Insulinoma presenting as temporal lobe epilepsy.
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Adult↗
Biomedical subjects
N S Levitt
Publications and source records attributed to N S Levitt.
Ambivalence of primary health care professionals towards the South African guidelines for hypertension and diabetes.
BACKGROUND: Consensus-derived guidelines for hypertension and diabetes management were introduced by the National Department of Health to improve quality of care. However, the incorporation of guidelines into clinical practice is largely dependent on the attitudes of health professionals. OBJECTIVE: To audit the responses and examine the attitudes of health professionals in primary care towards the diabetes and hypertension care guidelines. DESIGN: Qualitative focus group, in-depth discussions and clinic observations. SETTING: Four community health centres (CHCs) in the Western Cape. SUBJECTS: Fifteen doctors and 10 professional nurses. METHODS: The responses of health professionals to the guidelines were audited. Their attitudes were evaluated at a single pilot CHC using focus group discussions and in-depth interviews. Semi-structured interviews based on these themes were conducted at 3 other CHCs. Clinic consultations were observed to validate the responses. RESULTS: The guidelines were not systematically implemented at local CHCs and individual doctors consulted the guidelines infrequently. Several themes were identified as barriers to the application of the guidelines, including the consultation process by which the guidelines were developed, time constraints, scepticism about durability of the guidelines, conflict with local practices, health system problems, and patient beliefs. CONCLUSION: The usefulness of passive dissemination of guidelines to health professionals in primary care should be reviewed as several attitudinal barriers to implementation may exist. Guidelines may be adopted more readily if these barriers are addressed.
Attitude of Health Personnel↗
Parathyroid and thyroid function five years after treatment of laryngeal and hypopharyngeal carcinoma.
The proximity of the thyroid and parathyroid glands to the larynx and hypopharynx puts them at risk from treatment of squamous cell carcinoma (SCC) of this region. Consequently parathyroid and thyroid function was evaluated in patients surviving at least 5 years following treatment of primary SCC of the larynx or hypopharynx. Twenty-eight patients, initially treated from 1990 to 1992, were assessed and divided into four groups according to treatment received. Hypoparathyroidism (partial and hypocalcaemic) occurred in 88% and hypothyroidism (clinical and subclinical) in 50% in Group 1 (radiotherapy only) Group 2 (salvage laryngectomy for failed radiotherapy) had 66% hypoparathyroid and 33% hypothyroid. Group 3 (surgery + radiotherapy combined) had 89% hypoparathyroid and 89% hypothyroid. Group 4 (surgery only) had 63% hypoparathyroid and 63% hypothyroid. Significant endocrine hypofunction therefore occurs following the treatment of laryngopharyngeal carcinoma, more so with radiotherapy and combined therapy than with surgery alone.
Carcinoma, Squamous Cell↗
Modifiable risk factors for Type 2 diabetes mellitus in a peri-urban community in South Africa.
AIMS: To investigate the prevalence of Type 2 diabetes mellitus (DM) and its risk factors in a working class peri-urban community in South Africa. METHODS: A cross-sectional descriptive study was conducted in 1996, where all persons aged 15 years and older, who were resident in randomly selected houses in Mamre, 55 km from the centre of Cape Town, were sampled. Subjects underwent a 75-g oral glucose tolerance test. Socio-demographic and anthropometric data were obtained and physical activity was assessed using a 7-day activity recall questionnaire. The 1985 WHO criteria were used to define diabetes. RESULTS: The response rate was 64.5% (n = 974). The participants comprised 56% women, 44% men, mean age 37.6 (range 15-86) years. The crude prevalence of Type 2 DM was 7.1% and impaired glucose tolerance (IGT) 8.0%. The age-adjusted prevalence of Type 2 DM was 10.8% (95% confidence interval (CI) 8.2-13.5%) and IGT 10.2% (95% CI 7.7-12.8%). Regression analysis indicated that age (risk ratio (RR) 7.40, 95% CI 3.45-15.86), waist circumference (RR 4.53, 95% CI 2.04-10.05), low total energy expenditure (RR 1.75, 95% CI 1.07-2.56) and family history of diabetes (RR 2.31, 95% CI 1.42-3.77) were independent risk factors for Type 2 DM, while sex, obesity and regular alcohol consumption were not. CONCLUSIONS: This previously unstudied community has an intermediate prevalence on the international scale of Type 2 DM, which is linked to potentially modifiable risk factors.
