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Wiedmann M, Liebert UG, Oesen U, Porst H, Wiese M, Schroeder S, Halm U, Mössner J, Berr F. Decreased immunogenicity of recombinant hepatitis B vaccine in chronic hepatitis C. Hepatology 2000; 31:230-4. [PMID: 10613751 DOI: 10.1002/hep.510310134] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The immunogenicity of hepatitis B vaccine is unknown for patients with chronic hepatitis C, although hepatitis B vaccination is highly recommended in these patients. We therefore studied in a prospective open trial of 59 patients with chronic hepatitis C (mean age 42 years, hepatitis C for >10 years, Child-Pugh score < or = 5) and 58 healthy hospital staff persons the rate of nonresponse (anti-HBs <10 mIU/mL at 9 months) to recombinant hepatitis B vaccine (Gen H-B-Vax(R),10 microg intradeltoidal at month 0, 1, and 6). Nonresponse was observed in 18/59 (31%) patients with chronic hepatitis C and 5/58 (9%) healthy staff persons (P <.005) (vs. 7% in historical controls; P <.005), low response (anti-HBs 10-99 mIU/mL) in 19% of patients with chronic hepatitis C and 17% of staff persons. High-dose booster vaccination led to seroconversion in 12/15 (80%) of primary nonresponders. Primary nonresponse to HB vaccine was related neither to presence of early-stage liver cirrhosis nor magnitude of serum hepatitis C virus (HCV) RNA concentration, nor explained by the presence of human leukocyte antigen (HLA) types (B8 DR3, B44, DR7, DQ2) predisposing to low antibody response to hepatitis B surface antigen. The rate of primary nonresponse to the standard regimen of recombinant hepatitis B vaccine is surprisingly high in patients with longstanding chronic hepatitis C. Therefore, the antibody to HBV surface antigen (anti-HBs) titer response should be determined in these patients. Depending on the response titer, higher booster doses may be required to achieve and maintain seroprotection in these patients.
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Porst H. Editorial Comments. Int J Impot Res 1999. [DOI: 10.1038/sj.ijir.3900440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wollschläger S, Pätzold K, Bulang T, Meissner D, Porst H. [Effect of preventive selenium administration on development of ERCP-induced acute pancreatitis]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1999; 94 Suppl 3:81-3. [PMID: 10554538 DOI: 10.1007/bf03042200] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sodium selenite may play a role in reduction of enhanced oxygen free radicals in the early phase of experimental acute pancreatitis. The aim of the study was to determine whether ERCP induced pancreatitis can be used as a human model for early acute pancreatitis and if a prophylactic antioxidant therapy with sodium selenite or a prophylactic antibiotic therapy has a beneficial effect on the clinical outcome in patients with ERCP. PATIENTS AND METHODS Sixty patients were randomly allocated in 3 groups: A (n = 20, sodium selenite i.v. 1 day before ERCP 1 mg bolus/2 x 1 mg infusion); B (n = 20, metronidazole 0.5 g/ofloxacin 0.2 g before and 6 hours after ERCP); C (n = 20, controls, no prophylaxis). Various labor parameters and physical complaints after ERCP were determined. RESULTS Patients with an antibiotic prophylaxis or with a sodium selenite substitution had no less physical complaints or pancreatitis than the controls. Seven patients (= 11.7%) developed a pancreatitis after ERCP. Concentration of zinc, copper, manganese, vitamin A and E did not differ significantly between the various groups. CONCLUSION A prophylactic substitution with sodium selenite or prophylactic antibiotic therapy with metronidazole/ofloxacin has no beneficial effect on the clinical outcome in patients with ERCP.
