Similar Proportion Of Men Research Articles

Impact of 3.5 cm Artificial Urinary Sphincter Cuff on Primary and Revision Surgery for Male Stress Urinary Incontinence

We report our initial clinical experience with the new 3.5 cm artificial urinary sphincter cuff. We reviewed the records of all men who underwent artificial urinary sphincter placement done by a single surgeon since September 2009. A perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum after precise spongiosal measurement with a redesigned measuring tape. Clinical factors and cuff sizes were analyzed. During the 14-month study period 45 of 67 patients (67%) with an artificial urinary sphincter received the 3.5 cm cuff with no difference between primary and revision surgery (73% vs 58%, p = 0.29). Transcorporal cuff placement was reserved for 8 select patients (12%) after prior artificial urinary sphincter cuff erosion or complex urethroplasty. A tandem cuff artificial urinary sphincter was not used. Erectile dysfunction (89% vs 77%, p = 0.28) and prior radiation (47% vs 27%, p = 0.12) were more common in men who received a 3.5 vs a 4.0 cm or greater cuff. A similar proportion of men with a 3.5 cm vs a larger cuff (4 of 45 or 9% vs 2 of 22 or 9%) required explantation for infection and/or erosion. At our center the 3.5 cm cuff has become the predominant size used for primary and revision artificial urinary sphincter placement. Liberal use of the 3.5 cm cuff has simplified and improved artificial urinary sphincter placement without additional morbidity.

Recently diagnosed axial spondyloarthritis: gender differences and factors related to delay in diagnosis

A cohort of patients with recently diagnosed axial spondyloarthritis (SpA) was characterized with emphasis on gender differences and factors leading to delay in diagnosis. Clinical, laboratory, and imaging data of 151 consecutive patients diagnosed with ankylosing spondylitis or undifferentiated SpA in 2004-2009 and satisfying the new ASAS classification criteria for axial SpA, was collected and analyzed. Seventy-nine men and 72 women were enrolled. Both groups (men and women) had similar age of onset of disease-related symptoms, as well as similar delay time to diagnosis, follow-up duration and frequency of anti-TNF treatment. Inflammatory back pain, as a first symptom related to SpA, was reported more often by men, while women had more pelvic, heel, and widespread pain (WP) during the course of the disease. At the time of diagnosis, men were more limited in chest expansion and showed increased occiput-to-wall distance compared to women. Elevated erythrocyte sedimentation rate and/or C-reactive protein were detected in a similar proportion of men and women. Presence of WP in women almost doubled the delay in the diagnosis of SpA. No other differences in disease presentation or burden were demonstrated to correlate with delay in diagnosis.

Influence of socio-health variables on the cognitive state of mind of the geriatric patients of a health centre

To determine the influence of age, education, admission in nursing homes and chronic diseases (arterial hypertension, diabetes, hyperlipidaemia, anxiety and depression) on the cognitive state of the population over 65 years of age. A study was made of a geriatric outpatient population (patients living at home or institutionalised) with chronic diseases, who showed cognitive deterioration and depressive symptoms. The cognitive mini-exam (CME) and the geriatric depression scale (Yesavage) were administered. One hundred and forty-seven patients participated, with an average age of 71.4 years and a similar proportion of men (74; 50.3%) and women (73; 49.7%). Thirty-four subjects (23.1%) were living in nursing homes. The most prevalent diseases were hypertension (50%), anxiety-insomnia (30%), diabetes (22%), arthrosis (22%), depression (13%) and hypercholesterolaemia (12%). Half of the patients (79; 53.7%) were following treatment with more than three medicines; 60 (40.6%) with between two and three medicines, and only 8 (5.5%) were taking no medication. The percentage of subjects living in an institution increased with age. The consumption of medicines was also higher amongst the more elderly. The scores on the cognitive scale (CME) decrease with age and were also lower amongst subjects who live in institutions (above all if they suffer from depression). The patients who took psychotropics had lower scores on the CME. Although performances on the CME are lower amongst subjects with a low level of education, the differences do not reach statistical significance. The presence of hyperlipidaemia also decreased the results of the CME. The socio-health factors that altered performance negatively in the cognitive mini-exam are advanced age and institutionalisation. These results are also significantly influenced by depressive disease, hyperlipidaemia and the consumption of medicines that affect the cognitive state.

