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Chew K.-K.,Keogh Institute for Medical Research | Finn J.,Center for Nursing Research | Stuckey B.,University of Western Australia | Gibson N.,University of Western Australia | And 5 more authors.
Journal of Sexual Medicine | Year: 2010

Introduction: In spite of the mounting interest in the nexus between erectile dysfunction (ED) and cardiovascular (CV) diseases, there is little published information on the role of ED as a predictor for subsequent CV events. Aim: This study aimed to investigate the role of ED as a predictor for atherosclerotic CV events subsequent to the manifestation of ED. Method: The investigation involved the retrospective study of data on a cohort of men with ED linked to hospital morbidity data and death registrations. By using the linked data, the incidence rates of atherosclerotic CV events subsequent to the manifestation of ED were estimated in men with ED and no atherosclerotic CV disease reported prior to the manifestation of ED. The risk of subsequent atherosclerotic CV events in men with ED was assessed by comparing these incidence rates with those in the general male population. Main Outcome Measure: Standardized incidence rate ratio (SIRR), comparing the incidence of atherosclerotic CV events subsequent to the manifestation of ED in a cohort of 1,660 men with ED to the incidence in the general male population. Results: On the basis of hospital admissions and death registrations, men with ED had a statistically significantly higher incidence of atherosclerotic CV events (SIRR 2.2; 95% confidence interval 1.9, 2.4). There were significantly increased incidence rate ratios in all age groups younger than 70 years, with a statistically highly significant downward trend with increase of age (P < 0.0001) across these age groups. Younger age at first manifestation of ED, cigarette smoking, presence of comorbidities and socioeconomic disadvantage were all associated with higher hazard ratios for subsequent atherosclerotic CV events. Conclusions: The findings show that ED is not only significantly associated with but is also strongly predictive of subsequent atherosclerotic CV events. This is even more striking when ED presents at a younger age. © 2009 International Society for Sexual Medicine.

Stuckey B.G.A.,Keogh Institute for Medical Research | Stuckey B.G.A.,University of Western Australia | Yeap D.,Fertility Specialists of Western Australia | Turner S.R.,Hollywood Fertility Center
Fertility and Sterility | Year: 2010

Objective: Our objective is to report observed changes in thyroid-stimulating hormone (TSH) in two patients undergoing super-ovulation for IVF. Design: Case report. Setting: Private assisted reproduction practices. Patient(s): Two hypothyroid women taking thyroxine replacement therapy undergoing super-ovulation for IVF. Intervention(s): Laboratory records for TSH taken during ovulation induction cycles were retrieved retrospectively for six cycles and measured prospectively for one cycle each in both women. Main Outcome Measure(s): To document changes in thyroid status during super-ovulation. Result(s): Despite being euthyroid at the start of the super-ovulation cycle, both patients demonstrated a rise in TSH to hypothyroid levels during ovulation induction, even in the absence of ongoing pregnancy. Conclusion(s): High circulating E2 during super-ovulation for IVF induces increased thyroxine-binding globulin binding of thyroxine. In women taking thyroxine replacement therapy, hypothyroidism develops during a superovulation cycle. Whether such acute biochemical hypothyroidism is a hindrance to ovum quality, fertilization, conception, or ongoing pregnancy and whether thyroxine dose adjustment during a super-ovulation cycle would improve IVF outcomes requires further study. These case studies identify a potential management gap in assisted reproduction for women taking thyroxine therapy. © 2010 by American Society for Reproductive Medicine.

Ong G.S.Y.,Sir Charles Gairdner Hospital | Ong G.S.Y.,Queen Elizabeth Medical Center | Walsh J.P.,Sir Charles Gairdner Hospital | Walsh J.P.,University of Western Australia | And 11 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Serum total calcium (tCa) is routinely measured for diagnosing calcium disorders but may not reflect levels of biologically active ionized calcium (iCa) in disease or detect all cases of primary hyperparathyroidism. Objective: We investigated the utility of measuring iCa and tCa for diagnosing primary hyperparathyroidism. Design: This was an observational, retrospective, cross-sectional study. Patients: We studied a biochemistry cohort of consecutive ambulatory outpatients with suspected bone or calcium metabolism disorders referred for calcium metabolism biochemistry panels and a surgical cohort of consecutive tertiary hospital patients whose parathyroid specimens were submitted to a single center, and consecutive parathyroidectomy patients of a single surgeon with specimens submitted to a different center. Results: In 5490 biochemistry cohort patients, discordance between iCa and tCa in classifying calcium status occurred in 12.6% of cases overall but was worse in hypercalcemic (whether defined by tCa and/or iCa) cases (49%) and hypocalcemic cases (92%). Reliance on tCa alone would miss 45% with ionized hypercalcemia. In 315 biochemistry cohort cases with PTH-dependent hypercalcemia, 130 (41%) had isolated ionized hypercalcemia at diagnosis. In 143 patients with histologically proven parathyroid disease, 24% had isolated ionized hypercalcemia at diagnosis. These patients were younger (P = 0.022) with milder ionized hypercalcemia and better renal function (both P ≤0.001) than patients presenting with concurrently elevated iCa and tCa. Conclusion: In abnormal calcium states, tCa frequently disagrees with iCa in classifying calcium status. Histologically proven parathyroid disease can present with isolated ionized hypercalcemia. Measurementof iCa is required to accurately assess calcium status and improve diagnostic accuracy. Copyright © 2012 by The Endocrine Society.

