Effective Treatment for Erectile Dysfunction

Man Tea Rock-Hard Formula

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Surgical Interventions for Men with ED

There are three forms of penile prostheses available semi-rigid, malleable, and inflatable. Typical candidates for a penile implant are patients with chronic disease states such as long-term diabetes and end-organ failure or severe arterio-genic impotence combined with severe veno-occlusive dysfunction and men with treatment unresponsive Peyronie's disease in combination with ED. Typical

Ginseng And Morphine And Related Opioids

The relationship between morphine and associated opioids and ginseng has proved both remarkable and unexpected. Opioids are widely used as legitimate, effective analgesics, especially in terminal afflictions such as cancers although continued use of morphine-type drugs is rapidly accompanied by the development of tolerance, the craving for ever-increasing doses, and by psychic and physical dependence. Seeking effective antagonists of the narcotic and addictive effects of opium and morphine, H.S.Kim and his colleagues in a long series of studies from 1985 onwards have demonstrated the effectiveness of ginseng versus morphine tolerance. The protopanaxadiol-type ginsenosides Rb1 and Rb2 and the protopanaxatriol-type ginsenosides Re and Rg1 inhibited the development of morphine-induced tolerance in mice and ginsenosides Rb1 and Rg1 also had an inhibitory effect on naloxone-induced withdrawal jumping response. In addition the ginsenosides inhibited body weight loss in physically dependent...

Ginseng And Atherosclerosis

Ginseng was suggested as a medicament for the control of cholesterol levels and for the treatment of anaemia. Experimental evidence does shew that ginseng is capable of increasing the red blood cell count, of promoting serum protein synthesis and of stimulating RNA formation in the liver and DNA synthesis in bone marrow. Cholesterol, a steroid alcohol, occurs naturally in the body and is found particularly in the bile and gall bladder and in the lipoproteins of the blood plasma. Although endogenous cholesterol can be formed in all cells of the body, blood cholesterol is usually produced in the liver, the body organ that controls the normal cholesterol level in the blood. High levels of cholesterol can occur in insulin and thyroid hormone deficient subjects or in persons consuming a high fat, high cholesterol containing diet. Dietary cholesterol, also called exogenous cholesterol, derives from foods such as milk, cream, butter, cheese, eggs, beef dripping, offal and other meats....

Model Of Sexual Response Showing Various Incentives And Motivations To Be Sexual And Arousal Triggering And

For one or more of the earlier mentioned reasons, a woman choosing to be receptive to sexual stimuli (or to provide them) can subsequently become sexually aroused. The degree of emotional intimacy with her partner that may have even been the major motivating force, is also a very important influence on her arousability to the sexual stimuli. Various other psychological and biological factors will influence this arousability such that the processing of the sexual information in her mind may or may not lead to subjective arousal (27-31). On those occasions she becomes subjectively aroused, providing the arousal remains enjoyable, and the stimulation continues sufficiently long, and she remains focused, then the arousal can become more intense and an urge or sexual desire for more of the sexual sensations and emotions is triggered. This accessed or triggered sexual desire and the subjective arousal continue together, each reinforcing the other (32,33). A positive outcome, emotionally and...

Other Unlicensed Treatment Therapies for Men with ED

Several new formulations are being developed, such as topical alprostadil and intranasal apomorphine. New agents are being developed, including selective PDE3 4 5 inhibitors MS-223131 (Bristol-Myers Squibb), T-1032 (Tanabe Seiyaku), TA-1790 (Vivus), sildenafil nitrate (NCX-911) (NicOx) nonselective inhibitors of postsynaptic alpha-adrenoceptors within the corpus cavernosum phentolamine (Vasomax Schering Plough), melanocortin receptor agonists such as melatonan II (Palatin) (s.c. and intranasal) increases erections and sexual drive appetite (phase 2A) and the 5HT1 agonist VML670 (Lily Vernalis).

Ginseng As A Biological Response Modifier

Understanding the actions of ginseng has, until now, always been complicated by the mixed nature of the chemical compositions of the ginseng products used. Therefore it has not yet been possible to clearly define the biological response modifier. Ginseng preparations have been shewn to improve liver function as well as immune function and it is therefore probable that the protective action is related to an immunomodulatory effect. Pretreatment with ginseng extracts was found to prolong the survival times of test animals suffering experimental trypanosomiasis, to prevent the development of fevers induced by typhoid and paratyphoid vaccines in rabbits, and to retard the development of diseased (leukopenic) white blood cells in bacillary dysentery. Ginseng treatment stimulated the production of specific antibodies in guinea pigs immunised with influenza vaccine and in rats immunised with diphtheria toxoid and was more effective at lower doses. In mice, ginseng extracts offered protection...

The Sexual Response Cycle

There are four phases in the sexual response cycle I. excitation, II. plateau, III. orgasm, and IV. resolution (Masters, Johnson, & Kolodny, 1994). In men, phase I (excitation) is characterized by erection of the penis. Phase I takes place more slowly in women and is characterized by the production of lubricating fluid in the vagina, an increase in the diameter of the clitoris, and increased congestion of the labia with blood. For both sexes, phase II (plateau) is marked by a rise in the blood congestion of the pelvis and a strong feeling of sexual tension. A sex flush colors the forehead, neck, and chest, sometimes extending to the abdominal area. Phase III (orgasm) occurs in two stages in men a preejaculatory contraction of the muscles involved in ejaculation, and actual ejaculation. The same muscles are involved in the orgasms of women as those of men. During phase IV (resolution), which is usually completed more quickly in men than in women, the congestion of the blood vessels...

Ginseng And The Cardiovascular System

Ginseng has, as an adaptogen, been credited with the ability to normalise both high and low blood pressure conditions. Therefore it would appear to be potentially useful in the treatment of hypertension, a condition of high blood Lee et al. (1981) examined the effects of ethereal, ethanolic and aqueous P. ginseng extracts on cardiovascular function in dogs after intravenous injection (40 mg kg). The ether extract caused significant decrease of heart rate and central venous pressure, the ethanol extract significant decrease of heart rate and mean arterial pressure and the aqueous extract significant decrease of cardiac output, stroke volume and central venous pressure but the total peripheral resistance was markedly increased. Using intravenous injections of total ginsenosides in dogs, Chen et al. (1982) confirmed that the peak value of left ventricular pressure and the arterial systolic pressure were rapidly decreased. Heart rate and renal arterial blood flow decreased although renal...

Ginseng And Aphrodisiac Activity

The effect of ginseng on sexual activity has intrigued the general public and many research workers. Bao et al. (1984b) observed that there was no disturbance of the ovarian cycle in stressed female mice if ginseng was administered. Bao et al. (1984c) also reported that ginseng extracts given to male mice prevented stress-induced decrease of sexual activity. Similarly Lian and Zhang (1998) also noted that repeated daily hanging stress reduced sexual activity in male mice as assessed by licking, mounting and mating activity. The plasma testosterone level was reduced but treatment with ginsenoside Rb1 (2.5, 5 or 10 mg kg, i p) before each stress event countered the repeated stress-induced sexual deficiency and raised the plasma testosterone level. It was concluded that ginsenoside Rb1 was capable of maintaining the normal plasma testosterone level. The reported occurrence of oestrone, oestradiol and oestriol in liposoluble fractions of ginseng extracts, based on TLC results, was not...

Ginseng And Tumour Growth

The cancerous condition develops frequently in patients manifesting reduced resistance as in old age and such cancers can be combatted by strengthening the general body resistance whilst simultaneously treating the cancer with suitable drug therapy or appropriate radiation treatment. Therefore adaptogens such as ginseng or eleutherococcus should function well by stress resistance and antitoxic effect. Ginseng enhances the formation of antibodies and immune functions in cancer patients and in microbe-infected experimental laboratory animals, possibly by elevation of the cAMP (cyclic adenosine monophosphate) levels. Both antitumoral activity and stimulation of the immune function of cancer patients when ginseng was administered have been observed in experimental animals and in human subjects. The reduced susceptibility of the host to bacterial, viral or tumour attack or infection has been referred to as non-specific immunostimulation, para-immunity or biological response modification...

Ginseng And The Ageing Process

As people's lives become longer, particularly in the more civilised societies which have adequate medical and preventative services, ageing presents many problems. As we age we become less physically fit, we show obvious changes such as whitening or loss of hair, wrinkled skin which recovers more slowly from the pinch test, weakened hearing and vision, general slowing down of physical activities and we become more liable to suffer from various illnesses. Less obvious is the deterioration of the body organs prompting glandular disorders, reduction of hormone output leading to sexual impotency, gradual mental deterioration and breakdown of the immune system. Any life style, drug or medicine that can delay or slow this inevitable decline and improve the quality of life is therefore important. The ancient Chinese were convinced that ginseng was the tonic that fulfilled this role. After all, it is an adaptogen coping with stress, it is a metabolism regulator for proteins, carbohydrates and...

Ginseng In Cosmetic Preparations

Ginseng saponins are structurally near chemical relatives of the antiinflammatory compounds such as steroids and glycyrrhetinic acid from liquorice (Glycyrrhiza glabra L.). It is thus not surprising that antiinflammatory properties have been reported for ginseng extracts and ginseng has been suggested as an ingredient of cosmetic creams with non-allergenic, cutaneous bioactivity for the treatment of wrinkles and eczema. The many recent patent applications involving cosmetic creams, anti-wrinkle creams, acne applications and hair growth preparations with supporting claims of efficacy suggest probable effectiveness (cf Chapter 9). Curri et al. (1986) had reported that ginseng extract applied topically as a phospholipid liposomal formulation produced a favourable effect on skin ageing, moisturisation of the stratum corneum and improved skin elasticity. Saponins of ginseng, the ginsenosides Rb1, Rb2, Rc, Re and Rg 1, as well as 70 per cent methanolic extract of P. ginseng, increased the...

