Tadalafil zeichnet sich durch eine außergewöhnlich lange Halbwertszeit im Vergleich zu anderen PDE5-Inhibitoren aus. Diese pharmakokinetische Eigenschaft führt zu einer verlängerten Exposition des Wirkstoffs im Organismus. Die Eliminationsrate hängt von der hepatischen Aktivität des CYP3A4-Enzyms ab. Lipophile Eigenschaften unterstützen eine weite Verteilung in unterschiedlichen Geweben. Eine ausgeprägte Stabilität gegenüber Nahrungsaufnahme macht den Stoff besonders konstant in seiner Wirkung. Unter generischen Präparaten wird cialis online häufig mit einem vergleichbaren pharmakologischen Profil beschrieben.

Microsoft powerpoint - genital lumps and bumps - final version dr. olufunso olarinde [compatibility mode]

Consultant Physician, Dept of GU Medicine • To distinguish normal/variants of normal • Different causes of genital lumps and of oily secretions that keep the skin healthy & mistaken for warts –they do not change in size but warts do (especially in women) & may be mistaken for warts ‘Cord like’ swelling, usually just below the head of the penis Usually caused by a blockage in the lymphatics which then solidify May occur after vigorous sex or masturbation No treatment needed. Generally disappears – may take months! glands located at the entrance of the vagina • STI caused by the Human Papilloma Virus
• Transmission is via direct skin to skin contact • ‘Fleshy’ lumps around the anogenital area • >100 strains of the HPV have been identified • ‘Low risk’ types HPV 6 & 11 account for about 90% of • Warts may not appear for months/years after infection • HPV may be transmitted in the absence of visible warts – Purely cosmetic & depends on site, size, nature & number • Podophyllotoxin cream – non keratinised • Curettage – single/few pedunculated warts • Surgical excision – extensive warts • STI caused by Herpes Simplex Virus
• Painful blisters on anogenital skin which break down to form multiple tender ulcers – Aciclovir 400mg tds x 5/7 OR 200mg 5x daily – Oral → NSAIDs, Codeine phosphate– Topical → Lignocaine gel – Usually mild & self-limiting– If regular – Aciclovir 400mg bd x 6-12 months– Valaciclovir 500mg OD x 6-12 months lesions in moist areas of anogenital area – Syphilis serology– Screen for other STIs– Treatment • Penile Intraepithelial Neoplasia (PIN)
• Vulval Intraepithelial Neoplasia (VIN)
• Commonly ‘high risk’ types 16 & 18 – Chronic inflammatory genital skin conditions Penile Intraepithelial Neoplasia
Vulval Intraepithelial Neoplasia
• Slightly raised, well defined skin lesions pustule, warty area or ulcer with heaped up edges

Source: http://www.gplectures.co.uk/media/lecture_notes/Genitallumpsandbumps.pdf