RESUMO
The aim of this study was to assess the influence of anxiety and plasma catecholamines on the pharmaco-induced erection of psychogenic erectile dysfunction (ED) patients. A total of 23 patients with psychogenic ED aged from 19 to 43 y were submitted to: (1) anxiety evaluation by the Spielberger's State and Trait Anxiety Inventory-STAI; (2) intracavernous injection of PGE1 10 microg+phentolamine 1 mg with the response monitored by Rigiscan; (3) blood sampling from cavernous bodies and cubital vein for adrenaline and noradrenaline levels determination by high performance liquid chromatography. The whole procedure was done in a single clinical setting at the same day. We found no significant correlation between the erection rigidity and the cavernous or peripheral catecholamines or between erection rigidity and anxiety scores. Some patients showed rigid erections despite high anxiety scores or penile catecholamine levels while others, with incomplete erections, had much smaller levels. These results are suggestive of a more complex mechanism controlling the penile sympathetic responsiveness in psychogenic ED patients.
Assuntos
Epinefrina/sangue , Disfunção Erétil/sangue , Disfunção Erétil/psicologia , Norepinefrina/sangue , Ereção Peniana , Disfunções Sexuais Psicogênicas/sangue , Disfunções Sexuais Psicogênicas/psicologia , Antagonistas Adrenérgicos alfa/administração & dosagem , Adulto , Alprostadil/administração & dosagem , Ansiedade , Combinação de Medicamentos , Disfunção Erétil/fisiopatologia , Humanos , Injeções , Masculino , Ereção Peniana/efeitos dos fármacos , Fentolamina/administração & dosagem , Disfunções Sexuais Psicogênicas/fisiopatologia , Vasodilatadores/administração & dosagemRESUMO
OBJECTIVES: To study the efficacy and safety of 1 year of growth hormone (GH) therapy in children with steroid-dependent nephrotic syndrome. STUDY DESIGN: A prospective pilot, open study in which GH (mean dose 0.32 mg/kg per week) was administered for 1 year to 8 children with steroid-dependent nephrotic syndrome requiring prednisolone (mean dose 0.46 mg/kg per day) to maintain remission. Steroid dependence was defined as recurrence of proteinuria within 2 weeks of discontinuation of prednisolone, or when the dose was lowered below a critical level. At entry, all patients had been steroid dependent for at least 1 year. Anthropometric and bone mineral density measurements after treatment were compared with 1-year pretreatment data. RESULTS: Pretreatment mean (+/-SD) chronologic age was 12.6 (+/-3.1) years, with a mean bone age of 9.1 (+/-2.0) years, with delayed puberty in five patients. The mean height velocity increased from 3.7 (+/-1.4) to 9.4 (+/-2.1) cm/yr after 1 year of treatment (p < 0.05). The mean height standard deviation score increased from -1.4 (+/-1.6) to -0.3 (+/-1.1), (p < 0.05). In the spine, the mean bone mineral density increased from 0.50 to 0.64 gm/cm2 (p < 0.05), and in the femoral neck, from 0.55 to 0.64 gm/cm2 (p < 0.05) after 1 year of treatment. Mean lean body mass increased from 58.1% to 62.6% (p < 0.01). There were no significant changes in creatinine clearance, fasting glucose, fasting insulin, or glycosylated hemoglobin levels. The mean bone age increased to 11.4 (+/-2.4) years, and pubertal stage advanced in 2 patients. CONCLUSIONS: One year of GH therapy is effective in improving the height standard deviation score, height velocity, bone mineral density, and lean body mass of children with steroid-dependent nephrotic syndrome. There were no significant adverse effects. However, the bone age accelerated at a greater pace than the height age, and further studies are required to define the role of GH therapy in steroid-dependent nephrotic syndrome.
