Relation of Postexercise Reduction of Arterial Blood Pressure and Erectile Dysfunction in Patients with Coronary Heart Disease.

Penile erection is a hemodynamic process consisting of 2 synchronized components in which the first (active) requires proper vascular endothelium functioning, whereas the second one (passive) is based on a veno-occlusive mechanism. Antihypertensive treatment reduces the passive component, often leading to the development of erectile dysfunction (ED), but lifestyle modifications can improve the sexual functioning. The study aimed to evaluate the association between blood pressure (BP) reduction caused by cardiovascular training and the intensity of ED in men with coronary heart disease. A total of 101 men (mean age 59.50 ± 7.93) with ED treated invasively for coronary heart disease and subjected to cardiac rehabilitation were enrolled. Patient characteristics, the International Index of Erectile Function 5 (IIEF-5) questionnaire (IIEF-5), and BP values were collected at baseline and after 6 months of cardiac rehabilitation and were analyzed. Cardiac rehabilitation led to a significant reduction of 5.08 mm Hg in systolic BP (p <0.001) and of 1.60 mm Hg in diastolic BP (p <0.001). The IIEF-5 score (EQ) significantly increased (median 15, interquartile range 11 to 19 vs median 18, interquartile range 12 to 21, p <0.001). Greater improvement in sexual performance was significantly negatively correlated with age, concentration of triglycerides, and high-density lipoprotein, whereas it was positively correlated with the presence of diabetes and baseline IIEF-5 score. After excluding patients with diabetes, a greater decrease in systolic BP was found to be significantly associated with greater improvement in erectile performance. In conclusion, a reduction of arterial BP caused by cardiac training is accompanied by improvement in erectile performance. This effect is the strongest in patients with hypertension and those with dyslipidemia.

Tolerance of combined radiochemotherapy in cervical cancer patients.

BACKGROUND: Radiochemotherapy in cervical cancer was implemented to clinical practice based on 5 randomized clinical trials, published at the end of the 20th century, which showed improvement in the total and symptomless survivals by about 10-18%. The increase of therapeutic index of such treatment can take place only when the efficiency of the treatment outweighs the increase of its toxicity. Thus, it is necessary to monitor treatment reaction during radiochemotherapy. OBJECTIVES: The aim of this study was to assess the acute post-radiation reaction during radiochemotherapy for cervical cancer and the to analyze the reasons of the unplanned course of combined treatment. MATERIAL AND METHODS: A group of consecutive 176 cervical cancer patients in the clinical stage from IB to IIIB acc. to FIGO classification who underwent radiochemotherapy were taken under prospective observation in Clinical Gynecologic Radiotherapy Ward of the Lower Silesian Cancer Center in Wroclaw between April 2010 and September 2012. Early post-radiation reaction was assessed in RTOG/EORTC scale once a week. RESULTS: During the treatment early post-radiation reaction of upper part of alimentary duct was observed in 74.4% of the patients, the reaction of lower part of gastrointestinal tract in 51.2%, and in bladder 44.8%. The most frequent symptoms of post-radiation reaction are: nausea (73.3% of the patients), diarrhea (51.2%) and vomiting (20.9%). Leucopenia was observed in 97.1% of the patients, granulocytopenia in 70.4%, anemia in 69.2%, and thrombocytopenia in 25.5%. The planned dose of radiotherapy was administered completely in 90.1% of the patients. A break in radiotherapy was necessary in 15.7% of the patients. In total, 44.8% of the patients did not receive radiochemotherapy according to the plan, because of the side effects of the treatment (most often leucopenia, thrombocytopenia and gastrointestinal reaction). CONCLUSIONS: The presented data shows that radiochemotherapy causes the intensification of acute side effects of treatment and may cause unplanned course of treatment and prolongation of the total treatment time.

Sexual health of male cardiac patients - present status and expectations of patients with coronary heart disease.

