Why do patients with erectile dysfunction abandon effective therapy with sildenafil (Viagra)?

This prospective study determined the rate of abandonment of sildenafil therapy and assessed the reasons for abandonment. Between January 2001 and December 2002, 234 patients with erectile dysfunction (ED) at three independent centers successfully began therapy with sildenafil 50 or 100 mg. The rate of noncompliance was 31%. A telephone survey of these patients was conducted to determine the reasons for abandonment. The majority reported that they had had no opportunity or desire for sexual intercourse or that their partners had shown no sexual interest. Few patients stated that the high cost of the medication or that adverse events were the cause.     

A new deficient variant of alpha1-antitrypsin (MDUARTE). Inability to detect the heterozygous state by antitrypsin phenotyping.

A new molecular variant of alpha1-antitrypsin was discovered in the family of a woman with severe antitrypsin deficiency and bullous emphysema. The variant resembles the Z variant in most respects in that it results in severe antitrypsin deficiency with the homozygous state and intermediate deficiency with the heterozygous state, and is associated with diastase-resistant, periodic acid-Schiff-positive globules in the liver cells. It differs from the usual Z variant, however, by having normal mobility on acid-starch electrophoresis so that the heterozygous state with the normal M form cannot be distinguished by phenotyping procedures on either acid-starch or alkaline-agarose electrophoresis. The variant has been labeled MDUARTE. A review of phenotype patterns in all patients previously classified as having a homozygous ZZ phenotype reveals extra, fast-moving bands on acid-starch suggestive of an MDUARTEZ heterozygous state in 7.9 per cent of such cases. When intermediate antitrypsin deficiency occurs in the presence of a normal phenotype pattern, one must consider that the patient has inherited either a null gene for antitrypsin synthesis or an MDUARTE variant.     

International regional working groups on prostate cancer: results of consensus development

At the first Global Urologic Oncology Congress--which was held in conjunction with the SIU meeting in Honolulu, Hawaii, on October 2-3, 2004--a total of 250 urologists from nine regions throughout the world participated in working groups to develop consensus statements about the management of prostate cancer patients. The focus was on two areas of prostate cancer: first, screening and detection--including when to do a biopsy, and how to manage low-risk patients--and second, management of high-risk patients. CONCLUSION: Overall, there is marked global diversity of beliefs about optimal screening and management of patients with low- or high-risk localized prostate cancer. This diversity likely reflects regional differences in epidemiologic factors, resources, and treatment patterns. Participating in the process of trying to develop international practice consensus gives urologists the opportunity to broaden their perspective about handling common clinical scenarios.     

Monitoring a Remote Phototherapy Unit Via Telemedicine

Background The delivery of effective phototherapy to patients with psoriasis living in areas devoid of dermatologists is difficult. Telemedicine has proven useful in the delivery of health care in such locations. Objective This evidence-based study sought to investigate the use of telemedicine in the monitoring of phototherapy of psoriasis patients located in a Nova Scotia region with no dermatologist. Methods Psoriatic patients were reviewed six months before and after protocols and monitoring were instituted. First, charts of 23 patient treated with phototherapy were reviewed from the Aberdeen Hospital in New Glasgow. Patients were either self-referred or referred by a family physician and occasionally a dermatologist. Treatments were not monitored by a specialist. Second, a group of 33 patients receiving treatment were supervised via telemedicine by a dermatologist 250 km away in Halifax. Results During the study period, treatment time decreased from 140 to 37 days. In the monitored group, 40% more patients were clear of psoriasis at time of discharge. The number of patients with side effects decreased. The number of self-and family practice–referred patients dropped; the clinic became a referral center for dermatologists. Conclusion Telemedicine provided an excellent way to monitor patients receiving phototherapy in an area without a dermatologist. Overall, patient care improved: More patients were treated effectively with better outcomes and fewer side effects. Antécédents Il est difficile de livrer line photothérapie efficace aux patients atteints de psoriasis qui vivent dans des régions où il n’y a pas de dermatologues. La télémédecine s’est révélée utile dans la prestation de soins de santé dans ces régions. Objectif Cette étude factuelle cherche à sonder 1’usage de la télémédecine dans l’administration de la photothérapie aux patients atteints de psoriasis qui vivent dans une région de la Nouvelle-écosse dépourvue de dermatologues. Méthodes Les patients atteints de psoriasis ont été examinés six mois avant et six mois après la mise en place des protocoles et du suivi. D’abord, les dossiers de 23 patients du Aberdeen Hospital à New Glasgow ont été revus. Les patients étaient venus par eux-mêmes ou étaient référés par un médecin de famille ou parfois un dermatologue. Les traitements n’ont pas été surveillés par un spécialiste. Ensuite, grace à la télémédecine, un groupe de 33 patients recevant des traitements a été suivi par un dermatologue établi à Halifax, soit à 250 km. Résultats Durant la durée de 1’étude, le temps du traitement est passé de 140 jours à 37 jours. Le groupe ainsi suivi comptait 40% plus de patients guéris au moment de leur congé. Le nombre de patients ayant des effets secondaires a diminué. Le nombre de patients qui venaient par eux-mêmes ou qui sont référés par des médecins de famille a diminué; La clinique est devenue un centre d’aiguillage pour dermatologues. Presented at The Atlantic Provinces Dermatology Association meeting, Halifax, Nova Scotia, January 2002; The European Teledermatology Symposium, Graz, Austria, November 2002; and the Canadian Dermatology Association Meeting, Ottawa, Ontario, July 2003. Sponsored by the Atlantic Provinces Dermatology Association.     

Rapid-acting IM ziprasidone in a psychiatric emergency service: a naturalistic study

Atypical antipsychotics have gained acceptance as first-line treatment for psychotic disorders. Rapid-acting intramuscular (IM) atypicals may supplant benzodiazepine and/or neuroleptic alternatives. IM atypical ziprasidone studies excluded severe psychiatric agitation (PSYCH), or that due to the abuse of alcohol (ETOH) or other substances (SUBS). We report Behavioral Activity Rating Scale agitation scores (range, 1-7) and duration of physical restraints in a naturalistic study in a psychiatric emergency service using IM ziprasidone 20 mg and various doses for conventional antipsychotics. Baseline scores were high for PSYCH, ETOH and SUBS patients (mean, 6.5, 6.9 and 6.6, respectively). Agitation decreased rapidly from baseline with ziprasidone [mean, 5.6, 5.3 and 5.8, respectively, at 15 min (P<.05 for all), and 4.2, 4.1 and 4.1, respectively, at 30 min (P<.01 for all)]. At 2 h, scores were 2.6, 2.1 and 2.3 (P<.01 for all versus baseline). For 9 patients receiving conventional IM antipsychotics, scores were 6.6 (baseline), 5.7 (15 min), 4.2 (30 min) and 2.9 (2 h) (P<.02 versus ziprasidone). Compared with restraint durations from 80 patients receiving conventional IM agents 1 month prior to this study, restraint duration decreased from 91+/-4 to 54+/-3 min with ziprasidone (n=77; P<.01) and varied with conventional IM agents (mean, 60+/-12 min; n=4; P=NS). None of the 19 ziprasidone patients who received electrocardiograms showed prolonged QTc; one had a dystonic reaction. IM ziprasidone appears effective for severe agitation, including agitation associated with alcohol or substance intoxication, and may reduce time in restraints.