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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 60 male diabetics aged between 16 and 60 followed up for 5 years, libido was found to be reduced in 58% and potency in 63%. The alteration in sex function would not appear to be related to the duration or gravity of the diseases, nor with the existence of vasculopathy; it was, however, related to age (a prevalence in elderly subjects) and to the existence of neuropathy. In one third of subjects, impotence preceded or was contemporaneous with clinical diagnosis of diabetes. Spermiogenesis alterations, present in more than half the cases, were closely related to gonadotropinuria LH; this finding, added to personal results and those obtained previously by other researchers, suggests a two-fold hypophyseal and Leydigian pathogenesis of impotence in the diabetic.
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PMID:[Clinico-statistical data on the sexualtiy of the male diabetic]. 123 62

Diabetic neuropathy in some form or other afflicts a majority of patients with diabetes mellitus. Neuropathic disturbance of sensory, motor or autonomic nerves may occur singly or in combination. Cranial nerve and other mononeuropathies generally resolve spontaneously. Autonomic neuropathy which can result in orthostatic hypotension, gastroparesis diabeticorum, nocturnal diarrhea, atonic bladder and impotence, although chronic, may wax and wane in clinical severity. Neuritis, disesthesias and painful sensory neuritis may resolve with good diabetic control; on occasion, diphenylhydantoin has been of therapeutic benefit.
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PMID:Diabetic neuropathy, A review of clinical manifestations. 124 87

Male sexual impotence is the symptom of an alteration of central and peripheral mechanism neuropsychoendocrine, vascular and neurological. Nowadays it affects 8-10% of sexually active population. In some diseases, like diabetes and uremia, it can reach very high percentages of incidence. At our Andrology Center 35% of referrals are represented by sexual complaints. In the last years the diagnostic accuracy has increased, narrowing the percentage of unknown causes. Vasculopathy represents the most relevant pathological condition associated with impotence: it can affect both arterial and venous vessels. The new medical technologies and procedures permit an increase of the life span but often affecting the quality of life. Therefore, the iatrogenic causes of impotence, both pharmacological and surgical, are growing. A modern diagnostic approach starts with an accurate clinical history and physical examination, followed by an NPT (nocturnal penile tumescence) test and/or ICI (intracavernosal injection) with a standard dose of PGE1 and Doppler flowmetry of penile arteries. An endocrine evaluation (LH, testosterone and prolactin) is also performed. Further investigation of a vascular dysfunction is represented by more invasive procedures, like arteriography, cavernosography and cavernosometry. A suspect of neurological disease is confirmed by sacral evoked potentials. According to the findings of these examinations, a correct therapeutical approach can be applied in 100% of cases. An endocrine treatment is adequate only when a clear reduction of T plasma level or hyperprolactinemia are present. The treatment of other central disorders causing psychoneuroendocrine impotence is promising, but still under investigation. The intracavernosal injection of vasoactive drugs, apart from having revolutionized the diagnostic approach to the impotent patient, represents a clear standpoint in medical management of impotence, particularly in vascular and neurological diseases. The great advancement in the technology of penile prostheses has allowed the development of valuable and reliable tools to be used in selected cases.
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PMID:[Recent diagnostic and therapeutic aspects in male sexual impotence]. 128 49

Kinetic studies were conducted on the contractile response elicited by phenylephrine (PE) activation of the alpha 1-adrenergic receptor subtype in vascular smooth muscle isolated from the corpus cavernosum of impotent men. PE-induced contractions were separated into distinct phasic and tonic components, and the tonic portion was analyzed using a first-order rate equation to determine the maximal rate constant for onset of contraction (kobs max) and the maximum amplitude of the steady-state contractile response (Req max). The kobs max value in tissues from insulin-dependent diabetic patients was significantly greater than that in tissues from either noninsulin-dependent diabetics or nondiabetics. Additionally, the mean kobs max value in older patients (60-70 yr) was significantly greater than the mean kobs max value in younger patients (32-59 yr). Significant diabetes-related, but not age-related, alterations were also found in Req max. The observed changes in contractility resulted in dramatic age- and pathology-dependent alterations in the initial rate and/or magnitude of PE-induced response generation. These kinetic studies extend our previous observations at steady state and provide further evidence for heightened corporal tissue tone in the etiology of erectile dysfunction.
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PMID:Kinetic characteristics of alpha 1-adrenergic contractions in human corpus cavernosum smooth muscle. 132 59

We investigated in vitro the relaxant effect of exogenous acetylcholine (ACh) and electric-field stimulation (EFS) on rabbit and human corpus cavernosum smooth muscle strips (CC) precontracted with phenylephrine. The effects of EFS and ACh were monitored alone, after muscarinic receptor blockade and after inhibition of nitric oxide (NO) formation with L-N-nitro-arginine (L-NOARG). In rabbit and human CC, both atropine and L-NOARG abolished the relaxant effects of ACh. The relaxant effects of EFS, however, were only slightly reduced by atropine to 97.5 +/- 17.5% in human CC and to 89.0 +/- 6.1% in rabbit CC. L-NOARG further reduced the EFS effects to 0.8 +/- 1.7% in human CC and to 16.2 +/- 8.7% in rabbit CC. In strips obtained from impotent patients with diabetes mellitus, the relaxant effects appeared to be significantly less than in strips from nondiabetic impotent men. Tetrodotoxin blocked the relaxant EFS effects in human and rabbit strips completely. The data indicate the important role of NO in cholinergically induced relaxation of cavernous smooth muscle in rabbits and humans. Our findings support the idea of NO as the nonadrenergic noncholinergic neurotransmitter in penile erection in both species. Rabbit erectile tissue might serve as an in vitro animal model for further investigation.
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PMID:Nitric oxide mediates relaxation in rabbit and human corpus cavernosum smooth muscle. 135 5

