Long-term effects of two organic amendments on bacterial communities of calcareous mediterranean soils degraded by mining.

The application of organic amendments to improve the chemical and biological properties of degraded soils from calcareous quarries is necessary to accelerate restoration processes. The aim of this study is to assess the success of different restoration treatments in the long-term using two organic amendments (sewage sludge from urban waste water (SS) and compost from domestic solid waste (CW)). The chemical properties and bacterial communities of restored soils were compared with unamended soils (NA) and surrounding natural soils (NS) from a limestone quarry in a semi-arid ecosystem. After 10 years of the addition of organic amendments, the abundance of soil bacteria, diversity, and taxonomic composition at the phylum and genus level in each soil type was analysed by rRNA 16 S amplification (PCR), sequencing using Illumina, and comparison with the SILVA database using QIIME2 software. The relationships between soil bacterial taxa and chemical soil properties (pH, electrical conductivity (EC), total organic carbon (TOC), and total nitrogen content (TN)) were also studied, as well as the interrelations between soil bacterial taxa at the genus level or the next upper taxonomic level identified. The organic amendments changed the chemical properties of the restored soils, influencing the microbial communities of the restored soils. CW treatment was the organic amendment that most resembled NS, favouring in the long-term a greater diversity and proliferation of bacteria. Several bacterial communities, more abundant in NA and CW soils, were strongly correlated with each other (Craurococcus, Phaselicystis, Crossiella, etc.), forming a bacterial co-occurrence pattern (Co-occurrence pattern 1). Those bacteria showed high significant positive correlations with TOC, TN, and EC and negative correlations with the soil pH. In contrast, NA soils presented other groups of bacterial communities (Co-occurrence pattern 2) represented by Sphingomonas, Rubellimicrobium, Noviherbaspirillum, Psychroglaciecola and Caenimonas, which showed high significant positive correlations with soil pH and negative correlations with TOC, TN, and EC. The distance-based redundancy analysis indicated that SS soils remained in an intermediate stage of chemical and biological quality between NS and NA soils. Our results demonstrate that soil chemical properties and soil bacterial communities significantly changed with organic amendments in calcareous Mediterranean soils degraded by mining.

Assessing the effectiveness of sustainable land management policies for combating desertification: A data mining approach.

This study investigates the relationship between fine resolution, local-scale biophysical and socioeconomic contexts within which land degradation occurs, and the human responses to it. The research draws on experimental data collected under different territorial and socioeconomic conditions at 586 field sites in five Mediterranean countries (Spain, Greece, Turkey, Tunisia and Morocco). We assess the level of desertification risk under various land management practices (terracing, grazing control, prevention of wildland fires, soil erosion control measures, soil water conservation measures, sustainable farming practices, land protection measures and financial subsidies) taken as possible responses to land degradation. A data mining approach, incorporating principal component analysis, non-parametric correlations, multiple regression and canonical analysis, was developed to identify the spatial relationship between land management conditions, the socioeconomic and environmental context (described using 40 biophysical and socioeconomic indicators) and desertification risk. Our analysis identified a number of distinct relationships between the level of desertification experienced and the underlying socioeconomic context, suggesting that the effectiveness of responses to land degradation is strictly dependent on the local biophysical and socioeconomic context. Assessing the latent relationship between land management practices and the biophysical/socioeconomic attributes characterizing areas exposed to different levels of desertification risk proved to be an indirect measure of the effectiveness of field actions contrasting land degradation.

Acute high-grade acromioclavicular joint injuries treatment: Arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF.

