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Biomedical subjects

G Szasz

Publications and source records attributed to G Szasz.

At least 19 recordsLinked to original sources
PubMed1991

The combined use of vibrostimulation and in vitro fertilization: successful pregnancy outcome from a retrograde specimen obtained from a spinal cord-injured male.

While pregnancies have been documented through the independent use of the vibrator method, from other methods of procuring ejaculate from spinal cord injured men, and from artificial insemination using a retrograde specimen, we believe that this is the first case report of a live birth resulting from a retrograde ejaculate obtained by vibration from a spinal cord-injured male whose partner underwent in vitro fertilization. Vibrostimulation may well be successful in the two-thirds of men whose spinal cord lesions are at the T10 neurological level and above, who have an intact bulbocavernosus reflex and anal tone but no pain or temperature sensation of the genitalia. Blood pressure monitoring, prevention of autonomic dysreflexia, alkalinization, dilution and infection control of urine, and retrograde specimen retrieval are all important techniques to ensure patient safety and optimal ejaculates. The timing of ovulation and insemination is the crucial factor for the partner of a SCI male whose sperm quality is poor. A complete gynecological workup, including studies of tubal patency, should be done before embarking on a series of artificial inseminations. Stimulation of ovulation and well-timed inseminations should optimize the chance of conception. Depending on semen analysis, female partner factors, and emotional and financial costs, IVF can appropriately be either an early or a final option.

Adult↗
PubMed1991

Sex and disability are not mutally exclusive. Evaluation and management.

Managing sexual problems in persons with disabilities is a team effort. Physicians have three special roles; identifying problems that are sexual; assessing these problems; and providing psychological, pharmacologic, or surgical treatment methods in the context of the patients' rehabilitation programs.

Adult↗
PubMed1990

Return of sexual functioning following penile replant surgery.

The penis, scrotum, and testicles of a 31-year-old man were cut off in a fight. Fourteen hours later the penis and one testicle were reattached, but the testicle later had to be removed. By 3 weeks normal urinary function returned but the penis was misshapen. The patient had suicidal intentions. His partner was sexually supportive but afraid to touch the penis. By 10 weeks penile swelling occurred in response to a movie with frank sexual content. By 12 weeks the penile swelling was sufficient for entry but the partner was acutely afraid that her vaginal contractions would tear the scars. The man was concerned because he experienced only mild sexual tensions. Physical examination reassured both, and they gained hope for recovery. At 16 weeks erections were still not full but active intercourse was attempted and he experienced seminal seepage and mild orgasmic sensations; she was relaxed enough to have orgasm. Testosterone was administered at regular intervals from the 19th week on, with immediate improvement of erection. By 32 weeks full erection, ejaculation, and orgasmic functions returned and the couple resumed their normal sexual practices.

Adult↗
PubMed1989

Clinical observations in vibratory stimulation of the penis of men with spinal cord injury.

Less than 10% of men with complete spinal cord injury experience ejaculation in intercourse. Vibratory stimulation of the penis triggers a predictable series of body reactions in most men with lesions above the thoracic 11th spinal cord level. These reactions are very similar to the physical manifestations of the sexual response in men with intact nervous systems. Between half and three quarters of men with lesions above the thoracic 11th spinal cord level ejaculate. The spermatozoa count is within the normal range, but the percentage of motile spermatozoa is low. The reactions leading to ejaculation take between 30 sec and 3 min and are characterized by rhythmic abdominal and leg spasms, lowered, then elevated pulse rates, elevation of blood pressure, and after the culmination of these experiences, relaxation, tiredness, and a general feeling of well-being. Autonomic dysreflexia (elevation of the blood pressure and severe headache) was avoided with preventive medication. The observations suggest that interrelated ejaculatory centers may be located in the thoracic 11th-and-below areas of the spinal cord. The vibratory stimulation technique has positive implications for both the reproductive and sexual needs of men with spinal cord injury and their partners.

Adult↗
PubMed1989

Prostaglandin E1 versus phentolamine/papaverine for the treatment of erectile impotence: a double-blind comparison.

The use of intracavernous prostaglandin E1 was studied in 48 organically impotent men. Eight men with previous chemical priapism did not have chemically induced priapism at up to 4 times the minimum effective dose of prostaglandin E1. Of 15 men with arteriogenic impotence who had failed prior intracavernous phentolamine and papaverine therapy 10 had adequate erections with prostaglandin E1. A total of 25 men received intracavernous prostaglandin E1 and phentolamine plus papaverine in a double-blind fashion. Erections with prostaglandin E1 were equal or superior to those with phentolamine plus papaverine in each case.

Alprostadil↗
PubMed1987

Induction of penile erection by intracavernosal injection: a double-blind comparison of phenoxybenzamine versus papaverine-phentolamine versus saline.

