Efficacy and safety of human chorionic gonadotropin combined with human menopausal gonadotropin and a gonadotropin-releasing hormone pump for male adolescents with congenital hypogonadotropic hypogonadism / 中华医学杂志(英文版)

BACKGROUND@#Compared to adult studies, studies which involve the treatment of pediatric congenital hypogonadotropic hypogonadism (CHH) are limited and no universal treatment regimen is available. The aim of this study was to evaluate the feasibility of human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) therapy for treating male adolescents with CHH.@*METHODS@#Male adolescent CHH patients were treated with hCG/hMG (n = 20) or a gonadotropin-releasing hormone (GnRH) pump (n = 21). The treatment was divided into a study phase (0-3 months) and a follow-up phase (3-12 months). The testicular volume (TV), penile length (PL), penis diameter (PD), and sex hormone levels were compared between the two groups. The TV and other indicators between the groups were analyzed using a t-test (equal variance) or a rank sum test (unequal variance).@*RESULTS@#Before treatment, there was no statistical difference between the two groups in terms of the biochemistry, hormones, and other demographic indicators. After 3 months of treatment, the TV of the hCG/hMG and GnRH groups increased to 5.1 ± 2.3 mL and 4.1 ± 1.8 mL, respectively; however, the difference was not statistically significant (P > 0.05, t = 1.394). The PL reached 6.9 ± 1.8 cm and 5.1 ± 1.6 cm (P  0.05, t = 0.314). After 9 to 12 months of treatment, the T level was higher in the hCG/hMG group. Other parameters did not exhibit a statistical difference.@*CONCLUSIONS@#The hCG/hMG regimen is feasible and effective for treating male adolescents with CHH. The initial 3 months of treatment may be a window to optimally observe the strongest effects of therapy. Furthermore, results from the extended time-period showed positive outcomes at the 1-year mark; however, the long-term effectiveness, strengths, and weaknesses of the hCG/hMG regimen require further research.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT02880280; https://clinicaltrials.gov/ct2/show/NCT02880280.

Human chorionic gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL

ABSTRACT Purpose The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL. Materials and Methods We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. Results Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement. Conclusions Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.

Desencadenantes de la maduración ovocitaria en ciclos de fecundación in vitro / Triggers of oocyte maturation in cycles of in vitro fertilization

Tradicionalmente, desde que se iniciaron las técnicas de reproducción asistida, se solía usar un bolo de 5 000-10 000 UI de gonadotropina coriónica humana para la maduración final de los ovocitos como método estándar. Recientemente, se ha introducido un nuevo concepto, en el que los agonistas de la hormona liberadora de gonadotropina juegan un papel esencial en este campo. Ofrece importantes ventajas, entre las que se incluyen: una virtual prevención completa del síndrome de hiperestimulación ovárica. No obstante, algunos estudios defienden que el uso de hormona liberadora de gonadotropina puede ocasionar un defecto en la fase lútea que puede finalizar en una disminución en las tasas de implantación, en las tasas de gestación clínica o en un aumento de las tasas de aborto precoz. Así pues, en esta revisión analizamos las diferentes opciones terapéuticas para desencadenar la maduración final de los ovocitos en las técnicas de reproducción asistida, y discutimos los riesgos, beneficios y posibles complicaciones del uso de los agonistas de la GnRH como inductor de ovulación en ciclos de fecundación in vitro/inyección intracitoplasmática de espermatozoides(AU)

Traditionally, a bolus of 5000-10000 IU human chorionic gonadotropin (hCG) was used for final follicular maturation and ovulation as a standard method since assisted reproduction techniques started (ART). Recently, a new concept in which the releasing gonadotropin hormone agonists (GnRH-a) play an essential role has been introduced. This offers important advantages, including virtually prevention of ovarian hyperstimulation syndrome (OHSS). However, some studies described that using GnRH-a, could lead to defects in the luteal-phase that may result in a reduction of the implantation and clinical pregnancy rates; and also in an increase of early abortion rates. Therefore, the aim of this review is the analysis of different pharmaceutical options to trigger final oocyte maturation in ART, and the discussion of the risks, benefits and likely complications associated with the use of GnRH-a as an inductor of the ovulation during in vitro fecundation/intracitoplasmatic sperm injection cycles (IVF/ICSI)(AU)

Should human chorionic gonadotropine treatment increase thyroid volume?