Adolescent↗
An inverse relation between blood pressure and birth weight among 5 year old children from Soweto, South Africa.
STUDY OBJECTIVE: To examine the relation between birth weight and blood pressure at 5 years in a cohort of South African children. DESIGN: Prospective cohort study. PARTICIPANTS: 849 five year old children. SETTING: Soweto, a sprawling urban area close to Johannesburg, South Africa, which was a designated residential area for people classified as "black" under apartheid legislation. MAIN RESULTS: Systolic blood pressure at 5 years was inversely related to birthweight (r = -0.05, p = 0.0007), independent of current weight, height, gestational age, maternal age or socioeconomic status at 5 years. There was no relation between birth weight and diastolic blood pressure. After adjusting for current weight and height, there was a mean decline in systolic blood pressure of 3.4 mm Hg (95% confidence intervals 1.4, 5.3 mm Hg) for every 1000 g increase in birth weight. CONCLUSIONS: These data from a disadvantaged urbanised community in Southern Africa extend the reported observations of an inverse relation between birth weight and systolic blood pressure. The study adds to the evidence that influences in fetal life and early childhood influence systolic blood pressure. Further research is required to assess whether efforts to reduce the incidence of low birthweight babies will attenuate the prevalence of hypertension in future generations.
Birth Weight↗
Audit of public sector primary diabetes care in Cape Town, South Africa: high prevalence of complications, uncontrolled hyperglycaemia, and hypertension.
This study was undertaken to investigate the prevalence of diabetes complications and level of glycaemic and blood pressure control in Black African patients at the primary care level in the public sector Cape Town, South Africa. A stratified random sample of 300 patients attending the three largest ambulatory diabetes clinics in community health centres in Black African residential areas of Cape Town (100 patients from each) during the last 6 months of 1992 was selected. Each patient had a clinical examination, interview, and 1 year retrospective record review. Eighty-one per cent of the sampled patients were reviewed, 90% were non-insulin-dependent (NIDDM) and 10% were treated with insulin. The mean duration of diabetes was 8 (range 0-28) years. Acceptable glycaemic control was present in 49.4% (95% Confidence Intervals 45.6-53.5) of patients while 38.5% (CI 24.8-52.2) of hypertensive patients had acceptable blood pressure control. The prevalence of any grade of retinopathy was 55.4% (CI 48.90-62.9), proliferative and preproliferative retinopathy 15.6% (CI 8.5-22.8), cataracts 7.9% (CI 4.4-11.4), peripheral neuropathy 27.6% (CI 15.2-39.4), absent foot pulses 8.2% (CI 5.2-12.6), amputations 1.4% (CI 0.4-2.4), persistent proteinuria 5.3% (CI 2.5-8.1) and an elevated albumin-creatinine ratio 36.7% (CI 29.0-44.4). The complications were not documented in the clinic records of the preceding year with the exception of 1 patient with absent foot pulses and the 12 patients with proteinuria. The high prevalence of suboptimal glycaemic and blood pressure control as well as complications of diabetes, largely unrecorded in the preceding years' clinic notes, demonstrates the deficiency of and need for preventative diabetes care at the primary care level. The design, institution, and evaluation of effective intervention programmes are a priority to improve the quality of care provided and the health of diabetic patients.
Adult↗
Autonomic neuropathy in extra-hepatic portal vein thrombosis: evidence for impaired autonomic reflex arc.
BACKGROUND/AIMS: Autonomic dysfunction is common in cirrhosis, and may be associated with increased mortality and hyperdynamic circulatory changes. Our aim was to investigate whether autonomic disturbances occur in extrahepatic portal vein thrombosis and their correlation with hemodynamic abnormalities. PATIENTS AND METHODS: Heart rate variation in response to standing, deep breathing, and Valsalva maneuver, and blood pressure response to sustained handgrip and to standing, were studied in 16 subjects with portal vein thrombosis (10 males, 30.8+/-2.8 years: mean+/-SE), 12 with cirrhosis (7 males, 52+/-2.3 years), and 10 healthy controls (7 males, 30.8+/-3.0 years). Supine resting, and 10- and 30-min standing epinephrine and norepinephrine levels were measured and results correlated with cardiac output. RESULTS: Autonomic dysfunction occurred in 62% of portal vein thrombosis and 75% of cirrhosis subjects, but in no controls (p<0.02). Similarly, postural hypotension occurred in portal vein thrombosis (-10.25+/-0.65 mmHg, p=0.003) and cirrhosis (-7.42+/-0.82 mmHg, p=0.007) but not in controls. All groups had similar baseline epinephrine and norepinephrine concentrations. Epinephrine increased significantly in controls (45%, p<0.01 and 49%, p<0.02) after 10 of 30 min standing but not in the portal vein thrombosis or the cirrhotic group, and norepinephrine increased after 10 and 30 min standing in cirrhotics (128%, p<0.004 and 130%, p<0.008) and controls (129%, p<0.002 and 116%, p<0.004), but not portal vein thrombosis (34.5% and 39%, NS vs baseline). Portal vein thrombosis and cirrhosis groups had increased cardiac output (4441+/-509 and 3262+/-292) vs controls (1763+/-212 ml/min/m2, p<0.002), but there was no correlation with autonomic neuropathy or with catecholamine levels. CONCLUSIONS: Autonomic dysfunction and impaired catecholamine response to orthostatic stress occur commonly in portal vein thrombosis and suggest an impairment of the autonomic reflex arc, but changes do not correlate with hemodynamic abnormalities.