Recent data suggest that intracavernous injections of phenoxybenzamine in saline, and/or papaverine with phentolamine mesylate in saline, result in erection in otherwise impotent men. A double-blind study using normal saline and normal saline mixed with phenoxybenzamine or papaverine-phenotolamine mesylate showed that none of 11 subjects with organic erection dysfunction responded with appreciable penile swelling to saline injection, but all responded with some degree of penile swelling to the other solutions. The mechanism of penile erection in response to intracavernous injections is still unclear, but it is thought to be related to the alpha-adrenergic blocking and/or smooth muscle relaxant actions of these drugs; the volume of the injection or the normal saline content of the solution are not factors in causing penile tumescence.

Adult↗
PubMed1984

A Sexual Functioning Scale in multiple sclerosis.

73 MS patients were graded on a 5-point Sexual Functioning Scale in the process of routine data collection for the Minimal Record of Disability in MS. 45% of the patients were less sexually active or inactive since the onset of MS. 27% were concerned about this situation. The Demographic features, impairment, disability and handicap profile of patients in the various Sexual functioning Scale categories was analysed. The sexually less active or inactive patients were different from the active-as-before-MS patients in various ways, but most significantly in their difficulties with toilet transfer and bladder functioning. The concerned patients were bladder functioning. The concerned patients were also different from not concerned patient in various ways, but most significantly in their problems with ambulation and in maintaining their usual financial standards. Further studies are required to begin to understand the natural history of sex problems in MS.

Adult↗
PubMed1984

Sexual dysfunctions in multiple sclerosis.

The nature, incidence, prevalence, etiology and management of sexual problems in MS has not been well defined yet. Sexual dysfunctions in MS seem to be related to a combination of the neurological consequences of MS and the personal, partner and social reactions to this condition. A sexual history is valuable in defining the specific areas of concern, and bringing into focus the patient's and the couple's sexual resources. Physical examination and investigations may assist in clarifying the extent of the sexual impairment and disability, and its relationship to MS. Treatment strategies include: relevant information, education, physical rehabilitation and supportive therapy in combination with medical intervention, and when indicated, surgical treatment or sex therapy. Long-range prognosis with or without treatment is not clear yet.

Adult↗
PubMed1983

How to become comfortable talking about sex to your patients.

Dealing with patients' sex-related complaints is uncomfortable for many physicians. It can become more comfortable if the physician learns to apply his or her clinical knowledge of sexuality in combination with specific interpersonal interviewing skills. The level of comfort can be increased if the physician accepts his or her professional limitations in providing therapy and knows what other sources of care are available.

Counseling↗
PubMed1983

Sexual incidents in an extended care unit for aged men.

A survey was conducted among the nursing staff of a 400-bed extended-care unit for aged men by questionnaire to find out what patient behaviors were identified as sexual by the staff and how they reacted to these behaviors. Three types of behavior were identified as sexual and as "causing problems": sex talk (e.g., using foul language); sexual acts (e.g., touching or grabbing, exposing genitalia); and implied sexual behavior (e.g., openly reading pornographic magazines). As many as 25 per cent of the residents were thought to create such incidents. Acceptable sexual behavior identified by the staff were limited to hugging and kissing on the cheek, although their answers implied that residents could need more intimate touching and affection. The survey raised questions about the nature and causes of different types of sexual behavior in the institutionalized elderly and about the roles nursing staff, physicians, and administrators can play in recognizing individual needs while safeguarding both the residents and the staff from the consequences of unacceptable incidents.

Aged↗
PubMed1981

Sexual health care clinician in an acute spinal cord injury unit.

This article introduces the role of the sexual health care clinician, a nonphysician specialist trained to diagnose and treat sexual dysfunctions of disabled persons. Under medical supervision, the clinician is part of the treatment team in an acute spinal cord injury unit, a general rehabilitation center and an extended care unit. The clinician's role includes direct patient care; education for professionals, students and community agencies; liaison with other rehabilitation groups; and research. The process of sexual rehabilitation is conceptualized and experience with the specialty in an acute setting is described. Experience indicates that sexual assessment, diagnosis and management is a technical specialty which requires in-depth training. The major contributions of the service are an early legitimization of sex-related concerns; the crystallization of physiologic emotional and social capabilities and needs; and the specific instructions for experimentation with various sexual alternatives.

Adult↗
PubMed1979

Guidelines to birth control counselling of the physically handicapped.

Birth control counselling of well motivated physically handicapped men and women is discussed in a series of suggested steps: (1) preappointment arrangements are made to ensure physical access to the office, and the partner or a helper may be invited to the visit; (2) the patient is encouraged to name the desired birth control method; (3) the patient's fertility is established from the history and the results of physical examination and laboratory tests; (4) methods of birth control are matched to the patient's physical and mental capabilities; (5) potential side effects of the proposed methods are considered in the light of the handicap; (6) a method is finally recommended that may be a trade-off, with ease of use balanced against efficacy, and living with side effects balanced against the risks of pregnancy; and (7) rechecks are necessary to ensure that the patient is using the method with skill and satisfaction.

