AIMTo determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography.

METHODSA total of 69 erectile dysfunction (ED) patients aged 22-79 years were enrolled into the present study. Thirty-eight (55.1%) men with ED who did not respond to four attempts of treatment with 100 mg sildenafil after re-education were classified as sildenafil non-responders. A combination of three vasodilator drugs, 1.25 mg papaverine, 0.4 mg phentolamine and 5 mg prostaglandin E1, was given by intracavernous injection before penile Doppler ultrasonography was carried out. The erectile response to intracavernous injection and vascular parameters including peak systolic velocity (PSV), resistance index (RI), end diastolic velocity (EDV) and cavernosa artery diameter (CD) were measured and the results between sildenafil non-responders and responders were compared.

RESULTSNo statistical difference in vascular parameters measured by Doppler ultrasonography studies between non-responders and responders was noted. Sildenafil non-responders had a poorer penile rigidity response to intracavernous injection than responders (P < 0.05). Among patients with adequate PSV (>or=30 cm/s) and abnormal EDV (> 5 cm/s), individuals in the non-responder group had fewer positive responses to intracavernous vasodilator injection than in the responder group (35.3% vs. 72.2%, P < 0.05). Advanced age and comorbidity with diabetes mellitus were significantly associated with sildenafil non-response (P < 0.05).

CONCLUSIONSildenafil non-responders were characterized by a poorer penile rigidity response to intracavernous injection and had an associated impaired veno-occlusive mechanism. Advanced age and comorbidity with diabetes mellitus were two common factors associated with non-response.

Adult ; Aged ; Alprostadil ; therapeutic use ; Erectile Dysfunction ; diagnostic imaging ; drug therapy ; Humans ; Male ; Middle Aged ; Papaverine ; therapeutic use ; Phentolamine ; therapeutic use ; Piperazines ; therapeutic use ; Purines ; therapeutic use ; Sildenafil Citrate ; Sulfones ; therapeutic use ; Ultrasonography, Doppler, Color ; Vasodilator Agents ; therapeutic use

OBJECTIVETo analyze a Duchenne muscular dystrophy(DMD) patient's muscular regeneration, dystrophin expression and locomotive variation before and after he underwent umbilical cord blood stem cell transplantation in order to assess the therapeutic effect.

METHODSA 12-year-old DMD boy who could not walk for 3 years was confirmed by gene analysis and dystrophin protein immune test on his muscle. He had no other chronic disease. By HLA matching, a piece of umbilical cord blood stem cell with 6 HLA sites matching to the boy was found in Guangdong Umbilical Cord Blood Bank. The number of the nucleated cells of the umbilical cord blood stem cell was 24.08x 10(8). After pretreatment for the DMD boy with busulfan, cyclophosphamide and rabbit anti-human thymocyte globulin, the allergenic cord blood stem cells were transplanted into him by intravenous injection. Cyclosporin A, methylprednisolone, MMF, prostaglandin E1 and ganciclovir were given after the transplantation. At the same time, Gran, the granulocytic cell stimulating factor, and gamma globulin were administered. The biochemistry profile including serum creatine kinase (CK), the reconstruction of blood making, the deletion exon of DMD gene, the regenerating muscles, the dystrophin protein expression, and the locomotive function of the DMD boy were tested regularly.