Adult↗
Bile duct stricture complicating systemic lupus erythematosus.
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Adult↗
Staff knowledge, attitudes and practices in public sector primary care of diabetes in Cape Town.
OBJECTIVE: To audit staff knowledge, attitudes and practices in the interest of improved public sector primary care for diabetics. DESIGN: External audit using face-to-face, private, questionnaire-based interviews. SETTING: Twelve public sector ambulatory health centres in Cape Town. SUBJECTS: Non-specialist, principal staff members (N = 35)-12 doctors, 10 primary health care nurses (PHCNs), 7 registered nurses (RNs) and 6 staff nurses (SNs). RESULTS: Staff members were long-standing employees (mean-doctors 6 years, PHCNs 8 years, RNs 5 years, SNs 12 years). Few had post-basic training (doctors 25%, PHCNs 20%, RNs 26%, SNs 83%). Knowledge of chronic diabetic complications was adequate, e.g. diabetic eye disease was mentioned by 100% of staff. There were gaps in knowledge of pathophysiology and of signs and symptoms of diabetic emergencies, e.g. < 33% knew control of hypertension to be important in the prevention of diabetic nephropathy. Knowledge of appropriate care of patients with hypoglycaemia (94% mentioned glucose administration) was better than that of hyperglycaemia (69% mentioned intravenous fluids). Problems were reported in inter-staff communication within (approximately 50%) and between (approximately 75%) disciplines by doctors, PHCNs and RNs. Staff/patient communication problems were reported by approximately 75% of staff. Solutions suggested by staff included meetings between staff members and with management, in-service training programmes and appointment systems for patients. Despite logistic, organisational and communication-related problems, most staff enjoy and believe in the value of their work. CONCLUSIONS: This study reveals deficiencies in in-service training with consequent gaps in knowledge and practice. Recommendations that would lead to improved quality of care and increased staff and patient satisfaction have been given.
Attitude of Health Personnel↗
The prevalence of diabetes mellitus and associated risk factors in elderly coloured South Africans.
OBJECTIVE: To determine the prevalence of diabetes and its associated risk factors in elderly coloured South Africans. RESEARCH DESIGN: Cross-sectional analytical study. METHODS: A random sample of 200 non-institutionalised coloured (mixed ancestry) subjects aged > or = 65 years of age, resident in urban Cape Town, was drawn by means of a two-stage cluster design. The survey procedure included an oral glucose tolerance test, anthropometric measurements, and physical activity and alcohol intake assessments. RESULTS: The prevalence of diabetes was 28.7% (95% CI 21.7-35.7%), 25.7% in men and 30.3% in women. The prevalence of impaired glucose tolerance was 15% (95% CI 9.2-20.8%). Upper-segment fat distribution (P < 0.001) and body mass (P < 0.05) were identified as significant risk factors for diabetes. A differential age and sex interaction was evident; in men the association between the identified risk factors and diabetes increased with age, while in women the association was strongest in those aged < 70 years. Body mass index, alcohol intake and physical activity were not significant risk factors. CONCLUSIONS: The prevalence of diabetes in older coloured South Africans was found to be high. The predicted increase in the proportion of the coloured population aged 65 years and older during the next 4 decades has important implications for the allocation of health resources for management of chronic diseases associated with ageing; diabetes appears to constitute a major health problem in this regard.
Activities of Daily Living↗
Hyperglycaemic emergencies are a common problem.
