Angiogenesis Therapy for the Treatment of Erectile Dysfunction

IntroductionOver the past 15 years, significant advances have been made in the treatment of erectile dysfunction (ED). The most significant of these advances has been pharmacological treatment of ED with phosphodiesterase type 5 (PDE5) inhibitors. This therapy greatly increased the awareness of ED and has helped stimulate research into the underlying causes of ED. While treatment with PDE5 inhibitors continues to be the current therapy of choice, approximately 40% of men treated with PDE5 inhibitors fail to have significant improvement in erectile function and PDE5 inhibitors do not reverse the vasculopathic processes associated with ED. With this in mind, new therapies must be developed. The treatment with angiogenic growth factors such as vascular endothelial cell growth factor (VEGF) may be one such therapy.AimThis review will focus on defining key terms in the angiogenic process, angiogenic growth factors, and different delivery methods, and summarize results from angiogenic therapies for the treatment of ED.MethodsA review of the literature was performed on all angiogenic therapies for the treatment of ED. A brief review on the angiogenic factors was also performedResultsAngiogenic therapies for the treatment of ED are possible and promising; however, further investigation is needed to advance clinically.ConclusionsAlthough numerous studies have now employed angiogenic factors for the possible treatment of ED in several animal models, we are still not at the point to begin human investigations. Future studies need to examine proper dosage of the angiogenic agent, route of delivery, time course for delivery, and combination therapies. Lysiak JJ, Kavoussi PK, Ellati RT, Steers WD, and Annex BH. Angiogenesis therapy for the treatment of erectile dysfunction.     

Competency in laparoscopic colorectal surgery is achievable with appropriate training but takes time: a comparison of 300 elective resections with anastomosis

Aim The aim of this retrospective cohort study was to compare outcomes in patients who underwent elective laparoscopic colorectal resection with anastomosis performed by a single surgeon or his training fellow. Method A prospective electronic database of all laparoscopic procedures between January 2005 and September 2008 was used. Two groups were compared; those patients operated upon by the Consultant trainer (C) and those by seven supervised Fellows (F). Fellows were either post CCT or in their last year of training. Three hundred consecutive patients undergoing laparoscopic colorectal resection with anastomosis were examined, 150 in each group. Groups were matched for indication, age, American Society of Anesthesiology (ASA) grade, cancer T stage and resection performed. Preoperative work‐up, operative surgery and anaesthesia were identical between groups. Results No significant difference was demonstrated in age, mean 67 (26–91) or ASA grade. Indications for surgery were; cancer (C) 120, (F) 126, diverticular disease (C) 22, (F) 20, Crohn’s disease (C) 8, (F) 7. Fellow’s mean operative time was significantly longer at 123 min (95%CI 117–134) compared to the consultant trainer −105 min. (95%CI 98–111): P < 0.01). No significant differences in the complication or conversion rates were demonstrated. Length of stay and the 30‐day readmission rates were similar. Conclusion In this retrospective cohort study we have demonstrate that when matched patients are compared, supervised trainee operating time is significantly longer than that of the consultant trainer but without any significant increase in length of stay, complication or readmission rates. Training to a level of competency takes time but not at the expense of patient care.     

Magnetic resonance imaging of myxoid containing tumors

Myxoid tissue forms part of many benign and malignant soft-tissue tumors. The advent of percutaneous needle biopsy has made it important to be aware of the diagnostic implications of biopsy samples containing myxoid tissue. To determine whether the magnetic resonance imaging (MRI) characteristics could help establish the diagnosis, we compared the MR images of 11 tumors containing myxoid tissue with the resected tumor tissue. In our small series of these rare tumors, the MRI characteristics allowed differentiation of intramuscular myxomas from malignant neoplasms containing myxoid tissue. Intramuscular myxomas meet the following conditions: (a) they are well circumscribed; (b) they arise within muscle; (c) T₁-weighted images demonstrate uniform, decreased signal intensity; (d) T₂-weighted images demonstrate uniform increased signal intensity; (e) contrast-enhanced images exhibit an inhomogeneous increase in signal intensity. If any of these conditions is not met, then a malignancy containing myxoid tissue should be suspected.     

Xenogenic bone matrix extracts induce osteoblastic differentiation of human bone marrow-derived mesenchymal stem cells

Colloss and Colloss-E are sterile acellular lyophilizates extracted from bovine and equine bone matrix, respectively. Animal and clinical studies have shown that these xenogenic bone matrix extracts (BMEs) are effective as bone graft substitutes. In this report, we investigated the effect of Colloss and Colloss-E on human adult in vitro-expanded bone marrow-derived mesenchymal stem cells (BMMSCs). Specifically, we assessed whether these xenogenic BMEs induced osteoblastic differentiation of cultured BMMSC. We show that BMMSCs treated with either Colloss or Colloss-E exhibited characteristic osteoblastic morphological changes accompanied by the expression of osteoblast-specific markers, such as alkaline phosphatase activity, osteopontin secretion and calcium deposits, explicitly demonstrating that these bone matrix extracts induce osteoblastic differentiation of BMMSCs in vitro. Hence, xenogenic BMEs induce bone-specific differentiation of BMMSCs, presumably through providing stem cells with structural and soluble mediators that mimic the in vivo microenvironment. These results may explain the in vivo mode of action of these medical devices, and potentially provide a novel tissue engineering-based treatment of bone defect, using autologous BMMSCs pretreated with BMEs.     

