An investigation of erectile dysfunction in Gwent, Wales.

OBJECTIVE: To quantify incidence of erectile dysfunction (ED) and the associated risk factors in men attending community clinics in a large population in Wales, UK. SUBJECTS AND METHODS: Of 4060 men who were invited to attend 11 community clinics, primarily to check for prostate disease, 2025 (aged 55-70 years) attended. Of these, 2002 men answered a questionnaire about personal details, medical, family and sexual history, and detailed alcohol and smoking habits. All had their serum prostate-specific antigen (PSA) analysed and those referred for investigation of prostatic disease underwent serum testosterone analysis. RESULTS: Complete ED was reported by 265 men (13.2%), and was closely related to age (r = 0.19, P < 0.001) and medication (r = 0.2, P < 0.001). ED occurred in 6.9% of men aged 55-60 years, 12.5% aged 61-65 and 22.2% of those aged 66-70. Patients taking diabetic medication had the highest relative risk for ED and 11.3% of men with ED were taking nitrates. The numbers of years of smoking had the third closest correlation with impotence (r = 0.16, P < 0.001). A low serum testosterone level was a poor predictor of ED and increasing serum PSA levels did not influence the distribution of ED. CONCLUSION: About 13% of these men aged 55-70 years had complete ED; if this value is extrapolated to the whole of the UK, this equates to almost half a million men being unable to achieve any erections. The estimate would be much greater if those with milder forms of ED are included.

An investigation into the relationship between prostate size, peak urinary flow rate and male erectile dysfunction.

This study sought to identify whether a true relationship exists between benign prostatatic hyperplasia (BPH) and erectile dysfunction (ED). In a community-based study, 427 men underwent transrectal ultrasound (TRUS), uroflow studies and a questionnaire concerning erectile function. ED had a significant correlation to age (r = 0.19, P < 0.001). But comparisons of prostate volume and analysis of maximum flow rate showed no significant difference between three erectile functional groups; ranging from no ED to complete ED, (one way analysis of variance). However when these two parameters were correlated to age a significant association was found to exist (log prostate volume; r= 0.26, P < 0.001, log maximum flow rate; r= -0.13, P= 0.02). Prostate size and uroflow studies show no correlation with ED, but ED and BPH had a significant correlation with ageing. This makes a direct association between male ED and BPH unlikely but supports the theory that the association between the two pathologies could be due instead to the common link of ageing.

An investigation into the spatial relationship between prostate intraepithelial neoplasia and cancer.

The distribution of high grade prostate intraepithelial neoplasia (PIN) and cancer was analysed in 18 separate areas from 89 radical prostatectomy specimens that had been sectioned and digitally imaged. When the occurrence of each type of pathology was summated a predilection was demonstrated for both pathologies in the apex of the prostate and a linear relationship was found between the frequency of cancer and high grade PIN (r(2)=0.744, P<0.05). This relationship was strongest at the apex (r(2)=0.621, P<0.005), lower in the midgland (r(2)=0.828, P<0.05) and bordered on significance at the base (r(2)=0.621, P<0.063). These results support the theory that cancer could obliterate high grade PIN as it over grows the areas once occupied by PIN.Prostate Cancer and Prostatic Diseases (2001) 4, 97-100

Juvenile xanthogranuloma of the iris in an adult.

Juvenile xanthogranuloma is a self-limited skin disorder of young children that uncommonly affects the eye. Juvenile xanthogranuloma has been described in adults, but reported intraocular involvement is extremely rare. We report a case of juvenile xanthogranuloma diagnosed in a 25-year-old man who was seen with nontraumatic hyphema and iridocyclitis. Diagnosis was made from a biopsy specimen obtained from a suspicious skin lesion. Topical and systemic steroids, radiation therapy, and finally immunosupression were required to eliminate the iris tumor clinically and resolve the patient's recurrent symptoms.

Endogenous Aspergillus endophthalmitis after lung transplantation.

PURPOSE/METHODS: By fundus photography and histopathologic examination, we documented a case of early endogenous Aspergillus endophthalmitis in a 29-year-old man after lung transplantation. RESULTS/CONCLUSIONS: The clinical and histopathologic features of this case are consistent with those of previous case reports of endogenous Aspergillus endophthalmitis. Endogenous Aspergillus endophthalmitis represents a manifestation of disseminated aspergillosis, usually a fatal infection. This diagnosis should be considered in immunocompromised patients with visual disturbances, as early recognition of the fundus appearance may aid in systemic treatment.