October 12th, 2012
Psychological and/or psychiatric referrals: May provide important complementary insight into relationships and situational causes of ED. These assessments do not form a routine component of the ED workup and should be considered in the unusual case.
Vascular testing: A variety of vascular tests exist. Historically, a penile brachial index (PBI) assessment was used. The PBI is a noninvasive test that records penile pressure as an index of arm pressure, providing a rough idea of the penile circulation. buy ortho tri-cyclen online Read more »
October 11th, 2012
A strong association exists between ED and peripheral vascular disease and occult coronary syndromes. The physical examination may be an important opportunity to unmask these conditions. Assessment should include body habitus (secondary sexual characteristics), the peripheral circulation, neurological systems and genitourinary systems.
Identification of penile deformities such as Peyronie’s disease may be best achieved by stretching the penis to make the plaque more pronounced. buy ortho tri-cyclen Read more »
October 10th, 2012
The patient’s medical history is the cornerstone of the evaluation of sexual dysfunction and ED. The patient’s history will provide the likely diagnosis in the majority of cases. There are a variety of approaches to obtaining a thorough history, the most common of which is a supportive health care professional allowing the couple to relate their concerns and express their goals of treatment in an unhurried manner. Read more »
October 9th, 2012
• History and clinical questioning (this is the most important component of the ED evaluation).
• A focused physical examination (directed at neural and vascular systems essential for achieving and maintaining erections).
• Questionnaires (eg, International Index of Erectile Function, Sexual Health Inventory for Men [Appendix 1]).
• Laboratory tests, including serum glucose, hormonal screening (total testosterone or bioavailable testosterone) and lipid screening. buy ampicillin Read more »
October 8th, 2012
• To establish treatment of patient and partner.
• Use of diagnostic tests based on the patient’s presenting complaints and goals of therapy.
• To provide the patient and partner with a diagnosis and understanding of the likely etiology of ED.
• To offer treatment choices with comprehensive information on cost, likelihood of success and common side effects. Read more »
October 7th, 2012
ED is a highly prevalent condition that impacts the quality of life of thousands of Canadian couples. Dramatic advances in understanding the pathophysiology of erection have led to the development of new, highly effective, minimally invasive therapeutic agents. ventolin inhaler
PCPs are rapidly acquiring the diagnostic and therapeutic skills necessary to become the dominant health care providers for this condition. Armed with effective oral agents able to treat ED, such as the phosphodiesterase type-5 inhibitors (PDE-5i) and the promise of a multitude of other new oral and sublingual agents in the research pipeline, ED is becoming more of a medical than surgical clinical entity. Read more »
October 6th, 2012
• ED is the preferred clinical term to describe the inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity.
• Diagnosis and treatment of ED are performed most effectively by primary care physicians (PCPs).
• The underlying risk factors associated with ED are common to cardiovascular disease in general and, therefore, may represent the initial clinical sign of generalized vascular insufficiency. Read more »
October 5th, 2012
Dramatic advances in the understanding of the causes of erectile dysfunction (ED) have occurred over the past decade. Sildenafil citrate (Viagra, Pfizer Inc, USA), the first effective oral agent for ED is currently available, and others are under regulatory review and should be available in Canada by the end of 2003. These developments have fueled public interest and transformed the way in which couples with sexual dysfunction seek help. The patient is now often the source of referral, with many health care visits initiated and conversations about sexual concerns started following direct requests from patients. This mandates that clinicians are comfortable discussing these topics and that they are up-to-date on the therapeutics and approaches to treatment. The present article is based on the guidelines from the Canadian Urology Association, approved June 2002. buy asthma inhaler
October 4th, 2012
The pathogenesis of the disease is not yet known, but has been thought to be related to chronic biliary ductal inflammation from pancreatic juice reflux, biliary infection or stone disease . The resulting inflammation and duct dilation induces overproliferation of the bile duct epithelium followed by the dysplasia-carcinoma sequence. The obstruction is thought to be due to mucous secretion or the enlarging papilloma.
Treatment for this benign disease has included surgery (including liver transplantation), palliative stenting, drainage or ablation. In general, if the disease is localized, lobectomy offers the best chance for cure. Small, localized tumour masses may be ablated using radiofrequency when resection is not possible. Choledochotomy, tumour curettage and T-tube drainage have been used for tumours involving the common bile duct, which often prove to be the most challenging surgically. Read more »
October 3rd, 2012
BP is rare neoplasm first described by Caroli in 1959 . To date, there are fewer than 100 cases reported in the English literature. BP has a 2:1 male to female ratio, and mean age at presentation is the seventh decade of life (60 to 70 years of age). Initially, BP was thought to be a benign neoplasm associated with low malignant potential and an overproduction of mucin . However, recent studies are challenging this paradigm, noting that not all patients with BP have hypersecretion of mucin. In addition, malignant transformation rates are actually high, varying between 41% and 83% . Many patients with these benign premalignant papillary lesions of the biliary tract die from their disease. Read more »