Evaluating the content and quality of information about premature ejaculation on the Internet: what are men being exposed to ?

Premature ejaculation is one of the most common male sexual dysfunctions; however, only a few patients with premature ejaculation are seeking professional help or advice. Internet has become an important source of knowledge, and thus, more patients are looking online for health information. According to our best knowledge, no study has evaluated the content and quality of websites on premature ejaculation. We, therefore, aimed to evaluate the content and quality of currently available Internet-based information on premature ejaculation. A sample was obtained comprising the 50 top sites retrieved from Google, Bing and Yahoo search engines using the terms 'premature ejaculation'. Each site then was reviewed based on some predefined evaluation criteria to determine the general quality, condition-specific content quality, popularity index and ownership. The websites reviewed were differed highly in terms of quality and ownership. Only a few sites provided comprehensive medical and complete information on premature ejaculation. The online information available is often of uncertain calibre; therefore, men are being exposed to information about premature ejaculation with a highly variable degree quality. This fact should be considered both by health professionals and website owners, and better online resources should be provided for these patients.

Application of autogenous periosteum as a membrane in sinus lifting.

AIM: To evaluate the success level of autogenous periosteum in sinus lifting as a barrier membrane which contributes positively to wound healing and is effective in bone formation without the risk of tissue rejection. MATERIALS AND METHODS: In this study, 32 male New Zealand rabbits were used and were divided into four groups, in which eight rabbits were placed randomly. Sinus lifting with lateral window technique was applied bilaterally to all rabbits. In the first group, the upper face of the graft materials applied was left open. In the second group, the removed bone walls were placed back over the graft materials. In the third group, synthetic membranes were placed over the graft materials. In the fourth group, the autogenous periosteums obtained from tibias of the rabbits were placed over the graft materials. After 6 weeks, the rabbits in all groups were sacrificed, and the operated regions were examined histologically, and stereological assessments were conducted regarding new bone formation, connective tissue, and osteoblasts. RESULTS: After a 6-week recovery period, synthetic membrane showed the highest success rate regarding new bone formation. Autogenous periosteum, which achieved the second highest success rate regarding new bone formation, was the first in the number of osteoblasts. CONCLUSION: Autogenous periosteum was considered to have the potential to be an alternative to synthetic membranes.

Partial priapism secondary to tamsulosin: a case report and review of the literature.

Partial priapism is also called partial segmental thrombosis of the corpus cavernosum. It is a rare pathology, and its aetiology, physiopathology and treatment are still not completely understood. To our knowledge, partial priapism due to alpha blockers has not been reported previously in the literature. In this study, a successfully treated case of partial priapism occurring after the usage of alpha blocker is presented and discussed in light of the related literature.

Relationship between DNA damage and total antioxidant capacity in patients with glioblastoma multiforme.

AIMS: To assess oxidative DNA damage and total antioxidant capacity (TAC) in glioblastoma multiforme (GBM) and to compare the results with normal brain tissues. MATERIALS AND METHODS: Oxidative DNA damage and TAC were evaluated in GBM tissues extracted from 26 patients and in normal brain tissues of 15 subjects who underwent autopsy within the first 4h of death. Oxidative DNA damage was assessed by measuring 8-hydroxy-2-deoxyguanosine (8-OH-dG) using the 8-OH-dG enzyme immunoassay kit, a quantitative assay for 8-OH-dG, and TAC was analysed using the ImAnOx colorimetric test system for the determination of antioxidative capacity. The results were compared between two groups and any correlation between 8-OH-dG and TAC was sought. RESULTS: The median level of TAC in GBM (121.5 nmol/g wet tissue) was remarkably lower than that in normal brain tissue (298 nmol/g wet tissue). The difference was statistically significant (P=0.00001). In contrast, oxidative DNA damage was significantly higher in patients with GBM (74.9 ng/g wet tissue) than in controls (34.71 ng/g wet tissue). Again, the difference was statistically significant (P=0.00001). We also found a negative correlation between oxidative DNA damage and TAC (P<0.001). CONCLUSIONS: These findings indicate that the degree of oxidative DNA damage is increased and TAC is decreased in GBM. Oxidative DNA damage is correlated with the levels of TAC.

Serum and cerebrospinal fluid concentrations of E-selectin in patients with aneurysmal subarachnoid hemorrhage.

