No abstract

Ten male volunteers were studied in a randomized, double-blind crossover trial. Each received ketorolac tromethamine 30 mg and morphine sulphate 10 mg i.m. at an interval of 2 weeks. After a standard radiolabelled meal, gastric emptying half-time (GE) and small intestinal transit time (SIT) were measured using a gamma camera. Small intestinal transit time was measured also from end-tidal breath hydrogen (ETH), and overall gastrointestinal motility by time to first flatus (TFF). Mean GE, SIT and TFF were significantly prolonged by morphine compared with ketorolac (P less than 0.03); ETH was prolonged also, but the difference was not significant. There were no significant correlations between SIT, ETH and TFF. Most subjects reported adverse effects after morphine, but only one after ketorolac.

No abstract

To clarify the cause of their impotence, 20 diabetic patients underwent detailed assessments of: diabetic autonomic neuropathy (acetylcholine sweatspot test, pupil test‐PD%, five cardiovascular tests); vascular disease (radioisotope phallogram, response to intracorporeal papaverine); nocturnal penile rigidity; psychiatric disturbance (General Health Questionnaire). Results suggested cause as: vascular 7/20 (35%), vascular and autonomic neuropathy 7/20 (35%), autonomic neuropathy 3/20 (15%), psychiatric disturbance 2/20 (10%), beta‐blockers 1/20 (5%). The sweatspot test appeared to be the most sensitive assessment of autonomic neuropathy. Investigations suggested an alternative aetiology in all cases with a normal sweatspot test. In one patient with autonomic neuropathy, high deep‐artery velocity on Doppler but loss of papaverine‐induced erection, dynamic cavernosography revealed venous leakage; impotence was improved by surgical venous ligation. The results suggest that most impotence in diabetics has an organic basis. The sweatspot test (ideally in conjunction with cardiovascular tests and pupil test) and response to intracorporeal papaverine may identify and categorise most of these patients. Those with normal tests are unlikely to have organic disease and could be referred for psychosexual/psychiatric counselling. Doppler studies may identify those who need investigating for venous leakage. The others could then, in the first instance, be offered one of the recently described non‐invasive devices for overcoming diabetic impotence. Self‐administered intracorporeal papaverine may also be considered, but only a minority of diabetic patients seem to respond.