OBJECTIVE: To determine the number, type, precipitating factors and mortality associated with diabetic emergencies admitted to Groote Schuur Hospital. DESIGN: Administered questionnaire survey. SETTING: Groote Schuur Hospital, Cape Town. METHODS: All patients admitted from September 1991 to January 1992 with elevated blood glucose concentrations who required intravenous insulin and fluids were evaluated by an administered questionnaire prior to discharge from hospital. Patients were divided into four groups according to presence of ketosis, standard bicarbonate level and serum osmolality: (i) mild diabetic keto-acidosis (DKA); (ii) severe DKA; (iii) hyperosmolar state; and (iv) hyperglycaemia. RESULTS: There were 131 admissions in 122 patients. Sixty-five occurred in non-insulin-dependent diabetics, 45 in insulin-dependent diabetics and 12 in pancreatic diabetics. There were similar numbers of admissions in the four groups of hyperglycaemic emergencies. The mortality rate was 3% in the mild DKA and hyperglycaemic groups, significantly lower (P < 0.05) than in the hyperosmolar group (19%). The mortality rate was 11% in the severe DKA group (P > 0.05 v. other groups). Sixty-two per cent of participants had achieved Standard 4 to Standard 8 education. Only 39% were employed at the time of interview. Diabetic knowledge and general compliance were assessed as poor. Infections and poor compliance with hypoglycaemic therapy were the dominant precipitating factors. CONCLUSION: Hyperglycaemic emergencies precipitated largely by infections and poor compliance and associated with considerable morbidity and mortality commonly require admission to hospital. Improvement in diabetic education is required to reverse the current situation.
Adolescent↗
Thyroid dysfunction in the elderly.
OBJECTIVES: To determine the prevalence of thyroid dysfunction in institutionalised elderly people in Cape Town and to assess the usefulness of an abnormal thyroid-stimulating hormone (TSH) concentration as a screening test in this group. DESIGN: Cross-sectional survey. SETTING: Four old-age homes in Cape Town. SUBJECTS: Old-age home residents aged 60 years and over. OUTCOME MEASURES: Serum concentrations of TSH, free thyroxine and free tri-iodothyronine. RESULTS: Serum TSH estimations were performed on 658 participants, and were abnormal in 103 (15.6%)-41 (6.2%) being elevated (> 5.0 microU/ml) and 62 (9.4%) being low (> 0.4 microU/ml). There were 3 newly diagnosed cases of hyperthyroidism and 7 of hypothyroidism. Subclinical disease was diagnosed in 40 subjects. The overall prevalence of thyroid dysfunction in this population was 11.2%. In 22 (3.4%) this had previously been recognised, while in 50 (7.8%) the dysfunction was newly diagnosed by the current survey. The positive predictive value of a TSH concentration > 20 microU/ml in predicting hypothyroidism is 67%, while it will predict 100% of cases of subclinical hypothyroidism. A TSH concentration < 0.1 microU/ml will predict 23% of cases of hyperthyroidism, but 81% of cases of subclinical disease. CONCLUSIONS: The prevalence of thyroid dysfunction in institutionalised elderly people in Cape Town is similar to that reported for elderly people in other centres. Thyroid dysfunction had not previously been recognised in approximately two-thirds of the subjects in this study. The serum TSH concentration is a reliable screening test for thyroid dysfunction in the elderly, but is less useful if used to identify biochemical thyroid disease. An elevated TSH concentration is a better predictor of thyroid dysfunction in the elderly than a depressed TSH concentration.
Aged↗
Dexamethasone in the last week of pregnancy attenuates hippocampal glucocorticoid receptor gene expression and elevates blood pressure in the adult offspring in the rat.
