News Review From Harvard Medical School -- Bone Tests Urged for Some Older Men
It may be worth the cost to test bone strength in some older men and treat them if their bones are weak. That's the conclusion of a new study. Researchers used a computer program to estimate the risk of bone fracture for men over 65. They also looked at how much risk would be reduced by treatment. The study found it would be worth the cost to test bone strength for men over 65 who had an earlier fracture. The cost would include treatment if they had osteoporosis (brittle bones). It also would be worthwhile to do this for all men over 80, researchers said. The study was published July 8 in the Journal of the American Medical Association.
By Robert H. Shmerling, M.D. Harvard Medical School
What Is the Doctor's Reaction?
Male osteoporosis may not get the attention it deserves. That's my take on a study just published in the Journal of the American Medical Association.
Researchers looked at how often aging men get osteoporosis and have hip fractures. They concluded that routine testing and treatment may make sense for certain men as much as for women.
Osteoporosis means that bones are less dense than they should be. Even a slight injury can lead to a broken bone.
Fractures may occur in almost any part of the body. But hip fractures are the most devastating. They may need surgery. Many people never get back their former level of function or independence. The risk of death also increases.
It's routine for doctors to identify and treat women who have a high risk of fracture. That makes sense because osteoporosis is most common among women after menopause.
But the condition is also common in older men. That's why researchers designed this new study. They gathered the best available data. Then they estimated how likely it is that a man in the United States will develop osteoporosis and or break a hip. They also looked at the costs and benefits of testing and treating them for osteoporosis.
The findings suggest that we may not give enough attention to male osteoporosis.
Among 65-year-old men without a prior fracture, about 8% have osteoporosis. By age 80, it's almost 18%. The figures are based on measuring bone mineral density.
For men who have had a prior fracture, the rate of osteoporosis nearly doubles. It's 14.5% at age 65 and 34% by age 80.
For men ages 80 and older, routine tests for bone mineral density are cost-effective. So is drug treatment for those with a low density (osteoporosis). This means that people get significant benefit, at a cost that's generally accepted as worthwhile.
Testing and treatment also make sense for men 65 and older if they already had a fracture.
This study used data from white men in the United States. The conclusions may not apply to others, including African-American and Hispanic men. They have lower rates of fractures linked to osteoporosis. Still, this study suggests that testing for and treating osteoporosis in men should be a higher priority than it is now.
What Changes Can I Make Now?
Bone strength is an important part of overall health. Bones are most dense during early adulthood. The eating and exercise habits we begin early in our lives can affect fracture risk later.
You can take these measures to improve bone strength:
Get more exercise. Weight-bearing exercise, such as walking, may strengthen bones.
Change your diet. A diet that is rich in vitamin D and calcium can help build healthy bone and slow bone loss. Dairy products and salmon are examples of foods with a lot of calcium. It also is added to some orange juice. Good sources of vitamin D include certain fish, such as salmon, mackerel and tuna. Vitamin D also is added to many dairy products.
Consider supplements. Pills can provide enough calcium and vitamin D if you don't get enough from your diet.
Consider medicine. For people with low bone density, medicines can increase bone strength. These drugs include alendronate and risedronate. Some men have low amounts of the hormone testosterone. For them, treatment with extra hormones may help.
Avoid drugs that weaken bone. Certain drugs, such as prednisone, can lower bone density. Ask your doctor if you can reduce your dose or stop taking these medicines.
Even if your bones are strong, a fall can break a bone. Take these measures to help you avoid falls:
Exercise. Improving strength and balance may prevent a fall or lessen the impact. A physical therapist or personal trainers can design an exercise program for you.
Avoid medicines that increase fall risk. Medicines that make you drowsy, affect balance or lower blood pressure can contribute to or cause a fall. This includes many over-the-counter drugs. Ask your doctor if you can change your dose or stop taking them.
Inspect your home. Ask a physical therapist or other health professional to suggest simple changes that may lessen your risk of a fall. For example, you could remove slippery rugs, move cluttered furniture or get better lighting.