The goal of the present study was to determine concentrations of E-selectin in both cerebrospinal fluid (CSF) and serum of patients with aneurysmal subarachnoid hemorrhage (SAH) and to evaluate the correlation between the clinical parameters and E-selectin levels. Both CSF and serum samples obtained from 12 patients with aneurysmal SAH and 8 patients with hydrocephalus (control group) without any other known central nervous system disease were assayed for E-selectin by quantitative enzyme-linked immunosorbent assay and the results were compared between the two groups. Mean levels of soluble forms of E-selectin within the first 3 days and on the 5th and 7th days of SAH were 4.0 +/- 7.9, 2.8 +/- 5.2, and 3.1 +/- 4.9 ng/ml in the patient's CSF, and 33.7 +/- 9.2, 35.1 +/- 7.0, and 35.2 +/- 8.7 ng/ml in serum, respectively. In contrast, mean E-selectin levels were 0.1 +/- 0.2 ng/ml in CSF and 8.7 +/- 5.0 ng/ml in serum of control patients. The difference between groups was statistically significant regarding both CSF and serum E-selectin levels (P < 0.05). Thus, we have demonstrated a marked increase of E-selectin concentration in both CSF and serum of patients with aneurysmal SAH compared with control and suggest that blocking the interaction between E-selectin and vascular endothelium may have a beneficial effect on vasospasms.

A comparison of the clinical profile of cavernous malformations with and without associated venous malformations.

OBJECTIVE: Little is known about the clinical behavior of cavernous malformations (CMs) associated with venous malformations (VMs) of the brain. The aim of this study is to compare the clinical profile of patients harboring CMs with and without associated VMs. METHODS: A retrospective analysis of 55 consecutive patients harboring CMs of the brain who presented to a single neurovascular team during a 4-year period was performed. Forty-two patients (76%) had CMs alone (CM group), and 13 patients (24%) had CMs associated with VMs (CM + VM group). Detailed clinical information regarding each patient was gathered. Statistical analysis was performed using Fisher's exact test for binary variables and Mann-Whitney U test for continuous variables. RESULTS: The lesion location was infratentorial for 19 of the 70 CMs (27%) in the CM group and for 14 of the 21 CMs (67%) in the CM + VM group (P = 0.001). Familial histories of CMs were documented for 7 of the 42 patients (17%) in the CM group and none of the 13 patients in the CM + VM group. There was a female-to-male gender bias of 1.6:1 in the CM group and 3.3:1 in the CM + VM group. Sixteen of the 42 patients (38%) in the CM group and 8 of the 13 patients (62%) in the CM + VM group presented with symptomatic hemorrhage. Seizure presentation was documented in 11 of the 42 patients (26%) in the CM group and in 1 of the 13 patients (8%) in the CM + VM group. Repeated symptomatic hemorrhage was diagnosed in 4 of the 42 patients (9.5%) in the CM group and in 3 of the 13 patients (23%) in the CM + VM group. There were no apparent differences in the mean age at presentation, lesion size, or multiplicity between the two groups. CONCLUSION: Patients with CMs associated with VMs are more likely to be female patients, have associated symptomatic hemorrhage, have lesions in the posterior fossa (statistically significant), suffer from repeated symptomatic hemorrhage, and are less likely to present with seizures or to have familial histories when compared with patients with CMs alone. The possible mechanisms for these apparent differences in clinical profile are discussed.

Impact of Guglielmi detachable coils on outcomes of patients with intracranial aneurysms treated by a multidisciplinary team at a single institution.

OBJECT: The goal of this study was to investigate the impact of the introduction of the Guglielmi detachable coil (GDC) therapeutic option on the overall management outcome of intracranial aneurysms. The authors accomplished this by assessing patient morbidity and mortality, inflation-adjusted hospital charges, lengths of stay in the hospital and the intensive care unit (ICU), and treatment efficacy. METHODS: The authors conducted a retrospective analysis of consecutive cases of intracranial intradural aneurysms managed by a single multidisciplinary neurovascular team at a tertiary care, academic referral center during the 24 months preceding the introduction of the GDC procedure (Group I or pre-GDC era, 77 patients) and during the first 24 months after its introduction (Group II or GDC era, 99 patients). Treatment with GDCs was considered for cases of higher clinical grade or poor surgical risk, or in response to patient preference (27 [27%] of 99 patients in Group II). Host and lesion parameters in our cohort were validated against outcome parameters by using univariate and multivariate analyses. The pre-GDC and GDC subgroups of patients were comparable for major disease severity parameters (patient age, lesion location, clinical grade, and hemorrhage severity). There was no significant difference in clinical outcome at 6 months, infarcts on computerized tomography scanning, or aneurysm obliteration rates before and after introduction of GDC treatment. Decreasing trends in duration of hospital and ICU stay and in inflation-adjusted hospital charges occurred well before and thus were unrelated to the introduction of the GDC therapeutic option. CONCLUSIONS: The results of this study do not demonstrate any significant impact of integration of the GDC modality on clinical outcome, mortality, morbidity, or effectiveness of treatment. Ongoing improvements in hospital charges and length of hospital stay appeared unrelated to the introduction of the GDC option.

