Postoperative complications were classified according to the Clavien-Dindo classification of surgical complications and the grades of complication were recorded. Bladder evacuation disorder was defined as urinary incontinence or incomplete evacuation necessitating catheterization >4 weeks

after surgery. Postoperative sexual dysfunction was defined as new onset erectile and/or ejaculatory dysfunction in male patients and as impairment of vaginal lubrication in female patients. The data was collected using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire at 24 months after initial surgery. The costs Inhibitors,research,lifescience,medical of the two operations were estimated by summing up the market Inhibitors,research,lifescience,medical value of theater time, disposable instruments used, and hospitalization service charge. After discharge, follow-up was arranged regularly for buy Lapatinib clinical examination and carcinoem-bryonic antigen (CEA) test at 3-month intervals in the first two years and at 6-month intervals thereafter. The ultrasonography or imaging was not

routinely performed. This was only indicated when there was a clinical suspicion of disease recurrence or when CEA level increased over time. Local recurrence of cancer was defined as the radiologically evidence of tumor recurrence Inhibitors,research,lifescience,medical and/or histologically proven tumor within the operation field. Local recurrence in combination with distant recurrence was also considered as a local recurrence Inhibitors,research,lifescience,medical event. Distant metastases were defined as any recurrence occurring outside the pelvis. Pathological evaluation The rectal specimen was examined in the operation room by the surgeon to assess the distal resection margin and was then sent fresh to the histopathological department, where it was pinned on a cork board. The surface of the mesorectum was inked before slicing to assess the circumferential resection margin. Inhibitors,research,lifescience,medical Microscopic assessment included tumour infiltration through the bowel wall (T), the presence of positive lymph nodes (N), and analysis of the distal and circumferential resection margins. The circumferential resection margin was considered to be positive if it was <1 mm. Statistical analysis

Data were analyzed using the SPSS 16.0 software (SPSS, Chicago, IL, USA). The chi-square test was used for categorical variables. The Student t test or Mann-whitney U test were used for parametric and nonparametric continuous variables. Survival was calculated using the Kaplan-Meier method, and comparison between survival curves was performed using and the log-rank test. Statistical significance was defined as P<0.05. Results Characteristics of patients Between January 2005 and January 2008, 197 patients with rectal cancer were deemed eligible for participation in the study. Seventy five patients were excluded. The remaining 122 patients were allocated to rectal resection via a minilaparotomy (n=65) or via the laparoscopic approach (n=57). The consort flow chart is presented in Figure 3. Figure 3 The consort diagram of patient flow.

There was no follow-up after 24 hours of admission, so actual survival until hospital discharge was unknown. The reason for this was the transportation of patients to hospitals out of the primary HEMS region. Conclusion The HEMS of the eastern part of the Netherlands provides essential additional medical expertise not provided by the EMS. The only formal paediatric indication for HEMS at this moment is the paediatric cardiopulmonary resuscitation. This study calls for a lower threshold for HEMS activation in any serious incident involving

children, preferably based on the type of primary emergency call. Sixty-five percent of Inhibitors,research,lifescience,medical the vitally compromised selleck chemicals children received a preclinical medical procedure restricted to a physician, 78% received a medical procedure for which a physician was more experienced. The majority of all patients encountered by the HEMS had a NACA score of IV-VII. As Inhibitors,research,lifescience,medical the younger patients had a higher NACA score, special attention should be given to training and the provision of advanced life support procedures for younger children. Successful endotracheal intubation Inhibitors,research,lifescience,medical and subsequent appropriate ventilation in children is a difficult task for EMS paramedics; preclinical

endotracheal intubation of children calls for an experienced physician. The use of intraosseous access devices and the use of analgesics by EMS paramedics could be improved. Further investigation into the pre-hospital care for vitally compromised children is necessary. Key Messages • The HEMS of the eastern part of the Netherlands provides essential additional Inhibitors,research,lifescience,medical medical expertise not provided by the EMS. • The majority of all patients encountered by the HEMS had a NACA score of IV-VII. • A substantial proportion of all

