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Biomedical subjects

E J Keogh

Publications and source records attributed to E J Keogh.

At least 19 recordsLinked to original sources
PubMed1995

A study in patients with erectile dysfunction comparing different formulations of prostaglandin E1. Alprostadil Study Group.

PURPOSE: Prostaglandin E1 sterile powder and sterile solution are 2 new formulations of exogenous prostaglandin E1 that are more convenient for auto-injection therapy for erectile dysfunction than the presently used pediatric sterile solution. Therefore, the pharmacodynamic profiles of intracavernous prostaglandin E1 sterile powder and nonalcohol sterile solution were compared with the pediatric sterile solution in men with erectile dysfunction who were known to be stable responders to intracavernous prostaglandin E1. MATERIALS AND METHODS: Based on the dose used at home, patients were randomized to 1 of 5 dose groups: 0 microgram. (placebo), 2.5 micrograms., 5 micrograms., 10 micrograms. or 20 micrograms. Each patient received a single injection of the same dose of each of the 3 formulations. The primary pharmacodynamic end points were clinical evaluation of erectile response, RigiScan real-time evaluation of erectile response and patient evaluation of erectile response. RESULTS: No significant differences were identified among the formulations for any of these end points, either by comparison among all active doses or by comparison at each prostaglandin E1 dose level. There was also little or no intra-patient variation in dose response and the inter-dose variation in response between patients was not significant. Pharmacodynamic end points were well intercorrelated, although assessment of erectile response by the patients tended to be more positive than that by RigiScan or clinical evaluation. There were no major side effects. Penile pain on injection and/or during erection occurred in 9 to 17% of the patients according to the formulations. However, penile pain was also reported by 11% of the placebo-treated patients. CONCLUSIONS;: The 3 formulations of prostaglandin E1 showed equivalence and were safe for the treatment of erectile dysfunction with respect to side effects.

Alprostadil↗
PubMed1995

Does compression of the base of the penis improve the efficacy of intracavernosal injection of prostaglandin E1 for impotence? A randomized controlled study.

The objective of this study was to evaluate the effect on erections of impeding venous blood flow following intracavernosal injections of prostaglandin E1. Dispersion of injected X-ray contrast medium indicated that application of the RMRI penile clamp to the base of the penis retarded venous outflow. The clamp was then tested in impotent men to determine whether their erectile response was enhanced. Erectile response was assessed using a Rigiscan monitor, palpation of the penis by a staff nurse and the patient's subjective impression. The results demonstrate that there is no significant improvement in erectile response following venous compression.

Adult↗
PubMed1993

193-nm excimer laser sclerostomy using a modified open mask delivery system in rhesus monkeys with experimental glaucoma.

Excimer laser sclerostomy is a new glaucoma filtration procedure in which the argon fluoride excimer laser at 193 nm is delivered ab externo through a modified open mask system incorporating an en-face air jet to dry the target area and preserve hemostasis during ablation and a conjunctival plication mechanism, which allows the conjunctival and scleral wounds created by through-and-through ablation to separate once the mask is removed. No preparatory dissection of the conjunctiva is required. Five 200-microns and five 500-microns sclerostomies were formed by ablation at a pulse repetition rate of 20 Hz and a fluence per pulse of 400 mJ/cm2 in fellow eyes of five rhesus monkeys with experimental glaucoma. Overall, seven of the ten eyes attained a functional result, with intraocular pressures remaining below 21 mmHg for 6 +/- 1 days and rising to the pre-operative level after 10 +/- 3 days without adjunctive antifibroblast medication. The duration of filtration for 200-microns and 500-microns sclerostomies was similar, and parallels that previously observed for posterior lip sclerectomy in the same animal model. The three eyes with no functional result all had incorrectly positioned sclerostomies. Choroidal detachment and significant shallowing of the anterior chamber did not occur. Excimer laser sclerostomy appears to be a viable technique for filtration, provided that mask placement is accurate.

Animals↗
PubMed1992

The role of intracavernosal vasoactive agents to overcome impotence due to spinal cord injury.

