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Archive for the ‘Diseases’ Category

Ejaculatory Disorders

09 Jun

Ejaculation is a highly integrated process that involves both the sympathetic and parasympathetic neural pathways. Numerous studies reveal that ejaculatory dysfunction is a common disorder and the source of significant bother for many of those affected. Ejaculatory dysfunction is comprised of several different, more specific abnormalities including: premature ejaculation, inhibited ejaculation (consisting of delayed and absent ejaculation), and painful ejaculation. The evaluation of affected patients should include a comprehensive medical history, physical examination, and laboratory testing. Numerous thera-peutic options are available to treat ejaculatory disorders, with many of these leading to marked improvement in patients’ symptoms and associated bother.

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Introduction

The normal male sexual cycle consists of four stages: desire, arousal, orgasm, and resolution.

As Masters and Johnson originally reported, each of these stages is associated with distinct physiological changes in the male. Ejaculation, which normally occurs during the orgasm phase, is a highly complex, integrated process essential for the normal delivery of semen into the female reproductive tract during intercourse. Ejaculation disorders can lead to impaired reproductive potential in men and may necessitate the use of a variety of advanced diagnostic and therapeutic maneuvers. The impact of ejaculatory dysfunction is not confined to detrimental effects on men trying to achieve a pregnancy, as a recent study by Rosen et al. showed In a survey of 12,815 US and European men aged 50 years or older, the authors found that ejaculatory disorders are common, affecting 30.1% of men between 50 and 59 years of age. A majority (50.2%) of these affected men reported bother due to their ejaculatory problems. The authors noted that despite the pervasive focus among many clinicians on erectile dysfunction when assessing a patient’s sexual health, ejaculatory problems are almost as common and should also be considered. For these reasons, physicians should be capable of identifying and treating the broad spectrum of ejaculatory disorders; this is essential in order to effectively care for the large numbers of affected men.

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The Physiology of Ejaculation

Ejaculation in human men occurs simultaneously with orgasm. The concurrent timing of ejaculation with the rewarding sensory experience of orgasm, from an evolutionary perspective, serves to facilitate sexual behavior and human reproduction. Despite the close temporal link between orgasm and ejaculation, these are two distinct and unique physiologic events. Orgasm is largely a central nervous system process that can be generated by cerebral stimulation without any accompanying genital input. Thus, it is possible for men to experience orgasm in the absence of ejaculation. Clinically, this is illustrated in men who have undergone radical retropubic prostatectomy, with surgical extraction of their ampullary vas deferens, seminal vesicles, and prostate gland. Despite the absence of these accessory sex glands that play a central role in ejaculation, patients who have undergone radical prostatectomy are typically capable of achieving orgasm postoperatively.

Ejaculation consists of two phases: emission and expulsion. Each phase is coordinated by anatomical structures functioning together in a highly integrated fashion and is separately discussed below.

 
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Eczema Symptoms and Treatments

21 Dec

Itchy, blotchy and reddish swelling area on parts of your skin is clear signs of Eczema. It is a skin condition that is usually caused by bacteria as well as other factors. The skin becomes dry, flaky and even scaly. It is a terrible sight to see but even a worse thing to experience. To be prepared for an eczema onslaught, you should know the eczema symptoms and treatments available to be able to prevent and control the skin disorder.

The eczema symptoms and treatments are both easily acquired and they are dangerous too. That might be hard to believe but some basic treatments for this symptoms are harmful and ineffective in the long run. Good thing though there are tell-tale signs that point to eczema symptoms and treatments are there that can actually take care of the skin disorder.

Most of the time people can’t seem to handle the effects and treatments can be expensive as well as gross. Ointments and creams are not really a good sensation on the skin, especially those found in pharmaceutical clinics. However, when it comes to eczema symptoms and treatments, people sometimes just don’t have that many choices. Good thing there are ways to create natural treatments out of natural herbs and ingredients organically grown.