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Fabra M, Porst H. Bulbocavernosus-reflex latencies and pudendal nerve SSEP compared to penile vascular testing in 669 patients with erectile failure and other sexual dysfunction. Int J Impot Res 1999; 11:167-75. [PMID: 10404286 DOI: 10.1038/sj.ijir.3900404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this current study was to find out the coincidence of pathological penile vascular supply with pathological data in Bulbocavernosusreflex latency (BCR-L) measurements and Pudendal Nerve SSEP (PudSSEP) recordings. Six hundred and sixty-nine males (642 with erectile dysfunction, 27 with different sexual disturbances) (mean age 49.3 y, range 17-76 y) underwent consecutively a battery of neurophysiological investigations together with pharmacotesting of cavernous bodies combined with duplex sonography of penile arteries. Pathological vascular findings were indicated in 286 men (43%), pathological neurophysiological findings in 264 men (39%). Normal findings in both investigations (vascular and neurophysiological) were encountered in 252 men (38%); 131 men (19%) revealed pathological data exclusively in the neurophysiological parameters, 153 (23%) exclusively in the vascular parameters and 133 (20%) in both. The highest percentages of pathological findings were observed in patients with diabetes mellitus (110 out of 131, 88%) and patients who had sustained pelvic trauma or surgery (36 out of 44, 82%), in contrast to the lowest percentage in patients with a proven psychogenic etiology (10 out of 38, 26%). Somewhat surprising was the rather high proportion of vascular impairment in patients with defined neurological diseases such as alcohol abuse (20 out of 51, 43%), polyneuropathy (PNP) of various etiology (9 out of 19, 47%), lumbosacral radiculopathies (26 out of 65, 40%), and CNS diseases (24 out of 52, 46%), about half of them coinciding with pathological neurophysiological findings. Even if the validity of BCR-L measurement and PudSSEP recordings in the assessment of neurogenic impotence was controversely discussed, we conclude that in a large number of impotent males both neurogenic and vascular factors are responsible for the onset of erectile dysfunction.
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Meghdadi S, Porst H, Stackl W, Friehe H, Rodrigues M, Sinzinger H. Presence of PGE1 binding determines the erectile response to PGE1. Prostaglandins Leukot Essent Fatty Acids 1999; 60:111-3. [PMID: 10328331 DOI: 10.1054/plef.1998.0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The clinical benefit of PGE1 in erectile dysfunction in men is well proven, while other species including non-human primates show almost no response. The reason for that difference is still unclear. We examined PGE1 binding in human surgical material (n=27) and from transsexual surgery (n=7) as well as rhesus (n=10) and cynomolgus monkeys (n=8) corpus cavernosum tissue. Erection was judged after intracavernous injection of PGE1 in men (10 microg) and in monkeys (5 microg). Human corpus cavernosum shows high- (binding capacity 24.7+/-3.3 pmol/mg protein) and low-affinity (binding capacity 77.4+/-7.3 pmol/mg protein) PGE1 binding sites. Oestrogen (3 mg/day) for more than one month before transsexual surgery decreases receptor density significantly. In rhesus and cynomolgus monkeys no high-affinity binding could be detected, while they respond on PGE1 with slight tumescence only. These findings indicate a significant correlation between corpus cavernosum PGE1 receptor density and the erectile response.
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Williams G, Abbou CC, Amar ET, Desvaux P, Flam TA, Lycklama à Nijeholt GA, Lynch SF, Morgan RJ, Müller SC, Porst H, Pryor JP, Ryan P, Witzsch UK, Hall MM, Place VA, Spivack AP, Todd LK, Gesundheit N. The effect of transurethral alprostadil on the quality of life of men with erectile dysfunction, and their partners. MUSE Study Group. BRITISH JOURNAL OF UROLOGY 1998; 82:847-54. [PMID: 9883223 DOI: 10.1046/j.1464-410x.1998.00937.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the impact of treatment for erectile dysfunction on the quality of life of men and their partners. PATIENTS AND METHODS The study included 249 men with organic erectile dysfunction of more than 3 months' duration who self-administered transurethral alprostadil in an open-label, dose-escalating manner in an outpatient medical setting. Patients with a sufficient response (159) were randomly assigned in a double-blind protocol to either active medication or placebo for 3 months at home. Patients and partners each completed quality-of-life questionnaires before and after treatment. RESULTS In the clinic 159 of the 249 men (64%) had an erection sufficient for intercourse when using transurethral alprostadil. At home, 46 of 67 men (69%) reported intercourse at least once on transurethral alprostadil, compared with eight of 73 (11%) on placebo (P < 0.001). Patients on alprostadil showed a 34% improvement in their 'relationship with partner', a 5% improvement in 'personal wellness', and a 71% improvement in 'quality of erection' domains, compared with a decline of 11%, 8% and 1%, respectively, in patients on placebo (P < 0.005 for each comparison). Partners of patients on alprostadil showed a 35% improvement in the 'relationship with partner' domain, compared with a 12% improvement in the placebo group (P = 0.028). There was a trend toward improvement in other partner domains. Urogenital pain was reported by 14% of patients during home treatment. CONCLUSION The resumption of sexual intercourse with the use of transurethral alprostadil was accompanied by an improvement in several important quality-of-life domains in patients and their partners.
