The efficacy and safety of intracavernosal alprostadil was evaluated for the treatment of erectile dysfunction in men with type I or type II diabetes mellitus. This was an open-label, flexible doseescalating study involving 336 men (77% of whom were Asian=Oriental) enrolled by 15 centres in Australia, Canada and seven countries in Asia. The effective alprostadil dose, ie the dose producing penile rigidity adequate for intercourse and lasting up to 60 min, was established by titration at the clinic prior to entry into the 6 month self-treatment home phase. All men were fully trained in the self-injection technique before entry into the home phase. Efficacy and safety were assessed using patient and partner diaries and by interview at clinic visits during the titration phase and after 1, 3 and 6 months of treatment. An effective home dose was established by titration for 94% of the 336 men (median dose 20 mg, range 2.5 -60 mg). Of 278 (83%) men who entered the home phase, 277 men (247 with type II diabetes and 30 with type I diabetes) had evaluable data for alprostadil dosage and clinical response. During the home phase, a satisfactory erectile response was achieved after 99% of injections, and the median alprostadil dose remained unchanged. The initial home dose and clinical response were similar in type I and type II diabetic men. Treatment was generally well tolerated with a low incidence of penile pain (24%) In conclusion, intracavernosal alprostadil was effective and well tolerated in type I and type II diabetic men with erectile dysfunction of mixed aetiology.
through a bilateral subcostal incision. Pathology revealed Case report a 4.5×3.5×3 cm tumour involving the upper portion of the right kidney; the histological interpretation was A 62-year-old man in poor general condition was admitted with a cough and haematochezia. ClinicalFuhrman grade 2 adenocarcinoma of the kidney with associated metastatic lung cancer (Fig. 2a). Neuronexamination revealed a left abdominal mass which was tender, hard and fixed. A chest X-ray showed a specific enolase (NSE) stained positively and was consistent with the diagnosis of a SCC (Fig. 2b). The surgical 3.5×7 cm mass in the region of the right hilus, an obliteration of the cardiac border at the right lower lobe specimen of the left perirenal mass was 10×5×3 cm; the histological interpretation was SCC with neuroand pleural eCusion. Chest CT revealed the primary lung malignancy in the right lower lobe with displacement and occlusion of segmental bronchi, and lymphadenopathies in the right hilum, subcarina and anterior mediastinum. Bronchoscopy-guided fine-needle biopsies of the lung mass showed a small cell carcinoma (SCC). Abdominal CT revealed a right renal and left perirenal mass. The left perirenal mass displaced the kidney anteriorly and medially, but did not invade the renal parenchyma (Fig. 1). CT-guided fine-needle biopsies of the left perirenal mass showed a metastasis from lung cancer. The preoperative diagnosis was lung cancer metastasizing to the ipsilateral kidney and contralateral perirenal space, or right RCC and lung cancer metastasizing to the contralateral perirenal space. The left perirenal mass was excised and the right renal mass enucleated a b Fig. 2. a, The small cell carcinoma (left portion, small cells, dark stained and disorganized) contrasts vividly with well-diCerentiated
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