Self-injection devices for intracavernosal pharmacotherapy: operational classification and safety considerations.

Several self-injection devices have been recently proposed as an aid to home intracavernosal self-injection treatment for erectile dysfunction, with the purpose of allowing an easier drug administration, decreasing the artificiality of intracavernosal pharmacotheraphy, with the overall goal of increasing the acceptability of this treatment. We propose a classification of these devices according to the type of mechanical impact on the cavernosal tissue: self-injection pens, allowing for manual needle insertion and manual drug delivery; autoinsertors, with automatic needle insertion and manual drug delivery, and autoinjectors, that provide both automatic needle insertion and automatic drug delivery. The use of autoinjectors bears two theoretical risks: extra-corporal drug delivery in cases of wrong injection site, and trabecular damage due to high delivery pressure. In one device pressures 15 times higher the values reached by manual injection, and statistically higher than pressures obtained by maximal strength manual injection, were observed in an in-vitro investigation. Specific studies are needed to define a threshold pressure value for trabecular damage in the flaccid state; accordingly, information on autoinjector developed pressures should be provided by manufacturers. Clinical studies with adequate follow-up are needed as well, to verify the risk of autoinjector-induced extracorporal drug delivery, and the occurrence of intracavernosal nodules or penile curvature, compared to manual self-injection.

Audiovisual sexual stimulation by virtual glasses is effective in inducing complete cavernosal smooth muscle relaxation: a pharmacocavernosometric study.

Audiovisual sexual stimulation (AVSS) is frequently employed to promote cavernosal smooth muscle relaxation (SMR) in hemodynamic diagnostic settings for erectile dysfunction. Our aim has been to adapt conventional AVSS to the particular test conditions of pharmacocavernosometry and pharmacocavernosography (DICC), by the use of virtual glasses. Thirty-seven consecutive patients undergoing DICC were randomized in two groups: no-AVSS and AVSS through commercially available virtual glasses (VG-AVSS) with tri-dimensional capabilities and stereophonic headphones. Such device partially excludes the patient from the surrounding environment. In both groups a standard dose of vasoactive agents was intracavernosally administered, and possibly repeated (re-dosing), until complete SMR was obtained (3 doses/patient maximum). Psychometric tests (State Trait Anxiety Inventory and ad hoc visual analogue scales for embarrassment, stress and pain) were administered before and after DICC. The no-AVSS group consisted of 18 patients, the AVSS group of 19. Number of needed vasoactive agent doses: in the no-AVSS group 6 patients needed 1 dose, 3 patients 2, 9 patients 3 (mean dose number: 2.17); in the AVSS group 15 patients needed 1 dose, 1 patient 2, 3 patients 3 (mean dose number: 1.37). The difference in the number of doses used in the two groups was statistically significant (Student's t-test P = 0.007). Complete SMR, regardless of the number of used doses: in the no-AVSS group 9 patients (50%) achieved complete SMR, in the AVSS group 16 patients (84.2%). The difference in the two groups was statistically significant (chi-square P = 0.026). From evaluated psychometric measures no statistically significant difference between the two groups was detected. VG-AVSS significantly promotes complete SMR without increasing test related stress or anxiety. Its induced arousal suggests the possibility of performing dynamic evaluations of the erectile function with the oral agent sildenafil in place of intracavernosally administered vasoactive agents. VG-AVSS furthermore constitutes a promising tool for the investigation of normal physiology and pathophysiology of female sexual function.

Effect of streptozotocin-induced diabetes on electrically evoked erection in the rat.

This study was designed to investigate whether experimental diabetes in rats could functionally affect reflexogenic erection. Erection was elicited by means of electrical stimulation of the dorsal nerves of the penis and recorded as intracorporeal pressure. Rats were examined 1, 3 and 6 months after diabetes induction by streptozotocin. Three and 6 month diabetes caused a significant decrease of latency for erection and a slower phase of detumescence when compared to age-matched controls. In addition, a trend for a lower developed intracorporeal pressure was present in the 6 month diabetes group. Our results indicate that experimental diabetes is associated with alterations of reflexogenic erection.

Prostaglandin E1 diluted solution: preparation technique and stability evaluation.

The authors describe their prostaglandin E1 dilution method for the treatment of male erectile dysfunction. Preparation stability was investigated. Results suggest that PGE1 diluted solution can last as long as 90 days, while decreased concentrations of PGE1 are detected after three months.

Ultrastructural analysis of the cavernous and dorsal penile nerves in experimental diabetes.

The present study was designed to investigate whether experimental diabetes determines structural changes in peripheral nerves involved in reflexogenic erection, namely the cavernous and the dorsal nerve of the penis. Myelinated axons were examined in the dorsal nerve of the penis from rats with streptozotocin-induced diabetes (3- and 6-month duration). Morphometric analysis disclosed a significant decrease of myelinated fibre size most likely due to a progressive axonal atrophy. In addition, morphological analysis revealed diffuse accumulation of glycogen within axons, lipid droplets in Schwann cells and pronounced sequestration of axoplasm by adaxonal Schwann cell processes. These signs were particularly prominent in 6-month-diabetic rats. Myelinated and unmyelinated axons of the cavernous nerve were analysed in 6-month-diabetic animals. No substantial ultrastructural abnormalities were found in the cavernous nerves. These results suggest that in experimental diabetes regionally specific structural changes occur in neuronal pathways subserving erectile function.

