Posterior circulation stroke diagnosis in unselected group of acutely dizzy patients.

BACKGROUNDS: Diagnostics of a posterior circulation ischemia (POCI) in patients with acute vertigo is a challenging task. Recently, the combination of HINTS (Head Impulse, Nystagmus and Test of Skew) exam and ABCD2 has been recommended to identify stroke in these patients. Until now, studies regarding HINTS have mostly been tested on preselected patient groups and their results are only partially applicable to real clinical practice. AIMS: To compare the sensitivity and specificity of HINTS and ABCD2 and their combination in unselected acutely dizzy patients in the emergency department (ED) toward posterior circulation stroke detection. METHODS: A prospective cross-sectional monocentric study in ED patients with acute onset of dizziness lasting less than 72 h. Their clinical characteristics, HINTS, vascular risk factors, ABCD2 scores and neuroimaging data were analyzed. RESULTS: 140 patients were recruited. Acute stroke was identified by MRI in 39 patients. All patients had central pattern nystagmus, skew deviation or further focal neurological finding. The age (≥60) and arterial hypertension clearly distinguished stroke and non-stroke group (p < 0001). The sensitivity of HINTS, ABCD2 and their combination in the unselected group was high (82,1 - 97,4%), but specificity low. After removing patients with inconclusive diagnosis, including transitory ischemic attack, specificity was much higher and comparable to previously published results. CONCLUSIONS: The sensitivity and specificity of HINTS in previously published studies may vary because of their selection criteria. Even though, our study was performed on the unselected patient cohort, combination of HINTS and ABCD2 remained highly sensitive in detecting POCI and outperformed each of these tests alone.

[Erectile dysfunction as a result of spinal trauma]. / Erektilní dysfunkce jako následek spinálního traumatu.

Erectile dysfunction (ED) is one of many consequences of spinal trauma. Its extent is influenced by several factors, depending mainly on the height of spinal injuries as well as the premorbid state. The incidence of spinal cord injuries in the Czech Republic and around the world has a slightly upward trend. Epidemiological statistics include mostly young people for whom sexual activity has a reproductive function. Disorders in the intimate area seriously and significantly reduce the quality of life. The article presents current theoretical knowledge of erectile dysfunction, according to epidemiological data on spinal cord injuries in the Czech Republic, and an overview of up-to-date therapeutic modalities for erectile dysfunction in men after spinal trauma.

Intensity of pain and biochemical changes in blood plasma in spinal cord trauma.

STUDY DESIGN: Cross-sectional, observational and longitudinal. OBJECTIVES: The aim of the study was to analyze the relationship between pain intensity, plasma lipids and severity of spinal cord injuries in patients with paraplegia (n = 11), tetraplegia (n = 16) and polytrauma (n = 15). We concentrated on the hospitalization period immediately following injury. METHODS: Pain intensity was assessed on a visual analog scale immediately after patients were transported to hospital, again 14 days after injury and before discharge from hospital. Blood samples were also obtained at these same times. We measured following biochemical parameters: total protein, albumin, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glycemia, and C-reactive protein. Data were analyzed with respect to type of injury, state of unconsciousness immediately after injury, hemorrhage, measure of liability (self-inflicted injuries vs casualties), cause of the accident and pre-injury cholesterol levels. RESULTS: On the day of injury, pain intensity correlated positively with HDL cholesterol (r = 0.48, P = 0.04); on the day of discharge from hospital, pain intensity correlated positively with blood glucose levels (r = 0.67, P = 0.0002). Diagnostic subgroups did not differ either in pain intensity or in pain dynamics during hospitalization. Total cholesterol level was lowest in patients with polytrauma. In all patients, the lowest total cholesterol level was observed immediately after injury. HDL cholesterol was highest after injury. CONCLUSION: After spinal cord injury, lower total cholesterol levels reflected more serious trauma intensity and HDL cholesterol predicted more intensive pain. Subjects responsible for their own injuries suffered less intensive pain than those who were not responsible for their injuries.

