In many patients with hypertensive left ventricular hypertrophy, a beta-blocker is needed because of the prevalent myocardial ischemia

BACKGROUND

arterial hypertension (HTN) is a key risk factor for left ventricular hypertrophy (LVH) and a cause of ischemic heart disease (IHD). The association of myocardial ischemia and HTN LVH is strong because myocardial ischemia can occur in HTN LVH even in the absence of significant stenoses of epicardial coronary arteries.

OBJECTIVE

To analyze pathophysiological characteristics/co-morbidities precipitating myocardial ischemia in patients with HTN LVH, and provide a rationale for recommending beta-blockers (BBs) to prevent/treat ischemia in LVH.

METHODS

We searched PubMed, SCOPUS, PubMed, Elsevier, Springer Verlag, and Google Scholar for review articles and guidelines on hypertension from 01/01/2000 until 01/05/2022. The search was limited to publications written in English.

RESULTS

HTN LVH worsens ischemia in coronary artery disease (CAD) patients. Even in the absence of obstructive CAD, several pathophysiological mechanisms in HTN LVH can lead to myocardial ischemia. In the same guidelines that recommend BBs for patients with HTN and CAD, we were not able to find a single recommendation for BBs in patients with HTN LVH, but without proven CAD. There are several reasons for the proposal of using some BBs to control ischemia in patients with HTN and LVH (even in the absence of obstructive CAD).

CONCLUSION

Some BBs ought to be considered to prevent/treat ischemia in patients with HTN LVH (even in the absence of obstructive CAD). Furthermore, LVH and ischemic events are important causes of ventricular tachycardia, ventricular fibrillation, and sudden cardiac death; these events are another reason for recommending certain BBs for HTN LVH.

Contraindications differ widely among Beta Blockers and Ought to be Cited for an Individual Drug, Not for the Entire Class

Beta-blockers (BBs) have significant side effects that contribute to low adherence and persistence. Therefore, the optimal choice of BB is a vital mode to prevent BB's side effects, leading to an increase in compliance, which can improve the outcomes in BBs' evidence-based indications such as acute myocardial infarction, heart failure, etc. The paper aims to suggest an improved method of reporting contraindications for BBs. We used a search of the following indexing databases: SCOPUS and PubMed, and web search engine Google Scholar to identify guidelines on arterial hypertension (HTN). HTN guidelines published during the last two decades were analyzed (from 2000 to 2020). Some of the contraindications (e.g., bradycardia, acute heart failure) are true for every BB. However, some contraindications do not belong to the whole BB class. For example, propranolol and carvedilol are contraindicated in chronic obstructive lung disease, but nebivolol and bisoprolol are not. To our knowledge, there is a lack of guidelines citing contraindications for individual BBs because they vary a lot within the class of BBs. We suggest that contraindications specific for some BBs (i.e., not for the whole class) ought to be listed with the exact name(s) of the individual BBs. In this way, we may decrease the number of wrong choices among BBs and consequently increase drug adherence (which is currently worse for the class of BBs than for most of the other antihypertensive drugs). It is an approach to improve both primary medical education and guidelines.

High likelihood for atrial fibrillation in Cushing's syndrome

OBJECTIVE

This review analyzes the prevalence of the most important comorbidities associated with atrial fibrillation (AF) in the growing population of patients with Cushing's syndrome (CS).

MATERIALS AND METHODS

The review is arranged in a way to list important risk factors for AF and the references, which suggest the significant prevalence of these particular risk factors in CS. The search is conducted on PubMed, Science Direct, Springer, Wiley, SAGE, Oxford Press, and Google Scholar. PubMed search for "Cushing's syndrome atrial fibrillation" on 8/7/2019 revealed 4 papers only. None of them either analyzed or implicated high risk for AF in CS.