Activation And Regulation Of Sexual Response Processing of Sexual Information

Basis of a series of priming experiments Janssen et al. (76) presented an information processing model of sexual response. Two information processing pathways are distinguished (cf. 77). The first pathway is about appraisal of sexual stimuli and response generation. This pathway is thought to depend largely on automatic or unconscious processes. The second pathway concerns attention and regulation. In this model, sexual arousal is assumed to begin with the activation of sexual meanings that are stored in explicit memory. Sexual stimuli may elicit different memory traces depending upon the subject's prior experience. This in turn activates physiological responses. It directs attention to the stimulus and ensures that attention remains focused on the sexual meaning of the stimulus. This harmonic cooperation between the automatic pathway and attentional processes eventually results in genital responses and sexual feelings. Disagreement between sexual response components would occur,...

Panax ginseng CAMeyer

Seeking saponins in Panax ginseng plants, the Russian research group headed by Professor Elyakov isolated from methanolic extracts of ginseng roots a series of sugar-linked compounds which they named panaxosides panaxosides A and B were reported by Elyakov et al. in 1962 and C, D, E and F by Elyakov et al. in 1964. The Russian chemists noted that on hydrolysis the saponin glycosides panaxosides A, B, and C were based on the aglycone panaxatriol and that the panaxosides D, E and F formed a separate group based on the aglycone panaxadiol. In addition Elyakov's group were able to demonstrate that the sidechains of monosaccharide molecules were different. Thus panaxoside A possessed 3 glucose units, panaxoside B 2 glucose and 1 rhamnose units, panaxoside C 3 glucose and 1 rhamnose units, panaxoside D 4 glucose units, panaxoside E 4 glucose and 1 arabinose units, and panaxoside F 6 glucose units. At the same time, in Japan, a research group headed by Professor Shibata had isolated and...

Ginseng Memory And Intellectual Skills

Improved mental activity and therefore ginseng pretreatment was suggested for tasks requiring speed, accuracy and stamina. Ginseng administered orally was successfully used to counter the decline in learning ability that is normally produced under physiological stress (Bao et al., 1984a,c). In a 12-week doubleblind, placebo-controlled trial involving 16 fit male volunteers (aged 20-24 years) and an oral dosage of 100mg of Ginseng G115 twice a day, D'Angelo et al. (1986) noted statistically significant improvements in attention, information-processing, reaction times and well-being and, in particular, in mental arithmetic. More recent studies by Petkov and Mosharrof (1987) have offered a more detailed explanation of this improvement of learning, memory and physical capability induced by administration of standardised Ginseng G115 extract. Learning and relearning can be considered in terms of memory. Ginseng was considered particularly useful if the breakdown of mental activity was due...

Cryopreservation of Ginseng Explants

With regard to the production of specific compounds, however, cell cultures often show a remarkable instability. The cryopreservation of plant cells is still a routine laboratory method but it is necessary to optimize the individual steps of the cryopreservation procedure. Butenko et al. (1984) who cryopreserved ginseng cells for the first time, used a pretreatment which combines low temperatures (+4 C) with a high sucrose concentration (20 per cent). The use of sucrose as a preculture additive and a cryoprotectant seems to be advantageous as it is not toxic for the cells even at very high concentration. Seitz and Reinhard (1987) developed a cryopreservation procedure for P. ginseng cell cultures which makes long term storage of selected strains possible. Sorbitol was used as a short term preculture additive with or without supplementary DMSO as a cryoprotectant. Cell strains of similar appearance but different ginsenoside productivity do not differ in their response to the...

Genetic Transformation of Ginseng

The first report of the induction of hairy roots in P. ginseng and the establishment of the culture followed by the infection with A. rhizogenes was demonstrated by Yoshikawa and Furuya (1987). The ginseng hairy root cultures grew more rapidly and produced saponins more effectively than the ordinary cultured roots obtained by hormonal control. Production of ginseng saponins, such as ginsenosides Rb and Rg in the hairy roots and ordinary cultured roots, as determined by TLC, was comparable. The total saponin contents per dry mass were 0.35-0.95 per cent for the transformed hairy roots and 0.38-0.91 per cent for the ordinary cultured roots. The highest contents were obtained when both hairy and ordinary roots were grown on a medium supplemented with growth regulators such as IBA and kinetin. Inomata et al. (1995) achieved the highest growth rate of ginseng hairy roots in batch culture under the effect of BA which also increased the ginsenoside production. Ginsenoside production by hairy...

Erectile dysfunction

Erectile dysfunction (ED) may be defined as the consistent inability to achieve or maintain an erection sufficient to permit satisfactory sexual intercourse. The word consistent is included in the definition because most men experience transient episodes of ED that are temporary and usually associated with fatigue, anger, depression or other stressful emotions. The use of the formerly used term impotence has been virtually abandoned because of its inherent stigma of weakness and lack of power. Erectile dysfunction can occur as part of several r First, it may be useful to understand the mechanisms of normal penile erection. Penile erection occurs essentially when the penis becomes engorged with blood. The anatomical compartments (two corpora cavernosa and one corpus spongiosum) are capable of being distended with seven times their normal amount of blood. When this occurs in association with relaxation of the penile muscles, erection results. The sequence of events resulting in penile...

Ginseng And Antiulcer Activity

It has long been known that gastric ulcers are frequently a reaction to stress. As early as 1827 the American Indian doctor John Williams in the book The American Indian Doctor Dr. John Williams' Last Legacy, A Useful Family Herbal praised ginseng roots as an excellent medicine to alleviate inward hurts and ulcers when used in combination with other herbal drugs such as comfrey, spikenard, elecampane, camomile, angelica and fir boughs in a dilute alcoholic vehicle (Harriman, 1973). Tang and Craze in their book Chinese Herbal Medicine (1995) also refer to the use of ginseng to treat peptic ulcer due to stagnating stomach qi (or ch'i), weakness of spleen or excess heat and advise avoidance of alcohol, coffee and tea. Cheng et al. (1985) noted that ginseng pectin polysaccharide and dextrin could reduce the amount of gastric acid and the activity of the enzyme pepsin. Ginseng pectin inhibited histamine-induced secretion of gastric acid and was effective versus indomethacin-induced and...

Ginseng And The Central Nervous System

There are many contradictory accounts of the effects of ginseng, its extracts and its individual isolated ginsenosides on the central nervous system (CNS). Early work recorded that the stimulant effect of ginseng diminished the depressant action of hypnotic drugs such as chloral hydrate and barbiturates. Unlike amphetamine and related anorexies, ginseng can in small doses produce the CNS stimulant effect with no interference with normal sleep. Larger doses decreased motor activity yielding a general sedative effect. Such puzzling results stimulated Professor Takaji's Japanese group to carefully study the actions of the individual glycosides as well as ginseng extracts and saponin fractions. One fraction, containing the diol glycosides ginsenosides Rb1 and Rc, yielded sedative, tranquillising, analgesic and muscle-relaxing properties a second fraction, containing the triol glycosides ginsenosides Rg1, Rg2 and Rg3, shewed both stimulant and depressant activities in addition to...

Absorption Distribution Excretion And Metabolism Of Ginseng Saponins

Administering radioactively labelled ginseng saponins to rats orally, Joo et al. (1982) observed that total recovery of the radioactivity was only about 30 per cent and they concluded that the saponins had bound with macromolecular and membrane structures in forms which were not readily extractable. The saponins were widely distributed in the body tissues and especially in liver, kidney, blood serum, stomach and gastrointestinal tract. Early study of the pharmacokinetics of ginseng saponins revealed that little of the important protopanaxadiol-derived compound ginsenoside Rb1 is absorbed from the upper digestive tract after oral administration (100 mg kg) in rats. Intravenous injection (5 mg kg) in rats resulted in the serum level declining slowly and biexponentially with a half-life in the -phase of about 14j hours. Ginsenoside Rb1 persists for a long time in the serum and tissues, persistence being due to the Hasegawa et al., 1996) administered P. ginseng extract orally to human...

Ginseng And The Quality Of Life

Ginseng has been used as an agent to counter the subtle changes in health (fatigue, lack of energy, anxiety, restlessness, depression, etc.) and improve the quality of life of humans and several authors, using controlled clinical trials, have demonstrated the efficacy of standardised extracts of ginseng in combination with minerals (Tesch et al., 1987 Dorling and Kirchdorfer, 1989 Pieralisi et al., 1991). Such combination therapy has produced improved alertness, better physical activity and a feeling of well-being in both middle-aged persons and The Swedish group of Wiklund et al. (1994) devised two self-administered questionnaires, the Psychological General Well-Being Index and the Sleep Dysfunction Scale, to assess the quality of life in 205 participants taking Gericomplex capsules ( Geriatric Pharmaton, Pharmaton S.A.), capsules containing 40 mg standardised Ginseng Extract G115 and added vitamins, minerals and trace elements, and 185 persons taking identical-looking placebo...

Pharmacotherapy for Men with ED

Few licensed drugs are currently available for the treatment of men with ED. Those that are available elicit their effect by one of two mechanisms. The agent boosts either the neuronal control mechanism or the local control mechanism (13). As we shall see, oral therapies can have their effect on either system, whereas the intracavernosal and intraurethral systems act locally to produce an erection. Oral agents used to treat ED should be reliable, have minimal side effects, and be simple to use (22). The oral therapies currently licensed for ED are the phosphodiesterase 5 inhibitors (PDE5 inhibitors), which have a peripheral mechanism of action, and apomorphine, which acts centrally. These agents require sexual stimulation to initiate the neuronal activation required to start the hemodynamic erectile response. This is in contrast to the PGE mediated response initiated by intracavernosal and intraurethral alprostadil administration that forces an erection (see later). Yohimbine is...

