Sex steroid inhibition of LH induction of the LH receptor

Testosterone and estrogen were tested as possible mediators of the prolactin-dependent LH induction of LH receptors in hypophysectomized adult male rats. Animals were injected s.c. with saline, prolactin (100 micrograms/day), or combinations of testosterone (1 mg/day) or estrogen (1 mg/day) and prolactin for 7 days following a 7-day period of hypophysectomy. Twenty-four hours after the last saline or prolactin injection, the animals were given a single i.p. injection of either saline or oLH (10 micrograms) to evaluate LH-induced LH receptor induction. Membrane preparations from testicular homogenates were incubated with [125I]hCG as the binding ligand for determination of the receptor response and capacity. Neither testosterone nor estrogen were able to mimic the ability of prolactin to allow LH to induce the LH receptor. However, both testosterone and estrogen significantly inhibited prolactin-mediated, LH induction of its homologous receptor.     

Different testosterone and LH relationships in infertile men

In both man and animals, changes in Leydig cell structure and function accompany seminiferous tubule damage. In this study of 1745 men attending an infertility clinic, 14% of men with elevated levels of FSH also had elevated LH levels. Groups with severe seminiferous tubule failure (eg, Sertoli Cell Only syndrome or high FSH levels) showed an inverse correlation between LH and testosterone levels. In contrast, groups with milder forms of seminiferous tubule disorders (mild hypospermatogenesis, or FSH levels in the low-normal range) showed a positive correlation between LH and testosterone. It is concluded that different mechanisms must be operative to explain the opposite relationships between LH and testosterone, and that their elucidation may point to the etiology of some forms of seminiferous tubule damage in man.     

Effects of oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders

Pretherapy sperm cryopreservation in young men is currently included in good clinical practice guidelines for cancer patients. The aim of this paper is to outline the effects of different oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders, based on an 8-year experience of the Cryopreservation Centre of a large public hospital. Two hundred and sixty-one patients with testicular neoplasia and 219 patients with lymphoproliferative disorders who underwent chemotherapy and/or radiotherapy and pretherapy semen cryopreservation were evaluated. Sperm and hormonal parameters (follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, inhibin B levels) were assessed prior to and 6, 12, 18, 24 and 36 months after the end of cancer treatment. At the time of sperm collection, baseline FSH level and sperm concentration were impaired to a greater extent in patients with malignant testicular neoplasias than in patients with lymphoproliferative disorders. Toxic effects on spermatogenesis were still evident at 6 and 12 months after the end of cancer therapies, while an improvement of seminal parameters was observed after 18 months. In conclusion, an overall increase in sperm concentration was recorded about 18 months after the end of cancer treatments in the majority of patients, even if it was not possible to predict the evolution of each single case ‘a priori''. For this reason, pretherapy semen cryopreservation should be considered in all young cancer patients.     

Serum sex hormone concentrations in adolescent secondary amenorrhoea

The hormone concentrations of 17 amenorrhoeic adolescent girls, with no apparent environmental factor associated with the secondary amenorrhoea, were evaluated. 28 regularly menstruating adolescent girls served as controls. The clinical characteristics of both groups were similar, except that the amenorrhoeic girls showed clinical signs of androgenicity significantly more often than the regularly menstruating group. The concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, oestradiol, progesterone, testosterone, androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEAS), and sex hormone-binding globulin (SHBG) were determined in weekly blood specimens from the amenorrhoeic girls and during one menstrual cycle from the regularly menstruating girls. The amenorrhoeic girls had significantly higher concentrations of LH, androstenedione and free testosterone than the regularly menstruating girls. The LH/FSH ratio was significantly higher in the amenorrhoeic group than in the control group. The SHBG concentrations were significantly lower in the amenorrhoeic group than in the regularly menstruating group. Evaluation of the clinical signs of androgenicity combined with LH and androgen measurements seems important in the investigation of adolescent menstrual disorders.     