RESULTS

Arterial hypertension (AHT) can be found in approximately 80% of adult individuals with endogenous CS and in 20% of patients with exogenous CS. The reported prevalence of diabetes mellitus (DM) is from 13% to 47% in CS patients and the risk for de novo DM is approximately two-fold higher in individuals treated with glucocorticoids. High risk for myocardial infarction (MI) with hazard ratio (HR) 3.7 (95% confidence intervals, CI 2.4-5) in patients with endogenous CS was found. In CS patients the obesity can be detected in up to 41% and overweight in 21-48%. Left ventricular hypertrophy (LVH), pulmonary thromboembolism (PTE), infections, and hypokalemia are also more prevalent in CS as compared to healthy population. All cited comorbidities have been associated with AF. Therefore, clustering of the important factors associated with AF is confirmed repeatedly in CS.

CONCLUSIONS

The prevalence of AF in CS should be studied more precisely, both in a scientific way and at the individual patient's level.

Single prognostic cut-off value for admission glycemia in acute myocardial infarction has been used although high-risk stems from hyperglycemia as well as from hypoglycemia (a narrative review)

All original articles and meta-analysis use the single cut-off value to distinguish high-risk hyperglycemic from other acute myocardial infarction (AMI) patients. The mortality rate is 3.9 times higher in non-diabetic AMI patients with admission glycemia ≥6.1mmol compared to normoglycemic non-diabetic AMI patients. On the other hand, admission hypoglycemia in AMI is an important predictor of mortality. Because both admission hypo- and hyperglycemia correspond to higher in-hospital mortality, this graph is recognized as "J or U shaped curve". The review suggests two cut-off values for admission glycemia for risk assessment in AMI instead of single one because hypoglycemia as well as hyperglycemia represents a high-risk factor.

Ultrasonographic and computed tomography findings in renal suppurations: performance indicators and risks for diagnostic failure

OBJECTIVES

The main purpose of the study was to identify and quantify clinical variables which predisposed incorrect diagnosis based on ultrasonography (US) and computed tomography (CT) findings in the patients with suppurative renal infections.

PATIENTS AND METHODS

A retrospective review of radiological records of patients at 3 tertiary Serbian clinics of urology from 1999 to January 2006 was conducted. The series consisted of 49 women and 26 men, mean age = 56.7 years, ranging from 21 to 78. All patients underwent US examinations. Forty-one patients had undergone CT examinations, on 42 renal units (1 bilateral perirenal infection). The patients were categorized into 4 groups according to the type of suppurative infection: (a) unilocular renal or perirenal abscesses; (b) with pyonephrosis only; (c) with multiple renal or pyonephrosis infections along with extension on perirenal space, and (d) emphysematous infections.

RESULTS

Incorrect diagnosis based on US record only depended on the suppurative entity. In the presence of pyonephrosis only, the risk of incorrect diagnosis was reduced for 4 times [odds ratio (OR) = 0.25], and in presence of emphysematous infections the risk increased 19.5 times (OR = 19.49). Perinephric abscesses which were not seen on US were those associated with pyonephrosis, abscesses smaller than 6 cm and gas-forming abscesses. The diagnosis of abscesses considerably varied in the cases of unilocular purulent collections compared to complex purulent collections (chi(2) = 8.177, p = 0.004). Overall, the risk for incorrect diagnosis is about 14 times higher using US only (OR = 14.5), while CT reduced the risk of it for about 37 times (OR = 0.027).

CONCLUSIONS

CT was much more reliable than US to correctly identify the pathological entity of renal suppuration. Guiding treatment on US findings only seems hazardous as omission of some pathological processes is very likely.

[Quality of life after retroperitoneal lymphadenectomy in low clinical stages of nonseminomatous testicular tumors]

The surgical complications and quality of life in 139 patients who underwent primary retroperitoneal lymphadenectomy for clinical stage A and B1/B2 non-seminomatous testicular tumors during the period ranging from 1975 to 1997 were reviewed. Bilateral retroperitoneal lymphadenectomy was performed in 26 patients, and modified unilateral in 113 patients. There were 23 complications in 36 patients (16.5%) and only 1 case of surgery-related mortality. There were 28 early complications and 8 late complications. The most frequent minor complication encountered was superficial wound infection, whereas many of the major complications were related to small-bowel obstruction and atelectasis. The complication rate was lower in patients who underwent modified unilateral procedures than in those who had bilateral dissections (76.9:14.5%). The most prominent element of quality of life is preservation of normal ejaculation (69.8%), significantly better preserved in unilateral dissection (80.5:23.1%). This study reinforces the conclusion that primary unilateral retroperitoneal lymphadenectomy is and operation yielding minimal morbidity, excellent quality of life and no long-standing effects.