INTRODUCTION: Treatment of acute high-grade acromioclavicular joint (ACJ) injuries with metal hardware alters the biomechanics of the ACJ, implying a second surgery for hardware removal. The period during which the plate is present involves functional limitations, pain and a risk factor for the development of hardware-related-injuries. Arthroscopy-assisted procedures compared to open-metal hardware techniques offer: less morbidity, the possibility to treat associated lesions and no need for a second operation. The aim was to compare the Quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed arthroscopically with a non-rigid coracoclavicular (CC) fixation versus the QoL of patients managed with a hook plate, 24 months or more after their shoulder injury. PATIENTS AND METHODS: A retrospective revision of high-grade ACJ injuries managed in three institutions was performed. Patients treated by means of an arthroscopy-assisted CC fixation or by means of a hook plate were included. The inclusion period was between 2008 and 2012. The QoL was evaluated at the last follow-up visit by means of the SF36, the visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the global satisfaction (scale from 0 to 10). The presence of scapular dyskinesis and remaining vertical instability were evaluated. Comparison between groups was performed. RESULTS: Thirty-one patients were included: 20 arthroscopy-group (ARTH group: 3 Rockwood III, 3 IV and 14 V) and 11 hook plate-group (HOOK group: 5 Rockwood III and 6 V). The mean age was 36 [25-52] year-old for the ARTH group and 41 [19-55] for the HOOK group (P=0.185). The mean results of the questionnaires were: (1) physical SF36 score (ARTH group 58.24±2.16 and HOOK group 53.70±4.33, P<0.001); (2) mental SF36 score (ARTH group 56.15±2.21 and HOOK group 53.06±6.10, P=0.049); (3) VAS (ARTH group 0.40±0.50 and HOOK group 1.45±1.51, P=0.007); (4) DASH (ARTH group 2.98±2.03 and HOOK group 4.79±5.60, P=0.200); (5) Constant score (ARTH group 95.30±2.45 and HOOK group 91.36±6.84, P=0.026); (6) global satisfaction (ARTH group 8.85±0.93 and HOOK group 8.00±1.18, P=0.035). There was evidence of scapular dyskinesis in 15% (3/20) of the patients of the ARTH group and in 18% (2/11) of the patients of the HOOK group (P=1.000). Remaining vertical ACJ instability was observed in 40% (8/20) of the patients of the ARTH group and in 36.36% (4/11) of the patients of the HOOK group (P=1.000). CONCLUSION: Patients with acute high-grade ACJ injuries managed arthroscopically with a non-rigid CC fixation seem to have a better QoL than patients managed with a hook plate. LEVEL OF EVIDENCE: Level IV therapeutic; retrospective comparative study.

Evaluation and selection of indicators for land degradation and desertification monitoring: methodological approach.

An approach to derive relationships for defining land degradation and desertification risk and developing appropriate tools for assessing the effectiveness of the various land management practices using indicators is presented in the present paper. In order to investigate which indicators are most effective in assessing the level of desertification risk, a total of 70 candidate indicators was selected providing information for the biophysical environment, socio-economic conditions, and land management characteristics. The indicators were defined in 1,672 field sites located in 17 study areas in the Mediterranean region, Eastern Europe, Latin America, Africa, and Asia. Based on an existing geo-referenced database, classes were designated for each indicator and a sensitivity score to desertification was assigned to each class based on existing research. The obtained data were analyzed for the various processes of land degradation at farm level. The derived methodology was assessed using independent indicators, such as the measured soil erosion rate, and the organic matter content of the soil. Based on regression analyses, the collected indicator set can be reduced to a number of effective indicators ranging from 8 to 17 in the various processes of land degradation. Among the most important indicators identified as affecting land degradation and desertification risk were rain seasonality, slope gradient, plant cover, rate of land abandonment, land-use intensity, and the level of policy implementation.

Evaluation and selection of indicators for land degradation and desertification monitoring: types of degradation, causes, and implications for management.

Indicator-based approaches are often used to monitor land degradation and desertification from the global to the very local scale. However, there is still little agreement on which indicators may best reflect both status and trends of these phenomena. In this study, various processes of land degradation and desertification have been analyzed in 17 study sites around the world using a wide set of biophysical and socioeconomic indicators. The database described earlier in this issue by Kosmas and others (Environ Manage, 2013) for defining desertification risk was further analyzed to define the most important indicators related to the following degradation processes: water erosion in various land uses, tillage erosion, soil salinization, water stress, forest fires, and overgrazing. A correlation analysis was applied to the selected indicators in order to identify the most important variables contributing to each land degradation process. The analysis indicates that the most important indicators are: (i) rain seasonality affecting water erosion, water stress, and forest fires, (ii) slope gradient affecting water erosion, tillage erosion and water stress, and (iii) water scarcity soil salinization, water stress, and forest fires. Implementation of existing regulations or policies concerned with resources development and environmental sustainability was identified as the most important indicator of land protection.