Human epidemiological data show a strong association between low birth weight and hypertension in adulthood, an effect that has been ascribed to 'fetal programming'. In rats fetoplacental exposure to maternally administered dexamethasone throughout gestation reduces birth weight and produces hypertensive adult offspring, though the mechanism is unclear. Pre- and postnatal stress programmes hypothalamic-pituitary-adrenal (HPA) axis responses throughout the lifespan, an effect thought to be mediated via permanent effects on glucocorticoid receptor (GR) and/or mineralocorticoid receptor (MR) gene expression in the hippocampus. Corticosteroids also have specific central effects on blood pressure control mediated by GR and MR. This study investigated corticosterone (CORT) responses to restraint stress and GR and MR gene expression in areas of the brain postulated to mediate the central effects of corticosteroids on (i) HPA axis suppression (hippocampus), and (ii) blood pressure (organ vasculosum of the lamina terminalis (OVLT), sub-commissural organ, area postrema and nucleus tractus solitarius). Pregnant Wistar rats received dexamethasone (100 micrograms/kg.day-1) or vehicle on days 15-20 of gestation. This reduced birth weight by 11%. When the offspring were 16 weeks old, blood pressure was recorded directly and plasma CORT measured basally (AM) and after 30 min restraint. GR and MR mRNA expression were determined by in situ hybridization. Blood pressure was significantly elevated in the adult offspring of dexamethasone-treated pregnancies (dexamethasone 144 +/- 2/125 +/- 2 mm Hg vs. control 133 +/- 2.7/112 +/- 2.8 mm Hg; both p < 0.01). Offspring of dexamethasone-treated pregnancies had increased basal plasma CORT (155 +/- 29 nmol/l) compared to offspring of controls (79 +/-15 nmol/l, p < 0.05), but the CORT response to stress was similar. Hippocampal neuronal GR mRNA expression was significantly lower in the offspring of dexamethasone-treated pregnancies (dentate gyrus 20% lower, CA1 15% lower; p < 0.01). Similarly, hippocampal MR gene expression was decreased in CA1 and CA2 by 24 and 25%, respectively (p < 0.05). No differences in GR or MR mRNA expression were found in the OVLT, subcommissural organ, area postrema or nucleus tractus solitarius. These findings suggest that glucocorticoid excess in the last trimester of rat pregnancy (i) is sufficient to programme offspring hypertension; (ii) also increases basal plasma CORT levels, and (iii) permanently attenuates GR and MR mRNA expression in specific hippocampal subfields. Thus, if translated into protein, may reduce sensitivity to glucocorticoid feedback and thus contribute to the CORT excess. However, hypertension in this model is unlikely to be mediated by similar changes in GR or MR gene expression in the examined areas of the brain putatively involved in the more direct central regulation of blood pressure.
Animals↗
The natural progression of autonomic neuropathy and autonomic function tests in a cohort of people with IDDM.
OBJECTIVE: To test the natural progression of symptoms of autonomic neuropathy (AN) and function tests in subjects with IDDM. RESEARCH DESIGN AND METHODS: Seventy-six subjects with IDDM of < 10 years duration had cardiovascular autonomic reflex tests and were evaluated for signs and symptoms of AN. RESULTS: Fifty-seven subjects (66%) were available for restudy 9 years later (15 had died, 4 could not be located). Of the symptoms of AN, only gastroparesis increased in prevalence (P < 0.01). Of the five cardiovascular AN measures, only the R-R response to the Valsalva maneuver deteriorated (F[1,44] = 10.61, P < 0.01). CONCLUSIONS: The progression of AN in IDDM is monitored best longitudinally by the Valsalva maneuver because of the small variance ratio in repeated measures. Prevalence rates can be monitored by expiration-to-inspiration R-R or Valsalva ratios. Most clinical signs and symptoms of AN do not progress, underscoring the need for objective and quantitative autonomic function tests to identify people at risk for premature death.
Adolescent↗
Public sector primary care of diabetics--a record review of quality of care in Cape Town.
AIM: To evaluate the quality of health care received by diabetics. DESIGN: External audit by means of retrospective record review. SITE: Ambulatory outpatient diabetes clinics at community health centres in black areas of Cape Town. METHOD: A stratified random sample (520) of all patients who attended any of five health centres during 1991 was reviewed by a clinician who had been trained to do structured record reviews. RESULTS: The response rate was 73.1%. Of all patients reviewed 91% had non-insulin-dependent diabetes mellitus and the remainder insulin-dependent diabetes mellitus; 65% were female and 35.8% were employed. Only 35% attended optimally. Fingerprick blood glucose values were recorded at 98.4% of visits, blood pressure was recorded at 74.1% of all visits and for 97.4% of patients; urine dipstick test results were recorded at 84.6% of visits and for over 99% of patients in 1991, and weight was recorded at 68.8% of visits. In contrast, fundoscopy was recorded for 6% of patients and examination of the feet was performed in 4.7% of patients. Fewer than half (48.9%) of visits resulted in any change in management. Polypharmacy is frequent, with an average of 2.3 non-hypoglycaemic drugs prescribed per visit. CONCLUSION: Attendance and examination for treatable complications are inadequate. Care is routinised and reactive and there is polypharmacy. RECOMMENDATIONS: Simple but appropriate protocols and matching in-service education are likely to improve the care of and health outcome for diabetics at these sites.