Clustering of symptoms associated with fibromyalgia in a Finnish Twin Cohort

The objective was to assess the prevalence and heritability of symptoms associated with fibromyalgia in a population-based working-age twin sample. The study was based on the 12,502 like-sexed twins of the Finnish Twin Cohort and 49 diagnosed fibromyalgia patients who answered the same questionnaire in 1990–1992. Questions that were considered to best match symptoms of fibromyalgia were validated between the twins and the fibromyalgia patients. Latent class analysis was used to classify the subjects into more homogeneous groups with respect to the symptom items. The pairwise distribution of symptom classes in relation to zygosity and gender was modelled using quantitative genetic models to estimate heritability. Responses to all fibromyalgia-related items were obtained from 10,608 twins. A similar proportion of men (12%) and women (13%) was placed in the third latent class, which best represented possible fibromyalgia patients. Subjects in this class had a similar symptom profile as the diagnosed fibromyalgia patient group, but they were less severely affected. The two other latent classes represented subjects that were virtually symptom free and subjects with some symptoms. The heritability of liability to symptom class membership was estimated to be 51% (95% CI 45–56%). The prevalence of symptoms associated with fibromyalgia in our population-based sample unselected for disease status was comparable to the prevalence of widespread pain reported in population based studies. The symptoms known to be associated with fibromyalgia seem to have a strong genetic background.

Prospective Analysis of Withdrawal Times and Polyp Detection Rates During Screening Colonoscopy and a Comparison to US Multi-Society Task Force Recommendations: A Community-Based Continuous Quality Improvement Study

Background: A US Multi-Society Task Force on colon cancer suggests that the withdrawal time of a screening colonoscopy should be at least 6-10 minutes and expected to yield an adenoma detection rate of >25% in men and >15% in women. Aims: To assess the association between adenoma detection and colonoscopy withdrawal time as a surrogate measure of quality. Methods: A series of videotaped colonoscopies were reviewed in a group training session of 9 experienced gastroenterologists to develop a consensus of bowel prep quality measures, based upon a previously validated instrument. 506 screening colonoscopies were performed in an ambulatory endoscopy center. The withdrawal, cleaning, and total time was recorded by an assistant. Resected polyps were assessed for size, histology, and location. Results: Cecal intubation was achieved in 99.8% of exams. The mean patient age was 60.7+/−8.9 years, 47.9% were male, and 87.9% white. Among completed exams, a similar proportion of men and women had polyps (58.3% vs. 52.5%), though adenoma were more common in men (36.8% vs. 27.4%, p = 0.02) and tended to occur in older patients (p = 0.08). Isolated adenomas proximal to the splenic flexure were seen in 11.7% and isolated diminutive adenomas (<5 mm) were observed in 16%. Mean withdrawal time (excluding cleaning time) was 4.2 min (range: 0.8-9.8) with a mean total cleaning time of 2.6 min (range: 0-14.7). The proportion of patients with identified adenomas varied significantly by provider (p = 0.01) with a range of 10-50%. In univariate analysis, withdrawal time was significantly correlated with detection of polyps (p = 0.001) and with detection of adenomas (p = 0.04), and varied significantly by provider (p = 0.0001). The bowel prep quality was rated lower in those with adenomas (p = 0.02). In a multivariate logistic regression model accounting for provider clustering and including withdrawal time, bowel prep, body mass index, gender and age, only male gender (OR 1.52, 95% CI 1.02-2.26) and bowel prep (OR 1.08, 95% CI 1.00-1.17) were significantly associated with adenomas. Two patients required surgical resection, for a high grade flat dysplastic lesion in the cecum and a 4 cm tubulovillous adenoma in the ascending colon, respectively. Conclusions: A community-based gastroenterology practice did achieve the recommended adenoma detection goals, although there was significant variation across providers. Withdrawal time was associated with adenoma detection in univariate analysis, though it was not significant in a multivariate model. Further investigation is warranted to determine key predictors for high quality exams.

