Update on female sexual function.

In this review, we briefly discuss recently published data on female sexual desire, arousal, orgasm and pain, and on medical/iatrogenic factors associated with female sexual function. The studies reviewed highlight a number of important methodological and etiological issues in the study of female sexual function. Researchers are urged to use standardized methods for defining sexual disorders and for selecting patient samples. Placebo-controlled studies are essential for examining the pharmacological aspects of female sexual dysfunction. Evidence suggests that free testosterone levels may be associated with sexual desire in women. Sildenafil citrate increases genital blood flow but may not impact on subjective reports of arousal. Past research implicated the serotonin 5-hydroxytryptamine 2 and 5-hydroxytryptamine 1A receptors in female sexual function, while recent data suggest a role for the 5-hydroxytryptamine 3 receptor. Increasing attention is being paid to medical/health conditions that impact sexual function (e.g. neurological conditions, cancer, hysterectomy, and cardiovascular disease).

The neurobiology of sexual function.

This article provides a review of the past and current literature on the neurobiology of sexual function. The influence of endocrine, neurotransmitter, and central nervous system influences on male and female sexual function are discussed for sexual desire, arousal, and orgasm or ejaculation stages of sexual responding. Endocrine factors reviewed include the following: androgens, estrogens, progesterone, prolactin, oxytocin, cortisol, and pheromones. Neurotransmitters and neuropeptides discussed include nitric oxide, serotonin, dopamine, epinephrine, norepinephrine, opioids, acetylcholine, histamine, and gamma-aminobutyric acid. Central nervous system influences on sexual function are discussed briefly with reference to brainstem regions, the hypothalamus, and the forebrain.

Evidence that serotonin affects female sexual functioning via peripheral mechanisms.

A review of the literature indicates that serotonin is active in several peripheral mechanisms that are likely to affect female sexual functioning. Serotonin has been found in several regions of the female genital tract in both animals and humans. In the central nervous system (CNS), serotonin acts primarily as a neurotransmitter, but in the periphery, serotonin acts primarily as a vasoconstrictor and vasodilator. Since, in the periphery, the principal component of sexual arousal is vasocongestion of the genital tissue, it is likely that serotonin participates in producing normal sexual arousal. In addition, serotonin administration produces contraction of the smooth muscles of the genito-urinary system and is found in nerves innervating the sexual organs. Taken together, this evidence suggests that peripheral serotonergic activity may be involved in the normal sexual response cycle. In addition, exogenous substances that alter serotonin activity, such as selective serotonin uptake inhibitors (SSRIs) and the atypical antipsychotics, can produce sexual dysfunction. It is possible that sexual side effects seen with these drugs may result, at least in part, from their action on peripheral mechanisms.

Mechanism-based PK/PD model for the lymphocytopenia induced by endogenous and exogenous corticosteroids.

OBJECTIVE: Lymphocytopenia is a sensitive surrogate marker for the immunological effects of corticosteroids. This pharmacokinetic/pharmacodynamic (PK/PD) study investigated whether the circadian variation of blood lymphocytes observed after placebo is secondary to the circadian rhythm of endogenous cortisol, and developed based on this relationship an improved PK/PD model for a more sensitive description of the effect of low-dose corticosteroid therapy on blood lymphocytes considering the net activity of the exogenous corticosteroid budesonide and endogenous cortisol. METHODS: In an open, parallel study design, 3 mg oral budesonide or placebo were given at 8.00 a.m., 4.00 p.m. and midnight to two groups of 12 volunteers. Lymphocyte counts and serum concentrations of budesonide and cortisol were monitored for 24 hours. A mechanism-based PK/PD model which considered the non-linear protein binding of cortisol and the budesonide-induced cortisol suppression was employed to relate changes in blood lymphocytes to free cortisol levels after placebo and to the net activity of free budesonide and free endogenous cortisol after active treatment. RESULTS: The circadian rhythm of blood lymphocytes observed after placebo could inversely be related to the circadian rhythm of serum cortisol. After budesonide administration, lymphocyte counts could accurately be linked to the net activity of budesonide and endogenous cortisol. The resulting EC50 values for the effect of budesonide on cortisol, budesonide on lymphocytes and cortisol on lymphocytes were 0.063 +/- 0.034, 0.22 +/- 0.13 and 26.3 +/- 15.0 ng/ml (placebo group 15.4 +/- 3.4 ng/ml), respectively. CONCLUSIONS: The presented mechanism-based PK/PD model suggests that blood lymphocytes are under physiological control of cortisol. It further indicates that endogenous and exogenous corticosteroids and their pharmacological interaction need to be considered for modeling the effects of low doses of exogenous corticosteroids on the immune system.

