The prevalence of erectile dysfunction in men visiting outpatient clinics.

The prevalence of erectile dysfunction (ED) in men visiting outpatient clinics was analyzed using data reported by 1352 randomly chosen physicians who were requested to interview five to 20 consecutive patients aged >or=40 years about the presence of ED. A total of 25.12% of the physicians returned the questionnaires, containing data on 3552 patients, of whom 42.7% had ED, 44.9% had no ED and 12.4% declined to answer the questions. The duration of ED was <1 year in 8.1% of patients, 1-2 years in 32.2% and >2 years in 59.7% of patients. 86.4% of men with ED had >or=1 chronic disease. ED was present in 70.3% of men with coronary heart disease, 67.8% of those with hypertension, 78% of those with diabetes and 70.5% of patients with psychiatric diseases. 93.2% of patients with ED used one or more drugs chronically. In conclusions, 42.7% of men visiting outpatient clinics had ED. Patients with ED often had one or more chronic diseases and used at least one drug chronically. Older patients are less inclined to talk to their physicians about sexual problems.

Leptin messenger ribonucleic acid (mRNA) content in the human placenta at term: relationship to levels of leptin in cord blood and placental weight.

During fetal life, placental tissue represents an additional source of leptin for the mother and conceptus. It has been suggested that feto-placental production of leptin may be involved in placental and fetal growth regulation. The aim of this study was to examine the correlation between leptin mRNA expression in the placenta and the concentrations of leptin in cord blood. A total of 30 healthy, pregnant women who gave birth to healthy neonates were included in the study. Maternal blood (obtained from the cubital vein) and umbilical cord blood were drawn immediately after birth. Serum leptin concentration was determined by enzyme-linked immunosorbent assay and serum insulin concentration was measured by radioimmunoassay. Leptin mRNA was measured in placental tissue by a reverse transcriptase-polymerase chain reaction. The estimated mean leptin mRNA expression in placenta was 4.65 +/- 1.83 pg mRNA/microg DNA. Leptin mRNA correlated with cord serum leptin concentrations (r = 0.3691, p = 0.045). Placental weight correlated with placental leptin mRNA (r = 0.3686, p = 0.045). The mean leptin concentration in cord serum at birth was slightly lower (3.1 +/- 1.9 ng/ml) than that found in maternal serum (3.9 +/- 1.2 ng/ml). A positive correlation was observed between cord and maternal serum leptin levels (r = 0.58, p = 0.001). The mean insulin concentration in maternal serum was not significantly higher than that in umbilical serum: 22.2 +/- 17.8 microIU/ml vs. 6.9 +/- 3.6 microIU/ml; r = 0.069, p = 0.71). Neither maternal nor umbilical insulin concentrations correlated with leptin concentration in cord or maternal peripheral serum.

Retrospective analysis of cardiovascular outcomes in patients with type 2 diabetes mellitus after the first acute myocardial infarction.

We retrospectively analyzed survival in patients with type 2 diabetes mellitus (DM) after first acute myocardial infarction (AMI). The study was conducted in 5 sites in Poland and involved 521 patients who survived more than 30 days after AMI. In the 5-year period after the acute event, we investigated the following cardiovascular (CV) outcomes: death (overall mortality), next MI, stroke, hospitalization due to acute coronary symptoms (HACS), and composite outcomes (whichever occurred first). We also assessed: age, smoking habit, obesity, hypertension, dyslipidemia and coronary artery disease (CAD) diagnosed before AMI, and gender. 269 patients (52%) suffered one of the outcomes from the composite CV endpoint. HACS was the first event in 164 cases, MI in 59, death in 32, and stroke in 14 patients. Analyzing the prevalence of individual CV events, we found: HACS in 184 patients (35%), next MI in 79 patients (15%), death in 59 patients (11%), and stroke in 30 patients (6%). Only dyslipidemia, arterial hypertension, and CAD were independent risk factors with an impact on composite CV endpoint. Other analyzed risk factors like smoking and obesity did not have independent effects on the CV risk. In the retrospective analysis, we found that HACS was the most frequent CV event in individuals with type 2 DM after AMI. The CV risk in type 2 diabetics who suffered at least one myocardial infarction was further increased in those with coexisting dyslipidemia, arterial hypertension or CAD. These findings support the current guidelines which recommend aggressive management of CV risk factors including hypertension, dyslipidemia and CAD before a first myocardial infarction.

