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PubMed1997

First early patient contact for medical students in Prague.

BACKGROUND: Undergraduate medical education in the Czech Republic is currently undergoing extensive changes. OBJECTIVES: Since the very beginning of the study we have aimed to introduce mandatory education in general practice at the Second Medical School of Charles University in Prague. METHODS: A total of 106 medical students were divided into pairs; three pairs of students were assigned to one GP (trainer) who chose suitable families for them to visit after lectures in communication skills. The students met their trainers again after the visits, and 1 week of family placement was concluded by seminars that involved small groups of students led by assistant lecturers of the Institute of General Practice of the Postgraduate Medical School. RESULTS AND CONCLUSIONS: Early patient contact for medical students proved to be a good method of starting training in communication skills and for helping to understand the patient as a human being. Students evaluated highly their lecture notes and seminars for small groups as ways of preparing them for their future tasks. The attention that the medical students gave to their new subject, and their interest in continuing the seminars and visits of 'their' families, showed that the Family Placement project had a positive response.

Curriculum↗
PubMed2004

Interprofessional training in the context of clinical practice: goals and students' perceptions on clinical education wards.

AIMS: This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. CONTEXT: A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. MATERIAL AND METHODS: A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). RESULTS: The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. CONCLUSIONS: The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members.

Attitude of Health Personnel↗
PubMed1986

[New developments in the treatment of keratoconus].

The results of penetrating and lamellar keratoplasty in patients with keratoconus are communicated. In penetrating keratoplasty the graft healed clear in 93.5% of the cases treated (266 operations). A new method of surgical treatment of acute total keratoconus by "biological covering" with a lamellar corneal graft is proposed, which enables the process to stabilize, the eye to be saved, and in isolated cases a visual acuity of 0.5 or more to be achieved. The authors describe a new trend in studying the pathogenesis of keratoconus on the basis of biochemical investigations of the damaged areas of the cornea (lowering of the activity of enzymes of the antioxidant system and reduction in tocopherol content). A new method of conservative treatment for the initial forms of keratoconus using phonophoresis of Vitamin E (tocopherol) is proposed on the basis of the data gathered in the biochemical investigations.

Cornea↗
PubMed1999

Anatomical studies of the autonomic nervous system in the human pelvis by the whole-mount staining method: left-right communicating nerves between bilateral pelvic plexuses.

PURPOSE: Some recent neurophysiological studies have suggested cross-innervation of pelvic genitourinary organs by extrinsic left-right communicating nerves. However, no definite course for these nerves has been clearly determined macroanatomically in humans. In the present study we extensively investigated the adult human pelvis to elucidate their courses by the whole-mount staining method. MATERIALS AND METHODS: A total of 6 male human specimens that had been subjected to pathological dissection were examined by means of an acetylcholinesterase whole-mount staining method. A map of nerve pathways was made by composite photomicrography. Histologically, nerves dissected accurately under a dissecting microscope were stained with both Klüver-Barrera stain and the Bodian method. RESULTS: The communicating nerves between bilateral pelvic plexuses were observed at the back of the rectum and in the rectoprostatic space. The former were composed of nothing but myelinated fibers in the same way as the pelvic splanchnic nerve. By contrast, the latter were composed of unmyelinated fibers with a few myelinated fibers. The pelvic plexus could be divided into three portions, anterosuperior, anteroposterior and inferior areas, by ganglion type. Morphologically, fiber components differed among those three portions. CONCLUSION: The communicating nerves at the back of the rectum seemed to be predominantly parasympathetic communicantes between bilateral pelvic splanchnic nerves rather than pelvic plexuses. These nerves may be involved in postoperative voiding function in the case of pelvic surgery with hemilateral nerve preservation. The function of the pelvic plexus seemed to be heterogeneous in each portion according to our morphological results.

Aged↗
PubMed1999

Clinical experience with ultrarapid cryopreservation of human embryos resulting from intracytoplasmic sperm injection: brief communication.