[Calcitonin test]. / Test della calcitonina.

Considering that the Calcitonin is one of the main therapeutic means in the senile Osteoporosis, the authors go over and over the necessity of a simple diagnostic test in order to point out the sensitiveness and resistance to the drug in subjects suffering from this pathology. After a single subministration of the drug to the subjects suffering from Osteoporosis at a high turn-over, it has been considered as sensitive at the therapeutic effect. Subjects in whom, a lowering of the calcemia under 0.3 mEq/1 was obtained within ten hours since the drug had been given.

[Functional retraining in osteosynthesis of the femur]. / Rieducazione funzionale nell'osteosintesi di femore.

Kinesis therapy is now an integral and essential stage in osteosynthetic surgery. According to the different anatomical zones, a series of functional exercises designed to restore joint movement in fractures of the femur are described.

[Bloodless treatment of fractures of the clavicle using O-shaped soft bandages]. / Il trattamento incruento delle fratture di clavicola con bendaggio soffice ad O (BSO).

The authors, on the basis of the clinico-radiographic revieping of 45 patients suffering from clavicle fracture and treated through "O"-shaped soft bandage, state the results obtained: they particularly point out the advantages of such method in the fractures of clavicle 3rd medium, with single rima in patients aged between 10 and 70.

[Congenital hip dislocation: at what age to screen with ultrasound?]. / Displasia congenita dell'anca: quale età per lo screening ecografico?

The Authors report their experience in ultrasound screening for congenital hip dislocation. Goal of this study is to recognize the best age for the screening.

[Congenital hip dysplasia. The controversial results of a screening program]. / Displasia congenita dell'anca. Risultati controversi di un programma di screening.

The authors report their experience in a screening program for congenital hip dislocation. Goal of this study is to recognize the best technique for early diagnosis in this disease. The result show that we need further study and complete cooperation between pediatrician, radiologist and orthopedist to realize the best cost/benefit ratio.

[Painful ejaculation: a review].

Pain at ejaculation/orgasm perceived in perineum, urethra and/or urethral meatus, has a profound impact on the quality of life of the affected man. Although underestimated, this condition is reported to have a 1-9.7% prevalence over the general population. METHODS. Structured review of the relevant available literature. RESULTS. Among the main causes of pain experienced at ejaculation/orgasm are: prostatevesicular causes (LUTS/BPH, prostatitis, ejaculatory duct obstruction, vesicular stone), postsurgical causes (radical prostatectomy, inguinal hernioplasty), pharmacologic causes (antidepressants), psychogenic causes (psychosexual conflicts, sexual abuse), rare causes. For these pathologies, diagnostic and therapeutic strategies have been proposed. CONCLUSIONS. Ejaculatory pain is associated with a high level of personal distress, and represents a possible request for help within the andrologic/urologic area. Each field specialist should be competent in correctly interpreting every single case, in order to manage it appropriately.

Testosterone replacement therapy in male late onset hypogonadism: available pharmacological strategies.

During the last few years, the general aging of the population and the growing knowledge about male hormonal changes in older age have lead the scientific community to focus on the clinical aspects of secondary hypogonadism in aging males. This syndrome is well defined by the term late-onset hypogonadism (LOH). Although the pathophysiology and the diagnostic aspects have been studied and defined and various preparations are available, the debate on androgen supplementation therapy is still ongoing. As the spectrum of effects of endogenous testosterone is essentially based on its metabolism to dihydrotestosterone and estradiol, testosterone is the treatment of choice for male hypogonadism. The aim of the therapy is to establish a physiological concentration of serum testosterone in order to correct the androgen deficiency, relieve its symptoms and prevent long-term sequelae. All of the available products, despite their varying pharmacodynamic and pharmacokinetic profiles, are able to reach this goal. Here we examine the indications for therapy, the characteristics of the different routes of administration and how to monitor therapy in order to make the treatment safe and effective.

Diagnosing erectile dysfunction: instruments for the study of smooth muscle relaxation.

Complete cavernosal smooth muscle relaxation is the pre-requisite for the reliability of every evaluation of the integrity of the corporal veno-occlusive system. Such evaluation is needed whenever reaching a diagnostic conclusion on the haemodynamic status of a given patient is clinically relevant. Clinical challenges that a laboratory evaluation of veno-occlusive integrity face comprise both the induction of complete smooth muscle relaxation, and the possibility to monitor it. This article will review the relevant aspects of normal range values of veno-occlusive function, existing strategies aimed to promote complete smooth muscle relaxation, and available techniques to monitor the cavernosal smooth muscle status.

The role of arthrography in the diagnosis of meniscal tears.

The authors discuss the value of arthrography as a supplement to arthroscopy in the diagnosis of meniscal tears. Arthrography is superior to arthroscopy in its ability to detect lesions of the posterior horn of the medial meniscus, which are the most common meniscal tears. Moreover, arthrography can be done on an out-patient basis and at low cost. In any case, the best screening remains thorough clinical examination supplemented, if necessary, by imaging studies.