Objective Our aim was to investigate the thyroid function tests and thyroid volume differences among males with isolated hypogonadotropic hypogonadism (IHH) who take androgen replacement treatment (ART). Materials and methods Forty-four male with IHH with a mean age 33.2 (18-54), diagnosed in Endocrinology and Metabolism Department between September 2013 and September 2014 and 40 healthy male control with a mean age 27.77 (18-55) were involved to study. Patient group was divided to testosterone-treated patients (n = 19) and human chorionic gonadotropine (hCG)-treated patients (n = 25). Patient group was compared in terms of total testosterone, thyroid function tests [thyroid stimulating hormone (TSH), free thyroxine (fT4)] and thyroid volume, before and 6 months after treatment. Patient group was compared with control group as well. Results When we compared the patient group with the control group, there was no significant difference for age, Body mass index, TSH, fT4 and thyroid volume between two groups before treatment. There was no difference in terms of TSH, but fT4, testosterone levels and thyroid volume were significantly higher after treatment, when the patient group was compared before and after treatment (p < 0.05). When we compared testosterone-treated patients and hCG-treated patients; thyroid volume was higher among hCG-treated patients (p = 0.001) but there was no difference for thyroid volume before and after testosterone treatment (p > 0.05). There was no statistically significant correlation between testosterone levels with TSH, fT4 and thyroid volume (r = 0.09, p = 0.32; r = 0.14, p = 0.11; r = 0.15, p = 0.09, respectively). Conclusion Our study showed that ART increases the thyroid volume especially in hCG-treated patients. Therefore, we suggest that thyroid volume changes should be followed up in hCG-treated patients.

El síndrome de Pasqualini: hipoandrogenismo con espermatogénesis conservada

Pasqualini y Bur publican el primer caso de eunucoidismo con espermatogénesis conservada en 1950 en la Revista de la Asociación Médica Argentina. El síndrome de hipoandrogenismo con espermatogénesis incluye: (a) eunucoidismo bien definido, (b) testículos de volumen normal con espermatogénesis completa, llegando a espermatozoides maduros en una elevada proporción de tubos seminíferos, con células de Leydig indiferenciadas e inmaduras, (c) compensación funcional completa mediante la administración de gonadotrofina coriónica, mientras ésta se aplique (d) gonadotrofinas urinarias totales dentro de límites normales, y (e) esta definición fue ampliada con la actividad normal de las otras hormonas adenohipofisarias y la ausencia de malformaciones congénitas en la mayoría de los casos. En la fisiopatogenia del síndrome de Pasqualini, conocido también como síndrome del "eunuco fértil", se demostró primero la ausencia de hormona luteinizante (LH) en el plasma y orina de estos pacientes. El segundo gran avance fueron los estudios funcionales y genéticos que validaron la hipótesis de un déficit funcional de LH en estos hombres, extendido luego a las mujeres. Varios grupos, incluyendo el nuestro, demostrarían en estos casos una LH con diferentes grados de actividad inmunológica pero biológicamente inactiva, a partir de una o más mutaciones invalidantes en el gen LHB. Por último, la comprensión acabada del síndrome de Pasqualini permitiría revertir el fenotipo y la infertilidad de estos pacientes a partir de la utilización de gonadotrofina coriónica y las modernas técnicas de fertilidad in vitro. Este artículo es una revisión histórica y un homenaje a la memoria de Rodolfo Q. Pasqualini.

Pasqualini and Bur published the first case of eunuchoidism with preserved spermatogenesis in 1950 in Revista de la Asociación Médica Argentina. The hypoandrogenism with spermatogenesis syndrome included: (a) eunuchoidism, (b) testis with normal spermatogenesis and full volume, with mature spermatozoa in a high proportion of seminiferous tubes and undifferentiated and immature Leydig cells (c) full functional compensation through the administration of chorionic gonadotropin hormone, while hCG is administered (d) total urinary gonadotrophins within normal limits (e) this definition supposes the normal activity of the pituitary and the absence of congenital malformations in general. A first step in the understanding of the physiopathogeny of Pasqualini syndrome or the so called "fertile eunuch" syndrome was the absence of LH in plasma and urine of patients. The second breakthrough was the functional and genetic studies that validated the hypothesis of a functional deficit of LH in these men: it will then also be described in some women. Different groups including ours demonstrated in these cases a LH with varying degrees of immunological activity but biologically inactive in most of the patients, due to one or more inactivating mutations in the LHB gene. Finally, the full comprehension of Pasqualini syndrome allowed to reverse the hypoandrogenic phenotype and to restore fertility in these patients through the use of chorionic gonadotropin and the modern in-vitro fertility techniques. This article is an historical review and a tribute to the memory of Rodolfo Q. Pasqualini.