Twenty-two spinal cord injured men (mean age 35.2 years) referred because of impotence were treated with intracavernosal vasoactive agents. Papaverine 2-20 mg, papaverine 40 mg plus phentolamine 0.5 mg or prostaglandin E1 (1-20 micrograms) were used. Nineteen responded and were taught to self administer the medication with varying degrees of assistance from their partners. Fourteen men participated in a postal survey; 12 (86%) continued to use the drugs every 1 to 4 weeks and reported satisfaction with the method. Partner responses were positive in half of the group and when not so it influenced the patients to abandon or reduce the frequency of treatment. Counselling was essential to allay anxiety. Clinical management was not compromised and side effects were minimal. Overall we found this treatment effective, safe and worthwhile.

Adult↗
PubMed1992

Alcohol burns in the neonate.

The case histories of two infants who sustained chemical burns due to contact with alcoholic skin preparation solutions are presented. The skin permeability of the extremely low birthweight infant renders them susceptible to major burns following relatively brief exposure to such solutions. Care is needed in the selection and use of skin disinfection solutions in the neonatal nursery.

1-Propanol↗
PubMed1991

Late effects of childhood malignancies seen in Western Australia.

Eighty-nine pediatric oncology patients, in remission and off treatment for at least 4 years, were reviewed annually in the Late Effects Clinic of Princess Margaret Hospital for Children in Perth, Western Australia. Interval from time of diagnosis to follow-up ranged from 4 to 23 years (mean 10.8 years). Acute lymphoblastic leukemia (ALL) (40%) and Wilms' tumor (27%) were the most common primary malignancies in this group. Late sequelae included musculoskeletal abnormalities (23 children), growth hormone deficiency (11), second tumors (9), learning difficulties (7), puberty and fertility problems (4), and hypothyroidism (4). These complications were most often related to radiation therapy. The need for prolonged, regular follow-up of survivors of childhood malignancy for early detection of late sequelae and subsequent intervention is stressed.

Adolescent↗
PubMed1991

The physiology of penile erection.

Erection of the penis results from increase in blood flow into the corpora. The blood flows through the corpus spongiosum and glans which increase in volume, whereas the blood becomes trapped in the corpus cavernosum which becomes rigid as the pressure increases. The protrusion of the penis may be aided by relaxation of the retractor penis muscle. The major erectile fibres lie in the pelvic nerve and anti-erectile fibres in the sacral sympathetic outflow. The hypogastric nerves may contain both nerve types but there is considerable species and individual variation. The neurotransmitters mediating erection have yet to be determined. There is some evidence that acetylcholine is involved in the increase in blood flow through the corpus spongiosum but not in the corpus cavernosum. Vasoactive intestinal peptide may also have a role. It is possible that these and other substances interact to control the complete process. Erection is inhibited by noradrenaline released from sympathetic nerves, and this acts mainly on alpha-1 adrenoceptors within the penis and on the retractor penis muscle. During tumescence blood flows into the sinusoids from the helicine arterioles which supply them. The sinusoids become dilated due to relaxation of smooth muscle within the trabeculae. Blood may also be redirected from anastomoses between the dorsal arteries and corpus spongiosum through other helicine arterioles supplying the sinusoids of the corpus cavernosum. The significance of polsters (smooth muscle projections into the blood vessel lumen) remains controversial. Occlusion of venous drainage from the corpora cavernosa is both passive (due to increased corpus cavernosum pressure) and active. Relaxation of trabecular smooth muscle may also modify blood flow through the corpora cavernosa.

Animals↗
PubMed1990

Effects of acute alcohol on penile tumescence in normal young men and dogs.

To determine the cause of the inhibition of sexual function observed in normal subjects with elevated blood alcohol concentrations (BAC), nocturnal penile tumescence (NPT) was monitored in 11 subjects over three consecutive nights. On the third night alcohol was administered (BAC = 0.154 g/100 mL). We observed no effect of alcohol on the size, duration, or number of erections. These results were confirmed in dogs. The latent period, magnitude, and duration of corpus cavernosal pressure changes produced by pelvic nerve stimulation were not affected by mean blood alcohol levels of 0.327 g/100 mL in three dogs. These results suggest that the inhibition of sexual response caused in conscious subjects by the ingestion of alcohol is not due to a suppression of the underlying spinal reflex but may be the result of its effect on perceptual or cognitive sexual mechanisms.

Adult↗
PubMed1990

Effects of a sclerosant, ethanolamine, on the venous drainage system of the dog penis.