Impact of uremia on female reproductive cyclicity, ovulation, and luteinizing hormone in the rat

BACKGROUND: Impaired reproductive function accompanies chronic renal insufficiency (uremia) in both the human and experimental animal. Clinical hypogonadism occurs in both genders. The present studies were designed to investigate possible anti-ovulatory effects of uremia in the female rat, a species that produces multiple ova during the normal estrous cycle. METHODS: Renal insufficiency (uremia) was induced by 5/6 nephrectomy. Two control groups comprised sham-operated animals fed ad libitum (sham) or pair-wise with the uremic animals (pair-fed). Estrous cycles were determined by cytology of vaginal lavage. We examined concomitant changes in the preovulatory luteinizing hormone (LH) surge by radioimmunoassay (RIA), immunoradiometric assay (IRMA), and bioassay. Repetitive LH measurements were made from blood samples taken by intra-atrial catheter throughout the afternoon and evening of proestrus. The following morning (estrus), ovaries were collected, and ova were enumerated per oviduct. RESULTS: Experimentally uremic animals manifested a threefold elevation of plasma creatinine and urea nitrogen and concomitantly a more than 50% impoverishment of ova production. Analyses of a large group of animals (N = 83) by RIA revealed uremia-associated attenuation of the preovulatory LH surge. Further measurements of the preovulatory LH surge by independent IRMA and LH bioassay (N = 26) corroborated this attenuation. Additional experiments indicated that these hormonal changes, but not changes in ovulation, might further reflect modulation of LH release by the anesthesia used in the preparative nephrectomy and catheterization surgeries. When normalized to body weight, the ovaries of uremic rats were found to weigh more than those of either the sham or pair-fed animals. CONCLUSIONS: The present experiments take advantage of an experimental uremic model to document a consistent decrease in the number of ova released during estrus in the uremic animal. Possible disruption of hypothalamic-pituitary-ovarian regulation is further highlighted by attenuation in the preovulatory LH surge. These results provide a basis for further studies of neuroendocrine pathophysiology in a rodent model of uremia-associated ovulatory disruption.     

Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy?

Introduction and hypothesis

The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy.

Methods

This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model.

Results

MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p?=?0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01–1.11) for an increase of 1° in MCP laxity.

Conclusion

LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.

     

Advanced prostate cancer is associated with a decrease in serum luteinizing hormone

OBJECTIVE: Depletion of serum LH by LHRH agonists is used as a therapeutic treatment in hormone-sensitive prostate cancer (PCa). However, little information on serum LH in different patient groups is available. METHODS: Patients with biopsy-proven PCa, men with BPH (biopsy-proven absence of PCa), two subgroups (serum PSA <4 ng/ml; PCa and BPH), and a PCa cohort before and after radical prostatectomy were analyzed for serum LH, testosterone (T), dihydrotestosterone (DHT), total and free PSA by immunological procedures. RESULTS: PCa patients with cancer volumes >10 cm(3), or with advanced Gleason scores, had significantly lower LH values than men in a cancer-free control group (PSA <4 ng/ml). Eight weeks after radical prostatectomy, LH levels had returned to the level of the control group (p<0.0001). These alterations were not accompanied by corresponding changes of serum androgens. Introduction of a PSA/LH ratio appeared to increase the differences between BPH and PCA groups ranked according to Gleason scores, versus PSA or LH alone. However, the calculation of ROC curves indicated that PSA/LH ratios may not improve the discrimination of malignant and benign forms of the disease, compared to presently used parameters. CONCLUSIONS: A significant reduction of circulating LH is observed in the most advanced forms of PCa. The effect does not come about by T- or DHT-mediated feedback inhibition. Since LH values after prostatectomy returned to practically the same levels as seen in the control group (BPH with <4 ng/ml PSA), it appears that the healthy prostate has no marked influence on serum LH while advanced PCa induces a decrease in serum LH.     

