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Biomedical subjects

S B Levine

Publications and source records attributed to S B Levine.

At least 37 records · Page 2Linked to original sources
PubMed1991

Sexual, psychological, and marital impact of self-injection of papaverine and phentolamine: a long-term prospective study.

This prospective study assessed the long-term effects of self-injection of papaverine hydrochloride and phentolamine mesylate along several critical domains for 42 men and 26 partners. Over the course of one year, men were, on average, injecting themselves five times monthly, with 84% of these injections producing satisfactory erections. Treatment resulted in statistically significant improvements in quality of erection, sexual satisfaction, frequency of intercourse, and coital orgasm. The women also demonstrated significant improvement in sexual satisfaction, arousal, frequency of intercourse, and coital orgasm. Decreases in general psychiatric symptomatology were apparent for men but not for partners. The dropout rate was 57%. The common side effects of treatment were development of fibrotic nodules (26%), abnormal liver function values (30%), and bruising (19%). We conclude that self-injection should be considered among the accepted treatments for erectile dysfunction. It does appear to enhance the sexual lives of men and women when the treatment is efficacious and the couple is motivated to utilize it.

Adaptation, Psychological↗
PubMed1991

Informed consent in the electroconvulsive treatment of geriatric patients.

The past 15 years have been marked by an increasingly stringent regulatory atmosphere regarding the administration of ECT, leading to delays in treatment and declines in usage. Regulatory changes requiring judicial intervention in clinical decisions are driven by the notion that only the courts can provide adequate due process protections when legal rights and clinical need conflict. We retrospectively reviewed the documentation of the informed consent process for 62 geriatric patients receiving ECT to assess the degree to which clinicians conformed to the spirit of the informed consent doctrine in a state that allows significant clinical discretion in decisions to administer ECT to patients lacking decisional capacity. In the eight cases in which the patient's decisional capacity was questioned, we found appropriate documentation of the patient's failure to comprehend his condition or the proposed treatment, evidence of a high degree of family involvement in decision making, and extensive use of outside consultants to document decisional incapacity and the need for treatment. Evidence of family participation in decision making was present for a high percentage of cases in which decisional capacity was unquestioned. Our review demonstrated high compliance with the procedural safeguards contained in the state regulation and with the spirit of the informed consent doctrine.

Aged↗
PubMed1991

Diagnostic nasal endoscopy and functional endoscopic sinus surgery: an update and review of complications.

Diagnostic nasal endoscopy and functional endoscopic sinus surgery are relatively new techniques that have expanded our understanding of sinus physiology and the etiologies of sinus pathology. Diagnosis at an early stage of chronic sinus disease demonstrates that pathological changes are often limited to the osteomeatal complex and the anterior sinus group. Early disease refractory to aggressive medical management usually responds to surgical treatment. Surgery in this setting is most often performed under local anesthesia, without nasal packing, with an immediate improvement in the patient's symptoms, and with minimal risk of complications.

Chronic Disease↗
PubMed1990

Treating erectile dysfunction with external vacuum devices: impact upon sexual, psychological and marital functioning.

We evaluated prospectively the medical, sexual and psychosocial outcome of external vacuum devices in the treatment of erectile dysfunction. A total of 29 men regularly used such a device for 6 months and reported statistically significant improvements in erectile quality, frequency of intercourse attempts, frequency of orgasm and sexual satisfaction, as well as decreased psychiatric symptomatology, increased self-esteem and a trend toward improved marital satisfaction. Of the partners 18 reported improved sexual functioning, including increased frequency of orgasm, decreased masturbation and greater sexual satisfaction, with no changes in psychosocial parameters. The vacuum device was effective in producing erections in 89% of the men. Dropout, only 19% within 6 months, was primarily due to insufficient or pivoting erections and bruising. The most frequent adverse effects were blocked ejaculation and physical discomfort. Vacuum devices appear to provide a safe, effective, inexpensive, noninvasive treatment for erectile failure that enjoys high patient and partner acceptance.

Adult↗
PubMed1990

Essay on the diagnosis and nature of paraphilia.

Increasing clinical experience has allowed the formulation of three psychodynamic viewpoints about the nature of the paraphilic disorder. Paraphilia is a disorder of sexual identity development, often solely of the intention component, that has three characteristics: a long-standing, highly arousing, unusual erotic preoccupation; a pressure to act upon the erotic fantasy; sexual dysfunction with a partner during conventional sexual behavior. Paraphilia is also a disorder of self-regulation characterized by a considerable gap between personal aspirations and behaviors. Finally, paraphilia is a dramatic impairment in the capacity to love. Two rarely recognized issues complicate the nosology of paraphilia: Many related sexual problems are often confused with paraphilia, and some paraphilias manifest themselves as variations in gender identity and object choice. The defensive functions of paraphilia are discussed and common terms used in conjunction with paraphilia are redefined.