Resultados del tratamiento percutáneo de las fracturas proximales del húmero en pacientes jóvenes en edad laboral / Results of percutaneous treatment of proximal humeral fractures in patients of working age

Objetivo. Valorar los resultados obtenidos con el tratamiento percutáneo o mínimamente invasivo de las fracturas desplazadas de húmero proximal en una serie de pacientes en edad laboral y buena calidad ósea. Material y métodos. El estudio retrospectivo incluye 90 sujetos tratados en nuestro hospital. Las fracturas se distribuyeron según la clasificación de Neer en 21 fracturas en 2 partes, 44 en 3 partes y 25 en 4 partes. En 5 sujetos hubo luxación asociada. Las fracturas en 3 y 4 partes lo fueron impactadas en valgo y algún caso en varo. Todos los casos se resolvieron mediante cirugía percutánea o mínimamente invasiva, por manipulación de los fragmentos y estabilización con agujas de Kirschner y/o tornillos canulados. Resultados. La valoración se realizó mediante el test de Constant con un resultado promedio de 77. Sufrieron complicaciones 15 pacientes (17%), siendo la más frecuente la necrosis avascular con 4 pacientes (4%). Conclusión. Creemos que en sujetos jóvenes y en edad laboral el tratamiento percutáneo de estas fracturas constituye un método de tratamiento fiable, consiguiéndose en nuestra serie un 92% de reincorporaciones laborales y con escasas complicaciones (AU)

Objective. To evaluate the results obtained with percutaneous or minimally invasive treatment of displaced fractures of the proximal humerus in a series of patients of working age and with good bone quality. Material and methods. The retrospective study included 90 subjects treated in our hospital. The fractures were distributed, according to the Neer classification, into 21 fractures in 2 parts, 44 in 3 parts, and 25 in 4 parts. Five of the subjects had an associated joint dislocation. The fractures in 2 and 3 parts were impacted in valgus and some were in varus. All the cases were resolved with percutaneous or minimally invasive surgery by manipulation of the fragments and stabilising with Kirschner wires and/or cannulated screws. Results. The evaluation was performed using the Constant test, with a mean result of 77. A total of 15 (17%) patients suffered complications, the most frequent being avascular necrosis in 4 patients (4%). Conclusion. We believe that percutaneous treatment of these fractures young subjects of working age is a reliable treatment method, achieving a 92% return to work in our series and with few complications (AU)

Auditorías clínicas del procedimiento de la artroplastia total de cadera y su impacto en la mejora de la calidad asistencial / Clinical audits of the procedure of the total hip arthroplasty and its impact on the improvement of the quality care

Introducción. Las auditorías clínicas son el análisis crítico y sistemático de la calidad de la asistencia médica. La artroplastia total de cadera (ATC) primaria es un proceso habitual y coste-efectivo, aunque se dispone de poca información sobre la calidad asistencial de ella. Objetivo. Evaluar el impacto de un ciclo de auditorías clínicas en la calidad asistencial en el procedimiento de la ATC primaria por enfermedad no traumática. Pacientes y métodos. Se realizó un ciclo de 2 auditorías (primera auditoría en el 2005 y segunda auditoría en el 2007). Se incluyó a pacientes de ambos sexos con ATC primaria por enfermedad no traumática y un seguimiento de 6 meses. Se adoptaron como indicadores de gestión: el tiempo (días) de estancia ingresado en el hospital y el índice (porcentaje) de reingresos, y como indicadores de la práctica clínica: el índice (porcentaje) de luxación y el índice (porcentaje) de infección. Se compararon estos índices entre ambas auditorías. Resultados. Se estudió a un total de 160 pacientes: 79 y 81, primera y segunda auditoría, respectivamente. Indicadores de gestión: la mediana (rango) de los días de ingreso fue 8 (7-78) y 7 (6-16), p<0,001; el porcentaje de reingresos, el 5% (4/79) y 0 (0/81), p=0,057. Indicadores de la práctica clínica: el porcentaje de luxación fue el 8% (6/79) y 0 (0/81), p=0,013; y el porcentaje de infección el 1% (1/79) y el 1% (1/81), p=1. En un análisis multivariante no se encontraron otros factores relacionados con estos indicadores. Conclusiones. La implementación de un ciclo de auditorías clínicas ha mejorado la calidad asistencial del procedimiento de ATC primaria por enfermedad no traumática(AU)