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Porst H, Buvat J, Meuleman E, Michal V, Wagner G. Intracavernous Alprostadil Alfadex--an effective and well tolerated treatment for erectile dysfunction. Results of a long-term European study. Int J Impot Res 1998; 10:225-31. [PMID: 9884918 DOI: 10.1038/sj.ijir.3900365] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Long-term efficacy and safety of Alprostadil-Alfadex (EDEX/VIRIDAL) in intracavernous self-injection therapy for chronical erectile failure was investigated in a four year running multicenter European trial. Of the 16,886 protocolled injections 93% (15,713) resulted in rigid erections followed by successful sexual intercourse. Reported side effects by patients were prolonged erections > 6 h only occurring during the first year in 1.2% (2 out of 162), painful erections in 29% (47 out of 162) during the first year and decreasing to 12.1% by year 4, hematomas, neither requiring therapeutic measures nor impeding sexual performance in 33.3% (54 out of 162) in year 1 with a decrease to 12.1% by year 4, fibrotic penile alterations such as nodules, plaques or deviations in 11.7% (19 out of 162) with spontaneous healing in 48% (9 out of 19). Of the 162 patients involved in this trial 54 completed the 4 y. Of the 54 completers 91.4% considered the tolerability good or very good and were satisfied or very satisfied with self-injection therapy with Alprostadil-Alfadex. The respective rates of the female partners were 51.7% very satisfied and 39.7% satisfied. These data of the world-wide longest running prospective trial with a vasoactive drug in self-injection therapy provided impressive proof that Alprostadil-Alfadex represents a very effective and safe treatment for erectile dysfunction of both psychogenic and organogenic origin.
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Porst H. Transurethral Alprostadil With MUSE (Medicated Urethral System for Erection) vs. Intracavernous Alprostadil-A Comparative Study in 103 Patients With Erectile Dysfunction. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Porst H. [Transurethral alprostadil administration with MUSE ("Medicated Urethral System for Erection"). Current overview and personal experiences]. Urologe A 1998; 37:410-6. [PMID: 9738294 DOI: 10.1007/s001200050199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An analysis of the presently available results concerning transurethral application of Alprostadil with MUSE (Medicated Urethral System for Erection) up to 1000 micrograms indicates a 20-30% lower efficacy if compared to 20 micrograms i.c. injected Alprostadil. Whereas in prospective home-treatment trials only each second MUSE-application was successful in responders 87%-94% of the administrations in self-injection therapy resulted in successful coitus. In an own comparative trial in 73 pts the success rates after MUSE up to 1000 micrograms were 48% compared to 71% after i.c. Alprostadil. Reported side-effects of MUSE in the literature were: Hypotension 3-8%, syncopes 0.4%, penile/urethral pain 29%, urethral bleeding 5%, vaginal irritations 3%, priapisms < 0.1%. After MUSE-applikation the average Alprostadil contents of the ejaculate increased 40%. Whereas in prospective long-term studies of self-injection therapy with Alprostadil the risk of persistent fibrotic alterations of the penis varied between 5-7%, the risk of penile fibrosis after MUSE can not be finally estimated. Also the potential risk for urethral strictures after MUSE is presently not foreseable. The advantage of the technically easy use in confronted with a considerably lower efficacy. Therefore self-injection therapy must be further on considered the "golden standard" in Alprostadil administration.
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Williams G, Abbou CC, Amar ET, Desvaux P, Flam TA, Lycklama à Nijeholt GA, Lynch SF, Morgan RJ, Müller SC, Porst H, Pryor JP, Ryan P, Witzsch UK, Hall MM, Place VA, Spivack AP, Gesundheit N. Efficacy and safety of transurethral alprostadil therapy in men with erectile dysfunction. MUSE Study Group. BRITISH JOURNAL OF UROLOGY 1998; 81:889-94. [PMID: 9666777 DOI: 10.1046/j.1464-410x.1998.00703.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the safety and efficacy of transurethral pharmacotherapy for erectile dysfunction, involving the use of a novel therapeutic system to administer alprostadil (prostaglandin E1) to the urethral mucosa in a double-blind, randomized, parallel, placebo-controlled study conducted in five countries in Europe. PATIENTS AND METHODS In an outpatient setting, patients with primarily organic erectile dysfunction of at least 3 months' duration were treated with transurethral alprostadil, in an open-label, dose-escalating study. Testing stopped when the dose provided an erection sufficient for intercourse, as assessed by the patient and the investigator. Patients who achieved a sufficient response were then randomized to either active medication at the selected dose or to placebo for use at home for 3 months. After each home administration, patients recorded in diaries whether or not sexual intercourse occurred and any adverse reactions to the drug. RESULTS A total of 249 patients were treated in an outpatient setting; of these patients, 159 (64%) achieved an erection sufficient for intercourse and were randomized (1:1) to either active medication or placebo for home treatment. Of the patients randomized to alprostadil for home treatment, 69% reported intercourse at least once, compared with 11% of patients randomized to placebo (P < 0.001). The most common adverse reaction, urethral pain/burning, was reported by 7% of patients in the clinic. Most patients (83%) graded transurethral alprostadil as causing minimal or no discomfort in the clinic. No patient reported priapism or developed penile fibrosis. CONCLUSION Alprostadil delivered transurethrally by this system was well tolerated and effective in treating erectile dysfunction.