A cross-sectional study of cryptorchidism in children: testicular volume and hormonal function at 18 years of age

Purpose To evaluate the relationship between unilateral or bilateral criptorchidism, patient age, primary location of the gonad and modality of treatment with testicular volume and hormonal status at 18 years in patients diagnosed and treated for cryptorchidism during childhood. Materials and Methods Testicular volume, LH, FSH, and testosterone were evaluated in 143 young men at 18 years treated in childhood for unilateral (n=103) or bilateral (n=40) cryptorchidism. Results Unilateral cryptorchidism: Location of testis was prescrotal in 36 patients, inguinal in 52 and non-palpable in 15. The mean volume was 9.7 mL compared to 16.2 mL. for the spontaneously descended testicle in unilateral cryptorchidism. However, 22 patients who received HCG had a significantly bigger testis (11.8 mL.) than those treated with primary surgery (9.2 mL). The results showed a significant positive correlation between testicular volume and patient age at treatment. Bilateral cryptorchidism Location of testis was prescrotal in 34 cases, inguinal in 40 and 6 patients with non-palpable testicles. Mean volume at 18 years was 12.9 mL, greater than unilateral cryptorchid testis (9.7 mL) but smaller than healthy contralateral in unilateral cases (16.2 mL). There were significant differences in the testicular growth for bilateral patients with testicular descent after being treated with HCG (14.4 mL) in respect with those untreated (11.1 mL) or those who underwent primary surgery (11.4 mL). There was a significant positive correlation between the testicular volume and palpable (12.4 mL) or non-palpable testis (10.4 mL). There was a correlation between unilateral or bilateral cryptorchidism and levels of FSH. Conclusions Testicular volume and hormonal function at 18 years for patients diagnosed and treated for cryptorchidism during childhood are strongly influenced by whether the undescended testis was unilateral or bilateral. Location of the testes at diagnosis or ...

Gonadotropin therapy in assisted reproduction: an evolutionary perspective from biologics to biotech

Gonadotropin therapy plays an integral role in ovarian stimulation for infertility treatments. Efforts have been made over the last century to improve gonadotropin preparations. Undoubtedly, current gonadotropins have better quality and safety profiles as well as clinical efficacy than earlier ones. A major achievement has been introducing recombinant technology in the manufacturing processes for follicle-stimulating hormone, luteinizing hormone, and human chorionic gonadotropin. Recombinant gonadotropins are purer than urine-derived gonadotropins, and incorporating vial filling by mass virtually eliminated batch-to-batch variations and enabled accurate dosing. Recombinant and fill-by-mass technologies have been the driving forces for launching of prefilled pen devices for more patient-friendly ovarian stimulation. The most recent developments include the fixed combination of follitropin alfa + lutropin alfa, long-acting FSH gonadotropin, and a new family of prefilled pen injector devices for administration of recombinant gonadotropins. The next step would be the production of orally bioactive molecules with selective follicle-stimulating hormone and luteinizing hormone activity.

Medical management of non-obstructive azoospermia

Non-obstructive azoospermia is diagnosed in approximately 10% of infertile men. It represents a failure of spermatogenesis within the testis and, from a management standpoint, is due to either a lack of appropriate stimulation by gonadotropins or an intrinsic testicular impairment. The former category of patients has hypogonadotropic hypogonadism and benefits from specific hormonal therapy. These men show a remarkable recovery of spermatogenic function with exogenously administered gonadotropins or gonadotropin-releasing hormone. This category of patients also includes some individuals whose spermatogenic potential has been suppressed by excess androgens or steroids, and they also benefit from medical management. The other, larger category of non-obstructive azoospermia consists of men with an intrinsic testicular impairment where empirical medical therapy yields little benefit. The primary role of medical management in these men is to improve the quantity and quality of sperm retrieved from their testis for in vitro fertilization. Gonadotropins and aromatase inhibitors show promise in achieving this end point.