Background. Clinical audits are critical and systematic quality analysis of medical care. Total hip arthroplasty (THA) is a routine practice and cost-effective, although there is little information on the quality of care of it. Objective. To evaluate the impact of a clinical audit cycle in the quality of care in the primary THA procedures for non-traumatic cause. Patients and methods. A series of two audits (first audit in 2005 and second one in 2007) were performed. Patients of both sexes with non-traumatic primary THA and with a follow-up of 6 months were included. Time (days) in hospital stay and the rate (percentage) of readmissions were used as indicators of management; and as indicators of clinical practice: the index (percentage) of dislocation and the rate (percentage) of infection. Both audits were compared with respect to these indicators. Results. A total of 160 patients (79 and 81, first and second audit respectively) were analysed. Management indicators: median (range) of hospital stay was 8 (7-78) and 7 (6-16), p<0.001, and the percentage of readmissions 5% (4/79) and 0 (0/81), p=0.057. Indicators of clinical practice: the rate of dislocation was 8% (6/79) and 0 (0/81), p=0.013, and the rate of infection 1% (1/79) and 1% (1/81), p=1. A multivariate analysis did not find other factors related to these indicators. Conclusions. The implementation of a clinical audit cycle has improved the quality of care of primary THA procedures for non-traumatic cause(AU)

[Clinical audits of the procedure of the total hip arthroplasty and its impact on the improvement of the quality care]. / Auditorías clínicas del procedimiento de la artroplastia total de cadera y su impacto en la mejora de la calidad asistencial.

BACKGROUND: Clinical audits are critical and systematic quality analysis of medical care. Total hip arthroplasty (THA) is a routine practice and cost-effective, although there is little information on the quality of care of it. OBJECTIVE: To evaluate the impact of a clinical audit cycle in the quality of care in the primary THA procedures for non-traumatic cause. PATIENTS AND METHODS: A series of two audits (first audit in 2005 and second one in 2007) were performed. Patients of both sexes with non-traumatic primary THA and with a follow-up of 6 months were included. Time (days) in hospital stay and the rate (percentage) of readmissions were used as indicators of management; and as indicators of clinical practice: the index (percentage) of dislocation and the rate (percentage) of infection. Both audits were compared with respect to these indicators. RESULTS: A total of 160 patients (79 and 81, first and second audit respectively) were analysed. Management indicators: median (range) of hospital stay was 8 (7-78) and 7 (6-16), p<0.001, and the percentage of readmissions 5% (4/79) and 0 (0/81), p=0.057. Indicators of clinical practice: the rate of dislocation was 8% (6/79) and 0 (0/81), p=0.013, and the rate of infection 1% (1/79) and 1% (1/81), p=1. A multivariate analysis did not find other factors related to these indicators. CONCLUSIONS: The implementation of a clinical audit cycle has improved the quality of care of primary THA procedures for non-traumatic cause.

El servicio de atención a domicilio, ¿un recurso para las personas con enfermedad de Alzheimer? / The home care service: a resource for people with Alzheimer's disease?

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d(GA x TC)(n) microsatellite DNA sequences enhance homologous DNA recombination in SV40 minichromosomes.

The genomic distribution of the abundant eukaryotic d(GA x TC)(n) DNA microsatellite suggests that it could contribute to DNA recombination. Here, it is shown that this type of microsatellite DNA sequence enhances DNA recombination in SV40 minichromosomes, the rate of homologous DNA recombination increasing by as much as two orders of magnitude in the presence of a d(GA x TC)(22) sequence. This effect depends on the region of the SV40 genome at which the d(GA x TC)(22) sequence is cloned. It is high when the sequence is located proximal to the SV40 control region but no effect is observed when located 3.5 kb away from the SV40 ori. These results indicate that the recombination potential of d(GA x TC)(n) sequences is likely linked to DNA replication and/or transcription. The potential contribution of the structural properties of d(GA x TC)(n) sequences to this effect is discussed.

The formation of triple-stranded DNA prevents spontaneous branch-migration.

Branch-migration is a fundamental step in the process of DNA recombination that determines the location, and extent, of the exchange between the recombining duplexes. Four-way Holliday junctions assembled in vitro can migrate spontaneously in an uncatalysed reaction that mimics some of the aspects involved in branch-migration. Here, we have analysed the effects of a d(GA.TC)22 and a d(CA.TG)30 sequence on the rate of spontaneous branch-migration. Under most of the experimental conditions assayed, no significant effect was observed. However, the d(GA.TC)22 sequence induces a very strong arrest when branch-migration is performed at low pH, under conditions where the repeated sequence is forming an intramolecular [C(+)T(GA.TC)] triplex. A similar arrest is observed when the recombining duplexes contain intermolecular triplexes arising from the annealing of a d(GA.TC)22 duplex and a d(TC)22 oligonucleotide, indicating that the formation of triplex DNA constitutes a strong barrier for the progression of the Holliday junction. These results are discussed in the context of the possible contribution of triplex DNA to DNA recombination.