A comparative study of cefaclor vs. amoxicillin/clavulanate in tonsillopharyngitis.

BACKGROUND: Acute pharyngotonsillitis (APT) is one of the most common inflammatory processes of adults and children in an outpatient setting. Increasing failure rates, hypersensitivity to penicillin, the required multiple daily doses and common side effects lead to poor patients compliance and thus inadequate treatment duration, providing therefore ground for considering alternative antimicrobial agents. MATERIAL AND METHODS: This multicenter, randomized, single blind study was undertaken in order to compare efficacy and safety of cefaclor (375 mg BID) and amoxicillin/clavulanate (625 mg BID) in 10 days treatment regiment of ambulatory patients with APT. A total of 200 patients (age range between 12-65 years) with symptoms of APT and positive antigen strep test were enrolled into the study. Clinical and bacteriological responses were assessed after the end of treatment (14th-18th day) and at the follow-up visit (38th-45th day). All GABHS strains, isolated from throat cultures, were tested for in vitro sensitivity to the antibiotics used in the study and no strain was found resistant to both antibiotics. RESULTS: The results indicated that both antibiotics had high--almost 99% effectiveness at the post therapy visit. On the follow up visit an increased tendency of relapses was observed in the amoxicillin/clavulanate treated group, compared to cefaclor treated group (8.33% vs 3.29%). Relative risk of relapse in patients treated with amoxicillin/clavulanate was 2.6 greater compared to cefaclor. There were significantly higher rates of gastrointestinal adverse events in group treated with amoxicillin/clavulanate (29/97 patients; 29.89%) compared to cefaclor (16/95 patients; 16.84%) - p< 0.03. Frequency of other adverse events did not differ significantly between the groups. CONCLUSIONS: Cefaclor and amoxicillin/clavulonate provide a clinically and bacteriologically effective treatment for patients with pharyngotonsillitis caused by GABHS, but cefaclor treatment is significantly safer in regard to gastrointestinal side effects.

Vertebral fractures: a hidden problem of osteoporosis.

Osteoporosis is a progressive skeletal disease, which in many cases remains silent and asymptomatic until a fracture occurs. Vertebral fractures are the earliest and most common osteoporotic fractures. The prevalence of vertebral fractures increases steadily with age, ranging between 20% for 50-year-old postmenopausal women to 64.5% for older women. The majority of vertebral fractures are not connected with severe trauma, and only one in three is diagnosed clinically. Usually vertebral fractures are associated with such clinical symptoms as back pain, posture change, loss of height, functional impairment, disability, and diminished quality of live. Women with the most severe vertebral fractures are the most likely to incur further fractures, with as much as 3.4 times the risk of hip fracture, and 12.6 times the risk of new vertebral fractures. Almost 20% of women will experience another fracture within 1 year after a vertebral fracture. Vertebral fractures are accompanied by increased mortality. The relative risk of death following vertebral fracture is almost 9 times higher. The most important purpose of osteoporosis management in postmenopausal women is prevention of the first vertebral fracture. Raloxifene (Evista) is the only SERM approved by the American FDA for the treatment and prevention of osteoporosis. It is the first compound with selective estrogen agonist activity in bone and in the cardiovascular system, but with estrogen antagonist activity or no activity in reproductive tissues and breast. Raloxifene reduces the risk of positive estrogen receptor breast cancer, decreases total cholesterol and LDL cholesterol, increases HDL cholesterol, does not increase the risk of endometrial cancer or cause bleeding and spotting. After 3 years of treatment Raloxifene reduces the risk of first vertebral fracture by 55%. The fracture risk within one year is reduced by as much as 68%. Continued observation has proved its sustained efficacy in the further reduction of fracture risk by 49% in the fourth year. Raloxifene treatment does not change the physiological structure of bone quality and does not cause fibrosis, osteomalacia or other toxic effects.

[Luteal and follicular phase inhibin A and B in regularly cycling women]. / Inhibina A oraz inhibina B fazy follikularnej oraz lutealnej cyklu u kobiet w piatej dekadzie zycia.