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Fabra M, Frieling A, Porst H, Schneider E. [Provocation of corpus cavernosum EMG signals as a parameter in diagnosis of erectile dysfunction]. Urologe A 1998; 37:287-93. [PMID: 9646427 DOI: 10.1007/s001200050186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Parameters of CC-EMG able to distingiush between healthy controls and men with erectile dysfunction of different etiology in the individual case are currently unknown. Groups of healthy volunteers and men with erectile dysfunction however show significant differences in provocability of slow cavernous electric activity, i.e. if so called "typical single potentials" (tSP) can be recorded already under resting conditions, or only with provocation, or if any activity is missing. In men, who showed tSP already under resting conditions, a significantly higher extent of provoked activity could be assessed as in those, who showed tSP only after provocation. This applies to the number as well as for the extent of the responses to the 3 stimuli valsalva-manoeuvre, arousal and hyperventilation. Patients, who had shown tSP already under resting conditions, were similar to the controls, from whom those, who showed tSP exclusively with provocation differed significantly. Further research will have to prove, if the parameter "provocability" together with the parameter "extent of the provoked cavernous electric activity" might be able to to lead to a better distinction of healthy and pathological situations which would be a precondition for the introduction of the method into clinical use.
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Mössner J, Koop H, Porst H, Wübbolding H, Schneider A, Maier C. One-year prophylactic efficacy and safety of pantoprazole in controlling gastro-oesophageal reflux symptoms in patients with healed reflux oesophagitis. Aliment Pharmacol Ther 1997; 11:1087-92. [PMID: 9663834 DOI: 10.1046/j.1365-2036.1997.00242.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Pantoprazole is a benzimidazole derivative which selectively inhibits the proton pump H+. K+-ATPase necessary for the final step in gastric acid secretion. AIM To investigate the tolerability and the prophylactic effect of pantoprazole 40 mg once daily on relapse in patients whose reflux oesophagitis had been healed. METHODS The safety of pantoprazole 40 mg once daily was assessed in an open 1-year trial on 222 patients whose reflux oesophagitis had been healed with omeprazole or pantoprazole. Relapse was defined as endoscopically-confirmed reflux oesophagitis (at least Grade I), with endoscopies being performed for patients experiencing 3 consecutive days of disease-specific symptoms. RESULTS Kaplan-Meier survival analysis at 6 and 12 months gave estimated treatment failure rates of 2% and 6% from confirmed relapses (per-protocol), and of 9% and 30% for a worst-case group (all withdrawals counted as failures). The only population shift in laboratory variables was a doubling of the median serum gastrin level over the first 6 months; thereafter it stabilized. Fifty-four (24%) patients experienced adverse events; 15 of these withdrew. Serious adverse events were reported for 12 patients. CONCLUSIONS Pantoprazole appears to be highly effective and to have a good safety profile for long-term prophylaxis of reflux oesophagitis.
