Capsules

MORE THAN A REPUTATION

Yohimbine, a chemical derived from the tropical African yohimbe tree, has been touted for years as an aphrodisiac. And for years it has been dismissed by most scientists as a case of wishful thinking. But that opinion may soon need to be revised.

At Queen's University in Kingston, Ont., Urologist Alvaro Morales and a team of researchers have conducted a study of yohimbine's effect on 23 men with impotence related to physical problems, like diabetes. The men were given laboratory-synthesized yohimbine daily for eight to ten weeks. Ten improved, with six once again able to sustain erection and reach orgasm. The drug unexpectedly also relieves some of the numbness and prickling in the legs that frequently afflict diabetics. Unpleasant side effects were limited to temporary dizziness or gastrointestinal upset. The Canadian team is now beginning a two-year study of yohimbine vs. placebo in 120 men with impotence of organic or psychological origin.

How yohimbine helps potency is a mystery. The chemical blocks or stimulates the release of adrenaline at nerve endings in different parts of the body. Researchers think that this action changes blood flow or the transmission of nerve impulses to genital tissue.

A BACTERIAL WASH

The big three in the arsenal against cancer are surgery, radiation and drugs. But a new therapy, which has produced "exciting" preliminary observations, makes use of an unexpected weapon: bacteria. Staph germs (Staphylococcus aureus) are in fact essential in a blood-washing treatment under study at Baylor College of Medicine in Houston. In the technique, developed by Immunologist David Terman and his colleagues, blood plasma is removed from a patient and run through a device containing beads of charcoal coated with protein A, a component of the staph bacteria. The plasma is then returned to the patient. The scientists speculate that the bacterial protein somehow alters substances carried in the bloodstream that were paralyzing the body's natural defenses.

In the New England Journal of Medicine, the Texas researchers report trying the therapy on five women with advanced breast cancer that no longer responded to conventional treatment. The women experienced reddening of tissue, blistering and burning sensations at the tumor sites, as well as chills, nausea and vomiting. But in four patients, repeated washing reduced the tumor size by 33% to 79%. Despite these tentative successes, the team stresses that the technique is experimental. More work is needed to determine its usefulness and safety.

BLOODSUCKERS FROM FRANCE "If there's anything in the world I hate, it's leeches--filthy little devils!" Humphrey Bogart growled in The African Queen. He had just climbed out of a river, covered with the little suckers. Doctors tend to be less squeamish. But even for them leeches have long been associated with archaic medical practices, like bloodletting to cure everything from gout to mental illness. Lately, however, the unlovable little creatures have been having a minor revival. At New York's Montefiore Hospital and Medical Center doctors are using them effectively to help save reattached fingers.

Critical to the success of any replant surgery on a severed part is the restoration of blood flow through the injured tissue by reconnecting arteries and veins. Rejoining arteries is surgically difficult. Repairing much narrower and thinner-walled veins is often impossible. After surgery, fresh blood flows into the reattached part, but deoxygenated blood may not be able to flow away through the veins. Result: swelling, pain and sometimes loss of the part. Says Microsurgeon Berish Strauch: "You may spend many hours salvaging a part only to have it die three, four or five days later."

One rough and ready way to get rid of excess blood is to stick the skin with pins and make it bleed, but that has to be done repeatedly and causes damage to the tissue. Enter the leech. Surgeons at Montefiore got the idea from visiting French colleagues who have been pressing the tiny bloodletters into medical service for years.

Placed on the reattached digit, a leech happily punctures the skin and drains off accumulated blood. A 1-in.-long leech can take in 6 cc to 10 cc of blood during a single 20-min. repast, so there are few punctures in the patient's skin. When the leech is full, it simply drops off. Blood continues to ooze from the skin for a few hours more because of a potent anticlotting chemical that leeches produce. Relieving blood congestion gives the damaged blood vessels time to grow and establish a new circuit.

So far, the New York doctors have employed leeches imported from France, at $3 a leech, on eight patients with good results. Says Strauch: "It's as if the leeches were designed for the use to which we've put them." As for patient reaction, Strauch says: "People are a little concerned when we first propose leeches, but when we explain they usually go along.

And once they see the reattached part become pink and healthy looking, they think it's a pretty good idea."

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