Adult↗
PubMed1989

Side effects of self-administration of intracavernous papaverine and phentolamine for the treatment of impotence.

Beginning October 1985, 111 men agreed to enter a prospective study of the side effects of low dose papaverine/phentolamine therapy. A total of 46 men dropped out, 30 during the initial phase. The percentage of men with painless nodules almost consistently doubled from one followup examination to the next: 8 per cent at 1 month, 17 per cent at 3 months, 32 per cent at 6 months and 57 per cent at 12 months. The average injection frequency of those with nodules was 2 1/2 times higher than those without nodules. Of the men 41 per cent required an increased dose of medications during followup, and 40 per cent of 50 men had at least 1 abnormality of liver function, most of these involving mild to moderate elevations of alkaline phosphatase and lactic dehydrogenase. Priapism was not encountered during self-injection but it did occur twice in 329 physician-administered injections. Careful regular monitoring of patients should continue as some patients enter the second year of treatment.

Adult↗
PubMed1989

Why do so many people drop out from auto-injection therapy for impotence?

Although intracavernous injection of vasoactive substances has been shown to be a reasonable and reliable method of reversing impotence, studies assessing patient acceptance of this new technology are lacking. By prospectively following patients and willing partners over a 2-year period, this study sought to document patient utilization rates and the reasons why patients decline or discontinue injection therapy. The cumulative dropout rate was 46%, with patients being most at risk for leaving the program after evaluation or during the trial dose phase. Patients decline treatment because they are unable to accept the idea of injecting themselves or because of potential side effects. Patients discontinue treatment because of perceived lack of efficacy. Patient and programatic obstacles to utilization of self-injection therapy are analyzed.

Erectile Dysfunction↗
PubMed1989

Self-injection of papaverine and phentolamine in the treatment of psychogenic impotence.

This study prospectively assessed the use, effectiveness, and sexual and psychosocial impact of self-injection treatment in 15 men with psychogenic impotence. Sixty percent dropped out of self-injection treatment by 6 months. Those who remained used self-injections about four times monthly with a 94% success rate. Frequency of intercourse and sexual satisfaction increased. Anxiety decreased, and trends toward improvement in depression and self-esteem were evident. Qualitative data indicated that performance anxiety was not alleviated, dependence upon injections for intercourse remained, symptom substitution did not occur, and capacity for intimacy was not improved.

Erectile Dysfunction↗
PubMed1989

Comprehensive sexual health centers: is it time?

Psychiatric epidemiologic research, mental health professionals, and nonpsychiatric physicians still largely avoid dealing with the problems of sexual identity and function. The Department of Psychiatry at Case Western Reserve University, in contrast to these trends, has established a Center for Human Sexuality, an innovative mental health center that employs full- and part-time staff to provide services, education, and research. The Center may serve as a model for other institutions that perceive the social, academic, and economic value of dealing with these high prevalence, underserved problems. The support of administration and the multidisciplinary interaction of mental health professionals among themselves and with nonpsychiatric physicians have been crucial to the Center's viability. Strategies for dealing with health care administration are discussed.

Combined Modality Therapy↗
PubMed1988

Injection therapy for impotence.

Injection of vasoactive drugs is an effective form of treatment for selected patients with impotence from virtually all causes. The two most commonly employed drugs in the United States are either papaverine alone or various combinations of papaverine and phentolamine. Patients with organic and mixed impotence are best suited for injection treatment, but selected patients with psychogenic impotence also benefit from therapy. After the patient is selected for injection therapy, he undergoes a series of trial injections in the physician's office. The incidence of priapism will be minimized if the initially administered doses are low and the patient is titrated to an appropriate dose level. Uncontrolled trials have revealed that injection treatment produces a satisfactory erection in 65 to 100 per cent of patients for a follow-up period of as long as 2 years with minimal side effects, but the dropout rate is high. If priapism does occur, it almost always responds readily to treatment with aspiration, low doses of an alpha-adrenergic agent, or both. The other common side effects are bruising or ecchymosis and nodule formation at the injection site. This latter complication has not been noted to cause significant abnormal penile curavature necessitating cessation of the program.

Clinical Trials as Topic↗
PubMed1987

More on the nature of sexual desire.

A definition of sexual desire is offered that stresses the psychobiologic nature of its energy, its antecedent and accompaniment roles in relation to sexual arousal, and its tendency to generate sexual behavior. Two inherent properties are recognized: fluctuation of frequency and intensity and capacity to appear baffling. These properties are products of the changeable contributions of biologic drive, cognitive wish, and emotional willingness. These three elements of desire vary somewhat predictably with the stage in the life cycle, quality of current relationship, and the couple's rules that govern their sexual behavior. The transferential and sexual identity contributions are less predictable.

