Current status of intracavernosal injection therapy in erectile dysfunction.

INTRODUCTION: Erectile dysfunction (ED) is defined as the inability to attain and/or maintain a penile erection. The first introduction of intracavernosal injection (ICI) for the treatment of erectile failure was in 1982 by Virag who reported the positive effects of papaverine on erectile tissue, followed by Brindley concurrently conducting research on ICI therapy with alpha-blockade. ICI remains a viable option for the treatment of ED, even after FDA approval of phosphodiesterase type 5 inhibitors in 1998. The American Urological Association (AUA) and the European Association of Urology (EAU) both recommend ICI as a second-line therapy for the treatment of ED. We herein provide an overview of the current state of ICI therapy for the treatment of ED. AREAS COVERED: We performed a literature review from 1977-2022, using PubMed and the current AUA and EAU guidelines to discuss the current state of ICI for the treatment of ED. EXPERT OPINION: Although other oral agents are considered first line for the treatment of ED, the current guidelines and literature demonstrate that ICI is a safe and effective option for patients; however, careful patient selection and counseling should be performed to maximize the effectiveness and safety of this ED treatment.

An overview of emergency pharmacotherapy for priapism.

INTRODUCTION: Priapism is a compartment syndrome, defined as an unwanted penile erection lasting longer than 4 h, unrelated to sexual stimulation, and persistent even after ejaculation/orgasm. Ischemic priapism is considered a urologic emergency requiring time-sensitive management. Studies have documented that untreated priapism is associated with progressive ischemic histological changes in the corpora cavernosa, such as widespread smooth muscle necrosis, blood vessel and nerve attrition, and trabecular fibrosis. Treatment options include conservative management, corporal irrigation, pharmacologic therapy, and surgery. We herein provide an overview of the emergency pharmacology for priapism. AREAS COVERED: The American Urological Association (AUA) and the European Association of Urology (EAU) both recommend penile aspiration in conjunction with intracavernosal injection of sympathomimetics as the initial management of ischemic priapism. We have performed a retrospective review of the literature from 1914 to 2022 by using PubMed and a review of the treatment guidelines from the AUA and the EAU to discuss the various therapies for ischemic priapism in the emergent setting. EXPERT OPINION: After a thorough overview of the literature regarding the treatment of ischemic priapism in the emergent setting, we conclude that intracavernosal phenylephrine is superior to other agents due to its demonstrated efficacy and limited systemic side effects.

Stereotactic body radiotherapy for early-stage non-small cell lung cancer: a multicentre study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society).

PURPOSE/OBJECTIVE(S): Stereotactic body radiotherapy (SBRT) has become the standard of care for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and for patients who refuse surgery. The aim of this study was to evaluate the effectiveness and safety of primary SBRT in patients with early-stage NSCLC. MATERIALS/METHODS: Retrospective multicenter study of 397 patients (416 primary lung tumours) treated with SBRT at 18 centres in Spain. 83.2% were men. The median age was 74.4 years. In 94.4% of cases, the tumour was inoperable. The pathological report was available in 54.6% of cases. SPSS vs 22.0. was used to perform all statistical analyses. RESULTS: Complete response was obtained in 53.6% of cases. Significant prognostic factors were standard CT planning (p = 0.014) and 4D cone beam CT (p = 0.000). Acute and chronic toxicity ≥ grade 3 was observed in 1.2% of cases. At a median follow-up of 30 months, local relapse was 9.6%, lymph node relapse 12.8%, distant metastasis 16.6%, and another lung tumour 11.5%. Complete response was the only significant prognostic factor for local relapse (p = 0.012) and distant metastasis (p = 0.001). The local relapse-free survival was 88.7%. The overall survival was 75.7%. The cancer-specific survival was 92.7%. The disease-free survival was 78.7%. CONCLUSION: SBRT is an effective and well-tolerated treatment option for patients with early-stage lung cancer who are not suitable for surgery. The most important prognostic factor for local and distant recurrence was complete response, which in our sample depended on the type of CT planning and the IGRT technique.

