Priligy

Joel Grube PhD, MS, AB

• Adjunct Professor, Health and Social Behavior

https://publichealth.berkeley.edu/people/joel-grube/

Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome erectile dysfunction vitamin e . Management of childhood craniopharyngioma: can the morbidity of radical surgery be predicted? Early adjuvant radiotherapy toward long-term survival and better quality of life for craniopharyngiomas­a study in single institute erectile dysfunction causes and cures . Pediatric craniopharyngiomas: long term results of combined treatment with surgery and radiation natural treatment erectile dysfunction exercise . Endocrinological outcomes of pediatric craniopharyngiomas with anatomical pituitary stalk preservation: preliminary study erectile dysfunction treatment himalaya . Outcome of craniopharyngioma in children: long-term complications and quality of life. Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series. The clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngioma compared with adult-onset craniopharyngioma. Obesity after childhood craniopharyngioma­German multicenter study on pre-operative risk factors and quality of life. Obesity in childhood craniopharyngioma: relation to post-operative hypothalamic damage shown by magnetic resonance imaging. Reduced energy expenditure and impaired feeding-related signals but not high energy intake reinforces hypothalamic obesity in adults with childhood onset craniopharyngioma. Hypothalamic involvement predicts cognitive performance and psychosocial health in long-term survivors of childhood craniopharyngioma. Melatonin secretion and increased daytime sleepiness in childhood craniopharyngioma patients. Sleepdisordered breathing is increased in obese adolescents with craniopharyngioma compared with obese controls. Perioperative dexamethasone treatment in childhood craniopharyngioma­ influence on short-term and long-term weight gain. Risk factors for obesity in childhood survivors of suprasellar brain tumours: a retrospective study. Long-term outcome in children treated for craniopharyngioma with and without radiotherapy. Clinical outcome in children with craniopharyngioma treated with primary surgery and radiotherapy 215. Surgery, radiation, and combination therapy in the treatment of childhood craniopharyngioma­a 20-year experience. Selective parasympathetic innervation of subcutaneous and intra-abdominal fat­functional implications. Hyperphagia in children with craniopharyngioma is associated with hyperleptinaemia and a failure in the downregulation of appetite. Obesity in patients with craniopharyngioma: assessment of food intake and movement counts indicating physical activity. Melatonin treatment in obese patients with childhood craniopharyngioma and increased daytime sleepiness. Secondary narcolepsy may be a causative factor of increased daytime sleepiness in obese childhood craniopharyngioma patients. Increased daytime sleepiness in patients with childhood craniopharyngioma and hypothalamic tumor involvement: review of the literature and perspectives. The use of dextroamphetamine to treat obesity and hyperphagia in children treated for craniopharyngioma. Reductions in basal metabolic rate and physical activity contribute to hypothalamic obesity. Octreotide therapy of pediatric hypothalamic obesity: a double-blind, placebo-controlled trial. Hypothalamic obesity after craniopharyngioma: mechanisms, diagnosis, and treatment. Autonomic nervous system balance in children and adolescents with craniopharyngioma and hypothalamic obesity.