Wear hip protectors. There is some evidence that wearing special pads over the hips can reduce the impact of a fall on your hip. This can lessen the risk of fracture. A recent study suggested that the benefit may be small. But hip protectors could help people with a high risk of fracture.
See your doctor if you fall or feel unsteady, especially if you have osteoporosis. The doctor may be able to find a cause for the fall that can be treated. These include balance problems and arthritis.
ANEMIA AND LOW TESTOSTERONE LINKED TO MEN WITH DIABETES
DATE: January 19, 2007
Research by UB endocrinologists has shown that one-third of men with type 2 diabetes who have low testosterone concentrations are likely to have anemia, due to two mechanisms that suppress the formation of red blood cells.
The anemia finding follows on the heels of UB studies showing that male diabetics who have low testosterone levels also have high levels of C-reactive protein (CRP), a marker of chronic inflammation. "We know that testosterone stimulates the production of red blood cells, while chronic inflammation inhibits it," said Paresh Dandona, professor of medicine in the School of Medicine and Biomedical Sciences, head of the Diabetes-Endocrinology Center of Western New York and senior author on the study.
"Thus, both a low testosterone concentration and high inflammatory mechanisms may play important roles in the pathogenesis of the low-grade anemia we observed in some patients with type 2 diabetes. "Because high CRP concentrations are associated with atherosclerosis, and there are early data showing that low testosterone concentrations may be associated with increased cardiovascular events," said Dandona, "the anemic diabetic patient may be confronted with yet another risk factor for plaque formation in the arteries."
The study appeared in a recent issue of Diabetes Care.
These results imply that physicians treating anemia in type 2 diabetic men should consider testosterone replacement, he noted, and should be aware that anemic patients may carry a very high risk of heart attack and stroke related to a high CRP. The study involved 50 patients at the Buffalo center and 20 patients from an endocrinology specialty clinic in Midland, Texas, who had been referred to the clinics for management of type 2 diabetes. Researchers collected fasting blood samples to determine concentrations of plasma hemoglobin (the iron-containing portion of red blood cells); hematocrit (a measure of both the number and size of red blood cells); plasma testosterone; plasma CRP; certain hormones; and additional components in 16 patients who were found to be anemic.
Overall, 37 of the diabetic patients had significantly low total and free testosterone, and 30 of these men had high levels of CRP. The average hematocrit in those with low testosterone was significantly lower than in subjects with normal testosterone, and in patients with high CRP, hematocrit was lower still. Sixteen patients were found to have anemia, but the condition was associated with iron deficiency in only one of those subjects. However, of the remaining 15 patients, 14 had low concentrations of testosterone. The concentrations of erythropoietin, a hormone that stimulates the production of red blood cells, were high in these patients, said Dandona, and thus was not a cause of this anemia. "This demonstration of a significantly lower hematocrit in hypogonodal men and a direct relationship between hematocrit and testosterone in type 2 diabetic patients, which we are describing for the first time," said Dandona, "suggests that a low testosterone concentration may contribute to the pathogenesis of the mild anemia in these patients.
"Furthermore, the highly significant inverse relationship between CRP concentrations and the hematocrit, independent of testosterone concentrations, suggests that inflammatory processes in type 2 diabetes probably also suppress the hematocrit. It also appears that CRP, rather than being only a marker of inflammation, may contribute to inflammation by inducing adhesion of cells to vessel walls." The authors suggest that anemia in males with type 2 diabetes should be looked for in order to identify the cardiovascular risk and that the treatment plan should involve testosterone therapy rather than erythropoietin. Also contributing to this research, all diabetes researchers in the UB Department of Medicine, were Vishal Bhatia, Ajay Chaudhuri, Rashmi Tomar. Sandeep Dhindsa and Husam Ghanim.
NEW ORLEANS (AP) -- When is a man's medical emergency not all that urgent? Apparently when sports are on the tube.
A drop in the number of men going to the emergency room during sports broadcasts on TV is followed by a surge afterward, reports an ER doctor who reviewed case numbers over three years at the University of Maryland Medical Center in Baltimore.
