Venous Leak Embolization in Patients with Venogenic Erectile Dysfunction via Deep Dorsal Penile Vein Access: Safety and Early Efficacy.

PURPOSE: This all-comers registry aimed to assess safety and early efficacy of venous embolization in patients with venogenic erectile dysfunction due to venous leak in an unselected cohort. METHODS: Between October 2019 and September 2022, patients with venogenic erectile dysfunction resistant to phosphodiesterase-5-inhibitors were treated with venous embolization using ultrasound-guided anterograde access via a deep dorsal penile vein in a single center. A mix of ethiodized oil and modified cyanoacrylate-based glue n-butyl 2 cyanoacrylate (NBCA) monomer plus methacryloxy-sulpholane monomer (Glubran-2, GEM, Italy) was used as liquid embolic agent. Prior to embolization, venous leak had been verified based on penile duplex sonography and computed tomography cavernosography. Procedural success was defined as technically successful and complete target vein embolization. The primary safety outcome measure was any major adverse event 6 weeks after the procedure. The primary feasibility outcome measure was IIEF-15 (International Index of Erectile Function-15) score improvement ≥ 4 points in ≥ 50% of subjects on 6 weeks follow-up post intervention. RESULTS: Fifty consecutive patients (mean age 61.8 ± 10.0 years) with severe erectile dysfunction due to venous leak underwent venous embolization. Procedural success was achieved in 49/50 (98%) of patients with no major adverse events on follow-up. The primary feasibility outcome measure at 6 weeks was reached by 34/50 (68%) of patients. CONCLUSION: Venous leak embolization via deep dorsal penile vein access using a liquid embolic agent was safe for all and efficacious in the majority of patients with severe venogenic erectile dysfunction on 6 weeks follow-up.

Effect of different ascorbate supplementations on in vitro cartilage formation in porcine high-density pellet cultures.

Articular cartilage has only very limited potential for self-repair and regeneration. For this reason, various tissue engineering approaches have been developed to generate cartilage tissue in vitro. Usually, most strategies require ascorbate supplementation to promote matrix formation by isolated chondrocytes. In this study, we evaluate and compare the effect of different ascorbate forms and concentrations on in vitro cartilage formation in porcine chondrocyte high-density pellet cultures. l-ascorbate, sodium l-ascorbate, and l-ascorbate-2-phosphate were administered in 100 microM, 200 microM, and 400 microM in the culture medium over 16 days. Pellet thickness increased independently from the supplemented ascorbate form and concentration. Hydroxyproline content increased as well, but here, medium concentration of AsAP and low concentration of AsA showed a more pronounced effect. Proteoglycan and collagen formation were evaluated histologically and could be proven in all supplemented cultures. Non-supplemented cultures, however, showed no stable matrix formation at all. Effects on the gene expression pattern of cartilage marker genes (type I and type II collagen, aggrecan, and cartilage oligomeric matrix protein (COMP)) were studied by real-time RT-PCR and compared to non-supplemented control cultures. Expression level of cartilage marker genes was elevated in all cultures showing that dedifferentiation of chondrocytes could be prevented. Again, all supplementations caused a similar effect except for low concentration of AsA, which resulted in an even higher expression level of all marker genes. Besides that, we could not detect a pronounced difference between ascorbate and its derivates as well as between the different concentrations.

High intensity dependence of auditory evoked dipole source activity indicates decreased serotonergic activity in abstinent ecstasy (MDMA) users.

Neurotoxic damage of central serotonergic systems has been demonstrated in numerous animal studies after exposure to methylenedioxyamphetamines (ecstasy). A high intensity dependence of auditory evoked potentials and, particularly, of the tangential N1/P2 source activity has been associated with low levels of serotonergic neurotransmission in humans. We performed an auditory evoked potentials study in 28 abstinent recreational ecstasy users and two equally sized groups of cannabis users and nonusers. The ecstasy users exhibited an increase of the amplitude of the tangential N1/P2 source activity with higher stimulus intensities; whereas, both control groups failed to exhibit this feature. These data are in line with the hypothesis that abstinent ecstasy users present with diminished central serotonergic activity. This feature of information processing is probably related to the well-recognized neurotoxic potential of ecstasy. Our data indicate that recreational ecstasy use may cause long-term alterations in the function (and possibly structure) of the human brain.