The great thing about herbs and its role on eczema symptoms and treatments is the fact that they contain all natural ingredients. Symptoms are caused by bacteria and what better way to treat bacteria but with good bacteria, right? That is why some of these natural products have probiotics in them to counteract the bad bacteria.

Since eczema has also been known to be caused by stress, herbs such as chamomile and peppermint can prove quite effective treatments for you. These herbs can help soothe your body plus these help you relax allowing your body to heal properly.

Eczema symptoms and treatments should both complement each other. This is because there are different types of eczema and the symptoms are different and may vary with every person. Just as our genetic make ups are unique, so is our immune system and skin cells.

Other eczema symptoms and treatments can appear and work on other people but might not occur and work for you. So, to better handle everything, you need to research the different triggers as well as the variety of solutions that can actually help you get your smooth skin back.

 
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Savella a Treatment Option for Fibromyalgia

21 Jun

Fibromyalgia (FM) is an idiopathic, chronic, nonlocalized pain syndrome accompanied by generalized tenderness. From 2% to 4% of people in the U.S. are affected. Although usually recognized as a disorder that predominates in middle-aged women, it can also affect men and adolescents. In addition to experiencing widespread pain and tenderness, patients may also report sleep difficulties, fatigue, anxiety, depression, paresthesias, stiffness, and an overall decline in physical function. These symptoms are distressing and may have a severe impact on quality of life.
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The American College of Rheumatology uses specific criteria for diagnosing FM. The diagnosis is based on the presence of widespread pain for a period of at least three months and on the presence of 11 tender points among 18 specific anatomic sites.

The pathophysiology of FM is poorly understood. Emerging insights suggest that it is a disorder of central nervous system (CNS) pain-processing mechanisms, which results in increased nociceptive sensitivity. The augmented experience of pain is thought to be associated with either (1) excessive spinal facilitation of afferent nociceptive signaling to higher cortical pain-processing regions or (2) deficiencies in descending cortical mechanisms that dampen nociception.

Both ascending and descending nociceptive pathways are regulated through multiple neurotransmitters, including serotonin (5-HT) and norepinephrine. It is hypothesized that abnormal functioning of the noradrenergic and serotonergic neurons in the ascending and descending pathways lead to the painful symptoms of FM.

Treatment options include nonpharmacological and pharmacological therapies. The most common nonpharmacological treatments are exercise, patient education, and cognitive behavioral therapy, which have shown some efficacy in randomized, placebo-controlled trials.

Pharmacological therapies include a variety of antidepressants, antiepileptics, opioids, and non-steroidal anti-inflammatory agents (NSAIDs). Of the wide variety of medications available to treat FM, only three are approved by the FDA: pregabalin (Lyrica, Pfizer), duloxetine (Cymbalta, Eli Lilly), and milnacipran (Savella, Forest/Cypress Bioscience).

Milnacipran is a dual serotonin and norepinephrine reuptake inhibitor (SNRI) that is more selective for norepinephrine reuptake. It has been approved for the treatment of depression in parts of Europe and Asia since the late 1990s and has now been approved for patients with FM.5 This article reviews the pharmacology, pharmacokinetics, safety, and efficacy of milnacipran for FM.

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Modifying lifestyles. Hypertension

24 May

Physicians should try to spend as much time as possible with patients to educate them on the importance of lifestyle modification, but its important not to waste too much time before beginning drug therapy. With some patients, preaching life-style change is a fruitless exercise, and damage is being done while they struggle to cut salt from their diet or lose weight, Neutel says.

The decision needs to be made fairly early on as to whether its worth pursuing nonpharmacological treatment or whether its in the best interest of the patient to start drug treatment, he says. The physician can always stop the drugs if some dramatic improvement happens. Hydrochlorothiazide 25mg The longer it takes physicians to get to goal, the more likely they are to have some obstacle that results in acceptance of inadequate control.

Some physicians are turning to the Internet for ways to help patients learn to manage their blood pressure. One resource is a Web site that allows patients to assess their risk for hypertension, track their vital signs on a graph that can be sent to the physician, and access tips on lifestyle changes and the latest published research in the field.

