a normal nocturnal penile tumescence test the response was positive in only 1. Over-all, the results of the intracavernous papaverine injection test are correlated only fairly with those of the nocturnal penile tumescence test and the vascular investigations. This test could be useful to save some nocturnal penile tumescence tests in cases of suspected vascular impotence. However, the safety of this procedure must be confirmed in larger series. Indeed, 1 of our patients suffered priapism after a second intracavernous papaverine injection performed for a therapeutic purpose.

Ketoconazole-induced fulminant hepatitis

We report the cases of two adult patients in whom fulminant hepatitis developed after 17 and 103 days of ketoconazole administration. Histologic administration showed massive, predominantly centrilobular necrosis. Clinical manifestations of hypersensitivity and eosinophilia were absent in both patients, which suggests that ketoconazole hepatotoxicity is not mediated through an immunoallergic mechanism.

Hyperprolactinemia and sexual function in men

Male hyperprolactinemia (HPRL) is known to induce different types of sexual dysfunctions. In order to determine the incidence of HPRL among patients referred for sexual dysfunction, serum prolactin (PRL) was assayed in 1053 clinically idiopathic cases. Among 850 cases complaining of erectile impotence, 10 with marked HPRL (1.1%, PRL above 35 ng/ml) were found, of whom 6 cases were associated with a pituitary adenoma. 17 mild HPRL (2%, PRL 20-35 ng/ml) were also found. Among 124 cases with premature ejaculation, 13 (10%) mild HPRL were found. Serum PRL was normal in 51 cases complaining of an ejaculation without orgasm, and 27 patients exclusively complaining of reduced sexual desire. Our results lay stress on the fact that serum PRL must be assayed in every case of clinically idiopathic erectile impotence. Indeed, 5 of the 10 marked HPRL patients would have been misdiagnosed if we had only assayed this hormone when plasma testosterone was below the normal range. Moreover, in order to shed some light on the mechanisms by which HPRL disturbs male sexual function, the sexual behaviour of 17 markedly HPRL males was compared to their serum levels of PRL and testosterone, first before treatment, then at regular intervals during treatment. Our main conclusion is that impotence cannot be totally explained by a decrease in plasma testosterone, because this steroid hormone was within the normal range 7 of the 16 impotent patients. Moreover, when serum PRL was lowered by bromocriptine, 6 patients recovered their potency before plasma testosterone clearly increased, and in 3 of those patients before it reached the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical treatment of hyperprolactinemia

The current treatment of choice for primary hyperprolactinemia is medical. This is true not only for idiopathic forms, but also for micro- and macroprolactinomas, which are the most frequent causes of this pathology. Although questioned by some authors, the slow evolution of the illness, the rarity of transformation of a microadenoma into a macroadenoma, and the possibility of spontaneous cure cause most authors to favor medical treatment, with which they observe both normalization of gonadal function and tumor regression. By retrospective analysis of 95 hyperprolactinemic patients (72 women and 23 men including 26 cases of suspected microadenoma and 44 macroadenomas) treated with 3 dopamine agonists (bromocriptine, metergoline and CU 32085) between 1975 and 1983, and with the help of large series published in the literature, we have tried to review the present knowledge of this subject. After a quick review of different medications, we will consider their prolactin-suppressing effects, their influences upon gonadal and gonadotropic functions, and their antitumoral action. More specific problems will then be discussed: side effects, resistance, possibility of cure, the evolution of the prolactinoma, the place of medical therapy relative to surgery, and contraception in association with dopaminergics.

Comparative investigations in 26 impotent and 26 nonimpotent diabetic patients

To determine the causes of diabetic impotence the same investigations were performed in 26 impotent and 26 nonimpotent diabetics. The rates of abnormalities found were almost identical in the 2 groups in regard to Doppler examination of the penile arteries, conduction velocities of the median nerves, latency times of the bulbocavernosus reflex and cystometrograms. Conversely, urine flow rates (24 of 25 versus 2 of 26 patients) and Minnesota Multiphasic Personality Inventory (14 of 23 versus 0 of 14 patients) were almost exclusively abnormal in the impotent diabetics. In addition, inadequate sex-specific attitudes were found in 60 per cent of the impotent diabetic men, which was the proportion found in a carefully selected sample of psychogenically impotent nondiabetic men. The distribution of the abnormalities found suggests that in most diabetic patients impotence results from the addition of a subtle abnormality of the autonomic nervous system in almost every case or psychological and arterial factors.

[Contribution in oncology of fine needle puncture-aspiration of abdominal organs under echographic guidance in real time. Apropos of 265 cases]

The authors report a 3-year experience in the field of real-time ultrasonically-guided fine-needle aspiration biopsies of abdominal lesions in a Cancer Institution. The procedure is performed using a linear-array electronic biopsy transducer. Results obtained in a series of 265 aspirations are analyzed. Major benefits and applications of this technique in oncology are discussed while emphasis is put on the economical aspects of this diagnostic "shunt".