Assessment of serum progesterone level on the day of hCG injection in infertile polycystic ovarian syndrome patients referred to women's hospital, Tehran, 2009

Background: Polycystic ovarian syndrome [PCOS] is one of the most common causes of endocrine disorders and main reasons for infertility due to unovulation and recurrent abortions. There is no consensus on effect of serum progesterone level on the day of human chorionic gonadotropin [hCG] injection. This study aims to evaluate the effect of plasma levels of progesterone on the day of hCG injection on the rate of pregnancy in in vitro fertilization [IVF] cycles of PCOS cases

Materials and Methods: A stratified cohort study was conducted over a period of one year [2009] on 38 infertile women with PCOS who were suitable candidates for the IVF program. Patients were evaluated for other causes of infertility with hysterosalpingography [HSG], laparoscopy and normal sperm analysis. Patients were placed on the long protocol, followed by oocyte pick up, and finally IVF-embryo transfer [ET]. Study patients were grouped according to progesterone levels of greater or less than 1.2 ng/ml on the day of hCG injection. Pregnancy rates were defined in each group. Levels on day of hCG day clinical pregnancy outcome were assessed. Experimental data were then compared against Fisher's exact test in SPSS version 18

Results: The overall pregnancy rate in this study was 26.3%. In the group with progesterone levels more than 1.2 ng/ml on the day of hCG injection, the clinical pregnancy rate was 4 [21.1%] and chemical pregnancy rate was 3[15.8%]. In the group with progesterone levels less than 1.2 ng/ml, the clinical pregnancy rate was 1[5.3%] and chemical pregnancy rate was 2[10. 5%]

Conclusion: This study showed that PCOS patients with progesterone levels more than 1.2 ng/ml on the day of hCG injection resulted in higher chemical and clinical pregnancy rates. However, no significant statistical differences were found between the two groups. For further verification, we recommend additional studies with larger numbers of subjects

Hormônios utilizados na estimulação ovariana / Hormones used for ovarian stimulation

A fertilização in vitro (FIV) se tornou uma opção estabelecida e altamente eficiente para tratar a infertilidade conjugal de várias causas etiológicas. Por meio de uma hiperestimulação ovariana controlada, pode-se obter múltiplos oócitos de boa qualidade que potencialmente podem ser fertilizados, desenvolvidos e formar embriões. As gonadotrofinas são drogas fundamentais para essa estimulação. Com o uso de vários protocolos, conseguiu-se melhorar a estimulação folicular e a qualidade dos oócitos recrutados, a prevenção da liberação precoce de hormônio luteinizante, a diminuição das taxas de cancelamento de procedimentos e uma melhora nas taxas de gravidez. Esta revisão busca atualizar os conhecimentos sobre os hormônios atualmente utilizados com essa finalidade

In vitro fertilization (IVF) has become an established, highly efficient therapy for treating infertility of various etiologic causes. One of the major goals of IVF therapy is to obtain multiple fertilizable oocytes of good quality that can lead to diploid fertilization and early embryo development through a controlled ovarian hyperstimulation. Gonadotropins are the fundamental agents used in ovulation stimulation. Significant improvements were observed in the stimulation of follicular development and in the quality of developing oocytes; in the prevention of a premature luteinizing hormone release; in the cancellation rates; and an overall improvement in the total reproductive potential by using several different protocols. This review intends to update the knowledge about the hormones used in this process

Bases moleculares da história reprodutiva na prevenção do câncer de mama / Molecular basis of reproductive history on breast cancer prevention

A taxa atual de mortalidade por falha do tratamento do câncer de mama e o aumento de sua incidência suporta o investimento na preveção primária. O risco de desenvolver câncer de mama é dependente de condições endócrinas moduladas pela função ovariana, tais como a menarça precoce, menopausa tardia e a paridade. Gestação precoce é um fator sabidamente preventivo. Mulheres que levam uma gestação a termo antes de 24 anos de idade apresentam redução no risco de desenvolver câncer de mama e gestações adicionais aumentam a proteção. As tendências atuais de controle de natalidade e gestação tardia associadas à utilização de métodos hormonais de anticoncepção podem ser fatores responsáveis pelo aumento substancial na incidência do câncer de mama nas últimas décadas. Dados experimentais em modelos animais sugerem que o efeito preventivo da gestação é secundário à exposição à gonadotrofina coriônica humana (hCG). O hCG é capaz de modular a expressão genética de células mamárias, resultando em sua completa diferenciação. Essa ação parece ser mediada por mecanismos epigenéticos. A demonstração de que o hCG é capaz de modular a expressão de genes responsáveis pela diferenciação celular promovendo efeito quimio-preventivo é a base do modelo futuro da prevenção primária da doença.

