PubMed Health⌕ Search

Biomedical subjects

Federico Dehò

Publications and source records attributed to Federico Dehò.

12 recordsLinked to original sources
PubMed2006

Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial.

AIMS: To investigate the prevalence of erectile dysfunction (ED) in patients with CAD according to clinical presentation, acute coronary syndrome (ACS) vs. chronic coronary syndrome (CCS), and extent of vessel involvement (single vs. multi-vessel disease). METHODS AND RESULTS: 285 patients with CAD divided into three age-matched groups: group 1 (G1, n=95), ACS and one-vessel disease (1-VD); group 2 (G2, n=95), ACS and 2,3-VD; group 3 (G3, n=95), chronic CS. Control group (C, n=95) was composed of patients with suspected CAD who were found to have entirely normal coronary arteries by angiography. Gensini's score used to assess extent of CAD. ED as any value <26 according to the International Index of Erectile Function (IIEF). ED prevalence was lower in G1 vs. G3 (22 vs. 65%, P<.0001) as a result of less atherosclerotic burden as expressed by Gensini's score [2 (0-6) vs. 40 (19-68), P=0.0001]. Controls had ED rate values similar to G1 (24%). Group 2 ED rate, IIEF, and Gensini's scores were significantly different from G1 [55%, P<0.0001; 24 (17-29), P=0.0001; 21 (12.5-32), P<0.0001] and similar to G3 suggesting that despite similar clinical presentation, ED in ACS differs according to the extent of CAD. No significant difference between groups was found in the number and type of conventional risk factors. Treatment with beta-blockers was more frequent in G3 vs. G1 and G2. In G3 patients who had ED, onset of sexual dysfunction occurred before CAD onset in 93%, with a mean time interval of 24 [12-36] months. In logistic regression analysis, age (OR=1.1; 95% confidence interval (CI), 1.05-1.16; P=<0.0001), multi-vessel vs. single-vessel (OR=2.53; 95% CI, 1.43-4.51; P=0.0002), and CCS vs. ACS (OR=2.32; 95% CI, 1.22-4.41; P=0.01) were independent predictors of ED. CONCLUSION: ED prevalence differs across subsets of patients with CAD and is related to coronary clinical presentation and extent of CAD. In patients with established CAD, ED comes before CAD in the majority by an average of 2 up to 3 years.

Case-Control Studies↗
PubMed2006

A nomogram for staging of exclusive nonobturator lymph node metastases in men with localized prostate cancer.

OBJECTIVES: Some patients with localized prostate cancer are at risk of nonobturator lymph node invasion (NOLNI) and may require an extended pelvic lymph node dissection (ePLND). We explored the rate of exclusive NOLNI and developed a nomogram to predict it. MATERIAL AND METHODS: We mapped all ePLND specimens according to their anatomic location (obturator, external iliac, internal iliac lymph nodes) and assessed the location-specific rate of LNI in 565 patients. A multivariate logistic regression-based nomogram predicting NOLNI was then internally validated with 200 bootstrap resamples. RESULTS: Overall, 11.1% (63 of 565) had LNI and 21 (3.7%) had exclusive NOLNI. The nomogram predicting exclusive NOLNI was 80.2% accurate. The nomogram's negative predictive value was 99%, when it predicted 0-10% probability of NOLNI. This approach could allow the omission of an ePLND in 350 of 565 (61.9%) patients and still correctly stage 85.8% of NOLNI cases. CONCLUSIONS: Our nomogram-based approach offers the possibility of identifying men who are at virtually zero risk of exclusive NOLNI. In these men, an ePLND may be safely avoided.

Adult↗
PubMed2006

Women's sexual dysfunction: a review of the "surgical landscape".