男性黄褐斑皮损处微生态及血清性激素水平的研究

目的探讨男性黄褐斑发病的可能机理。方法分别用定量、定位、定性和放射免疫学方法对２６例男性黄褐斑患者皮损区微生态和２５例血清卵泡刺激素（ＦＳＨ）、孕酮（Ｐ）、雌三醇（Ｅ３）、黄体生成激素（ＬＨ）及催乳激素（ＰＲＬ）的水平进行研究,并将其结果与健康男性面部菌群、血清性激素水平加以比较。结果男性黄褐斑皮损区过路菌与健康人比较改变明显,产色素的微球菌及革兰氏阴性杆菌数量增加、分离率高,与健康人相比差异显著（Ｐ＜０．０１或Ｐ＜０．００１）,血清Ｅ３、Ｐ、ＦＳＨ、ＬＨ、ＰＲＬ差异无显著性。结论男性黄褐斑的发病可能与局部微生态改变有关,与性激素Ｅ３、Ｐ、ＦＳＨ、ＬＨ、ＰＲＬ水平无关。     

胰岛素对卵巢颗粒细胞黄体生成素/绒毛膜促性腺激素受体表达的影响

目的 :研究胰岛素 ( INS)对猪卵巢颗粒细胞黄体生成素 /绒毛膜促性腺激素( L H/ CG)受体表达的影响 ,探讨高胰岛素血症可能在多囊卵巢综合征 ( PCOS)卵泡发育停滞中的作用。方法 :采用逆转录聚合酶链反应 ( RT-PCR)及其蛋白免疫印迹 ( Westernblot)法分别对加药处理的 4组猪卵巢颗粒细胞检测 LH/ CG受体的 m RNA及其蛋白表达。结果 :RT-PCR结果表明卵泡刺激素 ( FSH) +INS组 ( 0 .2 47± 0 .0 44)与 FSH组( 0 .1 61± 0 .0 2 3 )相比 L H/ CG受体 m RNA表达明显增强 ( P<0 .0 5) ;FSH+L H+INS组( 0 .2 40± 0 .0 3 0 )与 FSH+L H组 ( 0 .1 2 1± 0 .0 1 3 )相比 ,L H/ CG受体 m RNA表达明显增强 ( P <0 .0 1 )。 Western blot结果表明 FSH +INS组 ( 570 2 .3± 81 5.9)、与 FSH组( 3 81 3 .0± 3 48.5)相比 L H/ CG受体蛋白表达明显增强 ( P<0 .0 5) ;FSH+L H+INS组( 5898.8± 93 3 .8)与 FSH+L H组 ( 2 42 1 .0± 3 41 .5)相比 L H/ CG受体蛋白表达明显增强 ( P<0 .0 1 )。结论 :INS可以协同 FSH及 L H增强卵巢颗粒细胞 L H/ CG受体的表达 ,推测高胰岛素可能通过增强 L H+CG受体表达使 PCOS患者发育至窦状卵泡阶段的卵泡颗粒细胞过早黄素化 ,导致卵泡发育停滞。     

Hormone load tests in infertile male patients.

The recognition that discreet hormonal abnormalities may cause ovulation disorders in women suggested that the male partner of infertile women might also suffer from unrecognized hormonal dysfunction amendable to substitution therapy. We obtained a combined stimulation test with gonadotropin-releasing hormone (GnRH), thyreotropin-releasing hormone (TRH), and ACTH in 225 males with childless spouses, when the couple sought to have children for at least one year. The following hormone levels were determined: estradiol (E), thyroid-stimulating hormone (TSH), prolactin, testosterone (T), dihydrotestosterone (DHT), androstenedione(A), 17-OH-pregnenolone (17-OH-Preg), 17-OH-progesterone (17-OHP), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), cortisone (F), and 21-desoxycortisone (21DF). Basal and stimulated, and adrenal-testicular steroids with and without ACTH stimulation failed to demonstrate a relevant relationship to semen parameters. Gonadotropin levels had a significant negative correlation to all important semen parameters (testicular volume, sperm count, motility, morphology, and vitality) and were positively correlated to spermiogenetic defects. Stimulated LH values were more clearly associated with spermiogenetic defects than basal LH. Nonetheless, basal FSH concentrations were more informative than LH. Stimulated prolactin values were positively correlated with both gonadotropin and with sperm morphology. E concentrations had a significant positive correlation with both basal and poststimulation DHEAS values, and showed a highly negative correlation with sperm count, morphology, and vitality. In comparison, good sperm parameters were associated with high poststimulation T concentrations. The results of this study suggest that basal FSH and E concentrations, as well as the stimulated LH, T, and prolactin determinations, should be included in the evaluation of male sterility.     