The current mortality rate due to breast cancer treatment failure and the worldwide increase in its incidence support the effort in primary breast cancer prevention. The risk of developing breast cancer is dependent on endocrine conditions modulated by ovarian function, such as early menarche, late menopause and parity. Early pregnancy is a known protective factor. Women who gave birth before 24 years old exhibit a decrease in their lifetime risk of developing breast cancer, as additional pregnancies increase the protection. Current tendency regarding birth control and late pregnancy associated with the use of hormonal contraceptive methods could be responsible or the increasing incidence of breast cancer. Experimental data in animal models suggest that this preventive role is due to the exposure to human chorionic gonadotropin (hCG). Human chorionic gonadotropin is able to modulate the expression of genes in breast cells resulting in the complete differentiation. The data gathered suggest that its modulation activity is due to a mechanism called epigenetic changes. The demonstration that hCG can modulate the expression of genes through epigenetic changes leading to breast cell differentiation and promoting a chemo-preventive effect is the base that support the future model for primary preventive care of this neoplam.

Síndrome do folículo vazio / Empty follicle syndrome

A síndrome do folículo vazio (SFV) é um evento raro que se caracteriza pela ausência de oócitos no fluido folicular ovariano de pacientes com boa resposta à indução da ovulação para ciclos de reprodução assistida (RA). Os possíveis fatores etiológicos envolvidos estão relacionados às alterações na foliculogênese e à baixa biodisponibilidade da gonadotrofina coriônica humana (hCG). A SFV permanece como assunto controverso frente à possibilidade de etiologia multifatorial, às dúvidas na condução dos casos e aos riscos inerentes aos tratamentos até então propostos. Em vista da ocorrência de gestações prévias e subseqüentes ao seu diagnóstico, não parece implicar redução do potencial de fertilidade em ciclos futuros de RA. Alguns serviços têm utilizado, com bons resultados, o tratamento com administração de uma segunda dose da hCG em pacientes cuja aspiração folicular do primeiro ovário não obtém oócitos, mas a ausência de estudos controlados não permite chegar a conclusões. A equipe médica deve, assim, buscar condições para lidar com o problema, abordando-o com o máximo de propriedade para que o casal tome ciência dos riscos de sua ocorrência desde sua entrada no serviço de reprodução assistida.

Tumor del sitio trofoblástico: presentación de 2 casos y revisión de la literatura / Placental site trophoblastic tumor: report of 2 cases and literature review

El tumor del sitio trofoblástico (TST) es una forma clínica de la enfermedad trofoblástica, constituye su variedad más infrecuente, la cual se investiga y se publican diversas propuestas para su manejo adecuado. Se presentan 2 casos de pacientes atendidas en el Servicio de Ginecología del Hospital Ginecoobstétrico Ramón González Coro y se describen sus características en cuanto a formas de presentación clínica, enfoque diagnóstico, manejo terapéutico y evolución posterior que ejemplifican las dificultades que reportan los autores en torno a esta entidad, tanto por la no respuesta al tratamiento habitual como por lo imprescindible de un certero diagnóstico imagenológico.

Placental site trophoblastic tumour (PSTT) is a clinical form of gestational trophoblastic disease, and its most uncommon variety. Two cases managed at the Ramón González Coro Hospital were reported, and their clinical features, diagnostic approaches, management and clinical evolution, were described. Those cases are examples of the difficulties reported by the authors due to the non-response to common treatment and to the need of an accurate imaging diagnosis. A review of the published data regarding PSTT was also presented.

