[Psychogenic erectile dysfunction and phosphodiesterase inhibitors type 5].

In the literature, much of the attention is focused on the organic erectile dysfunction (ED) rather than on psychogenic one. This article analyses the causes and mechanisms of psychogenic ED. It outlines the issues of diagnosis, therapy and specific features of using phosphodiesterase inhibitors type 5 in the management of psychogenic ED.

[Effect of herpes simplex virus on spermatogenesis].

To investigate the effect of Herpes Simplex virus (HSV) on spermatogenesis, HSV in ejaculate was detected by a rapid cultural method in 268 infertile males and 47 healthy ones. The number of mobile spermatozoa in HSV infected samples was less than in non-infected samples (21 mln/mlversus 40 mln/ml, p = 0.0001). The relative number of morphologically normal gametes was 13% versus 19% (p = 0.002), respectively. The quantitative karyological test discovered that males with HSV-infected ejaculate have more degenerating sex cells while in high virus contamination (more than 10 virus particles in 1 ml) the number of spermatides and spermatocytes of the 1 order at diploten stage is low. Organic testicular culture was used for more detailed study of pathogenetic mechanisms of HSV impact on spermatogenesis. Testicular explants infection was associated with reduction in the number of spermatogones, spermatocytes and spermatides on culturing week 2. The above findings reveal some pathogenetic mechanisms underling fertility disorders in males with HSV infection: a gametotoxic effect of the virus reducing populations of spermatogones, spermatocytes and spermatide; affected mobility and morphological characteristics of spermatozoa. Detection of the mechanisms of HSV action on spermatogenesis opens a perspective of antivirus drug administration in combined treatment of male infertility.

[Premature ejaculation: diagnosis, classification, algorithm of the patients' examination and results of their application].

We have analysed literature data and own experience with management of premature ejaculation (PE) in 3200 patients. This gave grounds for formulation of this phenomenon, creation of the classification and the examination algorithm. We applied the proposed methods in the treatment of 258 PE patients and made the conclusion about their adequacy and efficacy. PE is a polyetiological phenomenon and a multidisciplinary problem. Urological examination must be used as the first stage of the diagnostic process.

[Longidase in the treatment of chronic prostatitis].

Twenty eight patients with documented chronic prostatitis (CP) received standard therapy (a control group) while a study group of 28 patients received standard therapy plus a 10 longidase injections in a dose of 3000 IU. Treatment results showed that longidase is highly effective in bacterial and abacterial CP. Longidase addition to standard therapeutic methods significantly reduced the disease symptoms and regression of inflammatory-proliferative alterations in the prostate. Thus, a domestic drug longidase is effective and safe in CP. It can be widely used in combined therapy of CP.

[A new pathogenetic approach and a method of erectile dysfunction treatment and prevention--modulated erectile oxygenation of penile cavernous tissue]. / Novyi patogeneticheskii podkhod, a takze sposob lecheniia i profilaktiki érektil'noi disfunktsii - moduliruemaia erektil'naia oksigenatsiia kavernoznoi tkani polovogo chlena.

The analysis of sexual activity of 185 male Muscovites has revealed an age-related sharp progressive shortening of adequate and spontaneous erections. A novel, pathogenetically sound approach and a method of therapy and prevention of erectile dysfunction has been developed (RF patent N 2228754). The method, called "Modulated Erectile Oxygenation of Penile Cavernous Tissue" (MEOPCT), consists in erection activation by behavioral measures and/or erectogenic drugs which induce adequate, nocturnal spontaneous and/or artificial erections adequate in frequency and duration for providing such oxygenation of cavernous bodies that warrants maintenance of their normal structure and function. There is no continuous close correlation between sexual activity and erections, on the one side, and ejaculation and orgasm, on the other side. Application of MEOPCT in 43 patients demonstrated the method ability to improve erection and cavernous hemodynamics without negative side effects.

An unusual cause for ketoacidosis.

A 22-year-old male developed a severe degree of metabolic acidosis (plasma pH 7.20, bicarbonate 8 mmol/l), with a large increase in the plasma anion gap (26 mEq/l). Ketoacidosis was suspected because of the odour of acetone on his breath and a positive qualitative test for acetone in plasma (to a 1:4 dilution). Later, his plasma beta-hydroxybutyrate concentration was found to be 4.5 mmol/l. After receiving an infusion of 1 l of half-isotonic saline and 1 l of 5% dextrose in water over 24 h, as well as curtailing his large oral intake of sweetened beverages, all blood tests became normal. Diabetic ketoacidosis, alcoholic ketoacidosis, starvation ketosis and hypoglycaemic ketoacidosis were all ruled out, and his toxin screen was negative for salicylates. Finding another possible cause for ketoacidosis became the focus of this case.

[Method of penile scintigraphy]. / Metodika fallostsintigrafii.

A method of phalloscintigraphy, based on the gamma camera and computerized data processing, is offered. The results of examination of patients are described.

[Clinical effectiveness of beta-adrenoblockers and their effects on copulative function in patients with hypertension]. / Klinicheskaia éffektivnost' i vliianie beta-adrenoblokatorov na kopuliativnuiu funktsiiu u bol'nykh s arterial'noi gipertenziei.

