Number, distribution pattern, and identification of macrophages in the testes of infertile men

OBJECTIVE

To investigate the number, location, and secretory products of macrophages in human testes showing normal and abnormal spermatogenesis.

DESIGN

Evaluation of testicular biopsies with the use of immunohistochemistry, laser capture microdissection, and reverse transcriptase polymerase chain reaction.

SETTING

University research and clinical institutes.

PATIENT(S)

Infertile men with germ cell arrest (n = 10), Sertoli cell only (n = 8), or mixed atrophy (n = 7) syndromes, and with cases of idiopathic infertility showing normal spermatogenesis (n = 8).

INTERVENTION(S)

Diagnostic testicular biopsy was performed on participants.

MAIN OUTCOME MEASURE(S)

We recorded the location, number, distribution, and cytokine expression of human testicular macrophages.

RESULT(S)

CD68-positive macrophages were found in the testes of all groups analyzed. These macrophages expressed the genes for interleukin 1 and tumor necrosis factor-alpha, and were located in the interstitium, tubular wall, and tubular lumen. In Sertoli cell only and germ cell arrest syndromes, the overall macrophage number was increased over twofold. In all pathologic states, there was a significant shift of these cells from the interstitium to the tubules.

CONCLUSION(S)

Our study suggests that increased numbers of CD68-positive macrophages directly (via phagocytosis) or indirectly (via paracrine actions exerted through their secretory products) are involved in the regulation of steroidogenesis, Sertoli cell activity, germ cell survival, and, in consequence, in the pathogenesis or maintenance of infertility states in the human testes.

Evidence for catecholaminergic, neuronlike cells in the adult human testis: changes associated with testicular pathologies

Neuronlike, catecholaminergic cells expressing tyrosine-hydroxylase (TH) have recently been found in the testis of a nonhuman primate species, the rhesus monkey. We examined whether neuronlike cells are present in the human testis. To this end, we first determined if the genes for TH and for a voltage-activated sodium channel (NaCh), a prerequisite for neuronal excitability, are expressed in normal adult testes. Using an RT-PCR approach, cDNA clones, identical to the sequences of human TH and to the alpha subunit of a NaCh type, were isolated. Immunohistochemical methods localized the corresponding proteins in testicular biopsies from adult men (age range, 28-44 years) without testicular pathologies and from infertile patients with either Sertoli cell only (SCO) syndrome or severe hypospermatogenesis and germ cell arrest (GA). TH and NaCh antibodies, as well as antibodies recognizing dopamine-transporter protein, identified immunoreactive cells of mainly bipolar or occasionally multipolar, elongated phenotype in most, but not all, biopsies of each group (12 out of 23). The results were corroborated by identification of TH gene expression by RT-PCR approaches in biopsies. Immunoreactive cell bodies, as well as nerve fibers, were more readily detected in SCO and GA biopsies. This was quantified after immunohistochemically visualizing all testicular neuronal elements, cell bodies, and fibers, with a neurofilament 200 (NF-200) monoclonal antibody in one set of randomly selected sections from all biopsies. We found significantly increased NF-200-immunoreactive cell bodies and fibers in SCO-syndrome and GA biopsies. These results show the existence of an as yet unknown testicular catecholaminergic neuronlike cell type in the human testis. This cell type may complement and act in concert with the well-known testicular sympathetic innervation. The increase of both "intrinsic" (neuronal cells) and "extrinsic" (nerve fibers) neuronal elements in pathological testicular biopsies suggests that the two parts of the human testicular nervous system may be involved in pathogenesis and/or maintenance of GA and SCO syndromes.

Birth of healthy children after intracytoplasmic sperm injection in two couples with male Kartagener's syndrome

OBJECTIVE

To describe two cases in which intracytoplasmic sperm injection (ICSI) was successful for patients with infertility due to Kartagener's syndrome.

DESIGN

Case report.

SETTING

Private hospital for gynecology department of reproductive medicine, and university hospital center for andrology.

