Invasive diagnosis and therapy—are they still reasonable in the age of sildenafil?

Diagnosis of erectile dysfunction is important because sildenafil may not be the proper therapy for patients with underlying major diseases such as coronary sclerosis, arteriosclerosis of the stroke vessels, depression, etc., where erectile dysfunction is just a symptom of the disease.     

Conservative treatment of neurogenic bladder dysfunction

Summary In neurogenic bladder dysfunction conservative treatment is preferred whenever possible and preservation of renal function remains the main topic. Additionally, a patient-related form of bladder management with decreased intravesical pressure and social dryness is needed. Therefore many strategies are available and after evaluation of the underlying neurogenic bladder dysfunction an individual kind of treatment can be used. Possible options are the clean intermittent catherization, anticholinergic drugs, detrusor triggering, electrical stimulation and bladder emptying by Valsalva's manouvre.      

Erectile dysfunction. Is an oral medication during the diagnostic pathway indicated?

For patients with erectile dysfunction oral medication seems to be the most comfortable form of application. This can also be seen in the expectations looking forward to Sildenafil and other drugs in development. We present a prospective examination with the oral medication of 100 mg acecarbamol, 30 mg extract of cortex quebracho and 33 mg tocopherol acetate (Afrodor) in 100 patients complaining secondary erectile dysfunction. The patients were treated unselected with 3 x 1 tablet/day during the diagnostic schedule. 14% of the patients were able to perform satisfying sexual intercourse after 4 weeks of medication and another 15% showed an increased libido. Therefore we suggest, that the application of an oral medication, might be useful, especially during the time of diagnostics. Especially for those patients who gain without invasive diagnostic tools as intracavernous injection.     

Cross-cultural development of a quality of life measure for men with erection difficulties

Erection difficulties have a profound effect on a man's quality of life, however, the emotional consequences are often overlooked in quantitative research where most sex-related questionnaires focus on a man's functional ability. Consequently, we developed a cross-cultural instrument to measure quality of life specific to male erection difficulties (QOL-MED). The items in the QOL-MED originated from interviewing forty men with erection difficulties in Seattle and Boston. Twelve men in the USA and 29 men in England helped us refine the instrument. Testing the QOL-MED's psychometric properties involved two administrations over a two-week period in the USA (n=40) and the UK (n=29). For discriminant validity, we predicted quality of life would worsen with increased self-perceived severity of the condition. After controlling for years with erection difficulties in a linear regression model, we found a significant negative association between self-perceived severity and quality of life for men in the UK only (p<0.01). The expectation that the measure would produce evidence for convergent validity by being more closely correlated to well-being than functional status was not confirmed. Both the USA and UK instruments were internally consistent (Cronbach's =0.94 and 0.96, respectively), and reproducible (0.78 and 0.95, respectively). This instrument provides a promising tool for studying therapies and understanding quality of life in patients with erectile dysfunction.This research was supported from a research grant from Syntex, Inc.Mr. Wagner is now a doctoral student at the University of California at Berkeley, Berkeley, CA, USA.     

Thyroidal handling of radioiodine in sea level residents exposed to hypobaric hypoxia

In the present investigation thyroidal accumulation of radioiodine and its release were assessed by direct testing of thyroid function using radioactive iodine, in vivo, in sea level residents intermittently exposed to hypobaric hypoxia. Thyroidal accumulation of radioiodine and its turnover were examined daily for 14 days. Twelve healthy human male volunteers were divided into three groups, with an equal number of individuals in each group. A decompression chamber was used to expose each group of subjects to hypoxic conditions at a simulated altitude of 3810 m for 8 h/day for 14 days. An oral dose of 25Ci iodine-131 was administered to each individual of the first group immediately before the initiation of intermittent hypoxia. The second group of subjects received a tracer dose at the beginning of the 4th day of the 14 days, intermittent exposure to hypoxia, while the third group received the tracer dose 1 week after the completion of the exposure. Control studies were carried out on the subjects before they were subjected to the experimental conditions. Thyroidal accumulation of¹³¹I in experimental subjects during the hypoxic state and in the post-hypoxic state was higher than in the control studies. The pattern of accumulation during exposure to hypoxia and in the post-hypoxic state showed multiple peaks of radioactive iodine uptake (PRAIU), a unique feature. The multiple PRAIU by the thyroid in experimental subjects were sharp and of short duration, reflecting an increased rate of¹³I release from the thyroid. Control subjects had a single PRAIU by the thyroid 24 h after the administration of tracer.     

