早泄的诊断与分型

在复习国外有关研究的基础上，提出了本文作者拟议的早泄的亚型分类。     

早泄的诊断与分型

在复习国外有关研究的基础上 ,提出了本文作者拟议的早泄的亚型分类     

早泄的处理 --读者来信

编辑先生 :早泄虽系与心理因素有关的生理障碍 ,教科书上这方面讲的过于简单 ,能否谈谈早泄应怎样处理 ?河北省　李益答读者来信李益医师 :针对您提出的问题 ,查了有关文献 ,答复如下。男性性乐高潮是以射精为标志 ,射精过快时称早泄 ,早泄可引起性交不满意 ,严重者阴茎未插入阴道时就射精 ,成年男性早泄患病率为 30 %～ 4 0 % [1] 。1　病因1 1　焦虑与敌意　有人推测 ,射精阈降低是对阴道的害怕和焦虑 ,是对女性的敌意或与特定性伙伴的冲突。此外 ,早年与妓女匆忙的性体验 ,或在小汽车中快速做爱时形成了条件反射。该反射一旦建立 ,操作性…     

氯丙咪嗪治疗早泄的临床研究

早泄是男性性功能障碍之一,发病率因定义不一而差异较大,可为9%～38%。本研究使用氯丙咪嗪治疗早泄病人50例,报告如下。1　对象与方法入组标准:符合CCMD2R和DSM早泄的诊断标准,已婚,有规律性生活的男性,无勃起功能障碍,无肝、肾疾病,并自愿加入为期4周的治疗。共50例,年龄...     

星状神经节阻滞与氯米帕明治疗早泄对照研究

目的:比较星状神经节阻滞与氯米帕明治疗早泄的疗效。方法:将60例早泄患者随机分为两组各30例,神经节阻滞组用星状神经节阻滞,隔日1次,7次为1疗程。药物组口服氯米帕明25mg/晚,最好性交前1h口服,15d为1疗程。两组均治疗1个疗程,观察疗效。结果:两组在治疗1个疗程后与治疗前比较差异均有显著性(P均<0.01),两组间治疗后比较差异有显著性(P<0.01)。结论:星状神经节阻滞、口服氯米帕明治疗早泄均有良好效果,神经节阻滞组对早泄的改善明显优于药物组,治愈率高,起效时间快,不良反应轻,复发率低。     

心理干预合并小剂量氯米帕明治疗早泄的对照研究

目的探讨心理干预合并小剂量氯米帕明治疗早泄的效果。方法将33例符合CCMD-3诊断标准的早泄病人随机分成单用氯米帕明治疗组与合并心理干预组。于治疗前、治疗后3周及6周进行性功能状况和TESS评定。结果两组疗效均显著;治疗后3周及6周的性功能状况评分与治疗前相比,其差异有显著性,合并组效果更好且持久。TESS评分两组无明显差异。结论氯米帕明能明显延长射精潜伏期,可用于治疗早泄,若合并心理干预则可提高疗效。     

颅脑外伤与精神障碍的因果关系鉴定

近年来,颅脑外伤后出现精神障碍的鉴定案例明显增加,其中大多数是交通事故,也有部分是殴斗事件;当出现精神障碍时常涉及伤残程度评定及经济索赔。鉴定结论出现分歧也是经常的事,分歧内容包括脑外伤事实的确实性、因果关系及伤残程度评定等。为了提高鉴定结论的一致性,本文着重就因果关系问题提出看法,供同道参考。一、关于因果关系的类型在鉴定实践中,各学者提出的名称及概念并不完全一致,需要注意。有人将因果关系分为,(1)直接因果关系:指外伤性因素直接作用于健康脑部,致脑的解剖学结构受到破坏,并导致出现精神障碍。(2)间接因果关系:…     

海马硬化与癫痫的因果关系探讨

为了探讨海马硬化与癫痫的因果关系，选用Ｗｉｓｔａｒ大鼠以马桑内酯肌肉注射，制成全身强直－阵挛性发作的癫痫动物模型，并于点燃后连续用药，分别引起Ⅳ级以上抽搐发作２０和４０次。同时建立生理盐水和安定对照组，后者于注射马桑内酯前注射安定，以避免抽搐。并对海马ＣＡ１区进行病理形态学观察。结果显示，马桑内酯注射组与安定组大鼠海马ＣＡ１区有明显的病理改变，锥体细胞变性坏死，神经胶质细胞水肿变性，突触结构异常。抽搐４０次组病理变化重于抽搐２０次组，后者又重于安定组。生理盐水组未见上述改变。结果提示，马桑内酯可引起大鼠海马ＣＡ１区神经元损伤，既使无抽搐发作时也可造成这种损伤。反复严重的抽搐发作又可进一步加重海马ＣＡ１区的病损，抽搐次数越多，损伤越重。海马硬化可能是抽搐反复发作造成的结果。     