Iniencephaly: neuroradiological and surgical features. Case report and review of the literature.

Iniencephaly is a rare congenital anomaly characterized by spina bifida of the cervical vertebrae, fixed retroflexion of the head on the cervical spine, and occipital bone defect. There are only five reports of surviving patients with iniencephaly. The authors report the case of a newborn who presented with iniencephaly and an encephalocele that were surgically treated in our service. Neurological examination of the patient yielded normal results except for a moderate psychomotor retardation. The neuroradiological and surgical findings of the case suggested that the trigger of the anomaly was the occipital bone defect and rachischisis of the posterior vertebral arches.

Intramedullary tuberculous abscess: a case report.

STUDY DESIGN: This case report shows an intramedullary thoracic spinal cord abscess secondary to Mycobacterium tuberculosis in a 7-year-old boy with chronic progressive paraparesis and hypesthesia below T10. OBJECTIVES: The treatment of this patient involved drainage of pus followed by appropriate chemotherapy. SUMMARY OF BACKGROUND DATA: Abscess and tuberculomas of the spinal cord are rare entities. They are indistinguishable from neoplasms. The possibility of tubercular abscess or granuloma should be kept in mind when an intraspinal mass is found, provided that the clinical history is unusual for tumor. METHODS: A left T7-T8 hemilaminectomy was performed. A quantity of pus was drained through a small myelotomy. A small specimen was taken, and antituberculosis treatment was given after surgery. RESULTS: Excellent clinical outcome was obtained with a combination of medical and surgical management. CONCLUSION: The treatment of intramedullary abscess consists of surgical evacuation of the pus. Appropriate treatment offers a favorable prognosis even in cases with severe deficits.

Is it possible to recover from uncal herniation? Analysis of 71 head injured cases.

BACKGROUND: Uncal herniation (UH) caused by head trauma may become a fatal process if not treated rapidly. METHODS: We analysed the factors affecting the outcome in 71 surgically treated patients who had intracranial haematoma diagnosed by computerized tomography (CT), between January 1987 and June 1994 with the symptoms of UH. Age, incident-treatment interval, Glasgow Coma Scale (GCS), type of the lesion and the presence of polytrauma were correlated with Glasgow Outcome Scales (GOS) using SPSS PC+ statistical software. RESULTS: 49.3% of our patients were referred because of a fall from a height and 46.5% because of a motor vehicle accident. 12.7% of the patients were polytraumatized. The mean GCS of the series was 5.662. The mean GCS of the patients expired and who were in good recovery state were 4.8 and 6.9 respectively. Age, presence of polytrauma, type of the lesion and time interval between the incident and the treatment was found to be statistically insignificant when correlated with GOS. The correlation value between the GCS values and GOS was found to be highly significant (p < 0.00001). CONCLUSIONS: The findings showed that the degree of the herniation is the most important factor that affects the prognosis of the patients with UH. The reversibility of UH becomes more difficult if there are complications added during the grades of its progression but it may not be necessarily fatal and be reversible if appropriate interventions are rapidly performed.

Effects of sildenafil and vardenafil treatments on sleep quality and depression in hemodialysis patients with erectile dysfunction.

ED is prevalent in hemodialysis (HD) patients, and closely related to poor sleep and depression. Efficacy of treating ED either with sildenafil or vardenafil has been shown to be beneficial in ameliorating concomitant depression in non-HD patients. It is yet to be shown whether treatment of ED with a PDE-5 inhibitor would improve poor sleep in HD patients. We aimed to compare the effects of sildenafil and vardenafil on sleep quality and depression in HD patients with ED. A total of 32 maintenance HD patients with ED randomized into two groups to receive either sildenafil or vardenafil for 4 weeks. After a 2-week washout and a crossover, each group received the other drug for another 4-week period. Sleep quality and depression were evaluated via post-sleep inventory (PSI) and Beck's depression inventory (BDI), respectively, at baseline and at the end of the treatment. Sildenafil and vardenafil both improved PSI and BDI scores significantly compared with pretreatment values. However, there was no difference between sildenafil and vardenafil with respect to these parameters. PDE-5 inhibitors, sildenafil and vardenafil, caused a significant improvement in sleep quality and depression in this cohort of HD patients with ED.