Adoption↗
PubMed1979

Creatine kinase in serum: 6. Inhibition by endogenous polyvalent cations, and effect of chelators on the activity and stability of some assay components.

We studied the effects of some chelators on creatine kinase activity. Creatine kinase is competitively inhibited by endogenous polyvalent cations (e.g., calcium, Ki = 4.5 mmol/L); this can be reversed by adding chelators to the reagent, resulting in a mean increase in activity of 1.14-fold at 25 degrees C and 1.18-fold at 30 and 37 degrees C. Adding chelators, 5 and 10 mmol/L, to serum stored at 37, 30, 25, 4, and -20 degrees C increased isoenzyme stability in some cases, but under certain conditions decreased it, especially at higher chelator concentrations, and more so for EGTA than for EDTA. Blood sampling into tubes prepared with chelators and storage of plasma has no advantage over serum stored in the presence of chelators. The most striking effect of chelators is their protective effect on thiols in the creatine kinase reagent. In the presence of EDTA, 2 mmol/L, the reagent is stable for at least a day at 25 degrees C or a week at 4 degrees C. The poor stability of glucose-6-phosphate dehydrogenase, which is nearly independent of chelators, is the limiting factor for reagent containing EDTA. Bis-Tris, a buffer recently recommended for assay of creatine kinase activity, is a weak chelator. Imidazole acetate buffer combined with EDTA yields activities identical to those found with Bis-Tris at assay temperatures of either 25 or 30 degrees C.

Blood Specimen Collection↗
PubMed1978

Creatine kinase in serum: 4. Differences in substrate affinity among the isoenzymes.

The goal of this work was to find out whether it is possible to measure all three creatine kinase isoenzymes under the same reaction conditions in spite of their different kinetic properties. We found the tightest substrate binding for purified human BB, followed by the MB And MM isoenzyme preparations for both creatine phosphate and ADP. An increase in substrate concentration usually resulted in an inhibition. Nevertheless, it was possible with a method optimized for the MM isoenzyme also to measure the BB and MB isoenzymes at a rate of inhibition of only 6 and 3%, respectively. Marked differences in the apparent Km values between purified and native MM isoenzyme in human serum may indicate that the enzyme declined in substrate affinity during the isolation procedure. The use of enzyme preparations for standardization purposes, therefore, is only suitable if their kinetic properties are close to those of the enzyme in serum. Difficulties in the calculation of the apparent Km values are discussed and the graphical procedures of Lineweaver and Burk and of Eisenthal and Cornish-Bowden compared.

Adenosine Diphosphate↗
PubMed1978

Creatine kinase in serum: 5. Effect of thiols on isoenzyme activity during storage at various temperatures.

We studied changes in the activity of human creatine kinase isoenzymes (native MM in serum, MM, MB, and BB preparations in serum matrix) on storage in the presence of 0, 10, 20, and 50 mmol of N-acetyl cysteine, 2-mercaptoethanol, and 1-thioglycerol per liter of serum at 37, 30, 25, 4, and -20 degrees C. We also assessed the stability of the thiols under the same conditions. We generally confirmed increasing stability in the sequence: BB, MB, and MM isoenzyme. Above 30 degrees C irreversible inactivation is very rapid, even in the presence of thiols. At lower temperatures endogenous MM is sufficiently stable; thus, the use of protective thiols can be restricted to sera expected to contain isoenzymes MB or BB. Our studies lead us to prefer use of 50 mmol of N-acetyl cysteine per liter of serum. The other thiols cause turbidity to develop earlier and their decomposittion products diminish the activity more. The initial activity of the MB and BB preparations increased by as much as 2.3- and 1.8-fold on storage with thiols. This effect was not observed with either endogenous MB and MM or with the MM prepartion.

Creatine Kinase↗
PubMed1977

Creatine kinase in serum: 3. Further study of adenylate kinase inhibitors.

In search of an appropriate inhibitor to suppress the interference of adenylate kinase with the creatine kinase assay, we found that the combination diadenosine pentaphosphate (10 mumol/liter) and AMP (5 mmol/liter) is a better inhibitor than is fluoride (25 mmol/liter). The latter inhibits adenylate kinase uncompetitively and weakly (Ki = 2.5 mmol/liter), and must be incorporated in the starting reagent, and at 30 degrees C it becoms fully effective only after a lag phase of 6 min. In this concentration, fluoride inhibits adenylate kinase from erythrocytes, muscle, liver or platelets by 94, 92, 88, and 87%, respectively, and creatine kinase by 8%. Bromide and chloride also inhibit creatine kinase. Attempts to replace AMP by a specific inhibitor of liver adenylate kinase failed. Homologs of diadenosine pentaphosphate with either fewer or more phosphoryl groups in the polyphosphate bridge inhibited even more weakly than did the pentaphosphate. Platelets can significantly contribute to adenylate kinase activity in serum. The inhibitor combination inhibited adenylate kinase from platelets by 90%.

Adenine Nucleotides↗