Effect of correcting serum cholesterol levels on erectile function in patients with vasculogenic erectile dysfunction.

OBJECTIVE: This study evaluated the effect of correction of serum cholesterol levels on erectile function and sildenafil treatment in patients with erectile dysfunction who have only hypercholesterolaemia as a risk factor for erectile dysfunction. MATERIAL AND METHODS: Twenty-five patients with a single risk factor (hypercholesterolaemia, serum cholesterol > 200 mg/dl) for erectile dysfunction were included in the study. The patients were recommended to take sildenafil (minimum two 100 mg tablets/week) 1 h before sexual intercourse for 4 weeks. After 1 month washout period, the patients received a single dose of atorvastatin 10 mg/day for 1 month. Similarly, after a 1 month washout period, atorvastatin 10 mg/day and sildenafil (minimum two 100 mg tablets/week) were administered for 1 month as combination therapy. Erectile function was evaluated before and after all treatment regimens using the International Index of Erectile Function (IIEF). RESULTS: Following each treatment modality mean IIEF scores were significantly higher than baseline IIEF scores (p < 0.01). The IIEF score after sildenafil treatment was significantly higher than in the atorvastatin treatment group (p < 0.01); and the IIEF score after combined treatment was significantly higher than in the sildenafil and atorvastatin treatment groups. CONCLUSIONS: Correction of serum cholesterol levels with atorvastatin could improve erectile function in patients who have only hypercholesterolaemia as a risk factor for erectile dysfunction. Furthermore, atorvastatin could improve sildenafil's effects on erectile function in hypercholesterolaemic patients with erectile dysfunction.

Effects of parasympathetic blockade on hepatic and portal venous flow.

BACKGROUND/AIMS: To investigate the effect of parasympathetic blockade on the hepatic circulation, a study was performed in healthy men because the precise knowledge of factors to affect the hepatic circulation is required for the evaluation of liver diseases. METHODOLOGY: Doppler measurements of the hepatic venous and portal venous flow were obtained with measurements of cardiac function before and after the administration of atropine sulfate, 0.02 mg/kg. RESULTS: Parasympathetic blockade increased heart rate and cardiac output and changed diastolic right ventricular filling pattern. However, portal venous flow remained unchanged. Hepatic venous flow was triphasic at rest in 15 of the 20 subjects (75%). The amplitude of the oscillation of hepatic venous flow velocity was significantly reduced in association with an increase in heart rate and the hepatic venous flow pattern was significantly influenced by parasympathetic blockade in accordance with a change in right ventricular filling pattern. CONCLUSIONS: The autoregulation of portal venous flow was suggested to exist and that the influences of parasympathetic activity and/or heart rate affected hepatic venous flow pattern.

Endothelial activation response to oral micronised flavonoid therapy in patients with chronic venous disease--a prospective study.

BACKGROUND: Endothelial activation is important in the pathogenesis of skin changes due to chronic venous disease (CVD). Purified micronised flavonoid fraction has been used for symptomatic treatment of CVD for a considerable period of time. The exact mode of action of these compounds remains unknown. AIM: To study the effects of micronised purified flavonoidic fraction (Daflon 500 mg, Servier, France) treatment on plasma markers of endothelial activation. MATERIALS AND METHODS: Twenty patients with chronic venous disease were treated for 60 days with DAFLON 500 mg twice daily. Duplex ultrasonography and PPG was used to assess the venous disease. Blood was collected from a foot vein immediately before starting treatment and within 1 week of stopping treatment. Plasma markers of endothelial activation were measured using commercial ELISA kits. RESULTS: Reduction in the level of ICAM-1, 32% (141 ng/ml: 73 ng/ml) and VCAM 29% (1292 ng/ml: 717 ng/ml) was seen. Reduction in plasma lactoferrin (36% decrease, 760 ng/ml: 560 ng/ml) and VW factor occurred in the C4 group only. CONCLUSIONS: Micronised purified flavonoidic fraction treatment for 60 days seems to decrease the levels of some plasma markers of endothelial activation. This could ameliorate the dermatological effects of (CVD). This could also explain some of the pharmacological actions of these compounds. Our study demonstrates the feasibility of using soluble endothelial adhesion molecules as markers for treatment.

[Transurethral alprostadil administration with MUSE ("Medicated Urethral System for Erection"). Current overview and personal experiences]. / Transurethrale Alprostadilapplikation mit MUSE ("medicated urethral system for erection"). Aktuelle Ubersicht und eigene Erfahrungen.

An analysis of the presently available results concerning transurethral application of Alprostadil with MUSE (Medicated Urethral System for Erection) up to 1000 micrograms indicates a 20-30% lower efficacy if compared to 20 micrograms i.c. injected Alprostadil. Whereas in prospective home-treatment trials only each second MUSE-application was successful in responders 87%-94% of the administrations in self-injection therapy resulted in successful coitus. In an own comparative trial in 73 pts the success rates after MUSE up to 1000 micrograms were 48% compared to 71% after i.c. Alprostadil. Reported side-effects of MUSE in the literature were: Hypotension 3-8%, syncopes 0.4%, penile/urethral pain 29%, urethral bleeding 5%, vaginal irritations 3%, priapisms < 0.1%. After MUSE-applikation the average Alprostadil contents of the ejaculate increased 40%. Whereas in prospective long-term studies of self-injection therapy with Alprostadil the risk of persistent fibrotic alterations of the penis varied between 5-7%, the risk of penile fibrosis after MUSE can not be finally estimated. Also the potential risk for urethral strictures after MUSE is presently not foreseable. The advantage of the technically easy use in confronted with a considerably lower efficacy. Therefore self-injection therapy must be further on considered the "golden standard" in Alprostadil administration.

The effect of nilvadipine on bloodflow in the dorsal pedis artery in type 2 diabetic patients--a study using duplex Doppler ultrasonography.

The effects of nilvadipine on the peripheral circulation in the lower extremities using a duplex system of two-dimensional colour and pulse Doppler ultrasonography were studied in 32 patients with type 2 diabetes mellitus and mild essential hypertension. The patients (19 men and 13 women) were randomly divided into treatment and control groups. The anatomical cross-sectional area and blood flow index of the dorsal pedis artery were determined by colour and pulse Doppler ultrasonography before and 60 min after administration of 4 mg nilvadipine or placebo. Pulse rate and blood pressure were measured simultaneously. There were no significant changes in pulse rate or blood pressure after administration of either drug. Both cross-sectional areas (from 4.3 +/- 0.4 to 5.2 +/- 0.5 mm2, p < 0.05) and blood flow index (from 40.3 +/- 4.3 to 58.8 +/- 9.0, p < 0.05) were significantly increased in the treatment group, whereas there were no significant changes in either measurement in the control group. The findings showed that a single administration of nilvadipine increases blood flow in the dorsal pedis arteries of diabetic patients.