Structural analysis of gubernaculum testis in cryptorchid patients submitted to treatment with human chorionic gonadotrophin

OBJECTIVES: To make a histological and stereological analysis of gubernaculum testis elastic system fibers, collagen and striated muscle cells in patients with cryptorchidism treated with human chorionic gonadotrophin (hCG). MATERIALS AND METHODS: Gubernacula tissue samples were obtained from 12 patients with cryptorchidism. Patients' ages ranged from 1 to 3 years (mean 1.8). Of the 12 patients, 6 were treated with hCG. The samples were stained with Masson's trichrome to highlight muscle fibers and collagen, and Weigert's resorcin-fuchsin to highlight the elastic system fibers. The volumetric density of these components was determined by stereological methods. RESULTS: The volumetric density of collagen was increased in patients treated with hCG, ranging from 85.62 percent to 94.48 percent, while in patients not submitted to hCG treatment the volume density ranged from 52.12 percent to 89.46 percent (p = 0.0052). The volumetric density of the elastic system fibers was higher in patients treated with hCG, ranging from 9.62 percent to 19.62 percent, while patients not submitted to hCG treatment the volume density of elastic system fibers was between 10.38 percent and 12.38 percent (p = 0.0030). The volume density of striated muscle fibers in patients treated with hCG ranged from 4.76 percent to 39.16 percent, while and in patients not treated hCG it ranged from 3.24 percent to 11.14 percent (p = 0.0052). CONCLUSION: Gubernacular components alter significantly when submitted to treatment with hCG. Patients who underwent hCG treatment and had no complete testicular migration had an increase in the concentration of elastic and striated muscle fibers and a decrease in the volumetric density of collagen.

Stereological and morphometric analysis of collagen and seminiferous tubules in testes of patients with cryptorchidism submitted or not to treatment with human chorionic gonadotrophin

OBJECTIVES: Quantify the distribution of collagen and analyze the seminiferous tubules diameter in the testis of patients with cryptorchidism, to verify if the previous use of human chorionic gonadotrophin (hCG) affects these structures. MATERIALS AND METHODS: Samples of parenchymal tissue of cryptorchid testis obtained during peroperative biopsies were collected from 26 patients. Sixteen samples were embedded in paraffin and stained with picrosirius red to evidence fibers of collagen system. The quantification of these fibers was determined by stereological methods, using a test system M-42. To obtain seminiferous tubules diameter we used 10 of the 26 samples. These samples were embedded in Epon and the analyses were carried out in semi-thin sections, stained with toluidin blue. The selected results of each group were statistically analyzed and compared by the student's t and Tukey-Kramer's tests. RESULTS: The testicular interstitium and lamina propria of patients treated with hCG showed statistically significant less collagen system fibers, when compared to the testes of patients nontreated (0.30 percent versus 0.39 percent, p = 0.0079). The seminiferous tubules diameters were not statistically significant different between the testes of patients treated and nontreated with hCG (67.5 versus 59.35 µm, p = 0.0609). CONCLUSIONS: hCG use in the cryptorchidism could delay, at least temporarily, a progressive growth of fibers of collagen system. We did not find statistically significant difference in the seminiferous tubular diameters between treated and nontreated patients.

Utilização de gonadotrofina coriônica humana e cipionato de estradiol associado ao dispositivo de liberação controlada de drogas para sincronização de ovulação em cabras da raça Saanen / Use of human chorionic gonadodrophin and estradiol cipionate plus controlled internal drug release for synchronization of ovulation in Saanen goats

Dezesseis cabras nulíparas da raça Saanen foram distribuídas em dois grupos de tratamentos (T1 e T2) para sincronização da ovulação. Inicialmente, ambos os tratamento consistiram na aplicação concomitante do dispositivo de liberação controlada de drogas (CIDR-G®), de 5mg de dinoprost e de 1mg de cipionato de estradiol (CE) (dia 0). No quarto dia aplicaram-se 250UI de eCG e no quinto dia retirou-se o CIDR-G®. As cabras do T1 (n=8) receberam 1mg de CE 24 horas depois da retirada do CIDR-G® e as do T2 (n=8) receberam 250UI de hCG 30 horas após. Sete cabras do T1 e oito do T2 entraram em estro depois da retirada do CIDR-G®. Cabras que receberam hCG permaneceram em estro por 42,0± 6,9 horas e as que receberam CE por 45,0± 5,5 horas (P>0,05). As características ovulatórias não foram influenciadas pelos tratamentos. O intervalo da retirada do CIDR-G® à ovulação para ambos os protocolos de sincronização da ovulação não diferiu (P>0,05) entre tratamentos. As ovulações promovidas pelo CE ocorreram em menor intervalo de tempo.