[Uretero-cutaneoustomy--indications and quality of life]

Ureterocutaneostomy, the anastomosis of the ureter to the skin, represents the most simple supravesical urinary derivation. It can be performed as unilateral, bilateral, bilateral with one orifice, or rarely as transuretero-ureterocutaneostomy. In period 1993-1998 on the Clinic of Urology, Clinical Center of Serbia, ureterocutaneostomy was performed in 155 patients as definitive type of urinary derivation. The most frequent indication for this type of derivation was the bladder tumor (130 out of 155 pts.). The rest of 25 pts. had carcinoma of vaginal portion of uterus, vesico-vaginal fistula (most frequently after irradiation), high ureteric lesions bladder neurogenic disfunction or rare bladder diseases. Having in mind short period of follow up two major complications were noticed: stenosis of uretero-cutaneostomy and retraction of anastomosis with consecutive formation of subcutaneous urinoma and abscesses formation. Although rarely used as definitive type of urinary anastomosis, ureterocutaneostomy has its place in wide spectrum of urinary derivations, since it is the only way to help those patients that have no other option of urinary derivation that might provide better way of social and professional rehabilitation.

[Foreign language as a compulsory subject at the Medical School]

The paper presents the introduction of English for Specific Purposes (ESP) to the School of Medicine, University of Belgrade as a compulsory subject of Serbian undergraduate studies. The area of interest includes the distinction between GENERAL/STANDARD and SPECIFIC use of English as well as the history of ESP in four stages of development. Finally, the author presents the specificities of the use of English for Medical purposes (EMP), including the teaching aims and student needs and expectations after a two-year foreign language study period. The paper ends by presentation of examples of the difference in use among specific English terms.

Hypoosmotic swelling test for quality control of sperm prepared for assisted reproduction

This study evaluates the clinical usefulness of one additional parameter for assessment of human sperm cell function in vitro--the hypoosmotic swelling test. The hypoosmotic swelling test evaluated the functional integrity of the sperm plasma membrane. The investigation included a comparison of the hypoosmotic swelling test in samples containing motile and immotile spermatozoa and their correlation with the intrauterine insemination outcome. Motile spermatozoa expressed better membrane characteristics, without any importance of the hypoosmotic conditions. Positive correlation exists between HOS results and the outcome of IUI. This test can be a useful addition to the standard battery of semen analyzing tests.

Sperm morphology and motility in different age populations

A prospective study of 77 semen specimens was conducted by routine examination of patients reporting to our laboratory for sterility problems. Abnormal spermatozoa were found mostly in patients over 40 years of age. The most frequent head abnormality was angulation of head (found in 94% of patients) and the most frequent tail abnormality was bent jail (found in 90% of patients). Immature spermatozoa were noted mostly in patients over 40 years of age. Motile sperm concentration was higher in patients up to 26 years of age. However, there was a remarkable heterogeneity of routine andrological parameters within the examined groups.

Double minute chromosomes in an invasive adenocarcinoma of the prostate

Cytogenetic analysis of an uncultured, primary and invasive adenocarcinoma of the prostate showed several clonal abnormalities in a hyperdiploid karyotype, including double minute (dmin) chromosomes. The latter, although sporadic in this type of tumor, were previously reported in two cases of invasive prostatic cancer. This anomaly may therefore be associated with increased malignant properties.

Gonadotropins (FSH and LH) and testosterone in human male serum and seminal plasma

Concentrations of gonadotropins (FSH and LH) and testosterone (T) were measured in male serum and the seminal plasma of normo-, oligo- and azoospermic ejaculates. In addition, T levels were measured in tissue extracts of testis and prostate. The concentrations of FSH were nearly the same in seminal plasma and serum. However LH levels were higher in seminal plasma, while T levels were higher in serum. In azoospermic samples, the gonadotropins showed increased concentrations, while T levels were decreased. The concentrations of all three hormones differed in the seminal plasma of infertile men compared to the control group.

