intrapenile-injection-dangers

Injection Caverject©
Prolonged erection defined as erection lasting > 4 to ≤ 6 hours in duration occurred in 4% of 1861 patients treated up to 18 months in studies of CAVERJECT© Sterile Powder.
PRIAPISM is a much feared adverse effect of intra penile injection as it causes irreversible death of tissues of penis due to lack of fresh oxygen supply. Priapism is an emergency.
How to administer injections on penis has been covered in the previous chapter.
All other important side effects are given here.

Local Adverse Reactions:
The following local adverse reaction information was derived from controlled and uncontrolled studies, including an uncontrolled 18-month safety study.
TABLE 1 - Local Adverse Reactions Reported by ³ 1% of Patients Treated with Alprostadil for up to 18 Months*
Alprostadil
Event
N = 1861
Penile pain 37%
Prolonged erection 4%
Penile fibrosis** 3%
Injection site hematoma 3%
Penis disorder*** 3%
Injection site ecchymosis 2%
Penile rash 1%
Penile edema 1%
* Expected for penile pain (2%), no significant local adverse reactions were reported by 294 patients who received 1 to 3 injections of placebo.
** See PRECAUTIONS: General Precautions.
*** Included numbness, yeast infection, irritation, sensitivity, phimosis, pruritus, erythema, venous leak, penile skin tear, strange feeling of penis, discoloration of penile head, itch at tip of penis.

Penile Pain:
Penile pain after intracavernosal administration of Caverject was reported at least once by 37% of patients in clinical studies of up to 18 months in duration. In the majority of the cases, penile pain was rated mild or moderate in intensity. Three percent of patients discontinued treatment because of penile pain. The frequency of penile pain was 2% in 294 patients who received 1 to 3 injections of placebo.

Prolonged Erection/Priapism:
In clinical trials, prolonged erection was defined as an erection that lasted for 4 to 6 hours; priapism was defined as erection that lasted 6 hours or longer. The frequency of prolonged erection after intracavernosal administration of Caverject was 4%, while the frequency of priapism was 0.4%. In the majority of cases, spontaneous detumescence occurred. To minimize the chances of prolonged erection or priapism. Caverject should be titrated slowly to the lowest effective dose (see DOSAGE AND ADMINISTRATION).

The patient must be instructed to immediately report to his physician or, if unavailable, to seek immediate medical assistance for any erection that persists for longer than 6 hours. If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result.

Hematoma/Ecchymosis: The frequency of hematoma and ecchymosis was 3% and 2%, respectively. In most cases, hematoma/ecchymosis was judged to be a complication of a faulty injection technique. Accordingly, proper instruction of the patient in self-injection is of importance to minimize the potential of hematoma/ecchymosis (see DOSAGE AND ADMINISTRATION).

The following local adverse reactions were reported by fewer than 1% of patients after injection of Caverject: balanitis, injection site hemorrhage, injection site-inflammation, injection site itching, injection site swelling, injection site edema, urethral bleeding, penile warmth, numbness, yeast infection, irritation, sensitivity, phimosis, pruritus, erythema, venous leak, painful erection, and abnormal ejaculation.
Generalised
Systemic Adverse Events: The following systemic adverse event information was derived from controlled and uncontrolled studies, including an uncontrolled 18-month safety study.

STRICTLY NOT TO BE USED IN FOLLOWING CONDITIONS:
1] Hypersensitivity to the [PGE1] drug,

2] in patients who have 1. sickle cell anemia or trait, 2. multiple myeloma, or leukemia, or in patients with anatomical deformation of the penis, such as angulation, cavernosal fibrosis, or 3. Peyronie's disease as they are likely to have priapism.

3]Patients with penile implants should not be treated with Alprostadil.

4]Alprostadil should not be used in women or children and is not for use in newborns.

5]Alprostadil should not be used in men for whom sexual activity is inadvisable or contraindicated.

