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PubMed2005

[Therapy for organic erectile dysfunction].

Erectile dysfunction is a common disease of men. It is associated with various comorbidities and has a prevalence of about 50% in the 7th decade. Erectile dysfunction often affects the quality of life of the patient and his partner, and it is very important to offer adequate therapy that respects the individual circumstances of each patient. The mandatory diagnostic work-up includes a medical and psychosexual history, a physical examination and routine laboratory tests. Besides psychotherapy, oral pharmacotherapy with oral PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) is the most effective therapy for erectile dysfunction and is superior to centrally acting drugs (yohimbine). In cases of failure or contraindication of oral pharmacotherapy, local pharmacotherapy is the second-line therapy. The third-line options are vacuum erectile devices and penile implants, and these have a high patient satisfaction. New therapeutic strategies such as anti-serotoninergic substrates and growth hormone offer a promising future for the therapy of erectile dysfunction but remain to be evaluated.

Erectile Dysfunction↗
PubMed2000

Heparin-Induced thrombocytopenia: minimising the risks in the elderly patient.

Heparin therapy may sometimes be seriously complicated by heparin-induced thrombocytopenia (HIT). Heparin use for treatment and prevention of thromboembolism is more common in the elderly and that may be the reason why HIT is reported more frequently in this group of patients. The first approach in the management of HIT is awareness of this disorder. The morbidity and mortality associated with HIT may be reduced by avoiding unnecessary heparin exposure, by reducing the duration of heparinisation and by using low molecular weight heparins rather than unfractionated heparin. A decrease from baseline values of at least 30% in the platelet count, any unexplained thrombotic event and the finding of a white clot at thrombectomy are clinical warning signs that should alert physicians to a possible diagnosis of HIT. Indeed, early clinical recognition of HIT may sometimes prevent the severe complications associated with this disorder. Objective confirmation of the diagnosis of HIT is difficult because none of the available biological tests possess 100% sensitivity or 100% specificity. It is, however, possible to optimise the performances of the functional assay, mainly the platelet aggregation test (PAT), by following the manoeuvres described by differ- ent investigators. The use of 2 classes of assay (functional and antigen assays) and repeat testing on another day can avoid misdiagnosis of HIT. An alternative parenteral anticoagulant treatment is most often mandatory after heparin withdrawal. Danaparoid sodium and lepirudin are 2 drugs that are currently available for the treatment of HIT, and the efficacy of argatroban needs to be confirmed in greater numbers of patients with HIT. The use of these drugs has contributed to the reduction in the mortality and morbidity associated with HIT.

Aged↗
PubMed1984

Evaluation of history and simple supine cystometry as a preoperative test in stress urinary incontinence.

In a follow-up study the accuracy of a simple preoperative screening including history, Bonney 's test and supine cystometry was evaluated in patients with stress urinary incontinence. Based upon preoperative history alone, the patients were divided into two different groups, pure stress incontinence, and mixed stress and urge incontinence. All patients accepted had a normal supine cystometry at the preoperative work-up. The results of the operation were good in pure stress incontinence. In patients with mixed stress and urge incontinence the results were unsatisfactory and most of them presented a variety of urodynamic abnormalities postoperatively. Thus, in patients with pure stress incontinence, acceptance for surgery may be based upon a careful history, a simple supine cystometry and Bonney 's test, but in patients with mixed stress and urge incontinence a comprehensive clinical and urodynamic evaluation is mandatory. It seems that combination of detrusor instability and a history of pronounced urgency preoperatively calls for other therapeutic alternatives than operation.

Adult↗
PubMed2003

Role and levels of real-time monitoring for successful anti-fouling strategies--an overview.

Biofouling is a biofilm problem and any anti-fouling strategy will be greatly improved if the site and extent of biofilm growth can be monitored. A suitable monitoring system will provide early warning capacity and allow for specific optimization of countermeasures. As water samples do not give reliable information about biofilms, surface sampling is mandatory. Conventional biofilm monitoring techniques rely on removal of material from representative sites or on analysis of test surfaces which have been exposed. This procedure is time consuming and, depending on the parameters to be measured, requires skilled laboratory personnel. There is a strong demand for direct, on-line, in situ, continuous, non-destructive real-time information about biofilms in a system. Such demands can only be fulfilled by physical or physico-chemical methods, a number of which have already been successfully applied for biofilm monitoring. It is important, however, to be aware of the actual parameter they refer to in order to interpret the data properly. Three levels of information can be identified: (i) systems which detect increase and decrease of material accumulating on a surface but cannot differentiate between biomass and other components of a deposit, (ii) systems which provide biological information and distinguish between biotic and abiotic material, and (iii) systems which provide detailed chemical information. Examples for all three levels are presented and discussed.