Dr. David Jerrard's study, released Wednesday at a meeting of emergency physicians, didn't surprise the president of the American Academy of Emergency Medicine, Dr. Tom Scaletta. He said he saw much the same thing when he was a medical resident and earned an extra $100 a game running the emergency clinic during games at Wrigley Field in Chicago.
"It was a two-stage decision: If they were hurt, whether to go to the hospital or not. If they needed to go to the hospital, could they finish the game or not?"
Jerrard said his study is a follow-up to one he did two years ago, which found about a 30 percent drop in the number of men checking into the Baltimore hospital's ER during sports broadcasts. The new study looks at the four-hour period starting 30 minutes after the end of televised games of the NFL, major league baseball and the University of Maryland football and basketball teams.
Overall, the number of ER visits was about 40 percent above the average for the same time and day of the week without a sportscast. The biggest increase was after college football games when an average of 15 patients came to the ER, compared to 8 during the same time period on non-game days.
Dr. Larry Baraff, an emergency medicine professor at UCLA, said he's never noticed the pattern Jerrard describes, but added, "It's sort of common sense. If you've got a certain thing you can delay for an hour or two and something you want to do, you'll do it. Hopefully they're not delaying treatment for serious chest pains, but I find that unlikely."
Jerrard said his next analysis will focus on conditions treated. He wouldn't speculate on the possibility of post-game fights as a reason for the spike in cases.
Scaletta estimated that about one-third of the Wrigley Field patients who were told to go to a hospital asked if they could wait until after the game.
At least most people having a heart attack or stroke knew they needed to leave immediately, he said. "Alcohol, of course, does change the logic stream for a lot of people."
Blood in the semen, or hematospermia, is a fairly common event that can occur at any point in a man's life. Men are not accustomed to seeing bleeding from any body part or in any secretion. So when blood is present, most men panic.
"Could it be cancer? Infection? Injury? Will my genitals shrivel up and fall off?" are questions that race through men's minds when they see blood in a place that is not expected.
It can be bright red, clots, speckles, or just brown tinged. The good news is that hematospermia is not rare and is almost always a meaningless finding of no concern.
Usually not associated with any pain or discomfort, blood probably enters the semen from a small blood vessel that tears during ejaculation or even straining with constipation. Sometimes it just happens.
And as fast as it comes on, it can disappear. Other times, blood may linger for days, weeks or even months. If the bleeding is heavy or prolonged, then further evaluation by a urologist is in order. If there is pain or burning, then it is time to see your urologist.
For older men over 45, it is probably a good idea to get a prostate exam and PSA blood test, just to rule out any prostate cancer concerns. The good news is that if and when it occurs, it is not an omen of pending death or spontaneous combustion of your genitals.
LONDON (AP) -- Among people who have had blood clots, men are twice as likely as women to have them again after finishing treatment, according to an analysis of several studies.
"Gender may need to be considered when deciding how long patients should be treated with blood thinners," said Dr. Simon McRae, principal author of a paper published Friday in the medical journal Lancet.
McRae is a doctor with the department of hematology and oncology at Queen Elizabeth hospital in Woodville, Australia. He and his colleagues analyzed 15 studies in a review that considered approximately 5,400 people who had discontinued medication three to six months after having a blood clot.
Blood clots, or thrombosis, are thought to affect 1 in every 1,000 people. The clots develop in veins of the legs, which then get dislodged and can travel to the heart or lungs, potentially causing cardiac or pulmonary failure.
The condition has also been called "economy class syndrome," since remaining immobile for long stretches of time, for example during long-haul flights, is a known risk factor.
The Lancet study only concerns people with a past record of blood clots.
There is no discernible difference in the risk of a first blood clot between men and women. When it comes to recurrent thrombosis, however, McRae concludes that men appear to be statistically at higher risk.
McRae said that the discrepancy is significant enough that physicians should take gender into account when treating patients.
"The real potential of this study is that it will help doctors determine how long certain patients should remain on blood thinners," he said.