Twenty four hour blood pressure and ECG monitoring, assessment of sexual function (questionnaires, penile artery Doppler flowmetry) were carried out in male hypertensives treated with atenolol, metoprolol, or bisoprolol. Compared with atenolol and metoprolol bisoprolol was found to be more effective and safe. The use of bisoprolol was associated with no negative changes and even with improvement of some parameters of sexual function. Sildenafil could be used for correction of male sexual dysfunction occurring during treatment with other beta-blockers.

[Yohimbine in the treatment of erectile dysfunction]. / Iokhimbin v terapii érektil'noi disfunktsii.

Iochimbin hydrochloride was given to 153 men with erectile dysfunction. The results are available for 140 of them. The ability of iochimbin in a single dose of 5-10 mg to enhance arterial blood inflow to cavernous bodies of the penis was confirmed by dynamic angiopenoscintigraphy and Doppler ultrasonography. Iochimbin hydrochloride in a mean daily dose of 15-20 mg proved effective in erectile dysfunction--38 to 84% responders depending on the type of erectile dysfunction. Occasional side effects can be relieved by reducing the drug dose.

[A system of comprehensive assessment of symptoms in chronic prostatitis (CAS-XII)]. / Sistema summarnoi otsenki simptomov pri khronicheskom prostatite (COC-XII).

The system proposed for overall assessment of symptoms in chronic prostatitis was applied in the assessment of 75 patients. The system facilitates detection and analysis of the complaints, quantitates the disease symptoms, provides overall objective characteristics of all the multiplicity of clinical manifestations of chronic prostatitis in each patient by means of digital order. The system is rather effective for dynamic control of the patients' condition and treatment efficacy.

[Assisted reproductive technologies in urology]. / Vspomogatel'nye reproduktivnye tekhnologii v urologii.

Since 1996 the authors have examined and treated 42 infertile married couples (the husbands had azoospermia). To obtain spermatozoa directly from the testes or epididymis and subsequent ICSI, 42 patients underwent 53 interventions: TESE (n = 38), PESA (n = 10), MESA (n = 5). Spermatozoa were obtained from 32(76.1%) of 42 patients, fertilization occurred in 21(50%) cases, 10(23.8%) wives got pregnant. Assisted reproductive technologies expand potentialities of correcting severe forms of male infertility including azoospermia. The armory of the operative procedures in male infertility was replenished with MESA, TESE, PESA.

Application of pressure steps to mechanosensitive channels in membrane patches: a simple, economical, and fast system.

Mechanosensitive channels (MSCs) have been described in a wide variety of cells, but the molecular mechanisms that couple membrane tension or deformation to channel activity (i.e., mechanotransduction) are not understood. The ability to measure the dynamics of the temporal relationship between the pressure stimulus and the channel response is a key tool for gaining insight into mechanotransduction. Several laboratories have designed pressure clamps, but these instruments are complex, costly, and not commercially available. This paper describes a simple and inexpensive system for applying fast pressure steps to a membrane patch. This system is easy to build and achieves submillisecond 20% to 80% step response times on par with the fastest pressure clamp described. Application to a stretch-activated non-selective cation channel in the kidney is used to demonstrate the system.

KCNA10: a novel ion channel functionally related to both voltage-gated potassium and CNG cation channels.

Our laboratory previously cloned a novel rabbit gene (Kcn1), expressed in kidney, heart, and aorta, and predicted to encode a protein with 58% amino acid identity with the K channel Shaker Kv1.3 (Yao X et al. Proc Natl Acad Sci USA 92: 11711-11715, 1995). Because Kcn1 did not express well (peak current in Xenopus laevis oocytes of 0.3 microA at +60 mV), the human homolog (KCNA10) was isolated, and its expression was optimized in oocytes. KCNA10 mediates voltage-gated K(+) currents that exhibit minimal steady-state inactivation. Ensemble currents of 5-10 microA at +40 mV were consistently recorded from injected oocytes. Channels are closed at the holding potential of -80 mV but are progressively activated by depolarizations more positive than -30 mV, with half-activation at +3.5 +/- 2.5 mV. The channel displays an unusual inhibitor profile because, in addition to being blocked by classical K channel blockers (barium tetraethylammonium and 4-aminopyridine), it is also sensitive to inhibitors of cyclic nucleotide-gated (CNG) cation channels (verapamil and pimozide). Tail-current analysis shows a reversal potential shift of 47 mV/decade change in K concentration, indicating a K-to-Na selectivity ratio of at least 15:1. The phorbol ester phorbol 12-myristate 13-acetate, an activator of protein kinase C, inhibited whole cell current by 42%. Analysis of single-channel currents reveals a conductance of approximately 11 pS. We conclude KCNA10 is a novel human voltage-gated K channel with features common to both K-selective and CNG cation channels. Given its distribution in renal blood vessels and heart, we speculate that KCNA10 may be involved in regulating the tone of renal vascular smooth muscle and may also participate in the cardiac action potential.

