In a study of dialysis patients 79% of men complained of sexual dysfunction and 61% erectile impotence following uremia and the onset of regular dialysis therapy. Plasma testosterone levels were significantly higher in patients treated by continuous ambulatory peritoneal dialysis (p = 0.001) but the incidence of sexual dysfunction was not different from patients treated by hemodialysis. Although follicle-stimulating hormone levels were higher (p = 0.001) and penile blood pressure index levels lower (p less than 0.05) in patients with impotence, sexual function was not improved by exogenous testosterone, and vasculogenic impotence was identified in only 6% of patients. These findings suggest that a major component of uremic impotence is unrelated to primary testicular failure or penile vascular insufficiency.
potential for growth, presumably as a result of metabolic disturbances during the pregnancy, and may therefore be termed "macrosomic."Acker et al' reported that the incidence of shoulder dystocia in the deliveries of diabetic mothers was 50%, 23%, and 9% for infants weighing :4500 g, 4000-4499 g, and 3500-3999 g, respectively, compared with 23%, 10%, and 2% for deliveries of non-diabetic mothers. Thus many more infants of diabetic mothers are too large for their maternal pelvis, even when their birthweight is apparently normal.Control of diabetes in pregnancy should not be described as "good" or "bad" as it forms a continuous range and thus would not be expected to have an all or nothing effect on promoting fetal growth. A substantial percentage of infants of diabetic mothers with birth weights within the normal range will be affected by the metabolic disturbances in the uterus caused by diabetes. In a review of 225 infants of diabetic mothers Lemons et al reported that neonatal hypoglycaemia occurred not only in 36 (47%) of the macrosomic infants, but also in 31 (21%) of the infants with birth weights that were not large for gestational age.4 The extent to which an infant will be affected by maternal diabetes, as measured by birth weight or neonatal hypoglycaemia, will vary, explaining why "good" control in the conventional sense may result in a big baby who becomes hypoglycaemic whereas "bad" control may result in a small baby who does not.Our results suggest that all infants of diabetic mothers, irrespective of birth weight, are growth promoted to some degree by their mothers' disease, and thus every infant should be considered to be at risk from the biochemical and mechanical consequences of macrosomia. From an initial study of renal itch in patients undergoing long term haemodialysis 20 patients were identified as being severely affected by uraemic pruritus (itch score more than 200 a week).3 Three patients were excluded as they were on non-standard dialysis fluid, and the others continued to fulfil the previous entry requirements3 and were not taking drugs containing magnesium. The 17 patients included in the trial (one woman) were aged 25-69; had been undergoing maintenance haemodialysis for 4-79 months; received 9-14 hours of dialysis a week on Dylade D2 or Gambro AKIO machines, with Travenol ST12/11 dialysis membrane, and remained on the same machines and dialyser throughout the trial.The patients were randomly allocated into two groups by a double blind technique. Group 1 (seven patients) remained on the standard dialysis fluid (McCarthy's QE136) with a magnesium concentration of 0 85 mmol/l, while group 2 was changed to one free of magnesium (McCarthy's S597). In all other respects the composition of the dialysis fluid was identical. After two weeks the dialysis fluids of the two groups were swapped for a further fortnight. The serum magnesium concentration was measured before and after dialysis at entry and weekly throughout the trial. Serum parathyroid hormone concentration was measured at entry and...
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