Adult↗
Do "so-called" normal growth hormone concentrations (2-5 micrograms/l) indicate cure in acromegaly?
The study was undertaken to determine whether acromegalic patients with mean growth hormone (GH) concentrations of 2-5 micrograms/l have biochemically active disease following pituitary surgery or radiotherapy. 22 patients with acromegaly, 22 post surgery, 19 post radiotherapy had GH concentrations estimated during: (i) an oral glucose tolerance test (OGTT), (ii) a standard TRH test and (iii) 20 minute sampling for 8 hours. IGF-1 concentrations were measured. 6 normal subjects were also studied. Patients were divided into 3 groups on the basis of their mean GH concentration during the 8 hour sampling, > 5 micrograms/l, 2-5 micrograms/l, < 2 micrograms/l. Patients with mean GH concentrations of 2-5 micrograms/l (n = 6) had biochemically active disease: all had inadequate suppression of GH after OGTT, 5 had elevated IGF-1 concentrations, 4 had a paradoxical response to TRH. Patients with mean GH concentrations > 5 micrograms/l (n = 6) all had inadequate suppression after OGTT, 5 of 6 had increased IGF-1 concentrations, and 5 had abnormal responses to TRH. Of patients with mean GH concentrations < 2 micrograms/l (n = 10), 2 had elevated IGF-1 levels, 5 had abnormal responses to TRH and 4 inadequate GH suppression after OGTT. GH pulse number was similar in the three groups and GH pulse amplitude was significantly higher in those with GH > 5 micrograms/l compared to the other groups. In conclusion patients with GH concentrations of 2-5 micrograms/l have biochemically active disease and should be considered for further therapy after hypophysectomy.
Acromegaly↗
The prevalence and severity of microvascular complications in pancreatic diabetes and IDDM.
OBJECTIVE: To investigate and compare the prevalence, associations, and severity of retinopathy and nephropathy in patients with pancreatic diabetes (PD) and insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: Thirty patients with PD due to alcohol-induced chronic pancreatitis were matched for age, sex, and duration of diabetes with 30 patients with IDDM. Retinopathy was assessed by fluorescein angiography using the Wisconsin classification. Renal function was assessed by albumin excretion rates (AERs) in at least two timed overnight urine collections and glomerular filtration rates (GFRs) by single injection of 51Cr-EDTA. Microalbuminuria was defined as AER 20-200 micrograms/min and nephropathy as AER > 200 micrograms/min. RESULTS: Retinopathy was found in 33% of patients with PD and in 40% with IDDM. The spectrum of disease was similar in the two groups. The geometric mean of AER was 15 micrograms/min (range 1-1,541) in the PD group and 24 micrograms/min (2-2,288) in the IDDM group. Nephropathy was found in 7 PD and in 5 IDDM patients, and a reduced GFR was present in 8 (26%) and 4 (13%) of the two groups, respectively. Microalbuminuria occurred in 9 (33%) and hyperfiltration in 3 (10%) in each group. These differences were insignificant. Retinopathy correlated with AER in both groups. Retinopathy and AER correlated with duration of diabetes in the IDDM but not in the PD group. CONCLUSIONS: Microvascular complications are equally common and severe in PD and IDDM, and improved glycemic control should be the goal in both.
Albuminuria↗
Non-invasive management of organic impotence.
OBJECTIVE: To establish the efficacy of a vacuum device (ErecAid) in the management of organic impotence. DESIGN: Cohort study; questionnaire before and after a 6-month study period. SETTING: Groote Schuur Hospital, Cape Town. PARTICIPANTS: A total of 19 men with organic impotence, 8 diabetic and 11 with previous pelvic surgery or radiotherapy. INTERVENTION: Vacuum device (ErecAid, Osbon Medical Systems). OUTCOME MEASURE: Efficacy of ErecAid. RESULTS: Six of 8 diabetics and 6 of 11 non-diabetics reported successful intercourse, while 16 of the participants would recommend the device to others. Some difficulty with the device was experienced by 11 and only 9 described an increase in self-esteem. CONCLUSION: Although some difficulties may be experienced in the use of the ErecAid, it clearly has a role to play in the management of patients with organic impotence, who ideally should be able to select their preferred form of therapy.
Adult↗