Physiopathologic aspects of Leydig cell function in varicocele patients.

Leydig cell function was studied in 108 varicocele (V) patients with a mean age of 30.9 years, and a control group (C) of 46 men with a mean age of 30 years. Plasma gonadotropin levels were determined before and after GNRH stimulation. Testosterone (T), 17-OH-progesterone (17-OH-P), dihydrotestosterone (DHT) and estradiol (E2) were also assayed. Mean plasma T levels were significantly decreased in varicocele patients (V = 416 +/- 12.9, n = 106; C = 487 +/- 19.9, n = 40; P less than 0.01), while the basal 17-OH-P/T ratio was significantly increased (V = 0.38 +/- 0.02, n = 56; C = 0.28 +/- 0.02, n = 40; 0.02 greater than P greater than 0.01) and remained higher after hCG stimulation (P less than 0.01). No significant differences in mean sex steroid levels were observed when comparing varicocele patients with normal sperm counts (VN) and those who had oligozoospermia (VO). There was a significant negative linear correlation between age and 17-OH-P (n = 56; r = -0.47; P less than 0.01) and T values (n = 106; r = 0.27; P less than 0.01) in varicocele patients, which contrasted with the absence of any significant correlation with age in the controls. These data suggest that the duration of idiopathic varicocele influences testicular hormone secretion.

[Synthetic materials in reconstructive maxillofacial surgery]. / Materiali di sintesi nella chirurgia ricostruttiva maxillo-facciale.

Surgical or traumatic losses of substances should preferably be made good by autografts, though "alloplastic implants" are a sound alternative. An account is given of the chemical and physical properties of intrinsic and manmade synthetic polymers. The best polymers for the preparation of endoprostheses are indicated, and reference is made to their more common indications in maxillofacial reconstructive surgery.

Reconstruction of lower eyelid and periorbital district: an orbicularis oculi myocutaneous flap.

The upper eyelid has long been considered a good source of skin graft, but it is infrequently used as a unipedicled flap, based either medially or laterally, to reconstruct the skin of the lower eyelid. Here we describe a procedure in which we use the upper eyelid skin and underlying orbicularis muscle as a myocutaneous flap to reconstruct the lower eyelid and periorbital region.

Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device.

A skin graft may fail to adhere to the recipient site because of fluid collecting between the graft and the area being treated. We have devised a simple procedure, consisting of a vacuum-sealed dressing, to fix skin grafts on the lower limbs. A fully portable, battery-operated aspirator continuously draws secretions through a vacuum-sealed dressing, preventing accumulation of fluid underneath the graft. Patients are not confined to bed, thus reducing nursing time. The procedure was applied successfully in seven out of nine patients treated for ulcers of the lower limbs.

Testosterone precursors in spermatic venous blood of normal men and varicocele patients. A study of delta 4 pathway of testosterone biosynthesis.

In the present study we determined progesterone (P), 17-OH-progesterone (17-OH-P), androstenedione (delta 4), dehydroepiandrosterone (DHEA) and testosterone (T) in spermatic venous blood of 34 varicocele patients and of 13 normal subjects. We also used the DHEA/delta 4 ratio as an index of the delta 5/delta 4 pathway ratio in testosterone biosynthesis. The mean of T and delta 4 in the spermatic blood of varicocele (V) patients appeared to be significantly lower with respect to that of normal (N) subjects (T:N = 1718.2 +/- 202.4 (SEM) nmol/l, No. 11; V = 1243.7 +/- 97 (SEM) nmol/l, No. 34; P less than 0.03. delta 4: N = 56.4 +/- 5.6 (SEM) nmol/l, No. 12; V = 38.1 +/- 4 (SEM) nmol/l, No. 27, 0.02 greater than P greater than 0.01). A negative correlation was observed between the individual age of varicocele patients and 17-OH-P (No. 34, y = -30.66x + 1300, r = -0.57, P less than 0.01) delta 4 values (No. 27, y = -1.981x + 96.52, r = -0.67, P less than 0.01). When the ratio of T precursors was evaluated, we observed a positive correlation between the P/17-OH-P ratio and age of varicocele (No. 33, y = 0.0065x-0.092, r = 0.45, P less than 0.03). The 17-OH-P/delta 4 ratio was greatly increased with respect to that of normal subjects (N = 5.12 +/- 0.93 (SEM), No. 12; V = 10.77 +/- 1.31 (SEM), No. 27; P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma levels of 17-OH-progesterone and testosterone in patients with varicoceles.

