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Leydig cell function was studied in 108 varicocele (V) patients with a mean age of 30.9 years, and a control group (C) of 46 men with a mean age of 30 years. Plasma gonadotropin levels were determined before and after GNRH stimulation. Testosterone (T), 17-OH-progesterone (17-OH-P), dihydrotestosterone (DHT) and estradiol (E2) were also assayed. Mean plasma T levels were significantly decreased in varicocele patients (V = 416 +/- 12.9, n = 106; C = 487 +/- 19.9, n = 40; P less than 0.01), while the basal 17-OH-P/T ratio was significantly increased (V = 0.38 +/- 0.02, n = 56; C = 0.28 +/- 0.02, n = 40; 0.02 greater than P greater than 0.01) and remained higher after hCG stimulation (P less than 0.01). No significant differences in mean sex steroid levels were observed when comparing varicocele patients with normal sperm counts (VN) and those who had oligozoospermia (VO). There was a significant negative linear correlation between age and 17-OH-P (n = 56; r = -0.47; P less than 0.01) and T values (n = 106; r = 0.27; P less than 0.01) in varicocele patients, which contrasted with the absence of any significant correlation with age in the controls. These data suggest that the duration of idiopathic varicocele influences testicular hormone secretion.

In the present study we determined progesterone (P), 17-OH-progesterone (17-OH-P), androstenedione (delta 4), dehydroepiandrosterone (DHEA) and testosterone (T) in spermatic venous blood of 34 varicocele patients and of 13 normal subjects. We also used the DHEA/delta 4 ratio as an index of the delta 5/delta 4 pathway ratio in testosterone biosynthesis. The mean of T and delta 4 in the spermatic blood of varicocele (V) patients appeared to be significantly lower with respect to that of normal (N) subjects (T:N = 1718.2 +/- 202.4 (SEM) nmol/l, No. 11; V = 1243.7 +/- 97 (SEM) nmol/l, No. 34; P less than 0.03. delta 4: N = 56.4 +/- 5.6 (SEM) nmol/l, No. 12; V = 38.1 +/- 4 (SEM) nmol/l, No. 27, 0.02 greater than P greater than 0.01). A negative correlation was observed between the individual age of varicocele patients and 17-OH-P (No. 34, y = -30.66x + 1300, r = -0.57, P less than 0.01) delta 4 values (No. 27, y = -1.981x + 96.52, r = -0.67, P less than 0.01). When the ratio of T precursors was evaluated, we observed a positive correlation between the P/17-OH-P ratio and age of varicocele (No. 33, y = 0.0065x-0.092, r = 0.45, P less than 0.03). The 17-OH-P/delta 4 ratio was greatly increased with respect to that of normal subjects (N = 5.12 +/- 0.93 (SEM), No. 12; V = 10.77 +/- 1.31 (SEM), No. 27; P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Testosterone (T) and 5-a-Dihydrotestosterone (DHT) was measured in seminal plasma levels of forty-four varicocele patients and in seventeen normal men. T values were not significantly different from controls, while DHT values were significantly lower in varicocele patients. When grouped the patients according to the sperm count, we observed a decrease of DHT similar to that reported by other authors in oligozoospermic patients. However in the patients with normal sperm count, where the motility was the only parameter significantly lower, DHT in the ejaculate showed again a marked decrease. In contrast to that observed in the normal subjects, in the latter group, with normal sperm count, we observed a negative correlation between the age of the patients and DHT in the ejaculate. This suggests that the duration of varicocele per se could affect DHT seminal plasma levels.

Surgical or traumatic losses of substances should preferably be made good by autografts, though "alloplastic implants" are a sound alternative. An account is given of the chemical and physical properties of intrinsic and manmade synthetic polymers. The best polymers for the preparation of endoprostheses are indicated, and reference is made to their more common indications in maxillofacial reconstructive surgery.

In order to study Leydig cell function in patients with varicoceles, we determined plasma levels of the most important testicular steroids, 17-OH-progesterone (17-OH-P) and testosterone (T) in the basal condition and after hCG stimulation. There was a significant inverse linear correlation between age, plasma testosterone, and 17-OH-P (n = 65, r = 0.316, P = 0.01, n = 48, r = 0.532, P = 0.01). This was in contrast to the absence of such correlations in normal men in the same age range. Following hCG stimulation in 16 patients the 17-OH-P/T ratio was significantly increased with respect to normal controls. No correlation was been observed between sperm count and age in varicocele patients. Analysis of variance of 17-OH-P plasma levels between the patients with a sperm count less than 10 million/ml and that of more than 10 million/ml did not reveal any significant difference. These results suggest that the deleterious effects of varicocele on seminiferous tubules and Leydig cells are unrelated. Moreover the increased 17-OH-P/T ratio after hCG stimulation suggests that some enzymatic impairment involving the last steps of testosterone biosynthesis exists in patients with varicoceles. This is evident in middle aged varicocele patients with a premature decrease of plasma levels of testosterone.