Patients can type in their own blood pressure levels as well as pulse, weight, and cholesterol, and information pops up showing normal levels and what action should be taken if the patient falls outside the norm. The site also offers a place to keep personal and family health records, a reminder service for taking medications and making appointments, and a locator service for blood pressure kiosks around the country.

This kind of site helps physicians because it provides basic information to patients that they may not have time to cover in an appointment, says Michael Ruddy, MD, FACP, associate professor of medicine and chief of the section of hypertension in the division of nephrology at the Robert Wood Johnson Medical School in New Brunswick, NJ. Ruddy serves on the clinical advisory board for Lifeclinic.com. This helps patients have an active role in managing their high blood pressure, and thats the only way it will ever get under control.

The onus for improving blood pressure doesnt fall solely on the patient. Physicians must be more aggressive in their care, says Pablo LaPuerta, MD, clinical assistant professor at the Robert Wood Johnson Medical School and director of outcomes research at the Bristol-Myers Squibb Pharmaceutical Research Institute in Princeton, NJ, triamterene hctz.

LaPuerta was one of the authors of a study published recently in the Journal of the American College of Cardiology that outlined a set of indicators for measuring process quality in hypertension..sup.2 The indicators, based on national guidelines, include screening patients yearly for blood pressure, evaluating newly diagnosed patients for kidney function and cholesterol, getting patients started on drug therapy, and stepping up therapy to get control. When the indicators were tested on about 700 hypertensive women, deficiencies were found in every area.

One of the most notable things we found was that when patients persisted with uncontrolled blood pressure of more than 160/90 mm Hg for six months or more, 50% of the time physicians didnt change their treatment, LaPuerta says.

Patients in the study who had blood pressure control passed more indicators, showing that physicians who are more aggressive do achieve better results. A lot of physicians may think that a lot of the problems with blood pressure are outside their control, such as patient noncompliance, LaPuerta says. But this study suggests physicians can do something to improve control, like stepping up care when the blood pressure remains elevated. They may need to add another medication or go to a full dose of the existing medication.

 
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Treatment for hypertension. Set goals

12 May

One of the most important things that many physicians neglect to do for their hypertensive patients is set a blood pressure goal and inform the patient of that goal, Hill says. Its hard to meet a goal that hasnt been set and for which there is no feedback. You have to be aware of the fact that its the patients daily life that will make the ultimate difference. The day-to-day work is the patients, so you have to involve them in the decision making.
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One complicating factor in treating hypertension is that the same strategy wont work for every patient. Researchers at the University of Maryland have identified four distinct types of hypertensive patients based on lifestyle choices and the ability to adhere to medication protocols, and they say that tailoring treatment to each group may improve your chances of success.

Matthew Weir, MD, professor of medicine in the division of nephrology at the University of Maryland in Baltimore, and his colleagues interviewed 727 hypertensive patients by telephone about their beliefs and behaviors surrounding the management of their disease. They weighted the composition of the cohort to match the age and sex distribution of hypertensive patients in the 1992 National Health Interview Survey. The researchers found four distinct groups that need different management strategies:.sup.1

Group A. Patients use an effective mix of medication and lifestyle regimens to control blood pressure. These patients need positive reinforcement, such as monthly telephone contact by nurses and encouragement to gradually adopt more aggressive healthy lifestyle goals.

Group B. Patients are most likely to depend on medication and have high adherence rates, but they also have high rates of smoking (29%) and alcohol use (an average of 104 times per year) and are less likely to exercise regularly. This group needs more aggressive medical management and needs to take small steps toward a more active lifestyle.

Group C. Patients are most likely to forget to take medication, are likely to be obese, and find it most difficult to comply with lifestyle changes (except for very low rates of smoking and alcohol use). They need a simplified medication schedule with care taken to minimize side effects. They also need encouragement to incorporate easy physical activity such as taking the stairs or taking a 10-minute walk during lunch, into their daily life.