Intrathecal gadolinium-enhanced MR cisternography in the evaluation of CSF leakage.

BACKGROUND AND PURPOSE: Radiologic identification of the location of the CSF leakage is important for proper surgical planning and increases the chance of dural repair. This article describes our experience in analyzing clinically suspected cranial CSF fistulas by using MR imaging combined with the intrathecal administration of a gadolinium-based contrast agent. MATERIALS AND METHODS: A total of 85 consecutive patients with suspected CSF fistulas who presented with persistent or intermittent rhinorrhea or otorrhea lasting for more than 1 month between 2003 and 2007 were included in this study. RESULTS: We observed objective CSF leakage in 64 of 85 patients (75%). The CSF leak was located in the ethmoidal region in 37 patients (58%), in the superior wall of the sphenoid sinus in 8 patients (13%), in the posterior wall of the frontal sinus in 10 patients (15%), in the superior wall of the mastoid air cells in 6 patients (9%), and from the skull base into the infratemporal fossa in 1 patient (2%). Two patients (3%) showed leakage into >1 paranasal sinus. CONCLUSIONS: MR cisternography after the intrathecal administration of gadopentate dimeglumine represents an effective and minimally invasive method for evaluating suspected CSF fistulas along the skull base. It provides multiplanar capabilities without risk of radiation exposure and is an excellent approach to depict the anatomy of CSF spaces and CSF fistulas.

Serum hyaluronidase levels in patients with aneurysmal subarachnoid haemorrhage.

INTRODUCTION: The purpose of this study was to investigate the time course(s) of the serum hyaluronidase levels in patients with aneurysmal subarachnoid haemorrhage and to show whether there is a correlation between symptomatic vasospasm and serum levels of hyaluronidase. METHODS: This prospective, open, non-randomised clinical study consisted of 20 patients with aneurysmal subarachnoid haemorrhage, and eight patients with normotensive hydrocephalus who served as the control group. Serum hyaluronidase levels were detected within the first three days, days five and seven after aneurysmal subarachnoid haemorrhage, and the results were compared with those from the control group. The results were also compared with those of the clinical parameters, including the patient's outcome at six months and symptomatic vasospasm. RESULTS: Mean serum hyaluronidase levels were higher on days five and seven, and comparisons with either day five (p-value is 0.001) and/or day seven (p-value is 0.00001) showed a statistical difference between subarachnoid haemorrhage and controls. However, no relationship was found between elevated serum hyaluronidase levels and the clinical parameters including symptomatic vasospasm (p-value is greater than 0.05) and outcome at sixth months (p-value is greater than 0.05). CONCLUSION: Our results indicate that serum hyaluronidase is elevated in the acute stage(s) of subarachnoid haemorrhage; however, no difference was found between serum hyaluronidase levels and subarachnoid haemorrhage severity. Clinical studies with larger population of patients with aneurysmal subarachnoid haemorrhage are required.

The role of mebendazole in the surgical treatment of central nervous system hydatid disease.

Although hydatid disease is the most common human disease caused by helminths, cerebral and spinal involvement in hydatid disease is rare. Recurrence is common when cysts rupture during surgical removal. The authors present the results of combined treatment with surgery and mebendazole in four cerebral and five spinal cases of hydatid disease. The patients' ages ranged between 4 and 55 years with a mean of 26 years. In three of the four cranial patients who received mebendazole treatment, the cysts ruptured during surgical removal. Four of the five spinal cases had recurrent disease at the time of admission. Mebendazole was started immediately after surgery and continued over 12 months. All cases but one are stable clinically or radiologically at a mean 27 months follow-up period.

Benefits of supplementing St Thomas' Hospital cardioplegic solution with tetraethylammonium on functional and metabolic recovery of isolated rat hearts.

