Effect of short-term glucocorticoids on serum osteocalcin in healthy young men.

Young healthy men were studied during brief treatment with prednisone to determine the rapidity of the effects of glucocorticoids on serum osteocalcin. Seven subjects were given 60 mg of prednisone orally at 8 a.m. on 5 consecutive days. Serum osteocalcin fell to 68% of the pretreatment level within 24 hours after the first dose was administered (p less than 0.01) and reached a nadir of 37% of baseline between 48 and 96 hours after treatment was begun (p less than 0.005). When prednisone was discontinued, serum osteocalcin returned promptly to pretreatment levels. Similar, though less marked, effects were found with lower doses of prednisone. Serum osteocalcin was not different from baseline after 5 mg of prednisone in five subjects, but after treatment of five subjects each with 10, 15, or 20 mg of prednisone, osteocalcin levels were 83%, 78%, and 74% of baseline, respectively (p less than 0.05). Serum osteocalcin levels fell rapidly with glucocorticoid administration, indicating that the effects of glucocorticoids on bone cells may be demonstrated long before clinical evidence of osteoporosis becomes apparent.

Management of erectile dysfunction by the geriatrician.

Erectile dysfunction (ED) is the most common health disorder to afflict elderly men. Although 67% of men aged 70 years have ED, and their interest in sexual intercourse remains high, less than 5% receive adequate treatment. In this report, we review recent developments in our understanding of the pathophysiology of ED, how geriatricians can perform an office-based evaluation, and rational (evidence-based) treatment of this important disorder.

Prostaglandin E1 as treatment for erectile failure in elderly men.

OBJECTIVE: To determine the efficacy of intracavernosal injection of prostaglandin E1 (alprostadil) in elderly men with erectile failure. DESIGN: Prospective study. SETTING: Outpatients at a university-affiliated VA Medical Center. PARTICIPANTS: Ten subjects aged 65 years and older with duration of erectile failure of 6 months or longer. INTERVENTIONS: Subjects received intracavernosal injections of prostaglandin E1 in the office and self-administered intracavernosal prostaglandin E1 at home. MEASUREMENTS: Penile rigidity was measured by palpation and by the Rigiscan rigidity monitor. RESULTS: Intracavernosal injection of prostaglandin E1 produced erections adequate for intercourse in 9 of the 10 subjects. Attempts at intercourse were rated satisfactory by two-thirds of the subjects and their spouses. CONCLUSIONS: Intracavernosal injection of prostaglandin E1 is safe and effective for erectile failure in elderly men.

Should we treat high cholesterol in the aged?

Cholesterol may be a more important risk factor for coronary heart disease in the elderly than previously realized. Lipid-lowering therapies, including diet and drugs, seem to be as effective in the elderly as in the young. However, it may take several years to see a significant decrease in cardiac morbidity and mortality. Therefore, therapy should be reserved for those with a life expectancy of at least ten years. In our experience, diet therapy is difficult for the elderly to follow. Drug therapy is well tolerated, if, as with any other drug, you start low and go slow.

Combining intracavernous injection and external vacuum as treatment for erectile dysfunction.

We studied the effect of combining intracavernous injection and an external vacuum in 10 men with erectile dysfunction who previously failed attempts at treatment with either method as single therapy. We measured the length, circumference and buckling pressure of the penis at baseline, after applying negative pressure (250 mm. Hg for 2 minutes), 15 minutes after intracavernous injection of 60 mg. papaverine or 30 micrograms prostaglandin E1 and after combining both modalities. No patient achieved adequate rigidity (defined as a penile buckle pressure greater than 450 gm.) with single therapy. The mean buckle pressure using vacuum alone was 125.0 +/- 53.6 gm. After intracavernous injection the mean buckle pressure was 117.0 +/- 38.3 gm. In contrast, all 10 subjects responded to combination therapy with a mean buckle pressure of 565.0 +/- 56.8 gm. (p < 0.0001). After 10 months of followup 3 subjects were still using the combination and were satisfied with the erectile response, 1 found that he no longer needed the addition of external vacuum after using combination therapy for 3 months, 1 used the combination for 9 months and then stopped because of an intervening acute illness, 1 lost the partner due to death, 2 found combination therapy to be too cumbersome and 2 were lost to followup. We conclude that external vacuum devices can augment a partial response to intracavernous injection and the combination may be an alternative treatment before intrapenile prosthesis implantation.

Incidence of penile pain after injection of a new formulation of prostaglandin E1.

