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PubMed1992

Polysaccharide encapsulated bacterial infection in sickle cell anemia: a thirty year epidemiologic experience.

Annual age-specific incidence rates of Streptococcus pneumoniae or Haemophilus influenzae bacterial septicemia in sickle cell anemia (SS) were determined for the years of 1957 through 1989. Forty-nine patients had 64 episodes of septicemia among a population of 786 SS patients observed for 8,138 person-years. Peak frequency of infection occurred between 1968-1971 and 1975-1981 with a conspicuous absence of episodes in 1972, 1973, 1982-1984, and 1986-1987, thus demonstrating cycles of high and low attack rates. The annual age-specific incidence rate of septicemia varied from 64.5 (1965) to 421.1 (1980) per 1,000 person-years for those under 2 years of age and never exceeded 10.2 per 1,000 in those over 4 years of age. Following the introduction of pneumococcal polyvalent vaccine in 1978, incidence of infection decreased in SS children greater than 2 years of age. No modification of the risk of infection was observed in immunized children less than 2 years of age. During these three decades, there has been a ten-fold increase in the number of SS adults over 20 years of age. The relative risk of chronic sickle complications comparing the survivors of septicemia to the non-infected patients was: subsequent death 1.76, retinopathy 4.06, avascular necrosis 1.95, symptomatic cholelithiasis 1.33, stroke 1.30, and priapism 1.26. These data suggest that prognosis for lifetime severe SS is initially manifested as an increased risk of septicemia during childhood.

Adolescent↗
PubMed1992

Moxisylyte plasma kinetics in humans after intracavernous administration.

Obtaining and sustaining an erection are common problems for the male spinal cord injury patient. Intracavernous injection of vasoactive substances offers a new treatment option but it must be approached with caution in this population. In this work, the use of an alpha-adrenergic blocking agent, moxisylyte, after intracavernous administration for complete paraplegic patients with erectile impotence is described. During this study, the pharmacokinetic profile of moxisylyte has been defined. Unchanged moxisylyte is not found in plasma, this drug is immediately metabolized after administration. Three metabolites were found in plasma: desacetylmoxisylyte (DAM), conjugated DAM, and conjugates of desmethylated DAM (MDAM). Maximum plasma levels of 72.3 ng ml-1, 301.4 ng ml-1, and 88.8 ng ml-1 are obtained 0.22 h, 0.9 h, and 2.08 h after drug administration for these three metabolites, respectively. The elimination half-lives are 0.89 h, 2.16 h, and 5.32 h and the MRT, 1.38 h, 3.23 h, and 8.45 h, respectively. No side-effects were noted, only one patient presented sleepiness. Successful erections (10 to 25 min) were obtained in all patients and no priapism was noted.

Adult↗
PubMed1977

Aortocaval fistula as a complication of leaking aortic aneurysm.

The successful management of 2 patients is reported, each involving the closure of a fistula into the inferior vena cava as a sequel to the rupture of an atherosclerotic aortic aneurysm. It is an uncommon complication which should be suspected in the presence of an aortic aneurysm with a loud machinery bruit. Associated peripheral cyanosis and venous pulsation in the accessible proximal veins of the lower extremity and priapism afford strong supporting evidence.

Aged↗
PubMed2003

Fine-needle aspiration of secondary malignancies of the penis: a report of three cases.

Metastatic malignancy to the penis is an uncommon clinicopathologic entity, with only 300 cases reported since 1870. Of the reported cases, 75% were secondary to genitourinary primary tumors. Priapism is the most frequent symptom, although dysuria, ulceration, and node formation have also been described. We report three cases of penile metastatic involvement from primary tumors in the urinary bladder (two cases) and prostate (one case), respectively. Fine-needle aspiration (FNA) cytology from the penile nodules was performed in each case. The smears in all cases were highly cellular, and atypical neoplastic cells were observed singly, in clusters, or in papillary formations. The cells were pleomorphic with hyperchromatic nuclei and prominent nucleoli. Immunocytochemistry was performed for keratin 8 and 18 and prostatic-specific antigen (PSA). In conclusion, although it has rarely been used as a diagnostic tool, FNA of the penis can be proved effective and safe in diagnosing a suspected secondary malignancy.

Aged↗
PubMedDate not supplied

Second generation antidepressants: a comparative review.

