Schistosomiasis in Saudi Arabia, Egypt, and Iraq.

The incidence of schistosomiasis, a parasitic infestation caused by trematodes, or flukes, has decreased significantly in Egypt and other Middle Eastern countries. The education of people in the countryside is a primary reason. The water supply in these countries is now good, and, in most areas, women no longer use the stagnant river tributaries for washing clothes. Medications, which can be used to prevent the infection or kill the parasite include praziquante and metrifonate.

Smoking related carcinogen-DNA adducts in biopsy samples of human urinary bladder: identification of N-(deoxyguanosin-8-yl)-4-aminobiphenyl as a major adduct.

The prevalence of covalent modifications to DNA (carcinogen-DNA adducts) in 42 human urinary bladder biopsy samples was investigated by 32P-postlabeling methods, with enhancement by both nuclease P1 treatment and 1-butanol extraction. Total mean carcinogen-DNA adduct levels and the mean levels of several specific adducts were significantly elevated in DNA samples of 13 current smokers, as opposed to 9 never smokers or 20 ex-smokers (5 years abstinence). There was no significant difference between the latter two groups. Several DNA adducts enhanced by nuclease P1 treatment were chromatographically similar to putative hydrocarbon DNA adducts reported earlier for placenta and lung DNA samples obtained from cigarette smokers. Putative aromatic amine adducts were detected by 1-butanol extraction that were not present when the samples were treated with nuclease P1. One of these displayed chromatographic behavior identical to the predominant adduct induced by the human urinary bladder carcinogen, 4-aminobiphenyl, which is present in cigarette smoke. This adduct comigrated in several thin-layer chromatographic systems with a synthetic N-(deoxyguanosin-8-yl)-4-amino[2,2'-3H]biphenyl-3',5'-bisphosphate marker. Moreover, when this adduct was eluted from the thin-layer chromatograms of several individuals and injected onto an HPLC system, the 32P from the human bladder DNA samples coeluted in the same fraction as the tritiated synthetic N-(deoxyguanosin-8-yl)-4-aminobiphenyl marker. These data reinforce an association between cigarette smoking and DNA damage and suggest a molecular basis for the initiation of human urinary bladder cancer by cigarette smoke.

Continence level following radical prostatectomy.

The relationship of the urethral anastomosis and postoperative continence following radical prostatectomy is uncertain. The objective of this study was to determine radiographically the functional level of continence following radical prostatectomy relative to the site of the intraoperative urethral anastomosis. In 8 patients having a radical prostatectomy, an intraoperative hemoclip was placed at the site of the urethral anastomosis and the postoperative functional level of continence was determined using a standing lateral cystogram. The functional level of continence was 9 mm (SD = 3.0) distal to the site of the urethral anastomosis. The level in the urethra that continence occurs may be a function of the intrinsic continence parameters of each individual patient.

Synergist Erection System: clinical experience.

The Synergist Erection System (SES) was tested over a six-month period in 44 impotent patients with an organic etiology. The device was successfully used by 73 percent. The duration of erection for 75 percent of the patients was as long as they wanted to wear the device. The frequency of use was once a week for 47 percent. The quality of erection was rated satisfactory by 63 percent of the patients and 78 percent of the couples rated satisfactory intercourse. It appears the SES option is a valid one with high success and satisfaction rating at least on a short-term basis. In addition, it offers prophylactic protection.

Follow up outcome of intracavernous papaverine.

One of the more significant recent therapeutic developments in the treatment of male impotence has been intracavernous pharmacotherapy using penis self-injection technique. The intracavernous pharmacotherapy of impotence results in a relatively normal erection in most cases with minimal alteration of the anatomy, physiology, and psychosocial factor of impotence. However, early treatment success of the patient does not assure long-term success. The objective of this study was to determine the long-term utilization outcome of intracavernous pharmacotherapy in the management of impotence. Of 103 enrolled in the study, 50 patients (49%) were actively using the injection treatment method after 18 months. There were no significant difference in mean age of those patients who discontinued from those who continued to use intracavernous therapy. Of the 53 patients (51%) who discontinued intracavernous therapy, 33 patients (62%) were unsatisfied with the results, nine patients (17%) were unsatisfied with the methodology, eight patients (15%) developed penile complications, and three patients (6%) had improvement of sexual function. Thirty-four (69%) of those who discontinued therapy elected an alternative form of therapy and 16 patients (30%) were not interested in any further treatment. While it is difficult to assess the many factors involved in the outcome of therapy for impotence, the assessment of long-term intracavernous therapy utilization provides a relatively low risk means for clinical evaluation of the therapeutic value of pharmacotherapy for the individual as well as a clinical indication of the sexual function needs of the patient.

Reproductive toxicity: male and female reproductive systems as targets for chemical injury.

On the basis of current knowledge of reproductive biology and toxicology, it is apparent that chemicals affecting reproduction may elicit their effects at a number of sites in both the male and the female reproductive system. This multiplicity of targets is attributable to the dynamic nature of the reproductive system, in which the hypothalamic-pituitary-gonadal axis is controlled by precise positive and negative feedback mechanisms among its components. Interference by a xenobiotic at any level in either the male or the female reproductive system may ultimately impair hypothalamic or pituitary function. Normal gonadal processes such as spermatogenesis or oogenesis, ejaculation or ovulation, hormone production by Leydig or granulosa cells, and the structure or function of the accessory reproductive structures (e.g., epididymis, fallopian tube) also appear vulnerable to xenobiotics. The reproductive system is a complex one that requires local and circulating hormones for control. This brief review illustrates a system for characterizing the mechanism of action of reproductive toxicants, as well as for defining the sites available for disruption of reproduction. Unfortunately, at present, data addressing the actual vulnerability of reproduction are sorely lacking. However, when experiments have been conducted and combined with epidemiologic data or clinical observation, it has been possible to demonstrate impairment of reproductive processes by xenobiotics. The role of environmental exposure to xenobiotics in the increase in infertility that has been observed remains to be defined.

New apparatus to reduce urinary drainage associated with urinary tract infections.

The automatic release of povidone iodine (PVP-I) into the outlet tube of a urinary collecting bag significantly reduced urinary tract infections (UTIs) and provided a more practical bacterial barrier than manual instillation of PVP-I into the bag as used previously. In 52 patients using a new urinary drainage system with a cartridge that released PVP-I into the outlet tube of the collection bag UTIs developed in 3, compared with 57 patients using a standard closed drainage system and in whom 13 UTIs developed (p less than 0.005). The PVP-I group had 92 percent of the accumulative catheter-days free of bladder infection, compared with 77 percent in the standard group. The main route of bacterial contamination leading to urinary drainage UTIs was through the collection bag.

Vasocystostomy: a model for studying male reproductive toxicity in the rat.

A nonsacrificial rat model has been developed which permits the easy collection and measurement of spermatozoa. The ductus deferens is anastomosed to the bladder (Vasocystostomy) and urinary sperm is collected daily. The correlation between testicular histology and sperm counts indicates that this model is reliable. Using this model we demonstrate inhibition of sperm production by fluoroacetate.

Penile self-injection for impotence in patients after radical cystectomy-ileal loop.

Eight patients with impotence following radical cystectomy and ileal loop surgery for cancer of the bladder were treated with a mixture of papaverine/phentolamine at 30/1 ratio. All but 1 patient had a successful result. In the majority of patients the duration of the erection was significantly less than in impotent patients with different causations.