To explore the possibility of using venous sclerosant therapy to overcome venogenic impotence we studied the effects of ethanolamine on the veins draining the dog penis. Following injection of the sclerosant into the deep dorsal vein radiological and histological evidence of occlusion was obtained but by one month recanalization of thrombi had occurred and collateral venous channels had formed. These findings cast doubt on the effectiveness of this sclerosant as a means of treating impotence.

Animals↗
PubMed1990

Prostaglandin E1 therapy for impotence, comparison with papaverine.

The efficacy of prostaglandin E1 as a pharmacological treatment of erectile dysfunction (impotence) was compared with the standard treatment, papaverine, in a single blind, crossover trial. A total of 129 impotent men received intracavernous injections of either prostaglandin E1 (5 micrograms) or papaverine (18 mg.) 1 month apart. Observations by 1 observer recorded 10 to 20 minutes after injection demonstrated that prostaglandin E1 generated a better erection in 72 men (55.8%) compared to papaverine. Papaverine was more effective than prostaglandin E1 in 23 men (17.8%, chi-square 6.26, p less than 0.025). Subjective assessment by the patients who detected a difference showed that 71 (55%) preferred prostaglandin E1 and 35 (27%) preferred papaverine (chi-square 11.56, p less than 0.001). A total of 34 men achieved full erections with prostaglandin E1 compared to 17 who used papaverine.

Adult↗
PubMed1990

The male menopause. Fact or fancy?

Men over 50 may experience a decline in sexual, physical and intellectual potency. In many respects this is analogous to the menopause, hence the term male menopause. Although this term suggests profound hormonal changes and loss of reproductive capacity these do not occur in men. The hormonal changes are subtle and loss of fertility is relative. Other changes, part of normal ageing, include degeneration of neural tissue, arterial occlusion and loss of tissue turgor.

Aging↗
PubMed1989

Epithelial bridging on burn patients following primary excision and grafting.

Early tangential excision and primary grafting of full thickness and deep partial thickness burns has become a widely accepted practice, however, little attention has been paid to the epithelial bridging phenomenon, which occurs most frequently at the edge of these wounds. Over 5 years, 923 burn patients were treated and 407 were grafted, of whom 13 developed sufficiently severe epithelial bridging to require deroofing under general anaesthetic. Histological sections show that the bridges are derived from hair follicles. We advocate that patients with epithelial bridges should be observed in the outpatient department for many weeks and surgical intervention should only be used when they fail to resolve spontaneously.

Adolescent↗
PubMed1989

Treatment of impotence by intrapenile injections. A comparison of papaverine versus papaverine and phentolamine: a double-blind, crossover trial.

The efficacy of papaverine, and a combination of papaverine and phentolamine as a pharmacological treatment of impotence was compared in a double-blind, crossover trial. A total of 40 impotent men received intracavernous injections of papaverine (40 mg.) or a combination of papaverine (20 mg.) and phentolamine (0.5 mg.) at monthly intervals. Observations at 20 minutes after injection demonstrated that papaverine caused full erections in 27 per cent of the men and partial erections in 65 per cent. The combined injection resulted in full erections in 48 per cent of the men and 52 per cent had partial erections. The difference was significant (Z equals 2.29, p less than 0.05).

Adult↗
PubMed1989

The role of dynamic corpora cavernosography in the management of impotence.

Sixty eight impotent men underwent corpora cavernosography and corpora cavernosal pressure measurements during saline infusion. Nineteen of the men had internal pudendal arteriograms. Correlation between the cavernosograms and saline infusion induced pressure measurements was "good" in 56/66(84%), "approximate" in 5/66(8%) and there was no correlation in 5/66(8%). Two patients were excluded for technical reasons. The spread of results and the good correlation of the two tests speaks for the accuracy of the method. It was of value in diagnosis and will be of paramount importance if veno occlusive surgery becomes a reliable method of treatment.

Adult↗
PubMed1989

Complications associated with penile implants used to treat impotence.

The complications associated with a variety of penile prostheses used in the treatment of 302 men with erectile dysfunction are described. Infection of the prostheses resulted in their removal from 11 patients (3.6%), antibiotic therapy and replacement in five men. Mechanical failures required reoperation in 43 men (14.2%); however, recent advances in prosthesis design have reduced this type of malfunction. Adverse psychological reactions prompted removal of the prostheses from two men. Despite these complications, this surgery is remarkably effective.

Adolescent↗