Researchers are still trying to determine why men are more susceptible to recurrent blood clots than women. They believe physiological, genetic or hormonal variations might play a role.
"We know that diseases manifest in different ways between men and women," said Dr. Sidney Smith, director of the center for cardiovascular science at the University of North Carolina. "The next step is to design a prospective study so that we can see if these observed differences are actually real."
In an accompanying commentary in the Lancet, scientists in Italy conclude that "it is still too early to rely on patients' sex when determining the length" of treatment on blood-thinners.
"There is a lot of data available that could be examined in more detail," said Dr. Sania Nishtar, founder of Heartfile, a health-policy think tank in Pakistan, and frequent adviser to the World Health organization. "The Lancet study may not have found any definitive answers, but what it has done is to flag important research questions," said Nishtar.
Gout associated with Beer Drinking June 12, 2006 10:49 PM
Bad news for beer drinkers, Dr Hyon Choi and her colleagues at Massachusetts General Hospital have found that the men who drink two or more beers a day are two and a half times more likely to get gout than their none non drinking counterparts.
The study reported in The Lancet and carried out over 12 years on 47,000 male medical staff found that wine and spirit drinkers, although they have an increased incident of gout, were less affected that those men who drank beer. It does not appear to be the alcohol content alone that is the culprit. Dr Choi believes it is more likely to be the levels of purines, a chemical which breaks down into uric acid and which in excess amounts causing gout, that is the problem. Beer contains more purines than spirits and wine.
Gout, a form of arthritis causing inflammation of joints, tendons and other tissues, is an extremely painful disease that affects mostly men.
CORVALLIS, Ore. (AP) -- A main ingredient in beer may help prevent prostate cancer and enlargement, according to a new study. But researchers say don't rush out to stock the refrigerator because the ingredient is present in such small amounts that a person would have to drink more than 17 beers to benefit.
Oregon State University researchers say the compound xanthohumol, found in hops, inhibits a specific protein in the cells along the surface of the prostate gland.
The protein acts like a signal switch that turns on a variety of animal and human cancers, including prostate cancer.
Cancer typically results from uncontrolled cell reproduction and growth. Xanthohumol belongs to a group of plant compounds called flavonoids, which can trigger the programmed cell death that controls growth, researchers say.
Xanthohumol was first discovered in hops in 1913, but its health effects were not known until about 10 years ago, when it was first studied by Fred Stevens, assistant professor of medicinal chemistry at OSU's College of Pharmacy.
Last fall, Stevens published an update on xanthohumol in the journal Phytochemistry that drew international attention.
Stevens says it possible for drug companies to develop pills containing concentrated doses of the flavonoid found in the hops used to brew beer.
He also says researchers could work to increase the xanthohumol content of hops.
There are already a number of food supplements on the market containing hops, and scientists in Germany have developed a beer that contains 10 times the amount of xanthohumol as traditional brews. The drink is being marketed as a healthy beer, but research is still under way to determine if it has any effect against cancer.
The latest Oregon State University research was published in a recent issue of Cancer Letters.
Low Estrogen Levels In Men Linked To Increased Risk For Hip Fracture May 04, 2006 9:31 PM
A new study has found that men with low estrogen levels have an increased risk for future hip fracture, and those with both low estrogen and low testosterone levels have the greatest risk.
The study, to be published in the May issue of The American Journal of Medicine, was conducted by Shreyasee Amin, M.D., Mayo Clinic rheumatologist, and colleagues studying men from the National Heart, Lung and Blood Institute's Framingham Heart Study (http://www.framingham.com/heart) prior to her career at Mayo Clinic.
The study examined 793 men who had their estrogen and testosterone levels measured between 1981 and 1983 and no record of prior hip fracture. They were followed until 1999. The men were categorized as having low, midrange or high levels of each hormone. The researchers also recorded hip fractures not associated with high trauma occurring since the study start. During the study, 39 men experienced a low trauma hip fracture (for example, incurred due to a fall from a standing height or less). Those with low estrogen levels (total estradiol levels below 18 picograms per milliliter) had 3.1 times the risk of hip fracture compared to men with high estrogen levels. There was no significant increase in hip fracture risk for men with low testosterone levels alone. However, men with both low estrogen and low testosterone levels had the greatest risk, with 6.5 times the risk of hip fracture compared to the men who had both estrogen and testosterone levels in the high range or midrange.