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Porst H. Transurethral alprostadil with MUSE (medicated urethral system for erection) vs intracavernous alprostadil--a comparative study in 103 patients with erectile dysfunction. Int J Impot Res 1997; 9:187-92. [PMID: 9442415 DOI: 10.1038/sj.ijir.3900318] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A comparative study in 103 unselected patients with erectile dysfunction between MUSE up to 1000 micrograms and intracavernous Alprostadil (Prostavasin) up to 20 micrograms provided total response-rates of 43% (MUSE) vs 70% (Prostavasin). Complete rigid erections were reached in 10% (MUSE) vs 48% (Prostavasin). The average end-diastolic flow values in the deep penile arteries ranged between 9.2-9.4 cm/s after MUSE and 4.5-4.8 cm/s after i.c. Alprostadil confirming the investigator's assessment, that in the vast majority of patients MUSE were not able to induce a complete cavernous smooth muscle relaxation. In terms of side effects the reported penile pain/ burning-rate after MUSE was 31.4% compared to 10.6% after i.c. Alprostadil. In addition after MUSE clinically relevant systemic side-effects like dizziness, sweating and hypotension occurred in 5.8% with syncope in 1%. No circulatory side-effects were encountered after i.c. Alprostadil. Urethral bleeding after MUSE-application was observed in 4.8%. Due to the superior efficacy and lower side-effects self-injection therapy with Alprostadil remains the 'Gold Standard' in the management of male impotence. MUSE should be reserved for a subset of patients suffering from erectile dysfunction.
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Wollschläger S, Ludwig K, Meissner D, Porst H. [Effect of selenium administration on various laboratory parameters in patients with acute pancreatitis]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1997; 92 Suppl 3:22-4. [PMID: 9417490 DOI: 10.1007/bf03041955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recent studies presented evidence that activation of oxygen derived free radicals occurs in patients with acute pancreatitis. The purpose of this study was to evaluate the effect of sodium selenite as a possible antioxidant therapy in acute pancreatitis. PATIENTS AND METHOD 16 patients with moderate form of acute pancreatitis received a high dose of sodium selenite. Selenium in serum and whole blood, zinc, copper, manganese, superoxid dismutase (SOD), glutathione peroxidase (Gpx) and malondialdehyde (MDA) were determined (before selenium substitution, 3 days later, 8 days later, before demission). No selenium deficiency could be detected before selenium substitution. RESULT The selenium therapy caused a significant increase in selenium, a moderate increase in activity of Gpx, a significant decrease in activity of MDA, whereas SOD remained unchanged. CONCLUSION Concerning the particular point of view of "deficiency management", there is no need of selenium substitution in patients with a moderate form of acute pancreatitis in our region. The highly normal selenium concentration we established by our therapy is possibly connected with a decrease of the oxidative stress in acute pancreatitis. More clinical follow-up studies with more patients, who have different grades of severity of the acute pancreatitis, and besides that a control group of patients without selenium substitution, are necessary for evaluating the clinical relevance of our results.
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Fabra M, Frieling A, Porst H, Schneider E. Single potential analysis of corpus cavernosum electromyography for the assessment of erectile dysfunction: provocation, reproducibility and age dependence--findings in 36 healthy volunteers and 324 patients. J Urol 1997; 158:444-50. [PMID: 9224320 DOI: 10.1016/s0022-5347(01)64498-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Corpus cavernosum electromyography is a controversial method for assessing erectile failure. For its application as a diagnostic tool with clinical relevance, intra-individual stability of the parameters in independent recordings as well as information about provocation and age dependence are required. MATERIALS AND METHODS We investigated reproducibility, provocation and age dependence of 11 parameters of single potential analysis of corpus cavernosum electromyography for 36 healthy volunteers in 2 independent recordings with surface electrodes using a visual evaluation technique. Recording 1 results were compared to findings for 324 men with erectile dysfunction. RESULTS In healthy subjects all parameters varied extremely among individuals and they were poorly reproducible at repetition. The definition of a normal range as mean plus or minus 2.5 standard deviations did not result in useful diagnostic criteria for individual cases. Activity was not age dependent. Significant differences between healthy and impotent men as defined groups were found in provocation (overall maximum likelihood chi-square 15.5, dF = 2, p < 0.0005). CONCLUSIONS Single potential analysis of corpus cavernosum electromyography seems to be appropriate for distinguishing potent volunteers from patients with erectile dysfunction. Provocation of slow cavernous electric activity seems to be a promising parameter that should be considered for ongoing studies. However, a high range of variation of findings even intra-individually does not currently qualify the method for routine clinical use. Further research will show whether different means of documentation or evaluation, that is corpus cavernosum electromyography pattern analysis at rest after audiovisual sexual stimulation, drug application or digital conversion of data, will lead to better results.
