Objective To test if supplemental dietary selenium is associated with changes in the incidence of prostate cancer. Patients and method A total of 974 men with a history of either a basal cell or squamous cell carcinoma were randomized to either a daily supplement of 200 μg of selenium or a placebo. Patients were treated for a mean of 4.5 years and followed for a mean of 6.5 years. Results Selenium treatment was associated with a significant (63%) reduction in the secondary endpoint of prostate cancer incidence during 1983–93. There were 13 prostate cancer cases in the selenium‐treated group and 35 cases in the placebo group (relative risk, RR=0.37, P=0.002). Restricting the analysis to the 843 patients with initially normal levels of prostate‐specific antigen (≤4 ng/mL), only four cases were diagnosed in the selenium‐treated group and 16 cases were diagnosed in the placebo group after a 2 year treatment lag, (RR=0.26 P=0.009). There were significant health benefits also for the other secondary endpoints of total cancer mortality, and the incidence of total, lung and colorectal cancer. There was no significant change in incidence for the primary endpoints of basal and squamous cell carcinoma of the skin. In light of these results, the ‘blinded’ phase of this trial was stopped early. Conclusions Although selenium shows no protective effects against the primary endpoint of squamous and basal cell carcinomas of the skin, the selenium‐treated group had substantial reductions in the incidence of prostate cancer, and total cancer incidence and mortality that demand further evaluation in well‐controlled prevention trials.
A mechanical device for treatment of impotence based on the concept of entrapment of blood in the penis following vacuum-assisted tumescence is described and more than 15,000 units have been marketed. A total of 1,517 users who acquired the device between 1974 and 1987 completed a questionnaire concerning the system. Of these patients 92 per cent either achieved an erection or an erection-like state that was satisfactory for intercourse and 77 per cent had intercourse at least every 2 weeks. No serious ill effect from use of the device has been reported a and it is particularly effective in the management of partial impotence. In selected patients the device is an alternative to either surgical placement of a penile prosthesis, intracavernous injection of vasoactive drugs or sexual abstinence.
This review assesses the continuing role of noninvasive vacuum therapy as treatment for erectile dysfunction and discusses the action of negative pressure in producing assisted erection. Through recent research in this area has centered on the development of pharmaceutical therapies, vacuum-therapy programs appear to be a consistent long-term option for patients experiencing either chronic or occasional impotence of any etiology. Very little testing is required before the initiation of vacuum treatment, and the overall; clinical success rate is approximately 90%. Significant success has been reported in more difficult patient populations, including those with veno-occlusive disorders and explanted penile prostheses. Vacuum therapy may also be used in conjunction with other therapies to enhance results. Contraindications to the use of vacuum therapy are few and primarily include patients with unexplained intermittent priapism and bleeding disorders. Side effects such as occasional numbness, pain, penile bruising, or petechiae have a low incidence. A recently reported survey of 5,847 vacuum users showed that 83.5% of patients continue to use the device for intercourse as desired. Patients should receive individual instruction in the use of these devices and should expect a learning or practice period to achieve optimal results. As newer treatments for erectile dysfunction gain increasing attention, it should be kept in mind that nearly every patient showing impotence of any degree or duration as well as patients who have failed other therapeutic choices are candidates for vacuum therapy.
Two patients, 1 adult and 1 infant, with complete duplication of the penis are described. The adult had a single bladder, a bifid scrotum, a low abdominal wall hernia, separation of the symphysis pubis, bilateral inguinal hernias, rectal prolapse, bilateral vesicoureteral reflux and bilateral staghorn calculi. The infant had duplication of the bladder, hypoplasia of the left kidney, lumbosacral anomalies, a hypoplastic left lower extremity, an imperforate anus, a infraumbilical wall hernia and separation of the symphysis pubis. A survey of the anomalies accompanying the 2 main types of diphallus (shaft and glans, and glans alone)showed that there was a preponderance of anomalies of posterior structures such as colon, bladder and spine in the shaft and glans diphallus, and a higher incidence of isolated exstrophy of the bladder in diphallus of the glans alone. The embryogenic implications of these findings are discussed.
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