Medical Treatments for Erectile Dysfunction

Initially, there were few oral treatments for ED, being used by urologists, such as yohimbine based products, trazodone, and bupropion. They had only modest proerectile capability (11). Pharmaceutical companies were inspired to pursue oral treatments with the promise of less intrusiveness and even greater profits. The first visible evidence of fulfilling that promise was the sildenafil launch. Subsequent to Pfizer's success, multiple companies simultaneously pursued clinical trials of easy-to-use treatments for male SD. Among others, these included additional PDE-5 type compounds and other oral treatments, such as ixense (TAP Holdings, Deerfield, IL, USA), and topically applied compounds (MacroChem, Lexington, MA, USA). Additionally, PT-141 (Palatin Technology, Cranbury, NJ, USA) is a nasally administered peptide that is under development, which is presumed to work through a central nervous system mechanism. Currently, there are three highly efficacious PDE-5, FDA-approved treatments...

Psychological Therapies for Men with ED

In the majority of cases of ED, psychological factors are involved in either the development of the disorder or the maintenance of the problem. While recognising that many men would not seek a psychological approach to resolving the condition, an outline of performance anxiety about continued erectile failure and the effect this has on their partner and their relationship, is often appreciated by the man. Difficulties with communication and the development of suspicion and mistrust between partners may need discussion, recognition, and specific intervention. In each of these three situations, an integrative approach by the assessing clinician to ensure adequate assessment of both psychological and physical contributing factors may lead to more efficacious outcomes while recognising that the interventions themselves may be multiple, rather than relying on one treatment and progressing in a linear fashion to alternatives because of failure of first line therapy. Helping the man to start...

Sexual Functioning

Of all the psychosocial domains affected by testicu-lar cancer and its treatment, sexual function, for understandable reasons, has been among the most frequently studied. Although findings generally indicate that sexual functioning is altered among survivors, careful consideration of this outcome is warranted. The reasons for altered sexual functioning among survivors are varied. Factors such as the physical sequelae of testicular cancer itself, treatment-related side effects, or psychological distress following treatment can affect sexual functioning.38 For example, retroperitoneal lymph node dissection (RPLND), a surgical procedure commonly used in the treatment of testicular cancer, involves the resection of retroperitoneal sympathetic nerves involved in semen emission.38 A common side effect of RPLND is dry ejaculation, which can negatively impact sexual functioning and satisfaction. Nondis-ease-related variables, such as age, physical or psychological comorbidity, and marital...

Impotence

Penile erection is a vascular event, and it is important to recognize that local vasodilatation in the penis is under dual control by autonomic nerves and the endothelium (262). In the periphery major causes of impotence are vascular disease and diabetic autonomic neuropathy. Both neurogenic and endothelium-dependent relaxation of erectile smooth muscle can be impaired in diabetic men with impotence and in experimental diabetes (263,264). Within the corpus cavernosum, reduced levels of NA and decreased innervation by VIP-containing and AChE-positive nerve fibers have been reported in diabetic patients with impotence (265). NO has been proposed as an important neurotransmitter in erection. The production of NO by the corpus cavernosum following nerve stimulation is reduced in patients with vasculogenic impotence (266). In patients with neurogenic impotence a significant reduction in NOS-containing nerve fibers in the corpus cavernosum has been observed (267). Sildenafil, the latest...

Ginseng And Diabetes

The value of ginseng preparations in the treatment of diabetes mellitus is debatable. Diabetes, diabetes mellitus or sugar diabetes, is a common condition occurring worldwide and amongst all classes of people but more frequently amongst the poor and the aged in modern industrialised communities. In such societies it is rated as the third most common cause of death after cancers and cardiovascular conditions. The disease is characterised by impaired carbohydrate metabolism caused by inadequate production in the pancreatic islets of Langerhans of the hormone insulin, a small protein molecule (molecular weight 5808) comprising two amino acid chains connected to each other by disulphide linkages. In the absence of insulin in the blood stream the blood sugar level rises abnormally (hyperglycaemia) and sugar passes readily into the urine with The causes of diabetes are multifactorial depending on hereditary traits, age, pregnancy, obesity, stress, drug-related factors (corticosteroids and...

Ginseng Siberian

Historical note Siberian ginseng has been used for over 2000 years, according to Chinese medical records, where it is referred to as Ci Wu Jia. It was used to prevent colds and flu and to increase vitality and energy. In modern times, it has been used by Russian cosmonauts for improving alertness and energy, and to aid in adaptation to the stresses of life in space. It has also been used as an ergogenic aid by Soviet athletes before international competitions and was used after the Chernobyl accident to counteract the effects of radiation.

Ginseng And Alcohol

Alcohol is foreign to the human system and is normally destroyed in the liver by oxidation yielding acetaldehyde which is in turn destroyed by aldehyde dehydrogenase. Ginseng saponins significantly increased the rate of oxidation of ethanol in alcohol-fed rats (Joo et al., 1982). The liver decontaminates the body, converting chemical waste products to both useful and harmlessly useless products. In response to stress hormones the liver accelerates the conversion of waste and the generation of new protein enzymes and ginseng is known to facilitate such functioning of the liver (Fulder, 1980). Studying the effects of red ginseng extract and vitamins on alcohol-intoxicated mice, Saito et al. (1984b) stated that tocopherol inhibited alcoholic excitation and red ginseng extract and pantethine prevented memory failure in intoxicated mice. Using healthy human volunteers, Lee et al. (1987) demonstrated that in 10 out of 14 cases ginseng extract (3g 65 g body weight) accelerated blood-alcohol...

Ginseng And Sleep

Many ginseng users claim improved sleep patterns as an advantage gained by regular ingestion of the roots. That Panax ginseng extract given orally in drinking water modulated sleep in unrestrained rats was demonstrated by Rhee et al. (1990) who observed that the amount of wakefulness was significantly decreased during a 12 hr period of light whilst the amount of slow wave sleep was increased. Sleep was apparently unaffected during the dark period. The same group (Lee et al., 1990a) observed that the amount of slow wave sleep and wakefulness fluctuated significantly during 48 hours food deprivation and also during the following recovery periods. However, employing age-matched male rats chronically treated with ginseng extract via drinking water, the fluctuation was markedly reduced. Therefore it was suggested that the beneficial effect of ginseng might be related, in part, to improvement of sleep caused by a stabilising effect on sleep-waking disturbances. Investigating a ginseng...

B Ginseng

Ginseng is an herbal preparation derived from the aromatic root of a plant of the genus Panax, which is native to East Asia. Ginseng belongs to the Araliaceae family of plants. Siberian ginseng belongs to a different genus, Eleutherococcus senticosus. The English name of the plant is a modification of its Chinese name, ren shen, which means man and herb. The Chinese name comes from the ginseng root's resemblance to the shape of the human body, whence the plant's traditional use as a tonic for male sexual vigor and potency. The Latin name for the species, Panax, is derived from the Greek word panacea, which means cure-all, or, all-healer. There are three species of ginseng in common use in the United States American ginseng, Korean ginseng, and Siberian ginseng. All are regarded as adaptogens that normalize immune functions and are preparations that help the body adapt to change, thus lowering the risk of stress-related illness. American ginseng, whose botanical name is Panax...

Ginseng Korean

Historical note Gin refers to man and seng to essence in Chinese, whereas Panax is derived from the Greek word pan (all) and akos (cure), referring to its use as a cure-all. Ginseng is a perennial herb native to Korea and China and has been used as a herbal remedy in eastern Asia for thousands of years. It is considered to be the most potent Qi or energy tonic in TCM. Modern indications include low vitality, poor immunity, cancer, cardiovascular disease and enhancement of physical performance and sexual function. However, a recent systematic review of RCT found that the efficacy of ginseng root extract could not be established beyond doubt for any of these indications (Coon & Ernst 2002).

Former Reader in Pharmacognosy University of Bradford UK

The traditional interest in plants as sources of natural medicines prompted the grouping of closely related species under common names. Thus the name ginseng is loosely applied to a range of plants from the Araliaceous genus Panax although some other non-related ginseng species are also encountered in commerce e.g. Eleutherococcus senticosus Maxim, family Araliaceae (Siberian ginseng), Pfaffia paniculata Martius, family Amaranthaceae (Brazilian ginseng) and Rumex hymenosepalus Torrey, family Polygonaceae (Wild red desert ginseng or American wild red ginseng). The botanical characteristics including the microscopical details of the principal ginsengs were reviewed by Thompson in 1987. Subsequently more information has emerged concerning minor Asiatic species that are employed in folk medicines in tribal areas. Nevertheless there are problems in the nomenclature of the Panax species. The species names are liable, in the words of colleagues at the Royal Botanic Gardens, Kew, to a very...

Production of Secondary Metabolites by in vitro Culture

The first report on the production of ginsenosides in ginseng callus was published in 1970 by Japanese authors (Furuya et al., 1970). They detected by TLC and column silica gel chromatography analysis a large amount of ginsenoside Rg and a small amount of ginsenoside Rb in ginseng callus derived from petiole of cultivated ginseng grown on MS medium without glycine and supplemented with 1 mg l 2,4-D. Later Furuya et al. (1973) found that the kind and amount of saponins in the callus of the same origin are about the same as in the ginseng root. By means of TLC and column chromatography analysis they isolated the ginsenosides Rb1 and Rg1, panaxadiol, panaxatriol and oleanolic acid. Simultaneously they obtained a mixture of phytosterols consisting of a large amount of -sitosterol and a small amount of campesterol and stigmasterol. The presence of ginsenosides Rb1 and Rg1 was confirmed by NMR. The effect of auxins on saponin production in ginseng callus was studied by Furuya et al. (1983a)...

