[Sexual problems--possible counseling by the general physician]. / Sexuelle Probleme--Beratungs-möglichkeiten beim praktischen Arzt.

This short review discusses the sexual problems most frequently encountered in the general practitioner's office, together with their respective possible backgrounds and therapeutic approaches. The aim of the paper is to draw attention to the significance of medical sexual problems for the subjective quality of life of the patient, and to encourage the family doctor to adopt a more active approach to the sexual concerns of his patients.

[Hormone treatment of sex disorders in menopause--causal therapy or placebo?]. / Hormonbehandlung bei sexuellen Störungen in der Menopause--kausale Therapie oder Plazebo?

Clinical reports on successful hormonal treatment of climacteric or menopausal sexual dysfunctions are in contradiction with the lack of oestrous phenomena in humans as well as with the results of double-blind studies finding no objective proof for the alleged hormonal influence. A review of recent studies on the topic showed, that apart from a critical threshold, hormones exert no influence on sexual behaviour that would go beyond the alleviation of vasomotoric or genital menopausal symptoms or their consequences. However, psychosocial and relational factors play a major role in sexual dysfunctions generally and at this age of the "empty nest" and a doctor-patient relationship based on trust may well help in coping with them. Finally, a (new?) understanding of genital sexuality as a concise body-language or literally an incarnation of the relationship is advocated and may add a new dimension and quality to a couple's sex life.

[Salivary LH as an ovulation indicator: on the value of autopalpation of the cervix uteri for the detection of fertile and infertile days of the cycle]. / Speichel-LH als Ovulationsindikator: zur Wertigkeit der Autopalpation der Cervix uteri für die Erkennung der fruchtbaren und unfruchtbaren Zyklustage.

The validity of autopalpation of the cervix as an indicator of fertility has been studied in 115 cycles of 13 nulliparous and 13 parous women, aged 22 to 35 years and experienced in self-observation methods (SOM) of family planning. For this purpose, the reported cyclic changes of the cervix uteri (hard, closed and low positioned; soft, open and higher positioned or intermediate stages) have been compared with the salivary LH-peak as indicator of ovulation, the BBT-readings and cervical mucus quality. The study has confirmed that in principle it is possible to collect sufficiently reliable self observation data for family planning purposes by autopalpation of the cervix. Parous women detect the first preovulatory changes of the cervix earlier and more frequently than nulliparous. Nevertheless it is not possible for either group to determine the beginning of the fertile days in this way. The beginning of the postovulatory infertile phase, however, can be detected: if, in accordance with rising BBT, the cervix has returned to a hard and closed appearance for 4 days, this symptom signals infertility with the same high degree of accuracy as the third measurement of elevated BBT (BBT3). Thus a "rule of thumb" can be established, linking the beginning of postovulatory infertility to either the fourth day of the hard and closed cervix or to the evening of the day of BBT3, "whatever comes first". In this way, the beginning of the infertile phase could be recognized one to three days earlier by referring to the cervix in about 20% of the cycles.(ABSTRACT TRUNCATED AT 250 WORDS)

[Salivary LH as an ovulation indicator: comparison between salivary LH, serum LH and ultrasonic findings]. / Speichel-LH als Ovulationsindikator: Vergleich zwischen Speichel-LH, Serum-LH und Ultraschallbefund.

A radioimmunological method of salivary LH determination has been developed as a new non invasive approach to hormonal ovulation detection. In this study salivary LH patterns have been compared to serum LH peak and daily sonographic assessment of follicle maturation in 15 spontaneous cycles of 9 women experienced in self-observation of their cycles (NFP). The day where the mature follicle was no longer visible sonographically was labelled day 0. Serum LH peaks occurred in 11 out of 15 cycles on day -1, two times on days -2 and 0 and preceded salivary LH peaks in 8 out of 15 cycles. The latter coincided in 7 cycles with day 0 in two cycles each with days -1 and +1 and in 4 cycles with day -2. Thus 13/15 serum- and 11/15 salivary-LH peaks occurred within +/- one day of the disappearance of the mature follicle. A time lag of up to six hours between the sampling of saliva and serum might explain the difference in the respective peak days, however, more studies into the kinetics of LH transport and its circadian rhythmicity seem necessary. Nevertheless, in principle also the salivary LH peak is considered a suitable indicator of ovulation.

[Prenatal sex determination from the maternal saliva (author's transl)]. / Zur Geschlechtsbestimmung des Fetus aus dem Speichel der Mutter.