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Porst H. The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol 1996; 155:802-15. [PMID: 8583582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Prostaglandin E1 (PGE1, alprostadil) is used worldwide for self-injection therapy in erectile failure and was recently officially approved for this purpose in the United States and most European countries. Therefore a comprehensive overview on biochemistry, pharmacology and therapeutic results of PGE1 is provided. MATERIALS AND METHODS The relevant literature on PGE1 was reviewed along with personal experience with 4,577 patients during a 7-year period. PGE1 was compared to other vasoactive drugs, such as papaverine, the mixture of papaverine and phentolamine or linsidomine alone. RESULTS In Europe PGE1 was officially approved for the therapy of peripheral arterial occlusive disease of the lower limbs in 1984. The drug has direct relaxing effects on smooth muscle cells of vessels and cavernous bodies, shows inhibitory effects on platelet aggregation, on low-density lipoprotein entry into the vascular wall and on presynaptic noradrenaline release and, therefore, it prevents the progress of atherosclerosis. In erectile failure PGE1 shows a response rate of more than 70% and, compared to papaverine with phentolamine, a considerably lower risk of priapism (0.35% versus 6%, respectively) as well as of local fibrotic complications. Except for rare cases of blood pressure decrease, no systemic side effects were observed after intracavernous injection of PGE1. CONCLUSIONS For self-injection therapy, PGE1 presently represents the most efficacious and safest drug. Ongoing trials with topical and especially intraurethral PGE1 are promising and may offer less invasive therapies in the near future.
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Meisel H, Reip A, Faltus B, Lu M, Porst H, Wiese M, Roggendorf M, Krüger DH. Transmission of hepatitis C virus to children and husbands by women infected with contaminated anti-D immunoglobulin. Lancet 1995; 345:1209-11. [PMID: 7537841 DOI: 10.1016/s0140-6736(95)91992-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 1978-79 a single-source outbreak of hepatitis C occurred in 2533 women who had received virus-contaminated anti-D immunoglobulin. Children and husbands of 74 women with self-limited, and of 86 women with chronic, hepatitis C were followed up for over 10-15 years. In 3 of 231 investigated children (1.3%) serological evidence for HCV infection was found. However, none of the children developed an apparent or chronic hepatitis. Serum samples of the 94 husbands investigated showed no HCV antibodies or HCV RNA. We consider the risk of intrauterine or perinatal transmission of HCV, as well as that of transmission through close family contacts, to be low. No evidence was found for sexual transmission for women to men.
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Porst H. [Duplex ultrasound of the penis. Value of a new diagnostic procedure based on over 1,000 patients]. Urologe A 1993; 32:242-9. [PMID: 8511836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In the period between December 1989 and December 1991, penile duplex sonography was performed, mostly after intracavernous injection of prostaglandin E1 in more than 1000 patients with erectile dysfunction or other penile disorders (Peyronie's disease, penile deviations, priapism). The most reliable evaluation criterion was the assessment of the peak flow velocity. Values of more than 25-30 cm/s with reference to the deep penile artery and more than 35-40 cm/s with reference to the dorsal artery indicated the integrity of the penile arteries. The assessment of the resistancy index has not proved to be a useful criterion because of its dependence on diastolic blood flow and therefore on the erection state, especially in cases of so-called cavernous insufficiency. Similar observations were made concerning the assessment of the increase in diameter of the deep penile arteries after intracavernous application of vasoactive drugs. Based on the fact that the increase in diameter is more dependent on the relaxation capacity of the cavernous smooth musculature and not on the actual blood flow, the measured values may be equal both in normal and in clearly disturbed blood circulation. In conclusion, duplex sonography is at present, together with color Doppler imaging, the most reliable vascular diagnostic tool and has clearly proved its superiority both to conventional penile Doppler imaging and penile angiography.
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Porst H. Prostaglandin E1 and the nitric oxide donor linsidomine for erectile failure: a diagnostic comparative study of 40 patients. J Urol 1993; 149:1280-3. [PMID: 8479015 DOI: 10.1016/s0022-5347(17)36367-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A total of 40 patients (average age 55.9 years, range 23 to 78 years) with erectile failure was enrolled in a study to compare 1 mg. of the nitric oxide donor linsidomine to 20 micrograms prostaglandin E1 administered for diagnostic purposes. Prostaglandin E1 was considered comparable to linsidomine by 10% of the patients, slightly superior by 15%, moderately superior by 20% and much superior by 55%. No patient rated linsidomine superior to prostaglandin E1. Objective evaluation of erectile response to linsidomine versus prostaglandin E1 by the investigator revealed no response in 7.5% versus 0% of the cases, tumescence in 57.5% versus 17.5%, semirigid erection in 22.5% versus 17.5% and full erection in 12.5% versus 65%, respectively. Duplex sonography after linsidomine and prostaglandin E1 with evaluation of peak flow velocities (centimeters per second) showed that the increase in peak flow velocity after linsidomine was at least a third less than the increase after prostaglandin E1. The appearance after linsidomine often resembled arterial insufficiency, whereas after prostaglandin E1 there was no evidence of arterial insufficiency. The erectile and hemodynamic response to the nitric oxide donor linsidomine was modest compared to that of prostaglandin E1. Therefore, linsidomine is not a genuine alternative to prostaglandin E1 for the diagnosis and treatment of male impotence.