endotracheal intubations by EMS paramedics resulted in potentially Inhibitors,research,lifescience,medical lethal complications. • The use of intraosseous access devices and the application of analgetics in the field can be improved. Abbreviations EMS: Emergency Medical Service; HEMS: Helicopter Emergency Medical Service; NACA: National Advisory Committee for Aeronautics; SPSS: Statistical Package for the Social Sciences; ALS: Advanced life support; GCS: Glasgow Coma Scale; CPR: Cardiopulmonary resuscitation; SD: Standard deviation. Competing interests The authors declare that they have nearly no competing interests. Authors’ contributions BMG: main author, design of study. AS: data acquisition, design of research data base. BJP: statistical analysis, scientific structure. GJS: expert in anaesthesiology and critical care, medical reviewer. JMD: expert in emergency paediatric care, medical reviewer. All authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/10/6/prepub Acknowledgements No acknowledgements, no funding or grant was received for this study.

.. B-cell interactions with the innate immune system, such as those mediated by the presence of toll-like receptors (TLRs), play a key role in CMP. This tight relationship is of great significance because data have shown that when there is over-activation of B-cell and TLR-mediated pathways, inflammation and pathogenesis develops — as demonstrated in atherosclerosis, Inhibitors,research,lifescience,medical viral myocarditis, and septic CMP5, 6

— as well as maladaptive ventricular remodeling after myocardial infarction in mice.7 Thirteen TLRs have been identified, and one of specific importance is TLR-4, which is up-regulated in heart failure.8, 9 Other significant interactions with the innate immune system occur via myeloid differentiation factor Inhibitors,research,lifescience,medical 88 (MyD88) and interleukin-1 receptor-associated kinase 4 (IRAK-4), which determines the formation of mature, antibody producing plasma cells.6 Maladaptive signaling mechanisms via this pathway also are linked to cardiac fibrosis during progression to heart failure.10 Another potential

contributor from the innate immune system is interferon regulatory factor-3 (IRF-3), which is an important Inhibitors,research,lifescience,medical mediator of interferon gamma (IFN- ) synthesis. In an angiotensin-II-induced hypertension mouse model, decreased fibrosis was observed in mice lacking IRF-3 expression (IRF-3-/-) when compared to wild type.11 There are three roles that the B-cell performs during the immune response activation phase that also are relevant to the heart failure state. One role is the interaction with T-cells, specifically T helper (Th1) cells, Inhibitors,research,lifescience,medical to stimulate the production of circulating cytokines, which can affect contractility as well as adverse remodeling and have a great impact on prognosis and outcomes.12-15 Even though the interaction with T-cells remains important for the production of cytokines, Vorinostat order B-cells also can act in a T-cell independent way. This observation Inhibitors,research,lifescience,medical is supported by recent findings from our group demonstrating that nude/athymic

(nu-nu) mice, which lack T-cells, develop a severe, acute CMP similar to that observed in wild-type mice in a nonischemic CMP mouse model (unpublished data). The second role in heart failure, occurring when B-cells are activated, is to produce direct injury via apoptotic signaling pathways and complement-mediated cytotoxicity.16 This firmly correlates with the Methisazone observation that activated B-cells are upregulated during episodes of acute decompensated heart failure and then return to basal levels once it resolves.14 The third role in heart failure occurs when B-cells are activated and can become memory B-cells. These memory B-cells form a secondary response when they encounter the same antigen; the resulting response is greater, much stronger, and can eventually cause more damage.

5 Unmodified ECT was indeed associated with serious complications such as extremity fractures and compressive spinal fractures. However, for more than 50 years ECT has been administered under general anesthesia with neuromuscular relaxants, and this has eliminated these serious complications.6 Interestingly, the fear of permanent braindamage caused by ECT was recently placed Inhibitors,research,lifescience,medical in a different

perspective by reports that ECT might actually increase new neuron growth (neurogenesis) in the hippocampus.7 In order to minimize short- and longer-term memory deficits associated with ECT, major research efforts have been invested in trying to limit the stimulus path and to adapt the stimulus intensity to the seizure threshold of the individual patient.8 There are two main modalities of ECT, differentiated by electrode placement: bilateral and unilateral ECT In bilateral Inhibitors,research,lifescience,medical ECT the electrical stimulus traverses both cerebral hemispheres, while in unilateral ECT only the nondominant cerebral hemisphere is stimulated. In both cases, effective treatment requires that a generalized seizure be elicited. Although unilateral ECT results Inhibitors,research,lifescience,medical in fewer cognitive adverse effects, its efficacy relative to bilateral ECT was a source