Cytogenetic evidence of gene amplification in urothelial cancer--a possible mechanism of tumor invasiveness

A cytogenetically detectable form of gene amplification, presumably oncogene amplification, double minute chromosomes, has been found in 11 out of 45 specimens (24%) of moderately and poorly differentiated, deeply infiltrating transitional cell carcinoma of the bladder and ureter. None of the 75 low-grade low-stage tumors contained this karyotypic anomaly. It is obvious that double minutes are not a rare and sporadic phenomenon in this type of tumors; additionally there is strong evidence that they are involved in tumor progression, i.e. they are associated with tumor aggressiveness and unfavorable prognosis.

An extra X chromosome effect on craniofacial morphogenesis in men

A comparative study of the craniofacial complex in men with an extra X chromosome, and normal male and female individuals was carried out using cephalometric radiography. The anterior cranial base, anterior and posterior facial height, maxillary base and ascending ramus were found to be significantly decreased in men with Klinefelter syndrome when compared to the male control group. Significant differences in the lengths of mandibular base and posterior cranial base were not found. When compared to the female control, all structures examined were significantly increased, except for the maxillary base.

Intrauterine insemination with spermatozoa recovered from the aspirate of artificial spermatocoele

Congenital absence of both vas deferens accounts for approximately 10% of cases of obstructive azoospermia. The purpose of the present study was to develop a treatment protocol for a group of azoospermic patients using surgical implantation of alloplastic spermatocoele to enable repeated sperm cell aspiration. Nine patients with congenital absence of both vas deferens, two with obstructed and one with destroyed vas, underwent surgery for the implantation of an alloplastic spermatocoele. In 10 of the 12 patients, vital spermatozoa were recovered from the aspirate and used for intrauterine insemination of their female partners with induced ovulation, some of whom then conceived.

Phenotype of two males with abnormal Y chromosomes

Two infertile males with sex chromosomal abnormalities and mosaic karyotype, 45,X/46,X,dic(Yq) and 45,X/46,X,ring(Y), had considerably changed physical findings, including tooth sizes and craniofacial dimensions. Spermatogenesis was preserved with abnormal meiotic chromosomal behaviour. Mosaic karyotype and structurally changed Y chromosome in both cases had an influence on physical parameters. Tests were normally developed and spermatogenesis was preserved but depressed in later stages.

Kallikrein therapy of infertile men with varicocele and impaired sperm motility

A randomized group of 65 men with oligoasthenozoospermia and left side varicocele was subjected to a controlled study with kallikrein. Kallikrein (600 units orally per day) was given to 38 men for a period of 3 months. The other group of 27 men remained untreated but were followed up during the same period of time. After kallikrein treatment significant improvements in sperm quality could be observed: percentage of motile spermatozoa from 24.47 +/- 9.01 to 35.26 +/- 11.80, percentage of morphologically normal spermatozoa from 58.42 +/- 5.86 to 71.05 +/- 8.12. There was no improvement in sperm parameters in the untreated group of men. The results suggest that kallikrein therapy is useful for those men who refuse an operative or radiologic treatment of their varicocele and also as a primary or associated therapy of patients who underwent ligature or occlusion of spermatic veins.

Seminal antisperm antibodies and genitourinary infection

A total of 326 infertile men, 126 with genitourinary tract infection, and 200 without infection, were compared with 60 fertile men. Seminal plasma antisperm antibody with other clinical and microbiologic investigations were performed in all. Infertile men with genitourinary tract infection had antisperm antibody in 11.9 percent, infertile men without infection in 14.5 percent, and fertile men in 5 percent; these differences were not significant. The most common causes of these infections were gram-negative organisms and Chlamydia. Comparison of the levels of the titers of seminal plasma antisperm antibodies showed no significant difference between infertile and fertile men. This study shows no significant relationship between genitourinary tract infection and formation of the seminal antisperm antibody.