PATIENT(S)

Two couples with primary infertility due to Kartagener's syndrome in the male.

INTERVENTION(S)

ICSI.

MAIN OUTCOME MEASURE(S)

Pregnancy and birth after ICSI.

RESULT(S)

In both couples, ICSI was successful in the first cycle. The uncomplicated pregnancies resulted in the birth of three healthy children. One female and male/female twins.

CONCLUSION(S)

In couples with infertility due to Kartagener's syndrome in the male, ICSI has proved to be a successful therapy resulting in clinically healthy offspring. This knowledge may improve our understanding of the involvement of paternally inherited centrosomes, which nucleate microtubules, in human reproduction.

Congenital lower lip pits--a very rare syndrome? Report of two cases and review of the literature

A 43-year-old white man and his 12-year-old daughter both displayed congenital lower lip pits. Since Van der Woude's description of this syndrome more than forty years ago, little attention has been given to this uncommon anomaly, probably due to variable expressivity, incomplete penetrance, and recognition of its clinical stigmata. We describe two family members with Van der Woude's syndrome and review its clinical aspects, differential diagnosis, and treatment.

[Disorders of penile erection and their treatment]

With a prevalence of 1 to 2% among males of reproductive age, erectile dysfunction is relatively common. For the patient and his partner, erectile disorders may represent a highly stressful situation. Frequently, a number of overlapping causes may be found to be responsible, with a psychological component--which may also arise secondarily--being involved in nearly every form of erectile dysfunction. Possible causes, the diagnostic approach and therapeutic options are discussed.

Double-blind, placebo-controlled safety and efficacy trial with yohimbine hydrochloride in the treatment of nonorganic erectile dysfunction

This double-blind, placebo-controlled clinical trial of yohimbine hydrochloride included 86 patients with erectile dysfunction and without clearly detectable organic or psychologic causes. The patient group fulfilled all entry criteria; 85 of these could be considered for the Safety-respectively 83 for the Intention-to-treat (ITT)-analysis. Yohimbine was administered orally in a dosage of 30 mg a day (two 5 mg tablets three times daily) for eight weeks. Patients were seen for follow-up after four weeks' treatment, and for a final visit after eight weeks. Efficacy evaluation was based on both subjective and objective criteria. Subjective criteria included improvement in sexual desire, sexual satisfaction, frequency of sexual contacts, and quality of erection (penile rigidity) during sexual contact/intercourse. Objective criteria of outcome were based on improvement in penile rigidity determined by use of polysomnography in the sleep laboratory. Overall Yohimbine was found significantly more effective than placebo in terms of response rate: 71 vs 45%. Yohimbine was well-tolerated: Only 7% of patients rated tolerability fair or poor, and most adverse experiences were mild. There was no serious adverse event.

[Multiple cutaneous neoplasms in cyclosporine therapy after kidney transplantation]

We report on a 56-year-old renal allograft recipient receiving cyclosporin A immunosuppression. During this therapy he subsequently developed the following cutaneous neoplasms: squamous cell carcinomas, basal cell carcinomas, Bowen's disease, actinic keratosis, sebaceous hyperplasia, a dysplastic naevus and, finally a nodular malignant melanoma. Adverse effects of the cyclosporin A therapy are discussed, with special reference to dermatologic effects and the implications for patient and doctor.

[Soft roentgen therapy in cutaneous metastases of the eyelids]

HISTORY

Within 6 months a 88-year-old woman developed cutaneous metastases with infiltration of the eye-lid so that an opening of the eye-lids became impossible. The primary tumor histologically resembled a mamma carcinoma.

THERAPY

Within a few days the cutaneous metastases of the eye-lids decreased by using x-ray therapy with the Dermopan II with a single dosage of 5 Gy and a total dosage of 35 Gy on the eye-lids. Even 12 months after palliative therapy the opening of the eye-lids was possible without any problems.

