Warren R. Procci

Sexual dysfunction associated with oral antihypertensive medication: a critical survey of the literature.

It is commonly held clinical belief that antihypertensive agents affect sexual performance. The authors survey the English language literature concerning oral antihypertensive agents and critically review studies examining sexual side effects. Surprisingly, few studies support much of the conventional clinical wisdom. Evidence is strong for the pathogenicity of guanethidine upon ejaculatory mechanisms. Contrary to expectation, strong evidence also exists for the ability of propranolol, especially in high doses, to inhibit erectile functioning. Only equivocal support was found for the pathogenicity of methyldopa, reserpine, and clonidine upon sexual functioning. The authors suggest that this may be in part due to underdeveloped methodology for assessing the sexual side effects of hypertensive medications. Suggestions are offered for future studies as well as for the clinical evaluation of sexual dysfunction in the hypertensive patient.

Dietary abuse in maintenance hemodialysis patients

Abstract Thirty-one patients on maintenance hemodialysis were studied for compliance to prescribed diet, as measured by weight gain between dialyses and changes in weekly predialysis serum potassium levels. Nineteen patients were poor compliers. Patients who remained vocationally active had a significantly higher percentage of good compliance.

Autonomic Nervous System Dysfunction and Impotence in Uremia

The relationship between abnormalities in nocturnal penile tumescence (NPT) and autonomic function, measured by the Valsalva maneuver, was evaluated in 25 uremic patients and 22 normal subjects. NPT in uremic patients (45 +/- 6.8 min/night) was lower (p less than 0.01) than in normals (85 +/- 10.4 min/night). Valsalva ratio in uremics (1.58 +/- 0.07) was also lower (p less than 0.01) than in normal subjects (2.05 +/- 0.11). NPT and Valsalva ratio were significantly correlated in uremic patients (r = 0.62, p less than 0.01). The 12 uremic patients with abnormal Valsalva maneuver had NPT of 22 +/- 5.2 min/night, a value lower (p less than 0.01) than that (67 +/- 8.7 min/night) observed in the 13 uremic patients with normal Valsalva maneuver. There was also a significant correlation (r = 0.56, p less than 0.05) between the Valsalva ratio and the frequency of intercourse per month in the uremic patients, who had steady and active sexual partners. The data suggest that a dysfunction of the autonomic nervous system may be an important factor in the genesis of erectile abnormalities in patients with uremia.

Psychological factors associated with severe abuse of the hemodialysis diet

Thirty-one maintenance hemodialysis patients were observed for a six-month period. Seven of these patients (22.6%) were severe and persistent abusers of the hemodialysis diet. Because there are serious, even lethal, consequences of the sequelae of hemodialysis diet abuse such as fluid overload and/or hyperkalemia, this finding demands explanation. All seven severe abusers were men and, as a group, their current life situation was devoid of typical adult male gratifications. Their developmental histories indicated major difficulties with resolution of dependency/independency conflicts. Statistical analysis of demographic data and extensive psychiatric interviews support this. The author postulates that severe abuse of the hemodialysis diet results in part from the combination of unresolved dependency conflict, unfavorable current environmental circumstances, and a dependency-provoking treatment regimen. Severe abuse of the hemodialysis diet may serve an adaptive function by allowing at least some gratification in one area of the lives of these patients who suffers severe deprivation.

Preliminary observations of the utility of portable NPT.

Nocturnal penile tumescence (NPT) has been utilized as an aid in the differential diagnosis of male erectile failure. The development of portable NPT monitors will broaden its applicability. Surprisingly, there are few data correlating sexual history interviews with NPT. In this study, 50 normal controls, 25 chronically ill patients with normal renal functioning, and 48 men with end-stage renal disease (ESRD) provided both detailed sexual histories and NPT tracings from portable monitors. In general, the data obtained from these two different sources of information were congruent. The presence of a sexual partner who could verify the sexual history enhanced the congruity. Portable NPT is probably useful at the very least as a screening technique in the assessment of male erectile failure.

Psychosocial disability during maintenance hemodialysis

Overall psychosocial functioning was assessed in 21 maintenance hemodialysis patients. The Ruesch Social Disability Scale, which provides an overall Social Disability (DS) score as well as subscores for Physical Impairment (PI), Behavioral Impairment (BI), and Social Modifiers (MS), was utilized. A majority of the patients (13) experienced Major Social Disability and the mean DS score of this sample was in the Major Social Disability range (mean = 52.1 +/- 10.9). There were no differences between the mean DS score of men and women. Married patients had DS scores significantly lower than those who were divorced or never married (P less than .05). Patients with more than five years of maintenance hemodialysis had a mean DS score significantly higher than those with less then five years of maintenance hemodialysis (P less than .03). In those patients with more than five years of hemodialysis, the MS scale was significantly elevated (P less than .01) in comparison with their counterparts, whereas the BI and PI scores were not different. The data suggest that serious psychosocial impairment is a common sequela of maintenance hemodialysis, especially for long-term patients and those who are not married. Therapeutic approaches directed toward improved social functioning are indicated.

Consecutive-night reliability of portable nocturnal penile tumescence monitor.

Consecutive-night reliability of nocturnal penile tumescence (NPT) was determined in 77 patients, including 47 normal controls (NC), 16 patients with end stage renal disease on maintenance hemodialysis (ESRD), and 14 patients with chronic illnesses but normal renal functioning (CI). A portable NPT monitor was used in a clinical research ward setting. Since there is not yet widespread agreement as to the clinically most relevant NPT response criteria, three were examined: the proportion of sleep time during which an erection of a given penile circumference change was maintained, the maximum penile circumference change obtained, and the number of erections per night of a given penile circumference change. For all three response criteria in each of the three populations the consecutive-night correlation of results was statistically significant, suggesting that portable NPT has consecutive-night reliability.

A comparison of psychosocial disability in males undergoing maintenance hemodialysis or following cadaver transplantation

Sixteen males undergoing maintenance hemodialysis were evaluated for social disability through the use of the Ruesch Social Disability Rating Scale and were compared with a group of 16 cadaver renal transplant recipients, matched for age and marital status. All 16 had excellent functioning of their transplanted kidney. In both groups most patients experienced a major degree of social disability, indicating significant interference with life-style. Patients who were married had lower social disability scores (DS) than those who were divorced or single (P less than 0.01). Contrary to expectation, no differences were noted between these two groups with regard to the overall degree of social disability. The DS data are corroborated by other clinical indices, such as employment status, financial stability, degree of depression and sexual functioning, which indicated similar degrees of impairment in both groups. New approaches, aimed at the preservation and enhancement of social and avocational skills, are mandatory of a comprehensive effort seriously geared towards rehabilitation is to be implemented in the overall treatment of these patients. The expertise of the mental health professional, especially the liaison psychiatrist, is critical for this task.

Anorexia nervosa: A group case conference

Four patients with primary anorexia nervosa were interviewed in order to demonstrate some of the characteristic features of this disorder. Although this disorder occurs only rarely in males, one of these four patients was a young man. Primary anorexia nervosa is discussed from a variety of perspectives, including descriptive, psychodynamic, and hormonal. A brief review of the theoretical rationale underlying a variety of psychotherapeutic approaches is offered, and reports of their effectiveness are considered. Primary anorexia nervosa is probably best conceptualized as a complicated disorder with an admixture of serious psychological and somatic components, including the characteristic approach-avoidance conflict over eating. The authors speculate on the possibility of an underlying disorder of central catecholamine metabolism, particularly in relationship to dopamine transmission.