Interdisciplinary assessment and follow-up of patients with erectile dysfunction--psychiatric aspects.

The objectives of this investigation were to assess the psychiatric comorbidity and patients' satisfaction with treatment in a sample of 73 men with erectile dysfunction (ED) who were consecutively admitted to an andrologic outpatient centre. After comprehensive interdisciplinary assessment, 49% of these patients were assigned an organic etiology, 33% had psychogenic impotence, and in 18% somatic and psychogenic factors seemed to be relevant. 63% of all patients received a psychiatric diagnosis (according to ICD-9). Depressive disorders were found in 25%. Organic psychosyndromes (nonpsychotic) were prominent in the somatic group. In a follow-up after 29.4 +/- 5.0 months, 41 out of 73 patients could be reevaluated, of which 85% of organic patients had received some kind of therapy, but 65% were not satisfied with the chosen treatment. These results underline the importance of close interdisciplinary co-operation in the assessment and therapy of patients with erectile importance. Potential reasons for drop-out and limited acceptance of the offered treatments are discussed.

[Transsexualism and schizophrenic psychosis. Problems preparing expert opinion on transsexualism]. / Transsexualismus und schizophrene Psychose. Probleme bei der gutachterlichen Beurteilung nach dem Transsexuellengesetz.

We report on two schizophrenics with transsexual beliefs to illustrate the problems in nosological classification of these patients and the difficulties in preparing expertises on changing the first name or on the legal changing of sex status according to the German Transsexuals Act (TSG). We should differentiate between rare cases of true comorbidity of schizophrenia and transsexualism, and other patients in whom the transsexual wish presents as a symptom of psychosis. Before approving any legal changes or even sex reassignment surgery, the transsexual wish should have remained unchanged under otherwise successful antipsychotic treatment. Moreover, the patients must be able to translate into reality the desired sexual role in their social environment.

Cannabis and schizophrenia: results of a follow-up study.

A total of 39 schizophrenic patients with a history of current cannabis abuse at index admission was compared with a control group of schizophrenics without substance abuse matched for age, gender, and year of admission. At follow-up after 68.7+/-28.3 months, 27/ 39 cases and 26/39 controls could be investigated. 8/27 cases (30%) had continued cannabis abuse, 6/27 (22%) had become alcohol abusers. Only one patient of the control group had started abusing alcohol. Patients with previous cannabis abuse had significantly more rehospitalizations, tended to worse psychosocial functioning, and scored significantly higher on the psychopathological syndromes "thought disturbance" (BPRS) and "hostility" (AMDP). These results confirm the major impact of cannabis abuse on the long-term outcome of schizophrenic patients.

Treatment of erectile dysfunction with external vacuum devices.

In a retrospective study, the medical and psychological outcome of the use of external vacuum devices in the treatment of erectile dysfunction in 190 patients was evaluated, using a questionnaire and a clinical examination. 110/190 patients (57.8%) answered the questionnaire. 22/110 patients (20%) rejected the device primarily and 34/110 (30.9%) after a period of up to 16 weeks (primary rejection rate 50.9%). A secondary drop-out rate of 8/110 (7.3%) was observed after an intermediate time of 10.5 months. 46/110 (41.8%) patients were long-term users (median 27.6 months, range 7-70 months). Long-term users were mainly patients who did not respond to intracavernosal pharmacotherapy. In the group of long-term users, 98% of patients and 85% of their partners were satisfied with the vacuum therapy. Complications were minor (hematoma 9.8%; skin injury 2.2%), 69.8% of long-term users never had problems with the device. 74% of users reported regular orgasm. Vacuum therapy is a safe and effective non-invasive treatment of erectile dysfunction with a limited primary acceptance and low drop-out rates in long-term follow-ups.

What mothers in the Women, Infants, and Children (WIC) program feel about WIC and immunization linkage activities. A summary of focus groups in Wisconsin.

