Objective: To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD). Design: Double-blind, crossover, placebo-contro-lled study. Setting: Gynecological diabetic...Objective: To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD). Design: Double-blind, crossover, placebo-contro-lled study. Setting: Gynecological diabetic outpatient clinic and sexual clinic. Patient(s): Thirty-six type 1 premenopausal diabetic women affected by SAD. Intervention(s): Two 8-week periods of sildenafil 100 mg, washout, and placebo, by two possible sequences. Main Outcomes Measure(s): Each woman submitted blood samples to measure HbA 1c, and T, free T (FT), and PRL. Efficacy was assessed [1] subjectively by the Personal Experiences Questionnaire based on the 5- point Likert scale, quantifying arousal, desire, orgasm, enjoyment of sexual activities, and frequency of sexual relationships; and [2] objectively by translabial color Doppler ultrasound to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity of clitoral arteries. Result(s): Thirty-two women completed the study. The mean HbA 1c value was 8.0% ± 1.8% , and plasma concentrations of T, FT, and PRL were normal. Sildenafil seems to improve arousal, orgasm and sexual enjoyment, and dyspareunia in women affected by type 1 diabetes. However, by flowmetric measurements, the mean RI was significantly lower and both the mean PI and PSV of the clitoral arteries were significantly higher compared with baseline and placebo. Conclusion(s): Sildenafil seems to improve subjective sexual aspects and can be used to treat objectively genital arousal disorder of premenopausal women with type 1 diabetes.展开更多
We present the case of a full term neonate with severe persistent pulmonary hypertension of the newborn (PPHN) after birth asphyxia cared for at the St. Elizabeth Hospital in Curacao, Netherlands Antilles. Although th...We present the case of a full term neonate with severe persistent pulmonary hypertension of the newborn (PPHN) after birth asphyxia cared for at the St. Elizabeth Hospital in Curacao, Netherlands Antilles. Although the child was ventilated with high pressures and was given high doses of cardiovascular pressors, the arterial oxygen levels remained low with an alveolar-arterial O2 gradient of 651mmHg. As a last resort, sildenafil (1.5 mg/kg)was given via a nasogastric tube. This resulted in an immediate and sustained elevation of arterial oxygenation and subsequent complete recovery. After administration of sildenafil there was a transient hypotension which was corrected by a single bolus of saline. Conclusion:We discuss the current treatment modalities of persistent pulmonary hypertension of the newborn and the potential use of phosphodiesterase 5 inhibitors such as sildenafil in a situation where the standard of practice with inhaled nitric oxide and extracorporeal membrane oxygenation is not available.展开更多
Purpose: We aimed to assess the effects of sildenafil and evaluate optimal dosing in primary pulmonary hypertension(PPH). Sildenafil selectively inhibits phosphodiesterase 5(PDE5), which is abundant in pulmonary and p...Purpose: We aimed to assess the effects of sildenafil and evaluate optimal dosing in primary pulmonary hypertension(PPH). Sildenafil selectively inhibits phosphodiesterase 5(PDE5), which is abundant in pulmonary and penile tissue. This results in increasing nitric oxide(NO) at tissue level leading to pulmonary vasodilatation. Subjects and methods: Our study was a prospective study of sildenafil in 15 consecutive patients with severe symptomatic PPH of NYHA class III-IV. All patients were stabilized for a minimum period of 5 days with antifailure medications. Sildenafil was started at 50 mg twice daily for 4 weeks and increased to 100 mg bid for 4 more weeks in a step-up protocol. Primary end-points were change in Borg dyspnea index, NYHA class and 6-min walk distance, estimated at baseline 1, 2, 4 and 8 weeks. Results: NYHA class(baseline 3.8±0.4 vs. 4 weeks 2.4±0.5, p=0.002),Borg dyspnea index(8.1±1.7 vs. 4.4±1.9, p=0.0007), 6-min walk distance(234±44 vs. 377±128 m, p=0.001) and Pulmonary artery pressure(125±15 vs. 113±18 mm Hg p=0.05) are significantly improved with sildenafil 50 mg bid at 4 weeks. Increasing the dose to 100 mg bid did not produce further benefit. Echocardiography parameters of right heart dimensions and functions did not change markedly in the study period. Conclusion: Sildenafil is well tolerated with no adverse effects in severe pulmonary hypertension. It reduces symptoms, improves effort tolerance and controls refractory heart failure significantly by 2 weeks in 70%of patients at 50 mg twice daily.展开更多