TABLE 2 -
Systemic Adverse Events Reported by ³ 1% of Patients Treated with Caverject© for up to 18 Months*
Body System/Reaction ALPROSTADIL N=1861
Cardiovascular System
Hypertension 2%
Central Nervous System
Headache 2%
Dizziness 1%
Musculoskeletal System
Back pain 1%
Respiratory System
Upper respiratory infection 4%
Flu syndrome 2%
Sinusitis 2%
Nasal congestion 1%
Cough 1%
Urogenital System
Prostatic Disorder** 2%
Miscellaneous
Localized pain*** 2%
Trauma**** 2%
* No significant adverse events were more reported 294 patients who received 1 to 3 injections of placebo.
** prostatitis, pain, hypertrophy, enlargement
*** pain in various anatomical structures other than injection site
**** injuries, fractures, abrasions, lacerations, dislocations
The following systemic events, which were reported for

testicular pain, scrotal disorder, scrotal edema, hematuria, testicular disorder, impaired urination, urinary frequency, urinary urgency, pelvic pain, hypotension, vasodilation, peripheral vascular disorder, supraventricular extrasystoles, vasovagal reactions, hypesthesia, non-generalized weakness, diaphoresis, rash, non-application site pruritus, skin neoplasm, nausea, dry mouth, increased serum creatinine, leg cramps, and mydriasis.

Hemodynamic changes, manifested as decreases in blood pressure and increases in pulse rate, were observed during clinical studies, principally at doses above 20 micrograms and above 30 micrograms of alprostadil, respectively, and appeared to be dose-dependent. However, these changes were usually clinically unimportant; only three patients discontinued the treatment because of symptomatic hypotension.

DOES INJECTION FOR PENILE ERECTION AFFECT FERTILITY?
Caverject had no clinically important effect on serum or urine laboratory tests.
Carcinogenesis, Mutagenesis, and Impairment of Fertility: Long-term carcinogenicity studies have not been conducted. Rat reproductive studies indicate that alprostadil at doses of up to 0.2 milligram/kilogram/day does not adversely affect or alter rat spermatogenesis, providing a 200-fold margin of safety compared with the usual human doses.

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divorce_hazards-2

In 2005, divorced households in the United States spent as much as 56 per cent more on electricity and water per person than married households and used up to 61 per cent more resources per person than they did before the separation took place.
more than 73 billion kilowatt hours of electricity and 627 billion gallons of water could have been saved in the US.

In the United States, the proportion of divorced households jumped from five percent in 1970 to 15 percent in 2000, and numbers have surged even in China where divorce has not been traditionally as common, the study said.

In 2005, US divorced households spent as much as 56 percent more on electricity and water per person than married households, and used up to 61 percent more resources per person than they did before the separation took place.

If divorced households operated with an efficiency similar to married households, "more than 73 billion kilowatt-hours of electricity and 627 billion gallons of water could have been saved in the US," it said.

Researchers surveyed 3,283 homes in the United States between 2001 and 2005, and found that divorcing households registered a 61 percent increase in the number of rooms per person, compared with six percent increase in households that remained married.
12/3/2007 7:36 PM
90% of men kiss their wife goodbye when they leave the house.
The rest kiss their house goodbye when they leave the wife.
Now they can make the best of a bad marriage in the name of being environmentally friendly.
Scientists have quantified for the first time the extent to which divorce damages the environment. The researchers found that the combined use of electricity across the two new households created rose 53% while water use was up by 42%.
Across America – one of 12 countries studied – divorced households used 73 billion kilowatt-hours of electricity in 2005 that could have been saved if the families had not split up. That is equivalent to about a fifth of Britain’s consumption.
Broken couples also increase demand for housebuilding and infrastructure such as new roads. “The global trend of soaring divorce rates has created more households with fewer people, has taken up more space and has gobbled up more energy and water,” said Jianguo Liu of Michigan University, who carried out the latest research.
The study, to be published tomorrow in the Proceedings of the National Academy of Sciences, found that the average number of rooms per household was between 33% and 95% higher for divorced couples than for married ones.
Liu also calculated that America now has an extra 38.5m rooms in houses and apartments built to meet the demand for more accommodation generated by divorce over the past three decades.
The growth of single-person households is also damaging the environment. Research published in the journal Environment, Development and Sustainability found that:
- One-person households are the biggest consumers of energy, land and household goods, such as washing machines, refrigerators, TVs and stereos, per capita
- They consume 38% more products, 42% more packaging, 55% more electricity and 61% more gas per capita than four-person households
- People living alone create 1½ tons of waste annually compared with a ton by those in households of four or more.

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