Bruce R. Gilbert

Penile Doppler Ultrasound Predicting Cardiovascular Disease in Men with Erectile Dysfunction

Cardiovascular disease is a major cause of morbidity and mortality in the USA. Traditional risk factors such as obesity, physical inactivity, and diet are used to screen for cardiovascular disease. However, these risk factors miss a significant population who are at risk for future cardiac events. Erectile dysfunction (ED) has many associated conditions in common with cardiovascular disease and has been shown to be an independent risk factor for cardiovascular. Measurements made on penile Doppler ultrasound (PDU), such as cavernosal artery peak systolic velocity (PSV), cavernosal artery intima-medial thickness, and the finding of cavernosal artery calcification, are indicators of generalized vascular disease. Thus, elements of PDU can identify men at higher risk for cardiovascular disease. This review outlines the proper technique for PDU and the literature supporting the use of PDU to predict cardiovascular disease in men with erectile dysfunction.

Practical urological ultrasound

Practical urological ultrasound / , Practical urological ultrasound / , کتابخانه دیجیتال جندی شاپور اهواز

The Role of Acupuncture in the Management of Chronic Pelvic Pain

Acupuncture as a medical procedure has been growing in popularity over time. Its inception is believed to have occurred over 6000 years ago; however, it was not until 200 BC when acupuncture practices that mirror present-day practices were described. Acupuncture has been used for many different medical ailments including chronic pain disorders, sexual dysfunction, pregnancy related physiologic changes, and cancer treatment related side effects. It was originally believed that acupuncture’s effectiveness was due to its ability to manipulate qi, the energy of life. Studies examining acupuncture’s effects on chronic pain have demonstrated three primary locations of action, peripheral, spinal, and supraspinal. The use of acupuncture for chronic prostatitis/chronic pelvic pain syndrome has been growing in acceptance among urologists. Early studies were originally flawed with many methodological shortcomings; however, more recent studies are showing the effectiveness of the technique under more rigorous standards. There are over 3500 physician and 12,000 non-physician acupuncturists in the United States, and these practitioners are able to create a regimented treatment plan that has been shown to effectively manage pain in an otherwise complex and difficult-to-treat condition.

Data Management in the ART Laboratory: Requirements and Solutions

The assisted reproductive laboratory has unique requirements for data management. There is a constant stream of data from both the andrology and embryology laboratories as well as those from reference laboratories. There is also quality control (QC) and quality assurance (QA) tests that need to be done at specified times with the results constantly being monitored by the laboratory staff. In addition, much of these data points need to be both entered and accessed in real time in a secure and verifiable way. Then, of course, there is the need for reporting on this data for clinical decisions, patient discussions, and to satisfy regulatory requirements. These requirements for our database solution create the need for a complex management solution. The challenge for database developers is to program all these features in the background and create a user interface that is simple and intuitive. This chapter discusses the basic components of a database design and the special concerns for the assisted reproductive technologies (ART) laboratory. We also introduce key terminology for discussions with developers. Our intent is to present information that will allow the reader to understand the essentials of data management, specific concerns for the ART laboratory, and current regulatory issues in order to better evaluate their current or future database solution.

Transrectal Ultrasound of the Prostate

The transrectal ultrasound (TRUS) study of the prostate enhances patient care by providing a minimally invasive procedure that gives real-time information for a rapid and accurate diagnosis. This chapter includes discussions of the prostate anatomy and embryologic development, the indications for the TRUS, the performance of the study, and TRUS-guided biopsy and disease processes for which the study is used. The intent of the chapter is to assist the urologist in maintaining a high degree of proficiency in performing, interpreting, and documenting the transrectal ultrasound study and biopsy of the prostate.