Compresión medular por metástasis de partes blandas de hepatocarcinoma / Spinal cord compression due to soft issues metastases of hepatocellular carcinoma

Más del 90% de los hepatocarcinomas celulares (HCC) asientan sobre una hepatopatía crónica. En el momento del diagnóstico, la clínica suele estar en relación con la cirrosis hepática. La diseminación metastásica es poco frecuente siendo la extensión a partes blandas excepcional. Presentamos un paciente de 55 años con cirrosis hepática de etiología alcohólica y hepatocarcinoma que siguió una evolución rápidamente desfavorable, cuya primera manifestación clínica fue una compresión medular debida a la extensión intrarraquídea de una metástasis de partes blandas paravertebrales. La radiografía simple y la gammagrafía ósea eran normales, obteniéndose el diagnóstico mediante RM y estudio anatomopatológico. En la revisión bibliográfica no hemos encontrado referencia alguna sobre compresión medular por metástasis de partes blandas de HCC. Señalamos la necesidad de incluir las metástasis de partes blandas en el diagnóstico diferencial de las raquialgias con radiología y gammagrafía no demostrativas en los pacientes de riesgo, considerando también como tales aquellos afectos de hepatocarcinoma (AU)

Serum sickness-like syndrome due to mosquito bite.

Local inflammatory reactions at the site of a mosquito bite are frequent. Immediate systemic reactions have occasionally been reported. The first case of a patient with relapsing episodes of a serum sickness-like syndrome following mosquito bites is reported herein. A 62-year-old patient came to the emergency room complaining of sudden malaise, chills, fever, headache, cervical lymph node enlargement, arthromyalgia, generalized purpura and leukopenia 6 h after a mosquito bite. He had experienced multiple similar episodes in the last 20 years, also following mosquito bites. Infectious and autoimmune diseases were ruled out. Serum IgE was 9,102 kU/l. Prick test of whole-body Culex pipiens extract was positive. Specific IgE to Aedes communis was 2.25 kU/l. SDS-PAGE immunoblotting of the patient's serum with whole-body C. pipiens extract revealed 43 and 17 kDa IgG-binding proteins and 22 and 17 kDa IgE-binding proteins, neither of which were found with control sera. Skin biopsy was consistent with leukocytoclastic vasculitis. The presence of both mosquito-specific IgE and IgG in the patient's serum suggest a possible cooperative immune response leading to clinical manifestations of serum sickness.

The reported sex and surgery satisfactions of 28 postoperative male-to-female transsexual patients.

From 1980 to July 1997 sixty-one male-to-female gender transformation surgeries were performed at our university center by one author (A.M.). Data were collected from patients who had surgery up to 1994 (n = 47) to obtain a minimum follow-up of 3 years; 28 patients were contacted. A mail questionnaire was supplemented by personal interviews with 11 patients and telephone interviews with remaining patients to obtain and clarify additional information. Physical and functional results of surgery were judged to be good, with few patients requiring additional corrective surgery. General satisfaction was expressed over the quality of cosmetic (normal appearing genitalia) and functional (ability to perceive orgasm) results. Follow-up showed satisfied who believed they had normal appearing genitalia and the ability to experience orgasm. Most patients were able to return to their jobs and live a more satisfactory social and personal life. One significant outcome was the importance of proper preparation of patients for surgery and especially the need for additional postoperative psychotherapy. None of the patients regretted having had surgery. However, some were, to a degree, disappointed because of difficulties experienced postoperatively in adjusting satisfactorily as women both in their relationships with men and in living their lives generally as women. Findings of this study make a strong case for making a change in the Harry Benjamin Standards of Care to include a period of postoperative psychotherapy.

[Spinal cord compression caused by metastasis of soft tissue hepatocarcinoma]. / Compresión medular por metástasis de partes blandas de hepatocarcinoma.

