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American Family Physician Nov 2016Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is common, affecting at least 12 million...
Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is common, affecting at least 12 million U.S. men. The five-question International Index of Erectile Function allows rapid clinical assessment of ED. The condition can be caused by vascular, neurologic, psychological, and hormonal factors. Common conditions related to ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment. Performance anxiety and relationship issues are common psychological causes. Medications and substance use can cause or exacerbate ED; antidepressants and tobacco use are the most common. ED is associated with an increased risk of cardiovascular disease, particularly in men with metabolic syndrome. Tobacco cessation, regular exercise, weight loss, and improved control of diabetes, hypertension, and hyperlipidemia are recommended initial lifestyle interventions. Oral phosphodiesterase-5 inhibitors are the firstline treatments for ED. Second-line treatments include alprostadil and vacuum devices. Surgically implanted penile prostheses are an option when other treatments have been ineffective. Counseling is recommended for men with psychogenic ED.
Topics: Alprostadil; Chronic Disease; Erectile Dysfunction; Exercise; Healthy Lifestyle; Humans; Male; Penile Prosthesis; Phosphodiesterase 5 Inhibitors; Tobacco Use Cessation; Vacuum; Vasodilator Agents; Weight Loss
PubMed: 27929275
DOI: No ID Found -
Current Opinion in Allergy and Clinical... Jun 2019The following article provides an overview of food-dependent exercise-induced anaphylaxis (FD-EIAn). The review focuses on the epidemiology, pathophysiology, and... (Review)
Review
PURPOSE OF REVIEW
The following article provides an overview of food-dependent exercise-induced anaphylaxis (FD-EIAn). The review focuses on the epidemiology, pathophysiology, and clinical findings of FD-EIAn and details current practice in terms of the investigation, management, and treatment options available.
RECENT FINDINGS
The management of FD-EIAn has not changed significantly over the last few years and still requires careful investigation by an experienced clinician to ensure that the correct diagnosis is made and appropriate treatment is given. Although new therapies such as synthetic prostaglandin E1 analogs and IgE monoclonal antibodies have been trialed as treatment options for FD-EIAn, the mainstay of treatment remains the graded reintroduction to exercise in a supervised setting.
SUMMARY
FD-EIAn is a rare but serious condition that can have a significant impact on patients' lives. This review aims to discuss new relevant research into this field to help guide clinicians in managing this condition.
Topics: Allergens; Alprostadil; Anaphylaxis; Antibodies; Exercise; Food Hypersensitivity; Humans; Immunoglobulin E; Wheat Hypersensitivity
PubMed: 30893086
DOI: 10.1097/ACI.0000000000000531 -
Journal of Cardiac Surgery Jul 2020Tricuspid atresia (TA) is a complex congenital heart disease that presents with cyanosis in the neonatal period. It is invariably fatal if left untreated and requires... (Review)
Review
Tricuspid atresia (TA) is a complex congenital heart disease that presents with cyanosis in the neonatal period. It is invariably fatal if left untreated and requires multiple stages of palliation. Early recognition and timely surgical intervention are therefore pivotal in the management of these infants. This literature review considers the pathophysiology, presentation, investigations, and classification of TA. Moreover, it discusses the evidence upon which the latest medical and surgical treatments are based, as well as numerous recent case reports. Further work is needed to elucidate the etiology of TA, clarify the role of pharmacotherapy, and optimize the surgical management that these patients receive.
Topics: Alprostadil; Angiotensin-Converting Enzyme Inhibitors; Child, Preschool; Female; Fontan Procedure; Humans; Infant; Infant, Newborn; Male; Postoperative Care; Survival Rate; Treatment Outcome; Tricuspid Atresia; Tricuspid Valve
PubMed: 32484582
DOI: 10.1111/jocs.14673 -
Current Opinion in Pediatrics Oct 2020Chronic constipation is a common problem that substantially impacts the quality of life of patients and families, healthcare professionals, and resources. The purpose of... (Review)
Review
PURPOSE OF REVIEW
Chronic constipation is a common problem that substantially impacts the quality of life of patients and families, healthcare professionals, and resources. The purpose of this review is to discuss the medications that are available for management of chronic constipation, including medications that have been approved by the FDA for adults, other been studied in pediatrics now, and might become available within the upcoming years.
