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.

[Study of seminal fluid. Critical evaluation of various laboratory parameters]. / L'esame del liquido seminale. Valutazione critica dei vari parametri di laboratorio.

The various humoral and morphological parameters on which examination of seminal fluid is based are considered. Two groups of causes that may modify normal fertility are pointed out: one concerns functional changes of the gonad and/or of the accessory glands, the other the ejaculatory phase and specifically the modalities for collecting the ejaculte. In this regard, stress is laid on how the first fraction of split ejaculate not only possesses biochemical characteristics different to those of the second fraction, but also presents a much higher sperm concentration and, hence, greater fertilizing capacity. It is therefore clear that separate examination of the two fractions may point to states of "latent" subfertility which global examination cannot spot.

[Thyroid pathology: evaluation of the average value of NORs and its potential diagnostic and prognostic application]. / Patologia tiroidea: valutazione del valore medio dei NORs e sua possibile applicazione diagnostica e prognostica.

Argyrophilie technique to identify nucleolar organizer regions (NORs) applied in formalin-fixed paraffin sections of thyroid tissue allow us to reveal NORs as block dots in the nuclei of cells. In the present study the relationship between number of NORs and cellular activation emphasize significant statistical data: it was found that the number of AgNORs in malignant thyroid lesions significantly exceeded those of benign thyroid lesions. This objective assessment associated with easily method show an advantage in thyroid diagnostic histopathology an adjunct to routine methods.

Fructose, prostatic acid phosphatase and zinc levels in the seminal plasma of varicoceles.

The function of sex accessory glands in 95 varicocele patients was investigated by determining the fructose, prostatic acid phosphatase (PAP), and zinc levels in the seminal plasma. These biochemical substances are, in fact, markers of the seminal vesicles and prostate, respectively. It was observed that both the PAP and zinc levels were significantly lower (P less than .002) in varicoceles than in the control group, while both fructose and PAP levels were particularly low in a small subgroup of the older patients. The authors suggest that the impaired sex accessory gland functions could arise from decreased venous drainage in the vesico-prostatic plexus. The fructose/zinc ratio appears to be negatively related to sperm motility (r = .31, P = .01); this suggests that in varicocele the impaired sex accessory gland secretions could themselves influence the motility of ejaculated spermatozoa.

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)

Progesterone, 17-OH-progesterone, androstenedione and testosterone plasma levels in spermatic venous blood of normal men and varicocele patients.

Progesterone (P), 17-OH-progesterone (17-OH-P), Androstenedione (delta 4) and testosterone (T) plasma levels were measured in spermatic venous blood of twenty-nine varicocele patients (V) and in twelve normal subjects (N). Our data reveal a significant decrease of the mean testosterone in the spermatic blood of varicocele patients with respect to normal controls: (N = 1708.7 +/- 223.8 (SEM) nmol/l, n = 10. V = 1190.9 +/- 101.1 (SEM) nmol/l, n = 29. P less than 0.03). An inverse correlation has been observed between the age of varicocele patients and 17-OH-P (n = 29. y = -33.38x + 1384.70, r = -0.59, P less than 0.01) and delta 4 values (n = 23, y = -1.62x + 85.65, r = -0.49, P less than 0.05). The 17-OH-P/delta 4 ratio appears significantly augmented in varicocele patients with respect to normal controls (n = 4.80 +/- 0.86 (SEM), n = 12. V = 9.65 +/- 1.21 (SEM), n = 23.0.02 greater than P greater than 0.01). This indicates a deficiency in varicocele patients of 17-20 lyase activity. The positive correlation between the P/17-OH-P ratio and age of varicocele patients (n = 28, y = 0.007 x -0.090, r = 0.45, P less than 0.03) suggests a progressive impairment of 17-alpha-hydroxylase in such patients as they grow relatively older. These data demonstrated that the reduced spermatic levels of testosterone in varicoceles are due to the enzymatic impairment of testosterone biosynthesis, concerning firstly 17-20 lyase activity and secondly 17-alpha-hydroxylase activity. The latter enzymatic impairment is age related as is seen from the significant increase of the P/17-OH-P ratio in older patients.

Ovarian varicocele: ultrasonic and phlebographic evaluation.

The aim of this work is to suggest a new diagnostic approach to the "female varicocele syndrome" which utilizes transvaginal ultrasonography. The presence of circular or linear anechogenic structures with a diameter greater than 5 mm, which were found in transverse and oblique sections of the lateral fornices, was indicative of pelvic varices. The vascular nature of these structures was confirmed with the Valsalva's maneuver and in the upright position. The presence of "pelvic varices" was confirmed by retrograde phlebography of the left ovarian vein in 46% of the cases. In such cases the parity was greater than in subjects without "pelvic varices" (chi square = 12.75, p less than 0.001), and the principal symptoms were characterized by pelvic pains and menstrual cycle disorders.

Radiologic anatomy of the genital venous system in female patients with varicocele.

The diagnosis of varicocele in a female patient is difficult clinically. Until recently, only celioscopy and uterine phlebography were helpful. We have developed a new method for diagnosis of the pelvic varicocele using retrograde phlebography of the ovarian and iliac veins. Thirty-three women with pelvic pains and disorders of the menstrual cycle have been studied. In 15 patients, an insufficiency of the left ovarian vein was revealed. In three of the patients, an analogous insufficiency of the right ovarian vein was also recognized, along with chronic bilateral stasis in the pampiniform plexes. An insufficiency of the left iliac vein was present in seven of the patients without ovarian varicocele. The average age of the women without ovarian reflux was lower (22.5 years) than that of women with reflux (36.6 years) (p less than 0.01). In this last group of patients, the number of pregnancies was greater (30 children) than in the group without reflux (two children) (chi-square = 12.75; p less than 0.001). This indicates how parity plays an important role in the determination of the appearance of a varicocele. We conclude that the diagnosis of pelvic varicocele may be made by a new diagnostic method represented by retrograde phlebography of the ovarian and iliac veins. The use of it in patients with chronic pelvic pains and disorders of the menstrual cycle of unknown nature can be done routinely.

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.

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.

Effects of castration on androstenedione, testosterone and dihydrotestosterone plasma levels in adult male rats.

In the present study we investigated the effects of castration on androstenedione (A), testosterone (T) and dihydrotestosterone (DHT) plasma levels in adult male rats 5 and 47 days after castration. In another group of 60-day-old castrated rats, the three steroids have been evaluated during testosterone propionate administration. Our data show that 5 days after orchiectomy all three steroids were significantly decreased (p less than 0.001) with respect to control values. 47 days after orchiectomy, T and DHT were also significantly decreased with respect to the control group. In both groups of orchiectomized rats the A/T ratio increased significantly with respect to controls. On the contrary, the T/DHT ratio sharply decreased. This suggests that DHT, in orchiectomized rats, could derive from precursors other than T. A negative correlation between A and the T/DHT ratio was observed 47 days after castration in adult animals and emphasized upon testosterone propionate administration. In the latter group, T was significantly lower while A is significantly augmented with respect to control values. Finally, the above-mentioned negative correlation indicates a possible prevalent role of A in contributing to the circulating levels of DHT in adult orchiectomized rats.