More than 90% of hepatocellular carcinoma (HCC) arise in a chronical hepatitis. When HCC is diagnosed, most of the patients have symptoms in relation to cirrhosis of the liver. Spread metastases are not frequent and the extension to soft tissues is exceptional. We reported a 55 year old patient who had alcoholic cirrhosis and HCC with quickly development. The onset was a spinal cord compression due to soft tissues epidural metastases, seated at paravertebral zone. Plain radiographs and radionuclide bone scans were normal; diagnosis was achieved by magnetic resonance imaging and fine-needle aspiration cytology of the tumor. We have found no bibliographic reference on spinal cord compression due to soft tissues metastases from HCC. We want to point out the importance of including soft tissues metastases in differential diagnosis for radiculopathies with normal radiography and radionuclide scanning in patients at risk, considering also patients with hepatocellular carcinoma.

Use of intralesional verapamil to dissolve Peyronie's disease plaque: a long-term single-blind study.

OBJECTIVES: Multiple conservative therapies for the treatment of Peyronie's disease have been offered with variable and poor response rates. Calcium channel blockers have been shown in vitro and in vivo to inhibit secretion and synthesis of extracellular matrix, including collagen, glycosaminoglycans, and fibronectin, as well as causing increased collagenase and anti transforming growth factor-beta activity. Calcium antagonists, including verapamil, are effective in stimulating the remodeling and degradation of extracellular matrix in tissue by altering the metabolic pathways of fibroblasts. Recently, a pilot study (1994) showed preliminary promising results in treating plaque caused by Peyronie's disease. This randomized single-blind placebo-based study (1994 to 1996) was undertaken to confirm the hypothesis. METHODS: In this randomized single-blind study, 14 patients completed the study and were divided into two groups: the verapamil treatment group (n = 7) or the control saline group (n = 7). Verapamil or saline was injected directly into the Peyronie's plaque once a week for 6 months. Patients were evaluated before and after treatment with duplex ultrasound to confirm the extent of the lesion and to measure volume of the plaque, and by interview and mailed questionnaire 3 months after treatment. Patients being treated with oral calcium antagonists were excluded from the study. RESULTS: A decreased plaque volume was measured in 57% of the verapamil-treated men versus 28% in the control group (P <0.04). Penile curvature demonstrated an improvement trend of 37.71 +/- 9.3 degrees to 29.57 +/- 7.3 degrees in the verapamil-treated patients, but the difference was not significant (P <0.07). Plaque softening was noted in all patients treated with verapamil. There was significant objective improvement in plaque-associated penile narrowing in all patients in the verapamil group. Subjective plaque-associated erectile dysfunction (quality of erection) showed improvement in 42.87% of the verapamil group versus none in the control group (P <0.02). There was no local or systemic toxicity except for an occasional ecchymosis/bruise at the injection site. After a positive clinical response, plaque size, penile angulation, and symptoms continued to improve. Decrease in plaque size was noted in each of the responders in the first 3 months. CONCLUSIONS: This randomized single-blind study suggests that intralesional injection of calcium channel blocker may be a reasonable approach in some selected patients for the treatment of Peyronie's disease with noncalcified plaque and penile angulation of less than 30 degrees. Patients whose plaque failed to respond to intralesional verapamil therapy within 3 months or whose angulation was greater than 30 degrees at presentation were more likely to benefit from surgery.

Results of surgical treatment for abnormal penile curvature: Peyronie's disease and congenital deviation by modified Nesbit plication (tunical shaving and plication).

PURPOSE: We report a modification of the Nesbit plication with partial thickness shaving instead of conventional excision of a wedge of tunica albuginea. The technique minimizes intraoperative bleeding, obviates cavernous tissue damage and improves adhesion of plicated tunical layers. MATERIALS AND METHODS: Between September 1988 and September 1994, 32 patients underwent modified plication repair of chordee secondary to Peyronie's disease (26) or congenital penile deviation (6). The results were evaluated in the spring of 1996. RESULTS: Mean age plus or minus standard deviation was 55 +/- 8.8 years for patients with Peyronie's disease and 27 +/- 6.85 years for those with congenital penile deviation. Mean duration of Peyronie's disease was 22 +/- 9 months. Eight patients complained of erectile dysfunction and penile curvature. Plication for congenital deviation (6 patients) resulted in 100% satisfaction with the surgical result. Of the 26 men with Peyronie's disease 19 (78%) reported a good to excellent outcome. With prolonged followup (1 to 5 years) 7 patients had recurrent curvature due to progression of disease, including 5 with mild curvature who were able to have intercourse, in contrast with 2 who had severe early recurrence of deformity (more than 30 degrees) within 1 year postoperatively and underwent a second modified plication with good clinical outcome. Six of 32 patients with peyronie's disease were unable to resume satisfactory coitus with a postoperative straight penis. All 6 patients had concomitant poor erections preoperatively as shown by nocturnal peniletumescence and rigidity testing and 5 of them resumed regular intercourse with intracavernous pharmacotherapy. CONCLUSIONS: Long-term results of this modified plication demonstrate excellent clinical outcome with minimal morbidity.