Knowledge and attitudes of lay public erectile dysfunction instrumental , pharmacists impotence icd 9 code , and physicians toward the use of herbal products in north Jordan impotence type 1 diabetes . Biological diversity impotence gel , indigenous knowledge, drug discovery and intellectual property rights: Creating reciprocity and maintaining relationships. Potential glucosamine-warfarin interaction resulting in increased international normalized ratio: Case report and review of the literature and MedWatch database. Herbal therapy use in a pediatric emergency department population: Expect the unexpected. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Efficacy and tolerability of a fixed combination of peppermint oil and caraway oil in patients suffering from functional dyspepsia. The use of herbal and other non-vitamin, nonmineral supplements among pre- and post-menopausal women in Ontario. Long-acting propranolol in migraine prophylaxis: Results of a double-blind, placebo-controlled study. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: A randomized controlled trial. Over-the-counter medication and herbal or dietary supplement use in college: Dose frequency and relationship to self-reported distress. Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis. Efficacy and safety of Echinacea in treating upper respiratory tract infections in children: A randomized controlled trial. Medicinal herb use in a population-based survey of adults: Prevalence and frequency of use, reasons for use, and use among their children. A systematic review and meta-analysis of Hypericum perforatum in depression: A comprehensive clinical review. Saw palmetto extracts for treatment of benign prostatic hyperplasia: A systematic review. Second, it can be practice integrated with modern medicine by individual health care practitioners. Third, traditional and modern practices can be integrated as two branches of medical science, with the ultimate incorporation of elements of both to form a new branch (World 453 454 HerbalMedicine:BiomolecularandClinicalAspects Health Organization 2000a). However, documentation of its successful integration in clinical practice is lacking (Giordano, Garcia, and Strickland 2004). However, proof of efficacy or safety for the vast majority of herbal medicine has not been fully established through an evidence-based approach. Further, other issues, such as scientific, cultural, educational, economical, and legal, need to be addressed. In this chapter, we examine the current status and major scientific issues or factors that affect the integration of herbal medicine into evidence-based medical therapy. A recent population study on 2526 adults from the Australian state of Victoria indicated that almost a quarter of the adult population used some form of herbal medicine in 2006­2007 (Zhang et al. Established in 1999, the Consortium of Academic Health Centers for Integrative Medicine represents 44 academic health centers in the United States and Canada. Unfortunately, the quality of the majority of the clinical studies of herbal medicines reported to date is of great concern due to a number of factors that have rendered the data of dubious value. In these studies, only slightly over a quarter of the trials adequately reported blinding, and one-fifth reported generation of random allocation sequences (Gagnier et al. For example, only 15% of these studies used blinding, the sample size was mostly less than 300 patients, the controls were inadequate, few studies used quantitative outcome measures, and the studies were short term. There have been many nonclinical in vitro and in vivo studies on herbal medicines that have commonly supported the traditional therapeutic claims. However, systematic reviews of the study protocols or the data interpretation and validation are lacking. Further, the translation of an in vitro and/or in vivo biological/pharmacological effect of a herbal medicine to human therapeutic use may not be successful due to species differences or other mitigating circumstances, including the simple attribute of a biological or clinical outcome by the name of the mother herb, while neglecting the type of plant extract, methods of processing, and pharmaceutical formulation, which invariably contain varying content and proportions of active chemical components (Brinker 2009). Herbal medicine quality can be substantially different due to intrinsic and extrinsic factors. Species differences, organ specificity, and diurnal and seasonal variations are examples of intrinsic factors that can affect the qualitative and quantitative accumulation of the biologically or pharmacologically active chemical constituents produced and/or accumulated in the herb.