A modified Zimmermann reaction (detection of 17-keto-steroids) has been tested for its applicability to fetal sex diagnosis after 20 weeks of pregnancy. In 90 pregnant women the overall reliability of prediction was only 52%. It increased, however, to 67% by analyzing non-morning samples of saliva, while it decreased to 40% if the first saliva was collected. The sensitivity of the method was found to be unequivocally too low to measure salivary androgens. While this procedure in its present form is not suited to antenatal sex determination, further studies of the still unknown nature of the colour reaction might lead to a new understanding of the changes in salivary composition during pregnancy.

Effect of bromocryptine on 20 alpha-hydroxysteroiddehydrogenase regulation in the corpus luteum of the pregnant rat.

Pregnant Sprague Dawley rats were passively immunized with antiserum to bovine luteinizing hormone (anti-LH) on day 10 of pregnancy, and treated with 1 mg/day or 1.5 mg/day of the prolactin (Prl) inhibitor bromocryptine (BEC) between days 10 to 12 or 9 to 12, respectively. On day 12 a laparotomy was performed to assess the state of pregnancy and to remove the ovaries for histochemical detection of 20 alpha-hydroxysteroiddehydrogenase (20 alpha-OHSD) in the corpora lutea of pregnancy. In a second experiment pregnant rats were treated with 1.5 mg BEC/day from days 17 to 22, checked for foetal state and ovariectomized on day 22 before giving birth. Treatment with BEC in effective doses did not interfere with anti-LH-induced termination of pregnancy and consequent reappearance of 20 alpha-OHSD activity on day 12, or with spontaneous recurrence of enzyme activity at the end of gestation. It is concluded that Prl has no direct and immediate role in 20 alpha-OHSD regulation, at least on day 12, although substitution by endogenous rat placental lactogen at the end of pregnancy cannot be excluded.

Characterization of antisera against bovine prolactin for in vivo studies on prolactin function in the rat.

The IgG fraction of rabbit antisera to bovine prolactin (PRL), intended for in vivo studies on the role of PRL in the rat, was prepared and characterized in vitro and in vivo. The antibodies showed a strong reaction with bovine PRL in double diffusion, immunoelectrophoresis, radioimmunoassay and passive haemagglutination using bovine PRL-coated erythrocytes. In indirect immunofluorescence on paraffin sections of bovine pituitary glands the antibodies could be used for the detection of PRL-producing cells. Cross-reaction with rat PRL was observed in passive haemagglutination with rat PRL-coated erythrocytes and in indirect immunofluorescence on rat pituitary gland, but not in any of the other test systems. The ability of the antibodies to neutralize homologous, i.e. bovine, PRL was tested in lactating rats depleted of endogenous PRL by bromergocriptin treatment. The impaired lactation performance of such animals can be restored by substitution with bovine PRL. If the bovine PRL used for substitution was complexed with anti-bovine PRL-IgG, it lost its biological activity. On the other hand, injections of even high amounts of the antibodies into lactating rats failed to reveal any effect on lactation. It is concluded that either the antibodies do not cross-react with circulating rat PRL in contrast to pituitary PRL (preprolactin?) or that the cross-reacting antibody-populations(s) lack(s) the ability to neutralize the biological function of rat PRL.

Urinary androgen- and estrogen excretion in men with pachydermia laryngis and cancer of the larynx.

Considering the larynx as a hormone dependent secondary sex characteristic has previously led to successful antiandrogentherapy of pachydermia of the vocal cords, which may constitute a precancerous state. As a first step to further evaluate the endocrine state of patients with precancerous lesions or cancer of the larynx, the urinary excretion of 17-hydroxysteroids, 17-ketosteroids, testosterone and estrogens has been determined in male patients with pachydermia laryngis (n = 15) or cancer of the larynx (n = 20) as compared to controls with different other otorhino-laryngological affections (n = 20). No difference between groups was found in 17-hydroxysteroids and no significant difference in 17-ketosteroid excretion. The pachydermia group as a whole showed significantly increased levels of testosterone (p = 0.01) and estrogen (p = 0.04) of 64.6 +/- 39.9 microgram/24 hr testosterone versus 34.7 +/- 19.3 microgram/24 hr in controls and 31.7 +/- 16 microgram/24 hr in laryngeal cancer and 277 +/- 14.8 microgram/24 hr total estrogens versus 19.1 +/- 12 microgram/24 hr and 17.8 +/- 8.1 microgram/24 hr respectively. These data further support the idea of hormonal factors playing an important role in the pathogenesis of pachydermia and thus possibly cancer of the larynx. So far, however, they do not permit definite conclusions on the pathogenetic mechanisms involved.