RESULTS(1) The white blood cells (WBC) of peripheral blood decreased gradually to zero after pretreatment. In a period of 15 days after transplantation, the neutrophil increased to 0.5x 10(9)/L; at 25 days, WBC increased to normal level. Blood platelet was more than 20x 10(9)/L at 22 days. The hemoglobin rose to 85-100 g/L. At 140 days, sternal puncture revealed the rapid growth of neutrophil, blood platelet and hemoglobin. (2)At 140 days, the blood type of the DMD boy transformed from type O to type AB (the donor's blood type being AB). There was no grafe versus host reaction. (3) At 18, 30, 43, 55, 74 and 233 days after transplantation, the PCR-short tandem repeat test of the boy's peripheral blood DNA showed that his genotype was completely the same as the donor's. The results of PCR-short tandem repeat tests of the bone marrow cells DNA by sternal puncture at 140, 183 and 235 days were the same as those of the blood DNA. (4) At 60 days, DMD gene analysis by PCR showed that the defected DMD gene (exon 19 deletion) had been corrected by the umbilical cord stem cells transplantation. (5) At 75 days, the biopsy of calf muscle showed there were myoblast cells and muscular tubes growing. The dystrophin expressions were weak, but a few of them were strong. DNA analysis showed that the donor's gene DNA accounted for 1%-13%. At 126 days, obviously increased dystrophin positive muscular fibers of the boy were found. The donor's fibers rose to 2.5%-25%. (6) The serum CK of the boy declined from 5735 U/L to 274 U/L. (7) At 100 days, physical examination revealed improvement in his arms and legs.

CONCLUSIONThe therapy of Duchenne muscular dystrophy with allogeneic umbilical cord blood hematopoietic stem cell transplantation may reset up the blood-making function, decrease the serum CK level, restore the dystrophin in muscles, and improve the locomotive function of the DMD boy. These data suggest that the allogeneic umbilical cord blood hematopoietic stem cell transplantation may benefit the DMD boys.

Alprostadil ; therapeutic use ; Busulfan ; therapeutic use ; Child ; Combined Modality Therapy ; Cord Blood Stem Cell Transplantation ; methods ; Cyclosporine ; therapeutic use ; Dystrophin ; genetics ; Ganciclovir ; therapeutic use ; Humans ; Male ; Methylprednisolone ; therapeutic use ; Muscular Dystrophy, Duchenne ; genetics ; therapy ; Polymerase Chain Reaction ; Treatment Outcome

OBJECTIVESTo discuss the therapeutic choices of erectile dysfunction (ED) and to improve the therapeutic efficacy for different ED cases.

METHODSTwo hundred and twenty-seven patients with ED were treated repectively with psychological treatment(31 cases), oral testosterone(30 cases), Viagra(121 cases), psychological treatment + Viagra (16 cases), intraurethral PGE1 (8 cases) and intracavemous injection(21 cases).

RESULTSAmong those ED patients, 142 (62.6%) cases reported improved erections after they had undergone above-mentioned therapies. The improved patients include 12 cases(38.7%) with psychological treatment, 9 cases (30.0%) with oral testosterone, 91 cases (75.2%) with Viagra, 13 cases (81.3%) with psychological and Viagar, 2 cases (25.0%) with intraurethral PGE1 and 21 cases (71.4%) with intracavemous injection.

CONCLUSIONSED is a highly individualized disease, therapeutic choices of ED based on patient's situation can benefit those patients.

Administration, Oral ; Adult ; Aged ; Alprostadil ; therapeutic use ; Combined Modality Therapy ; Erectile Dysfunction ; drug therapy ; therapy ; Humans ; Male ; Middle Aged ; Phosphodiesterase Inhibitors ; therapeutic use ; Piperazines ; therapeutic use ; Psychotherapy ; Purines ; Sildenafil Citrate ; Sulfones ; Testosterone ; therapeutic use ; Treatment Outcome ; Vasodilator Agents ; therapeutic use

OBJECTIVE: To evaluate the clinical efficacy on the treatment of the low-middle frequency sudden hearing loss with postaurical injection of methylprednisolone. METHOD: The 80 cases of the low-middle frequency sudden hearing loss were randomly divided into postaurical injection and oral hormone groups. The postaurical injection group (42 cases) received the postaurical injection of methylprednisolone, 40 mg/2 d, combined with the treatment of Ginkgo dipyidamolum and Alprostadil for 14 d; The oral hormone group (38 cases) received the oral prednisone, 1 mg/kg/d, administrated once on the morning for 3 d, if effective, prolonging for another 2 d, as mentioned above for Ginkgo dipyidamolum and Alprostadil. RESULT: The total effective rate was 88.10% in postaurical injection group and 86. 4o%in oral hormone group. There was no significant difference between the twbogroups( P> 0. 5). CONCLUSION Postaurical injection of methylprednisolone for the low-middle frequency sudden hearing loss is effective, safe and simple, which may be an alternative for systemic administration of gulcocorticoid.
Alprostadil ; therapeutic use ; Biological Products ; therapeutic use ; Glucocorticoids ; administration & dosage ; therapeutic use ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; drug therapy ; Humans ; Injections ; Methylprednisolone ; administration & dosage ; therapeutic use ; Prednisone ; administration & dosage ; therapeutic use ; Treatment Outcome