This study is the first to report the link between low estrogen and hip fracture in a study group of men from the general population followed over time.
Though many people associate testosterone with men and estrogen with women, men possess both hormones, according to Dr. Amin.
The researchers who undertook this study knew that low estrogen levels had been associated with low bone mineral density in elderly men, but any link to hip fracture, an important health risk in the elderly, was unknown. Hip fractures are worrisome in the elderly, especially in men, explains Dr. Amin. Up to 50 percent of men require institutionalized care after the fracture. Hip fracture also is linked to higher levels of mortality: up to 37 percent of men die within one year of fracture.
"These findings add further evidence to the important role of estrogen in the bone health of older men," says Dr. Amin. "It's important for us to know what puts men at risk for hip fracture so that we can better determine how we may prevent these fractures."
Currently, no tests are routinely performed in men to determine estrogen levels. A man known to have low estrogen levels, however, may potentially benefit from interventions to improve his bone density and prevent hip fracture, says Dr. Amin. This may be especially important if he has low testosterone levels as well.
Other researchers involved in this study include Yuqinq Zhang, D.Sc.; David Felson, M.D.; Clark Sawin, M.D.; Marian Hannan, D.Sc.; Peter W.F. Wilson, M.D.; and Douglas Kiel, M.D. None of these researchers are from Mayo Clinic.
[report anonymous abuse]
May 01, 2006 1:50 PM
What Is Penile Cancer?
Penile cancer is the growth of malignant cells on the external skin and in the tissues of the penis. Penile cancer is a rare disease. It occurs most often in men who were not circumcised as infants.
What Causes Penile Cancer?
The exact cause of penile cancer is unknown. Failing to regularly and thoroughly cleanse the part of the penis covered by the foreskin increases the risk of developing the disease.
What are the symptoms?
The most common symptom of penile cancer is a tender spot, an open sore, or a wart-like lump that originates at the tip of the penis. The tender spot spreads slowly across the skin, and invades deeper layers of tissue.
As the cancer grows, pain and bleeding will occur.
If left untreated, penile cancer spreads to other parts of the body (lymph nodes and groin).
How is Penile Cancer diagnosed?
If you believe you may have penile cancer, visit your doctor. Your doctor will perform tests that will diagnose it. Some of the tests your doctor may perform are: physical examination and biopsy of lumps or abnormalities.
What are the Stages of penile cancer?
There are four main stages:
Stage 1, malignant cells are found only on the surface of the head (glans) of the penis.
Stage 2, the penile cancer has spread to the surface of the glans, tissues beneath the surface, and the shaft of the penis.
Stage 3, malignant cells have spread to lymph nodes in the groin, where they cause swelling.
Stage 4, the disease has spread throughout the penis and lymph nodes in the groin, or has traveled to other parts of the body.
What are the Treatment options?
Some of the most common treatment options are: Surgery and radiation therapy; amputation of all or part of the penis; medication, chemotherapy, and biological therapy.
Erectile dysfunction is a consistent inability to sustain an erection sufficient for sexual intercourse.
Erectile dysfunction can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.
Erectile dysfunction is also called impotence and ED.
What causes erectile dysfunction?
An erection requires a sequence of events. Erectile dysfunction can be a result of a disruption in one of the events. The sequence involves nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.
Other cause of erectile dysfunction are: injury to the penis, prostate surgery, medication, psychological factors, and injury to the bladder.
Medications that can cause erectile dysfunction are: blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine.
Diseases such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease account for a large percentage of cases of erectile dysfunction.
In older men, erectile dysfunction is usually caused by a physical aimment, such as disease, injury, or side effects of drugs.
How Is erectile dysfunction Diagnosed?
