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

Relaxation of the smooth muscle of the corpora cavernosa of the penis is necessary for penile erection. To determine the relation of impaired relaxation to impotence in diabetic patients, we performed an in vitro examination of corpus cavernosum tissue obtained at the time of implantation of a penile prosthesis in 21 diabetic and 42 nondiabetic men with impotence. Contraction was induced in isolated strips of corporal smooth muscle by norepinephrine; then relaxation was assessed with electrical stimulation of autonomic nerves and with the administration of three agents: acetylcholine, which is known to be mediated by endothelium-derived relaxing factor; papaverine; and sodium nitroprusside. The latter two act directly on smooth muscle (i.e., they are endothelium-independent). Autonomically mediated relaxation with electrical stimulation was less pronounced in the smooth muscle from diabetic men (n = 18) than in the smooth muscle from nondiabetic men (n = 24; P = 0.001). The degree of impairment increased with the duration of diabetes (r = 0.61, P = 0.007). Endothelium-dependent relaxation was also impaired, as evidenced by a lower degree of muscle relaxation after the administration of acetylcholine in the tissue from diabetic men (n = 16) than in that from nondiabetic men (n = 22; P = 0.001). The adverse effects of diabetes persisted after we controlled for smoking and hypertension. Endothelium-independent relaxation after the administration of nitroprusside and papaverine was similar in tissue from the diabetic and nondiabetic men. We conclude that diabetic men with impotence have impairment in both the autonomic and the endothelium-dependent mechanisms that mediate the relaxation of the smooth muscle of the corpora cavernosa. These findings may provide a rationale for the treatment of diabetic men with impotence by intracavernosal injection of vasodilators to induce endothelium-independent relaxation of the smooth muscle.
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PMID:Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence. 292 81

Twenty-one patients with high aortic occlusion treated at our institution from 1967 to 1986 were reviewed. There were seventeen men aged from 39 to 78 (mean age: 61.0) underwent surgical intervention. All patients presented clinical manifestations of vascular insufficiency of the lower limbs; rest pain in eleven patients, intermittent claudication in nine and the others. Sexual impotence was present in eight patients. Renal artery involvement was seen in one case, and renovascular hypertension was observed in this patient. Hypertension and ischemic heart disease were present in twelve cases, cerebrovascular insufficiency in one case, diabetes mellitus in three cases. The following surgical treatments were performed; end-to-end Y-shaped Dacron graft implantations from the infrarenal abdominal aorta to the common femoral arteries in six patients, onlay V-shaped Dacron graft implantations in three patients, axillofemoral extra-anatomic bypass in four patients, and amputation only in one. The hospital mortality was 18% (3/17). Twelve patients discharged from the hospital are followed up (average period was 118 months), but the follow up was lost in two patients. There were two late deaths, which course was not related to operations. The prognosis of high aortic occlusion after anatomic bypass is good, thus it was concluded that anatomic bypass with Y-shaped or V-shaped Dacron graft was recommended and extra-anatomic bypass might be performed only in a high risk patient.
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PMID:[Surgical treatment and result of high aortic occlusion]. 296 80

Six-hundred African diabetic patients were examined; 31% had peripheral neuropathy and 2% autonomic neuropathy. They were older and had had diabetes longer (p less than 0.001) than those without neuropathy. Blood glucose control, based on HbA1 levels, was poorer (p less than 0.05) in patients with neuropathy. A control group of 469 non-diabetic Africans was also examined. They were age- and sex-matched with the diabetic patients aged 35 years or more. Seven per cent had evidence of peripheral neuropathy, significantly less (p less than 0.001) than the diabetic population. Impotence was commoner in diabetic men than controls, mainly in association with neuropathy and the use of hypotensive drugs.
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PMID:The neurology of diabetes mellitus in Central Africa. 296 95

The incidence of erectile dysfunction in patients with long-term diabetes mellitus can be as high as 50%. Diabetic microangiopathy is regarded as the most important pathogenic factor. In this review of a group of 210 impotent patients evaluated and treated at our centre we report on the examination data (angiopathy, neuropathy, psychogenic factors) in 36 patients with diabetes in comparison with the corresponding findings in 169 non-diabetic patients. In 5 patients erectile dysfunction had actually preceded the clinical manifestations of diabetes mellitus. Autoinjection therapy was started in 62% of all the diabetic patients, since this is effective, minimally invasive and, therefore, applicable to a large group of patients. This form of therapy was accepted by 90% of our patients' partners, which is in accordance to the reports in the literature. However, treatment had to be interrupted in 2 out of the 22 patients, owing to lack of cooperation on the part of the sexual partner. No complications were attributable to autoinjection therapy.
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PMID:[Disorders of erectile potency in diabetes mellitus]. 304 17

Testicular and plasma testosterone levels were found to be decreased markedly in streptozotocin diabetic rats compared with those of controls. Treatment with 6 units NPH insulin daily for one week almost normalized plasma testosterone levels parallel to the increase in body and liver weights in diabetic rats, while testosterone levels in testicles were not significantly changed. Plasma prolactin and LH levels were unchanged among control, diabetic and diabetic insulin-treated rats. Thus, testosterone reduction in the testis might play a role in diabetic impotence.
Diabetes Res Clin Pract
PMID:Plasma and testicular testosterone in experimental diabetic rats. 310 88