[Experiences with closed screw placement in intra-articular fractures of the calcaneus. Surgical technique and outcome]. / Erfahrungen mit der gedeckten Verschraubung intraartikulärer Fersenbeinbrüche. Operationstechnik und klinische Ergebnisse.

For the closed treatment of an intraarticular fracture of the heel bone it is essential to know the 3D shape of the bone, the various types of fractures and to get skilled in reduction under an image intensifier. In our hospital we have made a comparison of 34 fractures treated with a plate and 94 treated with screws. The evaluation was made by the scores based on Merle d'Aubigne and clinical and radiological findings. The method of closed reduction and fixation with screws is easier, less dangerous for the patient and, compared to the open fixation, the results are the same or even better (good and excellent: 79.7%). As a result of gentle treatment of the soft tissues and the early reposition, the wound healing complications decreased to 2.1% compared to the 14% healing problems connected to open plating. Furthermore, cancellous grafting was necessary within the first group.

[Classification of distal radius fractures and its diagnostic value]. / Die Einteilung der distalen Radiusfrakturen und ihr diagnostischer Wert.

In the conservative treatment of distal radial fractures the main problem is redislocation due to instability. We evaluated the three classification methods most often used to find out how well the different groups correspond to instability and severity of fractures-thus what their prognostic value is in the probable recovery time. Based on an analysis of 633 cases, we found that neither the most often used Frykman nor the AO and older classifications have any practical significance in this respect.

[Prognostic evaluation of the classification of distal radius fractures]. / A radius distalis vég törések osztályozásának prognosztikai értékelése.

Authors give historical review of different classifications in the cases of distal radial fractures. They give analysis on advantage and disadvantage of three different classifications, based on 633 cases, according to the practical applicability, to the expected outcome and to the way of treatment. According to the analysis the Older classification gives good prognosis, but the Frykman classification is without any practical importance. The AO classification is prognostically more or less satisfactory.

[Osteosynthesis using absorbable implants]. / Osteosynthesis felszívódó implantátummal.

Authors report on one case of malleolar synthesis with the use of biodegradable implants. The advantages of the resorbing osteosynthesis materials and the possible complications are described.

[Duplex ultrasound evaluation of Basedow struma treated with iodine therapy]. / Duplexsonographische Beurteilung der Basedow-Struma unter Jod-Therapie.

Over a period of 18 months the thyroid gland of 31 patients suffering from Grave's disease was examined by Duplex ultrasound for changes in blood perfusion. In 24 of these patients a follow-up study was achieved immediately after a presurgical iodine therapy. For estimation of the perfusion the "Pulsatile Flow Index (PFI)" was calculated. Compared to the normal group (22 volunteers, mean: 0.46 +/- 0.11) changes of 41 and 22% were highly significant for this pre (mean: 0.65 +/- 0.08, p < 10E-6) and post therapy (0.56 +/- 0.1, p < 5E-5). Therapy was unsuccessful in 3 cases on a single, in one case on both sides. Altogether PFI yielded semiquantitative information on blood perfusion of the gland as well as on the rate of success.

[Structure of external fixators]. / A fixateur externek szerkezete.

