Pre- and postdexamethasone cortisol and prolactin levels in sexual dysfunction and normal controls.
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Biomedical subjects
Publications and source records attributed to E Jecht.
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Numerous investigations have reported an alteration of hormonal response to dexamethasone in depressive disorder. No such data are available in psychogenic sexual dysfunction. Pre- and postdexamethasone levels of testosterone, estradiol, LH and FSH were studied in 20 male patients with sexual dysfunction and 20 male healthy controls. Dexamethasone had no influence on testosterone, estradiol, LH and FSH in normal controls. The patients showed an increase in testosterone and LH but not in FSH levels in the morning after dexamethasone administration. When compared with basal levels, the increase in postdexamethasone levels in sexual dysfunction was significant for testosterone (delta T) but not for LH (delta LH). The altered gonadal steroid and gonadotropin response to dexamethasone in sexual dysfunction might be due to disturbances of dexamethasone metabolism and glucocorticoid receptor density comparable to similar findings in depressive disorder.
We report the results of an open multicenter clinical trial with 115 patients. The results of a pharmacological test using intracavernously applied mixture of papaverine and phentolamine were compared with the results of a multidisciplinary evaluation of erectile dysfunction. Sensitivity and specificity of our test were determined. The injection of our drug solution caused an increase in tumescence and/or rigidity in all patients. The evaluation of the dose dependent erectile response makes it possible to distinguish between the three main pathogenetic principles: non-vascular, arterial and venous etiology of erectile dysfunction. The pharmacological test requires one to four intracavernous injections of 0.5-3.0 ml of the drug solution (7.5-45 mg papaverine hydrochloride, 0.25-1.5 mg phentolamine mesylate).
Pre- and post-dexamethasone prolactin and cortisol levels of 40 endogenous and non-endogenous depressive patients and of 20 controls were studied. Dexamethasone had a suppressive effect on prolactin levels, which was expressed more in normal controls and in non-endogenous depressive patients than in endogenous depression. A "prolactin suppression test" by dexamethasone was constructed and provided comparable results to the usual DST. However, it failed to be a specific marker for endogenous depression. There are close relationships between various endocrine axes, which might be altered in depression.
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The distal reflux as we call it raises several anatomical, operative technical and andrological questions. Based on our experiences with four patients with reduced seminal quality, we wish to make some contributions to this subject which has been only occasionally addressed in the past. In these patients, venous reflux could be demonstrated over the left funiculus spermaticus by means of Doppler sonography. The retrograde phlebography, carried out to sclerose transvenously the supposedly insufficient internal spermatic vein revealed, however, sufficient venous cuspids without reflux. The inguino-scrotal exploration of the funiculus, indicated to clarify further the distal venous testicular supply, showed the external spermatic and/or the deferential veins with their collaterals congested and dilated. All these vessels were ligated and divided. The demonstration and the topically correct treatment of the distal venous reflux seems to diminish, at least partially, the failure rate of the suprainguinal operation according to Bernardi. The correlation between the results of Doppler sonography, phlebography and the selection of the incision has not been clearly established yet. The different venous supplies of the testis are initially described.
Nine volunteers were treated with metoclopramide (10 mg T.D.S.) for 4 weeks. Prolactin levels rose both in serum and in seminal plasma 1 week following the initiation of metoclopramide administration. At this point in time, sperm density and total sperm count increased about twofold. Thereafter, levels of prolactin slowly decreased while sperm density and total sperm count fell back to initial values.
The results of selective phlebography of the spermatic vein are reported in 580 infertile men with abnormal sperm morphology and suspected varicoceles. Percutaneous transvenous retrograde sclerotherapy of the internal spermatic vein was performed in 260 of the patients. Follow-up phlebography in 109 patients 3 to 6 months after treatment revealed a persistent varicocele in only 3% of them.
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Percutaneous occlusion therapy of insufficient internal spermatic veins was performed successfully as an outpatient procedure in 155 patients with varicoceles. The administration of the sclerosing agent (Varicocid) through a catheter selectively introduced into the spermatic vein caused therapeutic occlusion. Follow-up studies, both clinical and phlebographic, confirmed the effectiveness of the treatment.
Sclerosis of the spermatic vein for male infertility and varicoceles was carried out in 84 patients by a percutaneous method. If the catheter is correctly placed in the spermatic vein, sclerosis is possible in almost all cases, as was shown by controlled examinations after periods of more than three months. Together with the radiologic changes, there was also an improvement in the spermatologic parameters. 58% of the patients examined after three months were regarded as fertile.
A cellular immunodeficiency was revealed in a 39-year-old female patient suffering from Werner's syndrome. Relevant findings were negative intracutaneous tests to candidin, trichophytin, tuberculin and bacterial antigens, reduced lymphocyte response to PHA, and impaired intracellular killing of Candida albicans by granulocytes. The inclination of patients suffering from Werner's syndrome to develop neoplasms may be related to this immunodeficiency.
Eight patients suffering from chronic epididymitis, prostatis and urethritis were treated with levamisole. A definite and lasting improvement was seen six of the eight patients.
The results of selective phlebography of the spermatic vein in patients with primary sterility and suspected varicoceles are reported. In 60% of those examined there was left-sided, and in 8.8% right-sided, spermatic vein insufficiency or a varicocoele. The value of spermatic vein phlebography is borne out by the large number of anomalies of the venous system (67%) and by the finding of 82 left-sided varicoceles.
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20 male patients suffering from end-stage chronic renal failure and maintained on hemodialysis were investigated for pituitary response to GnRH. The GnRH-Test was performed simultaneously with hemodialysis; however, hemodialysis was started 60 min. after the injection of GnRH. Basal values of LH and FSH were significantly higher (P less than 0.0001 and 0.005, respectively) than the normal range, while basal values of testosterone were in the subnormal range or depressed (P less than 0.0001). Poststimulatory values of LH were significantly lower (P less than 0.01) than normal and--other than normal--did not decline within 180 min. following injection of GnRH (P less than 0.001). The same pattern was seen for FSH, however, no statistical significance could be secured. Testosteron was elevated 30 min. after stimulation with GnRH (P less than 0.001).