Elastase as an indicator of silent genital tract infection in infertile men

Due to the absence of clinical symptoms, silent genital tract inflammation can be diagnosed only by laboratory tests. In this study we have evaluated seminal plasma elastase levels, using an immunoabsorbent assay, in a group of 84 infertile men. Seminal plasma levels of elastase were correlated with the number of white blood cells in the ejaculate, the number of peroxidase-positive leucocytes and with sperm culture. A high number of leucocytes (greater than 10) and a significantly higher number of men with peroxidase-stained leucocytes exceeding 10(6)/ml was found in a group of men with elastase levels greater than 250 ng/ml. There was a significant correlation between sperm culture results and elastase levels, most men with negative sperm culture having a lower seminal plasma elastase level. Following the treatment with antibiotics of men with an elevated elastase level, sperm parameters improved in 67% of those in whom elastase levels were lowered after treatment. In those men with persisting elevated levels of elastase improvement of sperm parameters was found in only 10%. It is concluded that an elevated level of elastase is a sensitive indicator of asymptomatic genital tract infection and that a single determination gives a reliable criterion and relatively exact quantification of infection.

Distribution of marker chromosomes in relation to histologic grade in bladder cancer

Cytogenetic analysis was carried out in 100 tissue specimens from 88 patients with bladder cancer. Using a direct technique of chromosome preparation, analyzable metaphases were obtained in 60 cases. Various chromosomal abnormalities, numerical as well as structural, were found. The frequencies of different marker chromosomes, with the exception of the ring chromosome, increased from grade 1 to grade 3 tumors. The average number of markers per cell was one in G1, four in G2, and eight in G3 tumors. It was possible to make a distinction between structural aberrations occurring in all histologic grades and those specific for the invasive grade 2 and grade 3 tumors.

Post-irradiation cystitis improved by instillation of early placental extract in saline

21 patients with chronic cystitis due to irradiation therapy for carcinoma of the cervix had symptomatic and cystoscopic improvement from instillations of early placental extract in saline. There was a statistically significant difference between these patients and a control group.

Kallikrein and antibiotics in the treatment of infertile men with genital tract infections

A randomised group of 120 men with oligoasthenozoospermia and genital infections was investigated. All men received antibiotic treatment in a duration of 8 to 12 weeks, 64 men additionally kallikrein in a dosage of 600 units per day for a period of 3 months. No significant difference in sperm parameters could be detected between the two groups at the beginning of the study. After therapy a significant improvement was measured in sperm count as well as in percentage of motile and morphologically normal spermatozoa in either group. But in infertile men treated with antibiotics plus kallikrein improvement in sperm motility and percentage of normally shaped spermatozoa was significantly higher than in the non-kallikrein group. Pregnancy rate of 32% in the kallikrein treated group was higher than in the other group where it reached 17%. On the basis of these results we can conclude that treatment of infertile men with genital infections with antibiotics plus kallikrein is more effective than with antibiotics alone.

Chromosome analysis in patients with bladder tumor

Cytogenetic analysis was performed in 80 patients with bladder tumor. The mitotic activity in patients with tumor G1, G2 and G3 degree of differentiation was not significantly different among them. Most of the patients with noninvasive tumor (G1) had a diploid or nearly diploid chromosome number, but all patients with invasive (G2 and G3) tumor had polyploidy. Marker chromosomes were found in 14 patients and 9 of them developed recurrence very soon. There is a good correlation between the recurrence rate and numerical or structural chromosomal abnormalities. This study emphasizes the importance of the chromosome analysis in the evaluation of therapy and prognosis for patients with bladder tumors.

Incidence of aetiological factors in testicular obstructive azoospermia

Testicular exploration was performed in 225 azoospermic men with normal sized testes and normal serum levels of FSH. Thirty-one men had impaired spermatogenesis and the cause of obstruction was found in 46% of the subjects. Thirty-two men had a history of genital tract infection while 18 had a history of genital or inguinal surgery. A history of chest disease was noted in 25 men with obstructive azoospermia. Aplasia of the vasa was present in 9.3% of the group. The epididymis was the site of obstruction in 63% of patients but the cause of epididymal obstruction was unknown in 81 of the 141 men.

Spermatogenesis and meiotic chromosomal behaviour in aged men

Spermatogenesis and meiotic chromosomal behaviour was analysed in a group of males aged 60-80 years. Decreased spermatogenesis was found in most of these aged men although individual differences existed. Chromosomal analysis of cells undergoing diakinesis showed significantly lower chiasma frequency in elderly men, compared with a group of younger control males and also with infertile males.