BACKGROUND: Although studies indicate that strategies to improve immunization coverage among preschool-age children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are effective, the attitudes of parents of children enrolled in WIC toward the linkage between WIC and immunization programs is unknown. OBJECTIVE: To gain a better understanding of how parents using WIC resources feel about the association of WIC and immunization services, their attitudes toward WIC immunization activities, factors that may cause clients to drop out of the program, and the effects of racial background on parent attitudes. PARTICIPANTS AND METHODS: We conducted 8 focus group sessions with mothers whose children receive WIC services in Milwaukee, Wis. Mothers were between 18 and 35 years old, with at least 1 child between 6 and 24 months of age. The 47 mothers participating were each assigned to 1 of 8 focus groups, including 2 groups each of Asian, white, African American, and Hispanic mothers. A systematic content analysis was conducted for themes and key points within and across ethnic groups. RESULTS: Socially disadvantaged mothers reported their overall experiences in WIC to be very positive. Lengthy waiting time during a WIC visit was identified as the most important barrier to participation. Mothers believed strongly that it was the responsibility of parents to get their children vaccinated, but that WIC staff and the primary care provider should work together to remind parents when vaccinations were due. Mothers expressed very positive attitudes toward the linking of WIC and immunization activities. Telephone reminders and education were mentioned as the best ways to encourage mothers to get their child vaccinated on time. Immunization linkage activities and the requirement that a parent report to a WIC center more frequently if the child was underimmunized were not mentioned as reasons for dropping out of the WIC program; indeed, more frequent visits to a WIC center were actually viewed as a potentially effective strategy by several mothers. Some mothers found obtaining immunizations and WIC services at the same time and place to be very convenient. There did not seem to be any significant differences among ethnic groups in attitudes toward immunization linkage activities being performed in WIC. CONCLUSIONS: Mothers with preschool-age children enrolled in WIC feel that the linkage of immunization activities with WIC services is a helpful way to improve the health of their children. This linkage was not identified as a contributing factor for leaving the WIC program.

Discrepant karyotypes after second- and third-trimester combined placentacentesis/amniocentesis.

Cytogenetic data are presented from a total of 1306 consecutive pregnancies with successful diagnosis obtained from both chorionic villi after short-time culture (CVS-SC) and amniotic fluid cell cultures (AC); samples had been taken simultaneously at combined placentacentesis (placental biopsy) and amniocentesis during the second (92.8 per cent) and third (7.2 per cent) trimesters. Concordant results were obtained in 1218 pregnancies with a normal karyotype and in 62 pregnancies with an aberrant fetal karyotype. Discrepant, i.e. false-positive and false-negative, results were found in 26 cases (2 per cent). From these data the accuracy of CVS-SC, defined as the proportion of all correct diagnoses, is calculated to be 98 per cent. Three non-mosaic and 14 mosaic false-positive results obtained after CVS-SC could not be confirmed by AC. Related to 1235 true normal fetal karyotypes, the specificity of CVS-SC, i.e. the proportion of normal karyotypes correctly diagnosed, amounts to 98.6 per cent. In nine pregnancies, an aberrant fetal karyotype detected after AC was missed by CVS-SC. The sensitivity of CVS-SC, i.e. the proportion of abnormal fetuses correctly diagnosed (62 out of 71), amounts to 87.3 per cent in our study group.

The pattern of regional cerebral blood flow during alcohol withdrawal--a single photon emission tomography study with 99mTc-HMPAO.

Cerebral blood flow was investigated during alcohol withdrawal in 15 male alcoholics by single photon emission computerized tomography with 99mTc-HMPAO and compared with the results of a second study 3 weeks later when all symptoms of withdrawal had disappeared and when the patients had been free of medication for at least 1 week. Slice images were reconstructed parallel to the orbitomeatal plane, and tracer activity was analyzed in 8 regions of interest per hemisphere. During alcohol withdrawal a special pattern of cerebral blood flow distribution could be observed. Relative perfusion was elevated in both inferior temporal regions, whereas it was reduced in the superior temporal region of both hemispheres. The changes of cerebral blood flow distribution did not correlate with neuropsychological findings nor with the severity of withdrawal syndrome.

Inappropriate vasopressin secretion in severe alcohol withdrawal.

