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

The single potential analysis of cavernous electric activity (CC-EMG), registration bands were studied in 144 patients with erectile dysfunction followed from November 1992 to March 1993. We attempted to correlate abnormal electromyographic records with reduction of the cavernous bodies and albuginea expansibility, as measured by cavernosometry/rigidometry. In this selected group of patients, with venous leak of different flow, the main associated causes of the erectile dysfunction were cavernous neuromyopathy (91), diabetes mellitus (20), disturbances of the arterial influx (7), endocrinological factors (4), Peyronie's disease (3). Some patients (15) presented with a penile bend. A history of alcohol and tobacco use was obtained: 38 patients smoked 15 to 60 cigarettes/day and 43 patients drank moderate to heavy. The coexistence of other pathologies, has been investigated, showed many other associated diseases. The study attempts to determine if some electromyographic standards in patients with erectile dysfunction, could, by themselves, be a formal indication to penile implant, for a PGE1 self-injection program or for use of a vacuum device. Our results suggest that at least in some cases CC-EMG studies may be clinically relevant and allow choice of optimal therapy.
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PMID:The corpus cavernous electromyography in the erectile dysfunction diagnosis. 761 75

The contribution of organic and psychogenic factors in the aetiopathogenesis of impotence was studied in a large number of diabetic males, to develop an algorithm for its management. We examined 110 consecutive patients who were referred to the Impotence Clinic of the Diabetes Centre. All patients were initially evaluated by a diabetologist and then underwent psychosexual assessment by a specialized psychiatrist. Patients with primarily organic disease were referred to a urologist for further management while those with psychogenic impotence received psychosexual counselling. Peripheral neuropathy was present in 71 (65%) and two or more autonomic tests were abnormal in 22 (20%) patients. Neuropathy was the only cause detected in 29 (27%) patients, the main cause in 22 (20%), and contributing, but not the main factor, in 20 (18%). Psychogenic factors were the only cause detected in 12 (11%) patients, the main cause in 26 (24%) and contributed in 19 (17%). Marital disharmony, medical treatment, and peripheral vascular disease were the main aetiopathogenic factors in the remaining cases. Psychosexual counselling resulted in successful intercourse in 17 (60%) out of the 24 treated patients and papaverine injections in 31 (61%) out of 56 treated patients. It is concluded that although organic factors are mainly responsible for the development of impotence in diabetic males, psychological factors contribute significantly and psychosexual assessment and counselling are essential adjuncts to its management. Treatment with papaverine injections is generally inexpensive and effective to overcome the multifactorial causes of erectile dysfunction in this population. An algorithm which may facilitate the investigation and treatment of impotent diabetic males is proposed.
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PMID:Aetiopathogenesis and management of impotence in diabetic males: four years experience from a combined clinic. 758 14

Erectile dysfunction is more common than previously thought in men older than 40 years, perhaps because contributing medical risk factors increase with age. The medical history is of prime importance in outlining these factors, the most common of which are diabetes, hypertension, and smoking. Nocturnal penile tumescence and rigidity testing with a portable home monitor may be helpful in determining whether the cause of erectile dysfunction is primarily organic or psychological. Specific therapeutic measures include sex therapy, psychotherapy, treatment for alcohol or tobacco dependency, replacement of offending medications, improved glycemic control, constriction rings, vascular surgery, androgen replacement therapy, bromocriptine mesylate (Parlodel), and thyroid, adrenal, or pituitary replacement therapy. Nonspecific therapies include yohimbine hydrochloride (Yocon), use of vacuum tumescence devices, intracorporeal injections, and penile implants.
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PMID:Erectile dysfunction. Are you prepared to discuss it? 771 86