Authors described the development of the construction of fixateur externes supported by historical facts, analyse the biomechanical problems of the fixateur osteosyntheses, illustrated by drawings. They propose mountings, of modern montage proving its rightness. Finally a collection of synonyms is given to clear the nomenclature of the several montages.

[DHS (Dynamic Hip Screw)-osteosynthesis in the management of femoral fractures in the hip region and the place of this method in the treatment of such injuries]. / A csípötáji femurtörés DHS-osteosynthesise és a módszer helye ezen sérülések ellátásában.

In the last four years we performed 182 osteosynthesizes with Dynamic Hip Screw, besides other methods on the fractures of the hip region. Here we are presenting the evaluation of our results, which, regarding the international scene, fall into the medium category. The operations were performed within three days after the injuries in 61 per cent of our patients. Our results are good in 80 per cent of our patients. The incidence of method-specific complications is 15 per cent in our statistics/such as wound haematomas, local infections, cut out of the device of the femoral head, metal failures, the fracture of the femur at the site of the introduction of the device). The rate of complications is 30 per cent in case of Ender nailing. More than a 1 cm shortening in the fracture after weight bearing was observed in the 47 per cent of our DHS cases. Patients who are complaining of pain during weight bearing belong to this group. In accordance with other authors, we consider the DHS osteosynthesis, due to its high stability, the best technique in case of unstable pertochanteric fractures of elderly patients. We recommend the angular plate fixation to the pertrochanteric fractures in young patients, in whose case it requires a more accurate reposition and who are able to walk without weight bearing. We can achieve good results with Ender nails in case of stable pertrochanteric fractures of elderly patients.

[New information about the biomechanics of fracture fixation]. / Ujabb ismeretek a törésrögzítés biomechanikájához.

The better knowledge of the biomechanics of bone tissue and fracture healing resulted in the development of the AO principles and its methods of treatment. I have demonstrated on the femora of rabbits that the consequence of progressive dynamization versus the current unchanging stability of fracture fixation was a more rapid healing. According to our knowledge the more elastic, dynamizating or dynamizable fixation of the fracture are the methods of future. The new biodegradive implantates make not only their removal superfluous but help the fracture healing, too.

[Method of fracture fixation using external fixation devices]. / A töréskezelés taktikája külsö rögzítök alkamazásakor.

An improvement of the results of treatment can be reached, beside respecting the indication of external fixateurs, with correct tactics of the treatment. Because of the disadvantages of the fixateur externe, we strive to restrict their use, to the time by all means necessary, and if possible to use other methods of fixation. This is motivated especially by the effect on fracture healing and the hindering of the movements and activity of the patient.

[Fixateur osteosyntheses of the femur]. / Fixateurosteosynthesen am Oberschenkel.

Clip-type fixators are preferred for femur treatment because of the specific anatomic conditions. Good experience has been obtained from the Magdeburg fixator (an improved configuration of the Wagner fixator). Indication for fixator osteosynthesis on the femur does not differ from the generally valid principles. The approach was found to be suitable also for polytraumatised cases. Complications are controllable, and late results are satisfactory. The rate of osteitis amounted to 3.2 per cent. Problems were recorded from cases of infection, following plate-type osteosynthesis for multifragment fractures, which were even more severe when inspection and plate removal had been delayed. Methods have to be changed in all cases in which fractures have not healed within four to six months. Secondary osteosynthesis in such cases is usually combined with spongiosa reconstitution. A load-relieving fracture box may be sufficient for six months.

[External fixation of the pelvis--indications, assembly and results]. / Fixateur externe am Becken--Indikation, Montage und Ergebnisse.

Stabilisation of pelvic ring fractures by means of external fixation has been found to provide certain advantages over internal fixation. Good results can be achieved, provided that optimum forms and techniques of assembly are used. The authors' indications are reported together with their assembly techniques and forms. The clinical results reported are relating to ten patients, with a pelvic-arm fixator being used in three additional cases. The simple clamp fixator is recommended by the authors for cases of stable symphyseal rupture with a diastasis of more than 1.5 cm.