A total of 41 patients requested thawing of supernumerary embryos in an intracytoplasmic sperm injection (ICSI) programme. Mean patient age was 30.8 +/- 3.8 years. Embryo freezing by the ultrarapid method was performed at room temperature in 3 mol/l DMSO and 0.25 mol/l sucrose. Total freezing time was 2.5 min including filling of the straw. In the thawing process, the embryos were removed from liquid N(2), left at room temperature for 30 s, immersed for 40 s at 30 degrees C, and then successively transferred at room temperature for 10 min to each of three sucrose solutions of decreasing concentration. The embryos were kept in culture and only those that presented cleavage after 24 h were transferred. Embryos from 42 cycles were thawed and a total of 24 transfers was performed. The mean number of thawed embryos was 5.0 +/- 3.2 per cycle and the mean number of transferred embryos was 2.83 +/- 1.3. The clinical pregnancy rate per cycle obtained after the thawing process was 16. 6%. The clinical pregnancy rate per transfer was 29.2% and the implantation rate was 13.2%. The abortion rate was 14.3%. Six deliveries have been performed, with the birth of seven infants.

Adult↗
PubMed2005

Nutrition communication styles of family doctors: results of quantitative research.

OBJECTIVE: To assess the nutrition communication styles of Dutch family doctors and in particular to assess its psychosocial and sociodemographic correlates. DESIGN: A cross-sectional study in which a representative sample of 600 Dutch family doctors completed a questionnaire. SETTING: The survey was conducted in October and November 2004 in the Netherlands. SUBJECTS: A total of 267 family doctors completed the questionnaire (response rate 45%). METHODS: Principal component factor analyses with varimax rotation were performed to construct factors. Cronbach's alpha was used as an index of reliability. Our hypothetical model for nutrition communication style was tested using multiple regression analysis, combining the forward and backward procedures under the condition of the same results. RESULTS: Many family doctors felt at ease with a motivational nutrition communication style. The main predictor for motivational nutrition communication style was task perception of prevention (26%). Some individual and environmental correlates had an additional influence (explained variance 49%). Other styles showed explained variances up to 57%. The motivational style was the best predictor for actual nutrition communication behaviour (35%), while the confrontational style was the best predictor for actual nutrition communication behaviour towards overweight (34%). CONCLUSIONS: In contemporary busy practice, family doctors seem to rely on their predominant nutrition communication style to deal with standard situations efficiently: for the majority, this proved to be the motivational nutrition communication style. Moreover, family doctors used a combination of styles. This study suggests that family doctors behave like chameleons, by adapting their style to the specific circumstances, like context, time and patient. If family doctors communicate about nutrition in general, they select any of the five nutrition communication styles. If they communicate about overweight, they pick either the confrontational or motivational style.

Adult↗
PubMed1994

Notification and follow-up of Pap test results: current practice and women's preferences.

BACKGROUND: This study aimed to determine women's knowledge of their Pap test results and predictors of accurate knowledge, adherence to follow-up recommendations for abnormal results, current methods of notifying women about their Pap test results, women's preferences for notification method, and women's satisfaction with the current notification system. METHOD: A telephone survey was undertaken of 315 women with a recent normal or abnormal Pap test result, drawn from pathology records in Sydney, Australia. RESULTS: Findings revealed that 61% of women with a normal result and 93% of women with an abnormal result self reported having been notified about their result. According to women's reports, 7% of those with abnormal results had not been notified and a further 11% of women with abnormal results were unaware that their result was abnormal, giving a total of 18% of abnormal results not communicated adequately to women. Self-reported adherence with follow-up recommendations among women with an abnormal result was less than optimal. The most common methods of notifying women of their results were initiated by the women such as the woman phoning the doctor or receptionist. However, women strongly preferred doctor-initiated methods, such as a written record from the doctor, the doctor phoning the woman, or consultation with the doctor. CONCLUSION: Results suggest that better methods of notifying and educating women about their Pap test results are necessary to improve women's knowledge and satisfaction and, even more importantly, to improve their level of adherence with follow-up recommendations for abnormal results.

Adult↗
PubMed2006

Treatment of lesions involving both the infratemporal fossa and middle skull base.

