Ralph G. Wieland

Hepatic lipid in morbid obesity. Assessment at and subsequent to jejunoileal bypass.

Abstract Twenty-three massively obese patients (mean excess of ideal body weight of 137 per cent) underwent end-to-end jejunoileal bypass because of dietary treatment failure and complications of obesity. Histologic assessment was done on liver biopsies taken at operation and an average of 13 months later. Chemical measurement showed a mean (± S.D.) increase in total lipids from 110.7 ± 62.8 to 221.7 ± 180.2 mg per gram, and in triglycerides from 79.9 ± 63.3 to 177.2 ± 151.2 mg per gram (p<0.05). Phospholipid, free cholesterol and cholesterol esters were not significantly increased. Thus, controlled histologic estimates can provide a rough guide of lipid mass present in a given biopsy specimen within the range of 50 per cent. For purposes of experimental study, this degree of sensitivity and precision may be inadequate. Secondly, hepatic lipid accumulation does not correlate with degree of obesity. Thirdly, jejunoileal bypass for obesity is accompanied during the period of weight loss by a threefold incre...

Pituitary-Gonadal Function Before and After Vasectomy

Blood samples were obtained from 8 males (29-49 years) on the day of elective vasectomy and from 28 to 92 days thereafter when azoospermia had been demonstrated. No significant short-term changes in pituitary gonadotrophins or testosterone occurred as measured by immunoassays of blood serum.

A sensitive testosterone assay by protein-binding

Abstract A sensitive assay utilizing protein-binding has been developed for the measurement of testosterone in biological fluids. The assay utilizes pregnancy serum diluted to 0.25% to which testosterone-3H has been added. Only 2 ml of peripheral serum are required to satisfactorily measure normal female levels.

Studies on the mechanism of the production of the testicular feminization syndrome

Abstract Studies in a patient with testicular feminization are reported. Evidence is presented that the gonads produce testosterone as measured in the gonadal vein blood and in the urine. Urinary testosterone levels increased in response to gonadal stimulation with Pergonal and decreased following gonadectomy. Low normal urinary levels of estrogen persisted following gonadectomy despite the administration of large amounts of testosterone. In vitro studies of the gonad demonstrated their biosynthetic capacity to produce testosterone. Administration of large doses of exogenous testosterone for a period of three months produced no manifestations of virilization. It is concluded that the syndrome represents end organ unresponsiveness to testosterone. This unresponsiveness was demonstrated after gonadectomy, and it is therefore unlikely that it is due to gonadal secretion of an antiandrogenic substance [19].

17β-ol Androgens and Free Index in Hirsute and Hirsute Obese Women *

We have found the mean levels of combined serum testosterone and dihydrotestosterone (T+DHT) and the free index (FI) to be significantly higher and the mean dihydrotestosterone precipitation index (DHT-PI) to be significantly lower in hirsute women than in normal women. Although the mean T+DHT values of the different groups of hirsute patients were comparable, the FI value of the oligomenorrheic and/or obese patient was higher than that of the nonobese, normally menstruating group. In addition, the mean DHT-PI level of obese patients was significantly lower than that of nonobese patients. The lowest androgen binding was found in obese patients with oligomenorrhea. In our experience, hirsutism is associated with T+DHT values of 150 ng/dl or lower. Measurement of androgen binding and androgen levels in unchromatographed serum extracts provides valuable information in the treatment of hirsute women.

Pituitary-gonadal rhythms in the eugonadal adult male.

The regulation of the pituitary-testicular axis was studied in 4 healthy male volunteers (mean age 33 married 2-4 children) at Saint Lukes Hospital in Cleveland. During a 4-hour period commencing between 8-10 AM peripheral samples were obtained every 15 minutes for the determination of follicle-stimulating hormone lutenizing hormone and testosterone. The secretions of the gonadotropins and testosterone were episodic and unrelated within each individual. The number of peaks varied interindividually and the various hormones had different numbers of peaks intraindividually. No support was gained for the concept that fluctuations of basal secretion in normal males are caused by negative feedback control.