The authors review four "second generation" antidepressants (maprotiline, amoxapine, trazodone, and nomifensine) in terms of action on biogenic amines and receptors, antidepressive efficacy, and adverse effects. Doxepin is used as a comparative agent and is similar to the prototypical tricyclic agents in all the above categories. Maprotiline is a selective noradrenergic agent, but shares a similar adverse effect profile with doxepin and may be associated with a high frequency of seizures in overdose. Amoxapine is a mixed action antidepressant with significant neuroleptic activity in vivo. Its adverse effect profile is highlighted by symptoms related to its neuroleptic activity, and seizures and acute renal failure in overdose. Trazodone is a selective serotonergic agent with low anticholinergic activity, and minimal morbidity/mortality in overdose. Reports of priapism, leading to impotence in some men, however, is of concern. Nomifensine is a potent noradrenergic and dopaminergic agent with low anticholinergic activity, and minimum cardiotoxicity and low morbidity/mortality in overdose. Its most important adverse effects include overstimulation and infrequent, usually reversible, immunologic hypersensitivity reactions. Trazodone and nomifensine have favorable profiles for use in the elderly. Trazodone may be more favorable in the anxious/agitated patient due to its sedative effects, whereas nomifensine may be more beneficial in the retarded, apathetic patient.

Aged↗
PubMed1988

Microsurgical arterialization for vascular impotence.

Out of 400 patients with erectile lesions, Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavernosometry showed a concomitant increase of venous drainage in 38 of them. Phalloarteriography in 22 males demonstrated an occlusion of the interna pudendal artery in 21. In 15 patients penile arterialization was done by interposition of a saphenous vein-graft between the iliac artery and the deep dorsal penile vein. In four of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively, two of three of the patients are doing well. Failures in five included four diabetic neurovascular lesions and one postoperative priapism.

Arteries↗
PubMed1988

Overview of USA controlled trials of trazodone in clinical depression.

Trazodone's unique chemical structure reflects its distinct pharmacologic profile. Its antidepressant efficacy is postulated to occur through serotonin reuptake inhibition. It has little effect on other neurotransmitter systems. In the United States it has been studied in several double-blind trials which compared it to standard antidepressants and placebo. Both in- and outpatients spanning a spectrum of age and diagnoses have been studied. Trazodone has been shown to be at least as effective as standard antidepressants. There are few anticholinergic or cardiovascular side effects. Adverse reactions include drowsiness, dizziness, headache, nausea and rarely, priapism. It is relatively safe in overdose. Trazodone deserves special consideration in the treatment of patients with depression accompanied by marked agitation, anxiety, and insomnia, as well as those unable to tolerate anticholinergic side effects.

Clinical Trials as Topic↗
PubMed1980

Continuous-access phencyclidine self-administration by rhesus monkeys leading to physical dependence.

IV phencyclidine (PCP) self-administration was studied in five rhesus monkeys. The animals were given 23 h per day access with each respose producing an injection. For the first seven sessions saline was made contingent on responding. For the next 30 sessions responses produced 0.01 mg/kg PCP and for the next 20 sessions responses produced 0.05 mg/kg PCP. Withdrawal signs and symptoms were evaluated every 4 h during the subsequent saline-access period. All animals responded for 0.01 mg/kg injections at rates higher than their initial saline rates. Response rates decreased but total PCP intake increased during access to the higher dose. The levels of PCP self-administered resulted in severe intoxication. Evidence for physical dependence development was obtained. The symptoms emerged within 4--8 h after access was terminated, peaked at 12--16 h, and subsided by 24--48 h. The syndrome could be reversed by IV PCP administration. The most common symptoms were vocalizations, hyperresponsivity, bruxism, oculomotor hyperactivity, and diarrhea. During withdrawal the animals refused preferred food. In some of the animals piloerection, tremors, ear and facial twitches, and priapism occurred. Rhythmic abdominal contractions and emesis were seen in one subject and convulsive activity was seen in one subject.

Animals↗
PubMed1997

External vacuum therapy for erectile dysfunction: use and results.

This review assesses the continuing role of noninvasive vacuum therapy as treatment for erectile dysfunction and discusses the action of negative pressure in producing assisted erection. Through recent research in this area has centered on the development of pharmaceutical therapies, vacuum-therapy programs appear to be a consistent long-term option for patients experiencing either chronic or occasional impotence of any etiology. Very little testing is required before the initiation of vacuum treatment, and the overall; clinical success rate is approximately 90%. Significant success has been reported in more difficult patient populations, including those with veno-occlusive disorders and explanted penile prostheses. Vacuum therapy may also be used in conjunction with other therapies to enhance results. Contraindications to the use of vacuum therapy are few and primarily include patients with unexplained intermittent priapism and bleeding disorders. Side effects such as occasional numbness, pain, penile bruising, or petechiae have a low incidence. A recently reported survey of 5,847 vacuum users showed that 83.5% of patients continue to use the device for intercourse as desired. Patients should receive individual instruction in the use of these devices and should expect a learning or practice period to achieve optimal results. As newer treatments for erectile dysfunction gain increasing attention, it should be kept in mind that nearly every patient showing impotence of any degree or duration as well as patients who have failed other therapeutic choices are candidates for vacuum therapy.

