[Psychogenic erectile dysfunction and phosphodiesterase inhibitors type 5].

In the literature, much of the attention is focused on the organic erectile dysfunction (ED) rather than on psychogenic one. This article analyses the causes and mechanisms of psychogenic ED. It outlines the issues of diagnosis, therapy and specific features of using phosphodiesterase inhibitors type 5 in the management of psychogenic ED.

[Effect of herpes simplex virus on spermatogenesis].

To investigate the effect of Herpes Simplex virus (HSV) on spermatogenesis, HSV in ejaculate was detected by a rapid cultural method in 268 infertile males and 47 healthy ones. The number of mobile spermatozoa in HSV infected samples was less than in non-infected samples (21 mln/mlversus 40 mln/ml, p = 0.0001). The relative number of morphologically normal gametes was 13% versus 19% (p = 0.002), respectively. The quantitative karyological test discovered that males with HSV-infected ejaculate have more degenerating sex cells while in high virus contamination (more than 10 virus particles in 1 ml) the number of spermatides and spermatocytes of the 1 order at diploten stage is low. Organic testicular culture was used for more detailed study of pathogenetic mechanisms of HSV impact on spermatogenesis. Testicular explants infection was associated with reduction in the number of spermatogones, spermatocytes and spermatides on culturing week 2. The above findings reveal some pathogenetic mechanisms underling fertility disorders in males with HSV infection: a gametotoxic effect of the virus reducing populations of spermatogones, spermatocytes and spermatide; affected mobility and morphological characteristics of spermatozoa. Detection of the mechanisms of HSV action on spermatogenesis opens a perspective of antivirus drug administration in combined treatment of male infertility.

Molecular cloning of a glibenclamide-sensitive, voltage-gated potassium channel expressed in rabbit kidney.

Shaker genes encode voltage-gated potassium channels (Kv). We have shown previously that genes from Shaker subfamilies Kv1.1, 1.2, 1.4 are expressed in rabbit kidney. Recent functional and molecular evidence indicate that the predominant potassium conductance of the kidney medullary cell line GRB-PAP1 is composed of Shaker-like potassium channels. We now report the molecular cloning and functional expression of a new Shaker-related voltage-gated potassium channel, rabKv1.3, that is expressed in rabbit brain and kidney medulla. The protein, predicted to be 513 amino acids long, is most closely related to the Kv1.3 family although it differs significantly from other members of that family at the amino terminus. In Xenopus oocytes, rabKv1.3 cRNA expresses a voltage activated K current with kinetic characteristics similar to other members of the Kv1.3 family. However, unlike previously described Shaker channels, it is sensitive to glibenclamide and its single channel conductance saturates. This is the first report of the functional expression of a voltage-gated K channel clone expressed in kidney. We conclude that rabKv1.3 is a novel member of the Shaker superfamily that may play an important role in renal potassium transport.

[Premature ejaculation: diagnosis, classification, algorithm of the patients' examination and results of their application].

We have analysed literature data and own experience with management of premature ejaculation (PE) in 3200 patients. This gave grounds for formulation of this phenomenon, creation of the classification and the examination algorithm. We applied the proposed methods in the treatment of 258 PE patients and made the conclusion about their adequacy and efficacy. PE is a polyetiological phenomenon and a multidisciplinary problem. Urological examination must be used as the first stage of the diagnostic process.

[Longidase in the treatment of chronic prostatitis].

Twenty eight patients with documented chronic prostatitis (CP) received standard therapy (a control group) while a study group of 28 patients received standard therapy plus a 10 longidase injections in a dose of 3000 IU. Treatment results showed that longidase is highly effective in bacterial and abacterial CP. Longidase addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate. Thus, a domestic drug longidase is effective and safe in CP. It can be widely used in combined therapy of CP.

Properties of an inwardly rectifying ATP-sensitive K+ channel in the basolateral membrane of renal proximal tubule.

