The incidence and causes of erectile dysfunction after pelvic fractures associated with posterior urethral disruption

PURPOSE: Erectile dysfunction is a common sequel of pelvic fractures, particularly those associated with posterior urethral injury when it can be neurogenic or arteriogenic due to damage to the cavernous nerves or branches of the pudendal arteries. We studied erectile function of patients with posterior urethral injuries due to pelvic fractures. MATERIALS AND METHODS: Patients referred for posterior urethral reconstruction and strictures due to pelvic fractures were evaluated before reconstruction. All patients underwent nocturnal penile tumescence testing, and if those results were abnormal, penile duplex ultrasound with intracavernous injection was performed. Patients with normal vascular function on duplex ultrasound were diagnosed with neurogenic erectile dysfunction. Those patients with abnormal arterial function on duplex ultrasound underwent arteriography to further define the extent and location of arterial damage. RESULTS: The study included 25 consecutive patients with posterior urethral strictures and a mean age of 28.6 years. Of the patients 18 (72%) had erectile dysfunction as demonstrated by nocturnal penile tumescence and all underwent penile duplex ultrasound. Ultrasound confirmed normal vascular response in 13 of the 18 patients and they were diagnosed with probable neurogenic erectile dysfunction. The remaining 5 patients (28%) with erectile dysfunction had an abnormal arterial response, and significant arterial pathology was confirmed by arteriography. CONCLUSIONS: Erectile dysfunction is common in patients with pelvic fractures associated with urethral injury. We believe that erectile function should be assessed and documented in such patients before attempting urethroplasty. In the majority of these patients erectile dysfunction is caused by disruption of the cavernous nerves with sparing of arterial inflow.     

Enhanced erythrocyte adhesiveness/aggregation in obesity corresponds to low-grade inflammation

OBJECTIVE: Previous studies have suggested that obesity enhances the inflammatory response, producing macromolecules involved in the induction and/or maintenance of increased erythrocyte aggregation. The objectives of this study were to evaluate the correlation between inflammation markers, erythrocyte adhesiveness/aggregation, and the degree of obesity and to assess phosphatidylserine expression on erythrocyte surface membrane of obese vs. nonobese individuals. RESEARCH METHODS AND PROCEDURES: Erythrocyte adhesiveness/aggregation in the peripheral venous blood was evaluated by using a new biomarker, phosphatidylserine expression was assessed by means of flow cytometry, and markers of inflammation were measured in 65 subjects: 30 obese [body mass index (BMI) = 41 +/- 7.7 kg/m(2)] and 35 nonobese (BMI = 24 +/- 2.7 kg/m(2)) individuals. Pearson correlations and Student's t test were performed. RESULTS: A highly significant difference was noted in the degree of erythrocyte adhesiveness/aggregation and markers of inflammation between the study groups. BMI correlated with erythrocyte adhesiveness/aggregation (r = 0.42, p = 0.001), erythrocyte sedimentation rate (r = 0.42, p = 0.001), high-sensitive C-reactive protein (r = 0.55, p < 10(-4)), fibrinogen (r = 0.37, p = 0.004), and white blood cell count (r = 0.45, p < 10(-4)). The degree of erythrocyte adhesiveness/aggregation correlated with erythrocyte sedimentation rate (r = 0.5, p < 10(-4)), high-sensitive C-reactive protein (r = 0.56, p < 10(-4)), fibrinogen (r = 0.54, p < 10(-4)), and white blood cell count (r = 0.32, p = 0.01). DISCUSSION: Our results suggest that obesity-related erythrocyte adhesiveness/aggregation is probably mediated through increased concentrations of adhesive macromolecules in the circulation and not necessarily through hyperlipidemia or phosphatidylserine exposure on erythrocyte's membrane.     

A Web-based approach to low-cost telemedicine

We have developed a Web-based application for managing e-consultations. This solves some of the problems inherent in peer-to-peer email communication. Referrals were from three hospitals in Vietnam. Each hospital was provided with Internet access for up to 4 hours a day for an initial 12-month period. In the first six months, six doctors from the Vietnamese hospitals submitted a total of 30 cases. Specialists in Sydney provided their expertise on a voluntary basis. Preliminary data suggest that the Vietnamese doctors found the system benefited their diagnostic and management decision making. Challenges have included equipment failures, language barriers and the difficulty of obtaining feedback. Successes have included the relationship building between doctors in the two countries. Preliminary results were encouraging and most of the Vietnamese doctors (five of the six) reported that they were slowly incorporating use of the system into their daily practice.     

