This review attempts to summarize and discuss contemporary pathogenetic views on vibration-induced Raynaud's phenomenon assuming its multifactorial etiology. An increase in central and peripheral sympathetic nervous activity is discussed based on different physiological indicators of autonomic dysfunction and sympathetic hyperactivity. Local acral vasodysregulation is considered. Receptor and nerve endings dysfunction presented with predominance of alpha(2)-receptor function in the digital arteries and neuronal loss in those digital cutaneous perivascular nerves containing calcitonin gene-related peptide result in deficiency of endogenous release of this powerful vasodilator. Endothelial damage and dysregulation induced by vibration and increased shear stresses are demonstrated by the elevated plasma level of thrombomodulin and of von Willebrand factor and reduced endothelium-dependent vasodilator responses. The concentrations of endothelin-1 are high, the highest being in most advanced stages. Decreased plasma thiol level, indicating increased production and activity of free radicals, contribute to vasospastic paroxysms in vibration white finger patients. Dysbalance of local vasoactive factors with opposing effects on vascular smooth muscle like endothelin and nitric oxide, endothelin and calcitonin gene-related peptide, nitric oxide and superoxide anion are discussed. Disturbed smooth muscle response is supposed. Changes in hemostasis, fibrinolysis and hemorrheology, activation of blood cells with erythrocyte hyperaggregation and red cell hypodeformability, platelet aggregation with increased release of vasoconstricting thromboxane A(2) and serotonin as well as leukocyte activation, entrapment within capillaries and post-capillary venules and increased reactive oxygen species and lysosomal lytic enzymes release might also contribute to digital vasospasms and tissue damage. Elevated soluble intercellular adhesion molecule-1 levels involved in the adherence of leukocytes to endothelium and to other leukocytes have been found in patients with hand-arm vibration syndrome.

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Eight patients with congenital anorchism were examined and treated. Plasma LH, FSH, and testosterone concentrations and the saliva testosterone level were measured by RIA in 3 patients. The results showed a 2.75 times increase in LH level, a 1.66 times increase in FSH level, and hardly measurable serum and saliva testosterone amounts. A dynamic provocating test was applied in 4 patients by Pregnyl (2000 and 4000 IU) and the results showed absence of the gonads. The semen quality control manifested a low volume of ejaculate and aspermia. Scyntiscanning of 6 patients demonstrated no functional testicular parenchyma. Substitute androgen therapy in patients with diagnosed anorchism gave good results, which suggests that this treatment is appropriate and promising. Implantation of testiculo-prostheses by using silicon alloplastic material corrects the cosmetic defect and overcomes the physiological barrier caused by the biological inferiority complex.