OBJECTIVES: To assess the impact of urogynaecologic surgery for stress urinary incontinence, oncologic pelvic surgery, and hysterectomy on women's overall sexual health. METHODS: We used Ovid and PubMed (updated January 2006) to conduct a literature electronic search on MEDLINE that included peer-reviewed English-language articles. We analysed all studies identified that provided any functional outcome data about urogynaecologic surgery for the treatment of stress urinary incontinence, radical cystectomy for bladder cancer, surgery for rectal cancer, and hysterectomy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data. RESULTS: Most studies showed that either urogynaecologic or oncologic pelvic surgery may have a significant impact on women's sexual health. Epidemiology varied widely among the studies and reported either improvement or impairment of postoperative sexual functioning, due to different definitions, study designs, and small cohorts of patients. An increasing number of studies have prospectively examined this issue and have found often controversial findings about the role of pelvic and perineal surgery in women's sexual health. CONCLUSIONS: Although numerous controversies exist, data demonstrate an overall positive impact of the surgical repair for stress urinary incontinence on resolution of coital incontinence, coupled with an improvement of overall sexual life. In contrast, genitourinary and rectal cancers are commonly associated with treatment-related sexual dysfunction, but few studies rigorously assessed women's postoperative sexual function after major oncologic pelvic surgery. Data about the functional outcome after hysterectomy are often contradictory. Adequately powered prospective clinical trials are needed.

Female↗
PubMed2006

A comparative review of apomorphine formulations for erectile dysfunction : recommendations for use in the elderly.

Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. First-line oral therapy for ED includes the use of phosphodiesterase type 5 inhibitors (sildenafil, tadalafil and vardenafil) and sublingual apomorphine. Apomorphine is a dopamine D(1) and D(2) receptor agonist that has been approved for marketing in Europe. Different apomorphine formulations have been tested, such as sublingual, subcutaneous and intranasal. However, the sublingual formulation has shown the best results in terms of efficacy, safety and tolerability, especially the 2mg and 3mg doses. Although clinical studies of the efficacy and tolerability of apomorphine sublingual (SL) have included older patients, who are more likely to have ED, no study has specifically assessed the efficacy and tolerability of different doses of apomorphine SL in aging men. Therefore, a MEDLINE search was conducted from January 1987 to November 2005 to identify studies of the efficacy, safety (in particular cardiovascular safety) and tolerability of different apomorphine formulations and doses as treatments for ED in the subcohort of aging men. On the basis of the most recent peer-reviewed publications, the first part of this article critically evaluates data regarding the epidemiology of ED in the aging population. The second part of the article focuses on the mechanism of action and pharmacokinetics of apomorphine both in the general and the elderly population. Finally, a critical analysis of the efficacy and safety of different apomorphine formulations and doses for the treatment of ED is reported. Apomorphine represents a first-line oral treatment for ED. Available formulations include only sublingual administration. Few studies have assessed the efficacy and safety of apomorphine in the elderly population. However, in clinical practice, older patients with multiple vascular risk factors and systematic vascular damage show poor overall response to apomorphine SL for the treatment of ED.

Aged↗
PubMed2005

Comparison of the effect of sildenafil and apomorphine SL on nocturnal erections in healthy volunteers: a placebo-controlled study.

OBJECTIVE: To compare the effects of sildenafil and sublingual (sl) apomorphine on nocturnal erections. METHODS: In a prospective, single-blinded, placebo-controlled at-home study we compared the effect of apomorphine sl and sildenafil on sleep-related erectile activity in 30 healthy potent volunteers (mean age, 26.4 years; range, 23-35 years; Erectile Function domain of the International Index of Erectile Function > or =26), not reporting any subjective sleep abnormality during 4 consecutive nights with rigidity monitoring (NPTR) with the RigiScantrade mark device. After the first night of adaptation, they were randomized to receive placebo or apomorphine sl 2mg or sildenafil 50mg taken at bedtime during the following 3 consecutive nights. RESULTS: Sildenafil increased the mean+/-SE number of erections, overall length of erectile events, and the time of erections with rigidity >60% at both tip and base, as compared to placebo. The same parameters were reduced after administration of apomorphine sl. Similar findings were observed with regards to Rigidity Activity Units and Tumescence Activity Units. CONCLUSIONS: Our results confirm that sildenafil taken at bedtime might increase nocturnal erectile activity also in young potent men as compared to placebo. Apomorphine sl taken at bedtime seems to have the opposite effect.

