- Un homme sur cinq en souffre. [Journal Article]
- RPRev Prat 2017; 67(6):616-622
- News in erectile dysfunction. Erectile dysfunction (ED) is the most commonly treated sexual disorder affecting up to 20% of all men. As ED adversely affects the lives of millions of men, the public h...
News in erectile dysfunction. Erectile dysfunction (ED) is the most commonly treated sexual disorder affecting up to 20% of all men. As ED adversely affects the lives of millions of men, the public health implications of this condition are significant and represent a challenge for our healthcare system. Several options are available for treating ED : oral pharmacotherapy with phosphodiesterase 5 (PDE5) inhibitors represent so far the first-line option for many patients with ED. They are effective in three quarters of patients, with a similar response rate with the 4 available molecules (sildenafil, vardenafil, tadalafil and avanafil). Recently, an alprostadil cream (Vitaros) combining the active molecule with a skin enhancer has been allowed for usage in France. Low systemic adverse effects (3%), together with a high efficacy (up to 83%) make it a possible first-line therapeutic option for patients with ED who are reluctant to take systemic treatments. The intra-cavernous injections of alprostadil, the vacuum, and ultimately the penile implant (reserved for ED refractory to other treatments) remain effective therapeutic options that must be discussed with the patient. Other therapeutic options are currently under investigation, such as low-intensity shockwave lithotripsy, dopaminergic and melanocortin receptor agonists, which target central erectogenic pathways, soluble guanylate cyclases, rho-kinase inhibitors, and maxi-k channel activators that act peripherally. Newer formulations of existing medications, such as alprostadil and PDE5 inhibitors are also developed. Finally, stem cell regenerative techniques and gene therapy are promising new approaches to the treatment of erectile dysfunction. Most of these novel drugs have yet to reach Phase III studies. However, it is likely that in years to come, patients will be selectively treated with these novel agents as a monotherapy or in combination with others acting in a synergistic manner.
- The intra-meatal application of alprostadil cream (Vitaros®) improves drug efficacy and patient's satisfaction: results from a randomized, two-administration route, cross-over clinical trial. [Journal Article]
- IJInt J Impot Res 2018 Oct 15
- To investigate the efficacy, tolerability, and patient's preference of alprostadil cream for topical use administered within the urethral meatus versus the standard administration route, in erectile ...
To investigate the efficacy, tolerability, and patient's preference of alprostadil cream for topical use administered within the urethral meatus versus the standard administration route, in erectile dysfunction (ED) treatment. Seventy-one patients (mean age 59.7 ± 9.0 years) affected by ED were analyzed in this multicenter, randomized, two-administration routes, cross-over trial. All patients received a single dose of alprostadil cream applying the dispenser to the tip of the penis (without contacting the urethral meatus) (Standard administration route or ST.AR) alternating with a single dose of alprostadil cream applying the dispenser within the urethral meatus (New administration route or NEW.AR) separated by a one-week washout period, according to randomization. The primary objective of the study was to evaluate the change in International Index of Erectile Function (IIEF-5) total score from baseline to the control visit by comparing the ST.AR and NEW.AR. Secondary objectives of the study were to compare the different methods of administration by evaluating the change in the Sexual Encounter Profile (SEP-2 and SEP-3) questionnaire score and the Patient Reported Outcomes (PROs) by scoring the Patient Self-Assessment of Erection (PSAE) questionnaire. The treatment safety profile was assessed by analysis of adverse events (AEs). Based on the study findings it is evident that the NEW.AR is more efficacious than the ST.AR in improving IIEF-5 and SEP scores from baseline to control visit (IIEF-5: +3.8 vs +6.3; p < 0.001; positive response to SEP-2: 10 vs 27; p = 0.002) and in terms of PSAE (a significant improvement from the baseline in 31% of patients; p < 0.001). As regards the safety profile, no difference in terms of local and systemic side effects was found.
- Glans Ischemia after Circumcision in a 16-Year-Old Boy: Full Recovery after Angiography with Local Spasmolysis, Systemic Vasodilatation, and Anticoagulation. [Journal Article]
- EJEuropean J Pediatr Surg Rep 2018; 6(1):e66-e69
- Circumcision is one of the most frequent procedures performed by pediatric surgeons. A dorsal penile nerve block (DPNB) is commonly used for perioperative analgesia. We report the case of a 16-year-o...
Circumcision is one of the most frequent procedures performed by pediatric surgeons. A dorsal penile nerve block (DPNB) is commonly used for perioperative analgesia. We report the case of a 16-year-old boy with ischemia of the glans who presented on the first postoperative day after circumcision under DPNB (0.25% bupivacaine) at an outside hospital. The patient underwent immediate angiography under sedation. An intra-arterial spasmolysis was performed with alprostadil and nitroglycerine and a sufficient perfusion of the glans penis was confirmed. Subsequently, systemic sildenafil, arginine, and heparin were given. Following this 3-day medical treatment, ischemia resolved completely. Our case emphasizes the role of invasive angiography in the diagnostic workup and the therapeutic possibilities of local spasmolysis, systemic vasodilatation, and anticoagulation.