CONCLUSIONS

By using the x-ray therapy immediate and gentle help could be given to the terminally ill patients so that eye-lid surgery could be avoided.

[Hypogonadotrophic hypogonadism with pulsatile GnRH therapy]

In idiopathic hypogonadotropic hypogonadism of men it is possible to normalize the endocrine and exocrine testicular function by pulsatile therapy with a GnRH pump. The long duration of the therapy can cause difficulties with compliance in young patients.

[Dermatologic aspects of anorexia and bulimia nervosa]

Anorexia and bulimia nervosa are common in western civilized countries. They are frequently associated with disorders of the skin. Up to now, no dermatological studies of large numbers of patients with eating disorders have been published. We examined 145 patients with eating disorders (65 anorexia nervosa, 80 bulimia nervosa) regarding skin alterations. Simultaneously we controlled the moisture content and the superficial lipids of the skin. Several symptoms relevant to dermatology were found. In detail we report on: xerosis, hair changes, nail disorders, pathognomonic hand lesions, sialadenosis, lesions of the oral mucosa and the teeth, peripheral oedema, acrocyanosis, petechiae and artefacts.

Low-pigment skin type and predisposition for development of type I diabetes

To ascertain whether skin pigmentation type and sensitivity to ultraviolet (UV) light are associated with susceptibility to type I (insulin-dependent) diabetes, 55 type I diabetic patients were examined, 38 new-onset and 17 long-term cases. They were compared to 72 control subjects of the same geographic region and nationality. To evaluate the individual skin pigmentation type, a standardized questionnaire was developed. Reactivity to UV light was determined by a stepwise-graded UV irradiation. Significantly more diabetic patients in southern Germany had blue eyes than nondiabetic control subjects (55 vs. 26%, P less than 0.01), and significantly more diabetic patients had a low-pigment eye color (blue or green) than control subjects (66 vs. 38%, P less than 0.01). In addition, more fair skin color was noted among diabetic versus control subjects (84 vs. 60%, P less than 0.01). In response to UV irradiation, diabetic patients more often showed an increased UV-light sensitivity than control subjects (83 vs. 23%, P less than 0.001). The relative risk for susceptibility to type I diabetes in subjects with low-pigment eye color was 3.1, in subjects with fair skin type 3.4, and in subjects with increased UV-light sensitivity 5.8. The highest risk for the development of diabetes was seen in subjects who had low-pigment eye color and/or increased UV-light sensitivity (95 vs. 51%, P = 0.00002, odds ratio 17.4). We conclude that a low-pigment skin type may predispose for the development of type I diabetes.

[Gonococcal diseases today--a review of the diagnostic and therapeutic development of the past years]

The diagnosis of gonococci in vitro is reliable and simple nowadays. Investigations are still based on direct microscopic control and on culturing. With the help of coagglutination by monoclonal antibodies and enzymatically controlled color reactions, we are able to take Neisseria gonorrhoeae apart from other gram-negative and oxidase-positive diplococci. In the therapy of common gonorrhea, we now use antibiotics more recently developed than penicillin. The complicated extragenital and disseminated forms of the disease require special modes of treatment usually provided in hospital.