Adult↗
PubMed2005

Association between erectile dysfunction and coronary artery disease: a case report study.

Evidence is accumulating in favor of classifying erectile dysfunction (ED) as a vascular disorder. There are three main clinical scenarios in which ED and coronary artery disease (CAD) may coexist: the patient with ED who later develops CAD, the patient with overt CAD who is casually found to have ED, and the patient with acute coronary syndrome who has normal sexual function. This study presents three cases and discusses a "putative" pathophysiological mechanism underlying all these clinical presentations. Further studies, coupling functional and structural changes of coronary circulation with those of penile (i.e., dynamic penile test) circulation in each of these situations are mandatory to support this hypothesis.

Aged↗
PubMed2005

Safety and tolerability of oral erectile dysfunction treatments in the elderly.

Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. It is generally accepted that sexual function tends to decline with aging, which is often associated with a higher prevalence of sexual problems, including ED and loss of libido. As the mean age of men seeking medical help for sexual dysfunction continues to increase, it is important to assess the safety and tolerability of currently available medical treatments in elderly men, who often share other co-morbidities that should be carefully evaluated when any type of ED therapy is considered. With this aim in mind, a MEDLINE search was conducted from 1 January 1998 to 31 May 2004 to identify studies assessing the efficacy, safety and tolerability of treatments for ED in the elderly. Particular care was taken to assess the cardiovascular safety of oral drugs for ED in this subset of patients, who often have multiple cardiovascular risk factors which contribute to a complicated clinical scenario. The most important conclusion of the paper is that the high efficacy, reliability, safety and tolerability of oral ED treatments makes them appropriate first-line therapies for elderly patients with ED.

Administration, Oral↗
PubMed2005

Atypical small acinar proliferation (ASAP) on extended prostatic biopsies: predictive factors of cancer detection on repeat biopsies.

OBJECTIVE: To evaluate the clinical and histopathologic factors that may help to predict cancer detection by means of extended repeated prostate needle biopsies in patients with Jumma atypical small acinar proliferation (ASAP) results on initial prostate biopsy. MATERIALS AND METHODS: From 1998 to September 2003, 105 out of 121 (86%) patients with a diagnosis of ASAP after a first set of 10 to 12 systematic biopsies, were rebiopsied using the same technique plus additional biopsies on the ASAP site (mean number of repeat biopsy samples, 12.6). The median time until a second and third biopsy was 7.04 months (95% confidence interval [CI], 5.5-8.5), and 13.3 months (95% CI, 8.8-17.7; 19 patients), respectively. Each histological slide was reviewed blindly by a single experienced pathologist (M.F) who differentiated highly suspicious (ASAPH) and not highly suspicious (ASAPB) lesions for cancer. RESULTS: On initial biopsy, a concomitant HGPIN was present in 18 patients (17%) with ASAP The overall cancer detection rate in those who underwent two or three sets of biopsies was 39% (41/105); it was 35% (37/105) and 21% (4/19) in second and third biopsies, respectively. The overall cancer detection rate was higher in patients who had ASAP associated with HGPIN (50%) compared with patients who had isolated ASAP (37%) (p = 0.3). Statistical analysis showed that levels of prostate-specific antigen (PSA), PSA density, prostatic volume, digital rectal examination results, transrectal ultrasound findings, time until rebiopsy (less vs. more than 6 months), and histological level of suspicion were not significant predictors of prostate cancer at the time of rebiopsy. In particular, the cancer detection rate was not significantly higher in patients with ASAPH than those with ASAPB (49% vs. 33%, respectively; p = 0.11). In a univariate analysis, the mean prostate volume was statistically different in patients with cancer compared with those without (56.4 +/- 6.3 and 78.9 +/- 5.3 respectively; p = 0.009), but only in the group of patients who had isolated ASAP In these patients, the rate of cancer detection was significantly higher in patients who had a prostatic volume less than 60 mL (56%) than in patients with a prostatic volume greater than or equal to 60 mL (27%) (p = 0.03). CONCLUSIONS: Patients with an initial ASAP diagnosis after extended biopsies had an overall cancer detection rate less than 40% after two sets of extended biopsy. ASAPH lesions did not indicate a significantly higher risk of cancer than ASAPB lesions on repeated extended biopsies. Despite the extended rebiopsy plus the additional biopsies targeted to the ASAP lesion, the detection rate was lower for patients with a larger prostate than those with a smaller prostate.

