Outcome analysis of sildenafil citrate for erectile dysfunction of Japanese patients.

The approved maximal dose of sildenafil is only 50 mg in Japan, but the impact of dose regulation on treatment outcomes has not been established. Moreover, the contributors to the efficacy in patients having an intact peripheral nervous system have not been fully elucidated. We assessed in Japanese patients the treatment outcomes of sildenafil for erectile dysfunction (ED) under regulation of the approved dose and identified factors contributing to its efficacy among those with various etiologies other than pelvic surgery. We retrospectively reviewed 196 ED patients treated with sildenafil. The overall efficacy was 70.9% (139/196), and patients with psychological problems and concomitant cardiovascular disease showed high response rates (82.4 and 87.0%, respectively). Of the 139 responders, 89.9% achieved efficacy with a dose of 25 or 50 mg. Logistic regression analysis revealed concomitant cardiovascular disease and a favorable nocturnal penile tumescence result to be independent contributors to the efficacy.

Evaluation of the alleviative action of neurotropin for penile pain associated with intracavernous injection of prostaglandin E1 assessed using the visual analogue scale.

We examined whether penile pain associated with intracavernous injection of PGE1 could be alleviated with a intracavernous injection of neurotropin, a non-protein, bioactive agent extracted from skin tissue with inflammation elicited by the Vaccinia virus. Twenty-three patients with erectile dysfunction were enrolled in this study. They were divided into two groups. The first group was allocated 20 micrograms of PGE1 alone first, followed by PGE1 plus 1.5 ml of neurotropin after two weeks. The second group was allocated PGE1 plus 1.5 ml of neurotropin first, followed by PGE1 alone after two weeks. Pain was evaluated by the visual analogue scale (VAS). In the 17 patients reporting discomfort, pain scores for PGE1 injection with neurotropin were significantly lower than those without neurotropin. No patients showed local or systemic complications that might be related to neurotropin. From these data we conclude that neurotropin may be an effective and safe drug for penile pain associated with PGE1 intracavernous injection.

Effects of levodopa on nocturnal penile tumescence: a preliminary study.

We studied the effects of levodopa (L-dopa), which is reported to increase the dopamine level in the brain, on male erectile function. Of the 21 subjects studied, 12 subjects who were 50 years old or older showed significant increases of two nocturnal penile tumescence (NPT) parameters, NPT frequency and total tumescence time, with L-dopa. On the other hand, in nine subjects who were younger than 50 years, maximum penile circumference increase showed a significant increment with L-dopa. This significant increment of NPT with L-dopa was not observed in the subjects who had low androgen levels. The results of this preliminary study show a positive relationship between administration of L-dopa and erectile function. L-Dopa administration may improve erectile function in subjects aged 50 years and older who have normal androgen levels.

Post-traumatic arterial priapism evaluation with color Doppler ultrasonography: a case report.

The patient was a 19-year-old man who was examined due to persistent penile erection, which appeared following a blow to the perineal region during work. Color Doppler ultrasonography of the corpora cavernosa revealed a cavity in one part of the cavernous artery that suggested a blood leak, and a diagnosis of high flow type priapism due to trauma was made. Bilateral internal pudendal arteriography demonstrated dilation and extravasation in one part of the right cavernous artery, then transarterial embolization was performed superselectively in the right cavernous artery using an autologous clot. However, 2 weeks after treatment, slight penile erection reoccurred. Color Doppler ultrasonography revealed reformation of the cavity at the treated lesion, and embolization was again performed using a gelatin sponge. Following embolization, the course proceeded satisfactorily without any relapse. Color Doppler ultrasonography, which is non-invasive and can be easily performed, is considered to be an effective means for diagnosis and follow up of arterial high flow priapism.

[Long-term clinical course of Peyronie's disease treated conservatively].