This study was designed to evaluate whether the addition of potassium channel blockers, tetraethylammonium, 4-aminopyridine or glibenclamide, to St Thomas' cardioplegia improved myocardial preservation over that achieved by St Thomas' cardioplegic solution alone. Initially, isolated rat hearts were subjected to 30 min of continuous normothermic hypoxic cardioplegia. Control hearts were arrested with St Thomas' cardioplegia followed by tetraethylammonium, glibenclamide or 4-aminopyridine-enriched cardioplegia. Subsequently, in a second experiment, hearts were subjected to 45 min of normothermic global ischaemia, after 3 min of cardioplegia with either tetraethylammonium-enriched or standard St Thomas' cardioplegia. In both regimens, hearts arrested with tetraethylammonium-enriched St Thomas' cardioplegia showed better recovery of contractile function than controls (P<0.001). Creatine kinase levels were significantly lower in the tetraethylammonium group (P<0.001). 4-Aminopyridine treatment caused similar contractility to that of the control group but raised creatine kinase and lactate dehydrogenase levels (P<0.001). Glibenclamide diminished coronary flow autoregulation, and increased lactate dehydrogenase leakage in reperfusion (P<0.05) with similar contractility to controls. The results of this preliminary in vitro study demonstrate that, in rat heart, St Thomas' cardioplegia enriched with tetraethylammonium improves post-ischaemic contractile function and reduces creatine kinase release. It is concluded that high potassium blocks the membrane at the rapid depolarization phase with rapid sodium influx and tetraethylammonium further prevents repolarization by blocking voltage-dependent potassium channels.

Posterior fossa arachnoid cysts.

Arachnoid cysts of the posterior fossa are rare lesions that are considered to be mostly congenital in origin. In this article, we retrospectively review 12 patients who underwent surgical treatment for their symptomatic posterior fossa arachnoid cysts. The most common presenting symptoms were gait disturbances and headache. The diagnosis was established on computed tomography or magnetic resonance imaging. Surgery consisted of cyst wall excision with fenestration in nine cases and shunting procedures in three cases. In all cases except one who-died, the postsurgical follow-up neuroradiological investigations showed that the cysts had decreased in size, the cerebellum had re-expanded, and if there was preoperative hydrocephalus, the ventricular size was decreased. The follow-up period ranged from 1 to 11 years. All surviving cases are free of symptoms and no arachnoid cysts recurred. The classification, pathophysiology, differential diagnosis and surgical treatment of infratentorial arachnoid cysts are discussed and the relevant literature is reviewed.

Intraspinal schwannoma of the accessory nerve.

The second example of a schwannoma originating from the cervical portion of the accessory nerve is reported. The tumour was diagnosed by MRI and confirmed by surgery. The tumour was small and was located entirely within the cervical subarachnoid space without causing any detectable neurological deficit.

Changes in the activity of antioxidant enzymes (SOD, GPX, CAT) after experimental spinal cord injury.

We determined time dependent changes in the levels of the antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) at 1, 4 and 24 hours after standardized reversible spinal cord injury in rats. In each segment (rostral, lesion, caudal) enzyme activities at 1, 4 and 24 hours were not significantly different. Without time limitation we have found that SOD and GPx activities were not significantly different (p > 0.05), but CAT activity was significantly high (p = 0.008) in the lesion segment than the rostral and caudal segment. According to our results we suggest that one of the main reason for tissue damage during such a spinal cord trauma model may be neither H2O2 nor H2O2 derived radicals.

Atypical intradural spinal tuberculosis: report of three cases.

OBJECTIVE: To report three cases of intradural spinal tuberculosis (TB) by calling attention to atypical forms of spinal TB. SETTING: A University Hospital, Istanbul, Turkey. METHODS: Histopathological, radiological, surgical and physical examination findings of three patients with spinal TB were retrospectively reviewed. RESULTS: Based on histopathological, surgical and radiological findings, diagnosis of intramedullary abscess had been made in the first case and early and late phases of arachnoiditis in the other two patients, respectively. The clinical outcome was evaluated as satisfactory for the patient with intramedullary abscess who had been treated with medical and surgical interventions. The remaining two patients with arachnoiditis, who had been treated by shunting or simple decompression, had a relatively less favorable clinical outcome. CONCLUSION: Spinal TB, in its atypical forms, is a rare clinical entity and low index of suspicion on the part of the surgeon may result in misdiagnosis such as neoplasm. In cases presenting with an intraspinal mass lesion, possibility of a tuberculous abscess and/or a granuloma should be considered in the differential diagnosis.