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pronator - a muscle that produces or assists in pronation. supinator - a muscle (especially in the forearm) that produces or assists in supination. levator - a muscle that serves to lift some body part (as the eyelid or lip. antagonistic muscle - (physiology) a muscle that opposes the action of another; "the biceps and triceps are antagonistic muscles. eye muscle. ocular muscle - one of the small muscles of the eye that serve to rotate the eyeball. rectus - any of various straight muscles. muscle cell. muscle fiber. muscle fibre - an elongated contractile cell that forms the muscles of the body.
involuntary muscle. smooth muscle - a muscle that contracts without conscious control and found in walls of internal organs such as stomach and intestine and bladder and blood vessels (excluding the heart. tensor - any of several muscles that cause an attached structure to become tense or firm. muscle in (Informal) impose yourself . encroach. butt in. force your way in .

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There are two types of implants: inflatable and non-inflatable implants. One possible complication of this procedure is infection, which can cause penile erosion and reduced penile sensation. The drugs injected into the penis are called vasoactive drugs, which facilitate erection by relaxing the smooth muscle tissues in the penis. Three common drugs used for this technique are Papaverine, Alprostadil, and Phentolamine. There is a high success rate with this form of treatment for males who cannot take oral medication and for males with diabetes, a spinal cord injury, or radical prostatectomy. Some males find this treatment unnerving because it involves inserting a hypodermic needle into the corpora cavernosa of the penis. Side effects include penile pain, priapism (a continuous, usually nonsexual erection), and fibrosis (the development of excess fibrous connective tissues in an organ). This natural substance is found in the bark of the West African Yohimbe tree. The drug increases blood flow to the penis by indirectly increasing parasympathetic activity in the autonomic nervous system. The FDA has approved this drug, and it is available by prescription under such names as Yocon, Erex, and Yohimex.

Buy cialis black. There are over-the-counter products containing Yohimbine, but a study conducted by the FDA concluded that the concentration of Yohimbine in these products is negligible and has little or no effect. Some side effects of this drug are anxiety and insomnia.? Some side effects include hypotension (decreased or lowered blood pressure), priapism, urethral burning, syncope (a brief loss of consciousness associated with an inadequate flow of oxygenated blood to the brain), and penile pain.
Males with partners who are (or may be) pregnant should not use this method, since it can travel through the placenta of a pregnant female and impact fetal development. Treatment may involve injecting testosterone into the body or wearing testosterone patches on the skin. Although Viagra has become quite popular, it has a reputation for reducing spontaneity and has potentially serious side effects for people with heart problems. A new drug called Uprima claims to preserve spontaneity. This drug is placed under the tongue and takes effect in approximately twenty minutes. Researchers are hoping to have the treatment administered via injection only once or twice a year. Others hope to effectively create a cream that will produce the same results without the use of hypodermic needles. Some gene therapy methods in development directly target smooth muscle tissue in the penis, while others are designed to increase the production of nitric oxide, which open blood vessels and causes vasocongestion. LeVay, Simon, Janice I. Baldwin, and John D. Buy cheap cialis super active.
Sunderland, MA: Sinauer Associates, 2012. Print is maintained by students from the University of California, Santa Barbara who have studied advanced topics in human sexuality.
Causes and Symptoms There are many factors that can interfere with a male's ability to obtain or maintain an erection. If you are experiencing erectile difficulties, ask yourself the following questions: 1. Are there ways of reducing stress in your life? Treatments Psychological Treatments The way to combat these negative associations with sex is to change them to positive ones. Timing Viagra and Levitra are effective for four hours, but require sexual excitation and genital stimulation, so a male who engages in any type of continued sexual activity is likely to achieve a firm erection and experience sexual climax. External Vacuum Constriction Devices? Yohimbine This natural substance is found in the bark of the West African Yohimbe tree. Print Last Updated 13 May 2014. Buy cialis uk no prescription.
Penile erection occurs in response to cavernous smooth muscle relaxation, increased blood flow to the penis, and restriction of venous outflow. These events are regulated by a spinal reflex relying on visual, imaginative, and olfactory stimuli generated within the central nervous system (CNS) and on tactile stimuli to the penis.

