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cavernosum with a vasoactive drug combination for vasculogenic impotence J Urol 1985;133:39 41 Zorgniotti AW: Experience with buccal phentolamine mesylate for impotence Int J Impotence Res 1994;6:37 41 Goldstein I, Ferguson D Vasomax study group: Ef cacy and safety of oral phentolamine (VasomaxTM) for the treatment of erectile dysfunction using a crossover study design Int J Impotence Res 1998;10: (Suppl3),S61 Porst H, Derouet H, Idzikowski, et al Oral phentolamine (Vasomax ) in erectile dysfunction Results of a german multicenter-study in 177 patients Int J Impotence Res 1996;8:No3,117 Zorgniotti AW, Lizza EF Effect of large doses of the nitric oxide precursor L-arginine on erectile dysfunction Int J Impotence Res 1994;6:33 36 Mathers M, Klotz T, Bloch W, et al Effectiveness of oral L-arginine in the treatment of impotence in a prospective, randomized cross-over study Eur Urol 1999;35(Suppl 2), 67 Chen J, Wollman Y, Chernichovsky T, et al Effect of administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized, placebo- controlled study BJU International 1999;83:269 273 Sikora R, Sohn MH, Engelke B, et al Randomized placebo-controlled study on the effects of oral treatment with gingko biloba extract in patients with erectile dysfunction J Urol 1998;159:No5,(Suppl240) Choi HK, Seong DH, Rha KH Clinical ef cacy of Korean red ginseng for erectile dysfunction Int J Impotence Res 1995;7:181 186

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The demonstration by Virag in 1982 that intracavernous (IC) injection of papaverine produced a fullyrigid erection in normal males, introduced a new route of administration in the clinical management of pharmacologic agents for the treatment of erectile failure [1,2] Intracavernous injection of a vasoactive agent that readily produces erection has greatly simpli ed the multidisciplinary diagnostic investigations and management of erectile dysfunction (ED) Three groups of drugs are presently used for selfinjection therapy worldwide, or at least in some parts of the world These include papaverine, adrenoceptor blocking agents such as phentolamine or moxisylyte, and prostaglandin E1 (PGE1) These compounds have proven to be effective in all etiologies of erectile failure such as psychogenic, neurogenic or vasculogenic impotence Other agents that have been investigated for their suitability in self-injection therapy, but never reached the stage of of cial approval or even off-label use, comprise calcium channel blocking agents, vasoactive intestinal polypeptide, ketanserin, histamine, -adrenergic agonists, nitric oxide donors (linsidomine or sodium nitroprusside) etc Generally speaking, compounds that were able to relax the smooth muscle cells of both the penile arteries and the cavernous tissue, subsequently resulting in blood engorgement of the cavernous sinusoidal spaces, with activation of the veno-occlusive mechanism through compression of the subtunical veins, may be

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principally considered for self-injection therapy in ED Up to 1998, self-injection therapy was the only effective pharmacologic treatment in ED and was considered a rst-line option in this indication But with the launch of sildena l (Viagra ) IC self-injection therapy became generally a second-line option for the majority of ED patients, with the exception of those men in whom phosphodiesterase-5 (PDE-5) inhibitors were contraindicated, or turned out to be ineffective In the following, the essential features of those compounds are described, which are either approved and/or mostly used, even in off-label use, for self-injection therapy

ecoming a property owner means more than just making a cash investment and hoping for a return Perhaps you ve never managed anything in your life and see property as a lucrative investment option Maybe you ve been a manager but always avoided dealing with people (not everyone s a glad-handing gadabout or wants to be one) Ultimately, as the property s owner, you re responsible and if you choose to contract out management duties, that includes responsibility for the people acting on your behalf In this chapter, we discuss the finer points of property management We help you decide whether to manage a property yourself, and how to foster good relations with tenants We also discuss how to attract tenants who will pose the fewest problems for you; after all, management isn t just a one-way affair you can only work with what you ve got We also discuss the rights and responsibilities landlords and tenants owe one another, and ways to defuse disputes that arise Things don t always go smoothly, even in the best of relationships; establishing ground rules from the start will go a long way to ensuring things stay civil

/23 Internal Block B /25 /25

Alprostadil (PGE1 Caverject , Edex , Viridal )

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