Pituitary and ovarian function in women with vesicovaginal fistuale after obstructed and prolonged labour.

This study concerns 11 patients with menstrual disorders dating back to an obstructed and prolonged labour, and 5 women with similar histories but without menstrual disorders. All patients were able to secrete gonadotrophins. According to the gonadotrophin pattern, the patients could be divided into three groups: in the amenorrhoeic and in 2 normally menstruating women various degrees of suppression of basal and peak levels of luteinising hormone (LH) could be observed; patients with infrequent menstrual periods showed temporarily arrested secretion of gonadotrophins and ovarian steroids; and in polymerrhoea a non-cyclic but high secretion was seen. The gonadotrophin response to oestrogen levels was temporarily or permanently disordered in all but 3 patients in this series, whereas an ovarian refractoriness to gonadotrophins was only infrequently observed. There were 2 cases of 'ovulatory amenorrhoea' as judged by the normal profiles of ovarian steroids. Biopsies indicated inadequate endometrial transformation in many cases of amenorrhoea. Abnormal responses to the stimulatory tests of pituitary secretion of human growth hormone (HGH) and/or LH were seen in 6 patients. The study suggests that menstrual disorders after obstructed labour are associated with derangement of different hypophyseotrophic areas of the hypothalamus.     

Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy.

BACKGROUND: Many patients with end stage renal disease (ESRD) undergoing dialysis therapy suffer from sleep disturbances. The aim of this study was to investigate the prevalence of sleep disorders in a large population of uraemic patients recruited from 20 different dialytic centres in Triveneto. METHODS: 883 patients on maintenance dialysis were enrolled in the study. Demographic, lifestyle, renal and dialysis data were recorded. Renal parameters were compared with the database of the Veneto Dialysis Register. Using a self-administered questionnaire we assessed the presence of the following sleep disorders: insomnia, restless leg syndrome (RLS), obstructive sleep apnoea syndrome (OSAS), excessive daytime sleepiness (EDS), possible narcolepsy, sleepwalking, nightmares and possible rapid eye movement behaviour disorders (RBD). Moreover, in order to determine the prevalence of sleep disturbances and the possible effect of demographic or clinical data on sleep, we divided our population into two groups: with (SLEEP+) and without (SLEEP-) sleep disorders. RESULTS: The questionnaire revealed the presence of insomnia (69.1%), RLS (18.4%), OSAS (23.6%), EDS (11.8%), possible narcolepsy (1.4%), sleepwalking (2.1%), nightmares (13.3%) and possible RBD (2.3%). Eighty percent demonstrated SLEEP+, having at least one sleep disorder. Independent risk factors for sleep disorders were advanced age (P<0.001), excessive alcohol intake (P<0.04), cigarette smoking (P<0.006), polyneuropathy (P<0.05) and dialysis shift in the morning (P<0.001). CONCLUSIONS: The questionnaire showed a high presence of sleep disruption in dialytic populations. Awareness by Italian nephrologists regarding sleep disruption seems to be insufficient. Our data might help nephrologists to deal with uraemic patients with possible sleep disorders. Concerning the high prevalence of possible narcolepsy, further studies using polysomnographic records are necessary to confirm our results.     

Long-Term, Pulsatile, Low Dose, Subcutaneous Luteinizing Hormone-Releasing Hormone Administration in Men with Idiopathic Oligozoospermia Failure of Therapeutic and Hormonal Response

