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Vardenafil (Levitra) is a potent and selective phosphodiesterase 5 (PDE5) inhibitor used in the management of erectile dysfunction (ED). This retrospective subgroup analysis assessed the effectiveness of vardenafil treatment in men with ED of different baseline severity and disease classification.Data from two pivotal, randomized, double-blind, placebo-controlled clinical trials enrolling men from the general ED population who received placebo or vardenafil 5 mg, 10 mg, or 20 mg during a 12-week treatment period were retrospectively analysed, stratifying by psychogenic, organic, and mixed ED disease classification as determined by the investigator. Efficacy endpoints included the International Index of Erectile Function (IIEF)-Erectile Function (EF) domain score, per-patient diary response rates to questions on penile insertion [Sexual Encounter Profile (SEP-2)] and maintenance of erection (SEP-3) and rates of positive response to the Global Assessment Question (GAQ).Data from 1,385 men who received at least one dose of study medication and had pre- and post-baseline measures of efficacy available (intent-to-treat population) are presented. At baseline 37-41% of patients had severe ED, 30-34% moderate, 22% mild-to-moderate and 6-8% mild ED. At baseline, 46-51% of patients were considered to have an organic cause for ED, 13-16% psychogenic ED, and 36-38% mixed classification of ED. For all classifications and for mild-to-moderate to severe ED, men treated with 10 or 20 mg of vardenafil showed statistically and clinically significant improvements (P0.001) in IIEF-EF scores, diary response rates to the SEP-2 and SEP-3 questions, and GAQ as compared with those given placebo. The greatest improvements relative to placebo were noted in patients with more severe ED. The most common treatment-emergent adverse events were headache, flushing, rhinitis, dyspepsia, and were dose-related, mostly mild to moderate in intensity and consistent with the class.Vardenafil improves EF in men with ED irrespective of investigator-determined classification and baseline ED severity.

Oxybutynin is a drug of choice in the treatment of the detrusor instability. However the therapeutic doses given orally produce very often side effects due to oxybutynin anticholinergic properties (atropine-like action). The responsible compound is mainly the active oxybutynin metabolite-N-desethyl-oxybutynin, which is the result of the oxybutynin metabolism in liver (so-called first pass metabolism). Therefore it seems, that an attempt of the drug administration via the intrarectal route is an interesting alternative, which maintains the high oxybutynin concentration with the simultaneous reduction of the N-desethyl-oxybutynin.We qualified 20 patients for our study (12 men and 8 women, mean age 45.6) with the urodynamically proven detrusor instability. Patients with a neurogenic origin of detrusor instability were excluded from the study. Patients treated with oral oxybutynin in a dose of 5 mg b.i.d. and with strongly pronounced atropine-like side effects, making impossible the continuation of the therapy were offered an intrarectal form of oxybutynin in a dose of 5 mg b.i.d. Treatment efficiency was evaluated on the base of the patients symptoms (side effects, urgency, incontinence, frequency).15 patients (75%) had pronounced side effects, leading to the oral treatment discontinuation. The average time of the oral oxybutynin treatment was 1.5 weeks (3 days to 4 weeks). During the oral therapy these patients complained of the side effects of different magnitude: dry mouth (15 patients--100%), gastro-intestinal disorders (3 patients--20%), drowsiness (1 patient--6.7%). These side effects forced them to stop the oxybutynin oral therapy. After the change of the drug form from oral to the intrarectal one, none of the patients resigned from the treatment. 13.3% of the patients complained of the mild intensity dry mouth. After the one-month therapy period a complete disappearing of the unstable detrusor symptoms was reported by 5 patients (25%), while all others reported their significant reduction.The intrarectal oxybutynin administration shows the therapeutic efficacy comparable with the intravesical administration with reference to unstable detrusor symptoms reduction. Intrarectal administration reduces the oxybutynin side effects in comparison with the oral one.