Situación cognitiva como condicionante de fragilidad en el anciano: Perspectiva desde un centro de salud

To determine the influence of the cognitive state on the presence of different frailty factors in the elderly. Study of an outpatient elderly population with chronic diseases (resident at home or institutionalised), the presence of different frailty risk factors and their relation to cognitive state (measured using the mini-mental state examination-MEC). Study of 147 elderly people with an average age of 71.4 years and a similar proportion of men (74; 50.3%) and women (73; 49.7%). Thirty-four subjects (23.1%) institutionalised in residences. The percentage of patients showing cognitive impairment (MEC<24 points) is 12.9% (19 cases). Presence of frailty risk factors: low social support: 7.5% (11); falls: 17% (25); urinary incontinence: 18.4% (27); depression: 13.6% (20); anxiety-insomnia: 29.9% (44); hospitalisation-readmissions: 21.8% (32); multiple medications (>3 medicines): 53.7% (79); pluripathology (> or =3 diseases): 36.1% (53). The frailty factors that have a significant relation in patients with cognitive impairment (MEC<24) are falls [OR=59.5 (CI 95%=14.7-240.6)] (p<0.0001), urinary incontinence [OR=31.2 (8.9-109.1)] (p<0.0001), hospitalisation-readmissions [OR=32.9 (8.6-125.8)] (p<0.0001) and depression [OR=7.8 (2.5-23.5)] (p<0.0001). With respect to scoring on the MEC by percentiles, the risk factors that showed a tendency of lineal appearance are falls (p<0.0001), urinary incontinence (p<0.0001), hospitalisation-readmissions (p<0.0001) and pluripathology (p=0.002). Cognitive impairment marks the appearance in a significant form of frailty factors in the elderly, such as falls, urinary incontinence, hospitalisation-readmissions and depression. This relation is not only appreciable in patients with an established cognitive impairment (MEC<24 points), but there is also a trend to appear as this impairment progresses, with a statistical relation for falls, urinary incontinence, hospitalisation-readmissions and pluripathology.

Influencia de variables socio-sanitarias en la situación del estado cognitivo y de ánimo en los pacientes geriátricos de un centro de salud

Background. To determine the influence of age, education, admission in nursing homes and chronic diseases (arterial hypertension, diabetes, hyperlipidaemia, anxiety and depression) on the cognitive state of the population over 65 years of age. Material and methods. A study was made of a geriatric outpatient population (patients living at home or institutionalised) with chronic diseases, who showed cognitive deterioration and depressive symptoms. The cognitive mini-exam (CME) and the geriatric depression scale (Yesavage) were administered. Results. One hundred and forty-seven patients participated, with an average age of 71.4 years and a similar proportion of men (74; 50.3%) and women (73; 49.7%). Thirty-four subjects (23.1%) were living in nursing homes. The most prevalent diseases were hypertension (50%), anxiety-insomnia (30%), diabetes (22%), arthrosis (22%), depression (13%) and hypercholesterolaemia (12%). Half of the patients (79; 53.7%) were following treatment with more than three medicines; 60 (40.6%) with between two and three medicines, and only 8 (5.5%) were taking no medication. The percentage of subjects living in an institution increased with age. The consumption of medicines was also higher amongst the more elderly. The scores on the cognitive scale (CME) decrease with age and were also lower amongst subjects who live in institutions (above all if they suffer from depression). The patients who took psychotropics had lower scores on the CME. Although performances on the CME are lower amongst subjects with a low level of education, the differences do not reach statistical significance. The presence of hyperlipidaemia also decreased the results of the CME. Conclusions. The socio-health factors that altered performance negatively in the cognitive mini-exam are advanced age and institutionalisation. These results are also significantly influenced by depressive disease, hyperlipidaemia and the consumption of medicines that affect the cognitive state.