The Mechanism Of Stress Reaction

As one of the main uses of ginseng is as an antistress agent, it is necessary to consider the mechanism of stress reaction. In the living body such reaction is controlled by The hypothalamus receives signals from higher centres of the brain indicating a stress situation such stimulation causes release of chemical messengers called peptide neurohormones into the blood stream prompting the activation of the pituitary gland with the release of signals to the adrenal glands via the adrenocorticotrophin hormone (ACTH). Responding to ACTH stimulation the adrenal cortex, the outer area of the adrenal gland, secretes corticosteroids (glucocorticoids e.g. hydrocortisone or cortisol) which rapidly mobilise the body's carbohydrate, protein and fat reserves. In man hydrocortisone forms 95 per cent of the total glucosteroids formed in the adrenal cortex. Production and distribution of glucosteroid stress hormones is increased under stress although limited in the body at rest even when ginseng is...

Stress And Adaptogenic Activity

Probably the most important use of ginseng and its saponins is as anti-stress agents. Stress, a normal feature of life, can readily be reproduced experimentally and is apparent in all impaired and injured animals. Stress manifests in many forms e.g. reaction to external conditions such as the fight or flight phenomenon, heat, cold, noise, starvation, physical restraint, etc., reaction to psychiatric states e.g. fear, anxiety, emotional strains, psychosomatic diseases, etc., and reaction to disease, bacterial and viral infection, physical injury, wounds, surgical operations, chemical agents, pollutants, etc. In particular, the pace of modern society places individuals in abnormal situations where stress is often The eminent Russian pharmacologists I.I.Brekhman and I.V.Dardymov, working in the Biologically Active Substances Division of the Siberian Branch of the USSR Academy of Sciences in Vladivostok in the 1950's and 1960's, carefully studied the ability of ginseng (Panax ginseng),...

Somatic embryogenesis and plant regeneration

The suggestion of somatic embryogenesis in ginseng tissue cultures was first made by Butenko and her colleagues (1968) but at that time all attempts to achieve the regeneration of whole ginseng plants from isolated embryo-like structures failed. Pursuing their work on the culture of ginseng root tissues Chang and Hsing (1978) obtained embryoids from root derived callus in defined conditions. Regeneration systems via somatic embryogenesis were established in root callus (Chang and Hsing, 1980), in zygotic embryo callus (Lee et al., 1990) and in protoplast derived callus (Arya et al., 1991). High-yield and short period embryogenesis via callus induced by the culture of young flower buds on the MS medium supplemented with 2,4 D in the dark was developed in 1988 by Shoyama et al. Later, Arya et al. (1993) reported a rapid somatic embryo formation, obtained due to secondary and tertiary embryogenesis. Embryogenic callus was initiated from immature zygotic embryos of ginseng and the somatic...

Physical Stress Reaction

In earlier times and particularly in indigenous Chinese medicine ginseng root was employed as a remedy for premature weakness or exhaustion induced by physical or mental stress. In our own time improved physical and mental activity has frequently been reported and confirmed as the most important effect of ginseng (Sonnenborn, 1987). The period of active work is extended and the onset of fatigue correspondingly delayed. Fatigue and weariness occurs after prolonged activity, manifesting itself as irritability, failing concentration, reduced ability to rationalise and consequently inefficient working. Certainly repeated laboratory experiments had confirmed improved running ability, increased climbing performance and prolonged swimming endurance of test animals (Hou, 1978 Fulder, 1993). Positive gravity effects induced by radial acceleration generate considerable stress reaction. Kim and Koh (1964a), using 840 mice, found that a 2 mg kg body weight day injection of an ethanol extract of...

Heptadeca1 en46diyn39diol R H 513 Panaxytriol R OH

Studying extraction techniques for polyacetylene compounds in white ginseng root and using various solvents, Nho and his colleagues (1990) concluded that refluxing with methanol was the most efficient of the seven solvent systems investigated although Soxhlet extraction was almost equally effective. The solvents in order of decreasing efficiency were methanol, methylene dichloride, acetone, diethyl ether, ethyl acetate, methyl cyanide and petroleum ether. Panaxynol and panaxydol were the principal polyacetylenes present, the yield being 4.2 mg g and 6.4 mg g respectively. Continued interest in these compounds led to the isolation from the hexane extract of P. ginseng roots of a series of new polyacetylenes which were designated ginsenoynes A-E and acetylated ginsenoynes F-K (Hirakura et al., 1991, 1992)(see Appendix to Chapter 5). Later Hirakura et al. (1994) described the isolation and characterisation of the linoleoylated polyacetylenes panaxynol linoleate, panaxydol linoleate and...

Early Use As A General Tonic

The earliest Chinese texts praised the virtues of ginseng stating that if it was taken constantly it was a tonic to the five viscera (liver, lungs, heart, spleen and kidneys), quieting the spirits, establishing the soul, allaying fear, expelling evil effluvia, opening up the heart and brightening the eyes, benefiting the understanding and invigorating the body and prolonging life (Hou, 1978). Several more recent workers have shewn that ginseng extracts from stems or leaves given orally or intraperitoneally to young rodents produce body weight increase, increase in protein and ribonucleic acid (RNA) in muscle and liver cells, and no increase of weight in the prostate glands or seminal vesicles (Wang et al., 1982). Increased synthesis of protein, deoxyribonucleic acid (DNA) and RNA in the bone marrow and protein and RNA in the kidneys was also found and ginseng stem and leaf given orally accelerated the growth of young pigs. It was noted that the saponins of the aerial parts of P....

Temperature Stress Reaction

Ginseng and its extracts can prevent body temperature variations in animals subjected to the stress of cold and heat exposure, although not apparently affecting normal subjects at room temperature. This was realised in 1958 when the Chinese physiologists Sung and Chi published experimental results indicating that powdered P. ginseng root contained active principles with a protective property against temperature stresses. Using male white rats fed either on a normal diet or a normal diet with 5 per cent added ginseng powder, they were able to demonstrate that after 3 weeks the ginseng-fed group were more able to withstand heat stresses of 5-6 minutes at 78-90 C or 60 minutes at -2 C. In an alternative experiment one group of rats received 2.4 ml of 50 per cent ginseng extract one hour before the temperature stress whilst the other (control) group received water only. Ginseng treated rats, on being returned to normal conditions after hot chamber treatment, recovered almost immediately...

Planets

Was, and still is, the treatment of the patient as a whole, not as an isolated disease condition, coupled with prophylaxis, that is, obeying the axiom that prevention is far better than cure. Therefore the medical texts of those times e.g. Shen-nung Pen-ts'ao Ching (ca. 200 A.D.) that listed some 365 plant drugs, Ming-I Pieh-lu (ca. 500), Chia-yu Pen-ts'ao (1057) and Pen-ts'ao Kang-mu (1596) that included nearly 1900 drugs of animal, vegetable and mineral origin, recommended ginseng as an excellent tonic medicine which could maintain the body in good health, induce rejuvenation and retard the inevitable process of ageing. This was due to the restoration of Yang establishing the healthy Yin Yang balance in the five visceral areas. Ginseng was therefore employed in the treatment of conditions such as defective memory, gastrointestinal disturbance and debility states. As the treatment of illness comprised the rebalancing of Yin Yang forces, the herbal plants were evaluated for their Yin...

Conclusions

The above survey of the pharmacology and therapeutic potential of ginsengs indicates that ginseng can strengthen the debilitated body, stimulating recuperation and improving the quality of life. Ginseng has been shewn as an agent capable of improving memory and intellectual skills at all ages and it is also certain that ginseng is of value in the countering of stresses due to temperature variation, physical strain, disease states and toxic substances. Less clear is the anti-ulcer effect as ginsengs are usually used in combination with other plants containing substances such as mucilages, pectin polysaccharides and dextrins. There is evidence of the protective effects of ginseng in old age. Protection from neural degeneration, preservation of antioxidant levels and inhibition of malondialdehyde formation collectively retard the inexorable advance of age related deterioration. Therefore ginseng has potential in geriatric tonics and medicines for the treatment of conditions such as...

William Ecourt

During the past 50 years a vast amount of literature of widely varying quality has accumulated concerning the pharmacology of ginseng and its preparations and by 1990, despite the scepticism of many orthodox Western physicians and pharmacologists, ginseng had already attracted considerable interest and an ever increasing degree of respectability as a herbal medicine worthy of further study and of discussion at medical and scientific meetings worldwide.

Summary

Ginseng and the Quality of Life 3. Absorption, Distribution, Excretion and Metabolism of Ginseng Saponins 9. Ginseng and Anti-ulcer Activity 10. Ginseng, Memory and Intellectual Skills 11. Ginseng and Sleep 12. Ginseng and the Ageing Process 13. Ginseng and Alcohol 14. Ginseng and Morphine and Related Opioids 15. Ginseng and the Central Nervous System 16. Ginseng as a Biological Response Modifier 17. Ginseng and Tumour Growth 18. Ginseng and the Cardiovascular System 19. Ginseng and Atherosclerosis 20. Ginseng and Diabetes 21. Ginseng and Aphrodisiac Activity 22. Ginseng and Cosmetics

Combination Therapy The Road To Success

Combining sexual pharmaceuticals and sex therapy is the oral therapy of choice to optimize treatment for all SDs. This is true for men with ED, PE, or retarded ejaculation (RE) and will also be true for FSD. Less medication is required when you modify immediate causes while appreciating other psychological obstacles (20). However, CT is by no means a new idea, and sexual medicine is not the first specialty utilizing a broad-spectrum approach to increase efficacy and satisfaction.