OBJECTIVE: To investigate the level of inhibin A nad B in luteal and follicular phase in women of reproductive age. PATIENTS: Seventy women 39-52 years of age with regular menstrual cycle. INTERVENTIONS: Blood samples obtained on days 3-8 and on days 22-25 of menstrual cycle were assayed for FSH, estradiol, inhibin A, inhibin B. RESULTS: Luteal and follicular phase inhibin B was correlated inversely with age. Luteal phase inhibin A was correlated inversely with follicular phase FSH. CONCLUSION: Main form of inhibin in follicular phase of the cycle is inhibin B and in luteal phase inhibin A. Inhibin B can be potential marker of ovarian aging.

[Barlow's syndrome--personal studies]. / Zespól Barlowa--badania wlasne.

Symptoms of Barlow's syndrome were analysed in 60 patients. The diagnosis is described as a plenty of disturbances in the circulatory system. Observed arrhythmias were often one of the important symptoms.

[The effect of hypotensive drugs on left ventricular mass and diastolic function]. / Wplyw leków hipotensyjnych na mase miesnia i funkcje rozkurczowa lewej komory serca.

Chronic left ventricular hypertrophy (LVH) is associated with depressed contractile performance, abnormal compliance of the chamber, and ultimately, the development of a left ventricular failure. Thus the presence of LVH carries a particularly ominous prognosis in patients with essential hypertension. Finally, regression of LVH appears to be a worthwhile goal of an antihypertensive therapy along with blood pressure control. Of particular importance, is whether the functional derangements associated with hypertrophy will also be reversed. The present study was undertaken to determine whether antihypertensive therapy reduced ventricular mass, and whether these changes were accompanied by improved diastolic function. 47 patients with mild-to-moderate essential hypertension were divided into two groups. Group I--included 21 patients whose blood pressure responded to nifedipine monotherapy. Group II--included 26 patients whose normalization of blood pressure required combined therapy with nifedipine and metoprolol. 40 healthy volunteers comprised a control group. To assess the effects of antihypertensive therapy on the heart, left ventricular mas (LVM), systolic and diastolic function, by M-mode, 2-D and pulsed wave Doppler echocardiography had been evaluated. Measurements were performed before therapy and every 3rd month during first year, and every 40th month during the second year of observation. RESULTS. At baseline all hypertensive patients had significantly increased LVM compared to the controls. Indexes of systolic function in studied patients were normal, while indexes of LV diastolic filling were significantly abnormal compared to the controls. In the group treated with nifedipine, starting from the 9th month of observation, small but significant decrease in posterior wall thickness was noted but LVM did not change during the whole time of the observation. Similarly, there was no significant change in indexes of left ventricular diastolic filling. Contrary to patients treated with nifedipine, in group of patients treated with combination of nifedipine and metoprolol, significant reduction of LVM and improvement of LV diastolic filling was observed. Of particular interest was the fact, that improvement in diastolic, performance appeared earlier, and preceded regression of LVM. Most striking was the improvement in Ev/Av ratio which increased by 16% after 6 months and by 35% after 24 months of the therapy. CONCLUSION. 1. Combined therapy with nifedipine and metoprolol contrary to monotherapy with nifedipine alone, results in the regression of left ventricular mass and the improvement of left ventricular diastolic function. 2. Improvement of left ventricular diastolic function appears earlier, preceding the regression of left ventricular hypertrophy.

[Propafenone, flecainide, procainamide in the treatment of a fresh attack of atrial fibrillation]. / Propafenon, Flekainid i prokainamid w leczeniu swiezego napadu migotania przedsionków.

The purpose of the present work was an assessment of the effectiveness of intravenously administered propafenone, flecainide and procainamide in restoration of sinus rhythm in patients with atrial fibrillation attack lasting not more than 48 hours, The studies were carried out in 95 patients, including 30 treated with propafenone, 27 with flecainide, and 38 with procainamide. Propafenone turned out to be effective in 23 patients (76.7%), flecainide in 19 patients (70.4%), and procainamide in 14 patients (36.8%). Each of the drugs more effectively restored sinus rhythm in patients with smaller size of the left atrium and with shorter duration of atrial fibrillation attack, and propafenone and flecainide were also more effective in younger patients. The return of sinus rhythm was accompanied a reduction of the size of the left atrium. None of the studied drugs caused any more important adverse effects.