Pulmonary resection for metastatic adrenocortical carcinoma: the National Cancer Institute experience erectile dysfunction prevention . Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases erectile dysfunction treatments vacuum . A twelve-year experience with adrenal cortical carcinoma in a single institution: long-term survival after surgical treatment and transcatheter arterial embolization erectile dysfunction aafp . Gene expression profiling of human adrenocortical tumors using complementary deoxyribonucleic Acid microarrays identifies several candidate genes as markers of malignancy erectile dysfunction normal testosterone . Functional status is generally influenced by several factors, including disease bulk, stage, secretory status, and whether the peptide secreted is intact and causes distinct clinical symptoms. It is also recognized that the functional status of these tumors may change over time or with treatment. Moreover, some of these tumors can produce multiple hormones simultaneously, although symptoms related to one of these hormones often will dominate. Necrosis is usually absent or may be seen as spotty, limited areas in histologically more aggressive neoplasms. On the contrary, poorly differentiated neuroendocrine carcinomas are characterized by prevalent solid structure with abundant necrosis, often central, round tumor cell of small to medium size with severe cellular atypia and high mitotic index. The disadvantages are mainly its operator-dependent efficacy and limited option for further study (small sample size) to include prognostic variables. Conversely, the core needle biopsy (ideally 2 mm in diameter) produces a larger sized tumor sample, potentially allowing a cyto-/ histologic diagnosis complete with all known prognostic parameters. Minimum Immunohistochemistry Markers A large number of antigens, commonly defined as "neuroendocrine markers," are expressed in tumor cells. These antigens are defined as "general markers," since they are widely expressed in cells of the diffuse endocrine system. Hormones and/ or amines are produced by specific cell types and thus defined as "specific markers. Though some controversies remain, the grading system based on mitotic rate and Ki 67 labeling figure 85. Median survival for patients with localized, regional and distant metastatic disease were >10 years, 9. The general utility of such a grading scheme has been validated in a number of studies. Therefore, the distinction between G1 and G2, while prognostic, does not have major therapeutic implications. A more important issue is the distinction between G2 and G3 as platinum-based chemotherapy is generally recommended for G3 tumors. In a recent review of a large Nordic series, response rate to platinum-based chemotherapy was low for the subgroup of G3 patients with Ki-67 between 20% and 55%. Molecular genetics of Pancreatic neuroendocrine tumors Advances in technology over the past 5 years have led to an explosion of new data emerging from high throughput molecular analyses. Pain may also be secondary to tumor extension into the celiac ganglion (most commonly seen with tumors arising in the body of the pancreas) or to liver metastases that invade the liver capsule or extend to the parietal peritoneum. Occasional patients may experience gastrointestinal hemorrhage secondary to tumor erosion into the duodenum or secondary to splenic vein occlusion causing gastroesophageal varices (sinistral portal hypertension). Therefore, imaging of the pancreas during the arterial phase is critically important to detect these lesions and their hypervascular liver metastases. However, in patients without distant metastases (or minimal liver metastases) extended resections to include complex vascular resection and reconstruction may be considered at those centers with experience in such complex operations. Accurate preoperative diagnosis and staging of the primary tumor is necessary to ensure correct treatment. While these can be very useful for follow-up, isolated elevation of marker levels is generally not sufficient for diagnosis. These markers usually can be divided into those associated with specific endocrine syndromes and those more general markers that may be present in functional as well as nonfunctional tumors. The most important of these markers, CgA, is a 49-kDa acidic polypeptide that is widely present in the secretory granules of neuroendocrine cells. Once biliary obstruction is recognized and a stent is placed in the bile duct, an operation to remove the primary tumor or bypass the site of obstruction will likely be needed; in the absence of large volume distant metastases, the patient will most likely outlive the biliary stent and experience significant stent-related morbidity. We resect localized, nonmetastatic disease confined to the pancreas if a gross complete resection can be performed. If radiographically occult liver metastases are found at the time of the operation, they are removed if possible.