We prospectively evaluate the safety, morbidity and complication rates for first and repeat transrectal ultrasound guided prostate needle biopsies.In this prospective European Prostate Cancer Detection Study 1,051 men, with total prostate specific antigen between 4 and 10 ng./ml., underwent transrectal ultrasound guided sextant biopsy plus 2 additional transition zone biopsies. Biopsy samples were also obtained from suspicious areas identified during transrectal ultrasound and digital rectal examination. All 820 patients with biopsy samples negative for prostate cancer underwent re-biopsy after 6 weeks. Immediate and delayed (range 1 to 7 days) morbidity, patient satisfaction and complication rates were recorded.Of the 1,051 subjects the initial biopsy was positive for prostate cancer in 231 and negative, including benign prostatic hyperplasia or benign tissue, in 820. Of these 820 patients prostate cancer was detected in 10% (83) on re-biopsy. Minor or no discomfort was observed in 92% and 89% of patients at first and re-biopsy, respectively (p = 0.29). Immediate morbidity was minor and included rectal bleeding (2.1% versus 2.4%, p = 0.13), mild hematuria (62% versus 57%, p = 0.06), severe hematuria (0.7% versus 0.5%, p = 0.09) and moderate to severe vasovagal episodes (2.8% versus 1.4%, respectively, p = 0.03). Delayed morbidity of first and re-biopsy was comprised of fever (2.9% versus 2.3%, p = 0.08), hematospermia (9.8% versus 10.2%, p = 0.1), recurrent mild hematuria (15.9% versus 16.6%, p = 0.06), persistent dysuria (7.2% versus 6.8%, p = 0.12) and urinary tract infection (10.9% versus 11.3%, respectively, p = 0.07). Major complications were rare and included urosepsis (0.1% versus 0%) and rectal bleeding that required intervention (0% versus 0.1%, respectively). Furthermore, an age dependent pattern of pain apprehension during biopsy was observed with the highest scores in patients younger than 60 years.Transrectal ultrasound guided biopsy is generally well tolerated with minor morbidity only rarely requiring treatment. Re-biopsy can be performed 6 weeks later with no significant difference in pain or morbidity. Patients younger than 60 years should be counseled in regard to a higher level of discomfort, and local and topical anesthesia if desired.

The impact of unfunded medical research (ie, research conducted with no visible means of support) has received scant attention. In this study, we counted research contributions from the 10 most-cited journals in the fields of internal medicine, pathology, and surgery. Ten consecutive articles, excluding case reports and review articles, for the years 1987, 1989, and 1991 were sampled from each of 10 journals for the three areas of medicine. Unfunded articles accounted for the majority of contributions (60% of pathology articles, 62% of internal medicine articles, and 74% of surgery articles). In 1987, funded research articles published received somewhat more citations (2,961) than unfunded research articles (2,368). Among articles supported by an NIH grant, the first author of the article was seldom the grant's principal investigator (38.6%, 26.9%, and 16.7% of funded articles by pathologists, internists, and surgeons, respectively). These results indicate that unfunded research plays a major role in medical research.

The following letter was received after the authors had written their reply .—Ed. To the Editor. —The article entitled "Who Pays for Published Research?" by Stein et al 1 fails to cite our previously published contributions, in which we examined publications (520 articles) in six popular pathology journals and three general science journals. 2,3 Unfunded research (research not supported by a competitive grant) represented the vast majority of research produced by pathologists, accounting for 84% of published articles. Unfunded articles published in 1987 averaged 10.4 citations per article compared with 8.7 citations per funded article. In this study, there were 47 articles first-authored by pathologists that listed a source of funding. Twenty of those articles were funded by NIH grants. Publicly available grant listings were searched to determine the names of the principal investigator of the NIH grants listed. Only four of the 20 NIH-funded publications were first-authored by

A case of calicopyelocystostomy and one of pyelocystostomy are reported. In the first case, the operation was performed on an autotransplanted kidney. The operation was done in a patient with sponge kidney to facilitate spontaneous excretion of calculi. In the second case, the operation was performed in a patient with long-lasting urinary fistula which developed in a cadaver kidney transplant. Although the authors present only 2 cases, calicopyelocystostomy and pyelocystostomy can be recommended as a valuable method in complicated cases of recurrent nephrolithiasis and in patients with nonhealing long-lasting urinary fistulas which developed in transplanted kidneys.