Ceftriaxone for the treatment of primary and secondary syphilis

In a multicenter, open, randomized, prospective, comparative study, 28 patients with primary (n = 9) or secondary (n = 19) syphilis were treated with either ceftriaxone or penicillin G. 14 patients received ceftriaxone 4 x 1 g i.m. every 2 days. 14 other patients were treated with penicillin G 1 million IU i.m. daily for 15 days (standard therapy of primary and secondary syphilis). To avoid Herxheimer reaction we applied prednisolone 50-100 mg i.m. before specific treatment. Diagnosis was confirmed by clinical symptoms, dark-field microscopy and serological tests (VDRL titer, TPHA test and 19s-IgM-FTA-abs test or SPHA test). Follow-up examinations during therapy were repeated on days 2, 4, 6 (dark-field microscopy, physical examination) and day 14 (VDRL titer). To evaluate therapeutic efficacy, serological controls were repeated 1, 2, 3, 6 and 12 months after therapy (VDRL, SPHA). In all patients, a marked decline (minimum 2-dilution decrease) in VDRL titer and resolution of clinical symptoms were noted. An adverse reaction was seen in 1 patient of the clemizol-penicillin G group (allergic penicillin exanthema). There were no adverse reactions to ceftriaxone. Summing up, there was no detectable difference in clinical and serological response to syphilis treatment either with ceftriaxone or penicillin G. Ceftriaxone, thus can be regarded as an equivalent alternative to penicillin G in the treatment of primary and secondary syphilis.

[Skeletal changes following long-term treatment with retinoids]

The synthetic retinoids, the vitamin-D-derivatives etretinate and isotretinoin, have substantially enlarged the therapeutic arsenal in dermatology. They are primarily used in severe cases of acne and cornification disorders. In the majority of cases, long-term treatment is necessary. Certain side effects in the skeletal system can occur, e.g., osteoporosis, premature epiphyseal closure, and changes similar to DISH (diffuse idiopathic skeletal hyperostosis). We discuss the reports in the literature and our own observations in 31 patients treated at the Westphalian Wilhelms University in Muenster, as well as at the Technical University in Munich. In 3 out of 31 patients treated by retinoids on a long-term basis, skeletal changes were found radiologically as a result of the retinoid medication.

[Hemodynamic studies on the action kinetics of phenoxybenzamine in healthy persons and hypertensive patients]

The hemodynamic profile of the pre- and postsynaptic alpha-receptor blocker phenoxybenzamine (POB) was investigated by a non-invasive technique in healthy subjects and in patients with essential hypertension. At a dose of 0.03 mg POB/kg body weight no hemodynamic changes were detected. POB at a dose of 0.07 mg/kg resulted in an initial transient rise in systemic vascular resistance and mean arterial pressure and a fall in heart rate without changes in stroke volume or cardiac index. 6 h after administration of 0.13 mg POB/kg a transient fall in peripheral vascular resistance and mean arterial pressure with an increase in heart rate and cardiac index was observed. A rise of orthostatic index, however, occurred within 1 h after administration of POB and reached its maximum after 4 h. 8 h after POB no hemodynamic changes were detectable. In patients with essential hypertension a similar fall in systemic vascular resistance and mean arterial pressure was observed after 0.13 mg POB/kg body weight. No change in heart rate occurred and the hemodynamic effects were significant already 3 h after administration of POB and persisted up to 8 h after POB administration. In contrast to healthy subjects, patients with essential hypertension showed no significant changes in the orthostatic index after POB. These hemodynamic findings point to a previously unexpected rapidly reversible functional alpha-receptor blockade by POB.

Idiopathic hemochromatosis in a 45-year-old infertile man

The clinical manifestations of primary or idiopathic hemochromatosis include mainly hepatomegaly, diabetes mellitus, and hypogonadism. Most investigators postulated that the hypogonadism is caused by pituitary dysfunction and that the deposition of iron in the testes is of little importance. We found not only pituitary failure in a 45-year-old man with idiopathic hemochromatosis (low LH and FSH levels, no response to GnRH) but could also detect by light microscopy deposition of iron in capillary endothelial cells and in the perivascular space of the testicular tissue. Electron microscopic study of tissue from the testes showed intracytoplasmic hemosiderin deposits in capillary endothelial cells. Abundant lipofuscin granules were present in Sertoli cells and Leydig cells. The serum testosterone levels were also lowered. In our opinion, the androgenic deficiency in idiopathic hemochromatosis is not only caused by pituitary failure but also by testicular dysfunction due to deposits of hemosiderin and lipofuscin in the testes.