RECENT FINDINGS
Recent developments in the evaluation of childhood constipation are providing a better understanding into defecation disorders in children and not only new therapies are becoming available, including medications, but also other therapies, such as biofeedback for treatment of functional defecation disorders, electrical stimulation, and surgeries. The aim of this article is to provide an update on the medications that are available for management of chronic constipation, especially with the development and study of newer medications, such as Linaclotide and Lubiprostone with promising results in both adult and pediatric patients.
SUMMARY
This review will help us identify and have a better understanding regarding what medications are available for use and the indications, so that we can better manage patients with chronic constipation. VIDEO ABSTRACT.
Topics: Adult; Child; Chloride Channel Agonists; Constipation; Humans; Lubiprostone; Quality of Life
PubMed: 32833797
DOI: 10.1097/MOP.0000000000000938 -
Journal of Graduate Medical Education Apr 2017
Topics: Alprostadil; Internship and Residency; Pipemidic Acid
PubMed: 28439366
DOI: 10.4300/JGME-D-16-00850.1 -
Angiology Jan 2020
Topics: Alprostadil; Creatinine; Humans; Randomized Controlled Trials as Topic; Renal Insufficiency
PubMed: 31331187
DOI: 10.1177/0003319719865670 -
Portuguese Journal of Cardiac Thoracic... Jul 2023Buerger's disease is a distal segmental nonatherosclerotic vasculopathy that involves the inferior and superior limbs of smoker males younger than 45 years old. This...
Buerger's disease is a distal segmental nonatherosclerotic vasculopathy that involves the inferior and superior limbs of smoker males younger than 45 years old. This article aims to describe a clinical case and revise the literature about Buerger's disease. A 45-year-old smoker male repeatedly visited the emergency department for refractory pain and inflammatory signs in the right hallux. After developing ulcers in the right foot, Doppler ultrasonography revealed segmental occlusion of distal arteries of that limb. It was also observed in arteriography "corkscrew" collaterals. Autoimmune, thrombophilic and cardiovascular diseases were excluded. Analgesia, antibiotics and alprostadil were implemented. As a result, the patient stopped smoking and was submitted to minor amputation with complete healing, after which he remained asymptomatic. Buerger's disease is a diagnosis of exclusion. Therefore, smoking cessation is the most effective treatment and is crucial to prevent disease progression.
Topics: Humans; Male; Middle Aged; Thromboangiitis Obliterans; Arteries; Alprostadil; Pain; Smoking
PubMed: 37418773
DOI: 10.48729/pjctvs.259 -
Frontiers in Bioscience (Landmark... Oct 2023Ischemic stroke is one of the major causes of death and disability. Since the currently used treatment option of reperfusion therapy has several limitations, ongoing... (Review)
Review
Ischemic stroke is one of the major causes of death and disability. Since the currently used treatment option of reperfusion therapy has several limitations, ongoing research is focusing on the neuroprotective effects of microglia and stem cells. By exerting the bystander effect, secreting exosomes and forming biobridges, mesenchymal stem cells (MSCs), neural stem cells (NSCs), induced pluripotent stem cells (iPSCs), and multilineage-differentiating stress-enduring cells (Muse cells) have been shown to stimulate neurogenesis, angiogenesis, cell migration, and reduce neuroinflammation. Exosome-based therapy is now being extensively researched due to its many advantageous properties over cell therapy, such as lower immunogenicity, no risk of blood vessel occlusion, and ease of storage and modification. However, although preclinical studies have shown promising therapeutic outcomes, clinical trials have been associated with several translational challenges. This review explores the therapeutic effects of preconditioned microglia as well as various factors secreted in stem cell-derived extracellular vesicles with their mechanisms of action explained. Furthermore, an overview of preclinical and clinical studies is presented, explaining the main challenges of microglia and stem cell therapies, and providing potential solutions. In particular, a highlight is the use of novel stem cell therapy of Muse cells, which bypasses many of the conventional stem cell limitations. The paper concludes with suggestions for directions in future neuroprotective research.