In four normal men with a history of long standing infertility, severely disturbed sperm qualities (determined in at least three spermiograms), normal serum luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels (measured over a time period of 90 minutes), and lack of evidence of further andrological or other obvious endocrine disorders the effectiveness of luteinizing hormone-releasing hormone (LH-RH) treatment was investigated. LH-RH was administered subcutaneously with a portable, comterized infusion pump (Zyclomat) for 3 months, with administration intervals of 90 minutes and bolus dosages of 5 micrograms (three patients) and 20 micrograms (one patient). Semen qualities during and after LH-RH treatment, as compared to pretreatment values, showed no improvement in volume of ejaculate, number of sperms per milliliter and motility. During or at the end of the treatment period no evident differences were observed in serum LH, FSH and testosterone levels (measured over a 90 minutes period) compared with hormonal values before LH-RH therapy, nor at the low-dose (5 micrograms) neither at the high-dose (20 micrograms) administration schedule. It is concluded that pulsatile subcutaneous LH-RH treatment in normogonadotropic, oligozoospermic men does not seem to improve the therapeutical arsenal.     

Prevalence of sleep disorders among ESRD patients

Abstract

Sleep disorders are common among the patients undergoing dialysis in end stage renal disease (ESRD). Although variable, their prevalence has been reported to be higher when compared to the general population. The most frequently reported complaints are insomnia, restless leg syndrome (RLS), sleep-disordered breathing and excessive daytime sleepiness (EDS). The aim of this study was to assess the prevalence of sleep disorders in end stage renal disease patients on regular hemodialysis (group I with 30 patients) and CKD patients (group II with 30 patients) in comparison to 30 normal population (control group). In addition to laboratory investigations which included creatinine clearance using Cockroft and Gault formula, hemoglobin level (Hb), blood urea, serum creatinine, serum albumin, serum calcium and phosphorus and lipid profile, all subjects underwent one night of laboratory-based polysomnography (PSG) consisting of a standard montage of electroencephalography (EEG) (C3/A1 and O2/C3 or O1/C4), monopolar left and right electrooculography (EOG) referenced to the opposite mastoid, surface mentalis electromyography (EMG), respiratory airflow (measured by thermistor) and effort (piezoelectric sensors), electrocardiography (ECG), anterior tibialis EMG and pulse oximetry. For hemodialysis subjects, this study was performed on a night immediately following hemodialysis treatment. The results showed that patients on hemodialysis have sleep disorders, and that sleep disorders are common in group I and II than control group. The percentage of sleep disorders in hemodialysis patients were as follows: insomnia (69%), followed by obstructive sleep apnea syndrome OSAS (24%), RLS and periodic limb movement PLM (18%), nightmares (13%), EDS (12%), sleepwalking (2%), possible rapid eye movement behavior disorders RED (2%), possible narcolepsy (1.4%). While the percentage of sleep disorders in CKD patients were as follows: insomnia (54%), followed by RLS (19%), PLM (12%), OSAS (16%), nightmares (15%), EDS (15%), sleepwalking (4%), possible RBD (3%), possible narcolepsy (1%). There was inverse correlation between sleep disorders and Hb, albumin and creatinine clearance; also there was positive correlation between sleep disorder and phosphorus. We concluded that the sleep disorders are common in CKD patients either on conservative management or on regular hemodialysis. Treatment of anemia, hyperphosphatemia and hypoalbuminemia may improve sleep disorders among those patients.     

The persistent crucial role of the left hemisphere for language in left-handers with a left low grade glioma: a stimulation mapping study

Background

Left-handers have a more bilateral language representation than right-handers. Therefore, in left-handers with a low-grade glioma (LGG) in the left hemisphere (LH), one could hypothesize that the right hemisphere (RH) might allow language compensation, at least partly, with no or only a minor persistent role of the LH in speech. However, although LGG induces language reorganization in right-handed patients, little is known in left-handers. Here, we report the first series of left-handers who underwent awake surgery for a left LGG using intraoperative mapping, in order to investigate whether there was still an involvement of LH in language.

Method

Ten consecutive left-handed patients were operated for a left LGG (three frontal, four paralimbic, one parietal, one temporal, one parieto-temporal tumor) using an awake procedure with intraoperative electrical language mapping.

