RESUMEN
OBJECTIVE: Erectile dysfunction (ED) is a major complication in diabetes mellitus. A novel method, high-tone external muscle stimulation (HTEMS), has been proven to be useful in the therapy of diabetic and uremic peripheral polyneuropathy. The aim of this study was to test the potential effect of HTEMS on ED in diabetic patients. DESIGN: An open-label, self-controlled interventional prospective study was conducted at the 2nd Department of Internal Medicine and N.C. University of Pécs, Hungary. Six Type 2 diabetic patients (mean age 59 ± 7 years) with severe ED (International Index of Erectile Function (IIEF) score: 7.7 ± 8.5) and impaired renal function (eGFR: 61 ± 16 ml/min) were involved. INTERVENTION: The thigh muscles of the patients were treated with HTEMS for 1 h 3 times per week for a duration of 4 weeks. MAIN OUTCOME MEASURES: Penile peak systolic velocity (PSV) (in the flaccid state and semi-rigid (after 10 mg intracavernous papaverine injection)), IIEF score, quality of life and laboratory parameters. At the beginning also the acute effect of HTEMS on penile PSV was investigated. RESULTS: Under basal conditions penile PSV was rather low. The first HTEMS session of the thighs induced an insignificant increase of PSV in the flaccid state (4.1 ± 1.2 to 6.3 ± 3.3 cm/s) and a significant rise of PSV in the semi-rigid penis (from 6.5 ± 2.5 to 8.9 ± 2.2 cm/s (p = 0.009)). After 4 weeks of HTEMS treatment, under basal conditions no significant change of penile PSV (flaccid and semirigid) was observed. Similarly, IIEF score did not improve over the time period (7.7 ± 8.1 vs. 6.7 ± 8.5, p > 0.05). Also, metabolic parameters and eGFR were not influenced. CONCLUSION: In a pilot study of diabetic patients with severe ED HTEMS of the thighs induced an acute rise of penile PSV in the semi-rigid state. However, after 4 weeks of HTEMS therapy the basal PSV and symptoms of ED were not improved.
Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Disfunción Eréctil/terapia , Pene/irrigación sanguínea , Enfermedades del Sistema Nervioso Periférico/terapia , Flujo Sanguíneo Regional/fisiología , Uremia/complicaciones , Anciano , Velocidad del Flujo Sanguíneo/fisiología , Neuropatías Diabéticas/terapia , Disfunción Eréctil/etiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/etiología , Proyectos Piloto , Índice de Severidad de la Enfermedad , Muslo/irrigación sanguínea , Resultado del TratamientoRESUMEN
The nephrogenic systemic fibrosis - referred to in the literature earlier as nephrogenic fibrotizing dermopathy - is a rare clinical entity that develops in patients with renal disease. Its development has been described mainly after the usage of a gadolinium-based MRI contrast medium in patients with impaired renal function, mainly in dialysed patients. The nephrogenic systemic fibrosis is characterized by fibrosis evolving in the distal part of the extremities, and in more severe cases involving the lung, the liver, heart and skeletal muscles. The disease may have a fast progression and fatal outcome if it involves multiple organ systems, in approximately 5% of the cases. Until now, no evidence-based therapy of nephrogenic systemic fibrosis is known, however, in single cases an amelioration has been described after renal transplantation and plasmapheresis, and remission has been described after extracorporal photopheresis.
Asunto(s)
Enfermedades Renales/complicaciones , Enfermedades de la Piel/etiología , Piel/patología , Medios de Contraste/efectos adversos , Fibrosis/etiología , Gadolinio , Humanos , Enfermedades Renales/terapia , Trasplante de Riñón , Imagen por Resonancia Magnética/métodos , Fotoféresis , Plasmaféresis , Diálisis Renal , Enfermedades de la Piel/patología , Enfermedades de la Piel/terapiaRESUMEN
The authors review the case of a 30 years old female patient presenting with a 48 hours-standing anuria, who permanently used products of grist of a virtuous plant, Guarana and occasionally used a parenteral non-steroid painkiller. The clinical history and laboratory results showed acute renal and hepatic failure. The histological picture of the renal biopsy specimen verified an acute tubular necrosis. After temporary dialysis treatment, her renal function recovered progressively with compensatory polyuria. The authors would like to draw the attention to the risks of the use of over-the-counter marketed paramedicinal products, per se or in combination with pharmaceutically registered products, sold in pharmacies and nutrition supplement stores.