In 50 consecutive percutaneous transhepatic cholangiographies (PTC) the biliary system was visualized in 45 cases (90%). The success rate was 97% in dilated and 69,2% in non dilated ducts. Complications occurred in 9 patients (18%), major complications in 2 of them (4%): 1 perforation of the gallbladder and 1 bile leak. In 5 patients with malignant stenoses external bile duct drainages were performed. The PTC is an ideal complement of the ERC in the diagnosis of cholestasis. But the risk is high. Therefore it has to be warned against an uncritical use without sufficient experience.

Bile Duct Neoplasms↗

PubMed1980

[Reciprocal changes of triiodothyronine and reverse triiodothyronine in the early stage of myocardial infarction (author's transl)].

The changes of thyroid hormones and TSH in plasma of males in the early stage of myocardial infarction are described. Already on admission T3 was diminished and went on falling. On admission rT3 was elevated and reached its maximum after 19 hours. T4 and TSH did not show essential alterations. The results suggest that in the early stage of myocardial infarction a rapid shift of the monodeiodination of T4 to rT3 occurs instead of T3 with a quick decrease of T3 and increase of rT3 in the blood.

Aged↗

PubMed1980

[Plasma thyroid hormones and TSH during the early stage of acute myocardial infarction (author's transl)].

In 21 males (age 50-78 yrs) without endocrine diseases, plasma thyroxine, triiodothyronine, reverse-triiodothyronine and TSH were determined by specific RIAs in the early stage of an acute myocardial infarction. Blood was taken every 4 hours up to 43 hours after admission. The patients were separated in 2 groups, depending on the severity of the infarction (group A with 11 patients = severe infarction; group B with 10 patients = not severe infarction). 25 healthy men served as an aged-matched control group (age 56-83 yrs). Thyroxine in all patients (group A and B together) did not show essential fluctuations during the 43 hours of observation. The mean values were elevated, the individual values were predominantly in the normal range. There were no significant differences between the groups A and B. As well in the total-patients group as in the groups A and B already on admission, T3 was diminished and went on falling during the 43 hours. From 35 hours after admission, T3 was significantly decreased in group A compared to group B. On admission, rT3 was elevated in both the total-patients group and group A and B; it reached its maximum after 19 hours. Group A showed from 7 hours after admission a tendency more increased levels compared to group B. In all cases (total-patients group, group A and B) TSH levels were constant within the normal range during the whole time. The results suggest that in the early stage of myocardial infarction an important alteration in the thyroxine metabolism with enhancement of the inactive reverse-triiodothyronine production occurs very quickly. Moreover, the results show that this alteration may depend on the severity of myocardial infarction. Hypothyreoidism can be excluded because of the normal or elevated thyroxine values and the normal TSH levels.

Aged↗

PubMed1979

[Plasma testosterone, free testosterone fraction LH and FSH in males during the early stage of acute myocardial infarction (author's transl)].

In 18 males (age 49--79 yrs) without endocrine diseases, testosterone, free testosterone fraction, LH, FSH and cortisol (as indicator for stress) were determined in the early stage of an acute myocardia infarction. Blood was taken on admission as well as every 4 hours up to meanly 43 hours. The patients were separated in 2 groups for proving whether alterations of the parameters may depend on the severity of the myocardial infarction (group A=severe infarction; group B=not severe infarction). Testosterone showed a rapid decrease in the first 11 hours after admission, which continued less striking to the end of the investigation. Testosterone was significantly decreased in group A in comparison to group B. LH and FSH in both groups together were remarkably reduced during the whole time. Whereas group A demonstrated a tendency to decreased values in comparison to group B for LH, there were not any essential differences between the two groups for FSH. The free testosterone fraction was not altered. Cortisol in group A was twice as high as in group B during the entire investigation. The systolic pressure in group A was generally lower than in group B during the whole time. The results demonstrate an important reduction of the secretion of testosterone, LH and FSH during the early stage of the acute myocardial infarction. The testosterone suppression seems to be dependent on the severity of the myocardial infarction. These alterations may be caused by a general impaired perfusion as a consequence of myocardial infarction and a suppressive effect of increased cortisol values on testosterone levels.

Aged↗

PubMed1979

Hypothalamic-pituitary function (LH, FSH and prolactin) in males with chronic liver diseases.

Because of the central importance of the liver for the metabolism of estrogens and androgens the chronically ill liver per se represents an essential disturbing factor within the hypothalamic-pituitary-gonadal axis caused by the altered hepatic metabolism of the steroid hormones as well as the abnormal synthesis of steroid-hormone-binding proteins with changed free fractions of sex hormones. The question has been differently answered whether a chronic hepatic disease can also be the reason for disturbance on hypothalamic-pituitary and/or testicular level. Recent plasma determination of LH/FSH before and after LHRH and clomiphene, of sex hormones before and after HCG as well as unbound sex hormones in males with chronic hepatic diseases lead to the following conclusion. 1. Chronic liver disease (without idopathic hemochromatosis). Even sever chronic hepatic diseases are not accompanied by primary hypopituitarism. With regard to the impaired Leydig cells stimulation by HCG and the abnormal seminal fluid and testicular histology one can suppose a primary gonadal hypogonadism. However, an additional hypothalamic disturbance has to be considered. 2. Idiopathic hemochromatosis. Presumably in hemochromatosis a primary insufficiency of pituitary and/or testes can take place related to the general metabolic disturbances of this illness. The classic hypothesis of an exclusively primary lesion with secondary hypogonadism does not appear to be correct.

