Clinical course of penile fibrosis in intracavernosal prostaglandin E1 injection therapy: a follow-up of 44 patients.

A study was undertaken of 44 patients who had developed fibrotic changes in the penis in the course of intracavernosal prostaglandin E1 (PGE1) injection therapy for erectile dysfunction. Of these patients, 75.0% (n=33) were followed up for more than 24 months, and 59.1% (n=26) for more than 36 months. Of the patients, 52.3% (n=23) had clinical improvement of the fibrotic changes without therapeutic intervention and despite most (91.3%) continuing intracavernosal PGE1 injection therapy. These included 25.0% (n=11) no longer having clinically detectable penile fibrosis (PF). The presence of penile curvature or pain did not significantly influence this outcome. The ages of men who showed improvement and the duration of their injection therapy were similar to those who did not improve. It would be prudent to defer therapeutic intervention for PF in the course of intracavernosal PGE1 injection therapy in anticipation of possible spontaneous improvement.

Intracavernosal injection therapy. Does it still have a role in erectile dysfunction?

BACKGROUND: Male erectile dysfunction (ED) is a common problem in the community. It may go unnoticed unless specific questions are asked. The range of management options has increased markedly over the past two decades. OBJECTIVE: This article revisits the option of intracavernosal injection therapy for male erectile dysfunction. DISCUSSION: Erectile dysfunction has attracted considerable interest and research. The recent availability of an orally effective medication (sildenafil) has brought about a paradigm shift in its management.

Use of transurethral alprostadil (MUSE) (prostaglandin E1) for glans tumescence in a patient with penile prosthesis.

The presence of communication between the emissary veins from the corpora cavernosa and the circumflex veins draining the corpus spongiosum makes it possible for the transfer of alprostadil (prostaglandin E1) in MUSE from the spongiosal compartment to the cavernosal compartment of the penis after its absorption through the urethral mucosa. This leads to engorgement and tumescence of the corpus spongiosum as well as the corpora cavernosa. Lack of tumescence of the glans penis and poor penile girth can be a cause for disappointment and frustration in patients following penile prosthetic surgery. MUSE was used successfully in a patient with a Dynaflex penile prosthesis to enhance the tumescence of the glans penis. It will be a useful adjunct for patients in similar circumstances.

Erectile dysfunction in general medicine practice: prevalence and clinical correlates.

Erectile dysfunction (ED) is a common problem in general medical practice affecting especially the elderly and those with cardiovascular disease and diabetes mellitus. A study was undertaken by questionnaire distributed to consecutive adult male attendees at 62 general medical practices. 1240 completed questionnaires were available for analysis. The mean age of participants was 56.4y (range 18-91 y). 488 men (39.4%) reported ED: 119 (9.6%) 'occasionally', 110 (8.9%) 'often', and 231 (18.6%) 'all the time' (complete ED). Among 707 men aged 40-69y 240 (33.9%) reported ED and 84 (11.9%) had complete ED. The prevalence of complete ED increased with age, rising from 2.0% in the 40-49 y age group to 44.9% in the 70-79 y age group. Only 11.6% of men with ED had received treatment. Hypertension, ischaemic heart disease, peripheral vascular disease and diabetes mellitus were frequently associated with ED. 40% of diabetic men aged 60 y or older had ED all the time.

Erectile dysfunction, sildenafil and cardiovascular risk.

Cardiovascular risk factors are commonly associated with erectile dysfunction and should be identified and treated. Patients with cardiovascular diseases should be assessed and counselled regarding their fitness for sexual activity. The danger of concurrent use of sildenafil and nitrates under any circumstances, regardless of age and sex, must be highlighted at all levels of the community. Sildenafil is absolutely contraindicated in patients receiving treatment with long-acting nitrates for ischaemic heart disease. Patients who need sublingual short-acting nitrates infrequently should not be precluded from taking sildenafil, provided they are aware that sildenafil is not to be taken within 24 h of taking the nitrate.

Penile fibrosis in intracavernosal prostaglandin E1 injection therapy for erectile dysfunction.

Penile fibrosis (PF) may be a complication of intracavernosal injection therapy (ICI). It has been well documented as a side effect of papaverine, but there have been few reports associating penile fibrosis with prostaglandin E1 (PGE1, Alprostadil). Many authors did not find fibrotic changes in the penis while others reported penile fibrosis as a complication of intracavernosal PGE1 in only 0.76-2.1% of their patients. Recent studies, however, suggest that the incidence may be as high as 15%. Three hundred consecutive patients who returned to our Institute for repeat prescription of PGE1 were asked about penile curvature and deformity and the penis was examined for fibrotic change. Twenty-two were excluded because of concurrent or previous use of papaverine and/or phentolamine, 30 patients had pre-ICI evidence of fibrotic change and 3 had incomplete data. Of the remaining 245 patients, 57 (23.3%) were found to have penile fibrosis. These men, mean age 62 y (21-79), had been self injecting an average of 5.2 times per month (1-16) for an average period of 29.2 months (2-86). The mean dose of PGE1 used was 13 micrograms (2-60) and an average of 65.6 micrograms of PGE1 (3-360) was used per month. The mean total number of injections was 142.4 (8-810) and the mean total amount of PGE1 1703 micrograms (105-11,520). Penile fibrosis is hence a significant complication of intracavernosal PGE1 therapy. It is mandatory to examine patients methodically for fibrotic changes in the penis prior to commencement of treatment and at subsequent regular reviews. Patients should be specifically warned of the possibility of penile fibrosis and should be instructed on self examination so that they may report early changes if and when these occur.