[Aesthetic aspects of eyelid reconstruction]. / Aspects esthétiques de la reconstruction des paupières.

In eyelid reconstruction, filling the defect is not sufficient. In young patients, the aim is to obtain a reconstructed eyelid, as normal as possible. In elderly patients, the large amount of available skin and the good quality of scars seem to be favorable. But weakening and stretching of the connective tissue and eyelid structures and deficient production of tears may compromise the functional result. In every case, restoring aspect and function are going together. The purpose of this chapter is to show how different techniques may be used in eyelid reconstruction with good cosmetic result. Different cases are carefully described and illustrated.

Prevalencia, grado de control y tratamiento de factores de riesgo cardiovascular en diabéticos tipo 2 asistidos en un centro de atención primaria / Prevalence, degree of control and treatment of cardiovascular risk factors in type 2 diabetic patients in a health center

Objetivo: Estudiar la prevalencia, el grado de control y el tratamiento de los principales factores de riesgo cardiovascular (FRCV) en los diabéticos tipo 2 atendidos en un centro de salud para identificar los aspectos que podrían ser mejorados. Diseño: Estudio descriptivo, observacional y retrospectivo. Emplazamiento: Centro de Salud Segovia 1 de la ciudad de Segovia (España). Métodos: Se seleccionaron mediante muestreo aleatorio sistemático 60 diabéticos tipo 2 incluidos en el programa de diabetes del centro de Salud Segovia 1. Se recogieron de las historias clínicas de los pacientes los datos de fi liación, años de evolución de la diabetes, presencia de otros FRCV (hipertensión arterial [HTA], hipercolesterolemia, grado de obesidad y tabaquismo), parámetros de control de la diabetes y de los otros FRCV, y tratamientos prescritos para controlar los FRCV. Se utilizaron los criterios diagnósticos establecidos por los últimos consensos. Resultados: Prevalencia de FRCV: sobrepeso u obesidad 76,7%, HTA 61,7%, HC 61,7%, tabaquismo 16,7%. El 75% de los pacientes presentaba 3 o más FRCV. El grado de control fue deficiente en el 23,2% de los casos para la HTA, en el 41,3% para el índice de masa corporal, en el 20,5% para la hemoglobina glucosilada (HbA1c), en el 38,9% para el colesterol LDL (cLDL) y en el 16,7% para el tabaquismo. Conclusiones: La prevalencia de FRCV en la población estudiada es elevada, con una alta tendencia a la agrupación de éstos. Su grado de control es globalmente deficiente, por lo que sería necesario intensificar las intervenciones

Objective: To estimate the prevalence, degree of control and treatment of the major cardiovascular risk factors (CVRF) in the type 2 diabetic patients receiving medical attention in a health center to identify which aspects could be improved. Design: A descriptive, observational, retrospective study. Setting: Health care center 1 in the city of Segovia, Spain. Methods: Sixty type 2 diabetic patients included in the Segovia Health Care Center 1 Diabetes Program were selected by systematic random sampling. Data were obtained from the medical records of the patients. We recorded age, sex, duration of diabetes, presence of other CVRF (hypertension, hypercholesterolemia, degree of obesity, smoking habit), degree of metabolic control of diabetes and of the other CVRF, and treatments prescribed to control CVRF. The diagnostic criteria recommended by the latest guidelines were used. Results: The most prevalent CVRF were: overweight or obesity (76.7%), hypertension (61.7%), hypercholesterolemia (61.7%) and smoking (16.7%). Seventy-five percent of the sample population had three or more CVRF. The degree of control (according to the 2005 recommendations of the American Diabetes Association) was deficient in 23.2% of cases for hypertension, 41.3% for body mass index, 20.5% for HbA1c, 38.9% for low-density lipoprotein cholesterol and 16.7% for smoking. Conclusions: The prevalence of CVRF in the study population is high, with a marked tendency toward CVRF clustering. Overall, the degree of control is deficient, indicating the need to intensify interventions

[Notes apropos of cartilage grafts in secondary rhinoplasties according to Sheen's technique. Apropos of an analysis of 67 cases]. / Notes à propos des greffes cartilagineuses dans les rhinoplasties secondaires selon Sheen. A propos de l'analyse de 67 dossiers.

