Among 256 patients with acute hepatitis A, 17 (6.6%) had a relapse of the disease between 30 and 90 days after the primary episode. We studied 7 of these patients. Serologic testing showed mean alanine aminotransferase levels of 1668 IU/L during the acute stage, 107 IU/L during the early convalescence, and 1027 IU/L during the relapse. Tests for IgM antibody against hepatitis A virus were positive in the 7 patients at the onset of disease, with decreasing levels in 3 of the 4 patients tested during the evolution of the illness. Stools collected during the relapse phase showed hepatitis A virus by immune electron microscopy, radioimmunoassay, and molecular hybridization using a 32P-labeled cDNA-hepatitis A virus probe. Stools collected from 4 of these patients 6 to 12 months after the onset of disease were negative for the virus. The finding of hepatitis A virus in the stool of these patients during the relapse phase strongly implicates hepatitis A virus as the causative agent of the clinical relapse.
This study utilized a control group design to evaluate the effectiveness of group treatment of erectile dysfunction in men without partners. Twenty-one men with secondary erectile dysfunction were randomly assigned to one of two men's groups with different cotherapy teams or to a waiting-list control condition. Results indicated that while the two men's groups did not differ on any clinical-outcome measures, each men's group improved significantly more than the waiting-list clients on a variety of measures concerning sexual attitudes and behaviors related to erectile dysfunction. Furthermore, most of the treatment gains for men's group participants were maintained at six-week and six-month follow-up evaluations. However, the men's group and waiting-list participants did not differ significantly in the reported frequency of erection difficulties following treatment. In comparing the present findings with those of previous studies of men's group treatment, it is hypothesized that the absence of significant change in the frequency of erection difficulties in the present study may have been attributable to the older age of our clients or to the relative lack of emphasis on dating-skills training in this treatment format. This study illustrates the importance of including some form of no-treatment control condition in the evaluation of new treatments for sexual dysfunction.
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