Plantes et dysfonction érectile

Résumé: La dysfonction érectile est un phénomène de santé relativement important dont les conséquences sont néfastes pour lhomme et son entourage. De nombreux traitements par des molécules de synthèse sont actuellement proposés pour pallier ces troubles, mais leur coût élevé, ainsi que les effets secondaires quils engendrent, redonnent un nouvel élan aux substances naturelles. Certaines préparations dorigine végétale nont pourtant aucun effet et ne sont pour la plupart que légendes. Dautres, peu nombreuses, ont une activité réelle prouvée sur le plan scientifique. Par ailleurs, de nombreuses plantes prometteuses dans le traitement des dysérections nont fait lobjet que de rares investigations et mériteraient une étude pharmacologique plus approfondie.     

HDL-cholesterol level and cortisol response to synacthen in critically ill patients

Objective To explore the relationship between cholesterol levels and the adrenal cortisol response to synacthen in critically ill patients.Design Prospective observational study.Patients Critically ill patients with multiple organ dysfunction syndrome (MODS) with possible adrenal dysfunction defined as unexplained hypotension, ongoing inotropic support, unexplained fever, unexplained hyponatraemia or a combination of these symptoms.Measurements HDL-cholesterol levels (HDL), total cholesterol levels (TC), and triglycerides (TG) before administration of synacthen. LDL-cholesterol was calculated using the Friedewald formula. Basal cortisol and response to 250 g synacthen intravenously was measured. A cortisol rise of 0.25 mol/l in a 30-min or 60-min blood sample after synacthen infusion was defined as a proper adrenal response.Results Patients with a proper response to synacthen showed higher HDL-cholesterol levels than patients without that response (P=0.02). Severity of disease as measured by APACHE II or SOFA was not a confounder. LDL-cholesterol levels were extremely low in both responders and non-responders and were not associated with the absolute rise in cortisol. In linear and logistic regression analysis HDL-cholesterol was the sole predictor of cortisol response.Conclusions Adrenal cortisol response to a classic 250-g synacthen test relates in critically ill patients to HDL-cholesterol levels. LDL and TC levels did not show such a relation. These findings are in concordance with known biochemical pathways of cortisol production.     

The roles of historical experience and construct accessibility in judgments about alcoholism

A preliminary survey study (1) screened potential subjects and (2) identified characteristics associated with alcoholic and social drinker labels. Subjects at three experience levels (parent alcoholic, friend alcoholic, and no experience) then participated in a perception experiment in which a construct (alcoholic/social drinker) was experimentally primed, followed by an interpersonal understanding experiment in which subjects rated the drinking habits either of hypothetical others or of the self in hypothetical situations. Results indicated that primes significantly interacted with level of prior experience (only subjects with no historical experience tended to make drinking judgments that were more in the direction of alcoholism following an alcoholic prime). Results are discussed in terms of the notion that increased historical exposure to a construct may lead to the development of clearer construct boundaries, thereby reducing the tendency toward indiscriminate construct use under conditions of heightened accessibility.The present research was supported in part by the National Institute on Alcohol Abuse and Alcoholism Research Grant No. AA-06319 to the first author. Parts of this study were presented at the annual meeting of the American Psychological Association, Anaheim, California, August 1983.     

Patient assessment of a combined medical and nursing preparation to cytotoxic chemotherapy

At Auckland hospital there is a combined medical and nursing preparation for patients receiving cytotoxic chemotherapy. The aim of the current study was to assess whether patients felt that this combined approach had prepared them adequately for chemotherapy. Patients were asked to complete three questionnaires anonymously at different times in their treatment programme: Immediately prior to chemotherapy, after three cycles of chemotherapy and 2 months after completion of chemotherapy. A high level of satisfaction with the programme was demonstrated: 68% of patients thought the orientation programme had prepared them very well, 32% adequately and none poorly for their chemotherapy. Separate interviews with medical and nursing staff were thought a good idea by 86% of patients and only 1 of 100 medical and 100 nursing interviews was assessed as not worthwhile. This study suggests that a combined medical and nursing preparation is a worthwhile practice in preparing patients for cytotoxic chemotherapy.     