Between 1989 and 1992, eighty-one rhinoplasties included the addition of free autologous cartilage grafts, sixty-seven of which were secondary procedures. The aesthetic and respiratory results were assessed with at least one year of follow-up post-op for fifty four cases representing the true material of the study. This paper illustrates the advantages of septal cartilage graft versus conchal grafts, particularly for restitution of the dorsum of the nose. No "open rhinoplasty" procedure was necessary in this series. The authors conclude that "Sheen's" procedure using multiple isolated pockets in such cases is reliable if its basic rules are strictly applied and if one accepts that septal cartilage grafts must be preferred as far as possible.

[Histological typing of the breast by multifocal biopsies]. / Le typage histologique du sein par biopsies multifocales.

The current concept of high risk mastopathy was revolutionised by the work of Dupont and Page (1985), who demonstrated the importance of proliferative mastopathies in the assessment of the risk, particularly when they are associated with epidemiological factors. Based on these data, the Montpellier breast pathology study and research group (GERPAMM) developed on original method designed to define the precise histological profile of women considered to be at risk of breast cancer, despite the absence of any focal mammographic signs. This typing, consisting of a rigorous surgical protocol strictly complying with Page's histological definitions, was performed in women presenting a certain risk defined by clinical, cytological and radiological criteria (density and disseminated microcalcifications). This paper presents a preliminary review of 6 years' experience in 162 cases. The preliminary results confirm than many cases of atypical hyperplasia are not associated with a focal mammographic abnormality. However, in the absence of focal signs, certain types of disseminated microcalcifications with a morphological appearance suggestive of an intraductal origin, are significantly associated with high-risk histological signs. Histological typing is therefore useful to predict the cancer risk, to dedramatise cases without significant hyperplasia and to propose an adapted and justified approach to cases with a high histological risk.

[Surgery of mammary hypertrophy and ptosis using the dermal vault technique. 5 years' use (apropos of 230 surgically-treated patients]. / Chirurgie de l'hypertrophie et de la ptose mammaire par la technique de la voute dermique. Cinq ans d'utilisation (à propos de 230 patientes opérées).

Using the simplest possible criteria, the author reviews the results obtained in 230 patients who underwent breast reduction using the dermal vault technique. A part from the usual criticisms of the technique defined by J.P. Lalardrie, the analysis reveals: 44% of "good" or "very good", 42% of "acceptable" results and 14% of "unacceptable results". The increase of "good" cases and decrease of "unacceptable" cases with time and the number of cases confirm the author in his opinion that it is worthwhile to continue with operative procedure.

[Specificity of hatchet flaps in the laterofacial region]. / Spécificité des lambeaux en hachette dans la région latérofaciale.

The hatchet flap, well known for the repair after skin resection of the nasal pyramid, is adapted, in a cutaneo-aponeurotic form, to the laterofacial region. The authors describe the principle of the technique which they illustrate by several clinical cases. Its simplicity, its harmonious adaptation and its reliability led them to consider that it has a place in the therapeutic arsenal for skin repair after resection of jugal and temporo-jugal lesions.

[Mammaplasty on breast implants (or cutaneous expansion in treating distended skin)]. / Démammo-mammoplastie sur sein implanté (ou l'expansion cutanée au secours de la peau distendue).

The authors present their experience of the use of skin expansion in secondary surgery to previously implanted breasts. This technique constituted a relatively simple solution with minimal scarring for certain cases in which the residual breast volume was insufficient or non-existent and in which it was impossible to reconstruct a breast with acceptable shape and volume after removal of the implant.

