[Sperm intolerance as a possible cause for infertility?].
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Biomedical subjects
Publications and source records attributed to H J Vogt.
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We report on a 56-year-old renal allograft recipient receiving cyclosporin A immunosuppression. During this therapy he subsequently developed the following cutaneous neoplasms: squamous cell carcinomas, basal cell carcinomas, Bowen's disease, actinic keratosis, sebaceous hyperplasia, a dysplastic naevus and, finally a nodular malignant melanoma. Adverse effects of the cyclosporin A therapy are discussed, with special reference to dermatologic effects and the implications for patient and doctor.
HISTORY: Within 6 months a 88-year-old woman developed cutaneous metastases with infiltration of the eye-lid so that an opening of the eye-lids became impossible. The primary tumor histologically resembled a mamma carcinoma. THERAPY: Within a few days the cutaneous metastases of the eye-lids decreased by using x-ray therapy with the Dermopan II with a single dosage of 5 Gy and a total dosage of 35 Gy on the eye-lids. Even 12 months after palliative therapy the opening of the eye-lids was possible without any problems. CONCLUSIONS: By using the x-ray therapy immediate and gentle help could be given to the terminally ill patients so that eye-lid surgery could be avoided.
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In idiopathic hypogonadotropic hypogonadism of men it is possible to normalize the endocrine and exocrine testicular function by pulsatile therapy with a GnRH pump. The long duration of the therapy can cause difficulties with compliance in young patients.
To ascertain whether skin pigmentation type and sensitivity to ultraviolet (UV) light are associated with susceptibility to type I (insulin-dependent) diabetes, 55 type I diabetic patients were examined, 38 new-onset and 17 long-term cases. They were compared to 72 control subjects of the same geographic region and nationality. To evaluate the individual skin pigmentation type, a standardized questionnaire was developed. Reactivity to UV light was determined by a stepwise-graded UV irradiation. Significantly more diabetic patients in southern Germany had blue eyes than nondiabetic control subjects (55 vs. 26%, P less than 0.01), and significantly more diabetic patients had a low-pigment eye color (blue or green) than control subjects (66 vs. 38%, P less than 0.01). In addition, more fair skin color was noted among diabetic versus control subjects (84 vs. 60%, P less than 0.01). In response to UV irradiation, diabetic patients more often showed an increased UV-light sensitivity than control subjects (83 vs. 23%, P less than 0.001). The relative risk for susceptibility to type I diabetes in subjects with low-pigment eye color was 3.1, in subjects with fair skin type 3.4, and in subjects with increased UV-light sensitivity 5.8. The highest risk for the development of diabetes was seen in subjects who had low-pigment eye color and/or increased UV-light sensitivity (95 vs. 51%, P = 0.00002, odds ratio 17.4). We conclude that a low-pigment skin type may predispose for the development of type I diabetes.
Anorexia and bulimia nervosa are common in western civilized countries. They are frequently associated with disorders of the skin. Up to now, no dermatological studies of large numbers of patients with eating disorders have been published. We examined 145 patients with eating disorders (65 anorexia nervosa, 80 bulimia nervosa) regarding skin alterations. Simultaneously we controlled the moisture content and the superficial lipids of the skin. Several symptoms relevant to dermatology were found. In detail we report on: xerosis, hair changes, nail disorders, pathognomonic hand lesions, sialadenosis, lesions of the oral mucosa and the teeth, peripheral oedema, acrocyanosis, petechiae and artefacts.
The diagnosis of gonococci in vitro is reliable and simple nowadays. Investigations are still based on direct microscopic control and on culturing. With the help of coagglutination by monoclonal antibodies and enzymatically controlled color reactions, we are able to take Neisseria gonorrhoeae apart from other gram-negative and oxidase-positive diplococci. In the therapy of common gonorrhea, we now use antibiotics more recently developed than penicillin. The complicated extragenital and disseminated forms of the disease require special modes of treatment usually provided in hospital.
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In a multicenter, open, randomized, prospective, comparative study, 28 patients with primary (n = 9) or secondary (n = 19) syphilis were treated with either ceftriaxone or penicillin G. 14 patients received ceftriaxone 4 x 1 g i.m. every 2 days. 14 other patients were treated with penicillin G 1 million IU i.m. daily for 15 days (standard therapy of primary and secondary syphilis). To avoid Herxheimer reaction we applied prednisolone 50-100 mg i.m. before specific treatment. Diagnosis was confirmed by clinical symptoms, dark-field microscopy and serological tests (VDRL titer, TPHA test and 19s-IgM-FTA-abs test or SPHA test). Follow-up examinations during therapy were repeated on days 2, 4, 6 (dark-field microscopy, physical examination) and day 14 (VDRL titer). To evaluate therapeutic efficacy, serological controls were repeated 1, 2, 3, 6 and 12 months after therapy (VDRL, SPHA). In all patients, a marked decline (minimum 2-dilution decrease) in VDRL titer and resolution of clinical symptoms were noted. An adverse reaction was seen in 1 patient of the clemizol-penicillin G group (allergic penicillin exanthema). There were no adverse reactions to ceftriaxone. Summing up, there was no detectable difference in clinical and serological response to syphilis treatment either with ceftriaxone or penicillin G. Ceftriaxone, thus can be regarded as an equivalent alternative to penicillin G in the treatment of primary and secondary syphilis.