Adult↗

PubMed1978

[Investigations on pituitary-testes axis in males with chronic liver diseases (author's transl)].

In 27 male patients (age 31--60 years) with chronic hepatic diseases--10 of which with alcohol-toxic cirrhosis (ACi), 10 with hepatitic cirrhosis (HCi) and 7 with chronic aggressive hepatitis (CHAH)--total testosterone (T) and total oestradiol-17 beta (E2) in plasma were determined before and after HCG i.m. as well as LH and FSH before and 30 min and 60 min after LH-RH i.v. T, E2, LH and FSH were evaluated by specific RIA. Basal T was significantly decreased in ACi in comparison to normals and to HCi and CHAH. The increase after stimulation with HCG was reduced in all patient groups. Mean E2 before stimulation was altered in none of the groups compared to controls. After HCG there was an inadequate response only in ACi. Before as well as after stimulation with LH-RH, LH and FSH were increased in all patient groups. Our results point to the following: In males with chronic hepatic failure a testes insufficiency often occurs, which may depend on the etiology and the stage of the liver disease. An additional pituitary insufficiency appears not to exist.

Adult↗

PubMed1976

[Anterior pituitary gland-testes function in patients with diabetes mellitus, chronic kidney and liver diseases].

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Chronic Disease↗

PubMed1976

[Studies on the pituitary-testicular axis in male patients with chronic renal failure with different glomerular filtration rate (author's transl)].

In 32 male patients with chronic renal failure (age 22-60 yrs), of which 17 showed a creatinine clearance below 20 ml/min (group I) and 15 above 20 ml/min (group II), plasma levels of total testosterone (T) and total oestradiol-17beta (E2) were measured before and after stimulation with HCG i.m. LH and FSH were evaluated before and after stimulation with LH-RH i.v. Additionally, testosterone binding capacity (TeBG), free testosterone fraction (%FT) and "absolute" free testosterone (AFT) were determined. In comparison with normal persons T was clearly reduced before and after HCG in group I, whereas in group II it was reduced only after HCG. E2 showed normal basal values in both groups, but in group I it was decreased after HCG. Except for LH values after stimulation in group II, both groups showed increased LH and FSH levels before and after LH-RH in comparison with controls. TeBG and %FT did not show any changes in either group, whereas AFT was reduced in both of them. Comparing the results of group II and I we found in the latter decreased values for T before and after HCG and for E2 after HCG as well as decreased values for AFT, whereas LH and FSH before and after LH-RH were increased. There existed no significant correlation between any of the parameters T, AFT and E2 on the one hand and LH and FSH on the other hand. Significant correlations are found between creatinine clearance and T, AFT, LH and FSH. The results indicate a primary defect of the testis which gradually depends on the degree of renal insufficiency, but with well working feed-back mechanism. The possibility of an additional central regulation defect in the sense of a relative autonomy of the hypophyseal gonadotropin secretion is discussed.

Adult↗

PubMed1976

[Testosterone-binding capacity, free-plasma testosterone fraction, and free-plasma testosterone concentration in andrological patients (author's transl)].

Testosterone-binding capacity (TeBG), free-plasma testosterone fraction (%FT), and free-plasma testosterone concentration (AFT) were measured in 24 men with primary and 14 with secondary hypogonadism of various causes, as well as in eight with coital impotence. There was a highly significant correlation between TeBG and %FT (r = minus 0.891; P less than 0.0005). TeBG and %FT did not generally differ from normal in primary hypogonadism, while AFT was normal or decreased, depending on the corresponding whole testosterone concentrations. In secondary hypogonadism there was always an increased TeBG and decreased %FT. Depending on whole testosterone concentration, AFT was low or very low. In impotent subjects TeBG, %FT and AFT were generally normal. The role of AFT determination in andrological diagnosis is discussed.

Adolescent↗

PubMed1975

[Androgen status of male diabetics. Total testosterone before and following stimulation with HCG, free testosterone, and testosterone binding capacity of patients with and without potency disorders].

In order to investigate the androgen status of diabetics we determined in 39 patients, 18-60 years old, 17 of which suffered from potency disturbances, the basal total plasma testosterone, the free testosterone fraction and the unbound plasma testosterone as well as the testosterone binding capacity. In 39 of these patients we proved the response of Leydig cells to HCG. Between normal persons and patients with and without potency disturbances basal total plasma testosterone did not differ significantly (p greater than 0.10). After a 3-day stimulation with HCG the increase of basal total plasma testosterone was significantly lower in the two diabetic groups in comparison with the normal persons (p less than 0.0005). The group with potency disturbances had significantly lower values for the free testosterone fraction (p less than 0.005) and unbound plasma testosterone (p less than 0.0025) than normal persons whereas diabetics without potency disturbances did not reveal any significant differences (p greater than 0.25 and p greater than 0.40). Further there were significant differences between the patients with and without potency disturbances (p less than 0.025) and (p less than 0.025). Testosterone binding capacity was significantly increased in the group with potency disturbances (p less than 0.0005) and also in the group without potency disturbances (p less than 0.01) as compared with controls. Moreover was it significantly higher in the group with potency disturbances than that without potency disturbances (p less than 0.01). For none of the parameters a functional correlation of age or diabetes duration could be demonstrated. The results are discussed with regard to the causes of potency disturbances in male diabetics.

Adolescent↗

PubMed1974

[A test to evaluate Leydig-cell function performable in outpatients (author's transl)].

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Adolescent↗