A Qualitative Study of Cybersex Participants: Gender Differences, Recovery Issues, and Implications for Therapists

In a companion study to onepreviouslypublished on the effects of cybersex addiction on the family, a new, brief online survey was completed by 45 men and 10 women, aged 1 6 4 4 (mean, 38.7) who self-identified as cybersex participants who had experienced adverse consequences from their online sexual activities. Nearly all the respondents (92% of the men and 90% of the women) self-iden-tified as current or former sex addicts. Sign flcantly more men than women reported downloading pornography as a preferred activity. As in previous studies on gender differences in sexual activities, the women tended toprefer sex within the context of a relationship or at least e-mail or chat room interactions rather than accessing images. However, in the present small sample, several women were visually-oriented consumers of pornography. Two women with noprior histo y of interest in sadomasochistic sex discovered this type of behavior online and came toprefer it. Although a similarproportion of men (27%) and women (30%) engaged in real-tame online sex with another person, significantly more women than men (80% vs. 33.3%) stated that their online sexual activities had led to real-life sexual encounters. Some respondents described a rapid progression of a previously existing compulsive sexual behavior problem, whereas others had no history of sexual addiction but became rapidly involved in an escalating pattern of compulsive cybersex use after they discovered Internet sex. Adverse consequences included depression and other emotionalproblems, social isolation, worsening of their sexual relationship with spouse or partner, harm done to tbeir marriage or primary relationship, exposure of children to onlinepornography or masturbation, career loss or decreased job performance, other financial consequences, and in some cases, legal consequences. Although some therapists the participants consulted were very helpful, others were uninformed about the nature and extent of sexual activities available online and reportedly (1) minimized the significance of the cybersex behavior and did not accept it for the powerful addiction it was, (2) failed to make it a priority to stop illegal or self-destructive behaviors, and (3) did not consider the effect oj-the cybersex involvement on the spouse orpartner.

Sperm retrieval and fertilization in repeated percutaneous epididymal sperm aspiration.

Percutaneous epididymal sperm aspiration (PESA) for retrieval of spermatozoa for intracytoplasmic sperm injection (ICSI) is a new simplified technique in the treatment of men with obstructive azoospermia. There has been a fear that the PESA procedure, being blind, could cause damage to the epididymal duct system and make it impossible to retrieve spermatozoa if a repeated procedure is required. We report here on repeated PESA procedures from the same unilateral epididymis. Twenty-seven men with obstructive azoospermia were investigated retrospectively regarding sufficiency of the number of motile spermatozoa for ICSI, fertilization rate (FR) and possibility of collecting spermatozoa for cryopreservation in repeated PESA procedures. Sufficient motile spermatozoa for ICSI were found in a similar proportion of men at the first two attempts: 91 and 89% respectively. Fertilization rate and the possibility of collecting spermatozoa for cryopreservation were also similar at the first two PESA procedures: 62 versus 67% and 33 versus 33% respectively. At the third procedure, motile spermatozoa for ICSI were retrieved in 86% (6/7), FR was 47% and spermatozoa were cryopreserved in one case. Two men underwent a fourth PESA. In both cases, a sufficient number of motile spermatozoa for ICSI was found and FR was 62%. This study shows that in men with obstructive azoospermia, PESA can be repeated on the same unilateral epididymis up to three times, with good opportunity of retrieving sufficient motile spermatozoa for ICSI.

Occurrence of Mycoplasma genitalium in different populations and its clinical significance.

Mycoplasma genitalium is predominantly flask-shaped with cytadsorptive and glass-adhering properties. These biological features of pathogenicity are reflected in its ability to cause urethritis and salpingitis in subhuman primates when given experimentally, although its role in human disease is less clear. M. genitalium was initially recovered by culture of specimens from two of 13 men with acute nongonococcal urethritis (NGU), but culture remains a laborious and insensitive means of detection. This organism has, however, been detected in the urethra of > or = 20% of men with acute NGU by using a polymerase chain reaction (PCR) and in a similar proportion of men with chronic NGU. The possibility of sexual transmission of M. genitalium is supported by the fact that by using the PCR it has been detected in the lower genital tract of about 20% of women who were attending a clinic for sexually transmitted diseases. It has also been detected, together with Mycoplasma pneumoniae, in a joint of a hypogammaglobulinemic patient who was suffering from polyarthritis after pneumonia and has been isolated, again with Mycoplasma pneumoniae, from the throat in culture. Such detection raises the question of the preferred mucosal site of M. genitalium, which has yet to be determined.