Cytogenetic analysis of men with cryptorchidism and reduced fertility

A cytogenetic chromosomal analysis was performed in 140 infertile men with cryptorchidism--85 with unilateral and 55 with bilateral. The most frequent anomaly was sex chromosomal aneuploidy found in 7.1% of patients. This is significantly higher compared to a group of infertile men with normal descended testes. Other chromosomal anomalies were not more frequent than in infertile men without cryptorchidism.

Seminal plasma hormone profile in infertile men with and without varicocele

Seminal plasma FSH, LH, prolactin, testosterone, and oestradiol were estimated in 41 infertile men with varicocele and 45 infertile men without varicocele who failed to impregnate their wives after 2 years of marriage and 30 fertile men. There was significant elevation of FSH in the seminal plasma of the infertile men with varicocele compared with the seminal plasma of the other infertile and fertile men. Seminal LH and prolactin values were similar in both infertile groups but significantly higher than in the fertile men. Testosterone and oestradiol levels in the seminal plasma of infertile men with varicocele were lower than in the fertile and the other infertile males. Finding that both steroids were decreased in infertile men with varicocele could explain disturbed function of spermatozoa in men with varicocele. Further analysis will elucidate the importance of these hormone findings in the seminal plasma of infertile men with varicocele.

Androgen insensitivity suspected by estimation of serum hormone levels in oligozoospermic and azoospermic men

According to higher androgen insensitivity index than in fertile men, the group of 83 men, with high serum LH and high or normal testosterone levels, was separated from 800 infertile men. These patients with high androgen insensitivity index had oligozoospermia (6.38 +/- 3.18 X 10(6)/ml) or azoospermia. They had significantly higher serum LH and testosterone levels than compared groups of infertile and fertile men. Elevated serum FSH levels in infertile men with high androgen insensitivity index showed damage of spermatogenesis. There was completely disturbed hypothalamo-pituitary-testicular axis as the serum prolactin levels were significantly elevated too. There was no significant difference in serum estradiol levels among investigated groups. Using androgen insensitivity index we could identify those men whose infertility is not treatable.

Evaluation of sperm parameters in clinical trial with clomiphene citrate of oligospermic men

A randomized group of 101 oligospermic men, with low or normal serum follicle-stimulating hormone levels and infertile marriages of more than 2 years were studied with and without clomiphene citrate. For 6 to 9 months 56 patients were treated with 50 mg. clomiphene citrate daily and 45 men were given no treatment. Significant improvement in volume, sperm density and sperm motility was observed in the treated group but not in the control group. Sperm density greater than 20 times 10(6) per ml. was obtained in 18 men and there were 7 pregnancies in the treated group. In the control group 3 men had a sperm count greater than 20 times 10(6) per ml. and there was no pregnancy. This study showed statistically significant improvement in sperm parameters in the treated group but not in the untreated patients.

Hormone profile in hyperprolactinemic infertile men

Serum levels of FSH, LH, prolactin, testosterone, and estradiol in 46 infertile men with hyperprolactinemia were compared with the same in 50 infertile and 30 fertile men with normal serum prolactin levels. Serum FSH levels in hyperprolactinemic men were significantly higher than in the other groups, indicating disturbance of spermatogenic process among those men. Significantly raised serum LH levels were in infertile men with serum prolactin over 1000 U/liter. All men with hyperprolactinemia had significantly lower serum testosterone levels than other infertile and fertile men. Although serum testosterone was not under the lower limit of normal range and high LH levels demonstrated disturbance of Leydig cell function in hyperprolactinemic infertile men, serum estradiol levels were not different among investigated groups. Azoospermic men with raised serum prolactin had higher serum FSH and LH levels than oligospermic men with hyperprolactinemia. These data demonstrated disturbance in hypothalamopituitary-testicular axis in infertile men with hyperprolactinemia. Further studies of prolactin in males with reproductive failure could probably clear this problem.