Bacteria↗
PubMed2003

Maternal views and acceptance of antenatal HIV screening in a university teaching hospital in Hong Kong.

OBJECTIVE: To assess maternal acceptance, knowledge, attitude, perceived risks and barriers toward antenatal HIV screening. STUDY DESIGN: Prospective anonymous survey of 1,519 pregnant women recruited in a university teaching hospital RESULTS: Women demonstrated fairly good knowledge of and a positive attitude toward HIV screening. Condom usage was 61.4%, and 25.3% of women had at least 1 risk factor for HIV infection. Support for mandatory and universal screening was 31.4% and 48.8%, respectively. A total of 82.6% women agreed to HIV testing. The major reason for declining the test was that women considered themselves to be at low risk (84.3%). Women with risk factors tended to prefer more aggressive methods of antenatal testing (P < .001) and more readily accepted HIV screening (89.8% vs. 73.1%, P < .001). CONCLUSION: Given the high acceptance rate in our local population, universal offering but voluntary testing is the optimal mode of antenatal HIV screening in Hong Kong.

Adult↗
PubMed2004

Anaphylaxis during anaesthesia: diagnosis and treatment.

Anaphylactic and anaphylactoid reactions during anaesthesia are rare, but potentially life-threatening allergic events. The worst manifestations are cardiovascular collapse, bronchospasm and laryngeal oedema. Anaphylactic and anaphylactoid reactions are clinically indistinguishable. The most incriminated agents are neuromuscular blocking drugs and latex. Treatment consists of instant interruption of contact with possible antigens, 100% oxygen, intubation, adrenaline and volume expansion. The incidence of cross-reactivity between neuromuscular blocking drugs is high. Further investigation of a suspected anaphylactic reaction is mandatory to find the responsible drug and to make future anaesthesia safe. Diagnosis is made with intraoperative tests (serum histamine and mast cell tryptase) and postoperative tests (skin tests and RASTs for specific IgE antibodies).

Adrenergic Agonists↗
PubMed1983

Durability of carotid endarterectomy.

Carotid endarterectomy is the preferred treatment for patients with transient ischemic attacks and carotid stenosis. Although clinically these patients do well, the long-term fate of the operated carotid artery has not been well documented. To address this question, repeated noninvasive testing has been employed to follow our carotid endarterectomy patients since 1976. Supraorbital Doppler examination, oculoplethysmography-Kartchner, carotid phonoangiography and, later in this series, spectral analysis of the carotid Doppler velocities were performed after 193 endarterectomies. One hundred fifty-eight patients were initially tested within 3 months of operation, and 35 were initially tested 3 or more months after operation. Twenty-four arteries, four of which were symptomatic, had an initial abnormal test and are excluded from this study of carotid artery durability. Of the 169 patients with normal carotid tests, 36 had no further evaluation. Among the 133 patients who returned for serial testing from 1 to 60 months (mean 20 months), 115 carotid arteries continued to test normal at late follow-up but 18 subsequently developed test abnormalities. Ten had more than 75% stenosis, eight had 50% to 75% stenosis. Eight of these patients had contrast studies: three had normal findings; the five that had abnormal findings underwent reoperation. Interestingly, only two patients presented with symptoms appropriate to the abnormal test. The findings suggest that carotid endarterectomy is a reasonably durable operation. Recurrent stenosis was presumed or proven in 10% of 133 serially tested carotid arteries. This threat of restenosis makes long-term follow-up of these patients mandatory.

Arterial Occlusive Diseases↗
PubMed2005

Evaluation of the mandatory child abuse course for physicians: do we need to repeat it?

INTRODUCTION: Child abuse is one of the most common disorders affecting children of all ages. The objective of this study was to measure and assess the effectiveness of the mandated New York State child abuse and maltreatment course, and to identify and define the need for a refresher course. METHODS: This study was conducted in two parts. Part 1 consisted of a web-based survey among the paediatric members of 'Physicians Online' in New York State, and Part 2 consisted of an anonymous questionnaire survey using conventional US mail among the registered physicians in New York State who took the mandatory 'Recognition of Child Abuse and Maltreatment Course' between January 1988 and December 1998. The questionnaire included demographic information, test questions, and opinions of the physicians regarding the need for a refresher course. RESULTS: The web survey yielded 239/664 (36%) responses in 1 week. Approximately 45% of the respondents agreed that participation in the course produced a significant difference in their knowledge base and recommended that the course should be repeated every 5 years. The response rate for the mail survey was 56% (424/756). Among the respondents, 88% agreed that participation in the course produced an increased source of knowledge and practice (mean score of 3.2 +/- 1.2 using a scale of 1-5; where 1 = disagree and 5 = agree). The time since the course was taken (1-5 years vs >5 years ago) did not significantly influence their responses. Although 84% of the respondents answered the test questions correctly, significant differences were noted across practice specialty (P<0.05). In response to the question regarding the necessity for a refresher course, the mean score was 2.55 +/- 1.6 using a linear scale of 0-5 (where 0 = strongly disagree and 5 = strongly agree). CONCLUSIONS: These data suggest that practice specialty, not the time since the course was taken, made a significant difference in the knowledge of recognition and reporting of child abuse.