Erectile dysfunction can be diagnosed by patient history, physical examination, laboratory tests and a psychosocial examination.
How is Erectile Dysfunction Treated?
Erectile dysfunction is treatable in all age groups. Some of the most common treatments for erectile dysfunction are: psychotherapy, drug therapy, vacuum devices, and surgery.
Researchers believe erectile dysfunction affects between 10 and 15 million American men.
Epididymitis is an inflammation of the epididymis. The epididymis is the long coiled tube at the top and rear of each testicle. It carries sperm to the vas deferens. The vas deferens is the tube that is cut during a vasectomy to prevent sperm from mixing with the remainder of ejaculatory fluid.
See your doctor immediately if you think you have epididymitis.
What Causes Epididymitis?
Epididymitis can be caused by trauma to the scrotum, chlamydia and an infection with bacteria that are normally present in the intestinal tract. Sometimes it occurs without an infection or chlamydia.
Yes. The treatment will depend on the cause. If if was caused by an infection, antibiotics will be prescribed. If it was caused by chlamydia, treating chlamydia will make it go away. Other treatments are:
bed rest to relieve swelling
ice pack to relieve swelling
analgesic drugs for pain
asprin to control swelling and inflammation
surgery to drain an abscess (in rare cases)
How is Epididymitis Diagnosed?
The doctor will take a urine sample and a sample of the prostate gland to determine the infecting agent.
How Serious is Epididymitis?
Epididymitis is not too serious. It can be corrected with medication and without permanent damage to the scrotum and epididymis.
Yes. The treatment will depend on the cause. A cream may be prescribed to soothe inflammation. An antibiotic may be prescribed if it is caused by a bacterial infection. In some cases, circumcision may be necessary.
It is most often caused by bacterial infection and the mumps virus. Sometimes it occurs with infections of the epididymis. The epididymis are tubes on top of the scrotum that transport sperm to the vas deferens.
What is Kleinfelter Syndrome? May 01, 2006 1:37 PM
What is Kleinfelter Syndrome?
A "syndrome" is a medical condition that is categorized by a multitude of symptoms. Kleinfelter Syndrome is a chromosome abnormality that affects only men. People with this syndrome are born with at least one extra X chromosome. The male with Klinefelter Syndrome will be born with 47 chromosomes in each cell, rather than the normal number of 46. Klienfelter Syndrome is also called 47 X-X-Y syndrome.
Some Kleinfelter patients have 48, 49, or 50 chromosomes. All of the extra chromosomes are Xs. Males with several extra X chromosomes have distinctive facial features, more severe retardation, deformities of bony structures, and even more disordered development of male features.
What are Chromosomes?
Chromosomes are found in every cell in the body. Chromosomes contain the genetic makeup of your body. Chromosomes also determine whether the child will be male or female. Usually, a person has a total of 46 chromosomes in each cell. Two of the chromosomes are responsible for determining that individual's sex. These two sex chromosomes are called X and Y. The combination of these two types of chromosomes determines the sex of a child. A female has two X chromosomes. A male has one X and one Y chromosome.
What Causes Kleinfelter Syndrome?
Keinfelter's syndrome is caused by an extra X chromosome and affects only males. An infant with Kleinnfelter's Syndrome appears normal at birth, but the defect usually becomes apparent in puberty when secondary sexual characteristics fail to develop, and testicular changes occur that eventually result in infertility in the majority of those affected.
In mild cases, no abnormalities will be present. However, the individual will be infertile.
What are the Symptoms?
Some of the symptoms are: small penis, small firm testicles, diminished pubic, axillary, and facial hair sexual dysfunction, enlarged breast tissue (called gynecomastia), tall stature, abnormal body proportions (long legs, short trunk), learning disabilities, personality impairment, and a single crease in the palm.
How is Kleinfelter Syndrome Diagnosed?
There are many tests available to diagnose Kleinfelter Syndrome. Some of the tests are: physical examination (rectal exam) may show an enlarged prostate; karyotyping showing 47XXY, semen exam showing low sperm count, and a decreased serum testosterone level.