[Treatment of rosacea with isotretinoin. Results of a multicenter trial follow-up]

A follow up investigation was done on forty-seven patients of the German multicenter study with severe and long standing rosacea who had been treated with isotretinoin (0.5 mg/kg bw/day) over twelve or twenty weeks. During the post-treatment follow up which lasted an average of fifty-seven weeks, seven relapses were registered whereas forty patients remained in remission. After drug withdrawal, both the percentage of patients without inflammatory lesions (pustules, papules or nodules) as well as the mean values of inflammatory lesions remained almost constant over the whole observation period.

Sperm quality of healthy smokers, ex-smokers, and never-smokers

The possible effects of cigarette smoking on sperm quality were investigated in a blind study of 333 healthy male volunteers 19 to 40 years of age. All subjects with clinically proven abnormalities, operations, or inflammatory diseases of the genital organs, exposure to radiation exceeding routine x-ray examination, or medication were excluded, and the data from 150 smokers, 37 ex-smokers, and 52 never-smokers were evaluated. There was a small but insignificant decrease in sperm density from never-smokers to ex-smokers and to smokers. Eight smokers (6%) had sperm counts less than 1 X 10(6)/ml, whereas none of the ex-smokers or never-smokers fell into this category. This difference, however, is not statistically significant (P = 0.084). No statistically significant effect of smoking habits on sperm density, motility, and morphologic features was detected. It is concluded that smoking does not affect the motility and morphologic features of sperm in healthy adult men. The diminished sperm density in heavy smokers may be related to factors associated with smoking.

[13-cis-Retinoic acid and spermatogenesis. Spermatological and impulse cytophotometric studies]

Twenty male volunteers with severe acne conglobata were treated orally over a period of 12 weeks with 1 mg isotretinoin (13-cis-retinoic acid) per kilogram body weight. Before and after therapy, as well as 12 weeks after the end of therapy, the semen was examined spermatologically and the spermatozoa DNS determined by impulse cytophotometry. The sperm density remained unchanged in the otherwise healthy patients, whereas patients with previous gonadal defects (unilateral cryptorchism, hypogonadism, varicocele) the sperm count rose significantly (P less than 0.05) at the end of therapy; 3 months later a reverse trend in the sperm density was noted. The percentage of morphologically normal spermatozoa was slightly reduced at the end of therapy; 12 weeks after completion of therapy it was significantly reduced (P less than 0.05). This could, however, be due to the short elimination half-life of 13-cis retinoic acid and have nothing to do with the drug. On impulse cytophotometry the spermatozoa DNS showed no significant changes. According to the results of the cytophotometric examination, contraceptive measures for men during treatment with 13-cis-retinoic-acid need not be made obligatory.

Effect of selective ultraviolet phototherapy on DNA and antinuclear antibody titers in psoriatic patients

The sera of 21 psoriatics treated by selective ultraviolet phototherapy (SUP) for 1-7 months were screened for IgG- and IgM-anti-DNA antibodies and antinuclear antibodies (ANAs) by standardized ELISA and the indirect immunofluorescence technique. No patients developed IgG-antibodies against native DNA under SUP, but two patients increased their IgM-antibody titers five- and tenfold, respectively. The IgG- and IgM-anti-single-stranded-(ss)DNA antibody titers remained unaltered in 38% and 57% of the patients. In 43% and 24%, respectively, they rose to a maximum of three times their original; and in 20% they decreased to a minimum of 40% of their pretherapeutic titers. After 1 month therapy no patient had produced ANAs, but all three patients showing ANAs before therapy had increased titers (one titer step). These remained on the elevated level or were even further increased by one-titer step during progressive therapy. Two patients out of 14 developed low titers of IgM-(1:20) or IgA-(1:40)ANAs against deoxyribonucleoprotein (DNP), initially after 3 months of irradiation; in one of them IgG-ANAs (titer 1:10) against DNP were additionally formed after 6 months of therapy. Our results suggest that lesions in DNA and DNP generated by SUP trigger an immune response to nuclear antigens.