of controversy for many years.9 Recently, Sackeim and colleagues found that high-Sepantronium Bromide nmr dosage unilateral ECT (electrical dosage 500% above seizure threshold) and moderately suprathreshold bilateral ECT (electrical dosage 150% above seizure threshold,) are equivalent in response rate.10 Importantly, high-dose unilateral ECT is not associated with increased cognitive adverse effects. These findings underscore an important basic concept in ECT: although the seizure may seem to be an all-or-none Inhibitors,research,lifescience,medical event, not every generalized seizure has antidepressant properties. Stimulus intensity relative to threshold is a major factor in the efficacy of the therapy.11,12 Technique of ECT administration Pretreatment evaluation includes complete medical history, physical, neurological, Inhibitors,research,lifescience,medical and preanesthesia examinations, and relevant laboratory tests. Patients’ concurrent medications should be noted, since they might affect the

seizure threshold or interact with other medications used during ECT (Table I). Pretreatment preparations include 6- to 12-hour fasting, removal of dentures or other foreign objects from the patient’s mouth, insertion of a bite block into the mouth, and preoxygenation (100% O2 at a rate of 5 L/min). Table I. Drug coadministration with electroconvulsive therapy Anesthetic Adenosine agents should induce rapid unconsciousness and recovery and minimally affect hemodynamic parameters or seizure threshold.18 The most commonly used anesthetic is methohexital (0.75 to 1.0 mg/kg), due to its rapid onset, short duration of action, minimal anticonvulsive effect, and rapid recovery.19 Other anesthetics include thiopental, propofol, and etomidate. A muscle relaxant agent is administered 1 to 2 minutes after the anesthetic agent.

The main finding is that there were no deaths. Two cases of serious cardiotoxicity were reported,

but one was associated with concomitant chlorpromazine and the other with thioridazine. In another large case series of 235 patients admitted to the Edinburgh Royal Infirmary following Afatinib venlafaxine overdose, no deaths were reported, although a dose-dependent relationship between venlafaxine ingestion, Inhibitors,research,lifescience,medical tachycardia and corrected QT interval (QTc) prolongation was found and arrhythmias were documented in three patients [Howell et al. 2007]. Prolongation of the QT interval is associated with an increased risk of the potentially lethal cardiac arrhythmia, torsades de pointes, a risk that increases with the use of QT prolonging drugs [Anderson et al. 2002]. No cases of torsades Inhibitors,research,lifescience,medical de pointes were reported in this study and to the authors’ knowledge no cases have been published in the literature, although two cases have been reported on the ADROIT database [MHRA, 2012] neither of which were fatal. The analysis by Howell and colleagues used Bazett’s formula to calculate the QTc for heart rate. This is reported to overcorrect at higher heart rates [Desai et al. 2003] and, as venlafaxine is associated with tachycardia in overdose,

this may have influenced the findings in this study. Further case series of 96 cases of venlafaxine Inhibitors,research,lifescience,medical overdose [Kelly et al. 2004]and 51 cases of venlafaxine overdose [Whyte et al. 2003] also did not report any deaths on venlafaxine. The data reported by Whyte and colleagues have now been expanded, and venlafaxine overdoses for which ECGs Inhibitors,research,lifescience,medical were recorded were available for 273 patients on 369 occasions [Isbister, 2009]. No deaths were reported and venlafaxine was only found to cause minor abnormalities in the QT and QRS interval, unlikely to be associated with major arrhythmias except possibly with large doses. There are some data associating large

overdoses of venlafaxine with cardiotoxicity [Bosse et al. 2008; Hojer et al. 2008]. In a retrospective Inhibitors,research,lifescience,medical cohort study of 36 cases of venlafaxine self-poisoning and 44 randomly selected SSRI self-poisoning cases admitted to an emergency department in Australia, one death was reported in the venlafaxine group [Chan et al. 2010]. This patient had ingested 12,600 mg of venlafaxine XR with propanolol, much alcohol and amphetamine. No deaths were reported in the SSRI group. No clinically relevant changes in QT interval were noted. In this study venlafaxine was found to be prescribed preferentially in patients at a higher risk of serious suicide attempt. Duloxetine There are far fewer published cases on duloxetine overdoses. Two individual reports of overdoses on duloxetine have been reported [Kruithof et al. 2011; Menchetti et al. 2009]. Neither case was fatal.

