M. Basar

Music decreases anxiety and provides sedation in extracorporeal shock wave lithotripsy

OBJECTIVES To evaluate the efficacy of music on sedation in extracorporeal shock wave lithotripsy (ESWL) treatment to compare its anxiolytic effects with those of midazolam. METHODS Ninety-eight urolithiasis patients were randomly divided into two groups. Hemodynamic parameters, including mean arterial pressure, heart rate, respiration rate, and oxygen saturation, were recorded in all patients. In 50 patients (group 1), 2 mg of midazolam was administered intravenously 5 minutes before ESWL. In group 2 (n = 48), music chosen by the patients was listened to with a headset and continued during the treatment. The visual analog scale (0 to 100 mm), Observers Assessment of Alertness/Sedation Scale, State and Trait Anxiety Inventory-Trait Anxiety test, and State and Trait Anxiety Inventory-State Anxiety test were administered for the evaluation of pain, sedation level, and patient anxiety. RESULTS For the hemodynamic parameters, a statistically significant decrease in mean arterial pressure was noted at the end of the ESWL procedure in group 2 and in oxygen saturation from the 10th minute to the end of the treatment in group 1. Although the visual analog scale, Observers Assessment of Alertness/Sedation Scale, and State and Trait Anxiety Inventory-State Anxiety test did not show statistically significant differences, the State and Trait Anxiety Inventory-Trait Anxiety score was found to be lower in the music group (group 2) than in the midazolam group (group 1). CONCLUSIONS With the anxiolytic effects of music, ESWL can be performed more effectively with the patient in a comfortable state. Listening to music by patients during the ESWL session is a feasible and convenient alternative to sedatives and anxiolytics.

Sildenafil citrate for penile hemodynamic determination: an alternative to intracavernosal agents in Doppler ultrasound evaluation of erectile dysfunction

OBJECTIVES To suggest a new noninvasive method for penile Doppler ultrasound (PDU) evaluation of erectile dysfunction using oral sildenafil citrate as an erection induction agent. METHODS A total of 20 patients admitted with the complaint of erectile dysfunction were evaluated by the short form of the International Index of Erectile Function. A total score of less than 25 was accepted as erectile dysfunction and PDU was performed. The initial penile study consisted of PDU examination under visual sexual stimulation (VSS), and the peak systolic velocity, end-diastolic velocity, and resistance index were recorded. Measurements of all the parameters were repeated on the same patients after intracavernosal papaverine, intracavernosal prostaglandin E(1) (PGE(1)), and oral sildenafil citrate administration, plus VSS. All patients had these four tests in the same order at weekly intervals. Sildenafil citrate was given orally 45 minutes before Doppler investigation, and patients had VSS during the waiting period. The patients were asked about their satisfaction and comfort after each test. Statistical analysis was performed using the Wilcoxon and Mann-Whitney U tests. RESULTS The measurements with papaverine, PGE(1), and sildenafil citrate were significantly different from those after only VSS (P <0.008); however, the papaverine, PGE(1), and sildenafil citrate results were not different from each other according to the peak systolic velocity, end-diastolic velocity, and resistance index measurements (P >0.008). Patients commented that although PGE(1) was the strongest erectogenic agent, sildenafil citrate was the most convenient. CONCLUSIONS Since the results of PDU with oral sildenafil citrate in association with VSS were not statistically different, we suggest a new noninvasive erection induction method for the purpose of PDU evaluation of erectile dysfunction.

New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: Is it a useful test?

Abstract Background: The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno‐occlusive dysfunction.

Histopathological changes and nitric oxide synthase activity in corpus cavernosum from rats with neurogenic erectile dysfunction.

To investigate changes in histology and nitric oxide synthase (NOS) activity in cavernosal tissues from rats with neurogenic erectile dysfunction induced experimentally.

Comparative Study between Corpus Cavernosum-Electromyography Findings and Electron Microscopy of Cavernosal Muscle Biopsies in Erectile Dysfunction Patients

Background: Biopsy and electrical activity recordings of the corpus cavernosum are 2 new diagnostic methods for the evaluation of impotent men. We evaluated the corpus cavernosum ultrastructure and electromyography (EMG) recordings from patients with erectile dysfunction.

The efficacy of sildenafil in different etiologies of erectile dysfunction.