In order to study Leydig cell function in patients with varicoceles, we determined plasma levels of the most important testicular steroids, 17-OH-progesterone (17-OH-P) and testosterone (T) in the basal condition and after hCG stimulation. There was a significant inverse linear correlation between age, plasma testosterone, and 17-OH-P (n = 65, r = 0.316, P = 0.01, n = 48, r = 0.532, P = 0.01). This was in contrast to the absence of such correlations in normal men in the same age range. Following hCG stimulation in 16 patients the 17-OH-P/T ratio was significantly increased with respect to normal controls. No correlation was been observed between sperm count and age in varicocele patients. Analysis of variance of 17-OH-P plasma levels between the patients with a sperm count less than 10 million/ml and that of more than 10 million/ml did not reveal any significant difference. These results suggest that the deleterious effects of varicocele on seminiferous tubules and Leydig cells are unrelated. Moreover the increased 17-OH-P/T ratio after hCG stimulation suggests that some enzymatic impairment involving the last steps of testosterone biosynthesis exists in patients with varicoceles. This is evident in middle aged varicocele patients with a premature decrease of plasma levels of testosterone.

Testosterone and dihydrotestosterone seminal plasma levels in varicocele patients.

Testosterone (T) and Dihydrotestosterone (DHT) were measured in seminal plasma levels of forty-four varicocele patients and in seventeen normal men. T values were not significantly different from controls, while DHT values were significantly lower in varicocele patients. When we grouped the patients according to the sperm count, we observed a decrease of DHT similar to that reported by other authors in oligozoospermic patients. However in the patients with normal sperm count, where the motility was the only parameter significantly lower, DHT in the ejaculate showed again a marked decrease. In contrast to that observed in the normal subjects, in the latter group, with normal sperm count, we observed a negative correlation between the age of the patients and DHT in the ejaculate. This suggests that the duration of varicocele per se could affect DHT seminal plasma levels.

The influence of age on Leydig cell function in patients with varicocele.

In a large group of patients with varicocele (n = 108, mean age: 30.9 years) Leydig cell function was investigated by determining the plasma levels of gonadotrophins under basal conditions and after GnRH stimulation, and by measuring the plasma levels of 17-OH-progesterone (17-OH-P), testosterone (T), dihydrotestosterone (DHT) and oestradiol (E2). There was a significant positive correlation between age and the peak plasma LH values after GnRH stimulation (n = 48, r = 41, P less than 0.01). Conversely, an inverse correlation was observed between age and the basal plasma levels of 17-OH-P (n = 56, r = 0.47, P less than 0.01) and T (n = 108, r = 0.27, P less than 0.01). In normals controls of the same age range (n = 46, mean age: 30 years) such correlations were absent. In patients with varicocele, the 17-OH-P/T ratio was increased significantly in peripheral plasma under basal conditions (P less than 0.01) and after hCG stimulation (P less than 0.05), and a similar increase was found in spermatic venous blood. This suggests that in varicocele patients there is some enzymatic impairment involving the last steps of T biosynthesis. In order to verify the influence of ologozoospermia on plasma steroid levels we divided the patients into 2 groups according to sperm count (more than or less than 10 X 10(6)/ml). Three analyses of variance were then carried out between these 2 groups of patients: 1) analysis of peripheral plasma T levels; 2) analysis of peripheral plasma levels of 17-OH-P and 3) spermatic vein levels of these 2 steroids. However, none of these analyses revealed any significant difference between the 2 groups of patients. When we re-grouped the patients according to age (15-30 and 30-45 years) the same analyses of variance revealed significant differences. These results therefore suggest that the duration of idiopathic varicocele per se influences Leydig cell activity.

Testosterone and dihydrotestosterone seminal plasma levels in varicocele patients.

Testosterone (T) and 5-a-Dihydrotestosterone (DHT) was measured in seminal plasma levels of forty-four varicocele patients and in seventeen normal men. T values were not significantly different from controls, while DHT values were significantly lower in varicocele patients. When grouped the patients according to the sperm count, we observed a decrease of DHT similar to that reported by other authors in oligozoospermic patients. However in the patients with normal sperm count, where the motility was the only parameter significantly lower, DHT in the ejaculate showed again a marked decrease. In contrast to that observed in the normal subjects, in the latter group, with normal sperm count, we observed a negative correlation between the age of the patients and DHT in the ejaculate. This suggests that the duration of varicocele per se could affect DHT seminal plasma levels.