Secondary medical prevention among Danish patients hospitalised with either peripheral arterial disease or myocardial infarction.

OBJECTIVE: We compared the use of secondary prevention among patients with a first-time hospitalisation for peripheral arterial disease (PAD) of the lower limb with that among patients with a first-time hospitalisation for myocardial infarction (MI). DESIGN AND MATERIALS: Population-based follow-up study between 1997 and 2003 using registry data from the counties of Northern Jutland, Aarhus and Viborg, Denmark. RESULTS: Between 1997 and 2003, within 180 days after hospital discharge, 26% of patients with lower limb PAD (n=3,424) used antiplatelet drugs, 10% statins, 22% ACE-inhibitors/AT-II receptor antagonists and 13% betablockers compared with 55%, 46%, 42% and 78% respectively among patients with MI (n=11,927). Patients with PAD were substantially less likely than patients with MI to use antiplatelet drugs [adjusted relative risk (RR)=0.39 (95% confidence interval (CI): 0.36-0.41)], statins [adjusted RR=0.21 (95% CI: 0.19-0.23)], ACE-inhibitors/AT-II receptor antagonists [adjusted RR=0.43 (95% CI: 0.40-0.47)] and beta-blockers [adjusted RR=0.10 (95% CI: 0.09-0.11). Between 1997 and 2003 secondary prevention increased considerably in both patient groups, but the disparity in treatment persisted. CONCLUSIONS: Efforts to further increase secondary prevention among patients with PAD are needed urgently.

[Infusion cavernosography and erectile dysfunction]. / Infusionskavernosografi og erektiv dysfunktion.

Infusion cavernosography with the object of quantitating the rate of venous drainage from the penis and localization of possible abnormities in drainage was employed as a routine investigation in examination of erectile dysfunction in 46 patients. "Infusion to obtain erection" (IOE) and "infusion to maintain erection" (IME) were determined. In five patients, IOE was found to be greater than 180 ml/minute which was considered to be diagnostic of venous leakage. Infusion cavernosography could be assessed in 31 patients. Filling of the glans with the radio-opaque medium was found before rigidity was obtained in 27 whereas, in 19 filling of the glans occurred after rigidity was obtained. No localizing fistulae were demonstrated. It is concluded that routine employment of infusion cavernosography in investigation of impotence is unnecessary. Filling of the glans with the radio-opaque medium in infusion cavernosography does not appear to be a sign of a cavernoso-spongious fistula but rather a physiological phenomenon.

Vesico-ureteral reflux. I. Renal function and morphology in relation to anamnestic and urodynamic parameters.

Hundred and one children aged 12 years or less were consecutively referred with non-neurogenic vesico-ureteral reflux. None of the patients were previously operated for reflux. Based on the degree of reflux and the degree of nephropathy judged from urograms or renoscintigrams the patients were assigned an index defined as the sum status of both nephro-ureteric units. We found no correlation between VUR index, nephropathy index and GFR on one side, and bladder function parameters (spontaneous voiding, cystometry, bladder activity during sleep) on the other. Further, no correlation was found to history concerning urinary tract infections or enuresis the year before admittance. Possible reasons for the lack of correlation are discussed.

Vesico-ureteral reflux. II. The longterm outcome of kidney function in non-surgical treatment.

Seventy one patients were included in a prospective study of non-surgical treatment of vesico-ureteral reflux (VUR). We found 111 refluxing ureters, with 20 grade 1, 4 grade 2, 41 grade 3, 5 grade 4 and 1 grade 5. There was no correlation between presenting symptoms and degree of VUR or nephropathy, or between renal function in terms of glomerular filtration rate. During followup the patients were treated with long-term low-dose antibiotic prophylaxis and voiding disorders were corrected pharmacologically or by micturitional training. With a median follow up time of 6 years (3-10) 63% of the patients had cessation or down grading of VUR, irrespective of initial VUR degree. There was no correlation between cessation rate and urodynamic parameters, GFR, history of enuresis or previous urinary infections. The study supports a non-surgical attitude towards VUR patients irrespective of VUR degree, with prophylaxis of urinary infections and possibly correction of voiding disorders.

Pharmacologically induced prolonged erections produced by papaverine. Follow-up of injection therapy.

Over a 27 months period papaverine induced erections were routinely used in the treatment of erectile dysfunction (ED). A total of 53 patients, 29 with neurogenic, 20 with arteriogenic, one with a combined arteriogenic/neurogenic ED and 4 with ED of uncertain etiology, in total used 1149 injections, of which 1069 (93%) produced erections with a rigidity sufficient for vaginal penetration. Fifteen patients discontinued treatment during the observation period. Nine patients experienced sustained erections on 16 occasions; all cases were managed by aspiration of blood and/or injection of adrenergic drugs. Penile indurations occurred in three cases, one of which resolved spontaneously. Papaverine induced erections was found to be an effective and well tolerated tool in the treatment of erectile dysfunction.