BACKGROUND: Communicating occupying lesions of the intratemporal fossa and mid-cranial fossa represent challenges for neurosurgeons and maxillofacial surgeons. Lesions of the skull base, with complex anatomy, are extremely varied in their histopathology. They often spread via normal anatomic pathways or bony destruction to involve adjacent structures, especially in the case of malignant neoplasms. However, with the development of operative skills and reconstruction techniques, total or near total resection of many such lesions can be accomplished with a low morbidity rate. METHODS: The combined frontotemporal-preauricular infratemporal approach, frontotemporal-orbitozygomatic approach, combined frontotemporal and transmandibular approach, transmandibular approach, and transmaxillary approach were used to resect the lesions using microsurgical skills. The plastic reconstruction included reconstruction of the dura defects, osteosynthesis, and obliteration of the operative cavity. RESULTS: Thirty-three patients with communicating lesions invading both the infratemporal fossa and the middle skull base underwent microsurgery. Among them, lesions were totally resected in 23, subtotally resected in 6, and partially resected in 4. In 29 patients, clinical status improved significantly. Complications were encountered in 7 cases, and morbidity was not remarkable. CONCLUSION: The surgical approach should be selected depending on the size, location, histopathology, and invading extension of the lesion, which can provide excellent visualization and allow for an aggressive and safe resection of lesions involving this region. Familiarity with skull base anatomy, careful microsurgical manipulation, protection of vital structures, reliable plastic reconstruction, intraoperative nerve monitoring, as well as consideration of functional and esthetic outcomes, will all contribute to successful surgery and satisfactory results.

Adolescent↗
PubMed1978

A simultaneous comparison of three methods for language training with an autistic child: an experimental single case analysis.

In a single-case, simultaneous-treatment design, three methods for experimental language acquisition in one autistic child were compared using a Latin square design and trend-line analysis. Results showed a total communication approach to be significantly superior to sign-based and verbalization approaches. The verbalization treatment resulted in decreased performance. Results indicate that use of a cross-modality inhibitory process to explain the alleged superiority of the sign-based approach is questionable. Variation among autistic children indicates a need for further research and for caution against premature acceptance of a given treatment approach or theoretical explanation.

Autistic Disorder↗
PubMed2006

Surgeon communication behaviors that lead patients to not recommend the surgeon to family members or friends: Analysis and impact.

BACKGROUND: This study analyzes specific elements of physician communication that lead patients to not recommend surgeons to family members or friends (FMoFs). METHODS: Patients completed questionnaires after surgery clinic encounters. Questionnaires addressed whether surgeons used optimal communication behaviors and whether patients would recommend the surgeon. RESULTS: A total of 1,514 questionnaires were completed for 39 surgeons. Patients reported the following communication lapses: failure to ask whether the patient had questions (6.9% of occasions), failure to sit down (6.5%), use of words patients could not understand (5%), failure to educate patients about their condition (4.3%), failure to introduce themselves (4%), lack of interest in patients as persons (2.4%), and inadequacies in answering questions (2%). Surgeons omitted at least one of these optimal behaviors in 16.3% of encounters. Surgeons were not recommended in 1.7% of encounters. Twelve surgeons (31%) were not recommended on at least 1 occasion. Behaviors omitted most commonly in encounters where patients wouldn't recommend surgeons included failure to show interest in the patient (52%), explain their medical condition (52%), invite questions (40%), and answer questions (36%). CONCLUSIONS: Extrapolating these results to 1,618 patient visits/surgeon/year, results in the following number of patients annually who do not recommend their surgeons: 15 for failure to adequately explain their medical condition, 15 for failure to show interest in them, 11 for failure to ask if the patient had questions, and 10 for failure to answer questions. Considering the ripple effect due to the number of a patient's FMoFs, surgeons should be aware of the significant impact of even occasional lapses in optimal communication behaviors.

Adolescent↗
PubMed2001

Oral manifestations of human immunodeficiency virus (HIV)-infected patients in Singapore.