BACKGROUND: To evaluate the natural history of Peyronie's disease and to determine the suitable time for surgical treatment, we investigated changes of clinical findings of the disease over time. PATIENTS AND METHODS: We evaluated changes of plaque size, penile curvature and erectile dysfunction in 10 patients with Peyronie's disease. The mean follow-up period was 36.8 months. RESULTS: At the first examination, the mean plaque size of patients with erectile dysfunction was larger than that of those without erectile dysfunction, suggesting a positive association between size and erectile function. There was no significant relationship between plaque size and penile pain or penile curvature. The mean size of plaques decreased significantly compared with that at the first examination (p < 0.05). However, penile curvature, pain and erectile dysfunction persisted during the follow-up period in all but one patient, who showed improvement of penile curvature. CONCLUSION: These results suggest that we may recommend a shorter observation period until surgery that we have done for some patients who want to be surgically treated.

[Malignant mesenchymoma in the scrotum. A case report].

A 67-year-old man visited our hospital with the chief complaint of painless swelling of the left scrotal content. An elastic hard mass was palpable in the left scrotum. Resection of the tumor, including the left scrotal skin, was performed. The tumor originated from the scrotal wall and did not communicate with the testis, the epididymis or spermatic cord. Histologically, the tumor was diagnosed as a malignant mesenchymoma composed of liposarcoma, chondrosacoma and osteosarcoma. Malignant mesenchymoma is very rare, especially in the scrotum. Our case that originated from the scrotal wall is the first one reported in Japan.

Orgasm is preserved regardless of ejaculatory dysfunction with selective alpha1A-blocker administration.

We evaluated whether ejaculatory dysfunction induced with a selective alpha1A-blocker influenced orgasm. Fifteen healthy male volunteers took silodosin or a placebo in a randomized, double-blind crossover design. We investigated the ejaculatory volume before and after administration of the agents. After each ejaculation, participants self-reported the answers to an original questionnaire, which was about discomfort on ejaculation, orgasm and satisfaction with the discomforting ejaculation. All participants on silodosin had a complete lack of seminal emission and expulsion. All participants felt orgasm in spite of a complete lack of seminal emission. Of the 15, 12 (80%) who had a somewhat uncomfortable feeling during orgasm were dissatisfied with this feeling, although 9 of the 12 reported that its degree was mild. Orgasm is preserved regardless of the loss of seminal emission with silodosin administration. Although most participants reported mild discomfort during orgasm, they were greatly dissatisfied with the loss of seminal emission.

Cytosolic overexpression of p62 sequestosome 1 in neoplastic prostate tissue.

AIMS: To investigate the expression of p62 in various prostatic tissues, and to demonstrate different immunohistochemical patterns of p62 expression in distinct pathological entities of the prostate. The p62 sequestosome 1 (SQSTM1) gene product is a multifunctional protein with ubiquitous expression in normal adult tissue. METHODS AND RESULTS: Overexpression of p62 was detected in prostate cancer cell lines and tissues by reverse transcriptase-polymerase chain reaction. Immunohistochemical staining for p62 was performed on 73 cases of paraffin-embedded prostatic tissue. p62 was negative or weakly positive only in the nucleus (pattern N) of prostatic gland epithelium in nine normal and hyperplastic prostate specimens, whilst most cancerous tissue showed intense, uniform staining for p62 in the cytoplasm (pattern C). Of the prostate cancer specimens, 91% showed positive pattern C immunoreactivity. Of the cases with high-grade prostatic intraepithelial neoplasia (PIN) around cancer, 77% showed pattern C. However, in specimens from the patients without prostate cancer PIN displayed pattern C in only 32% of cases. Western blot analysis showed that all cancer cell lines expressed p62 in the cytoplasm but there was little nuclear expression. CONCLUSION: Cytosolic overexpression of p62 is a novel immunohistochemical characteristic in prostatic adenocarcinoma and high-grade PIN, suggesting that p62 might be a novel marker for prostatic malignancy.

Malignant fibrous histiocytoma of the spermatic cord: a case report.

We present a case of malignant fibrous histiocytoma of the spermatic cord. An 86-year-old man was admitted to the hospital with a right painless scrotal mass. Under the diagnosis of a testicular tumor, right radical orchiectomy was performed. Grossly, the tumor firmly adhered to the spermatic cord. The right testis and epididymis were normal. The histologic diagnosis was malignant fibrous histiocytoma. There was local recurrence 2 months after surgery. The recurrent tumor was resected with the surrounding soft tissue, but the patient died 5 months after the initial operation.