脑血管病防治研究的回顾、进展与展望

中华神经科杂志创刊已经历了半个世纪，如实记录了我国50年来脑血管病重要临床防治诊疗研究发展的概况。今天，为了纪念50年来此领域辉煌的成绩，在此引用部分国家级研究项目和成果内容及其他资料，简要地做一个重点回顾。     

脑血管生成与脑梗死的研究动态

治疗性脑血管生成方法的出现 ,为急性脑梗死的治疗开辟了一条通向缺血性脑卒中再血管化的新途径 ,现简述如下。一、脑血管生成的分子学基础脑血管生成可区分为 4个阶段 ,即最初的内皮细胞活化阶段 ,主动的血管生成的两个连续阶段和仅为血管周期性增殖的最后阶段。Ｐｌａｔｅ认为 ,脑血管生成是一个严密的调控过程 ,它受神经外胚层来源的生长因子与内皮细胞上表达的酪氨酸激酶受体结合而调节。大鼠脑血管生成 ,在出生后约2 0ｄ即告完成。但在病理情况下 ,如脑血管缺氧 /缺血、脑肿瘤生长 ,内皮细胞在成年后仍可增殖。现有证据显示 ,这种病理…     

Social phobia and premature ejaculation: a case-control study

In a previous case-control study, we found marked differences between a group of patients with male sexual disorders and a control group without any sexual disorder regarding the percentage of social phobia (SP) in each group. On this basis, our aim in this study was to test the hypothesis that premature ejaculation (PE) as a specific sexual disorder and SP might be strongly related, by comparing subjects with PE to a control group without any sexual disorder regarding the diagnosis of SP. Subjects with PE were recruited at private practice sexology settings in France. Control subjects were recruited among inpatients in a surgical ward. Diagnosis of SP was made with the Composite International Diagnostic Interview. Diagnosis of PE was clinician-rated according to DSM-IV criteria. Eighty-five subjects with PE only were compared to 93 control subjects without any sexual disorder. Forty (47%) subjects with PE versus 8 (9%) controls were diagnosed with SP (chi(2)=3.35, df=1, P=.001). Logistical analysis showed that SP and PE were strongly associated (odds ratio=10.97, 95% CI=4.49-26.06; chi(2)=28.28, df=1, P=.0001). This study is the first to show a clear relationship between SP and PE. Although requiring confirmation by further studies, this finding has immediate clinical consequences given that SP and PE can be treated by the same medication, a selective serotonin-reuptake inhibitor (SSRI). Moreover, since SP is a likely risk factor for PE, this might argue for preventive action on both disorders in children.     

New agents in the treatment of premature ejaculation

Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggest that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have “definite” PE, while men with IELTs between 1 and 1.5 minutes have “probable” PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors (SSRIs) offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains and is well tolerated. Investigational drugs such as the ejaculo-selective serotonin transport inhibitors (ESSTIs) such as dapoxetine and UK-390,957 represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control, and sexual satisfaction with minimal adverse effects.     

Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction

Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.     

Premature ejaculation: therapist perspectives

Premature ejaculation (PE) is a common sexual dysfunction affecting approximately 20%–30% of men. Despite important issues relating to PE definition, diagnosis, and therapy, there is a paucity of research investigating the experiences of practitioners delivering PE treatment. For the present study, interviews were conducted with eight psychosexual therapists and subjected to interpretative phenomenological analysis. Four master themes emerged from the analysis. These were Romantic Relationships, Vulnerability, Culture, and Diagnosis and Assessment. The Romantic Relationships theme included three sub-themes: Intimacy; Involvement; and Distress. Two sub-themes formed the Vulnerability theme: Self-Esteem; and Anxiety. The Culture theme contained three sub-themes: Religion and Ethnicity; Pornography; and Masculinity. The Diagnosis and Assessment theme included two sub-themes: Referral and Definitions. Findings have important implications for the diagnosis and treatment of PE. Future research should investigate therapist perceptions further, including those factors which impact on engagement with clients and PE treatment success.     

The experiences of men living with inhibited ejaculation

This study describes the experience of inhibited ejaculation in five men using qualitative methods. All the men shared some common features that emerged as four major themes. These were Sexual Development, Relationships, Fantasy versus Reality and Perception of the Problem/Situation. The participants described low self-esteem and lack of confidence in adolescence. They described a history of unhappy relationships and relationships outside of marriage. Sex in long-term relationships had become mechanical and they were unable to express their sexual needs. Masturbation appeared to be their preferred method of sexual satisfaction. The study concludes that an integrative approach to therapy is most suited for men living with inhibited ejaculation.     

Self-directed treatment for premature ejaculation: Preliminary case reports

Two case reports provide preliminary evidence that couples can successfully treat premature ejaculation using instructional materials in conjunction with minimal therapist contact. Following written treatment instructions and with less than one hour of phone contact with a therapist, each couple was able substantially to increase intercourse duration. Pre-, post-, and eight month follow-up information was collected and a method for obtaining objective data on ejaculation latency is described.