Homocysteine levels in schizophrenia patients newly admitted to an acute psychiatric ward.

OBJECTIVE: After the discovery of 'homocystinuria syndrome', many studies have suggested that high blood levels of homocysteine may be associated with schizophrenia. The aim of this study was to analyse the association between hyperhomocysteinaemia and schizophrenia. METHODS: In a population of inpatients suffering from exacerbated schizophrenic disorders (N=100), we evaluated homocysteine levels the day after their admission to an acute psychiatric ward and compared it with that of a non-patient control group (N=110), matched for age and gender. We statistically analysed the correlation between homocysteine levels and selected variables: gender, age, years of illness and number of previous psychiatric admissions as well as Brief Psychiatric Rating Scale, Positive Negative Syndrome Scale and Global Assessment Functioning (GAF) Scores. RESULTS: We observed elevated homocysteine levels (an increase of 7.84 µM on average per patient) in 32% of the patients, but we did not find any statistically significant difference between the homocysteine levels of our patients and controls. Hyperhomocysteinaemia presented a positive statistically significant correlation with years of illness (p<0.005) and a negative statistically significant correlation with GAF score (p<0.001), but not with other clinical variables. CONCLUSIONS: Hyperhomocysteinaemia, which occurred in our schizophrenia patients with poor social and relational functioning after many years of illness, could represent an effect of altered lifestyle due to psychosis, but not a specific marker for schizophrenia.

An open-label, randomized, flexible-dose, crossover study to assess the comparative efficacy and safety of sildenafil citrate and apomorphine hydrochloride in men with erectile dysfunction.

INTRODUCTION: We report the methodology and results of a study that compared a dopaminergic agonist, apomorphine, with a phosphodiesterase type-5 inhibitor, sildenafil, in terms of efficacy, tolerability, satisfaction and patient preference. PATIENTS AND METHODS: This was a 20-week open- label, randomized, flexible-dose, crossover study to assess the comparative efficacy and safety of sildenafil and apomorphine. One sequence group received treatment with sildenafil followed by apomorphine and the other sequence group received treatment with apomorphine followed by sildenafil. The primary efficacy variable was the measurement of the score of the erectile function domain (the sum of questions 1-5 and 15) of the International Index of Erectile Function (IIEF) questionnaire. The secondary efficacy variables were: the responses to the Global Efficacy Assessment Questions; the score of the responses to all the questions of the IIEF questionnaire; the index score of the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, and the event log variables. RESULTS AND CONCLUSIONS: A marked increase in the mean IIEF score was observed after treatment with sildenafil, compared with a small increase following treatment with apomorphine. The mean baseline and final scores before and after treatment with sildenafil were 13.9 +/- 5.2 and 24.1 +/- 5.2, while the corresponding mean scores before and after treatment with apomorphine were 14.2 +/- 5.1 and 16.8 +/- 6.2. The comparison between treatments showed a statistically significant difference in favor of sildenafil. Furthermore, sildenafil was found to be significantly superior to apomorphine in all the other secondary variables, produced a high level of patient satisfaction, and a significantly larger number of patients indicated their preference for sildenafil compared to apomorphine.

Male to female gender reassignment: modified surgical technique for creating the neoclitoris and mons veneris.

INTRODUCTION: The principal goal of surgical techniques for male to female gender reassignment is to provide aesthetic and functional external female genitalia. AIM: To present a new surgical technique which permits a safer and faster construction of the neoclitoris and the configuration of a natural-looking mons veneris. MAIN OUTCOME MEASURES: The neoclitoris sensitivity was reported by the patients themselves and checked during the follow-up medical examination. In order to define the degree of the patients' satisfaction with the mons veneris appearance, we used a simple questionnaire. METHODS: From April 2004 to February 2007, 26 patients underwent male to female sex reassignment surgery. The new technique was applied in the last 15 cases. A strip of albuginea, with the penile dorsal neurovascular bundle and a little portion of glans, was prepared, bended on itself, and fixed in the suprapubic area in order to create the mons veneris and the neoclitoris. RESULTS: This technique was easy to perform, permitting the safe preservation of the penile dorsal neurovascular bundle and a reduction in the operation time of 30-45 minutes. No major complications occurred in this series. Neoclitoris trophism and sensitivity were preserved in all patients. At follow-up, ranging from 3 to 20 months, the genital appearance was satisfactory, and the neoclitoris was pleasantly sensitive after a short period of hypersensitivity. Moreover, seven patients reported some form of climax during intercourse. The technical outcome was successful in all cases. The patients' satisfaction was extremely high for the neoclitoris sensitivity (present in all patients) and high in 11 out of 15 for the appearance of the mons veneris. CONCLUSIONS: The neoclitoris and mons veneris configuration with a strip of albuginea is a new, safe, and time-saving surgical procedure. The cosmetic appearance and function of transsexual female external genitalia appears to be improved by using this technique.

Evaluation of sexual function with an international index of erectile function in subjects taking finasteride for androgenetic alopecia.

OBJECTIVE: To evaluate variations in sexual and erectile function in subjects taking 1 mg of finasteride for androgenetic alopecia by administering the abridged 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire before and during treatment. DESIGN: In a multicenter study, 186 patients with androgenetic alopecia were asked to complete the IIEF-5 regarding the domain of erectile function before (at baseline) and 4 to 6 months after beginning finasteride treatment. The test was self-administered. SETTING: The study was conducted in 7 institutional dermatology departments in Italy (Bologna, Rome, Genoa, Cagliari, Milan, Florence, and Bari). PATIENTS: A total of 186 patients with androgenetic alopecia were evaluated before and 4 to 6 months after the initiation of finasteride therapy (1 mg). All patients (age range, 19-43 years; mean age, 28.3 years) were followed up as outpatients. RESULTS: The score on each of the 5 domains of the IIEF-5 did not show any significant change after 4 to 6 months of treatment. CONCLUSIONS: Our results support the clinical impression that sexual side effects are actually much less common than reported in clinical trials. The sexual function of all patients remained stable during treatment with 1 mg of finasteride.