- Comparison between iloprost and alprostadil for protection against ischemia/reperfusion injury in a rat model [Journal Article]
- TJTurk J Med Sci 2018 Jun 14; 48(3):661-669
- CONCLUSIONS: Alprostadil and iloprost seem to provide protection against IR injury, with iloprost being more protective in renal tissue. Alprostadil is more effective than iloprost in protecting lung tissue against IR injury.
- Malignant atrophic papulosis with motor aphasia and intestinal perforation: A case report and review of published works. [Case Reports]
- JDJ Dermatol 2018; 45(6):723-726
- Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gas...
Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30-year-old female patient with systemic manifestation of MAP 10 days after delivery of a full-term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil. Antibiotics were administrated due to intestinal perforation and secondary sepsis. Despite all treatment, the patient died a week later. We summarized all the previous reports of MAP based on thorough review of previous published work. Overall, this is the first patient with MAP combined with motor aphasia and intestinal perforation and may provide insights for future studies on the treatment of this disease.
- Prostaglandin E1 for maintaining ductal patency in neonates with ductal-dependent cardiac lesions. [Review]
- CDCochrane Database Syst Rev 2018 02 27; 2:CD011417
- CONCLUSIONS: There is insufficient evidence from randomized controlled trials to determine the safety and efficacy of PGE1 in neonates with ductal-dependent cardiac lesions. Evidence from observational trials have informed clinical practice on the use of PGE, which is now considered the standard of care for ductal-dependent cardiac lesions. It is unlikely that randomized controlled studies will be performed for this indication but comparative efficacy of newer formulations of PGE1, different doses of PGE1 and studies comparing PGE with PDA stents or other measures to keep the ductus open may be ethical and necessary.
- Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome. [Journal Article]
- RARev Assoc Med Bras (1992) 2017; 63(5):422-426
- CONCLUSIONS: Younger patients and early referrals had better outcomes. Endothelin receptor antagonist toxicity should be monitored, particularly in patients previously exposed to hepatotoxic drugs.
- Intra-arterial Thrombolysis for Extremity Frostbite Decreases Digital Amputation Rates and Hospital Length of Stay. [Journal Article]
- CICardiovasc Intervent Radiol 2017; 40(12):1824-1831
- CONCLUSIONS: Intra-arterial thrombolysis reduces digital amputation rates and hospital LOS in the setting of severe frostbite.
- Alprostadil cream in the treatment of erectile dysfunction: clinical evidence and experience. [Review]
- TATher Adv Urol 2016; 8(4):249-256
- Erectile dysfunction (ED) is a very common disorder with a deep impact on quality of life on both patients and partners. Several options are available for treating ED: oral pharmacotherapy with phosp...
Erectile dysfunction (ED) is a very common disorder with a deep impact on quality of life on both patients and partners. Several options are available for treating ED: oral pharmacotherapy with phosphodiesterase 5 (PDE5) inhibitors currently represents the first-line option for many patients with ED. Alprostadil, a prostaglandin, has been marketed for many years as a urethral stick and an intracavernous injection for the treatment of ED. It is now available in the form of a cream (Vitaros/Virirec), a noninvasive treatment which combines an active drug (alprostadil, a synthetic prostaglandin E1) with a skin enhancer improving its local absorption directly at the site of action. Alprostadil has a favourable pharmacodynamic profile and is poorly absorbed in systemic circulation, which makes it suitable in a lot of circumstances and results in a reduced risk of adverse effects (AEs). Systemic AEs are reported in only 3% of the treated population. Clinical efficacy has been demonstrated in both phase II and III trials, showing a global efficacy up to 83% with the 300 μg dose in patients with severe ED, significantly better than placebo. Its fast onset of action and lack of interactions with other drugs makes alprostadil cream a possible first-line therapeutic option for some patients with ED: individuals who are reluctant to take systemic treatments or have AEs, patients who do not respond, cannot tolerate, or do not accept PDE5 inhibitor therapy, and patients treated with nitrates. Therefore, this new treatment for ED can be offered to patients and could help address the needs unmet by other treatments.
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- Congenital Heart Disease Requiring Maintenance of Ductus Arteriosus in Critically Ill Newborns Admitted at a Tertiary Neonatal Intensive Care Unit. [Journal Article]
- JCJ Crit Care Med (Targu Mures) 2016; 2(4):185-191
- CONCLUSIONS: For those infants with severe cyanosis or shock caused by PDA dependent heart lesions, the initiation and maintenance of PGE1 infusion is imperative. The side effects of this beneficial therapy were transient and treatable.