Impaired cognitive performance in drug free users of recreational ecstasy (MDMA)

OBJECTIVES: Ecstasy (3,4-methylenedioxymethamphetamine (MDMA) and related congerers: MDA, MDEA) is the name given to a group of popular recreational drugs. Animal data raise concern about neurotoxic effects of high doses of ecstasy on central serotonergic systems. The threshold dose for neurotoxicity in humans is not clear and serotonin is involved in several functions including cognition. The purpose of this study was to investigate cognitive performance in a group of typical recreational ecstasy users. METHODS: A comprehensive cognitive test battery was administered to 28 abstinent ecstasy users with concomitant use of cannabis only and to two equally sized matched groups of cannabis users and non-users. The sample consisted of ecstasy users with a typical recreational use pattern and did not include very heavy users. RESULTS: Ecstasy users were unimpaired in simple tests of attention (alertness). However, they performed worse than one or both control groups in the more complex tests of attention, in memory and learning tasks, and in tasks reflecting aspects of general intelligence. Heavier ecstasy and heavier cannabis use were associated with poorer performance in the group of ecstasy users. By contrast, the cannabis users did not differ significantly in their performance from the non-users. CONCLUSIONS: The present data raise concern that use of ecstasy possibly in conjunction with cannabis may lead to cognitive decline in otherwise healthy young people. Although the nature of the emerging cognitive disturbance is not yet clear, an impairment of working memory might be the common denominator underlying or contributing to declines of performance in various tasks. The cognitive disturbance is likely to be related to the well recognised neurotoxic potential of ecstasy. The data suggest that even typical recreational doses of ecstasy are sufficient to cause neurotoxicity in humans.

Gas-chromatographic determination of pesticide residues after clean-up by gel-permeation chromatography and mini-silica gel-column chromatography6. Communication(*): Replacement of dichloromethane by ethyl acetate/cyclohexane in liquid-liquid partition and simplified conditions for extraction and liquid-liquid partitio.

A new extraction and partition step was introduced into the well established multi-residue method of Specht and Tillkes (DFG method S 19) replacing dichloromethane by ethyl acetate/cyclohexane (1+1). In addition, more simple working conditions were obtained. Results of fortification experiments with organochlorine, organophosphorus and organonitrogen pesticides showed good agreement with those obtained by the formerly published method.

Obstetric risks and outcomes: birth centre compared with conventional labour ward.

Birth centres in Australia provide an option for women and their professional advisors when choosing the setting for childbirth. It is important that empirical information about the risks is available to enable informed decisions to be made. The purpose of this study was to compare the obstetric outcomes for women admitted to the Birth Centre at Royal Hospital for Women in Sydney with outcomes for women admitted to the conventional labour ward, controlling for prenatal and intrapartum risk. The findings indicate that, with the existing back-up provided by the conventional service, the outcomes for women admitted to the Birth Centre were at least as good as those of the other women. The study also shows that there are differences between the two settings in the management of the intrapartum period. The rate of intervention is substantially higher for women admitted to the Labour Ward, after risk is taken into consideration. The evaluation indicates that the Birth Centre offers a viable choice for women with relatively low obstetric risk.

Obstetric high risk screening and prediction of neonatal morbidity.

A retrospective study using an obstetric risk score protocol was applied to a stratified sequential sample of 843 singleton livebirths, occurring in the Royal Hospital for Women, Sydney, over a 12-month period (March, 1985-February, 1986). Data collection included 53 prenatal factors, 41 intrapartum factors and 37 neonatal factors. The study was comprised of 346 women admitted to the hospital birth centre and 497 women admitted to labour ward. In labour ward admitted women there was a significant association between high prenatal scores, high intrapartum scores and high neonatal morbidity scores. Women admitted to the birth centre were subjected to a screening procedure which resulted in low prenatal and relatively low intrapartum risk scores. However, neonatal morbidity scores were similar for both groups. The risk scoring protocol used in this study requires further revision to allow the adequate selection of low risk women delivering infants with a low risk of neonatal morbidity in a low risk obstetric setting.