Topics: Humans; Microglia; Ischemic Stroke; Stroke; Alprostadil; Mesenchymal Stem Cells
PubMed: 37919085
DOI: 10.31083/j.fbl2810269 -
Andrology Sep 2021Because it is a superficial structure, the penis is ideally suited to ultrasound imaging. A number of disease processes, including Peyronie's disease, penile fractures... (Review)
Review
BACKGROUND
Because it is a superficial structure, the penis is ideally suited to ultrasound imaging. A number of disease processes, including Peyronie's disease, penile fractures and tumors, are clearly visualized with ultrasound. Baseline and dynamic assessment of cavernosal arterial changes after pharmaco-stimulation with alprostadil allows standardized diagnosis of arterial and venogenic causes of erectile dysfunction (ED).
OBJECTIVE
To illustrate how to correctly perform flaccid and dynamic penile duplex ultrasound (D-PDU) and in which patients to recommend it.
MATERIALS/METHODS
An extensive search of the literature was carried out on Pubmed with the insertion of the following Medical Subjects Headings (MeSH) terms and keywords "penile color Doppler ultrasound" "peak systolic velocity" "end-diastolic velocity", "acceleration time", "resistance index".
EVIDENCE
In our experience, arterial erectile dysfunction is identified after standardized intracavernous injection (ICI) of alprostadil (10 mcg) when values of peak systolic velocity (PSV) are <35 cm/s and, in the most severe forms, for values <25 cm/s. Arterial insufficiency can also be identified by increased acceleration time (AT) values (>110 ms) and/or by a lack of visualization of helicine arteries at power Doppler mode along with incomplete achievement of penile rigidity. The veno-occlusive incompetence is determined when end-diastolic velocity (EDV) values are >4.5-5 cm/s or in the case of resistance index (RI) values <0.75. The assessment of additional surrogate markers of endothelial dysfunction, that is, intima-media thickness, mean platelet volume (MPV), endothelial progenitor cells (EPC), endothelial cell specific molecule-1(endocan) are also useful in assessing the patient's cardiovascular risk but are still considered investigational in the interpretation of D-PDU results.
CONCLUSION
D-PDU scan after ICI with vasoactive drugs is a safe procedure and represents the gold standard for the diagnostics of penile pathologies and should be performed in men with ED not responding to oral conventional therapies and/or in those requiring accurate stratification of cardiovascular risk.
Topics: Alprostadil; Carotid Intima-Media Thickness; Erectile Dysfunction; Humans; Male; Penile Diseases; Penile Induration; Penis; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex; Vasodilator Agents
PubMed: 33960127
DOI: 10.1111/andr.13029 -
Expert Opinion on Pharmacotherapy Mar 2015Constipation is a frequent non-motor feature of Parkinson's disease (PD). It is the most common gastrointestinal symptom of the disease and it can precede motor symptoms... (Review)
Review
INTRODUCTION
Constipation is a frequent non-motor feature of Parkinson's disease (PD). It is the most common gastrointestinal symptom of the disease and it can precede motor symptoms by as much as 20 years. Constipation can produce discomfort and affect activities of daily living, productivity and quality of life, thus warranting early diagnosis and treatment.
AREAS COVERED
In this review, the safety and efficacy of traditional and novel strategies for constipation management will be discussed. A treatment algorithm for constipation in PD will be presented.
EXPERT OPINION
Polyethylene glycol and lubiprostone are first-line compounds recommended by evidence-based medicine guidelines for the treatment of constipation due to slow colonic transit in PD. Management of constipation secondary to defecatory dysfunction due to pelvic floor dyssynergia can be done by levodopa or apomorphine injections, botulinum toxin type A injection into the puborectalis muscle, and nonpharmacological interventions, like biofeedback therapy or functional magnetic stimulation, which showed some benefit in PD patients with constipation, but in general more extensive studies are warranted.
Topics: Alprostadil; Constipation; Defecation; Gastrointestinal Transit; Humans; Laxatives; Lubiprostone; Parkinson Disease; Polyethylene Glycols; Quality of Life
PubMed: 25539892
DOI: 10.1517/14656566.2015.997211