The limiting factor in obtaining wide margins is usually neurovascular or doctor for erectile dysfunction in dubai , occasionally erectile dysfunction doctor , bony juxtaposition erectile dysfunction depression treatment . Because very few soft tissue sarcomas invade bone directly erectile dysfunction can cause pregnancy , bone rarely needs to be resected; periosteum can be removed to provide an adequate margin when soft tissue sarcoma abuts the bone. Similarly, perineurium can be removed with the tumor to provide margins when the tumor is directly adjacent to a major motor nerve. In rare instances, a major nerve or vascular bundle is encased by a soft tissue sarcoma. Low-grade lesions may be bivalved to preserve the nerve; however, in the case of a high-grade tumor, resection may be required. As detailed in the next section, radiation therapy should be added to limb-sparing surgery for some high-risk patients. Neoadjuvant chemotherapy or investigational approaches should also be considered for patients with high-grade lesions >10 cm and for those with synovial sarcoma or myxoid/round cell liposarcoma >5 cm (subtypes highly responsive to chemotherapy) (see "Chemotherapy for Primary Localized Extremity/Truncal Sarcoma"). A significant subset of subcutaneous and intramuscular sarcomas can be treated by wide excision alone, with a local recurrence rate of only 8% to 20%. Indeed, in a group of 159 patients with small primary tumors resected with negative margins, adjuvant radiotherapy showed no benefit: the 5-year local control rate was 77% in those selected to receive adjuvant radiation, compared to 92% in those undergoing surgery alone (p = 0. In contrast, patients with large, low-grade lesions such as atypical lipomatous tumors rarely require radiation therapy, as local recurrence rates are low (<10%) in patients treated with surgery alone. At Princess Margaret Hospital, the rate of local recurrence was significantly higher in patients who were treated after unplanned excision on the outside than in patients who received their treatment at the institution (22% versus 7%; p = 0. In these cases, the authors attempt a re-excision if at all feasible; otherwise, patients are strongly considered for adjuvant irradiation. Its use is supported Radiation Therapy for Primary Localized Extremity or Truncal Sarcoma the goals of adjuvant radiotherapy in the management of soft tissue sarcoma are to enhance local control, preserve function, and achieve acceptable cosmesis by contributing to tissue preservation. A major limitation is that the target is less precisely defined, and therefore volume is larger and dose is higher, resulting in greater late tissue morbidity. The intact vascular supply may reduce the fraction of hypoxic cells particularly at the tumor margins, which under hypoxic conditions tend to be radioresistant, and thus may decrease the dose needed compared to postoperative radiotherapy. The major drawback of preoperative radiotherapy, as detailed subsequently, is that irradiation increases the risk of acute wound complications upon surgery. Preoperative radiotherapy doubled the risk of early acute wound complication, although this observation seems to apply almost exclusively to lower limb lesions. In addition, the preoperative and postoperative arms did not differ significantly in overall survival (73% versus 67%; p = 0. Recently, a meta-analysis of pre- versus postoperative radiation in localized resectable soft tissue sarcoma suggested that the risk of local recurrence may be lower after preoperative radiation, and that the risk of metastatic spread is not increased with the delay in surgical resection necessary to complete preoperative radiotherapy. However, at 3 to 12 months after surgery, the two groups showed no differences in these rating scores. The 2-year function and morbidity results297 show deteriorating late tissue sequelae (fibrosis and edema) in patients in the postoperative arm, resulting from larger radiotherapy doses and volumes. In addition, patients who received the higher doses-most of them in the postoperative group-may eventually have a higher rate of bone fractures. Preoperative radiotherapy can focus on the extent of definable disease (determined using imaging), and the target is based on the anatomic location, containment by barriers to spread (especially intact fascial planes), and allowance for geometric uncertainty related to potential variation in patient setup and physiologic movement. Special situations must also be considered, such as lesions arising in extracompartmental spaces such as the femoral triangle, antecubital space, and popliteal space, because these lesions have the ability to extend considerable distances proximally and distally with less anatomic restraint. The radiotherapy margins should reflect this and include undisturbed tissue planes and barriers to tumor incursion. This translates into field coverage approximately 5 cm long, allowing for beam penumbra and treatment uncertainties such as patient movement. A recent Radiation Therapy Oncology Group consensus panel, after reviewing data regarding the local extension of soft tissue sarcomas, set guidelines that included 3-cm longitudinal coverage and 1. The trial compares a standard volume (5 cm longitudinal margin to gross tumor volume or 1 cm from the surgical scar, whichever is longer in the cranio­caudal direction and 2 cm axial margin) versus an experimental volume (2 cm longitudinal margin to gross tumor volume and 2 cm axial margin). The goal is to assess if a reduced volume of postoperative radiotherapy will increase limb function without compromising local control. The preoperative dose used in most institutions is approximately 50 Gy in daily fractions of 1. Generally, a postoperative boost is administered only if the surgical margins are positive, and the benefit of this boost is unclear. A different conclusion was drawn from a retrospective study at the Princess Margaret Hospital of patients with extremity soft tissue sarcoma and positive surgical margins.

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