Patient Preference Sexual Scripts and Pharmaceutical Choice

Healer patient relations, minimize PSOs, and improve compliance. Preliminary comparator data, abstracted from the 2003 European Society of Sexual Medicine, suggested, patient preferences reflected, key marketing messages of the respective pharmaceutical companies (49). Prescribing physicians might take advantage of that hypothesis to increase efficacy. If safety and long-term side effects are the primary concern, sildenafil has the oldest longest database (12). If, pressed by questions regarding hardness of erection in vitro selectivity may or may not translate to clinical reality, yet some patients believe vardenafil provides the best quality erection with the least side-effect (13). What is the physician's experience with their own patients By taking a sex history and evaluating the premorbid sexual script (what used to work sexually), a skillful clinician may make an educated guess, as to which pharmaceutical to first prescribe. This transcends, try it, you'll like it. Knowledge of...

Summary And Conclusion

Sexuality is a complex interaction of biology, culture, developmental, and current intra and interpersonal psychology. A bio-psychosocial model of SD provides a compelling argument for CT integrating sex therapy and sexual pharmaceuticals. Restoration of lasting and satisfying sexual function requires a multidimensional understanding of all of the forces that created the problem, whether a solo physician or multidisciplinary team approach is used. Each clinician needs to carefully evaluate their own competence and interests when considering the treatment of a person's SD, so that regardless of the modality used, the patient receives optimized care. For the most part, neither sex therapy nor medical surgical interventions alone are sufficient to facilitate lasting improvement and satisfaction for a patient or partner suffering from SD. There will be new medical and surgical treatments in the future. Sex therapists and sex therapy will complement all of these approaches. This author is...

Vascular Supply Of The Spinal Cord

Spinal Cord White Ramus

Ligation of the great radicular artery during resection of an abdominal aortic aneurysm may result in anterior spinal artery syndrome. Clinical findings include paraplegia, impotence, loss of voluntary control of the bladder and bowel (incontinence), and loss of pain and temperature sensation (although vibration and proprioception sensation are retained).

Assessment Of Low Desireinterest And The Associated Low Arousability To Identify Therapeutic Options

Become sexually aroused are scarce or absent. The lack of interest is considered to be beyond a normative lessening with lifecycle and relationship duration (48). The current and past context biological, psychosocial, as well as sexual is clarified along with contextual details at the time of onset of the difficulties. The full picture of the woman's sexual response and her partner's response is obtained and importantly the degree of resulting distress is clarified. Predisposing factors are essentially intrapersonal psychological factors that impair her arou-sability such as a fear of being vulnerable, guilt or shame regarding sex, past negative sexual experiences, distractions while trying to be sexually responsive, and excessive need for control. Recent careful assessment of consecutive women with low desire found significant disturbance in emotional stability and self-esteem (17). These researchers emphasized how low desire cannot be thought of as a discrete phase disorder. Rather,...

Individual and Population Examples

Weight, and the huge potential profits for pharmaceutical companies from weight loss medications. Contrast this with the relatively weak and distant driving forces for population-based prevention research and action. These are funded largely from government sources, and the lack of political will due to a short-term political focus and limited public pressure for change remain major obstacles. As discussed later, the driving forces for the obesity epidemic are linked to much broader sectors such as transport, the food industry, education, urban planning, building design, and local government, and this adds to the sense of impotence among health authorities about obesity prevention.

Steroid Receptor Activity

Ginseng has been shown to increase the mounting behaviour of male rats and increase sperm counts in rabbit testes. The effect is not by a direct sex-hormone-like function, but probably via a gonadotropin-like action. Ginsenoside Rb1 has been shown to increase LH secretion by acting directly on the anterior pituitary gland in male rats (Tsai et al 2003). Ginsenoside Rh1 failed to activate the glucocorticoid and androgen receptors, but did demonstrate an interaction with oestrogen receptors in vitro. The effect was much weaker than 17-beta-oestradiol. Ginseng is therefore considered to contain phyto-oestrogens (Lee et al 2003). However, there are conflicting reports about oestrogen binding activity which may in part be explained by the presence or absence of zearalenone, an oestrogenic mycotoxin contaminant (Gray eta I 2004).

Cardiovascular Disease

Although there are reports of ginseng causing hypertension, red ginseng is actually used as an antihypertensive agent in Korea. Acute administration of an aqueous preparation of Korean ginseng (100 mg kg body weight) to 12 healthy, non-smoking male volunteers resulted in an increase in NO levels and a concomitant reduction in mean blood pressure and heart rate (Han et al 2005). Ginseng is often used in practice as an adjuvant to both conventional and CAM treatments. An open clinical study of 44 hypertensive patients found red ginseng, 1.5 g three times daily (4.5 g day), to be useful as an adjuvant to antihypertensive medication (Han et al 1995). A combination of red ginseng and digoxin was found to be more beneficial than either drug alone in an open study of advanced congestive heart failure. There were no adverse reactions (Ding et al 1995). A combination of ginseng and ginkgo extracts has been found to improve circulation and lower blood pressure in a controlled single-dose study...

Immunomodula Tion

Siberian ginseng appears to exert an immunomodulatory rather than just an immunosuppressive or stimulating action however, evidence for the immune enhancing effects of Siberian ginseng is contradictory. Clinical studies in vitro and in vivo have revealed stimulation of general non-specific resistance and an influence on T-lymphocytes, NK cells and cytokines (Bohn et al 1987, Schmolz et al 2001), although other studies suggest that Siberian ginseng does not significantly stimulate the innate macrophage immune functions that influence cellular immune responses (Wang et al 2003). Alternatively, another in vitro study has demonstrated that activation of macrophages and NK cells does occur and may be responsible for inhibiting tumor metastasis both prophylactically and therapeutically (Yoon et al 2004).

Adverse Reactions

Clinical trials of 6 months' duration have shown no side-effects from treatment (Bohn et al 1987). High doses may cause slight drowsiness, irritability, anxiety, mastalgia, palpitations or tachycardia although these side effects may be more relevant to Panax ginseng. Clinical note Case reports of Siberian ginseng need careful consideration Some adverse reactions attributed to Siberian ginseng have subsequently been found to be due to poor product quality, herbal substitution and or interference with test results. For example, initial reports linking maternal ginseng use to neonatal androgenisation are now suspected to be due to substitution with another herb, Periploca sepium (silk vine), as American herb companies importing Siberian ginseng from China have been known to be supplied with two or three species of Periploca (Awang 1991). Additionally, rat studies have failed to detect significant androgenic action (Awang 1991, Waller et al 1992) for Siberian ginseng. Another example is...

Materials and Methods

This study was an open-label, historically controlled, single center phase IIa study in which men diagnosed with HG PIN were treated with 60 mg day oftoremifene for 120 days. The study primary objectives were to determine whether toremifene was able to reduce HG PIN in men with HG PIN, to evaluate its effect on other intermediate endpoints including serum total PSA and free PSA, as well as its safety and impact on male hormonal status. The effects of toremifene on quality of life issues, i.e., changes in libido, erectile function, and hot flashes were also assessed. Once informed consent was obtained, subjects were referred to the study if any prostate biopsy within the last 6 mo had HG PIN (at least 6 prostate cores were needed to be included in the study). The prostate pathology was re-evaluated to confirm HG PIN. Subjects who had HG PIN and fulfilled all of the eligibility requirements were enrolled in the study. At study day 120, subjects underwent transrectal...

Open Simple Prostatectomy

This operation is reserved for BPH where the prostate weighs over 50-75 g. It is also appropriate where there is concomitant benign bladder disease requiring treatment such as a symptomatic diverticulum or a large stone. Potential risks are urinary incontinence, erectile dysfunction, retrograde ejaculation and urinary tract infection. The advantages over TURP are complete removal of the gland (therefore no recurrence) and no risk of dilutional hyponatraemia. However, there is an increased risk of intraoperative haemorrhage and a longer hospital stay. Previous prostatectomy, prior pelvic surgery and prostate cancer are contraindications to the operation.

Longterm Effects Of Cancer Diagnosis And Treatment On Survivors Family Members

The literature on the effect of cancer diagnosis and treatment on family members is sparse.74 Of studies in this area, most have focused on the impact of cancer soon after diagnosis, during recurrence, or at the terminal phase of the disease.75-77 One study shows that partners of men with prostate cancer, generally from small convenience samples, report more distress than their sick partners, but also believe that their partners are more distressed. The only reviewed study of long-term prostate cancer survivors found that couples' health-related QOL was associated with marital satisfaction.61 Distress was inversely related to levels of family support. The men's focus of concern, on their sexual functioning (i.e., impotence), was not shared to an equal degree by their non-sick partners.78,79 The most relevant study included

Integrating Diagnostic Levels

In addition, even if the character or personality structure is not fully intact, the specific nature of the characterological context that is impaired by a psychotic or organic process can be specified. If an organic impairment is found, it is useful to clarify whether it is mild or profound, acute or chronic. The characterological context in which the organic impairment occurs is essential to report, as is the presence of any neurotic symptoms that have appeared. This kind of specificity can have a significant bearing on prognosis and intervention. For example, if a phobia or sexual impotence is linked to a symptom level of functioning in an organically impaired patient, quite different implications would be drawn than if these phenomena appeared to derive from the organicity itself.

Overall Quality Of Life

Specific dimensions would consider distress that was due to treatment side effects (eg, ototoxicity, nephrotoxicity, and Raynaud's phenomenon), as well as fertility concerns and sexual functioning. Unfortunately, such a measure with good psychometric properties is not yet widely available.

Clinical features and epidemiology

Cases and are therefore classified as such rather than a ''unipolar mania''). In order to fulfill current criteria for depression (WHO, 1992 American Psychiatric Association, 1994) an episode must last at least two weeks but in practice most episodes last longer. In addition to low mood and low energy levels, other typical symptoms include anhedonia (the inability to enjoy), loss of self esteem, suicidal ideation, guilt and hopelessness. Biological symptoms are common such as disturbances of sleep, appetite, weight and sexual function. In mania the mood by contrast is one of elation (although irritability is also common). This is typically accompanied by racing thoughts, rapid speech, reckless overactivity, social and sexual disinhibition and overspending, sometimes to a ruinous level. There is almost always a reduced need for sleep and there are frequently expansive and grandiose ideas such as being in possession of special powers or abilities or of having become suddenly rich or...