[Treatment of male erectile dysfunction following spinal cord injuries using PDE5 inhibitors]. / Lécba erektilní dysfunkce muzu po poranení míchy inhibitory fosfodiesterázy 5.

UNLABELLED: The authors present results of a clinical study examining therapeutic effects of PDE5 inhibitors in the management of male erectile dysfunction following spinal cord injuries. The study was prospective, non-invasive, observational. AIM: The aim of the study was to determine efficacy and safety of tadalafil in the treatment of male erectile dysfunction following spinal cord injuries and to assess one-year treatment results. MATERIAL AND METHODS: 16 males, the mean age of 33 years, participated in a four-week assessment of tadalafil efficacy and safety. A paraplegic couple received 8 tablets of tadalafil 20 mg and recommendation of sexual intercourse twice a week. The males recorded the tablet intake in a "Diary". The following questionnaire scores were used in the assessment prior and after the four-week treatment period: IIEF-5 (International Index of Erectile Function), GAO (Global Assessment Question), SEP 2 a 3 (Sexual Encountner Profile, questions 2,3). A non-parametric test was used for statistical evaluation. RESULTS: In 94% of the males, the treatment resulted in improved erection quality (GAQ) and there was statistically significant improvement in ability for penis emission to vagina (SEP 2, p = 0.005). In 69% of the young disabled males, tadalafil-mediated erection was sufficient to perform a satisfactory intercourse (SEP3, p = 0.001). Based on the IIEF-5 questionnaire data, the erectile function score improvement was statistically significant, compared to that prior to therapy (p = 0.001). 75% of the paralyzed used the benefit of the long-acting PDE5 inhibitor and repeated the sexual intercourse within 36 hours of its intake. Undesirable effects were reported in 3 out of the 16 subjects and a single patient discontinued the treatment due to the side effects. 8 out of the 16 males (50%) continued the tadalafil treatment after one year of medication. The authors conclude that tadalafil treatment of male erectile dysfunction following spinal cord injuries is safe and effective and is well tolerated for over a year.

[Erectile dysfunction after traumatic pelvic injury]. / Erektilní dysfunkce po poranení pánve.

UNLABELLED: Erectile dysfunction is a serious consequence of pelvic injuries. The aim of the study was to review and assess erectile dysfunction rates in mono and polytraumatized males with the pelvic injury, and to highlight the impotence-type of the pelvic injury relation and to evaluate the therapeutic response of the patients. METHODS: In total, 231 mono- or polytraumatized males with the pelvic injury were mailed a private letter including the HEF-5 International Index of Erectile Function questionnaire. The AO classification was used to assess the relation of the pelvic injury type and the onset of the erectile dysfunctin. The c2 test was used to assess the statistical significance. The peroral treatment with the phosphodiesterase 5 (PDE5) inhibitors was the therapeutical method of first choice. The therapeutical effect was assessed using the IIEF 5 questionnaire. RESULTS: We concluded that the erectile dysfunction affects nearly a third (31.5%) of the males who suffered pelvic injuries. The fact, whether the patient suffered an isolated pelvic injury or a pelvic injury in a polytrauma, has no influence on the erectile dysfuntion onset (p = 0.218), however, the onset of impotence has a significant connection to the type of the pelvic injury. We confirmed a statistically significant increase in the erectile dysfuncion rates in patients with the pelvic ring injury type B and C (p = 0.023). The mean IIEF-5 score prior to the treatment initiation was 11.5. In 85% of the patients the peroral treatment of the erectile dysfunctin using the PDES inhibitors was successful and resulted in achievement of the pair sexual satisfaction. The score of the IIEF-5 questionnaire reached physiological values 23 (22-25) following the treatment. Based on the findings, the authors recommend, during their hospitalization, to inform the males who suffered the type B and C pelvic ring injury about a possibility of their sexual dysfunction, and to advise them to contact a sexual disorders specialist.