[Tuberous breast: clinical and therapeutic considerations. Report of 20 cases]. / Les séins tubéreúx: réflexions cliniques et thérapeutiques. A propos de vingt cas.

Tuberous breast is a so-called mammary deformity which associates: deficient and contracted base, enlarged nipple-areolar complex, glandular herniation through the areola. The parenchyma is reduced, cylindrical, asymmetric, and frequently posted. Surgery reveals a basic glandular ring. The gland passes through this ring like a "glove's finger", revealing the herniation. All the cases are very different, but the surgical correction is common: concentric skin excision for areolar reduction. "V" vertical excision, allowing gland dissection. Via the skin wedge of the "V", extended dissection is carried out and half of the breast is denuded. The inferior mammary sulcus is released. The basal ring is cut and the posterior breast tissue is radially incised to expanding base, the parenchyma is stretched out. Correction of volume abnormalities: augmentation (implant), posterior reduction of symmetry. Correction of ptosis by skin redraping over the new mammary shape.

[Breast reconstruction using skin expansion after radiotherapy: limitations of the procedure. Apropos of 10 cases]. / Reconstruction mammaire par expansion cutanée après radiothérapie: limites du procédé. A propos de dix observations.

The incidence of failure, be it partial or possibly total, in breast reconstruction after amputation and radiotherapy, appears to be too high in the author's experience. The analysis of ten of such cases focuses attention on what was really done concerning X-ray therapy. It is no longer acceptable to rely on a dose limit on of 50 GY for, expressed in this way, it is not sufficiently accurate. Attention is drawn to the need for a better knowledge of what has really been done before attempting breast reconstruction using temporary expansion.

[Esthetic surgery of large nasal tips. Contribution of the "flying wing" procedure]. / Chirurgie esthétique des pointes nasales étalées. Apport du procédé de "l'aile volante".

The "flying wing" procedure has been known for a long time. It is classically used in the treatment of moderately severe saddle nose. The author proposes the use of this technique for the aesthetic correction of certain flattened nasal tips. Technically, the original procedure is modified by: a transcartilaginous rather than marginal approach, partial rather than total transfer of the lateral crus to preserve the alar ring, resection as required at the junction of the two crura to allow transposition without deformation of the nostril aperture, the possible association with suture-approximation of the domes in order to accentuate the projection of the nasal tip. This procedure may be indicated in secondary, dysmorphic or simply unsightly fattened tips whenever the preoperative assessment reveals a low profile of the nasal spine with osteocartilaginous disjunction, even minor, associated with flattening of the tip, simultaneously resulting in: the need for reinclusion for harmonization of the profile and the need to shorten elevate and reduce the tip. Application of this technique to a limited series (11 cases) does not eliminate any other procedures, particularly reinclusions; the principle of the "flying wing" adapted in this way and respecting the continuity of the two arches of the alar cartilage, is nevertheless attractive.

[Current aspects of xeroderma pigmentosum: apropos of two new cases]. / Aspects actuels du "Xeroderma pigmentosum": à propos de deux nouvelles observations.

Two recent cases of children treated for xeroderma pigmentosum are reported, and knowledge of the disease updated based on numerous reports published over the last few years, particularly by french authors ( Vaillant et al., 1979 and Mouly , Dufourmentel and Papadopoulos , 1980). Points discussed include the similarity of histology and course of the malignant cutaneous lesions with those of adult outdoor workers (co- carcinogenic role of ultraviolet rays ?), and the effect of the introduction of vitamin A acid into treatment on the course of the general and cutaneous lesions (immunocompetence, tumoral growth rate). A further feature discussed is the question raised by the surgical attitude: radical, extensive and mutilating as in the first case, or limited and conservative, with consequent long-term inconveniences, as in the second case. The persistence of an extremely poor prognosis after more than a century of study of the disease (it received its name from Kaposi as early as 1882. . . !!) is a strong argument for imposing the preventive measures which are still applied with difficulty at the present time.