The potassium conductance of the basolateral membrane (BLM) of proximal tubule cells is a critical regulator of transport since it is the major determinant of the negative cell membrane potential and is necessary for pump-leak coupling to the Na+,K+-ATPase pump. Despite this pivotal physiological role, the properties of this conductance have been incompletely characterized, in part due to difficulty gaining access to the BLM. We have investigated the properties of this BLM K+ conductance in dissociated, polarized Ambystoma proximal tubule cells. Nearly all seals made on Ambystoma cells contained inward rectifier K+ channels (gammaslope, in = 24.5 +/- 0.6 pS, gammachord, out = 3.7 +/- 0.4 pS). The rectification is mediated in part by internal Mg2+. The open probability of the channel increases modestly with hyperpolarization. The inward conducting properties are described by a saturating binding-unbinding model. The channel conducts Tl+ and K+, but there is no significant conductance for Na+, Rb+, Cs+, Li+, NH4+, or Cl-. The channel is inhibited by barium and the sulfonylurea agent glibenclamide, but not by tetraethylammonium. Channel rundown typically occurs in the absence of ATP, but cytosolic addition of 0. 2 mM ATP (or any hydrolyzable nucleoside triphosphate) sustains channel activity indefinitely. Phosphorylation processes alone fail to sustain channel activity. Higher doses of ATP (or other nucleoside triphosphates) reversibly inhibit the channel. The K+ channel opener diazoxide opens the channel in the presence of 0.2 mM ATP, but does not alleviate the inhibition of millimolar doses of ATP. We conclude that this K+ channel is the major ATP-sensitive basolateral K+ conductance in the proximal tubule.

Regulation of an inwardly rectifying ATP-sensitive K+ channel in the basolateral membrane of renal proximal tubule.

Functional coupling of Na+,K+-ATPase pump activity to a basolateral membrane (BLM) K+ conductance is crucial for sustaining transport in the proximal tubule. Apical sodium entry stimulates pump activity, lowering cytosolic [ATP], which in turn disinhibits ATP-sensitive K+ (KATP) channels. Opening of these KATP channels mediates hyperpolarization of the BLM that facilitates Na+ reabsorption and K+ recycling required for continued Na+,K+-ATPase pump turnover. Despite its physiological importance, little is known about the regulation of this channel. The present study focuses on the regulation of the BLM KATP channel by second messengers and protein kinases using membrane patches from dissociated, polarized Ambystoma proximal tubule cells. The channel is regulated by protein kinases A and C, but in opposing directions. The channel is activated by forskolin in cell-attached (c/a) patches, and by PKA in inside-out (i/o) membrane patches. However, phosphorylation by PKA is not sufficient to prevent channel rundown. In contrast, the channel is inhibited by phorbol ester in c/a patches, and PKC decreases channel activity (nPo) in i/o patches. The channel is pH sensitive, and lowering cytosolic pH reduces nPo. Increasing intracellular [Ca2+] ([Ca2+]i) in c/a patches decreases nPo, and this effect is direct since [Ca2+]i inhibits nPo with a Ki of approximately 170 nM in i/o patches. Membrane stretch and hypotonic swelling do not significantly affect channel behavior, but the channel appears to be regulated by the actin cytoskeleton. Finally, the activity of this BLM KATP channel is coupled to transcellular transport. In c/a patches, maneuvers that inhibit turnover of the Na+,K+-ATPase pump reduce nPo, presumably due to a rise in intracellular [ATP], although the associated cell depolarization cannot be ruled out as the possible cause. Conversely, stimulation of transport (and thus pump turnover) leads to increases in nPo, presumably due to a fall in intracellular [ATP]. These results show that the inwardly rectifying KATP channel in the BLM of the proximal tubule is a key element in the feedback system that links cellular metabolism with transport activity. We conclude that coupling of this KATP channel to the activity of the Na+,K+-ATPase pump is a mechanism by which steady state NaCl reabsorption in the proximal tubule may be maintained.

Whole-cell currents in single and confluent M-1 mouse cortical collecting duct cells.