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Fabra M, Porst H, Schneider E, Bressel M. ["Single potential analysis of cavernous electric activity" (SPACE). Findings before and after surgical dissection of the cavernous nerves within the scope of radical prostatectomy]. Urologe A 1993; 32:145-50. [PMID: 8475613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Single potential analysis of cavernous electric activity (SPACE) is said to give information on the integrity of the central and peripheral parts of the autonomic nervous system insofar as it is involved in erectile function. A total of 30 patients who underwent radical prostatectomy with simultaneous severance of the cavernous nerves as treatment for locally advanced cancer were investigated by SPACE before and after the operation. The findings were compared to the those recorded on two different dates in 20 age-matched men who had not undergone surgery and in whom there was no evidence of any lesion of the autonomic nervous system. Even in this control group, few reproducible results were found. Nevertheless, with reference to the items "number of wedges" (i.e. monophasic elements with amplitudes of 25-100 microV) and "maximum amplitudes" of SPACE potentials there was a more than change correlation of the values on the two test dates, which was not found in the prostatectomy group. Although this difference between the two groups investigated was statistically significant, these findings cannot be interpreted as an effect of autonomic denervation of the cavernous bodies. This is attributed to the fact that the postoperative results in the prostatectomy group were more similar to the findings in the control group than to the preoperative measurements taken while the autonomic innervation was still intact. Therefore, our investigations lead us to conclude that routine application of SPACE as a direct check on the integrity of the autonomic nerve fibres involved in erectile dysfunction is not justified at present.
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Porst H. [Nitroglycerin ointment in erectile impotence?]. Dtsch Med Wochenschr 1993; 118:203. [PMID: 8436071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Pätzold K, Hahn L, Lohmann J, Porst H. [Liver cirrhosis and chronic hepatic porphyria]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 1993; 31 Suppl 2:114-5. [PMID: 7483690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chronic hepatic porphyrias (CHP) are associated with different degrees of liver damage. They range from minimal histological changes to cirrhosis and primary liver carcinomas. Forty patients with early stages of porphyrias were compared to 85 patients with clinically manifest porphyrias, Porphyria cutanea tarda. This comparison resulted in the fact that cirrhosis occurred more often in early (or latent) stages (65%) than in PCT (31%) confirmed by laparoscopy. Thus the severity of the liver disease does not depend on the duration and intensity of cutaneous symptoms or pathobiochemical syndromes but they more often depend on the long-term influence of so-called trigger factors, among them above all alcohol and iron overloading. We conclude that the proof of latent CHP has an index function for severer liver damage.
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Aruin LI, Sarkisov DS, Lisenco OA, O’Connor H, Cunnane K, Queiroz DMM, Mendes EN, Rocha GA, Moura SB, Resende LMH, Cunha-Melo JR, Carvalho AST, Coelho LGV, Passos MCG, Castro LP, Oliveira CA, Lima GF, Barbosa AJA, Passos MCF, Castro P, Testino G, Perasso A, Boixeda D, de Argila CM, Vila T, Redondo C, Cantón R, Avila C, Alvarez-Baleriola I, de Rafael L, Witteman EM, Becx MCJM, De Koning RW, Silva JCP, Nogueira AMMF, Paulino E, Miranda CR, Rudelli A, Vialette G, Sevestre H, Capron D, Ducroix JP, Smail A, Baillet J, Zerbib F, Seurat PL, Sauvet P, Bechade D, Rapp N, Peacock JS, Marchildon P, Zamaniyan F, Bond-Green J, Liu P, Ciota L, Lee A, Coltro N, Chen M, Alhomsi M, Adeyemi E, Goodwin CS, Rizzi C, Maieron R, Desinan L, Avellini C, Da Broi GL, Beltrami CA, Proto G, Grimaldi F, Proietti A, Scott CA, Takasashi S, Igarshi H, Ishiyama N, Nakamura K, Masubuchi N, Ozaki M, Saito