The Velodyne HDL-32E laser scanner is used more frequently as main mapping sensor in small commercial UASs. However, there is still little information about the actual accuracy of point clouds collected with such UASs. This work evaluates empirically the accuracy of the point cloud collected with such UAS. Accuracy assessment was conducted in four aspects: impact of sensors on theoretical point cloud accuracy, trajectory reconstruction quality, and internal and absolute point cloud accuracies. Theoretical point cloud accuracy was evaluated by calculating 3D position error knowing errors of used sensors. The quality of trajectory reconstruction was assessed by comparing position and attitude differences from forward and reverse EKF solution. Internal and absolute accuracies were evaluated by fitting planes to 8 point cloud samples extracted for planar surfaces. In addition, the absolute accuracy was also determined by calculating point 3D distances between LiDAR UAS and reference TLS point clouds. Test data consisted of point clouds collected in two separate flights performed over the same area. Executed experiments showed that in tested UAS, the trajectory reconstruction, especially attitude, has significant impact on point cloud accuracy. Estimated absolute accuracy of point clouds collected during both test flights was better than 10 cm, thus investigated UAS fits mapping-grade category.

Choosing appropriate landslide-controlling factors (LCFs) in landslide susceptibility mapping (LSM) is a challenging task and depends on the nature of terrain and expert knowledge and experience. Nowadays, it is very common to use digital elevation model (DEM) and DEM-derivatives, as a representation of the topographic conditions. The objective of this study is to explore topography in depth and simultaneously reduce redundant information within DEM-derivatives using principal component analysis. Moreover, this study investigates the impact of DEM-derived factors on LSM. Therefore, three various strategies were tested. The first strategy included a set of LCFs created from the four initial principal components, which were provided from DEM-derived factors. The second strategy included a set of parameters which contained additional lithological and environmental factors. The third strategy utilises the analytical hierarchy process (AHP) to assign weights to each LCF. The LSM was performed based on landslide susceptibility index. Obtained results show that 60% of existing landslides fell into high and very high susceptibility zones using first and second strategies. It proves that topographic factors play a significant role in LSM. Adding additional lithological and environmental factors to the set of LCFs did not improve the results significantly, unless the AHP was used in the third strategy. It improved results significantly; up to 70%. Results from second and third strategies highlight utility of AHP in LSM. Presented studies were performed on the area very prone to landslide occurrence in the region of Roznow Lake, Poland.

Calicocystostomy or calicopyelocystostomy was performed for the treatment of hydronephrosis of ectopic or transplanted kidney into the region of the iliac fossa. To the best of our knowledge there is no description of this treatment modality for hydronephrosis in a normally situated kidney. This prompted us to present 2 such cases observed in our clinic.

The late results of surgical treatment of pyeloureteral junction stenosis are reported for 5 patients with pelvic ectopy of the kidney. In all cases the results were good.

Regeneration of the ureter from a strip of healthy wall is well known. Regeneration after loss of the whole is an unusual phenomenon. A case of regeneration is presented after complete loss of 2.5 cm. Urography 1-5 years afterwards showed a normally functioning kidney. Bibliography of experimental and clinical work is discussed.

An original method for vaginal reconstruction, using a pedunculated bladder wall flap is described. The method can be applied for vaginal reconstruction in cases of congenital absence or hypoplasia, as well as in cases of male transsexualism. 4 patients have been operated by this method without complications. In 2 patients, with 11 and 8 months follow-up, the results are satisfactory. The authors clearly describe the technical method of operation.

Postirradiation rectovaginal fistula is a complex problem in colorectal surgery. The modified Parks procedure curettage of rectal mucosa heavily damaged by radiation is introduced. Fifteen cases of coloanal sleeve anastomosis for the repair of rectovaginal postirradiation fistula are described. All patients previously were irradiated heavily because of carcinoma of the uterine cervix. Three patients had simultaneous repair of vesicovaginal fistula. One postoperative death was observed. Of the surviving patients, functional results have been good in 11. In the seven patients with difficult stripping of the rectal mucosa, surgical curettage was performed. The latter procedure is suggested as the method of choice in relevant cases.