PURPOSE: We determined the incidence of pain with injection of a new formulation of prostaglandin E1. MATERIALS AND METHODS: A total of 63 subjects with erectile dysfunction underwent treatment with the new formulation of prostaglandin E1. Evidence of pain associated with injection was obtained by questionnaire and through questioning. RESULTS: A total of 451 injections was given to 63 subjects in the office, with 16 episodes (3.5%) of pain in 10 (15.9%). Then, 680 injections were performed by 38 subjects at home, with 15 episodes (2.2%) of pain in 8 (21%). Pain was not dose related. CONCLUSIONS: The new formulation of prostaglandin E1 is less likely to be associated with pain compared with alcohol based formulations.

Effect of clonidine and yohimbine on sleep in healthy men: a double-blind, randomized, controlled trial.

OBJECTIVE: To study the acute effect of clonidine, an alpha 2-adrenoceptor agonist, and yohimbine, an alpha 2-adrenoceptor antagonist, on nocturnal sleep in healthy men. SETTING: McGuire Veteran Affairs Medical Center, Richmond, Virginia, USA. SUBJECTS: Eight healthy male volunteers. METHODS: Each subject slept in the sleep laboratory for 2 consecutive nights on three separate sessions, at 3-week intervals. On the 2nd night of each session, the subjects received yohimbine (5.4 mg), clonidine (0.1 mg), or placebo in a double-blind, randomized, placebo-controlled, crossover design. RESULTS: There were no apparent effects of yohimbine. In contrast, clonidine completely suppressed rapid eye movement (REM) sleep in one subject and reduced REM sleep in the remaining seven subjects. CONCLUSION: Our study confirms that clonidine markedly decreases REM, even at a low single dose, and supports the hypothesis of the important role of alpha 2-receptors in controlling REM sleep.

Treatment of erectile failure with prostaglandin E1: a double-blind, placebo-controlled, dose-response study.

We report a double-blind, randomized, placebo-controlled, dose-response study of prostaglandin E1 as treatment for erectile failure. A total of 15 men 55.8 +/- 9.2 years old with a mean duration of erectile dysfunction of 7.6 years participated. During phase 1 (double-blind) subjects received injections of prostaglandin E1 twice weekly at doses of 0 micrograms. (placebo), 2.5 micrograms., 5.0 micrograms., 7.5 micrograms. and 10 micrograms. During phase 2 (nonblind) the dose was increased until a full erection or intolerance developed. Response was measured using a RigiScan monitor. During phase 3 the subjects injected prostaglandin E1 at home. Of the subjects 66% achieved an erection adequate for intercourse, with an average rigidity of 59%. The dose-response curve reached a plateau at 5 to 10 micrograms. Among those responding to prostaglandin E1 intercourse was rated satisfactory by 81% of the subjects and by 90% of the partners. There were no prolonged erections requiring reversal and pain was reported with only 10% of the injections. In summary, intracavernous prostaglandin E1 is an efficacious and effective treatment for erectile failure.

Catecholamine, renin, aldosterone, and arginine vasopressin responses to lower body negative pressure and tilt in normal humans: effects of bromocriptine.

We have examined the effects of the dopamine agonist bromocriptine (BEC) on the hormonal and hemodynamic response to graded lower body negative pressure (LBNP) and tilting in five normal volunteers. BEC blunted the plasma norepinephrine (NE), plasma renin activity (PRA), and aldosterone responses to both LBNP and tilting. The inhibitory effects of BEC on the plasma NE response to these maneuvers are likely mediated through presynaptic inhibition of peripheral neuronal release of NE as well as central nervous system effects of the drug. Since the PRA responses to LBNP and tilting are likely mediated through beta-adrenoreceptor stimulation, BEC probably indirectly blunts the PRA and aldosterone responses to those maneuvers through its inhibitory effects on NE secretion. BEC treatment resulted in a hypotensive response to tilting that was accompanied by a rise in plasma potassium and arginine vasopressin (AVP). No such rises in plasma potassium and AVP are observed, in the absence of BEC treatment, following graded LBNP and tilting. The rise in plasma potassium with tilting (BEC treatment) probably resulted from blunting of the NE rise. Thus, the rise in plasma NE may play an important role in preventing a rise in plasma potassium in association with LBNP and orthostatic stress. AVP levels in normal men are not responsive to unloading of cardiopulmonary and sinoaortic baroreceptors. It is only after overt hypotension is produced--as after BEC treatment--that plasma levels of AVP rise.