PSA velocity was decreased in 74% of those with metastases and 52% of those with only biochemical recurrence. In those with metastases, the high-dose group (n = 10) compared with the low-dose group (n = 24) had improved PSA velocity response (80%

response vs 67% response), time to progression (3.7 months vs 2.3 months), and overall survival (34.9 months vs 24.0 months; P = .33) (Figure 2). Although this survival advantage was not statistically Inhibitors,research,lifescience,medical significant, the expected median survival of the metastasis group was 19.5 months. Subsequently, the GVAX program was halted when a phase III study demonstrated no survival benefit in the GVAX arm when compared with decetaxol in patients with metastatic hormone Inhibitors,research,lifescience,medical refractory disease. Figure 2 (A)Progression-free survival and (B) overall survival in hormone-refractory prostate cancer patients receiving high-dose versus low-dose GVAX prostate cancer vaccine. Reproduced with permission from Small EJ et al.21 Other allogenic tumor cell vaccines have been evaluated in phase I trials. Michael and colleagues22 used 3 cell lines (LnCaP, P4E6, and OnyCap23) to vaccinate 26 men with HRPC and no detectable metastases.

Each patient received 8 × 106 irradiated cells from each cell line combined in 1 vaccine, with the first 3 doses occurring at 2-week intervals and then Inhibitors,research,lifescience,medical monthly for a total of 12 months. BCG was used as an adjuvant for the first 2 doses. The vaccine was well tolerated, with grade 1 to 2 local site reactions, arthralgias, rash, and gastrointestinal

symptoms. Eleven patients (42%) had statistically significant decreases in PSA level. Median time to disease Inhibitors,research,lifescience,medical progression was 58 weeks, compared with 28 weeks in historical controls. More recently, Brill and coworkers23 performed a dose-escalating phase I trial using LnCaP cells selleckchem transfected with IL-2 and interferon γ. A total of 6 men with metastatic HRPC were treated in 2 dose groups. Inhibitors,research,lifescience,medical Of the 3 high-dose patients, 2 had a greater than 50% decrease in PSA. The time to PSA progression in GBA3 these 2 patients was 322 and 693 days. The promising results in these initial investigations support the utility of tumor cell vaccines in prostate cancer treatment. Viral Vaccines Gene therapy has merged with immunotherapy to induce immunoreactivity and antitumoral response in patients with prostate cancer. The approaches used in this merger have included both DNA and viral vaccines, and often immunomodulatory agents have been added to amplify the response. The most extensive studies in this area have been PSA-based vaccines. The fact that PSA has localized expression to the prostate and increased levels in most prostatic adenocarcinomas makes it a prime target, though its expression in normal tissues leads to tolerance. Such tolerance needs to be overcome to develop an effective immune reaction.

In this paper, we report the development of a psychotic depressive episode after using varenicline for smoking cessation in a patient with the diagnosis of bipolar disorder. Case presentation A 47-year-old male was admitted to our psychiatry outpatient clinic with the symptoms of insomnia, agitation, and suicidal ideations during the last 4 days before his admission. His initial examination revealed paranoid ideas about his wife’s deception. He was arguing with his wife and was trying to keep her in their house. He was repeatedly calling his siblings due to his ideas and feelings that bad things might happen to them. He had been

suffering Inhibitors,research,lifescience,medical from severe insomnia during the previous 4 days. He also described suicidal ideas racing in his mind. He did not attempt any suicide during this period. The patient described that his complaints had Inhibitors,research,lifescience,medical acutely begun after an increase in the daily dose of oral varenicline tablets which was prescribed to him 10 days before by a smoking cessation clinic. He was prescribed 1 mg/day varenicline in the first week of his treatment, and then the dose was find more increased to 2 mg/day. Thus, he had been using 2 mg/day oral varenicline tablet for the last 3 days when he first presented to our psychiatry outpatient clinic. During the initial days, the patient’s

tobacco consumption dropped from Inhibitors,research,lifescience,medical 25 Inhibitors,research,lifescience,medical to 10 cigarettes/day. However, he had started to experience mild agitation. Other psychiatric symptoms such as insomnia, paranoid ideas and suicidal ideas had emerged on day 7. His past psychiatric history revealed the diagnosis of bipolar disorder for the last 25 years. His first episode was depressive which necessitated hospitalization. Then he was treated for 12 manic or hypomanic episodes and 7 depressive