INTRODUCTION: Oral lesions have been recognised as prominent features of acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection since the beginning of the epidemic. OBJECTIVE: This descriptive study was conducted to study the types of oral lesions among HIV-infected patients in Singapore. MATERIALS AND METHODS: Oral examination was done on 81 randomly selected HIV-infected patients attending the specialist outpatient clinic at the Communicable Disease Centre. RESULTS: A total of 9 different lesions were observed in 45 (56%) patients. The lesions observed were oral candidosis (35%), periodontal disease (16%), aphthous-like ulcers (5%), oral hairy leukoplakia (5%) and lymphoma (1%). CONCLUSION: The oral manifestations of HIV-infected patients in Singapore appear to be less frequent in comparison with those patients from Africa and Europe. Similarities in oral findings among the HIV-infected patients in Asia are evident with a notable lack of oral Kaposi's sarcoma (KS) and a low prevalence of non-Hodgkin's lymphoma and oral hairy leukoplakia.

Adult↗
PubMed1988

A nation-wide collaborative study on the long-term effects of bromocriptine in patients with Parkinson's disease. First interim report in Japan.

Two prospective projects were started in May 1985 to evaluate the long-term effects of bromocriptine in patients with Parkinson's disease. One of the projects is to see if combination therapy with levodopa and bromocriptine is superior to levodopa alone with regard to the prevention of late side effects of levodopa therapy. The other is to see the long-term effects of bromocriptine monotherapy. Patients with Parkinson's disease were allocated randomly to either combination or levodopa group in the first project. Parkinsonian symptoms, disabilities of daily life and severity of late side effects of long-term levodopa therapy were evaluated by a semiquantitative rating scale. This communication represents the first interim report. Methods of the studies and synopsis of the results at the end of the 12th month are described. A total of 702 patients was enrolled in the study (combination therapy, n = 216; levodopa therapy, n = 200, bromocriptine monotherapy, n = 286). At the end of the 12th month, the numbers of patients who dropped out from the study were 19, 16 and 55 in the three groups, respectively. It appears to be too early to make any definite conclusion with regard to which mode of treatment is superior, however, some evidence suggesting a superiority of the combination therapy over levodopa alone was noted in managing wearing-off phenomenon and dyskinesia. As many patients are sticking to the originally intended mode of treatment, it appears to be possible to obtain more meaningful data in several years.

Adult↗
PubMed2004

[Grammatical complexity and cohesion mechanisms in the communicative pragmatics of children with attention deficit hyperactivity disorder].

AIMS: The purpose of this study was to compare the grammatical structures and cohesion used in the narrative sequencing of real events by children with and without attention deficit hyperactivity disorder. SUBJECTS AND METHODS: A total of 27 children, between the ages of seven and eight, took part in the study; 15 of them had the combined subtype of ADHD and 12 participated as a control group. To obtain the narration the children were asked to talk about two real events they had experienced: 'What happened the last time you went to the doctor's?' and 'Have you ever been bitten by an insect?' An analysis of their narrations allowed us to obtain the following variables: the total number of communication units, their average length, the syntactic complexity index, the rate of lexical diversity, the lexical type referential cohesion procedures, the deictic and anaphoric grammatical procedures, the conjunctive procedures, discourse markers, changes of subject matter and dysfluency. RESULTS: Results show that there are significant differences between the two groups in the narrative cohesion indicators used, the group of normal children being those that were favoured by these differences. The most striking pragmatic peculiarities were difficulties in the use of conversational markers and the changes in the subject being discussed. CONCLUSIONS: The narratives of children with attention deficit hyperactivity disorder are more difficult to understand, which means that the listener has to adopt a more active role in order to make up for the missing information and has to infer a great deal more. This is an aspect that can have social implications and may make communication more difficult, especially with their peers, since these usually make less effort to understand the conversations than adults do.

Adult↗
PubMed2006

Household out-of-pocket payments for illness: evidence from Vietnam.