Comparison of estrogen priming effects with body weight restoration effects on the gonadotropin pattern of patients with anorexia nervosa

Plasma estradiol (E2), serum LH and FSH, and the gonadotropin response to two consecutive LHRH administrations (10 and 100 micrograms with an interval of 2 h) were determined in 19 patients with anorexia nervosa (AN) at the emaciation phase, before and after estradiol benzoate (E2B) injections (3 micrograms/kg/day for 7 days). The same investigations were repeated after weight restoration in 9 AN patients who remained amenorrheic. Both at the emaciation phase and after weight restoration, E2B enhanced the second LH response to LHRH and decreased serum FSH, suggesting that the functional capacities of the pituitary gonadotrophs are normal in AN. Unlike E2B injections, weight restoration increased all the hormone values, suggesting that the weight restoration effects on the abnormal gonadotropin secretory pattern of AN depend on another mechanism than the E2 lowering. That mechanism is probably a disorder of the hypothalamic LHRH secretion, the consequences of which could be reinforced by the low E2 levels.

Increased sperm count in 25 cases of idiopathic normogonadotropic oligospermia following treatment with tamoxifen

Twenty-five subfertile men, all presenting with idiopathic normogonadotropic oligospermia, were treated with tamoxifen (20 mg/day) for 4 to 12 months. Semen analysis was performed twice before treatment and at least twice after 3 to 12 months of treatment. In 14 patients, serum luteinizing hormone (LH), serum follicle-stimulating hormone (FSH), and plasma testosterone (T) were assayed before treatment, then again after 2 weeks and 12 weeks of treatment. Semen volume, sperm motility, and sperm morphologic characteristics were not modified by tamoxifen. Conversely, a twofold increase of both the mean sperm concentration and the mean total sperm count per ejaculate was observed during treatment (P less than 0.001). Mean values of T, LH, and FSH increased during treatment, but the difference was only significant for T (P less than 0.001) and FSH (P less than 0.05). Ten pregnancies (40% of cases) were reported during the 161 months of treatment.

[Blood prolactin in 845 cases of clinically idiopathic sexual dysfunction]

Serum prolactin levels were measured in 845 subjects presenting with clinically idiopathic sexual dysfunction, including impotence, premature or defective ejaculation and frigidity in women. Stimulation tests using thyrotrophin-releasing hormone (TRH) and sulpiride were performed in 80 men. One p. cent of impotent subjects had high serum prolactin levels associated with pituitary adenoma in 4/5 cases; 2.2% of impotent men, 10% of men with premature ejaculation and 5.6% of frigid women had moderate hyperprolactinaemia (50 ng/ml), probably not responsible for the sexual disorder. Mean serum prolactin levels were slightly below normal values (p less than 0.05) in impotent subjects. The results of stimulation tests were normal in all but one case. The mean area under the TRH response curve was moderately reduced in subject with impotence or defective ejaculation (p less than 0,05). The present study suggests that serum prolactin levels should be systematically measured in subjects with sexual impotence.

Lack of correlations between penile thermography and pelvic arteriography in 29 cases of erectile impotence

We studied 29 cases of penile impotence to determine whether thermography could be used to screen for cases of vascular origin and, therefore, candidates for arteriography. Sixteen thermographic parameters were used to compare 3 groups of patients having normal, mildly altered and severely stenotic arteries on arteriography of the aortic bifurcation and selective catheterization of the hypogastric arteries. The averages of these parameters were computed for each of the 3 groups, and 104 comparisons then were made using student's t test. A significant difference was found between 2 groups in only 2 of the comparisons (p less than 0.05) and no threshold for significant differences was found. Penile thermography did not correlate with pelvic arteriography and does not appear useful in the selection of candidates for arteriography.

[Hormonal profile in anorexia nervosa under control. Correlations with various somatic factors]

In order to precise the hormonal pattern of Anorexia Nervosa (AN) at its state phase, we assessed serum estradiol (E2), triiodothyronine (T3), LH and FSH, the maximum increments of their response to 100 microgram LHRH (delta LH and delta FSH) and the ratio of these increments (delta LH/delta FSH). These data were compared with those obtained in 10 normal women assessed at the early follicular phase (Student's test). Furthermore in 20 cases, we assessed LH and FSH during 5 days after a 20 mg IV injection of PREMARIN. E2, T3, LH and FSH are often decreased in AN. On the average, this decrease is very significant for the 3 first ones (p less than 0.001), and slightly significant for FSH (p less than 0,05). The LHRH-response is variable, with an inversion of the LH/FSH ratio as before the puberty in 56% of the cases. On the average, FSH-response is increased (p less than 0,05), and LH-response is normal. The response is delayed for the both gonadotropins. After PREMARIN, the 2 gonadotropins rarely clearly decrease (twice for LH and 5 times for FSH). There is a LH peak only in 3 cases. In order to specify the origin of these anomalies, we searched correlations between 11 hormonal data and some somatic parameters : weight, time, menstrual antecedents. We found 26 statistically significant correlations (12 times p less than 0,05- 5 times p less than 0,001- 9 times p less than 0,001). The following correlations are significant : E2 and LH, E2 and the maximal decrease of LH after PREMARIN (negative correlation), T3 and FSH, delta LH, and delta FSH, duration of the amenorrhea and T3, FSH and delta FSH, the weight and delta LH, the weight and delta LH/delta FSH, weight/height and delta LH/delta FSH, the menstrual antecedents and FSH. So, somatic factors strongly influence the hormonal pattern at the AN-state phase. The weight-decrease, the T3-decrease, and above all the E2-decrease which is independent of the previous ones seem to be the determining elements of the AN-hormonal pattern at this phase.