Sexual behavior and sexual function of adults after hypospadias surgery: a comparative study

PURPOSE: We assessed sexual behavior and sexual function in adults operated on for hypospadias. MATERIALS AND METHODS: Long-term psychosexual adjustment was assessed with a standardized questionnaire which was mailed to 57 patients with hypospadias older than 18 years and 60 age matched normal control subjects. RESULTS: A total of 37 patients with hypospadias and 39 controls participated. Self-reported strength of libido on a scale of 1 to 5 was shown to be similar in the 2 groups. Patients with hypospadias did not have problems in achieving erection and average self-rated quality of erection ranging from 1 to 5 was the same as that of controls (mean value 4.5). Patients with hypospadias noted curvature in a downward direction in a significantly higher proportion compared to controls (40% vs 18%, respectively). There were 13 patients with hypospadias who had ejaculation difficulties, of whom 6 had spraying and 7 had only dribbling of ejaculate. Patients with hypospadias masturbated significantly less often, were significantly less sexually active and had a smaller total number of sexual partners compared to control subjects. Control subjects were significantly more completely satisfied with their sexual life compared to patients with hypospadias (76.92% vs 51.35%, respectively). CONCLUSIONS: Sexual function of patients who underwent surgery for hypospadias in general is not affected. However, there is clearly a difference in certain aspects of sexual behavior between patients with hypospadias and controls. Followup and adequate counselling of patients who underwent surgery for hypospadias in adult life is necessary.     

Renal infarction in a child with systemic lupus erythematosus

Although patients with systemic lupus erythematosus (SLE), especially those with antiphospholipid antibodies, have a high incidence of arterial and venous thrombotic manifestations, renal infarction has been rarely reported in these patients and is probably underestimated. A 9-year-old boy with renal infarction, diagnosed by computed tomography and scintigraphy, is described. Initially he complained of severe flank pain; he had no urinary abnormalities and his blood pressure was normal. No evidence of systemic disease was found. He responded well to antibiotic treatment without the need for immunosuppressive therapy. In subsequent years he presented a spectrum of clinical symptoms, including fever, malaise, arterial hypertension headache, and mononeuritis multiplex, accompanied by an increased erythrocyte sedimentation rate and transitory proteinuria. This suggested vasculitis involving peripheral vessels as well as the central nervous system. Treatment with oral prednisone and azathioprine led to remission. Four years after the renal infarction, the child presented with recurrence of systemic disease. The diagnosis of SLE was established, with positive antiphospholipid antibodies. The sudden appearance of severe unexplained flank pain should alert the clinician to a possible underlying renal vessel thrombosis. Renal venous thrombosis is probably much more common; however, renal arterial thrombosis and infarction in association with SLE with positive antiphospholipid antibodies should be added to the differential diagnosis.     

Prophylactic antiemetics for laparoscopic cholecystectomy: droperidol, metoclopramide, and droperidol plus metoclopramide

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most significant problems in laparoscopic surgery. The antiemetic effects of metoclopramide and droperidol used alone or in combination for prevention of PONV after laparoscopic cholecystectomy (LC) were assessed in this prospective, double blind, placebo controlled randomized study. PATIENTS AND METHODS: A series of 140 patients, ASA physical status I or II, were included in the study. Patients were randomized to one of the following groups: 1, placebo; 2, metoclopramide 10 mg after the induction of anesthesia and placebo at 12 h postoperatively; 3, droperidol 1.25 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively; and 4, droperidol 1.25 mg plus metoclopramide 10 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively. Patients were observed for 24 hours for PONV, pain, need for rescue analgesics, and adverse events. RESULTS: Data were analyzed using the Student's t-test and chi-square test, with P < 0.05 considered statistically significant. The mean incidence of PONV was 54% with placebo, 42% with metoclopramide, 14% with two doses of droperidol alone, and 11% with a combination of metoclopramide plus droperidol. The patients receiving a combination of metoclopramide and droperidol had a significantly lower rate of PONV than those administered metoclopramide alone (P < 0.05) or placebo (P < 0.001). Those receiving two-dose droperidol alone also had a significantly lower incidence of PONV compared with metoclopramide (P < 0.05) and placebo (P < 0.001). There was no statistically significant difference between the metoclopramide and placebo groups. Sedation was significantly greater in patients administered droperidol 12 h postoperatively. CONCLUSION: The combination of metoclopramide and droperidol, and two-dose droperidol alone, were found to significantly decrease the incidence of PONV after LC, whereas metoclopramide alone proved inefficient.     