Differential studies on the mechanism of serum androgen and androgen-binding abnormalities in hirsutism

Abstract Twenty-eight patients with hirsutism were studied. Elevated levels of testosterone and dihydrotestosterone (T + DHT) and a decreased dihydrotestosterone precipitation index (DHT-PI) were found in about half the patients studied. The DHT-PI is a sensitive measure of steroid-binding β-globulin (SBβG). The DHT-PI was much more abnormal in patients with oligomenorrhea than in those with regular menses despite similar T + DHT levels. Chronic suppression of T + DHT levels with prednisone in hirsute patients did not normalize the DHT-PI. The addition of Premarin resulted in normalization of the DHT-PI. These findings would favor the hypothesis that the serum androgen-binding protein abnormality in hirsute females is not maintained by significantly increased circulating androgen levels.

Detection of 3β,17-dihydroxypregn-5-en-20-one in blood from a human adrenal tumor

The adrenal-venous blood obtained from a woman with a virilizing tumor of the adrenal was found to contain 13 μg of 3β,17-dihydroxypregn-5-en-20-one, 21 μg of 17-hydroxypregn-4-ene-3,20-dione, 28 μg of 3β-hydroxyandrost-5-en-17-one, and 72 μg of androst-4-ene-3,17-dione per 100 ml. No testosterone could be detected.

Serum gonadotropin levels during medical stress (myocardial infarction)

Abstract Twenty-one men and 10 postmenopausal women with acute myocardial infarction were studied for changes in circulating gonadotropin levels (radioimmunoassay). In the men the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) values did not change significantly during the first 5 days and were similar to convalescent levels. The values also did not differ significantly from a group of normal men. Postmenopausal women demonstrated a wide range of values and frequently marked daily fluctuations which were probably not induced by the myocardial infarction.

Hormonal evaluation of premature menarche produced by a follicular cyst

blood collected from their respective mothers at the time of delivery. Those preparations were always white. We studied these cells carefully and found a significant contamination of the lymphocytes by nucleated red ceils. When blood from these children was again studied six to eight weeks later with the same methods, we found that the T and B cells had apparently returned to normal. Smears had been made for differential analysis from the cord blood of those erythroblastotic children. We found a range of 89 to 120 nucleated red cells per 100 white cells in those infants. By six weeks of age, the reticulocyte count in these inf-ants had returned to normal levels of 4 per cent or less. coincident with the elevation to apparently normal levels of the T and B cells. It was not until the fifth erythroblastotic infant that we finally found an effective technique by which we could remove the nucleated red cells from the lymphocyte preparations without negativeIy affecting the lymphocytes. We found that the simple modification of adding 2 ml, of distilled water to the lymphocyte pellet, dispersing the cells for twenty seconds by pipetting, and then immediatelv adding a salt solution of sufficient strength to biing the molarity of the solution to O.l.?hi resulted in lysis of the nucleated red cells only, with retained functional lymphocytes. Cord blood was obtained at the time of delivery of this erythroblastotic infant, and the lymphocytes from the Ficollhypdque gradient interface were separated into two halves. Half of these cells were processed in the usual fashion, and half were water lysed. T and B cell determinations were then accomplished in the standard fashion on both samples. The sampIe that was studied without removal of. nucleated red blood cells was read as being 6 per cent T cells and 4 per cent B cells while t.he other aliquot gave 41 per cent T cells and 15 per cent B cells. All treated mothers who were studied (five) were fomld to have normal adult levels of both T and B cells (54 ? 6 r’s and 15 ? 3 B’s). There was no apparent effect of the promethazine hydrochloride on maternal lymphocyte numbers. 0ur first impression that the low levels of T and B cells found in the erythroblastotic newborn infant might be clue to the promethazine hydrochloride treatment was erroneous. When contaminating nucleated red cells were removed from the lymphocyte preparation, the levels of T and B cells in the patients studied so far appeared to be normal. In a recvnt paper by Rubinstein and associates,’ the authors have taken d situation with two variables. the disease pj-ocess erythrobiastosis and the