Dramatic progress in the understanding and treatment of erectile impotence has occurred over the past decade. Most cases have an organic cause that is related to vascular (arterial or venous) supply, innervation, or the hormonal milieu of the penis. Multifactorial causes of organic impotence are common and include diabetes mellitus, alcoholism, renal failure, and liver failure. Medications may cause impotence by a variety of mechanisms. The history and physical examination, along with simple laboratory tests, are the mainstay of evaluation and may be performed appropriately by family physicians. Successful new forms of nonsurgical treatment include penile self-injection with papaverine (sometimes with phentolamine) and penile-suction devices. Penile prostheses have been improved greatly in recent years. The patient may select among semirigid, multicomponent inflatable, and self-contained inflatable devices. New surgical treatments include penile arterial revascularization (for atherosclerosis) and ligation of the dorsal vein of the penis (for venous leak).
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PMID:Erectile impotence: evaluation and management. 327 58

The prevalence of diabetes mellitus and hypertension in the United States is increasing partly because of the incidence of these diseases in the growing geriatric population. Diabetes and hypertension have been associated with sexual dysfunction in both men and women. Neuropathy, vascular insufficiency and psychological problems have been implicated in impotence, impaired ejaculation and decreased libido in men and in decreased vaginal lubrication, orgasmic dysfunction and decreased libido in women. Several investigations of women with diabetes suggest fewer reports of sexual dysfunction than have been reported by diabetic men. However, there have been few evaluations of sexual dysfunction in women and no standard methods for assessment. Antihypertensive agents, especially diuretics, sympathetic inhibitors and beta-blocking agents have been associated with sexual dysfunction due to autonomic and hormonal effects. An estimated 40 to 80% of diabetic hypertensives have reported sexual dysfunction in several investigations. Clearly, the diabetic hypertensive patient should be evaluated for sexual dysfunction, and appropriate therapy, including changes in medication or referral for sex counseling, should become routine in clinical care.
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PMID:Sexual dysfunction in the diabetic patient with hypertension. 328 48

Of 44 male patients with idiopathic hemochromatosis who were diagnosed at an early stage without morphological or biochemical evidence of liver disease, 25% suffered from impotence and 34% manifested glucose intolerance. Impotence was correlated with a 50% reduction in plasma testosterone, resulting from a 63% decrease in testosterone production. Testicular atrophy was caused by insufficient secretion of gonadotropins due to the selective accumulation of iron in gonadotropic cells of the pituitary gland. However, peripheral sexual hormone metabolism, in particular the conversion of androgens to estrogens, remained unaltered. It was therefore possible to employ substitution therapy successfully with testosterone in these men, and hyperestrogenism was not observed as a side effect. The pathogenetic factors in the development of diabetes mellitus in patients with idiopathic hemochromatosis include impaired insulin secretion caused by the selective deposition of iron in B-cells of the pancreas and insulin resistance due to iron accumulation in the liver. In particular, the insulin resistance is markedly improved after depletion of body iron stores by phlebotomy treatment, resulting in lower insulin requirements in patients with insulin-dependent diabetes as well as improvement of carbohydrate metabolisms in about half of the patients with non-insulin-dependent diabetes. We have concluded that hypogonadism and carbohydrate intolerance are caused by the specific distribution pattern of excess iron in the organism, accompanied by functional impairment of affected parenchymal cells.
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PMID:Abnormalities in estrogen, androgen, and insulin metabolism in idiopathic hemochromatosis. 329 83

A personal series of 256 cases of acromegaly/gigantism seen over a 20-year period from 1963 is described. The insidious nature of the condition resulted in delay in diagnosis which was often made by a doctor when seeing the patient for an unrelated problem. Other features which commonly led to the diagnosis being made were headache, change in appearance, carpal tunnel syndrome, amenorrhoea and diabetes. The Hardy system for grading the radiological appearance of the pituitary tumour was used. Widely invasive tumours were not common but tended to occur in patients with younger age of onset and high GH levels. The occurrence of various symptoms and clinical features was noted and the changes resulting from reducing the GH level to normal. The incidence of hypertension, but not of coronary artery disease, is increased and the blood pressure may be reduced following successful treatment. The effects on the upper and lower respiratory tract are reported as well as sleep apnoea and problems associated with anaesthesia. Skin manifestations included sweating, pigmented skin tags, acanthosis nigricans and cutis verticis gyrata. In the skeletal system the incidence of kyphoscoliosis and osteoarthritis especially of the hip is reported: the question of hip replacement is discussed. Diabetes mellitus disappeared in most cases if the acromegaly was cured. In men but not in women the incidence of colloid nodular goitre was increased as was hyperthyroidism in middle-aged women. In two patients a parathyroid adenoma was present: hypercalcaemia was present in five additional patients, but the cause was not determined. The common occurrence of amenorrhoea in the younger women was noted, it was not always associated with hyperprolactinaemia, and often responded to successful treatment of the acromegaly. The association of acromegaly with hirsutism and galactorrhoea is confirmed. The incidence of impotence and loss of libid in the men is discussed: in a proportion of those in whom the acromegaly was cured, potency returned, but in a number depression occurred and what was believed to be psychogenic impotence persisted. Hyperprolactinaemia was found in 49 out of 151 patients with active acromegaly in whom the prolactin level was measured. Previous reports have indicated a doubling of death rates in acromegalics. In this series there were 47 deaths observed compared to 37.2 expected. The increased death rate was in women of all ages and in men under the age of 55, The increased deaths in the women were from cardiovascular and cerebrovascular causes and from breast cancer.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acromegaly. 330 90

The link between impotence and diabetes has been suspected since the 1700s, but it has been only within the last few decades that it has been scientifically investigated and confirmed. Of the 5 million diabetic men in the United States, 30% to 60% suffer from impotence, a complication of their disease that many of them fear more than any other, including blindness. Diabetes is the leading physiologic cause of impotence, and it occurs in both insulin-dependent and non-insulin dependent patients. In most cases, there is no relationship between the control, the duration, or the severity of diabetes and the occurrence of impotence. Treatment methods range from adjustments in nutrition to penile implants.
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PMID:Impotence and diabetes. 334 9


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