Classification and knowledge discovery in protein databases

We consider the problem of classification in noisy, high-dimensional, and class-imbalanced protein datasets. In order to design a complete classification system, we use a three-stage machine learning framework consisting of a feature selection stage, a method addressing noise and class-imbalance, and a method for combining biologically related tasks through a prior-knowledge based clustering. In the first stage, we employ Fisher's permutation test as a feature selection filter. Comparisons with the alternative criteria show that it may be favorable for typical protein datasets. In the second stage, noise and class imbalance are addressed by using minority class over-sampling, majority class under-sampling, and ensemble learning. The performance of logistic regression models, decision trees, and neural networks is systematically evaluated. The experimental results show that in many cases ensembles of logistic regression classifiers may outperform more expressive models due to their robustness to noise and low sample density in a high-dimensional feature space. However, ensembles of neural networks may be the best solution for large datasets. In the third stage, we use prior knowledge to partition unlabeled data such that the class distributions among non-overlapping clusters significantly differ. In our experiments, training classifiers specialized to the class distributions of each cluster resulted in a further decrease in classification error.     

A preliminary analysis of binge episodes: comparison of a treatment-seeking sample of Black and White women

OBJECTIVE: This study sought to examine differences in the nutritional composition of binges, both qualitatively and quantitatively, between participants with binge eating disorder (BED) and bulimia nervosa (BN) taken from a sample of treatment-seeking Black and White women. Overall qualitative and quantitative differences between diagnostic categories, regardless of ethnicity, were also explored. METHOD: Patients seeking treatment for eating disorders were assessed on binge content. Black (n=26) and White (n=26) participants were matched on age and body mass index (BMI). RESULTS: The binges of individuals with BN were lower in percent protein, but higher in calories, carbohydrates, and sugar, than those individuals with BED. However, there was little difference as a function of ethnicity between treatment-seeking Black and White women. DISCUSSION: Preliminary data suggest that health professionals are faced with similar binge eating pathology, regardless of ethnicity, despite, probably, etiologic variation. The importance of the role of ethnicity in the expression of eating disorders is discussed.     

Fasciocutaneous flaps in the treatment of soft tissue defects of the lower leg caused by explosive war injuries

The use of fasciocutaneous flaps for the reconstruction of lower leg soft-tissue defects inflicted during the bombing of our country is presented in this case report. The experience with 9 patients with soft-tissue defects of the lower leg is presented with the aim of examining the possibilities of war-wound reconstruction. The results of the earlier use of fasciocutaneous flaps in the lower leg reconstruction as well as the those obtained during the reconstruction of the lower leg soft-tissue defects in war wounds was proven to be safe and reliable method of the reconstructions of severe lower leg injuries, particularly of its distal segment and the malleolus region.     

Assessing the effectiveness of community-based substance abuse treatment for adolescents

The Adolescent Treatment Models initiative, a 10-site, multimodality, prospective study, was designed to evaluate adolescent substance abuse treatment outcomes and to assess the relative efficacy of different treatment models. Based upon longitudinal data gathered at multiple assessment points using a standardized instrument, treatment outcome trajectories were determined for a cohort of 1,057 adolescents from entry into substance abuse treatment until 12 months post-intake. Client outcomes on substance use and program effectiveness were explored across individual treatment programs and levels of care. Strong treatment effects, defined as a significant reduction in alcohol and other drug use at three months post-intake, were found. The reductions of greatest magnitude in relation to pretreatment use occurred among adolescents in residential treatment. Within level of care, few significant differences in treatment effects were found between programs. Relapse effects, defined as an increase in substance use at 12 months relative to three months, were observed across nearly all programs, but varied in relation to treatment modality. This is most evident among those entering residential treatment, with the highest rate of relapse occurring among adolescents in long-term residential treatment care. Despite strong evidence of treatment effectiveness, continuing care is vital to maintenance of treatment benefit.