Management of impotence. Diagnostic considerations and therapeutic options

Impotence affects an estimated 10 million American men. The cause is usually organic in men over age 50; psychogenic impotence is more common in younger men. Vascular disease is the most common cause of impotence. Evaluation in patients with impotence includes thorough history taking and diagnostic testing. Once the cause of impotence is determined, appropriate management can be chosen. Current therapeutic options include vacuum tumescence devices, self-injection, oral therapy, psychotherapy, and penile prostheses.     

Cerebral cavernous hemangiomas in childhood. Clinical presentation and therapeutic considerations

Cerebral cavernous hemangiomas (CCH) are relatively rare vascular hamartomas. Since the introduction of MRI there has been an increase in the number of case reports of CCH in the medical literature. CCH are often asymptomatic; they may, however, cause epilepsy or neurological deficits due to their space-occupying effects or hemorrhagic sequelae. The tendency of CCH to bleed has been well recognized, though gross hemorrhage is infrequent owing to the relatively low blood pressure and small blood flow in CCH. MRI findings of a CCH are characteristic and can differentiate the lesions from other vascular abnormalities. To date, there has been no consensus on indications for surgical intervention. Three cases are presented, which together demonstrate by their different presentation, clinical course and MRI findings that each patient with a CCH requires an individually tailored management. Presentation, clinical course and accessibility for operation are the factors that determine whether a surgical or a conservative approach should be adopted.     

Study of hemostasis factors in nephrotic syndrome. Pathogenic interpretation and therapeutic deductions

Thrombo-embolic accidents are extremely common during nephrotic syndrome (8 p. 100). They share the garvity of thrombo-embolic accidents occurring under other circumstances (20 p. 100 mortality). They are accompanied by numerous disturbances in clotting factors the mechanisms of which are discussed. Nevertheless the study of these disturbances does not make it possible to predict the onset of a thrombo-embolic problem. By contrast, the degree of hypoalbuminaemia is significantly correlated with the thrombotic risk (p. 0.001) and serves as an indication for the necessity of preventive heparin therapy, in the form of calcium heparinate. In this way the authors have been successful in eliminating the thrombo-embolic risk in association with nephrotic syndrome.     

Psychoanalytic psychotherapy with Asian clients: Transference and therapeutic considerations.

Argues that the belief that individual psychodynamic therapy is ineffective with Asians is partially caused by an indiscriminate application of popular psychoanalytic concepts that claim universal application to Asians. This problem is demonstrated using the theory of individuation separation (M. S. Mahler et al, 1975) and then proposing a reconceptualization of Asians' seeming lack of individuation from the view of contemporary psychoanalytic subjectivity theories. Implications for transference are discussed. It is argued that Western therapists need to be aware of their Western-culture-based organizing activities, and they need to use a sustained empathic-introspective approach to access the internal experiential world of an Asian client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contextual therapeutic relationship: Ecological considerations in psychotherapy research and practice.

While the psychotherapeutic relationship has been assumed to be relatively free from external influence, we suggest that the therapeutic alliance develops within a larger environment, much of which is beyond the control of client and therapist. The reticence of practitioners and researchers to recognize and explore ecological issues is likely related to therapeutic tasks that are necessary for insight-oriented treatments (e.g., developing a therapeutic setting that protects clients from the intrusion of outside influences). Two sources of ecological disruption are discussed, managed care and psychotherapy research, and an illustrative case example of ecological disruption within a psychotherapy research setting is presented. We suggest that addressing ecological disruptions in the context of the therapeutic relationship may facilitate the establishment and maintenance of a positive therapeutic alliance. By doing so, the therapist can integrate the demands of the external world into the therapeutic relationship, thereby increasing the meaningfulness of interpersonal interventions and easing discussions about therapeutic alliance ruptures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cerebral hemispheres and neural network simulations: Design considerations.

The conclusions concerning hemispheric specializations based on neural network simulations, which were previously reported by Kosslyn, Chabris, Marsolek, and Koenig (see record 1992-37420-001), are shown not to be valid. Differences in network performance on tasks said to be "categorical" and "coordinate spatial" in nature were due to imbalances in the input stimuli and cannot, in principle, be related to differences in performance on such tasks in human subjects. The use of truth tables and correlation coefficients in the design of neural networks is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical considerations and therapeutic options in papillomatosis of common bile duct. Clinical case

Gunshot wounds of the abdomen are associated with a 90% or greater incidence of intra-abdominal injury, prompting many trauma centers to routinely explore these patients via laparotomy. Increasingly, diagnostic laparoscopy has been used to evaluated the abdomen to exclude peritoneal violation by the missile. Retrospective analysis of the experience at a Level I Trauma Center with 20 isolated abdominal gunshot wound patients who did not have obvious indications for laparotomy such as peritonitis or shock is detailed. Outcome and cost analysis were compared in patients who had diagnostic laparoscopy or laparotomy. Patients who underwent diagnostic laparoscopy instead of laparotomy had a 42% reduction in operative time, a 33% reduction in hospital charges, and a reduction in hospital length of stay from an average of 3.5 days to less than one day. The only operative complication noted was in a patient who underwent laparotomy. Diagnostic laparoscopy may be used in select patients to exclude significant intra-abdominal injuries following gunshot wounds of the abdomen with reduction in health care costs and morbidity.     

