The aim of the present study is the definition of a brief structured interview (SI) providing scores useful for identification and quantification of pathogenetic factors of erectile dysfunction (ED). A SI was developed and applied to a consecutive series of 320 ED patients. A 13-item SI, with threefactor analysis-derived scales, was identified and applied for validation to an independent consecutive series of 194 ED patients. PGE 1 (10 lg) intracavernosal injection, penile duplex ultrasound (PDU), blood hormones, PSA, glycemia, and lipids were used for the assessment of an organic component (OC), and Middlesex Hospital Questionnaire (MHQ) modified for psychological disturbances. Scale 1, dealing with OC, showed a positive correlation with age, BMI, blood pressure, glycemia, and inverse correlation, with testosterone, PGE 1 and several parameters derived from PDU. Scale 2, related to partner's relationship, was not correlated with organic parameters. Scale 3, which measures psychopathological traits was correlated with MHQ scales. Scale 1 (43) had a sensitivity of 67.9% and a specificity of 67.6% for OC. SIEDY r provides information on ED pathogenesis and might assist physicians in diagnostic and therapeutic choices. International Journal of Impotence Research (2003Research ( ) 15, 210-220. doi:10.1038 Keywords: erectile dysfunction; anamnesis; penile duplex ultrasound; structured interview IntroductionErectile dysfunction (ED) is a relatively common multidimensional disorder that might significantly impair the quality of life. Several biological, psychological and lifestyle factors are often simultaneously present in each patient and they mutually concur in determining the disorder. 1 The correct assessment of the pathogenesis of ED is therefore rather difficult. Complex diagnostic procedures, such as intracavernosal injection of PGE 1 with or without penile duplex ultrasound (PDU) evaluation of penile vessels, cavernosometry and cavernosography, and nocturnal penile tumescence, can be very useful in the definition of pathogenetic factors underlying ED. 2 However, these procedures are rather expensive and they are not easily available in all practices. Conversely, anamnesis and physical examination can provide information accurate enough for a correct pathogenetic definition in most cases. 3 The accuracy of anamnestic information depends upon the specific experience and interviewing skills of the individual physician. In current clinical practice, structured interviews (SIs) can represent a standardized and therefore more reliable instrument, when compared to routine anamnesis.Specific self-reported questionnaires have been developed for the assessment of severity of ED. Selfreported measures of severity of ED 4,5 are widely recognized as valid instruments and are routinely used for the evaluation of the efficacy of treatments. However, attempts to use self-reported questionnaires as a means of differentiating psychogenic from organic impotence have produced mixed results. In 1975, Beutler et al 6,7 reported th...

Background and Purpose-The aim of this study was to explore the possible contribution of alterations in cerebral hemodynamics to the evolution of cognitive impairment in patients with Alzheimer disease (AD). Method-Fifty-three patients with AD were investigated. The evolution of cognitive decline over 12 months was evaluated by means of changes in Mini Mental State Examination (MMSE) and AD Assessment Scale for Cognition (ADAS-Cog) scores. Demographic characteristics, vascular risk profile, pharmacological treatment, and presence of white matter lesions were assessed at entry. Further, a basal evaluation of cerebrovascular reactivity to hypercapnia was measured with transcranial Doppler ultrasonography using the breath-holding index (BHI). Results-Of all the variables considered, both MMSE and ADAS-Cog changes had the highest correlation with BHI, followed by age and diabetes. After subdividing both cognitive measures reductions into bigger and smaller-thanaverage decline (2 points for MMSE; 5 points for ADAS-Cog), multiple logistic regression indicated BHI as the sole significant predictor of cognitive decline. Conclusions-These results show an association between impaired cerebral microvessels functionality and unfavorable evolution of cognitive function in patients with AD. Further research is needed to fully establish whether altered cerebral hemodynamics may be considered an independent factor in sustaining cognitive decline progression or an effect of pathological processes involved in AD.

The purpose of this study was to evaluate the efficacy of topiramate in the treatment of chronic migraine. This was a double-blind, randomized, placebo controlled, parallel-group study. Patients suffering from chronic migraine with analgesic overuse were randomly assigned in a 1 : 1 ratio to receive topiramate or placebo. Following a baseline phase of eight weeks, the study drug was titrated in 25-mg increments over one week to 50 mg daily. Titration phase was followed by a 8-week maintenance phase. Number of days with headache during a 28-day period was the efficacy variable. At baseline, there was no difference in the number of days with headache between patients treated with topiramate and those treated with placebo (mean +/- SD: 20.9 +/- 3.2 and 20.8 +/- 3.2, respectively). During the last 4 week-maintenance phase, topiramate-treated patients experienced a significantly lower 28-day headache frequency in comparison to those treated with placebo (mean number of days with headache +/- SD: 8.1 +/- 8.1 vs. 20.6 +/- 3.4, P< 0.0007). Topiramate at low doses proved to be an effective therapeutic approach to reduce headache frequency in patients with chronic migraine and analgesic overuse.

Routine use of LUS in the ICU setting can be associated with a reduction of the number of chest radiographs and CT scans performed.