Can it be Treated?
Unfortunately, there is no treatment available to change chromosomal makeup. However, some of the symptoms: delayed puberty and decreased sexual drive can both be treated.
Review Examines Prevalence Of Peyronie's Disease In Men With Erectile Dysfunction
Peyronie's disease (PD) is a localized connective tissue disorder that primarily affects the tunica albuginea and the areolar space between the tunica albuginea and erectile tissue. The majority of men with PD retain the ability to obtain and maintain an erection. However, they may have difficulties in achieving vaginal penetration and sexual activity, as a result of curvature, pain on intromission or partner dyspareunia. Inadequate erections are reported in about 20% of patients with symptomatic PD.
A recent review by Ahmed El-Sakka from Makkah, Saudi Arabia, examined the prevalence of Peyronie's disease among a population of men complaining of erectile dysfunction. Also analyzed were the risk factors and medical comorbidities in patients with this disease. The review is published in the March, 2006 issue of European Urology.
A prospective office-based study was performed from December 2001 to December 2004 and 1,440 male patients with a clinical diagnosis of ED were enrolled in the study. Patients were interviewed for ED using the IIEF. Patients were also interviewed for socio-demographic factors and relevant medical history. Socio-demographic factors included age, obesity and smoking habits. Medical history and risk factors included diabetes, hypertension, dyslipidemia, and psychological disorders. The diagnosis of Peyronie's disease was based on a penile plaque on routine examination of the penis, or acquired penile curvature that was confirmed by using an intracorporeal injection of 10mcg of prostaglandin E1.
Of the 1,440 patients, 84% were sexually active. 11.8% of the total had mild, 38.3% had moderate and 49.9% had severe ED. 11.3% of the patients had low testosterone levels and 9.2% had hyperprolactenemia. Analysis of the results showed that 7.9% of the patients had Peyronie's disease; of those 27.2% had sought medical advice at the time of screening. The remaining patients were detected during examination. Mean age of the patients were 54.1 years and 52.5 years for patients with and without PD respectively. Of the patients, 12.9% were below 40 years, 76.7% were overweight or obese, and 38.2% were current or ex-smokers. There were significant associations between PD and both longer duration and increased severity of ED. There were also significant associations between PD and the following socio-demographic risk factors of ED: age, obesity, smoking, duration and number of cigarettes smoked per day. Concomitant diseases and medical comorbidities such as diabetes, dyslipidemia, psychological disorders and the presence of at least one risk factor were significantly associated with PD in patients with ED.
This study offers a quantitative estimate of the prevalence of PD among ED patients in an office-based practice. There were significant associations between ED risk factors and PD.
Cialis Is Effective In The Treatment Of Men With Erectile Dysfunction Regardless Of Previous Effective Viagra Use
The phosphodiesterase type 5 (PDE-5) inhibitors have revolutionized the pharmacologic management of erectile dysfunction (ED). Viagra‚ (sildenafil citrate) was the first of the class to be introduced in 1998 and later followed by Levitra‚ (Vardenafil) and Cialis‚ (Tadalafil) in 2003. Therefore, men currently taking Cialis‚ may have had previous experience with Viagra‚. Because of the unique properties of each drug, many patients will try more than one of these agents.
Dr. Broderick of the Mayo clinic in Jacksonville, Florida and colleagues recently reviewed 14 placebo controlled, double-blinded trials of Cialis‚ use in men who were either previous Viagra‚ responders or naďve to the PDE-5 class of medications. A total of almost 2800 men were analyzed for this study. Patients who failed to have an erectile response to Viagra‚ were excluded from this analysis.
The investigators found that Cialis‚ at 10 or 20 mg improved erectile function over placebo regardless of previous Viagra use or PDE-5 inhibitor naive patients. Conclusions were based on results measured by the International Index of Erectile Function (IIEF) EF domain score, Sexual Encounter Profile (SEP) questions Q2 (successful penetration) and Q3 (successful intercourse) and a Global Assessment Question (GAQ1) about erectile improvement.