Close association of the N terminus of Kv1.3 with the pore region.

The Shaker superfamily encodes voltage-gated potassium (Kv) channels. The N termini of Shaker proteins are located intracellularly and contain several domains shown to regulate important aspects of channel function, such as speed of inactivation, channel assembly (T1 domain), and steady state protein level (T0 domain, amino acids 3-39 in rabbit). Mutations and/or deletion of certain amino acids in the T0 domain lead to a 13-fold amplification of Kv current as compared with wild type channels, primarily by increasing the absolute number of channel proteins present in the membrane (Segal, A. S., Yao, X., and Desir, G. V. (1999) Biochem. Biophys. Res. Commun. 254, 54-64). Although T0 mutants have kinetic properties virtually indistinguishable from wild type, they were noted to have a slightly larger single channel conductance, suggesting that the T0 domain might also interact with the pore region. In the present study we show that although T0 does not affect pore selectivity, it does modulate the binding affinity of the pore blocker, charybdotoxin. These results suggest that the N terminus of Kv1.3 is closely associated with the pore region.

The T0 domain of rabbit KV1.3 regulates steady state channel protein level.

The Shaker superfamily encodes voltage-gated potassium (Kv) channels. The amino (N) terminus is important for channel assembly and mediates fast inactivation. We recently isolated a Kv channel from rabbit kidney, denoted rabKv1.3 (Yao et al., J. Clin. Invest. 97, 2525-2533, 1996) and found that deleting a region (T0 domain, amino acids 3-39) proximal to the T1 recognition domain (a.a 42-185) leads to a 13-fold amplification of Kv current as compared to wild type channels (Yao et al., BBRC 249, 492-498). Here we show that deleting the T0 domain affects neither single channel conductance nor channel open probability. Instead, it increases the absolute number of channel proteins present in the membrane. We conclude that the T0 domain is a previously unrecognized Shaker Kv1.3, N-terminal regulatory region that modulates steady state channel protein density in the plasma membrane.

[Male reproductive function after inguinal hernia]. / Reproduktivnaia funktsiia muzhchin posle pakhovogo gryzhesecheniia.

Reproductive function and treatment results have been analysed for 59 patients aged 17 to 32 years after herniotomy. 28 and 31 of them underwent standard and endosurgical interventions, respectively. The control group consisted of 30 healthy males matched for age. As shown by 6-month follow-up, the endosurgical herniotomy was not associated with such complications as hydroscheocele, hydrocele, testicular atrophy, diminution of blood flow along the testicular arteries. Ejaculate, levels of sex hormones in the blood, cremasteric reflex remained intact. After routine herniotomy there appeared defects in scrotal and testicular microcirculation with partial testicular atrophy in 25% of cases, testicular circulation fell 2.2-2.5-fold, deterioration of spermogram and cremasteric reflex parameters, reduction of serum testosterone were observed.

Case studies in cholera: lessons in medical history and science.

Cholera, a prototypical secretory diarrheal disease, is an ancient scourge that has both wrought great suffering and taught many valuable lessons, from basic sanitation to molecular signal transduction. Victims experience the voluminous loss of bicarbonate-rich isotonic saline at a rate that may lead to hypovolemic shock, metabolic acidosis, and death within afew hours. Intravenous solution therapy as we know it was first developed in an attempt to provide life-saving volume replacement for cholera patients. Breakthroughs in epithelial membrane transport physiology, such as the discovery of sugar and salt cotransport, have paved the way for oral replacement therapy in areas of the world where intravenous replacement is not readily available. In addition, the discovery of the cholera toxin has yielded vital information about toxigenic infectious diseases, providing a framework in which to study fundamental elements of intracellular signal transduction pathways, such as G-proteins. Cholera may even shed light on the evolution and pathophysiology of cystic fibrosis, the most commonly inherited disease among Caucasians. The goal of this paper is to review, using case studies, some of the lessons learned from cholera throughout the ages, acknowledging those pioneers whose seminal work led to our understanding of many basic concepts in medical epidemiology, microbiology, physiology, and therapeutics.

[A scale for the quantitative evaluation of male copulative function (the MCF scale)]. / Skala kolichestvennoi otsenki muzhskoi kopuliativnoi funktsii (shkala MKF).

A scale of total quantitation of male copulative function (MCF) is offered to facilitate the diagnosis and monitoring of MCF abnormalities, control of MCF correction. The scale is based on normal values provided by statistical data on sexual activity of males and its age-related changes. The patient is asked to answer 13 questions of the questionnaire listed under the numbers I-XIII. Each question has 6 variants of answer having the score 0 to 5. The patient is to choose one variant and write down his choice. Such MCF scale is able to identify both sexual disorder and defects in components of the copulative cycle. The scale was applied 89 times to study sexual function of 68 males aged 24-77 years. The scale findings and those of a comprehensive clinical examination coincided. The scale was found useful in evaluation of male copulative function as a whole and by components, for analysis of the detected disorders, differentiation between psychogenic factor and primarily organic one, for ascertaining attitude of the patient to his sexual dysfunction.