Normal erectile physiology is heavily dependent on a delicate balance between the effects of endogenous vasoconstricting and vasorelaxing hormones on the tone of the corporal smooth muscle. Recent studies indicate that endothelin-1 (ET-1) is present and physiologically active in the human corpora. The primary goal of the present investigation was to further define the role of ET-1 in corporal physiology and to ascertain whether it might play a role in augmenting corporal tone in vivo, as reported in other vascular tissues. Thus, we conducted pharmacological studies of ET-1-induced steady-state contractions in isolated human corporal smooth muscle strips to determine if there were any detectable age- or diabetes-related alterations in ET-1-induced contractions. For statistical analysis, the patient population was divided into 2 age groups, A (< or = 59 years of age; = 11 patients) and B (> or = 60 years of age; n = 7 patients), and further subdivided into 2 diagnostic categories, diabetic (n = 7 patients) and nondiabetic (n = 11 patients). Construction of cumulative concentration response curves (CRCs) for ET-1-induced contractions revealed characteristically slow onset and long-lasting responses. Endothelin-1 CRC data were computer fit to the logistic equation to derive Emax (calculated maximal response), pEC50 (negative logarithm of the concentration that elicits one-half of the calculated maximal response) and slope factor (n) values. Two-factor analysis of variance revealed no detectable age- or diabetes-related alterations, nor any age-diabetes interaction in any of the logistic parameters. Furthermore, logistic analysis of ET-1 CRC data on 14 isolated corporal tissue strips derived from 3 potent patients with documented spontaneous erections revealed no differences in ET-1 contractility from that observed for patients with organic erectile dysfunction. Importantly, despite an apparent absence of age- or diabetes-related alterations in ET-1-induced steady-state contractions, preliminary studies demonstrated that coadministration of the alpha 1-adrenergic agonist phenylephrine and ET-1 produce much greater contractile responses than those observed in the presence of phenylephrine (PE) alone. Moreover, the magnitude of the augmentation was precisely that predicted by a model for simple additivity of agonist effects. Such observations suggest that the physiological relevance of ET-1 to corporal physiology may be related to its ability to augment the contractile responses of other vasomodulators present in the human corpora, in particular, perhaps modulating the contractile responses to sympathetic activity.
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PMID:Endothelin-1 as a putative modulator of erectile dysfunction: I. Characteristics of contraction of isolated corporal tissue strips. 775 83

Erectile failure, although a common problem in male diabetic patients, is one of the most neglected complications of diabetes. The availability of drugs like alprostadil (prostaglandin E1; PGE1) and papaverine for intracavernosal injection and the development of vacuum tumescence devices, while making therapy simple, have also reduced the necessity for specialised investigations. In the past 10 years, alprostadil has been shown to be the safest and the most effective of the intracavernosal self-injection treatments of erectile dysfunction. Vacuum tumescence devices are an acceptable noninvasive alternative in those who fail to achieve a satisfactory response to self-injection. Surgical techniques are being improved every day, and revascularisation procedures and prosthetic implants are available to couples in specialised centres. At present, systemic drug therapy has been largely ineffective for treatment in diabetic patients but progress is being made in this field. Whatever the option, involvement of the partner in decision making is of major importance for the treatment to be successful, and psychosexual counselling is a useful adjunct to medical or surgical therapy.
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PMID:Optimal treatment of erectile failure in patients with diabetes. 778 88

The aim of this study was to review the current situation of penile prostheses in the treatment of erectile dysfunction and to analyze the indications, degree of acceptability and complications in our experience. From 1987 to 1993, 35 implants were inserted in men suffering from impotence due to different etiologies. The mean age was 54 years and the mean duration of erectile dysfunction was 37 months. Diabetes, vascular disease and pelvic surgery were the most common pathologies recorded. We utilized the penoscrotal approach in 97.14% of the cases and implanted the following prostheses: 12 Hydroflex, 7 Uniflate 1000, 6 Acuform, 4 Mark II, 3 Dynaflex and 3 Alpha 1. The mean follow-up was 38 months. Infection of the prosthesis by Staph. epidermidis was observed in 5.71% of the cases. This infectious complication required removal of the prosthesis. Two patients with a Uniflate prosthesis complained of mechanical failure. Eighty percent of the patients and 74.28% of their partners were satisfied with the results. When asked if they would undergo another operation again if it were necessary, 71.42% answered "yes". Penile prostheses have withstood the test of time and continue to be an effective and valid therapeutic alternative in impotent men. Although the complication rate is low, adequate information must be provided to the patient and partner in order to enhance the results.
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PMID:[Penile prosthetic implant in the treatment of impotence: our experience]. 780 74

