Hiroshi Maruta

TESTICULAR FINDINGS, ENDOCRINE FEATURES AND THERAPEUTIC RESPONSES OF MEN WITH ACQUIRED HYPOGONADOTROPIC HYPOGONADISM

Background Men with acquired hypogonadotropic hypogonadism (AHH) who desire restoration of fertility are treated with exogenous gonadotropin. However, gonadotropin (Gn) therapy does not always restore testicular function. It is unknown whether the therapeutic responses to Gn therapy correlate with their testicular histological findings. Thus, we analyzed factors influencing testicular dysfunction and therapeutic responses in AHH.

Presence of Human Papillomavirus 6/11 DNA in Condyloma acuminatum of the Urinary Bladder

A Japanese woman with condyloma acuminatum of the urinary bladder is presented. The condyloma acuminatum lesion was resected endoscopically and human papillomavirus 6/11 DNA was detected. After treatment, there has been no recurrence of the disease.

Male idiopathic hypogonadotropic hypogonadismの精巣および内分泌学的所見とその治療への反応

The purpose of this study is to clarify the pathological and endocrinological variations of male idiopathic hypogonadotropic hypogonadism (IHH) from the viewpoint of testicular maturation. Twenty-five patients with IHH were classified into 3 groups according to the degree of germ cell maturation. The most mature germ cells in patients with severe IHH, moderate IHH and mild IHH were spermatogonia, primary spermatocytes and postmeiotic germ cells, respectively. All patients were treated with hCG alone or a combination of hMG-hCG for 1 year or more. The therapeutic efficacy of gonadotropin therapy was evaluated by findings of semen analysis, spermatogenesis and sexual maturation. The total GCI, which was expressed as the number of germ cells per Sertoli cell, diameter of the seminiferous tubules and testicular volume in mild IHH were the largest among the 3 IHH groups, and those in severe IHH were the smallest. Even in mild IHH, spermatogonial proliferation and meiotic activity were quantitatively smaller than those of normal pubertal boys. All patients showed extremely low basal testosterone levels. Response of serum testosterone to hCG administration correlated to the maturity of germ cells. Basal serum gonadotropin levels and responses to GnRH administration varied widely among the 3 groups. In particular, the response of serum gonadotropin to GnRH correlated to the maturity of the germ cells. Spermatogenesis could be initiated by hCG alone in IHH patients without cryptorchidism. Normal sperm density was obtained by hCG alone in the case of mild IHH; however, in moderate and severe IHH groups, hMG-hCG therapy was required for sufficient spermiogenesis. Sexual maturation was completely obtained by gonadotropin therapy within 1 year in moderate and mild IHH. However, in severe IHH, satisfactory sexual maturation could not be obtained within 1 year. The therapeutic prognosis for sexual maturation could be made based on the response to the hCG test at 6 months of gonadotropin therapy. In conclusion, the maturity of germ cells before treatment, which varies widely among patients with IHH, is a sensitive parameter for hypothalamo-pituitary-testicular function and the efficacy of gonadotropin therapy for testicular function. In severe IHH groups, to obtain satisfactory sexual maturation, the administration of testosterone should be considered in addition to gonadotropin replacement.

[Study on new quinolone-resistant strains isolated from urine--annual changes of its frequency and the relation to drug volume].

There is concerned that the new quinolone-resistant strains have increased along with its widespread usage. We analysed the annual changes in frequency of ofloxacin-resistant strains isolated from urine in the past four years at two different types of hospitals, department of urology in Sapporo Medical College and Muroran City Hospital, since the usage of these agents seem to be related to the annual changes of the frequencies. The results were summarised as follows: 1) In the two hospitals, drug volume of the new quinolones had been increased, in particular, the past six years from 1984. 2) The annual changes in frequency of ofloxacin-resistant Staphylococcus aureus have been increasing from 0 to 41.2 percent in Sapporo Medical College and 16.7 to 96.7 percent in Muroran City Hospital. The frequency of ofloxacin-resistant Pseudomonas aeruginosa also have been increasing from 24 to 66.7 percent in Sapporo Medical College and 37.5 to 81.8 percent in Muroran City Hospital. 3) The frequency of ofloxacin-resistant indole positive Proteus spp. and Serratia marcescens for four years at Sapporo Medical College (indole positive Proteus spp.: 0-1.8 percent, Serratia marcescens: 10-43 percent) was very different from that at Muroran City Hospital (indole positive Proteus spp.: 65-82 percent, Serratia marcescens: 71-100 percent). The difference seems to be caused by the hospital acquired infection.

[Studies on the testicular hypophyseal relationship. Report 3. Gonadotropin levels following castration and exogenous estrogen and testosterone administration (author's transl)].

The gonadotropin levels following castration exogenous estrogen administration and testosterone administration were studied in human males. Serum LH and FSH levels were measured by radioimmunoassay in patients with prostate cancer following castration and estrogen therapy. Effects of testosterone on gonadotropin levels were examined in patients with Klinefelters syndrome receiving androgen replacement therapy. The results were as follows. After castration serum LH and FSH levels increased gradually in all patients and reached levels 3.5 1.6 times higher than the previous values at the 7th postoperative day respectively. Administration of the extrogen Diethylstilbestrol diphosphate suppressed both LH and FSH. FSH levels were more easily suppressed than LH levels. The doses of estrogen required to suppress the gonadotropins to the lowest level were about 30-60 mg/day for DES-diphosphate and 10-30 mg/day for Hexestrol. By administering testosterone propionate (25-100 mg intramuscularly) LH levels were markedly suppressed as were FSH levels. (Authors modified) (Summary in ENG)