BACKGROUND: In Vietnam, illnesses create high out-of-pocket health care expenditures for households. In this study, the burden of illness in the Bavi district, Vietnam is measured based upon individual household health expenditures for communicable and non-communicable illnesses. The focus of the paper is on the relative effect of different illnesses on the total economic burden of health care on households in general and on households that have catastrophic health care spending in particular. METHODS: The study was performed by twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample--Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002. RESULTS: For the population in the Bavi district, communicable illnesses predominate among the episodes of illness and are the reason for most household health care expenditure. This is the case for almost all groups within the study and for the study population as a whole. However, communicable illnesses are more dominant in the poor population compared to the rich population, and are more dominant in households that have very large, or catastrophic, health care expenditure, compared to those without such expenditures. CONCLUSION: The main findings indicate that catastrophic health care spending for a household is not usually the result of one single disastrous event, but rather a series of events and is related more to "every-day illnesses" in a developing country context than to more spectacular events such as injuries or heart illnesses.

Catastrophic Illness↗
PubMed2002

[The analysis of medical-related cost for in-patients with injuries in Ningxia region].

OBJECTIVE: To understand socio-economic losses of inpatients and deaths caused by injuries in 2000 in Ningxia and to estimate their extent of harmfulness. METHODS: Eight of 35 local hospitals totaling 5 876 inpatients were recruited with two-stage sampling in Ningxia in 2000. All medical cost incurred during their hospitalizations for injuries, cardiovascular and cerebrovascular diseases, respiratory disease, cancer and communicable diseases, losses in labor time were analyzed, and years of potential life lost (YPLL), working years of potential lost (WYPLL), valued years of potential life lost (VYPLL) due to these diseases were estimated for the residents in Ningxia with corrected human capital method. RESULTS: The study showed that indirect economic losses due to hospitalization for injuries accounted for 24 million yuan, higher than those for other diseases. YPLL, WYPLL and VYPLL due to injuries were also higher than those in other diseases. CONCLUSIONS: Injury has caused serious threat to their health of the residents in Ningxia and brought heavy burden for the society and economy. It has become an important public health problem and its prevention and control should be strengthened as soon as possible.

Adolescent↗
PubMed2004

Patient-based outcome results from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice.

BACKGROUND: Shared decision-making (SDM) between professionals and patients is increasingly advocated from ethical principles. Some data are accruing about the effects of such approaches on health or other patient-based outcomes. These effects often vary substantially between studies. OBJECTIVE: Our aim was to evaluate the effects of training GPs in SDM, and the use of simple risk communication aids in general practice, on patient-based outcomes. METHODS: A cluster randomized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practices in Gwent, South Wales. A total of 747 patients with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments. After baseline, participating doctors were randomized to receive training in (i) SDM skills; or (ii) the use of simple risk communication aids, using simulated patients. The alternative training was then provided for the final study phase. Patients were randomly allocated to a consultation during baseline or intervention 1 (SDM or risk communication aids) or intervention 2 phases. A randomly selected half of the consultations took place in 'research clinics' to evaluate the effects of more time for consultations, compared with usual surgery time. Patient-based outcomes were assessed at exit from consultation and 1 month follow-up. These were: COMRADE instrument (principal measures; subscales of risk communication and confidence in decision), and a range of secondary measures (anxiety, patient enablement, intention to adhere to chosen treatment, satisfaction with decision, support in decision making and SF-12 health status measure). Multilevel modelling was carried out with outcome score as the dependent variable, and follow-up point (i.e. exit or 1 month later for each patient), patient and doctor levels of explanatory variables. RESULTS: No statistically significant changes in patient-based outcomes due to the training interventions were found: COMRADE risk communication score increased 0.7 [95% confidence interval (CI) -0.92 to 2.32] after risk communication training and 0.9 (95% CI -0.89 to 2.35) after SDM training; and COMRADE satisfaction with communication score increased by 1.0 (95% CI -1.1 to 3.1) after risk communication, and decreased by 0.6 (95% CI 2.7 to -1.5) after SDM training. Patients' confidence in the decision (2.1 increase, 95% CI 0.7-3.5, P < 0.01) and expectation to adhere to chosen treatments (0.7 increase, 95% CI 0.04-1.36, P < 0.05) were significantly greater among patients seen in the research clinics (when more time was available) compared with usual surgery time. Most outcomes deteriorated between exit and 1 month later. There was no interaction between intervention effects. CONCLUSION: Patients can be more involved in treatment decisions, and risks and benefits of treatment options can be explained in more detail, without adversely affecting patient-based outcomes. SDM and risk communication may be advocated from values and ethical principles even without evidence of health gain or improvement in patient-based outcomes, but the resources required to enhance these professional skills must also be taken into consideration. These data also indicate the benefits of extra consultation time.