Meiotic studies in two infertile males with autosomal translocations

Meiotic studies were performed in two infertile male carriers of balanced reciprocal translocations between chromosomes 3;5 and 6;10. The first patient had severe oligozoospermia with all stages of meiosis present. The other patient was azoospermic with meiotic breakdown after the first meiotic division. A ring quadrivalent configuration was found in diakinesis in both cases.

Chromosomal constitution of infertile men

Mitotic chromosome analyses performed on 820 infertile men revealed 60 (7.3%) men with some kind of chromosomal abnormality. Sex chromosomal abnormalities were detected in 28 (3.4%) and autosomal translocations in 9 (1.0%). Pericentric inversions of chromosome 9, with possible adverse effect on reproduction, was found in 23 (2.8%). Chromosome variants comprised a group of 77 (9.3%) subjects. We suggest that men with severe oligozoospermia and azoospermia should be considered for cytogenetical evaluation.

Patterns of hormones in the seminal plasma correlated with sperm count and motility

Seminal plasma FSH, LH, prolactin, and testosterone were estimated in 110 men with wives with no pregnancy during the last 24 months and 20 fertile males. Seminal FSH and LH levels were significantly higher in oligozoospermic men (sperm count over 10 X 10(6)/ml) and in males with reduced motility than in fertile men. Males with severe oligozoospermia (sperm count below 10 X 10(6)/ml) had values of gonadotropins similar to fertile subjects. Seminal prolactin levels were significantly elevated in all infertile males. Men with sperm count under 10 X 10(6)/ml had significantly lower seminal testosterone values than the other infertile and fertile men.

Endocrine profile of 45 patients with Sertoli cell only syndrome

The basal serum levels of FSH, LH, prolactin and testosterone were determined in 45 patients with Sertoli cell only syndrome and were compared with the same in patients with Klinefelter's syndrome, oligozoospermic men and normal, fertile men. The serum FSH and LH levels in patients with Sertoli cell only syndrome were significantly higher than in normal males. The elevation of gonadotropins in patients with this syndrome was not so high, and the testosterone not lowered, as those in patients with Klinefelter's syndrome. The finding that the basal serum LH levels were elevated and serum testosterone levels were in normal range, demonstrated that there was compensated dysfunction of the Leydig cells in patients with Sertoli cell only syndrome.

Correlation of hormone and histologic parameters in infertile men with varicocele

Serum FSH levels were significantly higher in infertile men with varicocele than in oligospermic and fertile men. Among the groups investigated there were no significant differences in serum LH, prolactin and testosterone levels. Men with varicocele and with severe depressed or absent spermatogenesis had a significantly higher serum FSH level than those with mild reduced or normal spermatogenesis. Leydig cell dysfunction was not detected in men with varicocele. Endocrine evaluation of infertile men with varicocele enables us to separate those who need not undergo surgical treatment (elevated serum FSH level) and those who need medical treatment after varicocelectomy (with disturbed Leydig cell function).

Low chiasma frequency as an aetiological factor in male infertility

Among 120 meiotic analyses of infertile men there were three cases with a particular meiotic anomaly: low chiasma count at diakinesis and spermatogenic arrest. All clinical findings, hormonal analyses and karyotypes from peripheral blood were normal. Meiotic studies showed that pachytene pairing was complete, but in diakinesis the mean number of chiasmata per cell was significantly lowered, chromosomes were fragmented and univalents could frequently be found. In all three cases azoospermia was the consequence of spermatogenic arrest, which occurred after diakinesis-metaphase I.

Hyperprolactinemia: histological and meiotic analyses in azoospermic men

High serum prolactin was detected in 15 out of 110 azoospermic men (13%). Patients underwent hormone assays, sellar radiography, and testicular biopsy (histological and meiotic analyses). Three patients, with most elevated serum prolactin level, had spermatogenic arrest. Nine patients showed no spermatogenic activity on histological and meiotic preparations. Three patients had normal and decreased spermatogenesis and normal meiotic divisions. The patients with spermatogenic arrest and with preserved spermatogenic process were treated with bromocriptine. Spermatogram in two patients with preserved spermatogenic process was ascertained to nearly normal range, after the treatment. There was no specific histologic or meiotic lesion in azoospermic men.