Drugs can have a facilitatory or inhibitory effect either on the nerves regulating this reflex or on the cavernous smooth muscle. Drugs that raise cytosolic calcium either prevent or abort erection. Conversely, drugs that lower cytosolic calcium relax smooth muscle and can initiate penile erection. Http://cialis-online-buy.surf.to.
Recent advances in our understanding of the pharmacology of penile erection are being translated into effective therapies for ED. Potential reasons for discontinuation of pharmacologic therapy include lack of efficacy, side effects, possible deterioration of underlying disease, psychogenic factors, and partner issues. This review will discuss the mechanisms whereby the categories of agents currently available or potentially useful for the treatment of ED influence penile erection. Penile erection is the result of increased blood flow to the penis, relaxation of cavernous smooth muscle, and restriction of venous outflow from the corpus cavernosum. Parasympathetic input to the penis occurs in response to visual, auditory, olfactory, imaginative, and tactile stimuli. The cavernous nerves arise from the pelvic nerves that exit the sacral spinal cord and supply autonomic input to the penis. These nerves release at least three neurotransmitters that are capable of relaxing the cavernous smooth muscle4 (Figure 1). These transmitters include nitric oxide (NO), acetylcholine (ACh), and vasoactive intestinal polypeptide (VIP), of which NO is the most important. The cavernous nerves contain neuronal nitric oxide synthase (nNOS). In nerves, nNOS synthesizes NO from L-arginine.
Transgenic mice with a deletion for part of the gene for nNOS remain potent, probably as a result of the remaining isoforms for nNOS. NO activates soluble guanylate cyclase within the cavernous smooth muscle cell, leading to a rise in cGMP. Purchase cheap cialis soft tabs.
In addition, NO may reduce norepinephrine (NE) release from noradrenergic nerves. Competitive PDE-5 inhibitors, such as sildenafil and vardenafil, structurally resemble cGMP. PDE-5 is also found in other tissues, including the anal sphincter, gastroesophageal junction, and urethra. Efferent fibers within the cavernous nerves also contain ACh and VIP (Figure 1). ACh activates endothelium via muscarinic receptors of the M3 subtype. In the penis, PDE-3 and 4 degrade primarily cAMP. These PDEs are also present in the myocardium.
Not surprisingly, use of selective inhibitors for PDE-3 and PDE-4 in the treatment of ED is limited by cardiovascular side effects. In addition, drugs acting through electromechanical mechanisms (voltage-gated channels) can relax cavernous smooth muscle and trigger penile erection. Potassium channels influence the basal tone of cavernous smooth muscle, the initiation and termination of contractile events, and relaxation because of their ability to hyperpolarize the cell (Figure 2). The most physiologically relevant channel is the KCa, or maxi-K, channel. Penile erection also occurs through inhibition of contractile mechanisms. NE released from sympathetic fibers coursing within cavernous nerves and the dorsal nerve of the penis inhibits erection. The actions of ETs on cavernous smooth muscle are probably mediated by ET-B receptors. These substances may influence smooth muscle contractility either directly or by modulating the effects of other substances such as NE.

(Permalink) #8 - 10. Aug. 17 - 13:09:24

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(Permalink) #9 - 10. Aug. 17 - 13:21:12

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The management of angina in patients who have taken sildenafil within 24 hours involves the use of non-nitrate antianginal drugs such as beta blockers. The use of heparin, narcotics, aspirin or calcium channel blockers for acute coronary artery syndromes is not contraindicated. cialis rezeptfrei If nitrates are inadvertently administered to a patient who has taken sildenafil and hypotension occurs, aggressive fluid resuscitation with the patient in the Trendelenburg position is the first step. An intravenous alpha-adrenergic agonist (phenylephrine) or an alpha- and beta-adrenergic agonist (norepinephrine) can be given if needed to support blood pressure.