Estradiol and testosterone concentrations in follicular fluid as criteria to discriminate between mature and immature oocytes

The objective of the present study was to examine the association between follicular fluid (FF) steroid concentration and oocyte maturity and fertilization rates. Seventeen infertile patients were submitted to ovulation induction with urinary human follicle-stimulating hormone, human menopausal gonadotropin and human chorionic gonadotropin (hCG). A total of 107 follicles were aspirated after hCG administration, the oocytes were analyzed for maturity and 81 of them were incubated and inseminated in vitro. Progesterone, estradiol (E2), estrone, androstenedione, and testosterone were measured in the FF. E2 and testosterone levels were significantly higher in FF containing immature oocytes (median = 618.2 and 16 ng/ml, respectively) than in FF containing mature oocytes (median = 368 and 5.7 ng/ml, respectively; P < 0.05). Progesterone, androstenedione and estrone levels were not significantly different between mature and immature oocytes. The application of the receiver-operating characteristic curve statistical approach to determine the best cut-off point for the discrimination between mature and immature oocytes indicated levels of 505.8 ng/ml for E2 (81.0 percent sensitivity and 81.8 percent specificity) and of 10.4 ng/ml for testosterone (90.9 percent sensitivity and 82.4 percent specificity). Follicular diameter was associated negatively with E2 and testosterone levels in FF. There was a significant increase in progesterone/testosterone, progesterone/E2 and E2/testosterone ratios in FF containing mature oocytes, suggesting a reduction in conversion of C21 to C19, but not in aromatase activity. The overall fertility rate was 61 percent but there was no correlation between the steroid levels or their ratios and the fertilization rates. E2 and testosterone levels in FF may be used as a predictive parameter of oocyte maturity, but not for the in vitro fertilization rate.

Seminoma primário do mediastino / Primary mediastinal seminoma

O seminoma é um tumor maligno de células germinativas que possui como sitio primário preferencial os testículos, embora existam raros casos de localização extra-gonadal. Os autores relatam caso de seminoma primário de mediastino em paciente masculino, 26 anos de idade, que apresentava dispnéia progressiva, tosse seca, rouquidão, dor torácica eventual, obstrução óbvia da veia cava superior e massa volumosa e palpável no mediastino ântero-superior. O diagnóstico etiológico foi suspeitado pelos exames de imagem, anatomopatológico e marcadores séricos e firmado pelo estudo imuno-histoquimico. Não havia evidência de metástase à distância, mas o tumor estava localmente avançado. O tratamento proposto foi poliquimioterápico com esquema PEB (cispiatina, etoposide e bleomicina) e o paciente evoluiu sem maiores intercorrências.

The seminoma is a malignant germ cell tumor that is rarely placed in an extra-testicular position. A 26 years old male patient with primary mediastinal seminoma was studied. His symptoms were: progressive dyspnea, unproductive cough, hoarseness, occasional chest pain, obvious superior vena cava obstruction, and a huge and palpable mass located in the upper anterior mediastinum. Image exams, serum markers and histological study led to diagnosis, of seminoma which was confirmed by immunohistochemical study. There was no evidence of distant metastatic disease although it was locally advanced. After the beginning of the treatment with chemotherapy, the patient's symptoms were improved.

Management of undescended testis.

The term cryptorchidism indicates a testis, which has failed to descend to the scrotum and is located at any point along the normal path of descent or at an ectopic site. Hormones play a pivotal role in testicular descent except during the migration to the level of internal inguinal ring. Cryptorchidism is present in about 4.5% of newborns with a higher incidence in preterms. The incidence decreases to 1.2% by the first year. It is classified as palpable and impalpable. The most common site of an ectopic testis is superficial inguinal pouch. Retractile testis is often bilateral and most common in boys between 5 and 6 years of age. Hypospadias and inguinal hernias are the most common associated anomalies seen with undescended testis. A thorough clinical examination helps in arriving at the etiology. A short hCG stimulation test helps to exclude anorchia. Different imaging techniques are of little help in diagnosis and require the help of an experienced radiologist. Laparoscopy has an important role in the diagnosis and management of undescended testis. The common complications include torsion and atrophy of testis. Infertility is seen in about 40% of unilateral and 70% of bilateral cryptorchidism. Undescended testis is 20 to 40 times more likely to undergo malignant transformation than normal testis. Both hCG and GnRH have been used with limited success in these children. All boys with cryptorchidism should be referred to a pediatric surgeon before 2 years of age. These children should be followed up every year after surgery to identify testicular tumors.