Conflict, Psychological↗
PubMed1987

Intracavernosal injection in the treatment of impotence: a prospective study of sexual, psychological, and marital functioning.

This study assessed the sexual, psychosocial, and medical impact of intracavernosal injection of papaverine hydrochloride and phentolamine mesylate in the treatment of impotence. Ninety-six percent of patients initially achieved satisfactory erections with injections. Common side effects of self-injections included bruising (26%), nodule development (21%), abnormal liver function tests (7%), and pain (5%). No nodules resulted in penile bending or pain, and no patient discontinued treatment due to nodule development. Dropout rate to date was 35%. Self-injection treatment was associated with increases in erection quality, intercourse frequency, and sexual satisfaction, and decreases in masturbation frequency for patients. Partners also reported increases in intercourse frequency, coital arousal, and satisfaction. Decreases in general psychiatric symptomatology and increases in relationship satisfaction and self-esteem were apparent for patients, but not for partners.

Erectile Dysfunction↗
PubMed1987

Pulsatile tinnitus.

Tinnitus is a frequent presenting symptom. Tinnitus that is rhythmic and synchronous with the patient's heartbeat is rare. Pulsatile tinnitus may be the only symptom of life-threatening and treatable diseases. The presence of hearing loss or vertigo focuses the diagnostic evaluation. The cause of pulsatile tinnitus may be found on otoscopic examination. Audiologic assessment and enhanced computed tomography often contribute to the diagnosis. Increased intracranial pressure should be excluded with a fundoscopic examination. Arteriography is required to diagnose life-threatening and treatable lesions in the presence of normal otoscopy, audiologic assessment, and enhanced computed tomography.

Adult↗
PubMed1987

Antiandrogen treatment of male sex offenders.

The management of sex offenders is a complex and frustrating biopsychosocial problem. Treatment programs are experimental and few in number. The Department of Psychiatry at University Hospitals of Cleveland has developed a treatment program for male sex offenders that uses weekly injections of an antiandrogen medication, medroxyprogesterone acetate (MPA), and psychotherapy. The following overview details out clinical experience.

Androgen Antagonists↗
PubMed1986

Acinic cell carcinoma of the parotid gland in children.

Acinic cell carcinoma is an infrequent malignancy of salivary gland tissue in adults that is very rare in children. Review of the English literature reveals only 25 reported cases of this neoplasm in pediatric populations. This is a case report of the youngest known child to undergo parotidectomy and facial nerve dissection for an acinic cell carcinoma. The unusual clinical and surgical findings might suggest the need for changes in approach to treatment of a tumor that has been previously described as relatively benign.

Carcinoma↗
PubMed1986

Evaluation and treatment of frontal sinus fractures.

We treated twenty-three patients with blunt or penetrating wounds of the frontal sinus from 1978 through 1983. Nondisplaced anterior wall fractures were observed or explored. Posterior table fractures--with displacement confirmed by computed tomography or polycycloidal tomography--were explored. Either obliteration of the sinus or nasofrontal duct reconstruction with a Sewall-Boyden-McKnaught flap was selected, depending on the magnitude of duct injury. In all cases, the anterior wall was primarily reconstructed. All penetrating wounds with posterior table involvement were treated by cranialization of the frontal sinus and temporalis muscle obliteration of the nasofrontal ducts. Only one case of meningitis occurred, resulting in prolonged hospitalization.

Facial Bones↗
PubMed1986

Blood transfusions in surgery of the larynx and neck.

Effective utilization of blood and blood products is an important consideration in elective surgical procedures. A cost-effective process will maintain availability to the general population while supplying reasonable surgical needs. Removing stored blood from the general pool strains these resources and drastically increases cost. To establish the first clinical model of study and to better predict blood requirements for elective surgery of the larynx and neck, medical records of 137 consecutive patients who underwent laryngeal surgery from January 1, 1981 to June 30, 1984 were reviewed. All patients had one or a combination of one of the following: radical neck dissection, total laryngectomy, hemilaryngectomy, and/or supra-glottic laryngectomy. Data analyzed included estimated allowable blood loss, estimated intraoperative blood loss, as well as preoperative and postoperative blood hemoglobin concentrations. Actual blood utilization was adjusted for individual patient need, and recommendations for appropriate blood screen and crossmatch were derived for each of the above surgical procedures. It was concluded that blood availability for the individual patient is best assessed by the surgeon.

Blood Grouping and Crossmatching↗