Male And Female Brains Are Different

Many of the sex differences seen in the brain manifest themselves in a variety of ways, such as sizes of particular regions of the brain, number of nerve cells in specific regions, distribution of neurotransmitters, and even development of behavior (Goldstein et al., 2001 Hutchinson, 1997 Segovia et al., 1999). In humans, for instance, there are region-specific dimorphisms, with some structures larger in females (caudate nucleus, hippocampus, Broca's area, anterior commissure, and right parietal lobe) and some larger in males (hypothalamus, stria terminalis, and amygdala) (Goldstein et al., 2001). In rodents, numerous sexually dimorphic nuclei have been studied, the following two perhaps most extensively. One is the sexually dimorphic nucleus of the preoptic area (SDN-POA), which is larger in males than females, and another is the anteroventral periventricular nucleus (AVPv), which is larger in females than males (Davis et al., 1995 Gorski et al., 1980 Simerly et al., 1988). Sex...

Cardiovascular Disease in the Medico Legal Era An Introduction

Other types of litigation such as personal injury (e.g. automobile accident), or product liability (e.g. adverse drug affects, or claims that cars or tires were defective leading to an accident) often also require knowledge of cardiovascular disease. For instance, an automobile accident may apparently lead to the death of the driver as a result of trauma however, if the driver actually had an arrhythmic cardiac arrest prior to the accident (e.g. coronary artery ischemia or cardiomyopathy) and then crashed, this would mitigate if not eliminate the liability of insurers or the automobile manufacturer. In another instance, a so-called drug adverse effect may represent the natural consequences of the underlying disease for which the drug was prescribed, rather than a complication of the drug. An example of this phenomenon is sudden cardiac death during sexual activity of an individual with diabetic cardiomyopathy, who is taking Viagra for erectile dysfunction secondary to diabetic...

Damon J Vidrine DrPh Ellen R Gritz PhD

Because of the young age at diagnosis and the extremely high survival rates following testicular cancer treatment, survivorship issues become tremendously important. Young men are most frequently diagnosed at or near the prime of life a time during which patients are establishing professional careers and planning families. While mortality may no longer pose the risk it did in earlier years, other important outcomes should be considered. These outcomes include toxicity of treatment, disease-related functioning (eg, body image, sexual functioning, and fertility), and overall quality of life (QOL). A better understanding of these outcomes and how they are influenced by each treatment modality (or combination of modalities) is vital for both physician and patient. Such an understanding will allow for the selection of the most appropriate treatment regimen as well as the early implementation of interventions that have the potential to minimize disease and or treatment-related impairment.

Gross Description

Ruptured Stomach Artery

There are complications of aneurysm in addition to fatal rupture. Aneurysms frequently thrombose and the thrombus may fragment and embolize into the distal circulation of the lower extremities leading to acute ischemia. If the aneurysm is fusiform, and the thrombus continues to aggregate, there may be partial or complete obstruction of the lower abdominal aorta. This can cause lower extremity ischemia, intermittent claudication, or gangrene. When there is lower extremity ischemia involving the thigh and below, in association with impotence, the Leriche syndrome (obstruction of the distal aorta) must be considered. In the absence of significant thrombosis, the ulcerative, atheromatous surface of an aneurysm may be the source of cholesterol and plaque emboli. These usually affect smaller vessels in the distal extremities, but may lead to toe and foot gangrene, or the so-called 'trash foot'.

Causes and symptoms

Acquired, situational HSDD in the adult is commonly associated with boredom in the relationship with the sexual partner. Depression, the use of psychoactive or antihypertensive medications, and hormonal deficiencies may contribute to the problem. HSDD may also result from impairment of sexual function, particularly erectile dysfunction on the part of the male, or vaginismus on the part of the female. Vaginismus is defined as a conditioned voluntary contraction or spasm of the lower vaginal muscles resulting from an unconscious desire to prevent vaginal penetration. An incompatibility in sexual interest between the sexual partners may result in relative HSDD in the less sexually active member. This usually occurs in the presence of a sexually demanding partner. priapism. Priapism is the occurrence of any persistent erection of more than four hours duration occurring in the absence of sexual stimulation. It is not associated with sexual excitement and the erection does...

Gnrh Enters Blood Vessels In

Round And Ovarian Ligaments

As the blood concentration of testosterone drops, the hypothalamus becomes less inhibited, and it once again stimulates the anterior pituitary gland to release LH. The increasing secretion of LH causes the interstitial cells to release more testosterone, and its blood concentration increases. Testosterone level decreases somewhat during and after the male climacteric, a decline in sexual function that occurs with aging. At any given age, the testosterone concentration in the male is regulated to remain relatively constant.

Shrinking Of The World

Physical movement also is restricted as the environment shrinks. Contrary to the dictates of human health requirements, older persons become more sedentary and engage in less exercise. Part of this reduced physical activity results from reduced participation in the environment because of physical or environmental barriers. Environmental barriers can include the structure of the home, its layout, and the presence of stairs. Storage spaces and appliances may be difficult to access or use, thus cutting back on the person's activity. Shrinkage of the environment due to the nature of the environment itself means that there is a lack of fit between the person and the environment. Such a lack of consonance means that the person is less stimulated by the environment and finds it to be more of a frustration. Increasingly, drawing away from the environment and curtailing their ability to manipulate the environment to their own best advantage results in persons losing control of their lives and,...

The Role Of Glutamate Receptor Subtypes In Opiate Withdrawal

The dose of LY293558 that was able to suppress most of the withdrawal-induced activation of LC neurons in anesthetized animals only suppressed the physical signs of opiate withdrawal by about 50 . Although anesthesia could account for some of this difference, another possibility is the participation of AMPA receptors in other brain areas in the genesis of morphine-withdrawal symptoms. Other potential brain sites include those with the highest density of AMPA receptors (i.e., hippocampus, layers I-III of the cortex, dorsal lateral septum, striatum, and the molecular layer of cerebellum (88,89) . Another area may be the central nucleus of the amygdala. The central nucleus of the amygdala has been hypothesized to play a role in aversive states (90) and morphine withdrawal (30). Indeed, local infusion of CNQX into the central nucleus of the amygdala also significantly attenuated many morphine-withdrawal symptoms, including irritability, ptosis, lacrimation, penile erections, wet-dog...

Vacuum constriction devices and constriction rings for men with

This device is useful as a treatment for men with ED who are unable to use oral therapies. It also avoids the use of ICI therapy, which some men find objectionable. It is fairly simple to use although it is somewhat obtrusive. One drawback of use with the constriction ring is that the erection pivots about the ring making it less natural. Its use has been studied in men with diabetes, SCI, explanted penile prosthesis, and requiring dialysis for various reasons. These studies have all reported high success rates of VCD use with approximately three-quarters of men. Partners too find the device an acceptable compromise. For a few individuals who are able to achieve an erection but not maintain it, they can use the constriction ring without the vacuum tube. This will enhance the firmness and size of the penis. In all cases where a constriction ring is used, a time limit of 30 min must be strongly emphasized.

Sacrococcygeal Teratoma And Oxcarbamazepine

(RPLND), 98-111, 100f, 107f, 113f bilateral, 112f full bilateral dissection, 106 nerve-sparing, 113, 116f postchemotherapy dissection, 107 postoperative considerations, 106-107 right-modified, 104f selection for, 101 sexual functioning, 299-300 surgical technique, 102-106 templates for, 114f Retroperitoneal mass, 153f Retroperitoneal metastases, 115f, 237f Retroperitoneal nodal dissection

Introduction The False Dichotomy

The 20th century marked huge strides in our knowledge of sexual disorders and their treatments, however, advancements were followed by periods of reductio-nistic thinking. Etiology was conceptualized dichotomously, first as psychogenic and then organic. Early in the 20th century, Freud highlighted deep-seated anxiety and internal conflict as the root of sexual problems experienced by both men and women. By mid-century, Masters and Johnson (1) and then Kaplan (2) designated performance anxiety as the primary culprit, while providing a nod to organic factors. Together, they catalyzed the emergence of sex therapy, which relied on cognitive and behavioral prescriptions to improve patient functioning. For the next two decades, a psychological sensibility dominated discussions of the causes and cures of sexual dysfunctions (SDs). However, during the late 1980s, there was a progressive shift toward surgical and predominantly pharmaceutical treatments for male erectile dysfunction (ED). By...

Chemical Components

The most characteristic compounds in the ginseng roots are the ginsenosides, and most biological effects have been ascribed to these compounds. The ginsenosides are dammarane saponins and can be divided into two classes the protopanaxatriol class consisting primarily of Rg 1, Rg2, Rf and Re, and the protopanaxadiol class consisting primarily of Rc, Rd, Rb1 and Rb2. Ginseng also contains other saponins, polysaccharides, amino acids (in particular glutamine and arginine) (Kuo et al 2003), essential oils and other compounds. Three new sesquiterpene hydrocarbons have also recently been isolated from the essential oil panaxene, panaginsene and ginsinsene (Richter et al 2005). Ginsenosides Rh1, Rh2, and Rg3 are obtained from red ginseng as artifacts produced during steaming. It is likely that ginsenoside is actually a prodrug that is converted in the body by intestinal bacterial deglycosylation and fatty acid esterifi-cation into an active metabolite (Hasegawa et al 2004) and therefore...

Pharmacological Treatment of the Paraphilias

Relapse is common upon cessation of the medication. Treatment with antiandrogens may result in erectile dysfunction, although many individuals maintain adequate sexual functioning. As with the SSRIs, the goal of antiandro-gen medications is to augment the individual's ability to achieve behavioral control (10).