INTRODUCTION: Due to the pathogenetic association between erectile disorders and cardiovascular diseases, cardiologists consult many patients with erectile dysfunction (ED). The aim of the study was to evaluate sexual function in patients with coronary heart disease (CHD) and the use of sexual knowledge in cardiology practice, both current use and that expected by patients. MATERIAL AND METHODS: One thousand one hundred and thirty-six patients (average age: 60.73 ±9.20) underwent a dedicated survey which encompassed demographic data and the presence of modifiable ED risk factors. The presence of ED was assessed using the International Index of Erectile Function (IIEF-5) Questionnaire. RESULTS: Sexual problems were discussed by cardiologists with 45 (3.96%) patients. The frequency of initiating the topic was significantly associated with the respondents' education level (p = 0.0031); however, it was not associated with the patients' age, duration of CHD, presence of ED, or modifiable risk factors. Four hundred and sixteen (36.62%) respondents indicated that they expect their cardiologist to take an interest in their ED. Nine hundred and twenty-six (81.51%) patients claimed good sexual function to be important or very important to them. Attitude to sexual function was significantly associated with age (p < 0.0001), duration of CHD (p = 0.0018), education (p = 0.0011), presence of ED (p = 0.0041), diabetes (p = 0.0283) and hyperlipidaemia (p = 0.0014). CONCLUSIONS: The low frequency with which cardiologists initiate the topic of ED is in contrast to the expectations of patients with CHD. The majority of these patients regard good sexual maintenance as an important part of their life.

Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease.

OBJECTIVE: Heart rate recovery (HRR) is a recognised marker used in clinical practice for assessing the risk of sudden cardiac death. Physical exercise leads to an improvement in HRR and has a proven beneficial effect on erection quality (EQ) related to the activity of the autonomic nervous system in men with ischaemic heart disease (IHD). This paper evaluates the relationship between HRR and EQ in patients with IHD and erectile dysfunction (ED) who underwent cardiac rehabilitation. METHODS: The main analysis was based on the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman correlation coefficient, Pearson's chi-square test, chi-square test, with the Yates correction and (if possible) parametric tests were used. This prospective, non-randomised intervention study included 124 men with IHD and ED [International Index of Erectile Function (IIEF-5) scores of ≤21]. Of these, 89 patients underwent a 6-month cardiac rehabilitation phase III programme, whereas 35 did not. The results of the participants' total IIEF-5 scores and their HRR, demographic and clinical data were analysed. RESULTS: The results of the 89 rehabilitated patients (mean age: 60.44±9.29 years) and 35 controls (mean age: 61.43±8.81 years) were analysed. In the rehabilitated patients, the mean baseline IIEF-5 score was 13.15±5.76 (95% CI: 11.93-14.36) and HRR was 16.49±7.68/min (95% CI: 14.88-18.11). After cardiac rehabilitation, the parameters of ED and HRR improved significantly and were significantly higher than those of the controls; the mean IIEF-5 score of the rehabilitated group increased to 15.36±6.51 (95% CI: 13.99-16.73), while HRR increased to 21.40±7.25/min (95% CI: 19.88-22.93). A significant correlation was found between ∆HRR and ∆EQ (r=0.409791) as a result of the 6-month cardiac training programme. CONCLUSION: Cardiac rehabilitation assessed by HRR has a sizable effect on autonomic balance in patients with IHD and ED, which plays a significant role in the mechanism of erection improvement.

[The value of the cytocins and the solubility of theirs receptors in the serum of the patients with the cervical cancer]. / Wartosc oznaczania wybranych cytokin i ich rozpuszczalnych receptorów w surowicy chorych na raka szyjki macicy.

The study encompassed 146 women with recognized invasive cervical cancer in 4 clinical stages. Patients underwent therapy in Oncologic Gynaecology Department of Wroclaw Medical University in 2001 and 2002 years. The correlation between pretreatment serum level of proangiogenic and inflammation factors--VEGF, sTNF-R1, IL-6 and clinical stage or early effects of therapy were observed. The strong and statistically significant relationship between pretreatment serum level of IL-6 and sTNF-R1 and clinical stage with early effect of treatment were found. The statistically significant correlation between serum level of all investigated parameters and clinical stage of cervix cancer was noticed. VEGF wasn't an independent prognostic factor in the study, but the prognostic value of IL-6 was demonstrated.

[Distribution of extrema on body surface isointegral maps in RBBB]. / Lokalizacja ekstremów na powierzchniowych mapach izointegralnych w bloku prawej odnogi peczka Hisa.

The investigations were undertaken in order to assess the characteristic features of the isointegral maps obtained from the patients demonstrating on the standard ECG complete and incomplete right bundle branch block (RBBB). The body surface potential mapping (BSPM) procedure was performed using Fukuda Denshi system enabling to record electrocardiographic signals simultaneously from the 87 leads arranged over anterior and posterior thoracic surfaces. The isointegral maps of QRST, QRS, early portion of QRS complex (from QRS onset to R wave peak), and of late portion of QRS (from R wave peak to QRS offset) were created. The distribution of extrema (maxima and minima) was found to be specific for RBBB cases and the characteristic differences between RBBB group and the controls were observed.