文摘Objective: To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD). Design: Double-blind, crossover, placebo-contro-lled study. Setting: Gynecological diabetic outpatient clinic and sexual clinic. Patient(s): Thirty-six type 1 premenopausal diabetic women affected by SAD. Intervention(s): Two 8-week periods of sildenafil 100 mg, washout, and placebo, by two possible sequences. Main Outcomes Measure(s): Each woman submitted blood samples to measure HbA 1c, and T, free T (FT), and PRL. Efficacy was assessed [1] subjectively by the Personal Experiences Questionnaire based on the 5- point Likert scale, quantifying arousal, desire, orgasm, enjoyment of sexual activities, and frequency of sexual relationships; and [2] objectively by translabial color Doppler ultrasound to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity of clitoral arteries. Result(s): Thirty-two women completed the study. The mean HbA 1c value was 8.0% ± 1.8% , and plasma concentrations of T, FT, and PRL were normal. Sildenafil seems to improve arousal, orgasm and sexual enjoyment, and dyspareunia in women affected by type 1 diabetes. However, by flowmetric measurements, the mean RI was significantly lower and both the mean PI and PSV of the clitoral arteries were significantly higher compared with baseline and placebo. Conclusion(s): Sildenafil seems to improve subjective sexual aspects and can be used to treat objectively genital arousal disorder of premenopausal women with type 1 diabetes.
文摘We present the case of a full term neonate with severe persistent pulmonary hypertension of the newborn (PPHN) after birth asphyxia cared for at the St. Elizabeth Hospital in Curacao, Netherlands Antilles. Although the child was ventilated with high pressures and was given high doses of cardiovascular pressors, the arterial oxygen levels remained low with an alveolar-arterial O2 gradient of 651mmHg. As a last resort, sildenafil (1.5 mg/kg)was given via a nasogastric tube. This resulted in an immediate and sustained elevation of arterial oxygenation and subsequent complete recovery. After administration of sildenafil there was a transient hypotension which was corrected by a single bolus of saline. Conclusion:We discuss the current treatment modalities of persistent pulmonary hypertension of the newborn and the potential use of phosphodiesterase 5 inhibitors such as sildenafil in a situation where the standard of practice with inhaled nitric oxide and extracorporeal membrane oxygenation is not available.
文摘Purpose: We aimed to assess the effects of sildenafil and evaluate optimal dosing in primary pulmonary hypertension(PPH). Sildenafil selectively inhibits phosphodiesterase 5(PDE5), which is abundant in pulmonary and penile tissue. This results in increasing nitric oxide(NO) at tissue level leading to pulmonary vasodilatation. Subjects and methods: Our study was a prospective study of sildenafil in 15 consecutive patients with severe symptomatic PPH of NYHA class III-IV. All patients were stabilized for a minimum period of 5 days with antifailure medications. Sildenafil was started at 50 mg twice daily for 4 weeks and increased to 100 mg bid for 4 more weeks in a step-up protocol. Primary end-points were change in Borg dyspnea index, NYHA class and 6-min walk distance, estimated at baseline 1, 2, 4 and 8 weeks. Results: NYHA class(baseline 3.8±0.4 vs. 4 weeks 2.4±0.5, p=0.002),Borg dyspnea index(8.1±1.7 vs. 4.4±1.9, p=0.0007), 6-min walk distance(234±44 vs. 377±128 m, p=0.001) and Pulmonary artery pressure(125±15 vs. 113±18 mm Hg p=0.05) are significantly improved with sildenafil 50 mg bid at 4 weeks. Increasing the dose to 100 mg bid did not produce further benefit. Echocardiography parameters of right heart dimensions and functions did not change markedly in the study period. Conclusion: Sildenafil is well tolerated with no adverse effects in severe pulmonary hypertension. It reduces symptoms, improves effort tolerance and controls refractory heart failure significantly by 2 weeks in 70%of patients at 50 mg twice daily.