Does He have a Vascular Basis to His ED

Diabetes, smoking, hypertension, hyperlipidaemia, and so on, are all underlying causative factors for vascular impairment. Since the erectile response is a hemo-dynamic event, it is hardly surprising that damage to the vessels will result in partial or complete loss of the ability to not only achieve but also maintain an erection long enough for it to be useful to its owner and his partner. A standard vascular examination can reveal important clues that may not only indicate a vascular reason for loss of the ability to have an erection, but may also point to major undetected pathology.

Vulvar Vestibulitis Syndrome

Cognitive-behavioral interventions for vulvar vestibulitis syndrome include cognitive-behavioral pain management, sex therapy, and pelvic floor biofeedback to target both pain reduction and sexual functioning. Success rates ranging from 43 to 86 have been reported in two uncontrolled studies in which sex therapy and pain management were combined (93,94). In 1996, Weijmar Schultz et al. (95) published a prospective and partially randomized treatment outcome study investigating the effectiveness of behavioral intervention with or without surgery. Results from this study indicated that women in both groups benefited in terms of pain reduction, with no significant differences between women who had undergone the behavioral intervention alone vs. those who underwent the combined treatment of behavioral intervention and surgery. The authors suggest that the behavioral approach should be the first line of treatment for ves-tibulitis sufferers, with the surgery acting as an additional form of...

The Effects Of Drugs On Womens Orgasmic Ability

Among the typical SSRIs, paroxetine has been reported to delay orgasm more frequently than fluvoxetine, fluoxetine, and sertraline (36) and more than nefazadone, fluoxetine and venlafaxine (37). One explanation for this greater impairment may be that paroxetine is a more potent inhibitor of the serotonin transporter than are fluoxetine and fluvoxetine, and does not inhibit the dopamine transporter, as does sertraline and, to a lesser degree, fluoxetine and fluvoxetine (38). As noted earlier, dopamine antagonists impair several aspects of sexual function. Women treated with fluoxetine, paroxetine, and sertraline for anxiety disorders reported delays in reaching orgasm and decreased quality of orgasm at 1 and 2 month follow-ups (39). However, the impairments in the fluoxetine group decreased by the end of the third month. In contrast to these findings of impaired orgasm with fluoxetine, one multicenter open-label study of fluoxetine reported an improvement in women's orgasmic ability...

Enhanced Cognitive Function And Alertness

Another double-blind, placebo controlled study investigated the effects of a single dose of guarana (75 mg) on cognition, in combination with and in comparison to ginseng (Panax ginseng 200 mg) in 28 healthy volunteers (Kennedy et al 2004). Guarana was shown to produce comparable effects to ginseng in improved task performance with all three treatments better than placebo. However, guarana was superior to ginseng in improving the speed of performed tasks. Once again, given the low caffeine content (9 mg) of the guarana extract used in that study, the effects are unlikely to be attributable to its caffeine content alone, particularly as the dose was shown to be as effective as a 16-fold dose of pure caffeine.

Significance to humans

Northern Muriqui

Atelidae are represented in the art and legends of the people they live nearby. Their large body size and social habits have probably always made them a source of prized meat. The large testes of Brachyteles were associated with sexual potency, and made into purses by hunters.

Triangular Test And Further Work

The triangular test has now been used in a wide variety of clinical studies concerned with many therapeutic areas. Examples include trials of corticosteroids for AIDS-induced pneumonia (41), of enoxaparin for prevention of deep vein thrombosis resulting from hip replacement surgery (42), of isradipine for the acute treatment of stroke (43), and of implanted defibrillators in coronary heart disease (44). In pediatric medicine, the triangular design has been used to study the use of surfactant to alleviate respiratory distress in infants (45) and in a trial concerning gastrointestinal reflux (46). An evaluation of the drug Viagra in the treatment of erectile dysfunction after spinal injury also used the method (47), and it has been implemented in animal studies of medical techniques (48). An interesting combination of the triangular test with the play-the-winner rule was applied in a study of spinal anesthesia during cesarean section (49). Within oncology, besides the renal and lung...

Bone Marrow Stimulation During Chemotherapy

Saiko-keishi-to, a spray-dried decoction of Bupleurum, (cinnamon, peony, ginger, licorice, ginseng, pinellia, zizyphus and baical) was administered to 24 people with epilepsy, who had frequent uncontrollable seizures (3-5 seizures per day in the most severe case and 5 seizures per month in the mildest case) of various types, despite treatment with pharmaceutical anticonvulsants. Of them, 6 were well controlled with Saiko-keishi-to whereas 13 experienced improvement and 3 showed no effect. No patients experienced worsening of their condition. Two patients dropped out during treatment (Narita et al 1982).

Anatomy and Physiology

When Masters and Johnson (10) published their account of the physiology of the sexual response, they opposed Freud's theory of the transition of erogeneous zones in women. According to these famous sexologists, nerve endings in the vagina are extremely sparse. Therefore, during coital stimulation the clitoris is stimulated indirectly, possibly through the movement or friction of the labia. Hite's data supported this point of view. Almost all women who reached orgasm through stimulation from coitus alone had experienced orgasm through masturbation. Many women needed additional manual stimulation to orgasm during coitus, and an even larger number was unable to orgasm during coitus at all (12). There remain large gaps in our understanding of the central nervous control of female sexual function. Most of the animal work relates to receptive behavior in female rats and very little to the control of genital responses. According to McKenna (32), the autonomic and somatic innervation of the...

Is Absent or Impaired Genital Responsiveness a Valid Diagnostic Criterion

Organic etiology may underlie sexual disorders in women with a medical condition. There are only a handful of studies that have employed VPA measurements in women with a medical condition. The only psychophysiological study to date that found a significant effect of sildenafil on VPA in women with sexual arousal disorder was done in women with SCI (46), suggesting that in this group there was an impaired genital response that can be improved with sildena-fil. Another study compared genital response during visual sexual stimulation of women with diabetes mellitus and healthy women, showing that VPA was significantly lower in the first group (47). A very recent study measured VPA in medically healthy women, in women who had undergone a simple hysterectomy, and in women with a history of radical hysterectomy for cervical cancer (48). Only in the last group was VPA during visual sexual stimuli impaired, whereas the women with simple hysterectomies reported to experience more sexual...

Adaptogenic And Tonic Effects

A randomised double-blind study Involving 232 subjects between the ages of 25 and 60 years found that extract equivalent to about 400 mg ginseng root for 4 weeks significantly Improved fatigue. Side-effects were uncommon, with only two subjects withdrawing from the study (Le Gal & Cathebras 1996). A randomised double-blind study of 83 subjects found that extract equivalent to 1 g ginseng root for 4 months decreased the risk of contracting a common cold or bronchitis, Improved appetite, sleep, wellbelng and physical performance (Glanoll & Rlebenfeld 1984). Ginseng Is used by many athletes to Improve stamina and to facilitate rapid recovery from Injuries. To examine the effects of ginseng supplements on hormonal status following acute resistance exercise, eight male college students were randomly given water (control group) or 20 g ginseng root extract treatment Immediately after a standardised training exercise. Human growth hormone, testosterone, Cortisol, and Insulln-IIke...

Anatomy And Physiology Of Erection

The nervous system of the penis is in three parts. The parasympathetic nerves are branches of spinal nerves S2-S4, which give rise to the so-called pelvic splanchnic nerves that pass around the posterior aspect of the prostate gland, forming the prostatic plexus. Passing forward, they form the cavernous nerves, which branch into the body of the penis. It is this parasympathetic system that is able to elicit an erection. The sympathetic nerves are branches of the sympathetic chain at levels T11-L2. These pass through the inferior mesenteric plexus, the superior hypogastric plexus, and the pelvic plexus and branch off to the organs involved in ejaculation. Overactivity of the sympathetic system (e.g., in the stressed individual) maintains a persistent state of detumes-cence, although not all sympathetic activity is inhibitory. The sensory nerves of the penis and scrotum are all branches of the pudendal nerve, which can be traced back to branches of S2-S4. With these systems in mind, it...

Models For Treating Sexual Dysfunction Sex Therapy

Sex therapy rapidly morphed into weekly sessions provided within a solo MHP's office based practice. Treatment continued to emphasize sensate focus exercises and the reduction of performance anxiety. By the 1980s, sex therapy reflected a cognitive-behavioral theoretical bias, while typically utilizing Masters and Johnson variations, such as Kaplan's, four phase model of human sexual response desire, excitement, orgasm, and resolution (1,4,5). The models were not necessarily linear and causes could become effects. For instance, an ED might cause diminished desire. However, generally speaking, sex therapy was and is, the diagnosis and treatment of disruptions in any of these four phases and or the sexual pain and muscular disorders. These dysfunctions occurred independent of each other, yet they frequently clustered. Sex therapy was an efficacious treatment for primary anorgasmia in women, some erectile failure in men, and was probably efficacious for secondary anorgasmia, , vaginismus...

Biological Theories of the Paraphilias

Understanding of the neurobiology of sexual functioning, both normal and deviant, is incomplete. Nevertheless, it is clear that sexual interest and function derive from both the central nervous system and endocrine factors. In normal sexual arousal, central nervous system involvement includes a cascade of connections from the neocortex to the limbic system and the hypothalamus, particularly the preoptic area and the brainstem (113). Sexual arousal begins via either sensory input, such as tactile, visual or olfactory stimulation, or via fantasy in the neocortex. This cortical arousal propagates through the limbic system and hypothalamus to enable a progression of physiologic events that promote sexual behaviors and orgasm. Subcortical brain areas are important for sexual functioning and include the limbic system and the preoptic nuclei in the hypothalamus. Both peptides, such as beta endorphin and oxytocin, and LHRH modulate sexual behavior in animals. Early biological hypotheses...