Results

Intraoperative language disorders were elicited in all cases but one by electrostimulation in the LH. Cortical language sites were detected in nine cases. Subcortical stimulation also demonstrated the crucial role of left white matter pathways in language, including the inferior occipital-frontal fascicle, arcuate fascicle, lateral segment of the superior longitudinal fascicle and fibers from the ventral premotor cortex. Moreover, stimulation of deep gray nuclei generated language disturbances in four patients. These nine patients experienced transient postoperative language worsening, supporting the persistent critical role of LH in speech. In only one patient, no language deficit was evoked intraoperatively and postoperatively. The ten patients returned to a normal life. Total or subtotal resection was achieved in all cases but one.

Conclusions

Our results suggest that, even though the RH may participate in language compensation, the LH in left-handers still plays a crucial role, despite a left slow-growing LGG. Thus, we propose to routinely consider awake surgery for left LGG removal in left-handers patients, to optimize the extent of resection while preserving language.     

Normal and pathologic implication of cytokines

Cytokines involved in the immune process proof, also, the neurotransmitter role, being synthesized by various cells of the body, with specific genes participation. Cytokines can act on the some membrane receptor like the neurotransmitters, and they can produce diverse biological effects. Pro-inflammatory, anti-inflammatory or haematopoetic cytokines as those in the central nervous system can be identified by immunoassay and bioassay methods. Recent works show that the cytokines implication in hypothalamo-hypophyso-corticopsuprarenal and gonad axis have consequence on ACTH, corticoids and LH secretion, explaining the ovulatory and gestational disorders. Excessive or insufficient cytokines synthesis, at neuronal level (astrocytes, microglies), explains psychiatric disorders such as schizophrenia, depression, Alzheimer's disease; cytokines (interferon) long term use for the treatment of some diseases, produce irritability, anxiety, delirium, and confusion etc.     

Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results

BACKGROUND: Liver surgery, especially for cirrhotic patients, is one of the last areas of resistance to progress in laparoscopic surgery. This study compares the postoperative results and the 2-year patient outcomes between laparoscopic and open resection for hepatocellular carcinoma in patients with histologically proven cirrhosis. METHODS: From May 2000 to October 2004, 23 consecutive cirrhotic patients who underwent laparoscopic hepatectomy (LH) for HCC were compared in a retrospective analysis with a historic group of 23 patients who underwent open hepatectomy (OH). The two groups were well matched for age, gender, American Society of Anesthesiology (ASA) class, tumor location and size, type of liver resection, and severity of cirrhosis. The selection criteria for both groups specified a small (size < 5 cm), exophytic, or subcapsular tumor located in the left or peripheral right segments of the liver (II-VI segments, Couinaud); a well-compensated cirrhosis (Child-Pugh A); and an ASA score lower than 3. In the LH group, 15 subsegmentectomies, 3 segmentectomies, and 5 left lateral sectionectomies were performed, as compared with 12 subsegmentectomies, 5 segmentectomies, and 6 left lateral sectionectomies in the OH group. RESULTS: One patient in the LH group (4.3%) underwent conversion to laparotomy for inadequate exposition. The mean operative time was statistically longer for the LH group (LH, 148 min; OH, 125 min; p = 0.016), whereas blood transfusions (LH, 0%; OH, 17.3%; p = 0.036), Pringle maneuver (LH, 0%; OH, 21.73%; p = 0.017), mean hospital stay (LH, 8.3 days; OH, 12 days; p = 0.047), and postoperative complications (LH, 13%; OH, 47.8%; p = 0.010) were significantly greater in OH group. There was no statistically significant difference in mortality and 2-year survival rates between the two groups. CONCLUSION: This study shows that LH for HCC in properly selected cirrhotic patients results in fewer early postoperative complications and a shorter hospital stay than the traditional OH. The 2-year survival rate was the same for LH and OH.     