13-cis-retinoic acid in conglobate acne. A follow-up study of 14 trial centers

A follow-up was done on the patients of the German multicenter study with severe conglobate acne who had been treated with different dosages of 13-cis-retinoic acid. Eighty-seven patients were monitored from 12 to 21 months. Optimal long-term therapeutic effects were obtained with an initial dose of 1.0 mg/kg body weight, for 3 months, followed by another 3-month-treatment period with 0.2 mg/kg body weight. Six months after the termination of therapy 96% of the patients were still in remission and 81% after 12 months. Comparative figures for the administration of doses were 84% as opposed to 47% (0.5----0.2 mg/kg body wt.) and 74% as opposed to 37% (0.2----0.2 mg/kg body wt.), respectively. It is suggested from the present data that a high initial dosage of 13-cis-retinoic acid be chosen in order to obtain optimal long-term therapeutic effects. Transiently elevated lipid levels as well as other tolerable side effects return to normal within 3 months at the latest after discontinuation of treatment.

[Premature ejaculation]

The constant failure to control the orgasm and the following ejaculation is called premature ejaculation. After having excluded organic factors the reason for premature ejaculation is always worry. When the reason for this fear is found, a psychotherapeutic treatment can soon be successful.

Testosterone in peripheral plasma, spermatic vein and in testicular tissue under basal conditions and after HCG-stimulation in patients with varicocele

The incretory testicular function was tested in 21 patient with varicocele aged 19 to 39 years. In one group baseline testosterone was measured, while a second group received a single injection of 5000 IU HCG. Testosterone was studied in peripheral plasma in the spermatic vein and in testicular tissue. Baseline values after stimulation were not different from those of normal controls. Testosterone in the spermatic vein rose, and in testicular tissue was greatly increased after HCG. The data provide further evidence that Leydig cell function is normal in patients with varicocele. In varicocele spermatogenesis is not impaired by low intratesticular testosterone concentrations.

[Disorders of sexual potency]

"Impotence" means the inability to have a normal coitus. Usually it is erectile dysfunction or inhibition of orgastic control. As many men are incapable of speaking openly about these problems and hope that the cause of their sexual dysfunctions is of organic origin. Therefore such reasons are offered with preference. The doctor has to separate the patient's account from the actual facts and the results of the physical examination as it is the practice with every other disease. A combination of somatic und psychotherapeutical treatment may thus be successful.

Effects of testosterone replacement on sexual behavior in hypogonadal men

Fifteen patients with hypogonadism due to testicular, pituitary, or hypothalamic failure were studied. After a pretreatment period without substitution, patients received intramuscular injections of testosterone enanthate, equivalent to 25, 50, 100, and 250 mg testosterone, or placebo. Each dose was given for 4 weeks, with injections given every 2 weeks. All patients with plasma testosterone values below 2 ng/ml during the pretreatment period reported impaired sexual function. They responded to testosterone injections (50, 100, and 250 mg) with improvement of sexual behavior, as rated by sexual desire and frequency of erections and ejaculations. In the range between 2.0 and 4.5 ng testosterone per ml, four patients reported high frequencies of erections and ejaculations that did not change after testosterone treatment. Four other patients with testosterone values in the same range reported impaired sexual behavior and were successfully treated with testosterone enanthate. These data indicate that male sexual behavior is testosterone dependent and that the individual limit of plasma testosterone below which sexual behavior is impaired lies between 2.0 and 4.5 ng/ml.

Double-blind study on the effect of cigarette smoking on the chromosomes of human peripheral blood lymphocytes in vivo

A double-blind study with 170 smokers and 124 non-smokers revealed a doubling of the frequencies of exchange-type aberrations in the peripheral blood lymphocytes of smokers as compared with non-smokers. Smokers (N = 24) had 1 SCE more per metaphase than non-smokers (N = 20), an effect that is significant but low when compared with the effect on structural chromosomal aberrations. These results show that structural chromosomal aberrations are better indicators of the genetical effects of low chronic exposures to mutagens in man than SCEs. The frequencies of micronuclei in 3-day lymphocyte cultures showed no differences in smokers (N = 95) and non-smokers (N = 39). Non-smokers (N = 99) had significantly higher frequencies of 2nd metaphases in 48-h cultures in vitro than smokers (N = 141), indicating an effect of smoking on the stimulation of lymphocytes by PHA in vitro.