[Interaction of captopril and digoxin]. / Interakcja kaptoprilu i digoksyny.

Interaction of digoxin and captopril was studied in 28 men with congestive heart failure of II class NYHA. Blood serum digoxin level was about 30% higher following the administration of captopril.

[Tests concerning the usefulness of serum myoglobin levels for the diagnosis of reperfusion in patients with imminent myocardial infarction]. / Badania nad przydatnoscia oznaczen stezenia mioglobiny w surowicy w rozpoznawaniu reperfuzji u chorych na zagrazajacy zawal serca.

Blood myoglobin, CPK and CK-MB activities were assayed in 32 patients with the acute myocardial infarction up to 360 minutes following the start of thrombolytic therapy. Plasma myoglobin, CPK and CK-MB activities increased significantly less in 18 patients in whom reperfusion of the coronary artery has been noted. Maximum increase in myoglobin levels preceded an increase in CPK and CK-MB activities and it may be an early marker of reperfusion.

[Effect of treatment with propranolol or pindolol on the left ventricular myocardium mass in patients with slight essential arterial hypertension]. / Wplyw leczenia propranololem lub pindololem na mase miesnia lewej komory serca u chorych na nadcisnienie tetnicze pierwotne stopnia lekkiego.

The effect was studied of 8 weeks of treatment with propranolol and pindolol on the left-ventricular myocardium mass, left-ventricular myocardium mass index, plasma renin activity, and serum aldosterone and total catecholamine concentrations. The studies were carried out in 72 patients with essential arterial hypertension of slight degree. A statistically significant decrease was shown of the left-ventricular myocardium mass, left-ventricular myocardium mass index, plasma renin activity, and aldosterone concentration in all studied patients. A decrease of total catecholamine concentration appeared in patients treated with propranolol. Weaker effect of pindolol on the studied parameters may be connected with its intrinsic sympathicomimetic activity. A correlation was shown between the decrease of the left-ventricular myocardium mass, and the decrease of systolic arterial blood pressure.

[Echocardiographic test of dipyridamole in recognition of coronary artery disease]. / Echokardiograficzna próba dipirydamolowa w rozpoznawaniu choroby niedokrwiennej serca.

To assess the feasibility, safety and usefulness of dipyridamole stress echocardiography for the detection of coronary artery disease we evaluated 194 patients (124 men, 70 women) with effort chest pain. All patients underwent electrocardiographic submaximal bicycle exercise testing and 2-dimensional echocardiography after dipyridamole injection. Echocardiographic test was considered positive when new wall motion abnormalities were observed after dipyridamole i.v. injection (0.56 mg/kg b.m.). Sensitivity and specificity of electrocardiographic exercise test and dipyridamole stress echocardiography were assessed in 37 persons who underwent selective coronary angiography. The sensitivity and specificity of dipyridamole stress echocardiography, were respectively 85.0% and 91.7% and were higher than those of exercise electrocardiography. 2-dimensional echocardiography after dipyridamole injection is a well tolerated, feasible and effective test in the diagnosis of coronary artery disease.

[Examination of the usefulness of echocardiography with dobutamine for diagnosis of coronary disease]. / Badania nad przydatnoscia echokardiograficznej próby dobutaminowej w rozpoznawaniu choroby niedokrwiennej serca.

To assess the feasibility, safety and usefulness of dobutamine stress echocardiography for the detection of coronary artery disease we evaluated 63 patients (45 men, 18 women) with effort chest pain. All patients underwent electrocardiographic submaximal bicycle exercise testing and 2-dimensional echocardiography during dobutamine infusion. Echocardiographic dobutamine test response was considered positive when new wall motion abnormalities were observed during dobutamine infusion. Sensitivity and specificity of electrocardiographic exercise test and dobutamine stress echocardiography were assessed in 25 patients who underwent selective coronary angiography. The sensitivity and specificity of dobutamine stress echocardiography, respectively 93.3% and 83.3%, were higher than those of exercise electrocardiography. 2-dimensional echocardiography during dobutamine infusion is a well tolerated, feasible and effective test for detecting coronary artery disease.