Health work in MERCOSUR: a Brazilian approach

MERCOSUR Member Countries (Brazil, Argentina, Paraguay, Uruguay, and Venezuela) have viewed the regional integration process and management of work and education in health as a concern for government, considering the health sector's specificities. Key issues are professional accreditation and harmonization of current legislation. This article discusses initiatives in the Permanent MERCOSUR Forum related to work in the health field. The Forum serves as a space for dialogue between various actors: Ministry of Health, health workers, and professional boards, with the aim of supporting the work by the Sub-Commission on Professional Development and Practice, under MERCOSUR Working Sub-Group 11, Health, aiding in the formulation of health management and education policies. The current challenge involves the creation of mechanisms for implementing joint actions to solve problems in the regulation of professional practice, especially in municipalities along the borders between MERCOSUR countries.     

Fibrinolytic administration for acute myocardial infarction in a tertiary ED: factors associated with an increased door-to-needle time

The purpose of this study was to evaluate the door-to-needle time for fibrinolytic administration for acute myocardial infarction (AMI) at Vancouver General Hospital (VGH) and identify factors associated with time prolongation. A retrospective chart review of all patients fibrinolysed for AMI in the ED at VGH was performed from January 1, 1998, to December 31, 1999, to determine door-to-needle time. A mixed-effects linear regression model was fit to the fibrinolytic data with the door-to-needle time to identify factors associated with prolonged times. One hundred forty patients were included in the final analysis. The mean and median door-to-needle times were 58 and 43 minutes, respectively. A door-to-needle time of under 30 minutes was achieved in 24.3% of patients, 30 to 40 minutes in 24.3%, 40 to 60 minutes in 22.1%, and over 60 minutes in 29.3%. EP prescribers without prior cardiologist consultation resulted in a significantly shorter door-to-needle time compared with requesting a cardiology consult before administration (mean [median] 41 [35] minutes vs. 108 [90] minutes respectively; P <.001). Patients who arrived by ambulance had shorter door-to-needle times than those who did not (mean [median] 50 [38] minutes vs. 71 [57] minutes, respectively; P =.008). Patients who arrived during the night shift (2300-0700 hrs) had significantly shorter door-to-needle times than those patients who arrived during the day (0700-1500 hrs) or afternoon (1500-2300) shifts (P = 0481); and patients who had a longer time from chest pain onset to ED arrival also had longer door-to-needle times (P =.0233). A significant number of AMI patients fibrinolysed at VGH do not meet the national guideline for door-to-needle time less than 30 minutes. Factors associated with this should be addressed to improve the care of patients with AMI.     

Myocardial contraction fraction: a volumetric index of myocardial shortening by freehand three-dimensional echocardiography

OBJECTIVES: This study sought to evaluate myocardial contraction fraction (MCF) as an index of myocardial shortening by comparison to conventional shortening indices in patients with hypertensive hypertrophy, athletes with physiologic hypertrophy and sedentary normal adult subjects. BACKGROUND: A significant percentage of patients with hypertensive hypertrophy have "normal" or "preserved" left ventricular (LV) systolic function by conventional echocardiographic measures whereas their systolic function is depressed when measured by the two-dimensional echocardiographic mid-wall shortening fraction (MWSF). A three-dimensional echocardiographic measure of myocardial shortening analogous to MWSF has been lacking. We describe a volumetric measure of myocardial shortening, the MCF, as the ratio of stroke volume (SV) to myocardial volume (MV), and hypothesize that it may be useful to compare myocardial performance in patients with different degrees and types of hypertrophy. METHODS: We compared the MCF using freehand three-dimensional echocardiographic reconstruction of the LV to conventional measures of LV function (ejection fraction [EF], endocardial shortening fraction [SF] and MWSF) in subjects with pathologic hypertensive hypertrophy, heart failure symptoms and preserved EF (n = 17), athletes with physiologic hypertrophy (n = 41) and normal sedentary adults (n = 80). RESULTS: The EF was in the normal range for all three groups. The MCF was lower in hypertensive hypertrophy compared with normal subjects (0.33 +/- 0.05 vs. 0.44 +/- 0.07, p < 0.01). It also successfully differentiated physiologic hypertrophy from normal subjects (0.50 +/- 0.05 vs. 0.44 +/- 0.07, p < 0.01). The endocardial SF did not distinguish athletes from normal subjects and the MWSF did not distinguish hypertensive from physiologic hypertrophy. CONCLUSIONS: The MCF, a volumetric measure of myocardial shortening, demonstrates that myocardial shortening is decreased in hypertensive hypertrophy and increased in physiologic hypertrophy. The MCF may be useful in assessing differences in myocardial performance in patients with similar degrees of hypertrophy.     

Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study

BackgroundOccult pneumothorax (OPTX) represents air within the pleural space not visible on conventional chest radiographs. Increased use of computed tomography has led to a rise in the detection of OPTX. Optimal management remains undefined.MethodsA pediatric subgroup analysis (age <18 years) from a multicenter, observational study evaluating OPTX management. Data analyzed were pneumothorax size, management outcome, and associated risk factors to characterize those that may be safely observed.ResultsFifty-two OPTX (7.3 ± 6.2 mm) in 51 patients were identified. None were greater than 27 mm; all those under 16.5 mm (n = 48) were successfully managed without intervention. Two patients underwent initial tube thoracostomy (one [21 mm] and the other with bilateral OPTX [24 mm, 27 mm]). Among patients under observation (n = 49), OPTX size progressed in 2; one (6.4mm) required no treatment, while one (16.5 mm) received elective intervention. Respiratory distress occurred in one patient (10.7 mm) who did not require tube thoracostomy. Nine received positive pressure ventilation; 8 did not have a tube thoracostomy. Twenty-four patients (51%) had one or more rib fractures; 3 required tube thoracostomy.ConclusionNo pediatric OPTX initially observed developed a tension pneumothorax or adverse event related to observation. Pediatric patients with OPTX less than 16 mm may be safely observed. Neither the presence of rib fractures nor need for PPV alone necessitates intervention.