Progesterone and 20alpha-hydroxysteroid-dehydrogenase regulation in the corpus luteum of the pregnant rat.

Female Wistar rats were mated and passively immunized against bovine luteinizing hormone (bLH) between days 7-12 of gestation. In a first series of experiments the effect of simultaneous progesterone treatment on the histochemically detectable activity of 20alpha-hydroxysteroiddehydrogenase (20alpha-OHSD) in the corpora lutea of pregnancy was evaluated. In other experiments the exact time course was established between the first histologically demonstrable signs of termination of pregnancy and the appearance of 20alpha-OHSD activity in corpora lutea of pregnancy. It was found that progesterone substitution not only prevented the deleterious effects of the anti-bLH-serum on gestation but also the re-appearance of 20alpha-OHSD activity in the corpora lutea of pregnancy up to day 12 of pregnancy. Moreover in animals injected with anti-bLH-serum from day 7 on and sacrificed on days 8-12, signs of foetal destruction clearly preceded the pathological re-appearance of 20alpha-OHSD activity by 2-3 days. These results support previous findings on a direct or indirct role of progesterone in the complex regulation of 20alpha-OHSD activity. Possible mechanisms of action are discussed.

First clinical experiences with hormone-therapy of pachydermia laryngis.

First clinical experiences with the anti-androgenic drug cyproterone-acetate in treatment of pachydermia laryngis are reported in eleven male and female patients. This endocrine therapy led to complete healing in four and to marked improvement in six patients. One did not respond. Evaluation of the endocrine state of these patients showed imbalance in the androgen/estrogen equilibrium. As the larynx constitutes a secondary sex characteristic and an endocrine target organ, the significance of endocrine factors for pathogenesis and therapy of epithelial changes on the vocal cords is discussed.

Immunological dissection of rat pregnancy: study of the mode of action of antisera to luteinizing hormone.

The sensitivity of rat pregnancy to luteinizing hormone (LH) depletion on days 7--12 (day 1 = day of insemination) was investigated by intraperitoneal administration of a single injection of various doses of an anti-bovine LH rabbit serum on the day in question. Day 11 was found to be the most susceptible time for this kind of intervention. The fate of the anti-LH antibodies in the recipients was followed in the serum and in various organs of the treated animals. Serological analysis revealed persistence of free antibodies to LH in the serum as late as 48 hr after injection. Immunofluorescence studies showed immune complex deposition in the kidney glomerula.

Anti-androgen-therapy in pachydermia of the female larynx--a new therapeutic possibility.

Case-report about a 56 year old white female patient with pachydermia laryngis and hirsutism, successfully treated with cyproterone-acetate, a testosterone antagonist. The significance of androgenic hormones for the development of epithelial changes in the female larynx is emphasized. The administration of antiandrogenic substances as a new therapeutic measure is discussed.

[Adrenal-like Leydig cells (author's transl)]. / Uber nebennierenrindenartige Leydigsche Zwischenzellen

Adrenal-like lipoid-rich Leydig cells, which could be found in a cryptorchid testis, were investigated by light and electronmicroscopy. There were nodular and diffuse proliferation of these adrenal-like cells in the interstitium of the testis. Electronmicroscopically these cells are fasciculated and characterized by large liposomes, many tubulovesicular mitochondria, and a large smooth endoplasmatic reticulum. But the presence of crystals of Reinke in these cells underlined their relationship to Leydig cells. The clinical history of this case is characterised by an extreme adipositas (167 kg) and high urinary estrogenexcretion. This excretion could be suppressed with dexamethasone and stimulated with HCG. After orchiectomy estrogen excretion decreased for 4 months and then increased again, after ACTH stimulation performed by reason of adrenal insufficiency. At this time there is no evidence of adrenal tumor; in the contralateral, scrotal testis, spermiogenesis and Leydig cells are without pathologic changes as revealed by biopsy.

[Determination of plasma progesterone using thin layer chromatography during pregnancy and normal menstrual cycle]. / Dünnschichtchromatographische Bestimmung von Progesteron im Plasma während der Schwangerschaft und im normalen Zyklus

Plasma progesterone levels were measured during pregnancy and the normal human menstrual cycle by thin-layer densitometry of a specific fluorescence reaction for delta4-3-ketosteroids. 94 determinations were carried out from the 7th week of pregnancy until term. 84 plasma progesterone concentrations were estimated between day 16 and day 26 and other 10 during the preovulatory phase of the normal menstrual cycle.