Group D. Patients are least likely to take medication, most likely to change or stop medication without consulting their physician (20%), most likely to smoke (40%), and least likely to control diet (29%). This group needs strategies to make it easier for them to take their medications and increased frequency of patient contact through a case manager.

Weir and his colleagues are planning another trial to test the hypothesis that tailoring treatment in those ways would reduce the incidence of high blood pressure. They suggest caregivers need a hypertension lifestyle assessment instrument that would identify the subgroup into which an individual falls, as well as clinical management protocols that are tailored for members of each group.

Congestive heart failure has increased in the last five years partly because hypertension is not well-controlled, Weir says. Anything we can do to improve hypertension would improve heart failure as well. We need to be more aggressive to get intensified control of hypertension.
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One way providers can become more aggressive is through the use of combination drug therapy, says Joel Neutel, MD, chief of clinical pharmacology and hypertension at the Veterans Affairs Medical Center in Long Beach, CA, and assistant clinical professor of medicine at the University of California, Irvine.

Because hypertension is a multifaceted disease, it is extremely difficult to get to goal blood pressure using only one drug, Neutel says. He recommends that physicians consider using low-dose combination therapy earlier in the treatment process.

Combining two drugs in one tablet is more likely to reduce blood pressure and makes compliance easier for patients. Theres been somewhat of a reluctance to using combination therapy, but now with the new low-dose products that are available, you are much more likely to get control, he says. Some are concerned that there might be more side effects, but when you compare studies in which patients are started on low-dose combination therapy to those on monotherapy, there are really no differences in the side-effect profile. In almost all patients, it is possible to find a treatment regimen that would not have side effects. You have to do that if you want your patients to comply.

The step-care approach has been ingrained in doctors as the right approach to treating hypertension, and thats not necessarily a bad thing as long as blood pressure is controlled, Neutel says. But by virtue of the fact that in 75% of patients were not getting to control, the system is somehow breaking down. We have to be more aggressive with combination therapy earlier on in the treatment of hypertension, which is something that is not taught at medical school. Physicians have to constantly change their approach.

 
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Treatment for hypertension

06 May

Aggressive treatment for hypertension yields results

Consider combination drug therapy, tailored treatment strategies

Last month in CHF Disease Management, you read the disturbing news that the dramatic improvements in hypertension management seen in the 70s and 80s have slowed and even decreased to the point that currently only about 25% of hypertensive patients have their blood pressure adequately controlled.

Experts largely blame hypertension for the increase in CHF in recent years and expect the problem will only worsen as improving life expectancy increases the number of elderly people in the United States.

This month, CHF Disease Management offers you some updated practical strategies for improving hypertension management, including fresh ideas for tailoring treatment to specific patient types, managing drug therapy, helping patients modify their lifestyles, and measuring the quality of care. Buy mexican hgh.

If these issues plague your practice, youre not alone. In April, a national alliance was formed by leading medical, patient, and government organizations to reverse the growing trend of uncontrolled high blood pressure. The group, From Awareness to Action: The National Alliance to Reach Blood Pressure Goals, is a coalition of about 25 organizations. Members include the National Association of Mayors, the National Center for Health Statistics, and the National Consumers League as well as the American Heart Association and the American College of Cardiology.

The alliance plans to sponsor a series of high- profile intervention programs, such as blood pressure screenings and open forums, around the country to promote meaningful dialogue between providers and patients, says Martha Hill, RN, PhD, chair of the alliances advisory council and director of The Center for Nursing Research at Johns Hopkins University School of Nursing in Baltimore.

A large percentage of the public does know that high blood pressure is serious, but knowledge is inadequate in terms of getting people to get their blood pressure checked, and if its high, getting it under control, she says.

Hill says negative experiences with the health care system long waits for appointments, medications with side effects keep many patients from getting their blood pressure under control. Thats why providers need to spend time learning and respecting the beliefs and attitudes of patients so they can find affordable, well-tolerated ways to lower blood pressure. Providers can take actions as simple as mailing out appointment reminders and calling people who have missed appointments to more complicated actions such as installing computer programs to track blood pressures.

 
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