Medical Letter In Reference To Erical Dysfunction

Human Sexual Response. Boston Little, Brown & Co, 1966. 6. Bohlen GJ, Held JP, Sanderson MO. Response of the circumvaginal musculature during masturbation. In Graber B, ed. Circumvaginal Musculature and Sexual Function. Basel Kager, 1982 43-60. 15. Levin RJ. Sexual desire and the deconstruction and reconstruction of the human female sexual response model of Masters & Johnson. In Everaerd W, Laan E, Both S, eds. Sexual Appetite, Desire and Motivation Energetics of the Sexual System. Amsterdam Royal Netherlands Academy of Arts and Sciences, 2001 63-93. 34. Feiger A, Kiev A, Shrivastava RK, Wisselink PG, Wilcox CS. Nefazodone versus sertraline in outpatients with major depression focus on efficacy, tolerability, and effects on sexual function and satisfaction. J Clin Psychiatry 1996 57(suppl 2) 53-62. 37. Bobes J, Gonzalez MP, Bascaran MT, Clayton A, Garcia M, Rico-Villade Moros F, Banus S. Evaluating changes in sexual functioning in depressed patients...

Postmenopausal Dyspareunia

Attempts to lessen the pain through the use of water-based lubricants and topical estradiol cream had not been successful, and she did not wish to try systemic hormone replacement therapy for fear of developing breast cancer. A detailed sexual history revealed that Brenda had suffered from intermittent pain during intercourse for at least 15 years but had never complained about it, and that Alexander had always had difficulties with ejaculatory control. Over the past 4 years, Brenda reported difficulty getting sexually aroused, diminished lubrication, postcoital bleeding, and less interest in sex. Their current sexual frequency was less than once every 3 months, a frustrating situation for Alexander, who had hoped that their youngest child leaving home in the previous year would result in more frequent sexual activity. In the previous 5 years, the couple had also experienced significant life stressors including the sudden death of Brenda's mother and major financial problems....

Glycaemic Control And Insulinsensitising Effect

Animal studies have indicated a potential for hypoglycaemic effects when used intravenously. Eleutherens A-G exert marked hypoglycaemic effects in normal and alloxan-induced hyperglycaemic mice (Hikino et al 1986) and eleutherosides show an insulin-like action in diabetic rats (Dardymov et al 1978). However, these effects have not been borne out in human studies (Farnsworth et al 1985) and may not relate to oral dosages of Siberian ginseng. A small, double-blind, randomised, multiple-crossover study using 12 healthy participants actually showed an increase in postprandial plasma glucose at 90 and 120 minutes when 3 g Siberian ginseng was given orally 40 minutes before a 75-g oral glucose tolerance test (Sievenpiper et al 2004). More recently, oral administration of an aqueous extract of Siberian ginseng was shown to improve insulin sensitivity and delay the development of insulin resistance in rats (Liu et al 2005). As a result further trials in people with impaired glucose tolerance...

What Does the Term Dyspareunia Mean

In 1874, Barnes (1) coined the term dyspareunia. He felt that it would be a convenient way of summarizing the different conditions underlying painful intercourse just as 'dyspepsia' is used to signify difficult or painful digestion, we want a word to express the condition of difficult or painful performance of the sexual function (p. 68). Although the usefulness of the term dyspepsia is a matter of some controversy (2), the diagnosis of dyspareunia has not been seriously challenged and is still used by all major classificatory systems, such as the DSM-IV-TR (3) and the ICD-10 (4). The lack of specificity of the word dyspareunia is evidenced by the growing number of overlapping terms (e.g., vul-vodynia, vulvar vestibulitis syndrome, dysesthetic vulvodynia, vestibulodynia) denoting presumed disease entities. The majority of these terms originate from a recent renewed interest in painful vulvar conditions. Even prior to this increased interest, the term dyspareunia was often used...

The Interactional View

The interactional view assumes that vaginistic complaints have a function in maintaining the balance between partners, or in the emotional functioning of the woman herself. In this sense, the complaint can form a solution There are very few authors who explain the phenomenon of vaginismus fully on the basis of this view. However, much of the literature mentions the behavior and the personality structure of the male partner. He comes forward as a low self-confidence, anxious, passive, dependent person who is afraid of failure and for whom sex is a loaded subject (27,38,39). The partners of vaginistic women are believed to often suffer from sexual problems themselves, such as impotence and premature ejaculation (29,35,39,40). Despite these problems, the couple usually look very harmonic on the outside. They give the impression of being very well suited (18,37). In a recent study, rates of parital discord were equal to the general population (3). It speaks for itself that within the...

Terminology and Definitions

The term andropause indicates a particular type of hypogonadism that is related to aging in men and is said to consist of the following diminished sexual desire and erectile function, decrease in intellectual activity, fatigue, depression, decrease in lean body mass, skin alterations, decrease in body hair, decrease in bone mineral density resulting in osteoporosis, and increase in visceral fat and obesity (24). The word andropause is an attempt to draw a parallel in men to

Identifying Psychosocial Barriers to Success

There are a variety of bio-psychosocial obstacles to be recovered that contribute to treatment complexity. All of these variables impact compliance and sex lives substantially, in addition to the role of organic etiology (20). There are multiple sources of patient and partner psychological resistance, which may converge to sabotage treatment (i) What is the mental status of both the patient and the partner and how will this impact treatment, regardless of the approach utilized What is the nature and degree of patient and partner psychopathology (such as depression) What are the attitudinal distortions causing unrealistic expectations, as well as endpoint performance anxiety (ii) What is the nature of patient and partner readiness for treatment When and how should treatment begin, and be introduced into the couple's sex life What is his approach to treatment seeking What should be the pacing of intimacy resumption The average man with ED waits 2-3 years, before seeking...

Epidemiology Of Sexual Dysfunction

Numerous population surveys in this and other countries indicate a high prevalence of sexual problems in the general population. These surveys indicate that 40 of women have evidence of psychosexual dysfunction. The corresponding number for men is 30 (25). We have more evidence concerning the prevalence of sexual problems in men than women although the data base in both groups is rapidly growing. Correlates of erectile dysfunction in men include diabetes, vascular disease, age, and cigarette smoking. Serum dehydroepiandro-sterone and high-density lipoprotein cholesterol were found to be negatively correlated with erectile problems (26). Depression was correlated with erectile function in cross sectional studies, whereas passive personality traits tended to predict who would develop impotence in a prospective study (27). Studies in other countries have, in general, found somewhat similar rates of erectile dysfunction in the same age population and also that erectile dysfunction tends...

Case Study Jon and Linda

His Chicago psychopharmacologist referred them to a well-known NYC urologist, when they first moved from Chicago. The urologist prescribed 50 mg of sildenafil, which was increased to 100 mg. There were multiple attempts at 100 mg, which all failed. The urologist then prescribed trimix. They used trimix ICI, 15 times, resulting in three coital erections and orgasms. Neither Jon, nor Linda liked the lack of spontaneity. The urologist recommended a penile prosthesis, but Jon declined and terminated that treatment. Some months later, still on 10 mg of escitalopram, a new, NYCpsychophar-macologist referred Jon to this author. Jon and Linda were seen six times conjointly and three times individually. She was helped to reframe his withdrawal, as insecurity, not rejection or abandonment of her. This reduced her anger and resentment. He was encouraged to be affectionate when not angry at her. Her criticalness was reduced, which led to a reduction in his passive-aggressive behavior. Although...

Side Effects Of Hormonal Therapy Similarities And Differences

Hormonal therapy for prostate cancer eventually produces decreases in libido and potency in virtually all patients regardless of the modality used.34,124 Additional side effects include lethargy, depression, anorexia, breast swelling with or without tenderness, hot flashes, anemia, and osteoporosis with potential for pathological fracture.14,125-130 Most side effects, including impotence and infertility, are slowly reversible with cessation of therapy. However, reduced bone mineral density often does not reverse after prolonged hormonal suppression. There is a consensus that irreversible changes occur more often after suppression of longer than 18-24 months.

Combined Androgen Ablation

Trials evaluating the effect of newer non-steroidal antiandrogens, such as biclutamide, in combination with or compared to castration are needed. Biclutamide is better tolerated than flutamide89 and has similar efficacy when combined with castration. A randomized trial of 813 patients with metastatic prostate cancer compared LHRH agonist with either flutamide or biclutamide and found no difference in efficacy or outcome but did not evaluate QOL differences between the two arms.90 Early evidence suggested that standard doses of biclutamide (50 milligrams per day) alone may be less effective than medical or surgical castration. However, high-dose biclutamide (150 milligrams per day) may provide equivalent cancer control with less diminution in QOL particularly with regard to sexual function.45,91-93 In an Italian Prostate Cancer Project study,46 2 20 patients with stage C or D prostate cancer were randomly allocated to receive either biclutamide monotherapy (150 milligrams per day) or...

Pharmacological Toxicological Effects 51 Endocrine Effects

P. ginseng may exert hypoglycemic effects possibly by accelerating hepatic lipogenesis and increasing glycogen storage (16-18). In a study of 36 newly diagnosed patients with type II diabetes, ginseng at a dose of 200 mg daily exerted a statistically significant benefit on glycosylated hemoglobin (HbA1c) compared to 100 mg of ginseng daily or placebo after 8 weeks of therapy, and patients receiving 100 mg of ginseng had smaller mean fasting blood glucose levels than patients taking 200 mg of ginseng or placebo (18). The actual difference among the mean HbA1c in the three groups was small the 200-mg ginseng group had a mean glycosylated hemoglobin of 6 vs 6.5 for the 100-mg ginseng and placebo groups. Likewise, the actual difference among mean fasting blood glucose in the three groups was small the mean fasting blood glucose was 7.7 mmol L for the 100-mg ginseng group, 7.4 mmol L for the 200-mg ginseng group, and 8.3 mmol L for the placebo group at the end of the study. The observed...

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