17-a-OH-Progesterone to Testosterone Plasma Ratios and their Modification after HCG in Normal Men and in Patients with Idiopathic Infertility/17-a-OH-Progesteron: Testosteron-Plasma-Relation und ihre Modifikation nach HCG bei normalen Männern und bei Patienten mit idiopathischer Infertilität

Summary: We have investigated on eventual relationships existing in men between plasma levels of 17-a-OH-Progesterone (17-a-OH-P) and, plasma levels of Testosterone (T) and on the modifications of these relationships after stimulation of the testicles by HCG (Human Chorionic Gonadotropin). An inverse correlation exists between basal plasma levels of the two steroids and their Δ max (%max increase 96 h after the injection of 5000 I.U. of hCG): r = -06, p 0.01. This suggests that the enzymatic steps of the Δ -4 steroidogenic pathway are rate-limiting for the synthesis of T. The Δ max of the two-steroids are also inversely correlated with the circulating levels of LH (Luteinizing Hormone) (r = -05, -06; p < 0.01) suggesting that the rate-limiting activity of the Δ 4 pathway is under endogenous LH control. A desensitized state of this pathway can be expected in presence of high circulating levels of LH. Similarly to LH also the FSH plasma levels, an index of function of the seminiferous tubules, are inversely correlated with the 17-a-OH-P and T Δ max (r = -0.4, -05; p 0.005) indicating close relationships between tubular and interstitial functions. In men with idiopathic oligozoospermia and high circulating levels of FSH we have found increased 17-a-OH-P/T ratios after hCG. Zusammenfassung: Es wurde eine Untersuchung durchgeführt hinsichtlich möglicher Beziehungen zwischen den Plasmawerten von 17-a-OH-Progesteron, den Plasmawerten für Testosteron und den Modifikationen dieser Beziehungen nach Stimulation der Hoden mit hCG. Danach besteht eine inverse Korrelation zwischen den basalen Plasmawerten der beiden Steroide und ihrem Δ max (% max. Anstieg 96Std. nach Injektion von 5000 I.U. hCG): r = -06, p0,01. Das weist daraufhin, daß die enzymatischen Schritte des Δ-4-Abbaues der Steroidogenese begrenzt sind für die Synthese von Testosteron. Das max der beiden Steroide ist ebenso invers korreliert mit den circulierenden Werten von LH (r = -05, -06; p <0,01) und weist darauf hin, daß die Ratenbegrenzte Aktivität des 4-Abbaues unter endogener LH-Kontrolle erfolgt. Ein unempfindlich gemachter Zustand dieses Abbaues kann in Anwesenheit von hohen circulierenden LH-Werten erwartet werden. Ähnlich zu LH sind ebenfalls die FSH-Plasmawerte als ein Index für die Funktion der Tubuli seminiferi invers korreliert mit Progesteron und Testosteron Δ max (r = -0,4, -05; p 0,005), das bedeutet geschlossene Beziehungen zwischen den tubulären und interstitiellen Funktionen. Bei Männern mit idiopathischer Oligozoospermie und hohen circulierenden Werten für FSH wurde eine erhöhte 17-a-OH-Progesteron/Testosteron-Rate nach hCG gefunden.     

Simultaneous measurement of gallbladder emptying with cholescintigraphy and US during infusion of physiologic doses of cholecystokinin: a comparison

Both ultrasonography (US) and cholescintigraphy are used to study gallbladder dynamics. The present study was undertaken to determine whether the two methods provide the same or different information relating to gallbladder emptying. Emptying was simultaneously studied with both methods during infusion of graded physiologic doses of cholecystokinin (CCK) in six healthy subjects. Infusion of stepwise increasing doses of CCK, ranging from 0.03 to 0.5 Ivy dog units per kilogram of body weight per hour (IDU/kg.h), induced significant dose-related increases in plasma CCK, decreases in gallbladder volume assessed with US, and gallbladder emptying assessed with cholescintigraphy. The threshold dose for inducing significant gallbladder emptying was 0.13 IDU/kg.h, as determined with both techniques, indicating similar detection limits. There was a highly significant correlation between decreases in gallbladder volume and decreases in radioactive counts over the gallbladder region, with a tendency toward greater gallbladder responses at sonography during the early phase of gallbladder contraction and toward greater responses at cholescintigraphy during the later phase of gallbladder contraction. It is concluded that these methods can be used interchangeably for the quantitation of gallbladder emptying.     

Direct demonstration of transsynaptic degeneration in the human visual system: a comparison of retrograde and anterograde changes

Transneuronal degeneration of retinal ganglion cells was directly demonstrated in a patient who had unilateral removal of the striate cortex forty years prior to necropsy. For comparison, another case is presented showing anterograde transneuronal atrophy forty years after enucleation of one eye.     

Remote psychotherapy for terminally ill cancer patients

We conducted a feasibility study of remote psychotherapy in 10 terminally ill cancer patients with diagnoses of adjustment disorder or major depression. Subjects received six sessions of individual cognitive therapy with the same therapist. Sessions alternated between face-to-face sessions and remote sessions delivered by analogue videophone. After each therapy session, a brief questionnaire was used to evaluate the subjects' level of satisfaction with the session, sense of connectedness to the therapist and overall progress being made in the therapy. Nine patients completed the study. Of 53 completed therapy sessions, 21 were by videophone and 32 were conducted face to face. Participants reported strong positive perceptions and acceptance after almost all therapy sessions, regardless of service delivery mode. The study suggests that there may be a role for the delivery of psychotherapy using low-bandwidth videophones.     

Bilateral extensive cerebral infarction and mesenteric ischemia associated with segmental arterial mediolysis in two young women

Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic non-inflammatory vascular disease that affects mainly muscular arteries of the splanchnic and cerebral territories. Reported herein are two cases of SAM in young women with fatal outcome. One of the patients had an atypical form of the disease, which primarily affected small intestinal submucosal and subserosal arteries, and resulted in acute mesenteric ischemia. The other had bilateral brain infarction with SAM of internal carotid arteries (ICA). Pathological examination of both cases did not reveal the cause of blood flow disturbance: large mesenteric branches of the former and ICA of the latter were free of either dissection or thrombosis; in addition, small intestinal arteries of the first patient did not show signs of vasculitis. These findings suggest that unusual pathways of arterial occlusion and dissection may occur in the context of SAM.