An intra-aortic balloon counterpulsation pump can be used if pharmacologic measures are ineffective. In the men who took the 50-mg dose of sildenafil, the mean duration of erection was increased by 10 minutes at the base of the penis and six minutes at the tip of the penis compared with placebo. The second phase of this study involved a diary of erectile activity in which 10 of 12 patients reported improved erectile activity while receiving sildenafil. The largest published trial of sildenafil evaluated efficacy based on the previously validated International Index of Erectile Function. The incidence of mild adverse effects was higher in the group taking sildenafil, but the incidence of cardiovascular events was similar in both groups. Sildenafil should initially be prescribed at 50 mg to be taken one hour before anticipated intercourse. The dose can be increased to 100 mg if needed. The development of sildenafil has prompted an unprecedented number of men to seek treatment. Sildenafil may not be appropriate for all patients, but other therapeutic options discussed in this article may be of benefit. A thoughtful evaluation may reveal treatable causes and provide family physicians with an opportunity to become involved in the comprehensive health care of men who otherwise would not have sought medical attention.

Buy cialis brand online. VIERA, LT, MC, USNR, is currently a staff family physician at Naval Hospital Guam. Viera graduated from the Medical University of South Carolina College of Medicine, Charleston, and completed a residency in family practice as co-chief resident at Naval Hospital Jacksonville in Jacksonville, Fla.... CLENNEY, LCDR, MC, USNR, is a staff family physician at the Branch Medical Clinic, Naval Weapons Station, China Lake, Calif.
Clenney is a graduate of the University of South Florida College of Medicine, Tampa. Shenenberger graduated from the University of South Carolina School of Medicine, Columbia, and completed a residency in family practice as co-chief resident at Naval Hospital Jacksonville. GREEN, CDR, MC, USNR, is a staff urologist at Naval Hospital Jacksonville. Green is a graduate of the University of Texas Health Science Center at San Antonio and completed his residency at Naval Medical Center, Portsmouth, Va. Address correspondence to Anthony J. Cheap generic cialis australia.
Viera, LT, MC, USNR, Family Practice Department, PSC 490, Box 9097, U. Naval Hospital, Guam, FPO AP 96538-1600.
Reprints are not available from the authors. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Navy Medical Department or the Naval Service at large. The role of nitric oxide in the physiology of erection. O'Keefe M, Hunt DK. Assessment and treatment of impotence. Med Clin North Am. Lue TF, Broderick G. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Endocrinologic evaluation of impotence. McConnell JD, Wilson JD. Cheapest cialis online canada.
In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, et al. Harrison's Principles of internal medicine. Buvat J, Lemaire A.

Akpunonu BE, Mutgi AB, Federman DJ, York J, Woldenberg LS. Routine prolactin measurement is not necessary in the initial evaluation of male impotence. Caverta cheap cialis generic viagra.
J Gen Intern Med. Engelhardt PF, Plas E, Hubner WA, Pfluger H. Med Lett Drugs Ther. Sundaram CP, Thomas W, Pryor LE, Sidi AA, Billups K, Pryor JL. Padma-Nathan H, Hellstrom WJ, Kaiser FE, Labasky RF, Lue TF, Nolten WE, et al. Intraurethral alprostadil for impotence. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Food and Drug Administration, October 1998.
Boolell M, Gepi-Attee S, Gingell JC, Allen MJ. Rendell MS, Rajfer J, Wicker PA, Smith MD. Cheapest cialis generic.
Sildenafil: an oral drug for impotence. All comments are moderated and will be removed if they violate our Terms of Use. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Want to use this article elsewhere? GREEN, CDR, MC, USNR, Naval Hospital Jacksonville, Jacksonville, FloridaAm Fam Physician.
Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access:See My OptionscloseAlready a member or subscriber? Log in Best Value! The Authorsshow all author infoANTHONY J.

(Permalink) #10 - 10. Aug. 17 - 13:27:32

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