The synthetic retinoids, the vitamin-D-derivatives etretinate and isotretinoin, have substantially enlarged the therapeutic arsenal in dermatology. They are primarily used in severe cases of acne and cornification disorders. In the majority of cases, long-term treatment is necessary. Certain side effects in the skeletal system can occur, e.g., osteoporosis, premature epiphyseal closure, and changes similar to DISH (diffuse idiopathic skeletal hyperostosis). We discuss the reports in the literature and our own observations in 31 patients treated at the Westphalian Wilhelms University in Muenster, as well as at the Technical University in Munich. In 3 out of 31 patients treated by retinoids on a long-term basis, skeletal changes were found radiologically as a result of the retinoid medication.
A follow up investigation was done on forty-seven patients of the German multicenter study with severe and long standing rosacea who had been treated with isotretinoin (0.5 mg/kg bw/day) over twelve or twenty weeks. During the post-treatment follow up which lasted an average of fifty-seven weeks, seven relapses were registered whereas forty patients remained in remission. After drug withdrawal, both the percentage of patients without inflammatory lesions (pustules, papules or nodules) as well as the mean values of inflammatory lesions remained almost constant over the whole observation period.
The hemodynamic profile of the pre- and postsynaptic alpha-receptor blocker phenoxybenzamine (POB) was investigated by a non-invasive technique in healthy subjects and in patients with essential hypertension. At a dose of 0.03 mg POB/kg body weight no hemodynamic changes were detected. POB at a dose of 0.07 mg/kg resulted in an initial transient rise in systemic vascular resistance and mean arterial pressure and a fall in heart rate without changes in stroke volume or cardiac index. 6 h after administration of 0.13 mg POB/kg a transient fall in peripheral vascular resistance and mean arterial pressure with an increase in heart rate and cardiac index was observed. A rise of orthostatic index, however, occurred within 1 h after administration of POB and reached its maximum after 4 h. 8 h after POB no hemodynamic changes were detectable. In patients with essential hypertension a similar fall in systemic vascular resistance and mean arterial pressure was observed after 0.13 mg POB/kg body weight. No change in heart rate occurred and the hemodynamic effects were significant already 3 h after administration of POB and persisted up to 8 h after POB administration. In contrast to healthy subjects, patients with essential hypertension showed no significant changes in the orthostatic index after POB. These hemodynamic findings point to a previously unexpected rapidly reversible functional alpha-receptor blockade by POB.
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The possible effects of cigarette smoking on sperm quality were investigated in a blind study of 333 healthy male volunteers 19 to 40 years of age. All subjects with clinically proven abnormalities, operations, or inflammatory diseases of the genital organs, exposure to radiation exceeding routine x-ray examination, or medication were excluded, and the data from 150 smokers, 37 ex-smokers, and 52 never-smokers were evaluated. There was a small but insignificant decrease in sperm density from never-smokers to ex-smokers and to smokers. Eight smokers (6%) had sperm counts less than 1 X 10(6)/ml, whereas none of the ex-smokers or never-smokers fell into this category. This difference, however, is not statistically significant (P = 0.084). No statistically significant effect of smoking habits on sperm density, motility, and morphologic features was detected. It is concluded that smoking does not affect the motility and morphologic features of sperm in healthy adult men. The diminished sperm density in heavy smokers may be related to factors associated with smoking.
The contradictory findings concerning the influence of smoking on spermatogenesis that have so far been presented in literature were derived from fertility patients in retrospective studies; our data, in contrast, are based on a blind study of 333 voluntary test persons. The data of 95 smokers and 83 non-smokers remained to be evaluated after application of the following exclusive criteria: comparatively high consumption of alcohol, taking of drugs, taking of medicine, radioactive exposure, and genital diseases. Significant differences between the two groups were only found with regard to behavior; smokers revealed a higher rate of divorces, they drank alcohol and took drugs more frequently, and had had the first sexual intercourse at an earlier age than non-smokers. On the other hand, all spermatological parameters as well as the outcome of cytophotometric examination of the spermatozoon DNA showed a close correlation between smokers and non-smokers. Although an individual (toxic?) reaction to tobacco smoking cannot be ruled out, our findings lead to the conclusion that cigarette smoking has no detrimental influence on the spermatogenesis of healthy men between the age of 20 and 40.
Twenty male volunteers with severe acne conglobata were treated orally over a period of 12 weeks with 1 mg isotretinoin (13-cis-retinoic acid) per kilogram body weight. Before and after therapy, as well as 12 weeks after the end of therapy, the semen was examined spermatologically and the spermatozoa DNS determined by impulse cytophotometry. The sperm density remained unchanged in the otherwise healthy patients, whereas patients with previous gonadal defects (unilateral cryptorchism, hypogonadism, varicocele) the sperm count rose significantly (P less than 0.05) at the end of therapy; 3 months later a reverse trend in the sperm density was noted. The percentage of morphologically normal spermatozoa was slightly reduced at the end of therapy; 12 weeks after completion of therapy it was significantly reduced (P less than 0.05). This could, however, be due to the short elimination half-life of 13-cis retinoic acid and have nothing to do with the drug. On impulse cytophotometry the spermatozoa DNS showed no significant changes. According to the results of the cytophotometric examination, contraceptive measures for men during treatment with 13-cis-retinoic-acid need not be made obligatory.