Interactions of halogenated industrial chemicals with transthyretin and effects on thyroid hormone levels in vivo

Previous results in experimental systems have suggested that hydroxylated PCBs may decrease thyroid hormone levels through associative interaction with transthyretin. In the present paper it was investigated whether this property was also shared by various industrial chemicals, mainly pesticides. In total, 65 compounds from 12 chemical groups were analyzed for direct interference with the T4 binding site of transthyretin using a competitive binding assay. Sixty per cent of the compounds were competitive at a concentration level of 100 M. Relatively strong interactions were observed by several chlorophenols, chlorophenoxy acids and nitrophenols, as well as by individual compounds such as hexachlorobenzene, dicofol, bromoxynil and tetrachlorohydroquinone. Examples from these chemical groups, e.g. pentachlorophenol, 2,4-dichlorophenoxybutyric acid, dinoseb and bromoxynil, also reduced plasma TT4 levels in rats. In addition, bromoxynil decreased plasma TT3 levels. The results suggest the existence of a number of halogenated industrial chemicals with a potential for lowering plasma thyroid hormone levels through interference with hormone transport carriers.     

Chloramphenicol toxicity associated with severe cardiac dysfunction

Summary A 9-month-old infant experienced severe chloramphenicol toxicity associated with high serum levels (313 g/ml). Cardiovascular collapse with cardiomyopathic changes and impaired left ventricular function was documented by echocardiography. Serial echocardiographic evaluation showed resolution of the cardiomyopathic findings as the chloramphenicol levels were spontaneously cleared. Clinical course was complicated by the development of liver disease and coagulopathy compatible with disseminated intravascular consumption. Patient's recovery was complete and uneventful, nevertheless, chloramphenicol toxicity in childhood is associated with a significant mortality rate of 40%. The related impaired cardiac function, although reversible, appears to play a major role in the pathogenesis and eventual outcome in this syndrome.     

Hereditary neuropathy with liability to pressure palsies

Summary Clinical, neurophysiological and pathological investigations were carried out in 11 affected members of 2 families with hereditary neuropathy with liability to pressure palsies (HNPP). The observations were related to findings in 261 cases of 47 families published in the literature. It was concluded that HNPP is a nosological entity characterized by the following diagnostic criteria: (1) an autosomal dominant inheritance; (2) the clinical presentation of a recurrent mononeuropathy simplex or multiplex, frequently related to an inadequate trauma to peripheral nerves; (3) a significant slowing of motor and sensory conduction velocity in clinically affected, but also in clinically unaffected nerves; (4) characteristic morphological findings in sural nerve biopsy featuring tomaculous swellings of myelin sheaths, transnodal myelination and segmental demyelination. The pathogenesis of HNPP is not clear. Hypothetical explanations of the pathogenesis of HNPP are discussed.In memory of Albert Bischoff (1921–1981), Professor of Neurology, University of Berne     

Effects of small dose of brotizolam on P300

Nine healthy men (mean age, 22.2 years) participated in two experimental sessions cross-overed randomly in a double blind manner; one with a placebo and the other with 0.125 mg of brotizolam (BTZ) administered in the morning. Resting electroencephalogram and event-related potential under oddball paradigm was recorded before and 1, 2, 4, 6 and 8 h after the administration. Mean 30-msec bin amplitude from 240 msec to 450 msec after the stimulus was compared between placebo and drug sessions in order to observe P300. Brotizolam reduced the amplitude of P300 at 6 h after administration. It was noted that the effects of BTZ were most marked at Fz.     

胸骨后甲状腺肿物的手术处理

为探讨胸骨后甲状腺肿物手术切除的进路方式，回顾性分析３０年来外科治疗的结果。１９６５年至１９９４年间全部患者共８７例，其中结节性甲状腺肿６４例，占７３．６％；甲状腺腺瘤１３例，占１４．９％；甲状腺恶性肿瘤１０例，占１１．５％。通过颈部入路手术切除的占７０％（６１／８７），胸骨正中劈开切除的占１６％（１４／８７），前切口开胸切除的占１４％（１２／８７）。随着经验的积累，除误诊为纵隔其它来源的肿物外，１９８０年以后已不再行前切口开胸手术切除，１９８５年以后的４３例中，只有１例胸骨后结节性甲状腺肿的患者行胸骨劈开手术，其余均从颈部入路手术。由于颈部入路相对并发症少、损伤小、安全可靠，建议对良性的胸骨后甲状腺肿物和部分恶性肿物行颈部衣领式切口手术。