Assuntos
Hormônio do Crescimento/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Prednisolona/uso terapêutico , Adolescente , Antropometria , Glicemia , Estatura/efeitos dos fármacos , Densidade Óssea , Criança , Quimioterapia Combinada , Feminino , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Projetos Piloto , Estudos Prospectivos , Puberdade Tardia/tratamento farmacológicoRESUMO
OBJECTIVES: To describe varicella complications in healthy and previously ill children hospitalized for varicella and to explore trends in group A beta-hemolytic streptococcus complications of varicella. METHODS: A retrospective record review of children hospitalized for varicella between January 1, 1990, and March 31, 1994, was conducted in nine large acute care hospitals in Los Angeles County, California. RESULTS: We identified 574 children hospitalized for varicella in study hospitals during the 4.25-year study period (estimated risk of hospitalization, approximately 1 in 550 cases of varicella); 53% of the children were healthy before the onset of varicella and 47% were previously ill with underlying cancers or other chronic illnesses. Children were hospitalized for treatment of complications (n = 427, 74%) or for prophylactic antiviral therapy or observation (n = 147, 26%). Systems involved in complications included skin/soft tissue (45%), neurologic (18%), respiratory (14%), gastrointestinal (10%), and hematologic, renal, or hepatic (8% or less). The mean age of children with skin/soft tissue infections was 2.7 years (range < 1 to 16 years) compared with 4.7 years (< 1 to 18 years) for other complications. Children with skin/soft tissue and neurologic complications were more often previously healthy (p < 0.05), whereas those with respiratory complications were more often previously ill (p < 0.001). Hospitalizations for skin/soft tissue infections increased during the study period. The proportion of complications as a result of group A beta-hemolytic streptococcus infection increased from 4.7% before 1993 to 12.2% for the remainder of the study period (p = 0.02). CONCLUSIONS: Prior health status was predictive of the type of complications experienced by children with varicella requiring hospitalization. Our data suggest a recent increase in skin/soft tissue complications of varicella requiring hospitalization and an increase in the proportion of complications related to group A beta-hemolytic streptococcus. Wide-scale vaccine use should reverse this trend and reduce the overall impact of varicella on both healthy and previously ill children.
Assuntos
Varicela/complicações , Adolescente , Doenças do Sistema Nervoso Central/complicações , Varicela/imunologia , Criança , Pré-Escolar , Gastroenteropatias/complicações , Nível de Saúde , Hospitalização , Humanos , Hospedeiro Imunocomprometido , Lactente , Doenças Respiratórias/complicações , Dermatopatias Bacterianas/complicações , Infecções dos Tecidos Moles/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenesRESUMO
The study was carried out in ten patients with venous insufficiency of limbs verified by clinical standards, photopletismography and descending venogram witch, previous venous stasis ulcer and branquial/ankle doppler index greater than 0.9. The valvular closing time (VCT) was measured with Duplex scanning, at the level of popliteal vein bellow de lesser safenous vein entrance. The ten patients showed an initial VCT greater than 0.5 sec, with the utilization of the elastic compression and new measurement of VCT, seven showed a normalization of VCT (valves lower than 0.5 sec). The elastic compression of limbs is efficient in reducing the venous reflux and it could be evaluated individually with a non invasive test--The Duplex scanning.
Assuntos
Bandagens , Perna (Membro)/irrigação sanguínea , Insuficiência Venosa/terapia , Humanos , Fatores de Tempo , Ultrassonografia Doppler Dupla , Insuficiência Venosa/diagnóstico por imagem , Pressão VenosaRESUMO
The papaverine test has been widely used as a diagnostic procedure in erectile impotence. However, when patients do not achieve full erection on the test, it is necessary to differentiate between insufficient inflow and excessive outflow. Gravity cavernosometry is a method designed to evaluate the pressure responses in the corpora when they are subjected to a constant infusion pressure. The infusion flow is of minor significance. The intracavernous pressure (ICP) was measured in cadavers, in psychogenically impotent patients and in patients with arteriogenic impotence, following administration of papaverine and gravity perfusion. During perfusion in cadavers and in psychogenic patients, the ICP showed values above 110 cm H2O, while in arteriogenic patients the values ranged from 30 to 141 cm H2O. In the arteriogenic group, 11/20 patients had an ICP lower than 110 during perfusion. There was no correlation between the pre-perfusion pressure and the final pressure with perfusion. Gravity cavernosometry is a simple, cost-effective and reliable method for the assessment of corporeal competence.
Assuntos
Disfunção Erétil/diagnóstico , Doenças do Pênis/fisiopatologia , Ereção Peniana/fisiologia , Adulto , Idoso , Pressão Sanguínea , Disfunção Erétil/etiologia , Gravitação , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Papaverina , Doenças do Pênis/complicações , Doenças do Pênis/diagnóstico , Pênis/irrigação sanguíneaRESUMO
Twenty-three patients with corpora cavernosa incompetence responsive to perineal compression were submitted to surgical exclusion of the crural ending of the corpora cavernosa. There were two mild complications: perineal hematoma and incisional pain for 10 days. At the end of the first month, 65% of the patients claimed better erections, and the late good results were 47.7%, with an average follow-up period of 18.9 months. Three of the failed cases were later submitted to a penile prosthesis implantation.