Iatrogenic chylothorax. Etiologic and therapeutic considerations, with presentation of two clinical cases

A case of mediastinal sclerosis after radiotherapy is presented as a curiosity in iatrogenic etiologies of chylothorax. After 7 weeks of conservative treatment, an operative pleurodesis was successful. In a second clinical case, the hazardous intra-thoracic coagulation of the chyle is illustrate. Etiology and therapeutic mangements of iatrogenic chylothorax in the literature are briefly reviewed.     

Kienb?ck's disease. Follow-up studies and therapeutic considerations (author's transl)

This paper presents a follow-up of patients with Kienb?ck's disease up to 30 years after their first symptoms. Only the shortening of the radius and the grafting of the lunate with cancellous bone offers some kind of basic therapy. The intercarpal arthrodesis, the arthrodesis of the wrist and the operation named after Steinh?user should only be considered in cases with severe deformation and disabling pain.     

Acute renal failure--etiologic and therapeutic considerations. A five-year experience at a single institution

In the present study we highlight the epidemiology, etiologic spectrum, and evaluation of ARF in adults. We then expand on the pathophysiologic mechanisms of renal failure and discuss the rationale for current therapeutic strategies in ARF patients. A total of 79 patients (45 male, female 34), aged 18-75 years (median age 51.2 +/- 17.7 years) with acute renal failure were studied in 5 years (January 1990 through October 1995). Emergency hemodialysis sessions following an acute anuric episode were instituted in 39 cases (49.3% of all patients). The median number of hemodialysis procedures per patient treated at our institution was 3.2 +/- 1.9. The total number of acute interstitial nephritis-associated ARF was 40. In 30 of them (75%) the acute renal insult included a combination of several therapeutic antimicrobial agents, in 2 cases (5%) ARF followed the administration of nonsteroidal anti-inflammatory drugs, in 1 (2.5%) it resulted from a combined therapeutic regimen and in the remaining 5 (12.5%) from the application of a single drug. Acute interstitial nephritis developed in 2 patients following a viral infection. In the hemodialysis-treated ARF group 12 patients (29.77%) had interstitial nephritis and 2 patients (5.13%) presented with renal impairment for an unspecified period of time preceding the development of overt ARF. In a subset of this group of patients, ARF occurred in 7 patients (17.95%) following an urologic intervention, in 8 patients (20.51%) as a consequence of thermal or mechanical trauma or intoxication and in 3 cases (7.69%) it resulted from fever of unknown origin. Three patients with postoperative peritonitis and 4 other (10.26%) with postoperative complications were encountered in our series. No cases of septic abortion-related or obstetric-related ARF were recorded. 92.3% of all hemodialysis-treated patients seen at our Institution had received a combination of antibiotics and only 2 patients had been pre-treated with a single antimicrobial agent. Our results underscore the strong tendency towards diversity in the etiologic spectrum of clinical entities causing ARF and the increase in the number of acute interstitial nephritis. These factors highlight the importance of precise dosing and administration of drugs, especially antibiotics, as well as the duration of antibiotic treatment.     

Ventrolateral hernias of the abdominal wall. The anatomicopathologic, clinical and therapeutic considerations]

Ventral lateral hernias of the abdominal wall are rare. On the basis of their location we can classify them as follows: hernias of the aponeurosis of the transversus muscle, hernias of the rectal sheath and transmuscular hernias of the iliac region. In a group of 3134 hernias of the abdominal wall observed in a period of 16 years, 11 ventral lateral hernias have been encountered (0.3%). The diagnosis often presents great difficulties as the symptoms and the clinical findings are not typical. They must be differentiated from hematomas of the rectus sheath, abscess or intra-abdominal processes. Echography and Computed Tomography have an important role in their detection. Nevertheless in some patients the true diagnosis is reached only intraoperatively. The treatment generally consists in surgical correction by layer closure of the fascial or muscular defect. In selected cases the use of prosthetic material and video laparoscopic repair are indicated.     

Hydrocephalus in premature infants

In the light of personal observations from the years 1948-1974 the author discusses the incidence of hydrocephalus in premature babies. The material observed confirms the generally accepted view that the incidence of hydrocephalus is higher in premature babies than in full-term babies. The author analyzes the causes which may be responsible for this finding and concludes that noxious factors during early or late pregnancy are the main cause although perinatal injuries play also a significant role.