Successful co‐treatment with LHRH‐agonist for ovarian over‐stimulation and cystic formation in premenopausal tamoxifen exposure

The present study evaluates the potential beneficial effect of cotreatment with LHRHagonist in resolving premenopausal tamoxifen's induced supraphysiological serum 17 estradiol levels and persistent ovarian cysts. Ultrasonographic and serum hormonal evaluations were performed before, during, and following three consecutive injections of long acting LHRHagonist administered to 14 premenopausal breast cancer patients treated with tamoxifen, who had supraphysiological serum 17 estradiol levels and simultaneous persistent ovarian cysts. Within 3 weeks of the first LHRHagonist injection, all patients had menopausal serum estradiol levels. Ovarian cysts completely disappeared within 2 months following the first injection. Following the discontinuation of LHRHagonist cotreatment, serum estradiol levels remained in physiological levels and the ovaries remained a normal size in 64.3% of the patients for 13.3 ± 11.5 months. 28.6% of the patients had a gradual reappearance of high serum estradiol levels and of ovarian cysts, and were, therefore, treated with a second course of LHRHagonist. Following the second course, serum estradiol levels remained in physiological levels and the ovaries remained a normal size for 8–15 months. It is concluded that short duration of cotreatment with long acting LHRHagonist administered to premenopausal breast cancer patients treated with tamoxifen, successfully resolved the tamoxifeninduced supraphysiological serum 17 estradiol levels and the ovarian cysts.affiliated with Sackler Faculty of Medicine, Tel Aviv University     

Monoclonal antibodies to ciliary glycoproteins of frog olfactory neurons

Monoclonal antibodies were produced against isolated frog olfactory cilia, a preparation enriched in dendritic extensions of the chemosensory neurons. Two antibodies, 18.1 and 35.6, were found to react against specific glycoproteins of the sensory organelles. These glycoproteins were identified by their differential binding to the lectins wheat germ agglutinin and Concanavalin A. The antibodies fluorescently labeled isolated olfactory cilia, as well as the ciliary surface layer of olfactory epithelium, whose extent was defined by anti-tubulin and anti-keratin antibodies. Respiratory epithelium (or other tissues) as well as isolated respiratory cilia were not labeled by antibodies 18.1 and 35.6, indicating tissue specificity. The olfactory-specific antibodies can be used as markers of the sensory epithelium and of the sensory regions of olfactory dendritic membranes. Antibody 18.1 recognized gp95, a specific and major integral membrane glycoprotein of frog olfactory cilia. Since gp95 has been suggested as candidate olfactory receptor protein (Chen, Z. and Lancet, D., Proc. Natl. Acad. Sci. U.S.A., 81 (1984) 1859-1863), antibody 18.1 could also be useful for functional studies.     

Dilated Cardiomyopathy Complicating a Case of Epidermolysis Bullosa Dystrophica

A child with epidermolysis bullosa dystrophica, recessive type (EBDR) developed significant anemia at 9 years of age and was treated with long-term transfusion therapy. At age 17 he had symptoms of congestive heart failure secondary to dilated cardiomyopathy. Treatment with digoxin and vasodilators for the past year has failed to improve his cardiomyopathy significantly. Chronic iron overload and secondary hemosiderosis may have contributed to his problems, and we propose that chelation therapy be used in any child receiving long-term transfusion therapy.     

DELETION OF HAPTEN-BINDING CELLS BY A HIGHLY RADIOACTIVE 125I CONJUGATE

Exposure of normal mouse spleen cells in vitro to highly ¹²⁵I-labeled dinitrophenyl (DNP)-protein carrier conjugates specifically inactivated cells able to mount an immune response to that hapten after in vivo challenge. The deletion was hapten specific and independent of the radioactive carrier to which the hapten was bound. DNP-binding cells were inactivated by radioactivity that was not part of the hapten, but was solely confined to the carrier moiety. The deletion of the anti-DNP response lasted 2–3 wk and could be specifically inhibited.     

DELAYED HYPERSENSITIVITY-TYPE GRANULOMA FORMATION AND DERMAL REACTION INDUCED AND ELICITED BY A SOLUBLE FACTOR ISOLATED FROM SCHISTOSOMA MANSONI EGGS

A soluble material has been isolated from schistosome eggs which in minute quantities without the addition of adjuvant induces sensitization to a delayed hypersensitivity type of granuloma forming around intact schistosome eggs. This material is secreted by intact eggs and is found in high concentration in the fluid released during the hatching process. When adsorbed to bentonite particles this substance elicits hypersensitivity type granuloma formation in specifically sensitized animals. The granuloma sensitizing factor also both induces and elicits delayed footpad swelling in mice. Quantities which sensitize with respect to these delayed type reactions do not induce antibody formation detectable by a sensitive hemagglutination. technique within the duration of the above experiments.     

Levels of depression and satisfaction with life as indicators of health services consumption

Objective: To evaluate the correlation between depression, satisfaction with life, and primary healthcare services consumption.

Methods: A random sample of primary healthcare clinic patients agreed to complete self-report questionnaires on demographics and physical activity, the Geriatric Depression Scale (GDS), Satisfaction with Life Scale and the Visual Analog Scale for Happiness. Treating physicians completed the Cumulative Illness Rating Scale (CIRS) for each patient. The relationships among psychometric, medical, the number of visits to health maintenance organization (HMO)-physicians during the previous year was assessed.

Results: Positive correlation was found between visits to HMO-physicians and depression severity, as assessed by GDS (p?=?.049), and between visits/year and illness severity, as measured by CIRS (p?p?=?.005). Physical activity correlated inversely with depression severity (p?=?.014). Gender and income had no impact on frequency of visits to HMO-physicians, depression, or satisfaction with life.

Conclusions: The results indicate that there is a correlation between depression and healthcare service consumption, as represented by number of HMO-physician visits and medication use. Thus, early detection of depression, using tools such as GDS, and early initiation of antidepressive treatment may help to lower the burden on the health system.