[Utilization of prosthesis in patients who underwent below-knee amputation].

BACKGROUND: Thirty-two patients, among them 25 men (78.1%) and 7 women (21.9%), underwent surgery for below-knee amputation at the Western Galilee hospital, Nahariya, received a prosthesis and began rehabilitation treatment at the same hospital. Of these, 27 patients--21 men (77.8%) and 6 women (22.8%) responded to the authors request to complete the questionnaire. Four of these underwent bilateral below-knee amputation. The authors had no previous information about routine use of prosthesis after the termination of the rehabilitation process. METHODS: All patients who underwent a below-knee amputation between the years 2000 and 2004 and received a prosthesis thereafter, were surveyed. Each one was asked to complete a detailed questionnaire. The patients were asked about the use of prosthesis during daily activities, their mobility inside and outside the home, the possibility of returning to work, the influence on their social activity, the various complications caused by the prosthesis, the use of a walking aid, their ability to drive a car or to use public transport, and their ability to accomplish some physical tasks. The questionnaire included information about the patient's age, sex, level of education, civil status and familial support, in order to evaluate their influence on the use of the prosthesis. RESULTS AND CONCLUSIONS: The statistically significant results were all dependent upon the amputee's age. With an increase in age, the patient wears the prosthesis fewer hours per day inside and outside the home, has difficulty in walking quickly, tires earlier while walking and has a reduced quality of life.

[Contribution of psychosexual approach to assessment and treatment of sexual dysfunction: a working model].

INTRODUCTION: Increasing awareness and medical studies of sexual dysfunction (SD) unveil the multi-dimensional nature of SD and the need for a multidisciplinary treatment approach. PURPOSE: To describe the psychosexual contribution to the multidisciplinary model for the assessment and treatment of SD. METHODS: The psychosexual contribution will be demonstrated by 4 case reports and data of subjects applying for sex therapy during 2004-8. OUTCOMES: A total of 822 women (age 35 +/- 12.0 years) and 813 men (age 38 +/- 13.2 years) applied for sex therapy; 44% were referred by a physician, 37% found information on the internet or in other media resources. The most frequent SDs in women were: hypoactive sexual desire disorder (HSDD] (29.7%), sexual pain (28.5%) and anorgasmia (20.9%); and in men: erectile dysfunction (44.2%), premature ejaculation (24.5%) and HSDD (17.5%). Co-morbid relationship distress was found in 217 of the cases (26.5%). CONCLUSIONS: Subjects, referred by a physician or on their own initiation, present a variety of SDs, stemming from a combination of physical, psychological and interpersonal contributing factors. The presenting sexual problem is frequently the tip of the iceberg of hidden psychological problems, relationship distress or partner's SD. The overall goal of treatment is increased pleasure and satisfaction, rather than achieving a perfect genital response. Therefore, successful treatment outcome depends on multi-professional assessment and successful resolution of the issues that accompany the sexual complaint, sharing the process with patients and their partners.

[Model approach for evaluation and treatment of men with premature ejaculation].

INTRODUCTION: Premature ejaculation (PE) is one of the most common sexual dysfunctions among men. PE is poorly defined and inadequately characterized, therefore, professionals find it difficult to cope with the diagnosis, treatment and research. Men who complain about their PE also describe their problem in different ways. PURPOSE: This article describes the prevalence of PE, presents the different definitions of the problem and provides a model for evaluation and treatment combining medical and psychosexual techniques. METHODS: The proposed model for the diagnosis and treatment of PE was composed by combining information from relevant literature with the multi-professional staff experience in our Sexual Medicine Center. OUTCOMES: Selective serotonin release inhibitors (SSRIs) have been the most promising medication for treatment of PE. Psychosexual therapy, offering cognitive-behavioral techniques contribute to the man's ability to improve his sexual and couple relationships. CONCLUSIONS: Diagnosis of PE is mainly based on sexual history as described by the male patient. Therefore, it is essential to have a comprehensive medical and sexual history, description of the effect of PE on sexual activity, and the degree of personal and couple distress. It is important to clarify the onset of the problem, as PE may be the result of another sexual dysfunction of the man or his sexual partner.

[Morel-Lavallee syndrome after crush injury].

Closed internal degloving is a significant soft tissue injury associated with pelvic trauma in which the subcutaneous tissue is torn away from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter, but may also occur in the flank, buttock and lumbodorsal region, and it is known as a Morel-Lavallee lesion. The diagnosis of closed degloving injuries is based on physical and ultrasonographic examinations. The presence of a soft fluctuant area is the hallmark physical finding. Decreased cutaneous sensation is often associated with the skin over the area of degloving. Local contusion or other signs of injuries such as tire marks may also be present. In two separate cases, a 26-year-old woman and a 67-year-old man were injured in low velocity automobile accidents. During hospitalization, subcutaneous swellings were diagnosed as internal degloving injuries, and were drained several times by a plastic surgeon. A follow-up one year later revealed that the woman still suffered from swelling in the buttocks and thigh, though liposuction was successfully conducted; the man recovered completely from his injury after the conservative treatment. In most cases of degloving injuries, there is bruising of the skin or superficial hematoma, which resorbs spontaneously. However, in some cases, injury to the subcutaneous fatty tissue can result in the formation of a pseudocyst due to lymphatic extravasation. When hematoma or fluid collection does occur, puncture drainage and pressure therapy is usually considered to be sufficient treatment. Otherwise, surgical intervention must be proposed.