Erectile dysfunction in hypertensive subjects. Assessment of potential determinants.

Hypertension is often cited as a risk factor for erectile dysfunction. To clarify the relation between hypertension and erectile dysfunction, we evaluated 32 consecutive hypertensive and 78 normotensive impotent men with respect to multiple potential determinants and parameters of erectile function, including medical and sexual history, depression, hormonal profile, penile nocturnal tumescence, penile vascular supply, and pudendal nerve conduction. The hypertensive men were older, had higher body mass index, and used more medications than the normotensive men. The groups were not different with respect to the prevalence of smoking and peripheral vascular disease, but the hypertensive men had a marginally higher rate of ischemic heart disease (P = .06). The prevalence of depression, abnormal nocturnal penile tumescence, anomalous pudendal nerve conduction, and impairment in arterial supply as determined by penile brachial index were similar in the two groups. Testosterone and bioavailable testosterone levels were lower in the hypertensive men. After stratification by age and body mass index, hypertensive men younger than 50 years with body mass index less than 30 kg/m2 had significantly lower testosterone levels (12.0 +/- 1.7 versus 21.3 +/- 1.4 nmol/L, P < .02) but not bioavailable testosterone levels (3.9 +/- 0.7 versus 6.4 +/- 0.7 nmol/L, P < .17) than the corresponding normotensive group. Prolactin, follicle-stimulating hormone, and luteinizing hormone levels of the two groups were not significantly different. Contrary to common belief and with the exception of lower circulating testosterone levels, the overall analysis showed little difference between hypertensive and normotensive men with respect to a wide range of classic determinants of erectile function. Direct study of the local vascular erectile apparatus appears necessary for further elucidation of the mechanisms underlying erectile dysfunction in hypertensive men.

Acquired immunodeficiency, malabsorption and lymphoma.

A 66 year old female with a long history of recurrent pulmonary infection presented with a full-blown malabsorption syndrome. She was found to be suffering from acquired immunodeficiency. She later developed non-Hodgkin's lymphoma of the cervical lymph nodes. The possible relationships between immunodeficiency, malabsorption and lymphoma are discussed.

Amyloidotic polyneuropathy in a Jewish family. Evidence for the genetic heterogeneity of the lower limb familial amyloidotic neuropathies.

The first instance of familial amyloidotic polyneuropathy affecting a Jewish family is reported. Vitreous opacities were its presenting feature in the father at age 30 and the son at 25. Severe autonomic dysfunction and progressive peripheral neuropathy affecting initially the lower extremities soon followed. Death, suicidal in the son, occurred after seven and four years of illness. Their amyloid contained three proteins-an entire variant monomer of prealbumin, glycine replacing threonine as residue 49, and both products of its cleavage at the point of substitution. Lower limb familial amyloidotic polyneuropathy has been recorded in many families in Portugal, Sweden and Japan and occasionally in families of various ethnic stocks. This ethnic diversity prompts consideration of genetic heterogeneity. Differentiation on a genetic basis is forestalled since all pedigrees are compatible with autosomal dominant transmission and clinical data are marred by observer variance, even regarding vitreous opacities. Notwithstanding, an isolated British family is unique in the frequent occurrence of intractable peptic ulceration, cataracts, deafness and renal disease not attributable to amyloidosis and a striking predominance of males afflicted. Biochemically, monomeric prealbumin has been demonstrated by electrophoretic and immunologic techniques as the single protein constituent of amyloids isolated from Portuguese, Japanese and Swedish patients. The variant prealbumin of Japanese amyloid is characterised by methionine replacing valine as residue 30 and is identical to that found in plasma (but not as yet in amyloid) of affected Swedes. These limited data suggest that: (a) derivation of their amyloids from prealbumin is the biochemical common denominator of lower limb familial amyloidotic neuropathies regardless of the ethnic derivation of the afflicted; (b) to the extent that ethnic diversity reflects genetic heterogeneity, this will be demonstrable in the amyloid (and hopefully in the plasma) of the afflicted as entity-specific variant prealbumin monomers distinguished by different single amino acid substitutions; (c) on clinical and biochemical grounds, lower limb familial amyloidotic neuropathies include at least three genetic entities. In the upper limb and facial forms of familial amyloidotic polyneuropathy first recorded in Swiss and Finns respectively, the differences in their patterns of neurological disease and ocular lesions could be the result of their amyloids deriving from proteins other than prealbumin.

Evaluation of a magnetic method for the measurement of small intestinal transit time.

A new method for the measurement of small intestinal transit time is described. An externally applied magnetic transducer senses the presence of an ingested ferromagnetic material--50 gm. of magnesium ferrite dispersed in a test meal--upon its arrival at the cecal area. The mouth-to-cecum transit time is thus determined. The method is noninvasive and is not associated with any radiation. The method was compared to the commonly used x-ray method and good correlation was found in 24 of 28 studies. The mean transit time in a group of 20 normal subjects was 157.5 +/- 63.9 min.

Study of gastric emptying using a ferromagnetic tracer.

A new ferromagnetic method for the measurement of gastric emptying is described. An inert tracer, magnesium ferrite, is added to a test meal. Its amount in the stomach is then measured at regular intervals by an external transducer using its ferromagnetic properties. The method is noninvasive and devoid of radiation exposure. The magnetic fields used are harmless. The feasibility, reliability, and reproducibility of the method are described. Gastric emptying was studied in 61 subjects. The shape of the gastric emptying curve conformed best to an exponential function. The mean half-time of gastric emptying was 49 +/- 17.4 min. In this limited series age and sex did not affect gastric emptying.

Magnet noncontact apexcardiography. A new technique for registering chest motion.

A new apexcardiographic recording system has been developed which is free of certain technical limitations. This noncontact magnetic transducer was tested alternately with a commonly used pneumatic piezoelectric transducer in a comparative study on ten normal subjects. The magnetic registration offered a more accurate timing and configuration of the ACG. Signal distortion, such as peaked waves and an early fall of the systolic wave, was eliminated. The magnetic transducer was capable of recording directional apex point tracings, as well as pulsations of a larger apical area. The new system proved to possess definite advantages and eliminated some of the inconveniences inherent in the pneumatically coupled system.