Erectile Dysfunction↗
PubMed1993

Complications of rubber band ligation of symptomatic internal hemorrhoids.

In a prospective study, 512 patients undergoing hemorrhoidal band ligation over a seven-year period were followed up to focus on complications. Thirteen patients (2.5 percent) were hospitalized: six with delayed massive rectal bleeding, three with urinary retention, pain, and fever (one developed perianal abscess), and three others with severe pain due to prolapsed thrombotic hemorrhoids (one developed difficulty in urination). One patient developed perianal abscess and perianal fistula two months after ligation. Twenty-four patients (4.6 percent) suffered from minor complications: 11 patients had painful thrombosed hemorrhoids; five experienced slippage of bands; three had mild bleeding; two developed band-related mucosal ulcer; one experienced each time, after two subsequent ligations, priapism lasting several hours; and difficulty in urination and tender induration above the dentate line occurred in two other patients. Rubber band ligation is, in effect, a miniature hemorrhoidectomy and has been considered, until recent reports of fatalities associated with this procedure, as an effective, safe, and efficient method of treating symptomatic second-degree and third-degree hemorrhoids. We conclude that the ability to handle complications that occur secondary to the rubber band ligation and, thereby, prevent sepsis and the low rate of major complications in our study justify reliance on this method of treating symptomatic hemorrhoids.

Female↗
PubMed1998

Comparison of Alprostadil (Caverject) and a combination of vasoactive drugs as local injections for the treatment of erectile dysfunction.

The efficiency and side effects of a single dose of 20 mcg of intracorporeally applied Alprostadil (Caverject, Upjohn), a prostaglandin E1, in inducing penile erection were examined in 30 patients. In addition, the effect of this dose of prostaglandin E1 was compared to that of 30 mg of papaverine plus 0.5 mg of regitine (phentolamine). All patients received a first injection of the combination of the vasoactive drugs and a second injection of the prescribed dose of Caverject. The degree of erection, time interval between injections and achievement of full erection as well as side effects during and after injection were compared. All patients had a burning sensation during the injection of Caverject. Two patients given the vasoactive combination got priapism and were evacuated; this complication was not reported for Caverject. In the doses used Caverject was superior to papaverine plus phentolamine in inducing penile erection and in achieving a higher grade of erection.

Alprostadil↗
PubMed1998

[Transurethral alprostadil administration with MUSE ("Medicated Urethral System for Erection"). Current overview and personal experiences].

An analysis of the presently available results concerning transurethral application of Alprostadil with MUSE (Medicated Urethral System for Erection) up to 1000 micrograms indicates a 20-30% lower efficacy if compared to 20 micrograms i.c. injected Alprostadil. Whereas in prospective home-treatment trials only each second MUSE-application was successful in responders 87%-94% of the administrations in self-injection therapy resulted in successful coitus. In an own comparative trial in 73 pts the success rates after MUSE up to 1000 micrograms were 48% compared to 71% after i.c. Alprostadil. Reported side-effects of MUSE in the literature were: Hypotension 3-8%, syncopes 0.4%, penile/urethral pain 29%, urethral bleeding 5%, vaginal irritations 3%, priapisms < 0.1%. After MUSE-applikation the average Alprostadil contents of the ejaculate increased 40%. Whereas in prospective long-term studies of self-injection therapy with Alprostadil the risk of persistent fibrotic alterations of the penis varied between 5-7%, the risk of penile fibrosis after MUSE can not be finally estimated. Also the potential risk for urethral strictures after MUSE is presently not foreseable. The advantage of the technically easy use in confronted with a considerably lower efficacy. Therefore self-injection therapy must be further on considered the "golden standard" in Alprostadil administration.

Alprostadil↗
PubMed2003

Pseudoaneurysm of the bulbourethral branch of the internal pudendal artery presenting as a urethral pseudodiverticulum in a child.

Pseudoaneurysm of the internal pudendal artery or its branches is a rare complication of pelvic trauma. It generally causes arteriocavernosal fistula leading to priapism. Connection between the urethra and the pseudoaneurysm has been documented in a few cases; however, pseudoaneurysm causing a urethral pseudodiverticulum has not been reported. We report a 7-year-old boy with a pseudoaneurysm of the bulbourethral branch of the left internal pudendal artery leading to a urethral pseudodiverticulum.

Aneurysm, False↗
PubMed2005

Adult surgical emergencies in a developing country: the experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.