Optimizing outcomes with antimicrobial therapy through pharmacodynamic profiling

In patients with infection, improving the probability of positive treatment outcomes depends on optimizing the interactions between the host, pathogen, and drug. In this setting, optimal regimens must be utilized which not only maximize effectiveness in a specific patient, but also minimize the development of microbial resistance. The probability of achieving a specifically targeted antimicrobial exposure can be assessed using Monte Carlo simulation, a technique which integrates an agents in vitro potency distribution (i.e., minimum inhibitory concentrations [MICs]) with the pharmacokinetic profile. The targeted pharmacodynamic parameters assessed by this technique include the ratio of peak concentration (C_max) to MIC (C_max:MIC); the ratio of the area under the plasma concentration-time curve (AUC) to MIC (AUC:MIC), and the time the drug concentration exceeds the MIC (T MIC). Some antimicrobials, e.g., the aminoglycosides, are most effective/bactericidal when they have a high C_max:MIC ratio; others, e.g., the fluoroquinolones, are more effective when the AUC:MIC ratio is high. In both of these scenarios, organism eradication is concentration-dependent, and the therapeutic goal is to maximize drug exposure. Like the fluoroquinolones, the efficacy of telithromycin, a newly developed ketolide, is most related to the AUC:MIC ratio. Outcome for other agents, such as the -lactams, is best predicted by the T MIC; in this case, organism eradication is time-dependent, and the therapeutic goal is to optimize the duration of antimicrobial exposure. This article discusses how the use of currently available antimicrobials can be optimized through an appreciation of pharmacodynamic profiling.     

The Use of “As Many As Can” Versus “Feel Like Continuing” Stop Rules During Worrying

Two studies are reported that investigated the processes involved in stopping worry. Study 1 found that the use of as many as can stop rules was significantly related to measures of trait worry and beliefs about the positive and negative consequences of worrying, and Study 2 demonstrated that the reported use of as many as can stop rules significantly predicted perseveration on behavioral measures of catastrophic worrying. Reported use of feel like continuing stop rules was unrelated to any measures of worry in both studies. These results indicate that the use of as many as can stop rules is a highly significant predictor of worry frequency and perseveration, and that beliefs about the positive and negative consequences of worry also independently predict the use of as many as can stop rules. These findings are consistent with (1) the view that the stop rules used by worriers are closely associated with, or directly derived from, the more stable, global beliefs that worriers hold about the utility of the worry process, and (2) predictions from the mood-as-input model of catastrophic worrying (H. M. Startup & G. C. L. Davey, 2001).     

Stories from doctors of patients with pain. A qualitative research on the physicians’ perspective

Goal of work .The aim of this study was to explore the physicians internal representation of the doctor–patient relationship in the dramatic field of the patient with pain.Methods Using an open narrative format, 151 physicians were asked to Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain. The narrations were examined in accordance with a clinical-interpretive method.Main results Three perspectives of observation were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the depersonalization of pain. In the professional perspective, the narrative concerns the patient as a person and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives.Conclusions The professional perspective seemed to be the only place in which physicians could stop, a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.     

Comparative effects of cuff size and tightness of fit on accuracy of blood pressure measurements

