Forty-eight patients with idiopathic normogonadotrophic oligozoospermia were treated with hMG plus hCG over a period of 3 months. Total sperm output increased by an average of 15.3 million spermatozoa per ejaculate and a similar significant increase was seen in the percentage of motile spermatozoa. Sixteen of the 48 men increased their sperm output by 25 million or more. Follow-up information was available in 33 patients. Ten pregnancies were reported within one year after initiation of treatment. Six of 12 responders impregnated their wives, whereas only 4 pregnancies were reported in a group of 21 non-responders. Endocrinological investigations showed no differences in mean basal levels of LH and FSH, or in the gonadotrophin response to a 100 micrograms GnRH stimulation between responders and non-responders. However, mean basal plasma testosterone concentration was significantly lower in the responder group than in the non-responders. Responsiveness to gonadotrophin treatment tended to be better in patients with basal plasma testosterone concentration lower than 4.5 ng/ml. Combined hMG/hCG treatment in subfertile men with idiopathic oligozoospermia seems to be efficient in only a small proportion of cases.

The patient, diagnosed as a case of testicular feminisation in infancy, was examined at the age of 15 years because of severe symptoms of virilising puberty with poor breast development. Plasma steroid analyses revealed a 10-fold elevated androstenedione concentration (A: 1562 ng/100 ml). Testosterone (T: 266 ng/100 ml) was in the male pubertal range. Thus the A/T-ratio was far above normal. The oestrone/oestradiol ratio was also elevated (Oe1/Oe2: 10.2/2.2 ng/100 ml). A, T, Oe1 and Oe2 could not be suppressed by dexamethasone, but reacted promptly to fluoxymesterone (A: 781 ng/100 ml). hCG caused a further increase of the A/T-ratio (2220/246 ng/100 ml); ACTH did not alter the A-concentration. These findings together with simular investigations after gonadectomy suggest that the failure to convert A to T and Oe1 to Oe2 is essentially located in the testes. In vitro incubations of testicular tissue showed reduced 17-ketosteroid reductase activity in tissue slices and in the subcellular fractions microsomes and cytosole. This form of male pseudohermaphroditism can easily be detected already in infancy, if steroid analyses and stimulation tests are performed. In case of female sex assignment patients should be submitted to early orchidectomy in order to avoid virilisation in puberty.

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Retrospektiv wurde bei alien in die Onkologische Klinik Bad Trissl stationär aufgenommenen Mammakarzinompatientinnen der Jahre 1984/85 der Einfluß eines manifesten Diabetes mellitus auf den Verlauf der malignen Erkrankungen, besonders auf das Auftreten von Metastasen geprüft. Von 863 Patientinnen konnten 752 statistisch ausgewertet werden. Dabei wurden Übergewicht, Fettstoffwechselstörungen, Lebensalter und Menopausenstatus ebenso berücksichtigt wie Tumorgröße und Nodalstatus bei Primärtherapie sowie Unterschiede in der Beobachtungszeit. Patientinnen mit Diabetes mellitus wiesen gegenüber Patientinnen ohne Kohlenhydratstoffwechselstörungen eine doppelt hohe Metastasierungsrate bei Mammakarzinom auf. Der Unterschied beider Gruppen war hochsignifikant (p < 10^-5). Die Signifikanz zwischen der Erkrankung Diabetes mellitus und höherer Metastasierungshäufigkeit gegenüber der Gruppe von nicht-diabetischen Mammakarzinom-Patientinnen blieb auch bei Berücksichtigung der Tumorgröße, Nodal-status, Lebensalter und Beobachtungszeit seit Primärtherapie als Störgrößen in einer Cochran-Mantel-Haensel-Analyse erhalten. Übergewicht, Fettstoffwechselstörungen, Lebensalter und Menopausenstatus korrelierten zwar mit dem Diabetes mellitus, nicht jedoch mit dem Auftreten einer Metastasierung.

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