S, Aoyagi T, Itoh T, Hirata I, Matysiak-Budnik T, Poniewierka E, Gasciniak G, Jelen M, Knapik Z, Gosciniak G, Neri WM, Susi D, Bovani I, Laterza F, Cuccurullo F, Amorosi A, Bechi P, Dei R, Mazzanti R, Lynch DAF, Sobala GM, Gledhill A, Jackson P, Crabtree JE, Foster PN, Axon ATR, Dixon MF, Maaroos HI, Sipponen P, Kekki M, Di Bello MG, Raspanti S, Vardar T, Sancho FJ, Olivia E, Saiz S, Mones JP, Hood C, Lesna M, Alcolado R, Knitht T, Greaves S, Wilson A, Corlett M, Webb P, Wyatt J, Newell D, Hengels K, Forman D, Elder JB, Farinati F, Cardin R, Valiante F, Libera GD, Plebani M, Rugge M, Baffa R, Guido M, Mario FD, Naccarato R, Gilvarry J, Leen E, Sant S, Sweeney E, Morain CO, Schönlebe J, Riedel H, Prinz M, Hahn L, Porst H, Lohmann H, Orsini E, Guerre J, Tulliez M, Chaussade S, Gaudric M, Canton R, Sampedro J, García-Plaza A, Cognein P, Parodi MC, Tucci A, Gasperoni S, Stanghellini V, Tosetti C, Paparo GF, Varoli O, Siringo S, Santucci R, Monetti N, Barbara G, Corinaldesi R, Di Mario F, Dotto P, Vianello F, M. F, Grasso GA, Bianco TD, Laino G, Germanà B, Battaglia G, Axelson CK, Andersen LP, Szecsi PB, Olsen KN, Lundborg CJ, Andre C, Descos L, Martin A, Cavagna S, Brassens-Rabbé MP, Wu S, Wadström T, Mégraud F, Perdichizzi G, Muratori L, Pallio S, Bottair M, T. Fera M, Quattrocchi E, Caruso V, Karttunen T, Kerola T, Kartttunen R, Niemelä S, Kosunen TU, Bonchviam F, Pretolani S, Baraldine M, Cilla D, Baldinelli S, Gasparrini G. Pathology. Ir J Med Sci 1992. [DOI: 10.1007/bf02942888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nicolas V, Spielmann R, Maas R, Bressel M, Wagner B, Porst H, Bücheler E. [The diagnostic value of MR tomography following gadolinium-DTPA compared to computed tomography in bladder tumors]. ROFO-FORTSCHR RONTG 1990; 153:197-203. [PMID: 2168077 DOI: 10.1055/s-2008-1033361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In a prospective study, 58 patients with carcinomas of the bladder were examined by CT and MRI; in 48, gadolinium-DTPA was administered intravenously. MRI provided exact staging in 89%, compared with 80% with CT. There was 13% over-staging with CT and 11% with MRI. MRI, unlike CT did not result in any under-staging. In 36 patients a quotient could be calculated from the signal intensity of the tumour and surrounding soft tissues both before and after the intravenous contrast medium and the increased quotient after contrast administration could be estimated. There was a significant increase in the tumour/muscle quotient with a mean of 72 +/- 22% (minimum 43%, maximum 153%), corresponding to a marked increase of the signal from the tumour when compared with the pre-contrast images. This had the following advantages compared with CT: accurate differentiation between superficial and intramural spread. MRI was better than CT at demonstrating tumours in the roof of the bladder and at the trigone.
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Porst H. [Pharmacoangiography and pharmacoangiodynography of the penis in erectile dysfunction]. Urologe A 1990; 29:120-5. [PMID: 2200190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In 80 patients suffering from eretile dysfunction both pharmaco-angiography and pharmaco-Dopplerultrasonography of the penis were performed. The two methods showed a correlation of 96% with regard to the dorsal arteries and 92% with regard to the deep penile arteries. In a further 21 patients with erectile dysfunction pharmaco-angiodynography with the new QUANTUM device from Philips has been performed in recent weeks. The excellent illustration of vasculogenic details, even in the penile periphery, the exact measurement of the relevant hemodynamic parameters, e.g. peak flow velocity or pulsatility index, the short time needed for investigation and its non-invasive character give convincing evidence for the superiority of this new method over conventional angiographic procedures. This is also true when procedures for revascularization of the penis are planned. The only remaining indication for conventional pharmaco-angiography of the penis is now clarification of the connections in posttraumatic impotence of arterial etiology.
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