Aged↗
PubMed2004

Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of a cross-sectional study.

OBJECTIVE: The aim of this study was to determine the prevalence of sexual dysfunctions in women with urinary incontinence and/or lower urinary tract symptoms as compared to a general female population. METHODS: We extensively evaluated 227 consecutive women (mean age 52; age range 19-66) complaining of urinary incontinence (UI) and/or lower urinary tract symptoms (LUTS) with a comprehensive history (including several validated questionnaires), a complete physical examination and a urodynamic multichannel evaluation. Two hundred and sixteen patients were eligible for sexual function investigation because 11 out of 227 (5%) were not interested in dealing with questions regarding their own sexuality and were thus excluded from the final evaluation results. A group of 102 age-matched women (mean age 54; age range 19-63) assessed for a yearly routine gynaecological evaluation and not complaining of urinary symptoms were enrolled as cross-sectional controls and investigated in accordance with the Female Sexual Function Index (FSFI). RESULTS: Sexual dysfunction was diagnosed in 99 out of 216 patients (46%). Of these, 34 (34%) reported hypoactive sexual desire, 23 (23%) reported sexual arousal disorder; 11 patients (11%) complained of orgasmic deficiency, and 44 (44%) suffered from sexual pain disorder (e.g., dyspareunia or non-coital genital pain). Women reporting low sexual desire commonly suffered from stress incontinence (47%). We found that 60% of the women with sexual arousal disorders and 61% of those with sexual pain disorders also complained of recurrent bacterial cystitis. Forty-six percent of those complaining of orgasmic phase difficulties also reported a troublesome urge incontinence. The FSFI values in both groups scored as follows (patients versus controls; median value; p value): desire: 2.0 vs. 3.2 (p<0.01); arousal: 2.8 vs. 3.6 (p=n.s.); lubrication: 3.2 vs. 4.4 (p=0.01); orgasm: 4.1 vs. 4.4 (p=n.s.); sexual satisfaction: 2.7 vs. 4.0 (p<0.01); sexual pain: 1.8 vs. 4.0 (p<0.001). CONCLUSIONS: Women reporting UI or LUTS also complained of sexual dysfunctions in a significantly higher number than a general, healthy female population not complaining of urinary symptoms. Investigation of female sexuality is suggested for these patients.

Adult↗
PubMed2004

Common grounds for erectile dysfunction and coronary artery disease.

PURPOSE OF REVIEW: Evidence is accumulating to consider erectile dysfunction as a vascular problem. This review focuses on background, pathophysiological mechanisms and clinical evidence of the link between erectile dysfunction and coronary artery disease. RECENT FINDINGS: The link between erectile dysfunction and coronary artery disease is suggested by the following. (1) Common risk factors for atherosclerosis are frequently found in erectile dysfunction. (2) Erectile dysfunction is frequently found in vascular syndromes such as coronary artery disease, hypertension, cerebrovascular disease, peripheral arterial disease and diabetes. (3) A similar pathogenic involvement of the NO pathway leading to impairment of endothelium-dependent vasodilatation and late structural vascular abnormalities is shared by erectile dysfunction and vascular disorders. Given this background, the "artery-size hypothesis" is a recently proposed pathophysiological mechanism to explain the link between sexual dysfunction and myocardial ischemia. SUMMARY: Erectile dysfunction and coronary artery disease appear to be linked tightly each other.

Coronary Artery Disease↗