Adolescent↗
PubMed1998

Functional evaluation techniques in mitochondrial disorders.

Most of the mitochondrial disorders affect the brain and muscle metabolism with variable degrees of impairment. The diagnostic usefulness of the following physiological and imaging methods, which also offer functional information that can be used for follow-up, is critically assessed: lactate levels, exercise testing, phosphorus magnetic resonance spectroscopy (MRS), proton MRS, functional magnetic resonance imaging, positron emission tomography, optical tissue oximetry and single photon emission tomography. Knowledge of the advantages, shortcomings and results of each method in the evaluation of mitochondrial diseases is mandatory before they can be applied to other disorders with suspected oxidative impairment.

Evaluation Studies as Topic↗
PubMed1992

[Does isolated TSH elevation need treatment? Study of risk factors for the development of manifest hypothyroidism].

Isolated elevations of basal TSH levels are frequently observed in the general population. In a prospective study we analyzed the spontaneous evolution of thyroid function over time in such patients. The mean observation period was 5.4 (0.5-12) years. During the follow-up period 20% of these patients developed overt hypothyroidism. The risk of developing hypothyroidism was determined primarily by the initial TSH value and an additive effect was found for the thyroid antibodies and the thyroidal reserve (delta-T3) after TRH stimulation (Cox proportional hazard model). The cumulative risk for overt hypothyroidism after 10 years was only 22% for a mean TSH level of 12 mU/l for patients with negative thyroid antibodies and a good thyroidal reserve (low-risk), but increased to 63% for patients with positive antibodies and impaired T3 reserve (high-risk). Therefore, patients with isolated elevation of TSH can be divided into two subgroups according to the results of TSH, antibody status and T3 reserve: (1) In the "low-risk group" with good prognostic factors the patients should be followed up by periodic laboratory testing only (TSH, FT4, every 2-3 years). (2) In the "high-risk group" with clearly abnormal parameters, however, frequent controls are mandatory (every 6-12 months) or treatment with thyroxine may be indicated.

Adult↗
PubMed2006

Nonclinical toxicology study of recombinant-plasmid DNA anti-rabies vaccines.

The absence of standard guidelines from National and International regulatory agencies for the safety evaluation of biotechnology products challenges the ingenuity of toxicologists. At present, the development of standard pre-clinical toxicology protocols for such products is on an individual case basis. The present investigation is an attempt to evaluate the safety profile of the first indigenously developed DNA based anti-rabies vaccine in India. The test compounds were DNA rabies vaccine [DRV (100 microg)] and combination rabies vaccine (CRV (100 microg DRV and 1/50 dose of cell culture vaccine)), intended for clinical use by intramuscular route on 1, 7, 14 and 28 day. As per the regular mandatory requirements, the study has been designed to undertake acute (single dose--10 days), sub-chronic (repeat dose--28 days) and chronic (intended clinical dose--120 days) toxicity tests using three dose levels viz. therapeutic, average (2 x therapeutic dose) and highest dose (10 x therapeutic dose) exposure in Swiss Albino mice. The selection of the rodent model viz. Swiss Albino mice is based on affinity and rapid higher antibody response during the efficacy studies. Apart from physical, physiological, clinical, hematological and histopathology profiles of all target organs, the tier-I immunotoxicity parameters have also been monitored. There were no observational adverse effects even at levels of 10x therapeutic dose administration of DRV and CRV. The procedure also emphasizes on the designing of protocols for the products developed by recombinant technique.

Animals↗
PubMed1996

[Preventive thyroidectomy in hereditary medullary thyroid gland carcinoma].

Screening for hereditary medullary thyroid carcinoma (MTC) includes both calcitonin stimulation tests and DNA analysis. Positive results of these diagnostic procedures are indicators for the presence of neoplastic C-cell hyperplasia or an asymptomatic MTC. Thyroidectomy and lymphadenectomy of the first compartment are mandatory in both conditions even in young children.

Adolescent↗
PubMed1995

[Validity of clinical signs and provocative tests in carpal tunnel syndrome].