Sympathetic skin response (SSR) was investigated in 60 normal subjects (mean age 37.7 +/- 15.9) and 30 patients (mean age 47.2 +/- 12.0) referred from the department of urology for further electrophysiological evaluation of erectile dysfunction (ED). SSR was present in all normal subjects. Mean latency in the lower extremities was 2.16 +/- 0.20 sec. The coefficient of variance for repeated measurements in individual subjects was 10%. The latencies correlated slightly positively with the height of the subjects (r = 0.271, p < 0.05), but not with age. SSR in patients was compared to the bulbocavernosus reflex (BCR) and somatosensory evoked potentials (SSEP) of the pudendal nerve. All patients had a complete urological work-up with evaluation of hormonal function, pharmacotesting and Dopplersonography, as well as pharmacocavernosography and measurement of nocturnal penile tumescence if indicated. Six patients were diagnosed to have functional impotence, 4 dysfunctions were probably of vascular origin, 5 were neurogenic and 15 of the mixed type of vascular and neurogenic origin. Diabetes mellitus was the underlying disease in 14. In the two groups with neurogenic involvement (5 neurogen, 15 mixed) 14 of 20 patients had a pathological BCR, 12 had pathological SSEP and 9 had an absent SSR. Of these 9 patients two showed normal BCR and SSEP. Sensitivity for neurogenic dysfunction was 70% for the BCR, 60% for the BCR and SSEP, but that it detects some patients with erectile dysfunction, in whom other parameters are not pathological.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of erectile dysfunction with the sympathetic skin response in comparison to bulbocavernosus reflex and somatosensory evoked potentials of the pudendal nerve. 785 72

A follow up study of 603 patients with chronic erectile failure was carried out concerning the long term effects of intracavernous injection therapy with papaverine/phentolamine (n = 172 evaluable) and venous surgery (n = 134 evaluable). Injection therapy was effective in 95.8% of injections. Side effects included prolonged erections in 0.15% of injections and fibrotic palpable indurations in 3.4%. Acceptance of therapy was high among patients and their partners and improvement of self image or partnership was reported in 77.8% and 79.5% respectively. Results of venous surgery were not satisfactory. Only 19.4% of patients achieved sufficient spontaneous erections and 35.1% needed adjuvant injections. Spongiosolysis yielded better results. Patients with neurological impairment, diabetes mellitus, postoperative onset of erectile dysfunction and age above 40 years showed poorer surgical results. Venous surgery should only be offered to a highly selected group of patients.
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PMID:Long-term results of therapy with intracavernousal injections and penile venous surgery in chronic erectile dysfunction. 793 40

We studied the nocturnal penile tumescence (NPT) value obtained by simple method and the vascular and neurological findings closely related to the ability to achieve/maintain an erection in order to investigate the causative factors of organic erectile dysfunction seen in diabetes. Studies were carried out on 62 male diabetics (32-78 y.o.). The results were as follows. 1. There were no cases of a decrease in the nocturnal penile tumescence (NPT) value among eight subjects who showed no erectile dysfunction. However, a decrease in the NPT value was recorded in 28 (85%) of 34 subjects who showed complete failure to achieve/maintain an erection. It was, therefore, surmised that there is a large organic contribution to the erectile dysfunction seen in diabetes. 2. We determined the penile blood pressure index (PBPI), the reactions of papaverine tests, conduction velocity of the dorsal nerve of the penis and the latency of the bulbocavernosus reflex. 42 (67.7%) of the 62 subjects had penile vascular disorders and the cases with severe vascular disorders were skewed to the high age brackets. There were also many cases with neuropathy involved in the ability to achieve/maintain an erection: 38 (61.2%) of the 62 subjects. Moreover, many of the subjects were found to have damage to both the blood vessels and the nerves relating to an erection, and these forms of damage were surmised to be deeply involved in the decrease in the NPT value. 3. Multivariate analysis indicated that the most important factor involved in the decrease in the NPT value was vascular damage (contribution rate: 30.8%), followed by neuropathy (6.9%). These two factors represented the most important explanatory factors of the organic erectile dysfunction seen in diabetes. 4. The contribution rate of vascular damage to the decrease in the NPT value was 18.8% for diabetic subjects under the age of 60 years, but 45.1% for subjects aged 60 years or more. The contribution rate was thus higher in the elderly subject group. On the other hand, the contribution rate of neuropathy to the decrease in the NPT value was 7.7% for diabetic subjects under the age of 60 years, but the rate decreased to 4.7% for subjects aged 60 years or more.
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PMID:[Etiological analysis of male diabetic erectile dysfunction with particular emphasis on findings of vascular and neurological examinations]. 799 Feb 96

We report 7 men (ages 45-61 years) with impotence associated with the Charcot-Marie-Tooth syndrome (CMT). The range of onset of erectile dysfunction varied from 38 to 55 years of age. One patient had classic CMT 1A with autosomal dominant inheritance, slow motor nerve conduction velocities and the 17p DNA duplication. One had probable type-II hereditary motor and sensory neuropathy. None of the patients had diabetes. There was some benefit from papaverine injection therapy or penile implants. The association of impotence with CMT is likely to be more common than previously recognized.
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PMID:Impotence associated with the Charcot-Marie-Tooth syndrome. 803 41


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