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MD Co-morbidities in the psychiatric patient population: case finding and treatment Supervision: Prof AJM Loonen, Prof JRBJ Brouwers & Dr KTaxis Location: Delta Psychiatric Hospital Poortugaal The project will focus on co-morbidities in psychiatric patients which should receive more attention of the medical doctor and other health professionels. From earlier studies it has been shown that movement disorders, metabolic disorders and dermatological problems are undertreated in the psychiatric population. Questions to answer are: -What is the prevalence of the different co-morbidities in the psychiatric population? -What are specific problems in the different psychiatric patients groups? -What treatment option are realistic in these patients group? -Special attention is given to dermatological diseases in psychiatric patients?, because cozaar indications.
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Surgical therapy is an important part of the urologists' arsenal in the treatment of medically refractory ED. With advances in basic science research, newer pharmacological therapies and potentially future genetic therapy will slowly decrease the indications of surgical therapy. Historically, surgical therapy to treat the flaccid penis did not begin until the turn of the twentieth century. Extraordinarily, similar procedures are still being practiced today. Wooten in 1902 described the ligation of the dorsal vein of the penis as a method for restoring erections 101 ; . Penile prosthesis surgery was described in the early 1930s. 102 ; The superficially placed rigid prosthesis made from synthetic material soon followed. 103 ; It was not until the early seventies that satisfactory results were seen with the introduction of modern prosthetic devices which fit into the corpora cavernosa and provided both good functional as well as cosmetic results 102, 104, 105 ; . Penile arterial bypass surgery was first reported in the early seventies as a treatment for erectile dysfunction with many variations in technique existing in the literature. Finally, venous leak surgery was re-introduced in the early eighties to treat corporal veno-occlusive dysfunction. To this day, prosthesis surgery is considered the standard surgical treatment of erectile dysfunction except in a judiciously selected group of patients, which can be offered curative vascular surgical repair. Young patients with congenital or traumatically acquired ED may be candidates for curative surgical therapy arterial bypass or venous surgery ; . Patients with generalized penile disease should be offered prosthesis surgery. Indications for prosthesis surgery include: patients with a poor response to non-surgical therapies; inappropriate candidates for vascular surgery including generalized arterial disease, old age, heavy smokers, drug abusers, and chronic systemic disease. Patients that decline vascular surgery arterial and venous ; or decline to use non-surgical therapies can also be considered for prosthesis surgery after receiving appropriate counselling and detailed informed consent. Patients considering vascular surgery require a detailed evaluation of their pelvic and perineal vasculature. Arteriogenic erectile dysfunction is the inability to produce adequate arterial inflow to the cavernosa to achieve an erect state, while venogenic erectile dysfunction is the inability to achieve or and detrol.
Once your platelet count has recovered, your hickman line will be removed if you do not require further treatment. This is a much smaller procedure than having the line inserted. It is removed in the ward under local anaesthetic and takes approximately 10-15 minutes. Your hickman line may be removed prior to discharge. All patients have a bone marrow test 100 days after the transplant the day the marrow peripheral blood stem cells is transfused ; . This is to check the quality of the `graft` and exclude disease. Other tests to investigate the response to treatment include CT scans and x-rays for lymphomas. In order to help you with the drugs you will be given a patient-held record on which you can write the names of your drugs and how often they are taken. As your drugs can be changed, you should bring your card to all visits to the ward. When you attend the O.P. Dept or clinic you will be seen by a doctor. Your observations, including temperature, will be taken and possibly urine and throat samples. Please discuss any problems or worries you may have when you visit. It is essential to tell us about the following: s FEELING UNWELL s A FEVER s COLD SYMPTOMS s RASHES particularly if you have had an Allograft ; s DIARRHOEA particularly if you have had an Allograft ; s SHORTNESS OF BREATH s PAIN ANYWHERE s ANY BLEEDING s WORRIES ~ Are you coping? Is your partner coping? We can help with all these, and some problems can even be life threatening if not treated very soon.
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Physician: I think that sometimes we are obliged to resort to a legal route to try to get pharmaceutical companies to tow the line. Oncology Fellow: Again, the FDA does regulate directto-consumer advertising and also takes enforcement actions against companies who do not abide by their rules. Some drug companies submit their ads to the FDA before they appear in print or on television, but all are supposed to do so least simultaneously with the advertisement's appearance. In 2004, the FDA reviewed 52, 800 promotional pieces [4]. The mechanism of legal action against ads that do not provide fair balance is to send a warning letter that results in the termination of a campaign. The FDA can also ask that the drug companies undertake a corrective campaign. This happened with an advertisement for Taxotere docetaxel; Aventis Pharmaceuticals Inc. ; that was found to be misleading. Still, some feel that the FDA's oversight is not rigorous enough. Beyond the FDA, I wonder if oncology providers need to get more involved in regulating cancerrelated direct-to-consumer advertising. Social worker: It is a public health issue, no question about it. I think of the International Physicians for Prevention of Nuclear War. They came out and spoke against weapons being produced and how it affected physicians, taking the position that "we are the healers and we are telling you that you are hurting, not healing." It is hard to do that directly with drug companies, but it might be necessary and diflucan.
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