Efficacy and safety of vardenafil in men with erectile dysfunction caused by spinal cord injury.

OBJECTIVE: To assess the efficacy and tolerability of vardenafil in men with erectile dysfunction (ED) due to traumatic spinal cord injury (SCI). METHODS: In this multicenter, double-blind, placebo-controlled, parallel-group 12-week study, 418 men aged 18 years and older with ED for more than 6 months consequent to SCI were randomized to vardenafil (n = 207) or placebo (n = 211) (10 mg for 4 weeks, then maintained or titrated to 5 or 20 mg at weeks 4 and 8). Efficacy assessments included the erectile function (EF) domain score of the International Index of Erectile Function questionnaire and diary questions regarding penetration, maintenance of erection to completion of intercourse, and ejaculation. RESULTS: Baseline patient characteristics were similar in the vardenafil (mean age 40 years) and placebo (mean age 39 years) groups. Mean baseline EF domain scores were 11.6 in the vardenafil group and 12.1 (moderate ED) in the placebo group. EF domain score in the vardenafil group improved to 22.0 (mild ED) at last observation carried forward vs 13.5 in the placebo group (p < 0.001). Over 12 weeks of treatment, mean per-patient penetration (76% vs 41%), maintenance (59% vs 22%), and ejaculation (19% vs 10%) success rates were significantly greater vs placebo (all p < 0.001). The most frequently reported drug-related adverse events were headache (vardenafil 15%, placebo 4%), flushing (vardenafil 6%, placebo 0%), nasal congestion (vardenafil 5%, placebo 0%), and dyspepsia (vardenafil 4%, placebo 0%). CONCLUSION: Vardenafil significantly improved erectile and ejaculatory function and was generally well tolerated in men with erectile dysfunction due to spinal cord injury.

Brain function and cognition in a community sample of elderly Latinos.

BACKGROUND: Previous studies using PET to measure cerebral glucose metabolism in AD have found metabolic reductions in the temporoparietal and posterior cingulate cortices in individuals with dementia and those at risk of developing it. This study was designed to extend this finding to individuals selected from a population-based cohort of Mexican Americans with a wide spectrum of cognitive ability. METHODS: A group of 93 individuals was selected from the Sacramento Area Latino Study on Aging, and subjects were categorized into four groups of increasing levels of cognitive impairment: normal, memory impaired, cognitively impaired but not demented (CIND), and demented. PET was performed with the tracer [(18)F]-fluorodeoxyglucose, and data were analyzed with both statistical parametric mapping and an atrophy-corrected volume of interest approach. RESULTS: Individuals with dementia had metabolic reductions that were most robust in the posterior cingulate cortex, whereas CIND subjects had less statistically robust reductions in the posterior cingulate cortex. Cingulate hypometabolism increased the risk of dementia and was a significant risk factor for dementia in logistic regression models that also incorporated MR measures of hippocampal volume and white matter hyperintensities. CONCLUSION: Posterior cingulate cortical hypometabolism is clearly detected in individuals with dementia who are selected from a population with lower education and a high prevalence of cerebrovascular risk factors, supporting the generalizability of this finding. These metabolic reductions occur prior to the onset of dementia but only in those persons with relatively advanced symptoms.

Visual estimation of angles by orthopedic surgeons.

A literature review indicates that the exactness of visual estimation of angles has not adequately been addressed. This study used a series of angles to examine how accurately and consistently practicing orthopedic surgeons were able to visually estimate angles. The data indicate that orthopedic surgeons were able to visually estimate angles to within 10 degrees 93.1% of the time and to within 5 degrees 64.6% of the time. Repeat measurements 6 weeks later were within 5 degrees of the initial responses 82.2% of the time and within 10 degrees of the initial responses 94.5% of the time. The number of years in practice or in training was irrelevant to the validity and reliability of the estimates. Acute angles of 31 degrees or less were consistently overestimated.

In vitro responses of detrusor smooth muscle to stretch and relaxation.

In vitro studies subjecting detrusor smooth muscle to stretch and relaxation support the concept that bladder tonus and accommodation result from physical properties of the bladder wall and are not dependent upon neural activity. The properties of automaticity, hysteresis and length/tension relationships of smooth muscle seen clinically and in vivo are also seen in vitro.

Clinical experience with the Storz Modulith SL 20 lithotriptor.

BACKGROUND: A Food and Drug Administration pre-market approval study evaluated the safety and effectiveness of the Storz Modulith SL 20 lithotriptor. METHODS: Protocol was a maximum of 2,000 shock waves per treatment and no more than three treatments per patient. Safety and effectiveness parameters were defined and followed. RESULTS: The overall success rate was 74.6% with a stone-free rate of 63.6%. No clinically or statistically significant adverse trends were noted acutely or in follow-up. CONCLUSIONS: The Storz Modulith SL 20 lithotriptor is a safe and effective device to treat renal and ureteral calculi in an outpatient setting using intravenous sedation/analgesia.

Iliopsoas abscess following catheterization of the femoral artery: diagnostic and treatment strategies.

The following case is presented to illustrate the necessity of arthrotomy of the hip when an iliopsoas abscess lies adjacent to the hip joint capsule. Arthrotomy of the hip through a separate incision adds minimal morbidity, does not expose the hip to the abscess, and assures the surgeon that the hip has been debrided. This is important considering the 15% incidence of communication of the iliopsoas bursa with the hip joint.

Differentiation of human prostate cancer from benign hypertrophy by in vitro 1H NMR.

In vitro 1H NMR spectra were acquired for perchloric acid extracts of tissue samples of human prostate. Seven patients were diagnosed with prostate cancer, 13 with benign prostatic hypertrophy, and 3 with both conditions. Statistically significant differences between the cancer and benign groups were seen for the metabolite peak area ratios of citrate, creatine, and phosphorylcholine to alanine, and citrate to glutamate. There was no correlation of Gleason grade with any of the ratios measured for the cancer samples. Spectra from different sections of large tumors often yielded substantially different area ratios, confirming the heterogeneous nature of these prostate tumors.