We report here on our surgical experience with venous leakage of the cavernous bodies. Out of 159 patients operated on, 134 were available for long-term follow-up. Depending on the cavernosographic findings, one of three different surgical procedures was carried out: ligation of the deep dorsal vein of the penis, spongiosolysis, or ligation of the crura. 18% of the patients undergoing ligation of the deep dorsal vein, postoperatively attained spontaneous erections, while 35% needed adjuvant corpus cavernosum autoinjection therapy. Spongiosolysis gave a more favourable result: spontaneous erections in 30% and vasoactive drug-dependent erections in 35%. Crural ligation did not prove successful. No serious complications were encountered postoperatively. Our data suggest that venous surgery should only be offered to a selected group of patients comprising young impotent men with venous leakage, maybe in combination with arterial disease, and patients suffering from distal venous leakage. Old age, neurogenic disorders causing erectile dysfunction, and diabetes mellitus should represent exclusion criteria for venous surgery.
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PMID:Venous surgery in erectile dysfunction. The role of dorsal-penile-vein ligation and spongiosolysis for impotence. 141 25

The effect of oral prostaglandin E1 (limaprost) on erectile function was studied in a double-blind placebo controlled trial. Fifty one patients who agreed to participate were examined for their subjective symptoms and nocturnal erection was recorded using an erectometer at the beginning of the study, after an initial 6 week period, and again after a second 6 week period. Patients were randomly assigned to a group which received placebo followed by limaprost or to a group which received limaprost followed by placebo. Ten cases dropped out. In the remaining forty one patients, NPT during the limaprost phase was significantly different from that during the placebo phase. Patients with the history of diabetes mellitus, hypertension, or pelvic surgery showed relatively poor responses to oral prostaglandin E1. Oral prostaglandin E1 achieved 42.9% effectiveness in the psychogenic impotence, and this effectiveness is significantly higher than that of placebo. Oral prostaglandin E1 was suggested as an additional or alternative therapy in the management of psychogenic impotence. Psychogenic impotent who didn't respond to sex therapy and patients with slight organic causes would seem to benefit from oral prostaglandin treatment.
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PMID:[Double-blind trial of oral prostaglandin E1 on impotence]. 143 68

In an assessment of the contributions of autonomic neuropathy and vascular disease to the aetiology of male impotence in diabetes, evidence of autonomic neuropathy was identified in 23/39 (59%) individuals complaining of impotence. Thirteen of 26 men aged < 60 years tested with an intracorporeal injection of papaverine experienced little or no response and seven had tumescence but no rigidity. Radioisotope phallography demonstrated vascular disease in six of these seven, suggesting evidence of a vascular component in 19/26 (73%). Only one patient had non-organic impotence. Overall, evidence of vascular disease alone was demonstrated in 10/26 (38%), vascular disease plus autonomic neuropathy in 9/26 (35%), and autonomic neuropathy alone in 6/26 (23%). Many diabetic men complaining of impotence appear to have a significant vascular component which renders intracorporeal papaverine treatment ineffective. We compared the performance of a vacuum constriction-band (Erecaid) and condom-type (Synergist) device in 10 randomly selected men from this group. The devices, provided in random order for 5 months each, were assessed by questionnaire and interview of both the patient and partner. Two couples defaulted and another could use neither device. Although erectile capacity could be restored in the remainder, subsequent intercourse was only deemed satisfactory to both partners in five couples, who unanimously preferred the constriction-band device. In treatment with vacuum devices the constriction-band type seems to be the device of choice; the condom type should probably be reserved for those unable to use the constriction-band type.
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PMID:Impotence in diabetes: aetiology, implications for treatment and preferred vacuum device. 147 32

Intracavernosal injection of vasoactive drugs is a safe, effective, and commonly used treatment for impotence in diabetic men. In prospective studies infection has rarely occurred. We report a case of life-threatening Staphylococcal septicaemia complicating this treatment in a 61-year-old man with Type 2 diabetes, probably due to a combination of an unsterile technique and drug-induced priapism. Infection is a potential risk in diabetic men using intracavernosal injection therapy and those offered it should be informed of the importance of a scrupulous sterile technique and the need to seek urgent medical help for decompression if an erection persists for more than 4-6 h.
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PMID:Staphylococcal septicaemia complicating intracavernosal autoinjection therapy for impotence in a man with diabetes. 147 42

A review of findings pertaining to EDRF (endothelium derived relaxation factor) which proved to be nitric oxide, NO. After an account of the vasodilatating action of NO in the cardiovascular system the main attention is devoted to macrophages, the source of NO and to the formation of NO during activation of infections and during septic shock. NO participates also in the cytotoxicity of macrophages. NO may be the cause of hypotension in hepatic failure. Cumulation of endogenous inhibitors of NO formation in renal failure may be the cause of hypertension. The author analyzes other clinical effects of NO with regard to impotence and diabetes: NO stimulates insulin secretion from the B-cells of the islets of Langerhans. Attention is also drawn to the possible function of NO in the pituitary, in particular with regard to the arginine test which stimulates STH secretion.
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PMID:[A new agent--nitric oxide]. 148 81


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