Adult ; Aged ; Alprostadil ; therapeutic use ; Female ; Hemorheology ; Humans ; Male ; Middle Aged ; Pneumoconiosis ; blood ; drug therapy ; physiopathology ; Respiratory Function Tests

OBJECTIVETo investigate the therapeutic effect of prostaglandin E1 (PGEl) on diabetic nephropathy (DN) after a one-year treatment.

METHODSAccording to Mogensen DN diagnostic criteria, the patients were divided into DN stages III, IV and V groups. Patients in stage IV nephropathy were subdivided into three groups according to the proteinuria, namely early stage IV (protienuria less than 1.5 g/day), mid-stage IV (protienuria between 1.5 and 2.5 g/day) and late stage IV (protienuria above 2.5 g/day). The patients were randomly given PGEl, PGEl plus angiotensin-converting enzyme inhibitor (ACEI), ACEI mono-therapy or basal treatment (control group). Proteinuria and albuminuria were measured before and at 15 days and 1 year of the treatment.

RESULTSIn the patients in DN stages III and early stage IV, proteinuria and albuminuria decreased significantly after 15 days and 1 year of treatment with PGEl+ACEI and PGEl (P<0.01), and the decrements were greater than that in patients receiving ACEI only (P<0.01 or P<0.05). In the patients in mid- and late stage IV nephropathy, proteinuria and albuminuria decreased significantly in PGEl+ACEI group after 15 days and 1 year of treatment (P<0.01), showing greater decrement than in ACEI group (P<0.01 ). Proteinuria and albuminuria decreased significantly in PGEl group after 15 days of treatment (P<0.01), but remained higher than that in ACEI group at one year (P<0.05). In the patients with stage V nephropathy, significant proteinuria and albuminuria reduction occurred in PGEl+ACEI and PGEl groups at 15 days (P<0.01) with a greater decrement than that in ACEI group (P<0.01 or P<0.05). In PGEl+ACEI group, proteinuria and albuminuria showed no significant changes at one year but were lower than those in ACEI group (P<0.05). Proteinuria and albuminuria increased significantly in ACEI and PGEl group after the treatment but were comparable between the two groups (P<0.05).

CONCLUSIONSThe therapeutic effects are much better in patients with stage III nephropathy than in those in stage V. The combination of PGEl and ACEI produces stronger therapeutic effects than PGE1 or ACEI alone even at the one-year follow up.

Adult ; Aged ; Albuminuria ; urine ; Alprostadil ; therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Diabetic Nephropathies ; drug therapy ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged

OBJECTIVESTo evaluate the outcome of treatment in patients with erectile dysfunction (ED) using sildenafil or intracavernosal injection of prostaglandin E1(PGE1).

METHODS54 patients with ED were randomly classified into two groups and received either oral sildenafil (group A) or intracavernosal injection of PGE1(group B) for 4-9 months with an average of 6 months.

RESULTSThe percentages of efficacy in the two groups were 80.0% and 83.3%, respectively. There was no statistical difference between group A and B (P > 0.05). Two of six patients who did not respond to sildenafal in group A achieved erections sufficient for sexual intercourse when the six patients received intracavernous injection of PGE1. None of the four patients who did not respond to intracavernous injection of PEG1 in group B achieved erection sufficient for sexual intercourse when they received oral sildenafil.

CONCLUSIONSBoth oral sildenafil and intracavernous injection of PGE1 are effective for patients with ED of various etiologies. The patients who do not respond to sildenafil can receive intracavernous injection therapy. The satisfactory results can probably achieved.