Reversibility of androgen deprivation therapy in patients with prostate cancer

PURPOSE: We determined the duration of testosterone suppression and recovery in patients with prostate cancer treated with a hydrogel implant releasing the gonadotropin releasing hormone (GnRH) agonist histrelin or treated with a depot GnRH agonist. MATERIALS AND METHODS: Luteinizing hormone (LH) and testosterone (T) responses were monitored in 3 groups. Group 1 comprised 7 patients treated with histrelin implant, which is inserted into the arm of the patient while under local anesthesia, and suppresses LH and testosterone. Following implant removal antiandrogens (flutamide or bicalutamide) were administered. Group 2 comprised 8 patients treated with long-term depot GnRH super agonists which were later withheld and patients were given bicalutamide. Group 3 consisted of 7 patients treated with bicalutamide. RESULTS: In group 1 LH and T were in the castration range while implants were in place. LH increased 1 to 6 weeks after implant removal followed by an increase in T. In 7 of 8 patients in group 2, LH, T and prostate specific antigen remained suppressed for 9 months. In 6 of 7 group 3 patients LH and T increased with a decrease in prostate specific antigen. CONCLUSIONS: Despite continuous prolonged T suppression for up to 3 years due to histrelin implant, LH and T increased rapidly following implant removal, indicating that suppression is reversible. In view of the 9-month suppression of LH and T after the last depot GnRH injection in 7 of 8 patients, it is possible to space GnRH agonist administration at longer intervals. However, T must be monitored to determine that suppression is maintained.     

The assessment of the state of the blood lipid spectrum, hemostasis, hormonal homeostasis and hemodynamics in the early diagnosis and drug correction of the cardiovascular changes in prostatic cancer patients undergoing estrogen therapy]

A complex of investigation was performed in 30 males with newly diagnosed prostatic cancer (stages T2NOMO-T3NO-1MO) before treatment with estrogens, 2-3 months and 1 year after its start. The complex included evaluation of blood lipid spectrum (HDL, LDL, VLDL, triglycerides), hemostasis (coagulation, platelet aggregation, fibrinolysis), hormonal profile (blood hydrocortisone, aldosterone, testosterone, estradiol, STH, FSH, LH, prolactin, plasma renin activity), central and intracardiac hemodynamics, ECG. 66 healthy men of advanced age served control. It was found that estrogen therapy affected blood lipid metabolism, leading to impairment of physiological correlation between HDL and triglycerides, increased blood levels of VLDL and triglycerides. Long-term estrogen treatment brought about enhancement of hemocoagulation and platelet aggregation. Hormonal shifts involved hyperprolactinemia, hypersomatotropism, hypercorticism, aldosterone hypersecretion, proportional androgens-estrogens alterations. Hormonal abnormalities produce side effects in estrogen-treated CHD and hypertonic patients: negative ECG readings indicative of deteriorated coronary circulation and hypertensive episodes, central hemodynamic disorders, respectively. In view of possible cardiovascular damage related to estrogen therapy, a differentiated approach is proposed which would allow a long-term estrogen treatment free of relevant complications.     

Andropause: incidence and pathogenesis

One hundred forty-five male volunteers, 60 to 91 years old, without any hepatic, renal, or metabolic pathology, and not under any steroid therapy for at least 1 year were studied. Plasma luteinizing hormone (LH), Follicle Stimulating hormone (FSH), Testosterone (T), 17-beta-Estradiol (E2), Androstenedione (A), Maximal increase (MI) of LH and FSH after luteinizing hormone releasing hormone (LHRH) (50 gamma iv), and pulsations (P) of LH and FSH over a 3 hr period were measured by radioimmunoassay (RIA). The patients were divided in four groups according to LH and T levels. Group I: (46% of our subjects) showed no signs of hypogonadism with normal LH, T, E2, A, MI of LH and FSH, and normal P-LH, P-FSH. Group II: (15%) with high LH but normal T, showed high FSH, MI-LH, MI-FSH, P-LH, and P-FSH, but normal A and E2. Group III: (22%) with classical signs of hypergonadotropic hypogonadism (high LH and low T) showed high FSH, MI-LH, MI-FSH, and P-FSH, normal P-LH and E2, but low A. Group IV: (16.5%) with signs of hypogonadotropic hypogonadism (low LH and low T) had also low MI-LH, MI-FSH and A, but normal FSH, P-LH, P-FSH, and E2. Contrarily to menopause in women, andropause is not an obligatory event in men, and when it does occur, its pathogenesis and hormonal aspects are very variable.