Faculty Bibliography

The Food and Drug Administration has approved the marketing of the first prescription drug for the treatment of impotence, a condition that affects 10 million to 20 million American men. The FDA's action Thursday gives Upjohn Co. in Kalamazoo, Mich., permission to market the drug, alprostadil, under the brand name Caverject. Upjohn already markets alprostadil, a naturally occurring form of prostaglandin E11, for pediatric cardiac use. Caverject is a synthetic version of alprostadil. The FDA approved use of Caverject for a broad group of patients whose impotence is due to psychological factors like sexual performance anxiety, nerve dysfunction or damage to arteries, capillaries and veins. Use was also approved to help diagnose erectile dysfunction, which is the consistent inability to achieve and maintain a penile erection

The FDA on Jul 6, 1995 approved the marketing of alprostadil, the first prescription drug for the treatment of impotence, a condition that affects 10 million to 20 million American men

The FDA on Jul 6, 1995 approved the marketing of the first prescription drug for the treatment of impotence, a condition that affects 10 million to 20 million American men. The action gave the maker, the Upjohn Co, permission to market the drug, alprostadil, under the brand name Caverject

Male golden Syrian hamsters from Sasco form cholesterol gallstones when fed a lithogenic diet; in contrast, female hamsters are resistant to stones when fed the identical diet. Upon addition of the synthetic androgen, methyl-testosterone, to the diet, the incidence of cholesterol gallstones in female hamsters increased from 0% to 40% after 3 weeks and from 0% to 86% after 6 weeks. Cholesterol cholelithiasis remained high in the males. Biliary cholesterol and phospholipid levels were elevated in the females fed the hormone and approached those of the males. The cholesterol saturation of bile in the females increased from 36% to 75% after 3 weeks and from 54% to 109% after 6 weeks. In addition, an appreciable proportion of the cholesterol in the bile of female hamsters was now present in the form of vesicles. The bile acid composition was significantly altered by methyltestosterone even though the total bile acid concentration did not change; the bile acid composition of the female hamsters approached that of the males. The glycine to taurine ratio of the bile acids was drastically reduced by methyltestosterone in the females and to a lesser extent in males. In summary, in female hamsters the addition of methyltestosterone to the lithogenic diet induced cholesterol gallstones, elevated total biliary phospholipid and cholesterol, altered the bile acid composition, and changed the distribution of cholesterol from micelles to vesicles. The data obtained so far do not enable us to define the precise mechanism of action of methyltestosterone.

Multidrug resistance has become an increasingly important problem in the control and prevention of tuberculosis in large urban centers. Although several small outbreaks of multidrug-resistant (MDR) tuberculosis in New York City have been reported, the increase in the number of cases is not fully explained by these recognized outbreaks, and the modes of transmission have not been clearly delineated. Transmission patterns of MDR tuberculosis in New York City, therefore, were studied by stratifying Mycobacterium tuberculosis isolates from 167 newly diagnosed tuberculosis patients according to their DNA restriction fragment length polymorphisms (RFLP). Forty-three (34%) of 127 drug-susceptible isolates and 19 (79%) of 24 multidrug-resistant isolates had RFLP patterns representing possible recent exogenous infection (primary tuberculosis). Patients who had such isolates were more likely to be seropositive for human immunodeficiency virus (58%; p < 0.05), non-Hispanic black (56%; p < 0.005), U.S.-born (57%; p < 0.001), and have MDR tuberculosis (79%; p < 0.0005). In a logistic regression model, primary tuberculosis remained significantly associated with MDR tuberculosis and black race. In contrast to previous reports, in New York City recent exogenous transmission accounts for most new cases of multidrug-resistant tuberculosis

Lamm, a physician, notes that he always feels "a sense of trepidation when a patient comes in complaining of stomach pain." Abdominal pain that is continous, severe, or accompanied by a fever warrants medical care

Structured interviews measuring tuberculosis knowledge were administered to 494 New York City injection drug users, 31% of whom reported a history of having a reactive tuberculin skin test. Medical records review of a subsample confirmed the validity of self-reported data. Most respondents understood the mechanisms of tuberculosis transmission. Three fourths of the subjects did not fully understand the distinction between a reactive skin test and active tuberculosis, but those who reported a history of skin test reactivity were twice as likely to understand this distinction. Forty percent of subjects did not understand the importance of medication adherence. Misunderstandings, based on a recent lack of tuberculosis education, may contribute to the fear and confusion that interfere with efforts to control tuberculosis

To clarify the diverse published results of cranial electrostimulation (CES) efficacy, we conducted an extensive literature review that identified 18 of the most carefully conducted randomized controlled trials of CES versus sham treatment. For the 14 trials that had sufficient data, we used the techniques of meta-analysis to pool the published results of treating each of four conditions: anxiety (eight trials), brain dysfunction (two trials), headache (two trials), and insomnia (two trials). Because studies utilized different outcome measures, we used an effect size method to normalize measures which we then pooled across studies within each condition. The meta-analysis of anxiety showed CES to be significantly more effective than sham treatment (p < .05). Pooling did not affect results that were individually positive (headache and pain under anesthesia) or negative (brain dysfunction and insomnia). Most studies failed to report all data necessary for meta-analysis. Moreover, in all but two trials, the therapist was not blinded and knew which patients were receiving CES or sham treatment. We strongly recommend that future trials of CES report complete data and incorporate therapist blinding to avoid possible bias