Further studies on intratesticular testosterone concentration in patients with disturbed fertility

32 patients with azoospermia or severe oligozoospermia were studied. In all cases testosterone was in the normal range. Luteinizing hormone (LH) in plasma was elevated in 10 patients and follicle stimulating hormone (FSH) was elevated in 18 cases. The testes were evaluated by morphometry. The higher the degree of tubular atrophy the smaller the testes and the more Leydig cells found in a given piece of tissue. The percentage of the testes occupied by Leydig cells correlated wtih the intratesticular testosterone concentration(r = 0.435, P < 0.001). In the subgroup of patients with normal plasma testosterone and elevated LH values the intratesticular testosterone was significantly (P < 0.001) elevated as compared to the patients with normal LH.

[Organically induced potency disorders (author's transl)]

The man who feels his sexual function is disturbed is at first not prepared to look for psychic grounds for the condition he considers a defect. He rather expects his physician to find an organic lesion. The knowledge of the many congenital and acquired diseases which can have a negative effect on potency permit the application of a suitable laboratory program in addition to the specific history and physical examination. If a relevant disease should be found, this must first be treated before the psychic fixation which is sure to have developed is gone into. On the other hand, should an organic disease be overlooked, even the best psychotherapy will be unsuccessful.

[The treatment of Dupuytren's contracture. A social medical problem (author's transl)]

After a brief description of the characteristics of Dupuytren's disease the operative and conservative therapeutic measures are examined from both clinical and social medical aspects. It is shown in 154 patients with Dupuytren's contracture of the hands in various stages that an advance of this disease could usually be prevented by treatment with soft X-rays. A comparison of costs shows that this therapy is at least 11 times cheaper than a good operative procedure without follow-up treatment. For the patient it is highly important that only little time is lost in the outpatient compared with inpatient treatment. Loss of work-place, professional incapacity or inability to work because of Dupuytren's disease can be prevented with a probability bordering on certainty.

Testosterone and testosterone precursors in the spermatic vein and in the testicular tissue of old men. Reduced oxygen supply may explain the relative increase of testicular progesterone and 17 alpha-hydroxyprogesterone content and production in old age

Testosterone and the testosterone precursors pregnenolone, progesterone, 17 alpha-hydroxyprogesterone, 17 alpha-hydroxypregnenolone, androstenedione, androstenediol and dehydroepiandrosterone were measured in the spermatic vein plasma and in the testicular tissue of young and old men. Testosterone and its precursors decreased in the testicular tissue of old men. However, progesterone and 17 alpha-hydroxyprogesterone increased in relation to testosterone in the testicular tissue and in the spermatic vein of old men. It is assumed that these age-dependent changes are caused by an impaired oxygen supply of the ageing testes. This hypothesis is supported by the observation that the same changes in steroid pattern seen in old age can be observed under reduced oxygen supply in in vitro incubation experiments with testicular tissue.

[Early diagnosis of minimal cerebral dysfunction]

The aim of this retrospective study was to find indicators for an early diagnosis of the MCD-syndrome. Two groups of children (n = 18), with and without MCD at the age of five years were compared in view of medical history and early developmental data. The results suggest that illnesses of the mother before the birth of the child, risk factors in the course of the second half of pregnancy, as well as slight retardation of the child's early psychomotor development deserve particular attention in further studies.