M-1 cells, derived from a microdissected cortical collecting duct of a transgenic mouse, grown to confluence on a permeable support, develop a lumen-negative amiloride-sensitive transepithelial potential, reabsorb sodium, and secrete potassium. Electron micrographs show morphological features typical of principal cells in vivo. Using the patch clamp technique distinct differences are detected in whole-cell membrane current and voltage (Vm) between single M-1 cells 24 h after seeding vs cells grown to confluence. (a) Under control conditions (pipette: KCl-Ringer; bath: NaCl-Ringer) Vm averages -42.7 +/- 3.4 mV in single cells vs -16.8 +/- 4.1 mV in confluent cells. Whole-cell conductance (Gcell) in confluent cells is 2.6 times higher than in single cells. Cell capacitance values are not significantly different in single vs confluent M-1 cells, arguing against electrical coupling of confluent M-1 cells. (b) In confluent cells, 10(-4)-10(-5) M amiloride hyperpolarizes Vm to -39.7 +/- 3.0 mV and the amiloride-sensitive fractional conductance of 0.31 shows a sodium to potassium selectivity ratio of approximately 15. In contrast, single cells express no significant amiloride-sensitive conductance. (c) In single M-1 cells, Gcell is dominated by an inwardly rectifying K-conductance, as exposure to high bath K causes a large depolarization and doubling of Gcell. The barium-sensitive fraction of Gcell in symmetrical KCl-Ringer is 0.49 and voltage dependent. (d) In contrast, neither high K nor barium in the apical bath affect confluent M-1 cells, showing that confluent cells lack a significant apical K conductance. (e) Application of 500 microM glibenclamide reduces whole-cell currents in both single and confluent M-1 cells with a glibenclamide-sensitive fractional conductance of 0.71 and 0.83 in single and confluent cells, respectively. Glibenclamide inhibition occurs slower in confluent M-1 cells than in single cells, suggesting a basolateral action of this lipophilic drug on ATP-sensitive basolateral K channels in M-1 cells. (f) A component of the whole-cell conductance in M-1 cells appears as a deactivating outward current during large depolarizing voltage pulses and is abolished by extracellular chloride removal. The deactivating chloride current averages 103.6 +/- 16.1 pA/cell, comprises 24% of the outward current, and decays with a time constant of 179 +/- 13 ms. The outward to inward conductance ratio obtained from deactivating currents and tail currents is 2.4, indicating an outwardly rectifying chloride conductance.

An unusual cause for ketoacidosis.

A 22-year-old male developed a severe degree of metabolic acidosis (plasma pH 7.20, bicarbonate 8 mmol/l), with a large increase in the plasma anion gap (26 mEq/l). Ketoacidosis was suspected because of the odour of acetone on his breath and a positive qualitative test for acetone in plasma (to a 1:4 dilution). Later, his plasma beta-hydroxybutyrate concentration was found to be 4.5 mmol/l. After receiving an infusion of 1 l of half-isotonic saline and 1 l of 5% dextrose in water over 24 h, as well as curtailing his large oral intake of sweetened beverages, all blood tests became normal. Diabetic ketoacidosis, alcoholic ketoacidosis, starvation ketosis and hypoglycaemic ketoacidosis were all ruled out, and his toxin screen was negative for salicylates. Finding another possible cause for ketoacidosis became the focus of this case.

[Clinical effectiveness of beta-adrenoblockers and their effects on copulative function in patients with hypertension]. / Klinicheskaia éffektivnost' i vliianie beta-adrenoblokatorov na kopuliativnuiu funktsiiu u bol'nykh s arterial'noi gipertenziei.

Twenty four hour blood pressure and ECG monitoring, assessment of sexual function (questionnaires, penile artery Doppler flowmetry) were carried out in male hypertensives treated with atenolol, metoprolol, or bisoprolol. Compared with atenolol and metoprolol bisoprolol was found to be more effective and safe. The use of bisoprolol was associated with no negative changes and even with improvement of some parameters of sexual function. Sildenafil could be used for correction of male sexual dysfunction occurring during treatment with other beta-blockers.

[A new pathogenetic approach and a method of erectile dysfunction treatment and prevention--modulated erectile oxygenation of penile cavernous tissue]. / Novyi patogeneticheskii podkhod, a takze sposob lecheniia i profilaktiki érektil'noi disfunktsii - moduliruemaia erektil'naia oksigenatsiia kavernoznoi tkani polovogo chlena.

The analysis of sexual activity of 185 male Muscovites has revealed an age-related sharp progressive shortening of adequate and spontaneous erections. A novel, pathogenetically sound approach and a method of therapy and prevention of erectile dysfunction has been developed (RF patent N 2228754). The method, called "Modulated Erectile Oxygenation of Penile Cavernous Tissue" (MEOPCT), consists in erection activation by behavioral measures and/or erectogenic drugs which induce adequate, nocturnal spontaneous and/or artificial erections adequate in frequency and duration for providing such oxygenation of cavernous bodies that warrants maintenance of their normal structure and function. There is no continuous close correlation between sexual activity and erections, on the one side, and ejaculation and orgasm, on the other side. Application of MEOPCT in 43 patients demonstrated the method ability to improve erection and cavernous hemodynamics without negative side effects.