Forty-one male alcoholics suffering from alcohol withdrawal syndrome were investigated to assess the relationship between vasopressin (ADH), water homeostasis and alcohol withdrawal. During 10 d, we found a significant decrease in serum vasopressin, from 3.08 +/- 0.61 to 1.71 +/- 0.22 pg/nl. There were no concomitant changes in osmolality, so that a general dysregulatory state of vasopressin secretion during alcohol withdrawal cannot be assumed. Only patients with delirium tremens (8/41) had higher vasopressin levels despite lowered serum osmolalities. These findings support the hypothesis of an inappropriate rebound secretion of vasopressin in severe alcohol withdrawal. Furthermore, they may contribute to the pathogenesis of focal alcoholic brain damage, because rapid and/or profound changes in osmolality are suspected to cause circumscribed cerebral demyelinization.

[Treatment of delirium tremens--a comparison between clomethiazole and clorazepate with reference to effectiveness and rate of side effects]. / Zur Behandlung des Delirium tremens--ein Vergleich zwischen Clomethiazol und Clorazepat hinsichtlich Effektivität und Nebenwirkungsrate.

In an open clinical trial patients with full-developed delirium tremens were treated either by controlled infusion of clomethiazol (n = 21) or by intravenous injections of clorazepate (n = 20). Acute symptomatic quickly decreased after a few days and medication could be reduced. By adding haloperidol a further stabilization in patients suffering from vivid hallucinations could be obtained. The duration of intravenous therapy and the total period of treatment did not differ in the two groups. Statistical analysis of cardiovascular parameters revealed a significant lower heart rate under clorazepate therapy. So treatment with clorazepate proved to be an alternative to standard therapy with clomethiazol even for severe cases of delirium tremens regarding its wide therapeutical range and the low rate of cardio-pulmonary complications.

Diagnosis and therapy of male gamblers in a university psychiatric hospital.

From 1980 to mid-1990 fifty-one gamblers were evaluated and treated at the psychiatric university hospital of Homburg/Saar in Germany. All were men with a mean age of 33.7 years. Gambling had lasted 5.2 years on average. Most patients were motivated to undergo therapy by members of their family. The majority of them had been in psychotherapeutic treatment before. Thirty-six of the 51 patients had committed punishable acts including fraud and embezzlement and, in 7 cases, robbery. The sample could be divided into three clinical subgroups. The first group consisted of patients with severe psychiatric diseases such as schizophrenia, manic-depressive illness or organic brain disorder. Patients of the second group suffered from serious personality disorders. Those of the third group showed deep-rooted problems in their current relationships.

[Acceptance of corpus cavernosum auto-injection therapy in long-term treatment of erectile dysfunction]. / Akzeptanz der Schwellkörper-autoinjektionstherapie (SKAT) bei der Langzeitbehandlung der erektilen Dysfunktion.

A total of 121 patients suffering from erectile dysfunction were evaluated by means of a questionnaire. In all these cases corpus cavernosum autoinjection therapy had been recommended. The aim of the study was to determine the acceptance and complications of the therapy, general level of satisfaction with it, and reasons for refusal. Completed questionnaire were received from 89 patients (75.5%), 56.2% of whom had applied the therapy continuously, while 18% had broken it off and 25.8% had never started on therapy (cumulative dropout rate 43.8%). The complications encountered were temporary hematomas (25.8) and deviations of the penis (10.1%). In 6.1% indurations of the penis were found. The frequency of prolonged erection needing an antidote was 0.07% in the continuous treatment group. The relatively high drop-out rate in the autoinjection therapy group shows the necessity for intensive patient care and the need for alternative therapy options and a more critical view of reports already published of success with autoinjection therapy.

[The value of corpus cavernosum sonography following administration of vasoactive substances in the diagnosis of patients with erectile impotence]. / Stellenwert der Schwellkörpersonographie nach Gabe vasoaktiver Substanzen bei der Diagnostik von Patienten mit erektiler Dysfunktion.

