Impact of smoking on endovascular abdominal aortic aneurysm surgery outcome.

OBJECTIVE: Smoking plays a major role in deficiencies of the vascular system, and seems to have consequences for the treatment of cardiovascular diseases. We hypothesized that smokers have a higher mortality and more complications after endovascular abdominal aortic aneurysm surgery than non-smokers. METHODS: We assessed mortality and complications of 3270 patients who underwent endovascular abdominal aortic aneurysm surgery in Europe between January 1994 and July 2001. Survival and (post) operative complications were assessed by smoking status. RESULTS: Mortality did not significantly differ between smokers and non-smokers. Smokers had a higher number of intra-operative additional procedures, but a lower number of late endoleaks in comparison to non-smokers. In addition, smokers had a reduced risk of late type II endoleaks in comparison with non-smokers. CONCLUSION: There seems to be no significant difference in endovascular abdominal aortic aneurysm surgery outcome between smokers and non-smokers, although there were significant differences in intra-operative additional procedures and late endoleaks.

Routine psychophysiological screening of 384 men with erectile dysfunction.

Psychophysiological screening was carried out on 384 consecutive patients with erectile dysfunction of psychogenic or psychogenic-organic origin. Visual sexual stimulation with penile vibration caused a satisfactory erection in roughly 50% of patients. Nonresponders subsequently produced a good penile response with intracavernous injection of vasoactive substance. Orgasm-ejaculation can occur in the absence of a full erection. In such cases subsequent intracavernous injection brought about a (near) full erection. A first intracavernous injection was most effective when combined with visual and vibrotactile stimulation. The magnitude of the response to such stimulation is useful to enable the doctor to prescribe the lowest dose of a vasoactive substance, thus minimizing the risk of priapism. Preferably, drug treatment of men with erectile dysfunction should be combined with sexual counseling or therapy.

The impact of marital satisfaction and psychological counselling on the outcome of ICI-treatment in men with ED.

We investigated the relationship between marital satisfaction and choice of and compliance with treatment in 195 consecutive men with erectile dysfunction (ED). Marital satisfaction as measured by means of the Maudsley Marital Questionnaire (MMQ), was compared between four groups: (1) patients on intracavernous injection (ICI) treatment after the trial-dose phase (32%); (2) patients dropped out ICI in the trial-dose phase (12%); (3) patients on other treatment (31%); and (4) patients following first counselling renounced treatment (25%). Above, in a small group of 15 patients the effect of ICI treatment in combination with short-term psychological counselling (ICI + treatment) was assessed. No significant differences were found in marital satisfaction between the four groups. In the ICI + treatment group we experienced that providing information about factors that contribute to erectile function and enabling couples to communicate about sexual problems were the most important factors to increase efficacy of ICI treatment.

Sexual dysfunction in men with multiple sclerosis--a comprehensive pilot-study into etiology.

UNLABELLED: Ideally, the etiological diagnosis of sexual dysfunction in patients with multiple sclerosis is established on the basis of both objective and subjective tests. Accordingly, we assessed sexual function in 16 male patients with multiple sclerosis and complaints of sexual dysfunction by means of subjective data from interviews and questionnaires and objective data, obtained from (psycho)physiological tests. Psychophysiological investigation consisted of measurement of sleep erections and of erectile response to visual erotic stimulation and penile vibration. Urodynamic investigation was used to assess the neurological status of the genital tract. Sixteen male patients with clinically definite multiple sclerosis, complaints of sexual dysfunction and a steady heterosexual relationship participated in the study. The majority of patients had no abnormalities in the objective tests. Only one (1 out of 15) patient showed disturbed sleep-erections, and four (4 out of 12) other patients showed signs of neurological dysfunction of the genital tract. CONCLUSION: In our patient-group, disturbed sleep erections and abnormal findings on urodynamic investigation appeared unrelated to the complaint of erectile dysfunction. Sexual function was related to psychological factors, decreased general sensitivity, and motor impairment.