Eosinophilic granuloma presenting as post-traumatic scalp hematoma with epidural hemorrhage. A case report.

Langerhans cell histiocytosis (LCH) encompasses a range of clinical presentations. Pure osseous involvement is referred to as eosinophilic granuloma (EG), whereas systemic involvement can either be classified as Hand-Schuller-Christian disease or Letterer-Siwe syndrome. It is estimated that of the total incidence of LCH (0.5 per 100,000 children per year in the United States), nearly 70% are categorized as EG (1). We describe a case of clinically occult calvarial eosinophilic granuloma brought to medical attention only after a traumatic event led to scalp and epidural hemorrhage at the site of the lesion. Osseous EG initially presents as a painful or tender mass, at times even mimicking osteomyelitis. Computed tomography (CT) reveals a lytic lesion with beveled edges. Magnetic resonance (MR) imaging is often non-specific, but usually demonstrates a marrow-replacing process that is T1 hypointense, T2 hyperintense, with homogenous enhancement. The complex MR imaging findings in our case provided a unique perspective regarding the presentation of EG. Once pathology established eosinophilic granuloma, skeletal survey confirmed the lesion was solitary, despite a compelling history of present illness.

Pharmacotherapy or psychotherapy?: effective treatment for FSD related to unresolved childhood sexual abuse.

Childhood sexual abuse (CSA) is the form of sexual victimization most correlated with sexual dysfunction in adulthood (Atkeson, Calhoun, Resick, & Ellis, 1994; Sarwer & Durlak, 1996; Laumann, Paik, & Rosen, 1999). The goal of this study was to address the sexual ramifications of unresolved CSA and consider the effectiveness of vasoactive pharmacotherapy, specifically sildenafil, for the treatment of women with unresolved CSA. The sample included 35 women (mean age, 45 years) who presented to a sexual health clinic and who were not of childbearing potential. Of the sample 7 women (23%) had a history of unresolved CSA. Following a psychosexual history and medical evaluation, all women were treated with 100 mg of sildenafil, to be used over a 6-week period at home. When home doses were complete, participants filled out the FIEI, a valid and reliable 5-item questionnaire asking about sexual response post sildenafil. Parameters of sexual response included vaginal lubrication, amount and quality of sensation, satisfaction with intercourse, and ability to reach orgasm. Trends were calculated comparing women with and without unresolved CSA history. A minority of women with CSA responded positively to sildenafil.

Erectile dysfunction is a marker for cardiovascular complications and psychological functioning in men with hypertension.

The aim of this study was to investigate the incidence of cardiovascular complications in hypertensive patients with erectile dysfunction (ED). An anonymous questionnaire was mailed to 467 and received from 104 hypertensive male patients. Despite the low response rate of 22%, the following interesting findings could be observed: 70.6% of the patients who responded suffered from ED. The hypertensive patients with ED had significantly higher prevalence of cardiovascular complications (P < 0.05). The correlation between depression and low quality of life as well as between ED and low sexual satisfaction was also statistically significant (P = 0.05). ED in hypertensive patients can be considered as a marker for cardiovascular complications in this patient group.

Hypertension is associated with severe erectile dysfunction.

PURPOSE: The prevalence and severity of erectile dysfunction in patients with hypertension need to be further evaluated. We evaluate medical and hypertension status, and erectile function in patients with hypertension. MATERIALS AND METHODS: The International Index of Erectile Function, which is a detailed questionnaire, including well established components to evaluate patient medical history, hypertension status and erectile dysfunction, was mailed to 476 male patients of the outpatient Hypertension Center of Columbia Presbyterian Medical Center. RESULTS: The questionnaire was completed by 104 (22.3%) patients, and mean age was 62.2 years (range 34 to 75). Of the patients 84.8% were sexually active and 68. 3% had various degrees of erectile dysfunction, which was mild in 7. 7%, moderate in 15.4% and severe in 45.2%. Compared to the general population of erectile dysfunction cases in the literature our study population with hypertension had a higher incidence of severe erectile dysfunction. Although correlations of antihypertensive medications with incidence of erectile dysfunction did not reach statistical significance, there was a clear trend with patients treated with diuretics and beta-blockers having the highest incidence and those treated with alpha-blockers having the lowest incidence of erectile dysfunction. CONCLUSIONS: In addition to the observation that erectile dysfunction is more prevalent in patients with hypertension than in an age matched general population, our study shows that it is more severe in those with hypertension than in the general population.