The correlation between the new RigiScan plus software and the final diagnosis in the evaluation of erectile dysfunction.

PURPOSE: The computer generated recordings for 2 nights in 40 patients studied with the RigiScan device were reevaluated using the new RigiScan Plus software to test its value in improving the discrimination between psychogenic and organic erectile dysfunction. MATERIALS AND METHODS: Each man was evaluated for erectile dysfunction with a detailed medical and sexual history, physical examination, biothesiometry, plethysmography, 2 nights of ambulatory RigiScan monitoring and a psychological evaluation that usually included a private interview with the sexual partner. At the conclusion of evaluation each patient was broadly classified as having organic or psychogenic erectile dysfunction. The RigiScan reports were initially independently analyzed without the investigator's knowledge of the final diagnosis by determining the single best erectile event, with a minimal cutoff value of 60% erection for 5 minutes as necessary to be considered normal and the sum of measurements from the 2 nights. The original reading and final diagnosis were correlated. At this point the data were processed with the new RigiScan Plus software using 2 new measurements: 1) rigidity activity units and 2) tumescence activity units at the base and tip of the penis, and the results were correlated with the final diagnosis. RESULTS: Evaluation of the single best event again showed that tip rigidity was the best single predictor if the diagnostic criteria were modified to 70% tip rigidity for 5 minutes with an estimate of correct classification of 92.5%. Nearly the same accuracy was obtained by base single event rigidity, tip rigidity and base tumescence activity units (each 90%). The summary analysis of all erectile events during the 2 nights of evaluation that had a low correlation with the final diagnosis using the original software showed that the best overall predictor of final diagnosis was tip tumescence activity units (92.5%), followed by base rigidity and tumescence activity units (each 90%). CONCLUSIONS: The RigiScan Plus software introduced 4 new parameters that facilitate interpretation of the RigiScan data. The new software did not improve the correlation with the final diagnosis compared to the subjective single best event analysis but added new objective parameters, measured and displayed by the software, that facilitate use of the data by the physician.

[Detailed evaluation of sexual function after radical prostatectomy: is patient satisfaction correlated with the quality of erections?]. / Evaluation détaillée de la fonction sexuelle après prostatectomie radicale: la satisfaction des patients est-elle corrélée à la qualité des érections?

INTRODUCTION: Post radical prostatectomy potency rates, quantified on the basis of physician survey, have ranged up to 80%. Physician derived potency data, however, may not be representative of true post-prostatectomy potency rates or more importantly may not accurately portray patients' post-operative sexual satisfaction. We conducted a pilot study combining physician derived and patient derived subjective data with objective measures of erectile function. MATERIALS AND METHODS: Eleven men, mean age of 59 years, who were treated with nerve sparing radical retropubic prostatectomy formed the study group. Initially, the patients responded to a physician directed telephone survey on sexual status. Potency was then objectively assessed utilizing Rigiscan testing on two consecutive evenings. Lastly, the patients completed a validated short questionnaire directed to obtain a patients' subjective perception of sexual function. RESULTS: All the patients responded to the first part of the study by informing the physician that they were sexually active or potent after radical prostatectomy. Of these 11 patients, however, only 2 (18%) were mostly satisfied with their sex life according to the quality of life questionnaire. Rigiscan testing revealed that 8 of the 11 patients had nocturnal erections which were adequate for vaginal penetration. Of the 5 patients who stated that they were mostly dissatisfied with their sexual functioning, 3 had objective evidence of adequate erectile ability as documented by Rigiscan. Three of the four patients who were ambivalent with respect to their sexual function also demonstrated objective evidence of normal erectile activity. CONCLUSION: Although a patient may inform his care provider that he is sexually active or potent, he may not be satisfied with his present level of sexual functioning. In addition, we observed that some dissatisfied patients do have normal Rigiscan patterns indicating that a percentage of patients who are not happy with their level of sexual function after radical prostatectomy may have a psychogenic component to their problem.