The relevance of EMG study was assessed to ascertain the diagnosis of carpal tunnel syndrome in cases of positivity of clinical signs and provocative tests. A prospective study was conducted in 60 patients presenting 85 symptomatic hands. Correlation between 11 signs and tests (isolated or associated) was performed with EMG used as "standard". None of the signs or tests reached an acceptable level of sensitivity, specificity or predictive value. This exam was positive in only 62 per cent of cases. EMG seems to mandatory before deciding on surgical release of the carpal tunnel syndrome.

Adult↗
PubMed1997

Prenatal HIV screening in pregnant women: a medical-legal review.

Identifying pregnant women's human immunodeficiency virus (HIV) infection status provides them with the opportunity to seek appropriate treatment and to take measures to prevent vertical and horizontal transmission. Prenatal screening program options include targeting at-risk women, testing on a voluntary basis, or mandating prenatal HIV screening. When examining these options, the number of cases identified, programmatic costs, long-term health care costs, and legal implications must all be considered. Research indicates that targeting at-risk women misses a significant percentage of seropositive women, although programmatic costs may be lower. It is difficult to ascertain the difference between voluntary and mandatory programs with respect to the number of cases identified and treated. As a result, long-term savings are difficult to calculate. Mandatory programs would have the greatest direct costs and place the greatest burden on the woman's constitutional rights. By making HIV counseling and testing a routine component of prenatal care, voluntary programs could achieve the benefits of prenatal HIV screening without violating the woman's civil liberties.

AIDS Serodiagnosis↗
PubMed2005

Surveillance and epidemiology of MRSA bacteraemia in the UK.

Surveillance of bacteraemia caused by methicillin-resistant Staphylococcus aureus (MRSA) in the UK has involved collection of data from hospital microbiology laboratories via several mechanisms, including a voluntary reporting scheme that has been operational in England and Wales since 1989 and mandatory reporting schemes that have been running independently in England, Wales, Scotland and Northern Ireland since 2001. In addition, surveillance schemes involving panels of participating sentinel laboratories that submit isolates for centralized susceptibility testing, such as the Bacteraemia Resistance Surveillance Programme run by the BSAC, have also been established. Each of these data sources have particular advantages, but they also have their individual limitations, with the result that they each give an incomplete picture if considered in isolation. However, by pooling the findings from these different but complementary surveillance programmes, a much more comprehensive and credible picture of the problem posed by MRSA is produced. These schemes have shown both a dramatic rise in the total numbers of cases of S. aureus bacteraemia reported annually and an increase in the proportion of such cases that involve MRSA (from 2% in 1990 to >40% in the early 2000s), although the most recent data indicate a slight reversal of these trends. Characterization of isolates of MRSA shows a marked temporal relationship between the rise in MRSA bacteraemias and the emergence and spread of two strains of epidemic MRSA, EMRSA-15 and EMRSA-16. Surveillance and control of MRSA infection continue to be high profile and further developments to the mandatory surveillance system in England are likely in the near future.

Bacteremia↗
PubMed1979

Predicting the need for prolonged ventilatory support in adult cardiac patients.

Forty-nine cardiac surgical patients had ventilatory function tests and measurements of maximum inspiratory (MIP) and maximum expiratory (MEP) pressures preoperatively. The differences between the values of various function tests were compared for patients requiring less than 24 hours of ventilator support and those requiring more than 24 hours. There was a significant difference in the mean values for the two groups in vital capacity (VC) first-second forced expired volume (FEV) midexpiratory flow between 50 and 75 (MMEF 50--75) and 75--85 percent of expired volume (MMEF 75--85), and MEP. The standard deviations of each of the variables were so large that the clinical usefulness was limited. However, when discriminant analysis was used for more than one variable, the combination of MMEF 75--85 and MEP predicted success or failure to wean in 24 hours correctly in 90 percent of instances. On the basis of these simple tests, patients predicted to succeed should be weaned from ventilator support on recovery from anesthesia. Those predicted to fail should be placed on intermittent mandatory ventilation (IMV) and should be weaned following a planned, logical process.

Adult↗
PubMedDate not supplied

Ethanol content of various foods and soft drinks and their potential for interference with a breath-alcohol test.

A variety of breads and soft drinks were tested and found to contain low concentrations of alcohol. The potential for these products to generate false readings on an evidential breath-alcohol instrument was evaluated. Alcohol-free subjects ingested these products and then provided breath samples into a DataMaster. It was found that breath samples provided immediately after consumption of some of these products, or with them still present in the mouth, did produce low levels of apparent breath alcohol, which may or may not be rejected as invalid by the breath-test instrument. If the subject swallowed or expectorated the food or beverage and then observed a 15-min deprivation period during which nothing was introduced into the mouth, the apparent effect was eliminated. These findings emphasize the need for the mandatory pretest alcohol-deprivation period and the benefits of duplicate breath sampling.

Beverages↗