[A system of comprehensive assessment of symptoms in chronic prostatitis (CAS-XII)]. / Sistema summarnoi otsenki simptomov pri khronicheskom prostatite (COC-XII).

The system proposed for overall assessment of symptoms in chronic prostatitis was applied in the assessment of 75 patients. The system facilitates detection and analysis of the complaints, quantitates the disease symptoms, provides overall objective characteristics of all the multiplicity of clinical manifestations of chronic prostatitis in each patient by means of digital order. The system is rather effective for dynamic control of the patients' condition and treatment efficacy.

[Method of penile scintigraphy]. / Metodika fallostsintigrafii.

A method of phalloscintigraphy, based on the gamma camera and computerized data processing, is offered. The results of examination of patients are described.

[Yohimbine in the treatment of erectile dysfunction]. / Iokhimbin v terapii érektil'noi disfunktsii.

Iochimbin hydrochloride was given to 153 men with erectile dysfunction. The results are available for 140 of them. The ability of iochimbin in a single dose of 5-10 mg to enhance arterial blood inflow to cavernous bodies of the penis was confirmed by dynamic angiopenoscintigraphy and Doppler ultrasonography. Iochimbin hydrochloride in a mean daily dose of 15-20 mg proved effective in erectile dysfunction--38 to 84% responders depending on the type of erectile dysfunction. Occasional side effects can be relieved by reducing the drug dose.

[Assisted reproductive technologies in urology]. / Vspomogatel'nye reproduktivnye tekhnologii v urologii.

Since 1996 the authors have examined and treated 42 infertile married couples (the husbands had azoospermia). To obtain spermatozoa directly from the testes or epididymis and subsequent ICSI, 42 patients underwent 53 interventions: TESE (n = 38), PESA (n = 10), MESA (n = 5). Spermatozoa were obtained from 32(76.1%) of 42 patients, fertilization occurred in 21(50%) cases, 10(23.8%) wives got pregnant. Assisted reproductive technologies expand potentialities of correcting severe forms of male infertility including azoospermia. The armory of the operative procedures in male infertility was replenished with MESA, TESE, PESA.

[A scale for the quantitative evaluation of male copulative function (the MCF scale)]. / Skala kolichestvennoi otsenki muzhskoi kopuliativnoi funktsii (shkala MKF).

A scale of total quantitation of male copulative function (MCF) is offered to facilitate the diagnosis and monitoring of MCF abnormalities, control of MCF correction. The scale is based on normal values provided by statistical data on sexual activity of males and its age-related changes. The patient is asked to answer 13 questions of the questionnaire listed under the numbers I-XIII. Each question has 6 variants of answer having the score 0 to 5. The patient is to choose one variant and write down his choice. Such MCF scale is able to identify both sexual disorder and defects in components of the copulative cycle. The scale was applied 89 times to study sexual function of 68 males aged 24-77 years. The scale findings and those of a comprehensive clinical examination coincided. The scale was found useful in evaluation of male copulative function as a whole and by components, for analysis of the detected disorders, differentiation between psychogenic factor and primarily organic one, for ascertaining attitude of the patient to his sexual dysfunction.

Application of pressure steps to mechanosensitive channels in membrane patches: a simple, economical, and fast system.

Mechanosensitive channels (MSCs) have been described in a wide variety of cells, but the molecular mechanisms that couple membrane tension or deformation to channel activity (i.e., mechanotransduction) are not understood. The ability to measure the dynamics of the temporal relationship between the pressure stimulus and the channel response is a key tool for gaining insight into mechanotransduction. Several laboratories have designed pressure clamps, but these instruments are complex, costly, and not commercially available. This paper describes a simple and inexpensive system for applying fast pressure steps to a membrane patch. This system is easy to build and achieves submillisecond 20% to 80% step response times on par with the fastest pressure clamp described. Application to a stretch-activated non-selective cation channel in the kidney is used to demonstrate the system.