Inhibitors,research,lifescience,medical episodes until his admission. His last episode was 3 years ago, depressive in nature and he had responded well to 400 mg/day oral amisulpirid. He was under 200 mg/day oral amisulpirid treatment when he was admitted to our clinic. He had a cousin who committed suicide in his twenties most probably due to a depressive episode. His medical history was nonsignificant. In his mental state examination he was oriented Isotretinoin to time, person, and place. His associations were slow, however, psychomotor agitation was easily recognized. His thought content included paranoid, depressive, and suicidal ideas. He was apparently dysphoric during his interview. In light of all of the available data presented above, the patient was diagnosed with bipolar disorder (current episode is depression with psychotic features) according to the DSM-IV diagnostic criteria. Then, varenicline was immediately stopped because it was considered as a triggering and maintaining factor in the current episode of the patient. He was prescribed 600 mg/day dose of quetiapine extended release oral tablets.

These findings may be explained by the different periods of application of EPDS or the different culture backgrounds.32 The load of presentation of a major depressive symptom is a culture-bound phenomenon with somatic presentation is prominent in the eastern and mental presentation in western societies,34 and this may be explained by Inhibitors,research,lifescience,medical the differences in the findings from explanatory factor analysis of this scale in different studies. Although the first validation study,13 suggested the 9/10 as the cut-off score for use of the scale in the community surveys and screening, the 12/13 threshold was

more useful in the clinic assessment of the postnatal depression.35 Berle et al.16 reported a cut-off point Inhibitors,research,lifescience,medical of 11, a sensitivity of 96%, a specificity

of 78%, and positive predictive value of 59%, and negative predictive value of 62%, which are somehow different from our results. In Spain the EPDS cut-off point was reported as 13.5 with a sensitivity of 84% and a specificity of 79%.17 A cut-off of 11/12 was reported as more suitable for screening a French population,36 Inhibitors,research,lifescience,medical and a cut-off score of 8/9 with a sensitivity of 94.4% and a specificity of 87.4% was more appropriate in an Italian population.37 In the present study, the ATM Kinase Inhibitor solubility dmso optimal sensitivity of 78%, specificity of 75%, and the area under the curve of 0.84 (CI 95%: 0.77-0.90), which was obtained by ROC curve with cut-off point of 13 in HDRS, allows the use of this score in the community screenings. Given the false positivity of EPDS and the importance Inhibitors,research,lifescience,medical of differentiating various forms of major depression by clinical interviews for different managements, our choice of cut-off point score was mandated by the need to screen mothers Inhibitors,research,lifescience,medical rather than to definite diagnosis of depression. Therefore, we propose a clinical interview for definite diagnosis of MDD in those with a score of above 12 in EPDS. The present study suffers from the fact that the prevalence rate of 18.3% for postnatal depression that we achieved is more than the average prevalence rate of 13% reported by O’hara in a meta-analysis

of 59 studies.10 This may through be a limitation for the positive and negative predictive values of this version. However, the similarity of our prevalence rate with other studies in Iran,38 might support our findings that the rate of depression might be higher in Iran. Conclusion The findings of the present study indicate that the Persian version of the EPDS has a satisfactory reliability and factor analysis indicated by two components. Receiver operating characteristic curve analysis versus HDRS provides the score of 12 as the best cut-off point for PPD screening in Iranian society. Acknowledgment We are grateful to all participants and staff of local health centers, who helped us to conduct this study.

This is consistent with other reports in the literature. How common is

erectile dysfunction after RP? Jason D. Engel, MD: One of the problems in answering this question has been the moving target that the reporting of postprostatectomy ED has been in the literature. The most commonly accepted definition of potency is an erection adequate for intercourse with or without the use of a PDE-5 inhibitor. Using this definition, a highly experienced surgeon can show potency rates of nearly 90% at 1 year. However, most of these men will not Inhibitors,research,lifescience,medical report themselves as potent. Using validated surveys, which are a much stricter format, you almost always find that nearly 50% of men will have significant ED at 1 year. I tell all Inhibitors,research,lifescience,medical of my patients before surgery that all men will have severe ED after surgery, and that this will persist for a minimum of 6 months. Some men will start to have return of function at that point with help, but only 50% to 60% of men with good erectile function before surgery will consider themselves fully potent at 1 year. This scenario gives a much more realistic picture to Inhibitors,research,lifescience,medical the patient, and creates a setting whereby the patient realizes he and his partner will have to manage expectations. Herbert Lepor, MD: I agree with this perspective. Some experts