Adult↗
PubMed2002

Primary care resident, faculty, and patient views of barriers to cultural competence, and the skills needed to overcome them.

INTRODUCTION: Primary care residencies are expected to provide training in cultural competence. However, we have insufficient information about the perceptions of stakeholders actually involved in healthcare (i.e. residents, faculty and patients) regarding commonly encountered cross-cultural barriers and the skills required to overcome them. METHOD: This study used a total of 10 focus groups to explore resident, faculty and patient attitudes and beliefs about what culturally competent doctor-patient communication means, what obstacles impede or prevent culturally competent communication, and what kinds of skills are helpful in achieving cultural competence. A content analysis was performed to identify major themes. RESULTS: Residents and faculty defined culturally competent communication in terms of both generic and culture-specific elements, however, patients tended to emphasize only generic attitudes and skills. Residents and patients were liable to blame each other in explaining barriers; faculty were more likely to consider systemic influences contributing to resident-patient difficulties. All groups emphasized appropriate skill and attitude development in learners as the key to successful communication. However, residents were sceptical of sensitivity and communication skills training, and worried that didactic presentations would result in cultural stereotyping. DISCUSSION: All stakeholders recognized the importance of effective doctor-patient communication. Of concern was the tendency of various stakeholders to engage in person-blame models.

Clinical Competence↗
PubMed2003

Identification of communicating branches among the dorsal, perineal and cavernous nerves of the penis.

PURPOSE: The mechanism of human erection requires the coordination of an intact neuronal system that includes the cavernous, perineal, and dorsal nerves of the penis. We defined the communication of these 3 nerves that travel under the pubic arch using specific neuronal immunohistochemical staining and 3-dimensional reconstruction imaging technique. MATERIALS AND METHODS: A total of 18 normal human fetal penile specimens at 17.5 to 32 weeks of gestation were studied by immunohistochemical techniques. Serial sections were stained with antibodies raised against the neuronal markers S-100, and neuronal nitric oxide synthase (nNOS), vesicular acetylcholine transporter (VAChT), calcitonin gene-related peptide and substance P. RESULTS: The continuation of the dorsal neurovascular bundle of the prostate was documented under the pubic arch. Two distinct nerve bundles were identified superior to the urethra and medial to the origin of the crural bodies. Nerve bundles were observed to join the corporeal bodies at the penile hilum. Proximal to the penile hilum the dorsal nerves stained only for S-100 and VAChT. From the junction of the crural bodies at the hilum to the glans penis dorsal nerve fibers stained positive for S-100, VAChT and nNOS. Calcitonin gene-related peptide and substance P demonstrated positive staining at the distal nerves, particularly at the glans. In contrast, the whole course of the cavernous nerve stained for S-100 and nNOS. Under the pubic arch at the penile hilum the cavernous nerves were found to convey nNOS positive branches to the dorsal nerve to transform its immunoreactivity to nNOS positive. Proximal nNOS negative perineal nerves were shown to stain positive for nNOS distal on the penis. Interaction between nNOS positive dorsal nerve branches and perineal nerves was at the cavernous-spongiosal junction, where the bulbospongiosus muscle terminates. CONCLUSIONS: At penile hilum, where the corporeal bodies start to separate, the cavernous nerve sends nNOS positive fibers to join the dorsal nerve of the penis, thereby, changing the functional characteristics of the distal penile dorsal nerve. Similarly the nNOS negative, ventrally located perineal nerve originating from the pudendal nerve becomes nNOS reactive at the cavernous-spongiosal junction. These 2 examples of redundant neuronal wiring in the penis may impact erectile function, especially during reconstructive surgery.

Calcitonin Gene-Related Peptide↗