The goal of this study was to examine the adult surgical emergencies seen at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, with a view to proffering preventive solutions where appropriate and improving outcome. From the register of patients seen at the Casualty department and from the operations register in the main operation room of NAUTH, names and hospital numbers of adult patients treated as emergencies over a 5-year period, from 7 September 1998 to 6 September 2003, were obtained. The hospital folders were then retrieved from the Records Department. From each folder, the following details about each patient were extracted: age, sex, diagnosis at presentation, causative factors, treatment given, and outcome. A total of 902 adult patients were treated during the period. The commonest emergency operation was appendectomy for acute appendicitis in 139 patients (97 women and 42 men), followed closely by road traffic accidents (RTAs) involving 137 patients (103 men and 34 women). Gunshot injuries, which resulted mainly from armed robbery attacks, accounted for 127 cases. More men (113) sustained gunshot injuries than women (14). Of the 92 cases of acute intestinal obstruction seen, 62 occurred in women and 30 in men. Some 126 men presented with acute urinary retention, and two others presented with priapism. Governments at various levels should provide modern diagnostic tools for the accurate preoperative diagnosis of surgical emergencies in hospitals. Governments should also inculcate strict discipline into drivers using the highways, particularly in relation to abuse of alcohol and drugs. Good roads and adequate security should be provided for the people. The need for Pre-Hospital Care for the efficient evacuation of accident victims is emphasized. These measures will help to improve the management and outcome of surgical emergencies, and decrease the number of surgical emergencies resulting from RTAs and gunshot wounds.

Adolescent↗
PubMed1998

Tricyclic antidepressants in adolescent depression. A case report.

A boy aged 11 years 11 months, with normal premorbid personality, presented with a severe depressive episode with somatic and psychotic features. A clinical response to amitriptyline was complicated by ECG changes leading to the abrupt withdrawal of amitriptyline, with the development of a withdrawal syndrome. Further trials of antidepressant medication were unsuccessful, including paroxetine (clinical deterioration), lofepramine (ECG changes and clinical deterioration), and trazodone (priapism). Finally, a good clinical response to dothiepin augmented with lithium was achieved. ECG changes were assessed as being idiosyncratic responses to medication, rather than ischaemic in nature. A dose/response relationship with dothiepin was observed. All medication was successfully stopped after 26 months of treatment. Clinical phenomena relevant to the development of guidelines for use of tricyclic antidepressants in childhood and adolescence are discussed.

Amitriptyline↗
PubMed1993

Identification of a new vascular smooth muscle contracting polypeptide in Phoneutria nigriventer spider venom.

The fractionation of Phoneutria nigriventer spider venom by gel filtration (Sephadex G-10-120) followed by ion-exchange chromatography (microgranular CM-cellulose-52) resulted in sixteen fractions (CI to CXVI) from which CVII+VIII, CIX and CX+XI caused dose-dependent and short-lived contractions of both arterial and venous rabbit vessels. Fraction CX+XI was further purified by a reverse phase HPLC, and a contractile polypeptide (PNV2) was isolated. The amino terminal sequence of PNV2 (LAKRADICQPGKTSQRACET) indicated that it represents a pure polypeptide consisting of a single chain. Furthermore, the amino acid analysis of PNV2 revealed the presence of four disulfide bridges, a high content in Lys (14%), Glx (11%), and the absence of His. The global amino acid composition showed that this polypeptide is composed of 102 residues (Trp not included) with a calculated molecular weight of 12,114. Whether this peptide is responsible for the vascular alterations observed in Phoneutria envenomation, such as lung edema and priapism, remains to be further investigated.

Amino Acid Sequence↗
PubMed1988

Spinal subarachnoid injection of somatostatin causes neurological deficits and neuronal injury in rats.

The tetradecapeptide somatostatin produced dose-related neurological deficits following subarachnoid injection in the lumbar spinal cords of rats. Lower pharmacological doses (1.6 and 3.1 nmol, i.t.) of somatostatin caused only transient deficits, while higher doses (6.2-25 nmol, i.t.) caused persistent deficits characterized by motor and sensory impairments in hindlimbs and tail, hindlimb edema, priapism, bladder atony with infarction, and urinary incontinence. Pretreatment with 0.3 nmol of the somatostatin receptor antagonist cyclo[7-aminoheptanoyl-Phe-D-Trp-Lys-Thr(Bzl)] blocked the hindlimb paralytic effects of 3.1 and 6.2 nmol of somatostatin, and significantly improved neurological recovery injection of 12.5 nmol of somatostatin. Higher doses of the antagonist produced hindlimb paralysis by itself. Neuroanatomical evaluations revealed extensive cell loss and necrosis in the lumbosacral spinal cords of rats paralyzed by 25 nmol of somatostatin. Collectively, these results suggest that through interactions with a receptor, somatostatin destroys neurons involved in diverse spinal cord functions.

Animals↗