In 70 Patients with erectile dysfunction, ultrasound examination of both corpora cavernosa after intracavernous injection of papaverine was done using B-scan, Duplex scan and Doppler color. B-scan can detect morphological disease in a penis profundis, the higher degrees of cavernous muscle myopathia, and disease of the tunica albuginea. For the analysis of pulse curve and the measurement of blood-flow velocity, the Duplex scan is necessary. Doppler color imaging enables ultra sonographic examination of a dorsalis and a penis profundis and can detect intracavernous vascular pathology. The results show that ultrasonography is an important diagnostic tool in patients with erectile dysfunction. A differentiated therapeutic strategy can be based on this examination, especially when revascularization procedures are being discussed. Additionally, better follow-up of patients under self-injection therapy is possible.

Extrication, immobilization and radiologic investigation of patients with cervical spine injuries.

Most cervical spine injuries are due to motor vehicle accidents. Proper extrication of the victims is vital; the ideal device should be easily assembled and applied, should facilitate removal of victims from automobile seats without changing the body's position, must not hinder airway access or the performance of cardiopulmonary resuscitation, must accommodate all types of patients, including children and obese or pregnant patients, and must completely immobilize the patient, especially if hyperextension is suspected. Current methods of immobilization, such as the use of a soft collar and sandbags, allow neck extension; the short board protects against extension but interferes with airway access. Newer devices are discussed in this article. Injuries of the upper cervical spine are less common but more serious than those of the lower portion and usually involve the vertebral arch. Radiologic examination of the first and second cervical vertebrae and the seventh cervical and first thoracic vertebrae should be emphasized. If lateral and anteroposterior views do not reveal abnormal findings and injury is still suspected, oblique views and computed or conventional tomography should be used. Cervical spinal cord injuries can be minimized or prevented if proper early management is applied.

Mechanisms of nondisjunction: facts and perspectives.

An ordered segregation requires distinct processes of differentiation within the germ cell for recognition and segregation of homologous chromosomes/chromatids. These include synchronous maturation of the nucleus and cytoplasm, chromosome pairing and assembly at the metaphase plate, and movement within the spindle; all of them may be under direct/indirect regulatory control by the surrounding somatic compartments. Interference, e.g., by hormonal alterations at any of these steps, may alter the normal program of differentiation, thus increasing the risk of chromosomal malsegregation. Hence, many different causative mechanisms may exist which basically, nevertheless, act via (a) nonsegregation, (b) chance segregation, both during meiosis 1 and 2, or (c) presegregation during meiosis 1. In our animal models of the Djungarian hamster and the NMRI/Han mouse strain, we are analyzing the mechanisms of nondisjunction and presegregation during meiosis 1 in oocytes, as well as during aging of the females, by the application of hormones (gonadotrophins and steroids) and specific microtubular inhibitors (colchicine and methylbenzimidazolcarbamate). We suggest that chromosomes play a relatively passive role, although chromosomal properties, e.g., length, chiasma number, NORs, and position within the spindle, may provide an individual risk for each bivalent to be affected by nondisjunction. Failures in the endocrine control of follicular and germ cell maturation are considered to be primary causes for nondisjunction in young and aging oocytes. The understanding of the differentiation processes resulting in the maturation of follicles "at risk" may provide us with the tool to prevent the generation of aneuploidy in man.

Utilization of trimethylamine and other N-methyl compounds for growth and methane formation by Methanosarcina barkeri.

A number of N-methyl compounds, including several methylamines, creatine, sarcosine, choline, and betaine, were readily fermented by enrichment cultures yielding methane as a major product. Methylamine, dimethylamine, trimethylamine, and ethyldimethylamine were fermented by pure cultures of Methanosarcina barkeri; except for ethyldimethylamine, these amines are considered important substrates of this methanogenic microorganism. Creatine, sarcosine, choline, and betaine were fermented to methane only by mixed cultures. During growth of M. barkeri on methyl-, dimethyl-, or trimethylamine, methanol was not excreted into the medium. The fermentation of trimethylamine gave rise to an intermediary accumulation of methyl- and dimethylamine in the medium. An accumulation of methylamine during the fermentation of dimethylamine was not observed. Methane and ammonia were produced from the three methylamines by M. barkeri in amounts expected on the basis of the appropriate fermentation equations. The growth yield was 5.8 mg of cells (dry weight) per mmol of methane and was not dependent on the kind of methyl compound used as substrate.