will report potency rates of 90%, but this is only in a highly selected group and, often, validated, self-administered questionnaires are not used to assess potency. In our reported series,4 a 50-year-old Inhibitors,research,lifescience,medical man with

excellent baseline erections and no cardiovascular risk factors who undergoes bilateral nerve-sparing surgery will have over an 80% likelihood of recovering erectile function. However, our series also included men who are 70 years of age, who, despite being classified as potent at baseline, Inhibitors,research,lifescience,medical have only fair erections and cardiovascular risk factors. For these men, a potency rate of 30% to 40% is more realistic. The surgeon must reconcile that providing unrealistic expectations will lead to dissatisfied patients. Andrew McCullough, MD: Some degree of through ED is almost universal after RP. One of the clear problems is the definition of ED after RP. RP is one of the most commonly performed open procedures during urologic residency, and it has become apparent that many factors are involved in a successful erectile outcome after surgery. Preoperative, intraoperative, and postoperative issues all influence outcome. Until 1992 and the National Institutes of Health (NIH) consensus selleck chemicals position paper on ED,5 there was no uniformly accepted definition of ED. Many of the articles published on post-RP ED before and after 1992 did not use uniform or standard definitions or validated questionnaires in reporting their rates of erectile function preservation. The first simple and validated questionnaire used by urologists was introduced by O’Leary and coworkers6 in 1995.

43 Although current data seem promising, more placebo-controlled trials must be undertaken to gain a better understanding of the role of ESWT in PD treatment. Transdermal Electromotive Administration: Iontophoresis Iontophoresis is the transport of ions through tissue by means of an electric current. Levine and associates noted that verapamil was found within the exposed tunica albuginea from patients after a single intraoperative exposure during plaque incision and grafting surgery.44 Di Stasi and colleagues reported on

a prospective, randomized study of 96 patients treated with verapamil, 5 mg, plus dexamethasone, 8 mg, using iontophoresis versus 2% lidocaine delivered electromotively. Objective improvement of plaque Inhibitors,research,lifescience,medical size and penile deviation was noted in 43% of the verapamil and dexamethasone group. Patients in the lidocaine group reported no changes.45 In 2007, Greenfield and colleagues reported on their experience with the use of verapamil, 10 mg, versus saline iontophoresis. Approximately 65% of the verapamil group and 58% of the saline group reported Inhibitors,research,lifescience,medical improvement in curvature (mean 9.1°; vs 7.6°; in the verapamil and saline groups, respectively). The authors concluded

that the electrical current itself might have some beneficial effect on the wound healing. The initial findings have been promising; selleck kinase inhibitor However, no new data have been Inhibitors,research,lifescience,medical published. Further investigation into iontophoresis is needed to clarify its role as a treatment modality for PD.46 Penile Traction Systems Traction therapy is a relatively new therapy option for urological problems. However, it has a long history Inhibitors,research,lifescience,medical of use in other areas of medicine such as orthopedics. Initial results on the efficacy and safety of penile traction were first reported in 2001.47 The penile traction device was used for at least

4 hours per day for a total treatment period of 3 to 6 months. A decrease in mean Inhibitors,research,lifescience,medical erect curvature of 14°; was seen. The downsides of the study were a small cohort of patients and no control group. In 2008, Levine and associates reported the results of a study of 11 men with PD who underwent penile traction therapy. Patients were instructed to wear the device for a minimum of 2 hours per day but were encouraged to increase the duration of use to a maximum of 8 hours per day. Treatment was continued for 6 months. Every 2 weeks the penile extender Tolmetin rods were lengthened by 0.5 cm and an evaluation of penile length was performed. A total of 10 men completed the study. Improvements in length and curvature were reported from all patients, 0.5 to 2.5 cm and 10°; to 45°; (mean, 22°;), respectively. No side effects were noted. Patients reported a high satisfaction and an improvement of the IIEF score.48 On the other hand, Gontero and colleagues published their results with a penile traction device and could not confirm the promising findings that were seen by Levine and associates.