Further studies on hypothalamic-pituitary-testicular function in old rats

The dysfunction of the hypothalamic-pituitary-gonadal axis in old age was studied in 24-month old male Wistar rats which were compared with 3-month old animals. The hypothalamic LH-RH content and the pituitary LH were significantly lower in the old than in the young adult animals. The plasma concentrations of LH and testosterone were significantly higher in the young rats. The primary cause of these age-dependent changes probably is a hypothalamic dysfunction. When isolated Leydig cells of young and old rats were incubated in vitro, the testosterone secretion per cell was significantly smaller in old than in young cells with as well as without HCG stimulation. In vivo stimulation of rats by iv injection of biologically active iodinated hCG revealed that the intratesticular uptake of the gonadotrophin was not different in young and old rats. The testosterone response, however, was significantly reduced in old age. An in vitro "desensitisation" experiment in which the LH receptor capacity was artificially reduced demonstrated that the 40% reduction of receptor capacity in old testes as described earlier will not impair the testicular uptake of gonadotrophin from blood. Repeated injection of hCG results in equally elevated testosterone concentrations in young and old rats.

Intratesticular testosterone concentration in patients with disturbed fertility

45 patients with azoospermia or severe oligozoospermia were studied. Testosterone and luteinizing hormone in plasma were in the normal range. Intratesticular testosterone values were higher the greater the degree of tubular atrophy was. Patients with testes of subnormal size (less than 12 ml) had significantly higher values than those with normal sized gonads. 31 out of 37 testes obtained by castration of patients with carcinoma of the prostate showed slight to severe disturbance of spermatogenesis. In this group no positive correlation was observed between the degree of testicular atrophy and intratesticular testosterone concentrations. Intact spermatogenesis was observed in testes with a testosterone content as low as 542 pg/mg tissue.

In vitro and in vivo studies on Leydig cell function in old rats

Young adult (3 months old) and old (26-28 months old) male Wistar rats were studied. Testicular weight was 1.66 g (range: 1.33--2.86) in the younger group and 1.62 g (range: 1.04--1.90) in the older group. The total Leydig cell volume as measured by a quantitative histometric method was significantly larger in the old animals (-x = 0.153 ml vs. -x = 0.089 ml). The testicular HCG binding capacity was 2.54 ng HCG per 100 mg tissue (range: 1.88--3.77) in the younger animals and 1.83 ng HCG per 100 mg tissue (range: 0.80--3.02) in the older ones (P less than 0.01). Plasma testosterone was on an average 242 ng/100 ml (range: 72--1162) in the young adult rats and 91 ng/100 ml (range: 23--277) in the older rats. Plasma LH was only slightly (P less than 0.05) decreased and was 49 ng LH-RP-1/ml (range: 14--120) in the younger group and 40 ng LH-RP-1 ng/ml (range: 5--98) in the older. When the testicular tissue pieces were incubated with different doses of HCG or dibutyryl cAMP and testosterone production was measured, identical dose-response curves for old and young tissue were obtained. After in vitro incubation with a NADPH generating system, which under the conditions used was a much stronger stimulus for steroid biosynthesis than HCG or dibutyryl cAMP, the tissue of young rats produced about twice the amount of testosterone precursors (pregnenolone, progesterone, 17alpha-hydroxyprogesterone and androstenedione) than old tissue.

Age dependence of testosterone precursors in plasma of normal adult males

Radioimmunoassays for the measurement of pregnenolone, 17alpha-hydroxyprogesterone, androstenedione, dehydroepiandrosterone (DHEA) and androstenediol (5-androstene-3beta, 17beta-diol) have been developed. In addition the reliability criteria of these methods have been established. Age dependence of testosterone precursors in plasma was studied in 80 normal males aged 19 to 93 years. When a young to middle aged group (19-54 years) was compared with an old age group (67-93 years) a highly significant (P less than 0.001) decrease was observed for all the precursors studied: DHEA -68.1%, pregnenolone -60.3%, androstenediol -53.8%, 17alpha-hydroxyprogesterone -47.5% and androstenedione -39.2%.