Administration, Oral ; Adult ; Aged ; Alprostadil ; therapeutic use ; Drug Administration Routes ; Erectile Dysfunction ; drug therapy ; Humans ; Male ; Middle Aged ; Piperazines ; therapeutic use ; Purines ; Sildenafil Citrate ; Sulfones ; Treatment Outcome

OBJECTIVESTo evaluate the efficacy and safety of PGE1 cream[Befar, NexMed Pharmaceuticals(Zhongshan) Ltd] on men with ED of various etiologies in China.

METHODSThis was a double-blind, randomized (1:1, placebo: PGE1 cream), placebo-controlled clinic study of PGE1 cream performed at Peking University Pepole's Hospital for 8 weeks. A total of 42 subjects suffered from erectile dysfunction of psychologic, organic or mixed etiology were screened and randomized, and visited occurred at weeks -4, 0, 2 and 4 weeks covering a 4-week no treatment run-in period and a 4-week period of double blind treatment.

RESULTSAt week four PGE1 cream was shown to be significantly (P < 0.01) effective over placebo in the sexual function endpoints analyses. The primary efficacy variables (Questions 3 and 4 from IIEF) revealed a statistically significant (P < 0.01) improvement over placebo along with a clinical efficacy change score with an effective rate of 63.16% on PGE1 cream vs 9.52% on placebo. The secondary efficacy variables supported the conclusion of the primary efficacy (assessing the proportion of successful attempts at sexual intercourse 68.42% on PGE1 cream vs 19.05% on placebo), and the global assessment question (treatment had improved their erections, 73.68% on PGE1 cream vs 19.05% on placebo). PGE1 cream was well tolerated when given prn. Subjects in the study had a low discontinuation rate (4.76%), only one subject (2.38%) discontinued due to adverse events. The incidence of adverse events was higher for PGE1 cream (30.00%) than for placebo (4.76%). The common adverse events were mild pain of penis and urethra.

CONCLUSIONSPGE1 cream is an effective, safe and well-tolerated treatment in subjects with erectile dysfunction of organic, psychologic or mixed etiology.

Adult ; Aged ; Alprostadil ; adverse effects ; therapeutic use ; Double-Blind Method ; Erectile Dysfunction ; drug therapy ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Vasodilator Agents ; adverse effects ; therapeutic use

OBJECTIVESTo evaluate the efficacy of intrameatal application of low dosage alprostadil (PGE1) cream (300 mcg) for the treatment of erectile dysfunction (ED).

METHODSA total of 43 ED patients were selected in the study based on the inclusion criteria. All of the patients signed informed consent forms and entered a 4-week open-label clinical study. A dosage of 300 mg PGE1 in 75 mg cream was applied intrameatally.

RESULTSThe results showed that the primary efficacy (IIEF Q3 + Q4) reached 70.73% after application of the cream. The successful intercourse rate was 86.41%. Based on the GAQ (global assessment Question); 73.17% of the patients were satisfied with their sexual life. At the same time, all of the secondary criteria supported the primary efficacy results. Two patients withdrew during the study period. Six patients (14.63%) had urethral pain or penile redness, which were mostly mild and transient.

CONCLUSIONSWith intrameatal low dosage (300 mcg PGE1) of the PGE1 cream can achieve an equivalent efficacy as that with the full dosage.

Adult ; Aged ; Alprostadil ; administration & dosage ; therapeutic use ; Erectile Dysfunction ; drug therapy ; Humans ; Male ; Middle Aged ; Penile Erection ; drug effects ; Treatment Outcome ; Vasodilator Agents ; administration & dosage ; therapeutic use

Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each.
Alprostadil/therapeutic use ; Erectile Dysfunction/etiology/*rehabilitation ; Humans ; Male ; Penile Implantation ; Phosphodiesterase 5 Inhibitors/therapeutic use ; Prostatectomy/*adverse effects/rehabilitation ; Prostatic Neoplasms/*surgery ; Risk Factors ; Vacuum ; Vasodilator Agents/therapeutic use