Does compression of the base of the penis improve the efficacy of intracavernosal injection of prostaglandin E1 for impotence? A randomized controlled study.

The objective of this study was to evaluate the effect on erections of impeding venous blood flow following intracavernosal injections of prostaglandin E1. Dispersion of injected X-ray contrast medium indicated that application of the RMRI penile clamp to the base of the penis retarded venous outflow. The clamp was then tested in impotent men to determine whether their erectile response was enhanced. Erectile response was assessed using a Rigiscan monitor, palpation of the penis by a staff nurse and the patient's subjective impression. The results demonstrate that there is no significant improvement in erectile response following venous compression.

View from beneath: pathology in focus. Synovial sarcoma of hypopharynx.

Synovial sarcoma of the hypopharynx is a rare neoplasm. To date only 23 cases of synovial sarcoma of the hypopharynx have been reported in the literature. An additional case in an 18-year-old male is presented. This is the first case of synovial sarcoma in the hypopharynx to be reported in Singapore. The presentation was that of a mass in the hypopharynx; progressive dysphagia, intermittent hoarseness and gradual airway compromise. A CT scan was valuable in determining the site of origin and extent of the lesion. Histopathology was diagnostic. Treatment comprised of wide surgical excision of the tumour and post-operative radiotherapy.

Genetic Consequences of Blocking Polar Body I with Cytochalasin B in Fertilized Eggs of the Pacific Oyster, Crassostrea gigas: I. Ploidy of Resultant Embryos.

The effect of blocking polar body I (PB1) with cytochalasin B (CB) on the ploidy of embryos was studied in the Pacific oyster, Crassostrea gigas. To block the release of PB1, fertilized eggs were treated with CB (1.0 µg/ml) for 15 min beginning at 5 min post-fertilization at 25°C. The CB treatment and its control were repeated in three crosses. Ploidy of 8-h-old embryos was determined with karyological analysis. In control groups, the majority of the cells (89.3%) had a diploid number of 20 chromosomes, although spontaneous haploids (0.7%), triploids (1.3%) and aneuploids (8.7%) were also encountered. In CB-treated groups, only 4.5% of the cells remained as diploid, and the majority were either triploid (15.6%), tetraploid (19.4%) or aneuploid (57.6%). Despite variation among the three crosses, contingency Chi-square analysis showed that the occurrence of triploids, tetraploids and aneuploids had a significant (P = 0.0001) dependence on the CB treatment. The majority of the aneuploids fell into two groups containing either 23-25 or 35-37 chromosomes. The production of triploids, tetraploids and aneuploids in specific distributions suggests that blocking PB1 complicates subsequent chromosome segregation.

Genetic Consequences of Blocking Polar Body I with Cytochalasin B in Fertilized Eggs of the Pacific Oyster, Crassostrea gigas: II. Segregation of Chromosomes.

The effect of blocking polar body I (PB1) with cytochalasin B (CB) on subsequent chromosome segregation was studied in fertilized eggs of the Pacific oyster, Crassostrea gigas. To block the release of PB1, fertilized eggs were treated with CB (1.0 µg/ml) for 15 min beginning at 5 min post-fertilization at 25{deg}C. Chromosome segregation in both control and CB-treated eggs was analyzed with an acetic orcein stain. In untreated eggs, ten maternal tetrad chromosomes went through meiosis I and II, and released two polar bodies, reaching a haploid number of 10 chromatids. In CB-treated eggs, meiosis I proceeded normally and produced two groups of dyads, ten in each group. However, blocking PB1 dramatically changed chromosome segregation in meiosis II. In the majority of the treated eggs (68%), the two groups of dyads from meiosis I entered meiosis II through a "tripolar segregation", although two other types of segregation, namely "united bipolar" (7%) and "separated bipolar" (12%) were also observed. After anaphase II, chromatids at the peripheral pole were released as polar body II (PB2). The release of two sets of chromatids as PB2 through either a united bipolar or a separated bipolar segregation resulted in the formation of meiosis I triploids (14%). The release of one set of chromatids as PB2 from an unmixed tripolar or a separated bipolar segregation formed meiosis I tetraploids (20%). Aneuploids (56%) were produced, primarily when the two groups of dyads from meiosis I united or overlapped before entering the tripolar segregation.

Clinical role of informal tests of hearing.

Clinical tests of hearing are regularly used in adults but their role, now that pure-tone audiometry is almost universally available, has not been evaluated by modern methods of analysis including sensitivity and specificity. Free-field voice testing was carried out in 101 patients and the Rinne tuning-fork test in a different group of 127 patients prior to clinical or audiometric evaluation. The results were subsequently compared to air and bone conduction pure-tone thresholds assessed using rigorous standards. Depending on the audiometric definition as to what constitutes a hearing impairment, the sensitivity of free-field voice testing to identify such an impairment because of an inability to hear a whispered voice at two feet (60 cm.) was 86 per cent or better with the specificity being in the region of 90 per cent. In the Rinne test the 256 Hz fork was superior to the 512 Hz fork (p less than 0.05) and the loudness comparison method superior to the threshold decay method (p less than 0.01) in detecting an air-bone gap. Combining the responses to the two forks did not improve the results. The Rinne test with the 256 Hz fork will identify correctly 48 per cent of individuals with a 15 dB, 69 per cent with a 20 dB, 87 per cent with a 25 dB, and 95 per cent with a 30 dB conductive impairment. In all instances the specificity is greater than 90 per cent.