Meteorological factors involved in Japanese encephalitis virus infection in cattle.

From 1982 to 1987 a total of 4,371 dairy cattle in Saitama Prefecture, were examined for levels of hemagglutination inhibition (HI) antibody to Japanese encephalitis virus (JEV) and the correlation with meteorological factors and an antibody positive rate was studied. Positivity rates of HI antibody from July to October each year (Yi) ranged from 58.8 to 88.0% with a considerable annual variation. Simple regression analysis of Yi with the comparative meteorological value (Xi) was determined from mean temperatures (Ti, j-1), rainfalls (Ri, j-1) for 10-day-periods each, and the number of days showing 25 degrees C or above (ti, j-1) from June to September, which yielded a correlation coefficient of 0.8147 (p less than 0.05) and an equation for estimated HI antibody positivity rate: Yi = -0.04Xi+79.9 (p less than 0.05). Multiple regression analysis with the power values of three meteorological parameters as independent variables and Yi as the dependent variable, showed a multiple correlation coefficient of 0.987 (p less than 0.05) and a multiple regression equation: Yi = -3991T1/13-0.0035R-12+1978t1/9+4187 (p less than 0.05), giving estimated positivity rates almost equal to the values from the observations. Therefore, a predictive equation was formulated reflecting positive and negative correlations of sero-positivity with the temperature and the precipitation, respectively.

The correlation between penile tumescence measured by the erectometer and penile rigidity by the RigiScan.

BACKGROUND: The goal of this study was to evaluate the correlation between increments of penile tumescence and penile rigidity measured by the erectometer and the RigiScan, respectively. METHODS: Nocturnal penile tumescence (NPT) was measured in 25 volunteers (mean age, 49.5 years). The erectometer and the RigiScan were used simultaneously for a total of 47 nights. We studied the correlation between maximum penile circumferential changes determined by the erectometer and penile rigidity patterns measured by the RigiScan. RESULTS: Maximum circumferential changes during NPT measured by the erectometer were well correlated to those determined by the RigiScan (correlation coefficient, 0.719). In addition, penile circumferential changes measured by the erectometer corresponded well to the penile rigidity pattern determined by the RigiScan (P=0.0001). Specifically, maximum penile circumferential changes of more than 30 mm and less than 10 mm had 70% positive predictive value and 100% negative predictive value for predicting the normal rigidity pattern, respectively. CONCLUSIONS: Penile circumferential changes measured by the erectometer were well correlated to penile rigidity measured by the RigiScan, particularly when the increments were larger than 30 mm or less than 10 mm. These results suggested that the erectometer was a useful tool to estimate the penile rigidity patterns of the RigiScan.

Efficacy of a 14-day course of oral ciprofloxacin therapy for acute uncomplicated pyelonephritis.

This study aimed to evaluate the efficacy and safety of oral antibacterial treatment with fluoroquinilone for acute uncomplicated pyelonephritis Thirteen female patients with acute uncomplicated pyelonephritis were treated with oral fluoroquinilone (ciprofloxacin; CPFX). They received 200 mg of the drug three times a day while febrile (3-5 days). Once they become afebrile, the same dose of the drug, given twice a day, was given for another 9-11 days. The mean duration of the course of CPFX was 14 days. Symptoms were evaluated, and laboratory examinations, including urine culture and measurement of the minimal inhibitory concentration (MIC) of CPFX were conducted before treatment, and 3, 7, 14, 21, and/or 28 days after the initiation of the treatment. Of the 13 patients, only 5 needed to be hospitalized, and the period of hospitalization was only a few days. On the 14th day after the commencement of treatment, bacteriologic and clinical cure rates were 100%. Escherichia coli was the most common uropathogen, being isolated from the urine of 8 patients. No clinical relapse of the disease was found during a follow-up period of up to 4 weeks. The patients tolerated the drug well without developing any serious adverse effects. Oral antimicrobial chemotherapy with fluoroquinolone, given on an outpatient or short-term hospitalization basis, achieved satisfactory bacteriological and clinical outcomes in the treatment of acute uncomplicated pyelonephritis. This treatment regimen is indicated for patients with this disease who are not in a serious condition with complications such as shock.