To determine the effect of snugness of cuff wrap on the accuracy of blood pressure (BP) measurements, we performed two studies on 6 healthy volunteers. In both studies, control values were obtained from the right upper arm with cuffs of appropriate size and snug fit. Study 1 had two phases. In the first, cuffs of appropriate size were wrapped snugly around the upper left arm of seated subjects. The effects of two other degrees of cuff snugness on the measurement of BP were evaluated by placing a filled 250-mL intravenous fluid bag between the cuff and arm over the triceps, measuring BP, then draining the same bag of half its contents and then all of its contents without rewrapping the cuff (loose, very loose fit), each time measuring BP. The second phase of study 1 was identical in procedure, except that the cuffs used on the left arm were one size too small. In study 2, the experimental cuffs were placed just above the right ankle. To alter the signal-to-noise ratio, BP was raised or lowered: the standing position elevated mean BP by an average of 90 mm Hg, and elevation of the legs decreased mean BP by an average of 43 mm Hg. In study 1, we found that appropriately sized cuffs, whether wrapped tightly or loosely, gave correct BP readings. Cuffs snugly wrapped, but too small for the subject, gave high BP readings, on the average by approximately 10 mm Hg. Loose wrapping of small cuffs gave variable results in individual subjects that exaggerated systolic BP from 2 to 80 mm Hg. In study 2, elevating the legs or standing decreased or increased BP consistently. Loose wrapping of appropriately sized cuffs around the ankles of the subjects had no additional significant effect on BP.     

The “lung pulse”: an early ultrasound sign of complete atelectasis

Objective Complete atelectasis can be immediately generated by selective intubation. A dynamic lung ultrasound sign can be described as the association of absent lung sliding with the perception of heart activity at the pleural line, a sign which was called lung pulse. We examined whether this sign be used promptly to confirm complete atelectasis due to selective intubation.Design and setting Prospective study in the medical intensive care unit of a university-affiliated teaching hospital.Patients Consecutive patients with no history of respiratory disorders and needing intubation were enrolled. Fifteen patients with selective intubation of the right lung were compared with 30 patients with nonselective intubation and 15 healthy volunteers.Interventions The lung pulse was sought at the left anterolateral chest wall in intubated patients. Healthy subjects were studied during breathing and apnea.Results A left lung pulse was immediately present in 14 of 15 patients with right selective intubation, and absent, with normal lung sliding, in all 30 correctly intubated patients and in all 15 healthy subjects during breathing. All healthy subjects exhibited a lung pulse in apnea. The lung pulse had a sensitivity of 93% and a specificity of 100% for the diagnosis of complete atelectasis following selective intubation in patients without previous respiratory disorders.Conclusions The lung pulse is a sign of complete atelectasis which is observable immediately before radiological changes. Its absence which is correlated with the absence of selective intubation and of conserved lung inflation can eliminate the need for confirmation radiography.Electronic Supplementary Supplementary material is available in the online version of this article at .     

Prostacyclin counteracts the increase in capillary permeability induced by tumour necrosis factor-α

Objective To analyse how prostacyclin interferes with the short-term local circulatory effects of tumour necrosis factor- (TNF) in a skeletal muscle.Design An autoperfused sympathectomised cat gastrocnemius muscle enclosed in a plethysmograph.Interventions Arterial blood flow, total and segmental vascular resistances (large-bore arterial vessels, arterioles and veins), hydrostatic capillary pressure, tissue volume and capillary filtration coefficient were followed during local intraarterial infusion of TNF at various rates (2.5, 5.0 and 7.5 g/kg per min) and during intra-arterial infusion of prostacyclin simultaneously with the highest dose of TNF. The capillary filtration coefficient reflects the capillary surface for fluid exchange.Results Arterial infusion of TNF had no influence on vascular resistance up to 5.0 g/kg per min but induced vasodilation at 7.5 g/kg per min. No effects on the recorded hydrostatic capillary pressure were observed. The capillary filtration coefficient and the capillary filtration increased with the infusion rate of TNF the former by 55%. Simultaneous arterial infusion of prostacyclin (350 ng/kg per min) caused further vasodilation and an increase in hydrostatic capillary pressure and completely restored the capillary filtration coefficient to control. The TNF-induced filtration was partly restored.Conclusions The local circulatory effect of TNF is small apart from a graded increase in the capillary filtration coefficient, most likely reflecting an increase in capillary permeability. The prostacyclininduced decrease in capillary filtration coefficient most likely reflects a restoration of capillary permeability. The TNF-induced transcapillary filtration is not fully reduced by prostacyclin due to a simultaneous increase in hydrostatic capillary pressure.