Kahapola Arachchige K.M.,Western Diagnostic Pathology | Wardrop R.,PathWest Laboratory Medicine | Lim E.M.,PathWest Laboratory Medicine | Stuckey B.,Sir Charles Gairdner Hospital | And 4 more authors.
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2012

Aim To assess age at which median follicle-stimulating hormone (FSH) is elevated above 10 U/L. Background Fertility and ovarian reserve decrease over the 4th decade with evidence that sensitive markers such as anti-Mullerian hormone fall even earlier. Despite its limitations, a basal or day 2-3 FSH is commonly used to assess ovarian reserve with levels over 10 U/L often used as a cut-point for further investigations. Methods Women referred to a community laboratory for 'hormone testing', including FSH and oestradiol (n = 40 254), were included in a retrospective analysis. Cases excluded were those with suppressed FSH (<1 U/L) who were likely on the oral contraceptive pill or pregnant and those with increased oestradiol (>500 pmol/L) who were likely approaching mid-cycle or pregnant. Remaining cases (n = 32 445) were analysed in five-year age bands for FSH median, mean, and 2.5 and 97.5 percentiles. Results Median FSH remained consistently low (≤5 U/L) in women a;circ35 years of age and was 6 U/L in 35- to 40-year-olds. The mean FSH and 97.5 percentile increased steadily. The 97.5th percentile was 10 U/L or lower in women up to 30 years of age. Conclusions Follicle-stimulating hormone is a late indicator of known reducing ovarian reserve, and in this study, median FSH did not increase over 10 U/L until >45 years of age. FSH levels >9 U/L were above the 97.5th percentile in those <25 years of age. If fertility is a concern, FSH levels persistently above age-specific medians in women under 40 years may prompt earlier follow-up with more sensitive tests for ovarian reserve. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Rubio-Aurioles E.,Asociacion Mexicana para la Salud Sexual A.C. AMSSAC | Kim E.D.,University of Tennessee at Knoxville | Montorsi F.,San Raffaele Hospital | Hackett G.,The Good | And 8 more authors.
Journal of Sexual Medicine | Year: 2012

Aim. To compare Sexual Self-Confidence and other treatment outcomes following 8 weeks of treatment with tadalafil 5mg once a day (OaD) vs. tadalafil 20mg or sildenafil 100mg as needed (pro re nata [PRN]) in patients with erectile dysfunction (ED). Methods. A randomized, open-label, crossover study in men ≥18 years of age with history of ED and satisfactory response to current oral phosphodiesterase 5 (PDE5) inhibitor PRN. Data were analyzed with a mixed effects model for crossover design. Main Outcome Measures. The primary outcome measure was the Sexual Self-Confidence domain of the Psychological and Interpersonal Relationship Scales (PAIRS) between tadalafil OaD and sildenafil PRN. Secondary Outcomes Included. Time Concerns and Spontaneity domains of PAIRS, and the Self-Esteem and Relationship (SEAR) scale. Results. Men naive to tadalafil OaD were enrolled (N=378), with 61-69% prior PDE5 inhibitor use. There were improvements in all PAIRS domains from baseline when comparing tadalafil OaD and PRN with sildenafil PRN (P<0.001). The Sexual Self-Confidence domain improved from baseline and was 0.50±0.78 following tadalafil OaD, 0.5±0.72 for tadalafil PRN, and 0.39±0.67 for sildenafil PRN. The difference in least-squares mean was 0.12±0.04 (confidence interval [CI]=0.04, 0.19; P=0.001) between tadalafil OaD and sildenafil PRN and 0.01±0.04 (CI=-0.06, 0.08; P=0.872) between tadalafil OaD and tadalafil PRN. The Time Concerns domain score was lower with tadalafil OaD than tadalafil PRN (P<0.001). There were no differences in SEAR scores between treatments. Conclusions. Tadalafil OaD and tadalafil PRN compared with sildenafil PRN demonstrated greater improvements in Sexual Self-Confidence, Time Concerns, and Spontaneity. There was no significant difference in Sexual Self-Confidence between tadalafil OaD and tadalafil PRN. Changes in SEAR, the erectile function domain of the International Index of Erectile Function, and the Erectile Dysfunction Inventory of Treatment Satisfaction scores from baseline to end point were similar. © 2012 International Society for Sexual Medicine.

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