Purpose: The aim of this study was to evaluate the efficacy of sildenafil and success of treatment in particular etiological causes in erectile dysfunction lasting more than 3 months. Material and methods: A total of 141 patients between 27 and 78 years old without any cardiac compromise, despite controversial, which precludes sildenafil (Viagra®) treatment, were included in this study. All patients had only International Index of Erectile Capacity Form (IIEF) for pre-treatment evaluation and 50 mg sildenafil was started. Patients were assessed monthly for 6 months thereafter. Erectile capacity changes were questioned by IIEF on each follow-up and 100 mg sildenafil was given in patients without a response and monthly follow-up was scheduled. All patients had SMA-12, hormonal analyses and penile colour Doppler ultrasonography during the treatment course. The difference between IIEF score of each patient was displayed by Paired-ttest and p-values less than 0.05 was applied as significant. Results: The average beginning IIEF score of 141 patients was11.80 ± 0.47 [6–22], and increased to 20.70 ± 0.62[6–30] after a month of 50 mg sildenafil treatment. The mean increase was 75.4% and found to be significant (p= 0.000, p < 0.05). The average IIEF scores were recorded as 22.57 ± 0.69 after 3, and 22.12 ± 0.24 after 6 months. There was no difference between these values and 2nd month controls (p3 month = 0.5675,p6 month = 0.6138, p > 0.05). A positive response was recorded in 102 patients (72.3%) and 39(27.7%) patients were unresponsive. Doubled doses of sildenafil (100 mg) was effective in additional 17 patients. After overall treatment, 119 (84.4%) patients had benefit from sildenafil. Penile Doppler ultrasonography displayed arterial insufficiency in 79 (56.03%), veno-occlusive dysfunction in 14 (9.93%), mixt vascular pathology in 14 (9.93%) patients. Normal ultrasonographic findings in 32 patients (22.7%) were classified as psychogenic dysfunction. Among the organic causes, sildenafil was found to be most effective in arterial insufficiency group. Conclusion: Sildenafil is a successful management modality in erectile dysfunction with minimal pre-treatment evaluation. As far as etiological causes concerned, sildenafil was found to be most effective in arterial insufficiency group and psychogenic group. The efficacy of sildenafil treatment has not been changed with the treatment time, since IIEF scores were stable during follow-up controls.

Anaesthesia and the Acute Phase Protein Response in Children Undergoing Circumcision

Concentrations of acute phase proteins (CRP: C-reactive protein, albumin) change during surgery. We investigated the acute phase response to circumcision and the effects of anaesthesia on this response. The children were divided into four groups; group 1 (intratracheal general anaesthesia, n = 40), group 2 (general anaesthesia with mask, n = 20), group 3 (ketamine, n = 20), group 4 (local anaesthesia, n = 35). Blood samples were obtained, 24 hours before circumcision, after premedication, and 24 hours after circumcision. CRP and albumin before circumcision were comparable for all groups. There was no increase in CRP, and albumin remained steady throughout the study. No difference was observed among the groups, and related to anaesthesia. No responsiveness may be explained with the size of injured tissue or anatomical and histological type of preputium.

C-reactive protein in early detection of bacteriemia and bacteriuria after extracorporeal shock wave lithotripsy.

OBJECTIVES To evaluate the value of plasma C-reactive protein (CRP) levels in early detection of bacteriuria and bacteriemia after extracorporeal shock wave lithotripsy (ESWL) of calcium and infection stones. METHODS A total of 75 patients who had infection stones (n = 27) and calcium stones (n = 48) were included in the study. All patients had sterile urine before ESWL. The mean age was 41.6 +/- 4.85 and male/female ratio was 2.12. Blood cultures were obtained within 1 hour post-ESWL period. Urine cultures were obtained 3 times just after and on the first and seventh day of ESWL. RESULTS Post-ESWL evaluations showed 3 positive blood cultures with 2 (2.66%) patients in infection stone and 1 (1.33%) patient in calcium stone groups, whereas urine cultures revealed 6 (8%) positive results in infection stones and 4 (5.33%) in calcium stones. The patients who had positive cultures also had elevated plasma CRP levels when compared to the levels in patients with negative cultures (p = 0.000). CONCLUSIONS Bacteriuria and bacteriemia after ESWL have been well-identified entities and may be responsible from some of the post-ESWL complications. CRP can be useful for early detection of such complications.

Assessment of the autonomic nervous system is an appropriate biological marker for the well-being in erectile dysfunction

AIM To investigate whether the autonomic nervous system (ANS) components are suitable biological markers for representing well-being in patients with erectile dysfunction (ED). METHODS The present study included 74 male patients who had applied for check-ups in the cardiology outpatient clinic at Kirikkale University (Kirikkale, Turkey) and who had been diagnosed as having hyperlipidemia. Of these patients, 26 had an additional diagnosis of ED and made up the patient group. The remaining 48 patients formed the control group. Well-being was assessed with short-form 36 (SF-36). The International Index of Erectile Function (IIEF) was used as a measure of libido and erectile function. Quantitative assessment of the ANS was made based on the analysis of heart rate variability by means of 24-h holter monitorization. RESULTS Comparisons between the ED and control groups showed significant differences only in energy scale of SF-36. The ED group also had significantly higher values of sympathetic activity. Except for the general health score of SF-36, which was found to be correlated with parasympathetic activity only in ED group, there were similar correlation patterns within the groups. Although well-being and sympathetic activity were correlated negatively, parasympathetic activity and well-being were correlated positively. CONCLUSION Quantitative assessment of the ANS by heart rate variability analysis might be a suitable marker for well-being of patients with ED.

Electrical activity of the corpus cavernosum in denervated rats

Background: We evaluated the electrical activity of the corpus cavernosum after intracavernous papaverine injection in rats that had been denervated experimentally.