Two cases of idiopathic retroperitoneal fibrosis (IRPF) were reported. The first case, in a 72-year old man, was admitted for hydronephrosis with indistinct origin. Following percutaneous nephrostomy, biopsy of retroperitoneal tissue was performed, and IRPF was diagnosed. The treatment consisted of bilateral ureterolysis, intraabdominal transposition of ureters and oral administration of prednisolone for 3 months. The second case, in a 51-year-old woman, was admitted for the evaluation of severe azotemia. As ovarian carcinoma and its ureteral invasion was suspected, simple hysterectomy and bilateral ovariectomy were performed. Typical histological finding of IRPF was also observed. Oral administration of prednisolone has been continued for two years. Recurrence of IRPF has not been observed in these two cases for over two years.
Treatment of immature rats with pregnant mare serum gonadotrophin followed by human chorionic gonadotrophin (HCG) caused an acute and temporary increase in concentrations of progesterone, testosterone and oestradiol in plasma with maximum levels 3 h after the administration of HCG. Concurrent injection of indomethacin and HCG reduced, in a dose-dependent manner, the mean number of ova shed and this was accompanied by a dose-dependent decrease in concentrations of plasma progesterone and testosterone but not of oestradiol when they were measured 3 h after the injection of HCG. The minimum effective dose that blocked ovulation completely at 0 h abolished the acute increase of progesterone and testosterone, suggesting that prostaglandins act on ovulation by stimulating steroidogenesis at an early stage in the preovulatory process. The anti-ovulatory action of the minimum effective dose at 0 h became progressively less potent as the time between injection of HCG and administration of indomethacin was increased, although plasma concentrations of progesterone and testosterone measured at autopsy 18 h after treatment with HCG had not changed appreciably. When indomethacin was administered 10 h after HCG, the relationship between the dose of indomethacin and the mean number of ova differed from that observed when simultaneous injections of indomethacin and HCG were given, and the minimum effective dose that prevented ovulation was much higher than that at 0 h, suggesting that prostaglandins act differently on ovulation in the later stage of the preovulatory process. It was concluded that prostaglandins may mediate the action of HCG on ovulation through two mechanisms which operate at different stages of the preovulatory process.
To investigate steroidogenic function of human follicles in the light of their structures, eight antral follicles of different sizes were mechanically isolated from ovaries of patients laparotomized in the follicular phase of the menstrual cycle with or without pretreatment with human menopausal gonadotropin (hMG). A portion of each follicle was taken for histology and slices of each follicle were incubated with [1-14C]-acetate. Incorporation into progestins, androgens, and estrogens was assessed by the reverse dilution technique with recrystallization to constant specific activity. A predominant incorporation into androstenedione with a lesser incorporation into 17β-estradiol was observed in two maturing follicles, whereas a marked increase in incorporation into 17β-estradiol with a concomitant decrease in incorporation into androstenedione was verified in two other mature follicles. Remarkable enhancement in relative incorporation into C21 steroids was commonly noted in four preovulatory follicles. However, with the progress of preovulatory stages toward ovulation, as judged from structural changes of the follicles, actual incorporation into C19 and C18 steroids showed a moderate increase, followed by a drastic decrease around the time of ovulation. hMG injection induced similar relationships between the steroidogenic: pattern and the follicle structure of different stages, although overall incorporation was considerably increased. We conclude that marked qualitative and quantitative changes in the steroidogenic function and accompanying corresponding changes in structure occurred over the period of follicular maturation and ovulation.
Steroid hormone biosynthesis by human ovarian follicles in vitro over a period of follicular maturation and ovulation was studied in the light of follicle morphology. The largest follicle was isolated from each of the five ovaries removed at various stages in the follicular phase of the menstrual cycle from patients who were undergoing surgery for carcinoma of the uterus. Slices of each follicle tissue were incubated with 50μCi of acetate-1-14C in Hanks's solution for 3 hours at 37°C under the gas phase of 95% oxygen and 5% carbon dioxide. A portion of the follicle was subjected to histological examination. Incorporation of radioactive acetate into pregnenolone, 17α-hydroxypregnenolone, progesterone, 17α-hydroxyprogesterone, dehydroepiandrosterone, androstenedione, testosterone, estrone and estradiol-17β were assessed by a reverse isotope dilution technique with recrystallization to constant specific activity.Although a minimum amount of incorporation of radioactive acetate into progestogens and estrogens was identified, androstenedione was the only major product in a less matured follicle which had a moderate proliferation granulosa cells and a relatively small thecal cell.On the other hand, the predominant incorporation into estrone and estradiol-17β with a concomitant slight increase in the incorporation into progestogens was observed in a mature follicle as judged by its histology with marked proliferation of granulosa cells and regularly arranged nuclei in the elongated basal granulosa cells.Progesterone and 17α-hydroxyprogesterone were the major steroidal products in the two preovulatory follicles. These were characterized by granulosa cells tending to be ovoidal in shape with a relatively abundant cytoplasm, a slight swelling of the thecal cells and hyperemia in the thecal layer, although these morphological features differed from each other to a considerable degree.In the follicle just prior to rupture, as evidenced histologically by the indistinguishable border between granulosa and thecal layer, and the contracted thecal cells sparsely scattered in surrounding hemorrhage, only progesterone preserved a relatively high production. On the other hand, 17a-hydroxyprogesterone showed a distinct decrease, and the production of androgens and estrogens were severely interrupted in this follicle.The role of the granulosa and thecal cells is discussed in relation to the above described changes in steroidogenesis.