Planning birth centres.

This paper draws attention to the different definitions of 'birth centre', and the lack of consensus regarding the physical and organisational characteristics that distinguish a birth centre from conventional labour suites. Two case studies of decision-making about the location of a new birth centre are presented; they illustrate the need to take account of the views of each client and professional group concerned. The need for integrating organisational development with physical planning procedures is emphasised.

Patient satisfaction with outpatient primary health care in a metropolitan medical center.

This paper presents rates and correlates of patient satisfaction with primary care in a New York medical center. Over an eight-week period, we studied only first-time, "workup" encounters. Patient satisfaction was measured with three scales and one single-item measure. The highest rates of satisfaction were registered in relation to (1) the encounter in general, followed by (2) doctor conduct and (3) convenience. Four sets of independent variables were studied: sociodemographic variables, social psychological antecedent variables, other patient characteristics, and physician characteristics. Age was found to be the most important sociodemographic characteristic of patients affecting their satisfaction with the encounter; having positive expectations of the encounter had more effect on subsequent satisfaction ratings than other social psychological variables studied here. When each of the satisfaction measures was regressed on the sets of independent variables, the proportion of variance explained changed, as did the relative contribution of the different independent variables. We discuss the importance of studying patient satisfaction with specific medical encounters, along with the findings of our study.

The multidimensionality of patient satisfaction with a clinic visit.

Three hypotheses regarding the factor structure of patient satisfaction with an ambulatory health care encounter were tested in a New York medical center outpatient sample. All three hypotheses were generally supported. It was found that patients evaluated four distinct aspects of the clinic visit: doctor conduct, convenience, appointment getting, and the visit in general. A significant proportion of the variance in general satisfaction was explained by satisfaction with doctor conduct and satisfaction with convenience. Three factor scales of patient satisfaction were developed with demonstrable internal consistency reliability. Some possible effects of response method on satisfaction ratings were studied; these method effects were not substantial, and it is suggested that this type of psychometric procedure be used in further studies of patient satisfaction.

The meaning of patient satisfaction with prepaid primary health care in Israel.

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.

Toward a theory of patient satisfaction.

Despite the widespread concern in health care literature with patients'--or clients'--satisfaction, there has been no explicit definition of that concept nor systematic consideration of its determinants and consequences. The definition of satisfaction proposed here is derived from Fishbein and Ajzen's attitude theory and from job satisfaction research. Among the various probable determinants of a patient's satisfaction with health care are his/her attitudes and perceptions prior to experiencing that care; after reviewing relevant social science theories, we hypothesize five such social psychological variables which affect satisfaction ratings. The present attempt to define the concept patient satisfaction and to hypothesize some of its determinants can be regarded as first steps in building a theory of patient satisfaction.

Social psychological determinants of patient satisfaction: a test of five hypothesis.

Five hypothesis regarding the social psychological determinants of patient satisfaction were tested among patients attending the primary care clinics of a university medical center in Manhatten. The social psychological variables operationalized here were expectations, values, entitlement and perceived occurrences; the three dimensions of satisfaction studied were doctor conduct, convenience and general satisfaction. The social psychological variables together were found to explain only a small proportion of the variance in satisfaction, although their contribution varied with the dimension of satisfaction. Expectations consistantly explained most of the variance in satisfaction ratings; particularly noteworthy was the direct effect of prior expectations of the doctor's conduct on subsequent satisfaction with that dimension of the care received. Values had little independent effect on satisfaction, and the combination of values and expectations (their interaction) was unrelated to satisfaction. Feelings of entitlement were also unrelated to satisfaction ratings. There was some support for the discrepancy model, which holds that the greater the discrepancy between perceived occurrences and prior expectations the less the satisfaction. The importance of carrying out further methodological studies aimed at developing reliable measures of these constructs is stressed.