Showing papers by "London Bridge Hospital published in 2013"

Erectile dysfunction in general medicine.

Abstract: Erectile dysfunction (ED) affects millions of men worldwide with implications that go far beyond sexual activity. ED is now recognised as an early marker of cardiovascular disease, diabetes mellitus (DM) and depression. The risk factors that are associated with ED (sedentary lifestyle, obesity, smoking, hypercholesterolaemia and the metabolic syndrome) are very similar to those for cardiovascular disease (CVD). Arguably, the awareness of ED as a symptomatic entity in the post-Viagra™ age is on the rise. Nevertheless, ED is commonly missed when evaluating patients in the hospital setting, either because of lack of consideration or awareness, or through simple embarrassment (of both clinician and patient). This article provides an overview of the aetiology, assessment and importance of ED and hopes to promote its consideration in day-to-day clinical practice.

Erectile dysfunction and asymptomatic coronary artery disease: frequently detected by computed tomography coronary angiography but not by exercise electrocardiography.

Abstract: Summary Aims Erectile dysfunction (ED) and vascular disease, in particular coronary artery disease (CAD), have the common denominator of endothelial dysfunction. ED frequently precedes a CAD event by between 2 and 5 years (average 3 years). ED also predicts an acute coronary syndrome as well as increased mortality, suggesting the rupture of an asymptomatic coronary plaque. This study compares multi-detector cardiac computed tomography (MDCT) with maximal treadmill exercising in men with ED and no coronary symptoms as a means of detecting coronary lesions. Methods Sixty-five men with organic ED and no cardiac symptoms were prospectively screened for CAD. All underwent maximal exercise testing and MDCT in the same 7-day period. The Sexual Health Inventory for Men questionnaire established the presence of ED. Findings The exercise ECG was borderline abnormal in three men and normal in 62. CT calcium was present in 53 (score 5–1671) and non-calcified plaque in seven. The MDCT angiogram was normal in only 5 (3.25%). Conclusion Erectile dysfunction may predict CAD in the absence of cardiac symptoms. MDCT detects subclinical plaque which may be vulnerable to rupture and which is not flow limiting enough to influence the exercise ECG. The window of 2–5 years between ED and a CAD event offers an opportunity for aggressive risk factor reduction. ED should be a routine question in any risk calculator.

Extensor Pollicis Brevis tendon damage presenting as de Quervain’s disease following kettlebell training

Abstract: Kettlebell exercises are more efficient for an athlete to increase his or her muscle strength. However it carries the risk of injury especially in the beginners. A 39 year old gentleman came to our clinic with radial sided wrist pain following kettlebell exercises. Clinically patient had swelling and tenderness over the tendons in the first dorsal wrist compartment, besides Finklesten test was positive. Patient had a decreased excursion of the thumb when compared to the opposite side. Ultrasound/MRI scan revealed asymmetric thickening of the 1st compartment extensors extending from the base of the thumb to the wrist joint. Besides injury to the Extensor Pollicis Brevis (EPB) tendon by repetitive impact from kettlebell, leading to its split was identified. Detailed history showed that the injury might be due to off-centre handle holding during triceps strengthening exercises. Our report stresses the fact that kettlebell users should be taught about problems of off-center handle holding to avoid wrist injuries. Also, in Kettlebell users with De Quervains disease clinical and radiological evaluation should be done before steroid injection as this might lead to complete tendon rupture.

Let's talk about sex.

Abstract: Giving sexual advice to cardiac patients is an important aspect of their overall management, no matter the cardiovascular disease (CVD) condition [1]. Sexual health is an integral component of human (male and female) well being. The World Health Organisation made it clear that all individuals have a fundamental right to sexual health, including ‘‘freedom from...factors inhibiting sexual response and impairing sexual relations...[and] organic disorders, disease and deficiencies that interfere with reproductive function’’ [2]. In 1978 I concluded ‘‘It should be routine policy to advise patients and their spouses (update this to partners) on sexual activity, whether they have had an infarction or are regularly attending with angina pectoris. Most patients with ischaemic heart disease can enjoy normal sexual relations without risk’’ [3]. Unfortunately 35 years later, though sexual counselling of patients with CVD and their partners is recognised to be an important part of recovery, advice is still not routinely provided [1–4]. The bold paper in this issue from the Netherlands depressingly confirms we have hardly moved on [5]. Of 980 members of the Netherlands Society of Cardiology mailed 53.9 % responded—were the rest too embarrassed to answer?—and only 16 % said they discussed sexual function routinely with 2 % referring for specialised advice. 54 % hid behind ‘‘lack of initiative of the patient’’ and 43 % could not make time, whilst 35 % admitted to a lack of training. The importance of initiating the enquiry has been emphasised repeatedly in several key-note publications with sample questions provided [6, 7]. Lack of time is simply a pathetic excuse whilst lack of training or understanding is recognising an honest need for further education which should be made available [8, 9]. Indeed, most studies of CVD patients and their partners suggest health care professionals provide inadequate advice about sexual activity and wish more information was provided— in other words the health care professional needs to ask pro-actively [10, 11]. Studies have clearly shown that sexual counselling improves knowledge about CVD and sex, helps relieve anxiety, increases confidence and alleviates the fear of sexual activity [12]. The cardiovascular responses to sexual activity including intercourse is similar to mild to moderate non-sexual effort—walking 1 mile (1.6 km) in 20 min on the flat or briskly climbing two flights of stairs in 10 s [13]. In longstanding (not casual) relationships the heart rate and blood pressure response is similar to that experienced during other aspects of normal daily life. Coital death is rare (±1 % of sudden deaths) and occurs usually as a result of casual sex with an age mismatch, following too much to eat and drink [14]. The need for cardiologists to be actively involved in providing sexual advice is increasing as the link between erectile dysfunction (ED) and CVD has identified endothelial dysfunction as the common denominator, with ED predicting cardiovascular events and mortality in asymptomatic men and also frequently being a problem after a CV event [6, 12]. It is also becoming a problematic area in grown up congenital heart disease [15]. There is no doubt that sexual activity is a concern for patients with CVD and their partners (it may be one person’s problem but it is a couple’s concern) and some cardiologists looking after them [8]. Because counselling is such an important component of treatment, cardiologists need to understand the physiological aspects of sex, the risks involved, and the therapy available. The Dutch have G. Jackson (&) London Bridge Hospital, Tooley Street, London SE1 2PR, UK e-mail: gjcardiol@talk21.com

PCA3 and Other Urinary Markers

Abstract: With worldwide increasing diagnosis of localised prostate cancer, primarily due to the sensitive but nonspecific PSA test, urologists have dedicated huge resources to identifying urinary biomarkers for prostate cancer diagnosis. Due to the intimate relationship between the prostate and the evacuation of urine through it, a urinary marker is far more appealing than a serum biomarker. Markers would be easy to collect and may not require an invasive procedure if present in sufficient quantities in the urine naturally. Over the last decade, a range of potential urinary markers have been proposed for this role, and this chapter examines their current and potential use in clinical practice.