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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The recent introduction of intracorporeal injections of papaverine and phentolamine for the diagnosis and treatment of impotence has resulted in an increased incidence of iatrogenic priapism. Based on our research into penile hemodynamics we propose a refined approach to all types of priapism. Intracorporeal blood gas and pressure monitoring should be used to differentiate ischemic (low flow) from nonischemic (high flow) types. Most cases of papaverine-induced or phentolamine-induced priapism will respond to aspiration alone or in combination with intracorporeal instillation of a diluted alpha-adrenergic agent. In spontaneous priapism alpha-adrenergic agents can be tried first if patients have only mild or no ischemia. In patients with severe ischemia stagnant blood should be evacuated and a shunt procedure should be performed to allow metabolic replenishment of tissue. Intracorporeal pressure monitoring will help to determine the size and number of shunts needed to re-establish corporeal circulation.
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PMID:Priapism: a refined approach to diagnosis and treatment. 371 92

The incidence of urethral stricture has been surprisingly high following cardiovascular surgery in the last few years. We conducted a prospective study on 68 male patients undergoing cardiovascular surgery to determine the main factor(s) responsible for the development of urethral stricture. The penile-brachial pressure index was checked by strain gauge plethysmography. We found that urethral strictures developed in 15 patients (22 per cent) within an average of 3 months after cardiovascular surgery. Of these patients 13 had a penile-brachial index of 0.6 or less and complained of erectile impotence. A latex type of catheter was used in 11 and a silicone catheter in 4 of these 15 patients for urinary drainage. We conclude that urethral ischemia has an important role in the development of stricture, particularly when a latex urethral catheter is used for drainage. We recommend that a vascular penile study should be done in patients with erectile impotence undergoing an open heart operation, and that serious consideration should be given to the use of a cystocatheter diversion the night before the operation in those with a penile-brachial index less than 0.6. We strongly recommend the use of a silicone catheter in all other patients undergoing open heart surgery with hypothermia.
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PMID:Urethral stricture following cardiovascular surgery: role of urethral ischemia. 394 57

Three-hour oral glucose tolerance tests (GTTs) were performed for 58 men with secondary impotence (SI), 63 with normal sexual function (NL), and 69 with premature ejaculation (PRE). All were apparently nondiabetic. Diagnoses of diabetes and impaired glucose tolerance were based on serum glucose levels during GTT as recently defined by the National Diabetes Data Group. Covariance analysis corrected for weight and age differences. Mean glucose levels in patients with SI were significantly higher at one and two hours after glucose ingestion than in the other groups. Seven patients with SI (12.1%) were found to have diabetes. The three groups did not differ notably in frequency of impaired glucose tolerance. Inorganic serum phosphate levels were lower for the SI group. The high frequency of diabetes in subjects with SI who have no diabetic symptoms (12.1%) suggests that localized neuropathy or penile ischemia may produce impotence in otherwise asymptomatic patients.
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PMID:Previously unrecognized diabetes mellitus in sexually impotent men. 743 71

Olfactory dysfunction has been reported in individuals with diabetes mellitus, but the etiology is unknown. Diabetes is often complicated by serious medical conditions which could be related to the development of decreased olfactory ability. Overall, our 111 subjects with diabetes showed deficiencies in their ability to identify odorants measured with the Odorant Confusion Matrix (mean = 67.8% correct). The presence of macrovascular disease was found to be associated with olfactory dysfunction. Glycemic control as well as the type and duration of diabetes were not related to olfactory ability. Also, there was no distinct association with the presence of neuropathy, retinopathy, nephropathy, hypertension, or impotence. Consistent with previous studies utilizing measures of odorant identification, performance decreased with increased age, females were somewhat superior to males, and smoking had a deleterious effect. Other nondiabetes-related medical conditions and medications had no apparent effect on the olfactory ability of our subjects. These results suggest that the sequelae associated with macrovascular disease, such as perhaps, ischemia, to the olfactory area, impact negatively on olfactory ability.
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PMID:Olfactory dysfunction in diabetes mellitus. 843 58

A patient with conus syndrome following arteriogenic impotence is described. A 62-year-old man became impotent. 7 months after the onset, he was admitted because of a sudden left sensorimotor disturbance (L2 to S5 segments) when he awoke. A marked bilateral reduction of cutaneous sensation in the S2 to S5 dermatome distribution persisted. An MRI of the spinal cord demonstrated no abnormal lesion on T2-weighted and Gadolinium enhanced images. Angiography of the pelvic artery showed severe arteriosclerotic findings. We diagnosed this case as a conus syndrome due to ischemia in the conus medullaris. The impotence in our case was considered to be arteriogenic because there was no detection of the bilateral deep arteries of the penis on angiography after an intracorporeal PGE1 injection. In this case, arteriogenic impotence might be a prodrome of a conus medullaris infarction.
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PMID:[A case of conus syndrome following arteriogenic impotence]. 874 51

This study was designed to clarify the functional results, morbidity and the patient-partner satisfaction observed with, the American Medical System 700 CX three-piece inflatable prosthesis in the treatment of impotence associated with Peyronie's disease. Thirty-three patients were treated and additional plaque surgery was performed in 13 cases (40%). Within 10 days of surgery, four patients (12%) developed a wound infection which was treated conservatively and one patient (3%) experienced glandular ischemia. At the 6-week follow-up, complete penile straightening was achieved in 23 patients (70%), while penile rigidity was considered optimal by all patients. On the contrary, the penis was considered short by 10 patients (30%). Five diabetic patients (15%) complained of severe scrotal and penile pain during full activation of the implant and in one of these patients (3%) the implant had to be removed. Due to spontaneous erections occurring after implant activation one patient (3%) required replacement of the reservoir from the Retzius space into the peritoneum. At the long-term follow-up (mean +/- SE: 17 +/- 2.2 months), 23 patients were evaluated and all found to be engaging in intercourse with the prosthesis. However, five patients (21%) and three of the 13 partners (25%) assessed were not yet completely satisfied. The American Medical System CX700 inflatable penile prosthesis obtains complete penile straightening in 70% and rigidity in 100% of impotent patients with Peyronie's disease. Patients should be fully informed about possible surgical morbidity and actual post-operative penile length.
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PMID:AMS 700 CX inflatable penile implants for Peyronie's disease: functional results, morbidity and patient-partner satisfaction. 885 96

Priapism is a condition of prolonged penile erection which often causes pain and is unrelated to sexual desire. There is a high risk of impotence despite immediate intervention. The incidence has doubled since the introduction of intracorporeal injection therapy for impotence. Two subtypes of priapism have been described, depending on the underlying cause. The more common type, termed low flow, is characterised by inadequate venous outflow, leading to a hypoxic painful prolonged erection. The etiology is either idiopathic or related to intracorporeal injection therapy. Treatment consists of aspiration and instillation of a diluted alpha-adrenergic agent, or surgery, depending on the degree of hypoxia. The less common subtype, high flow, is arteriogenic, and causes less pain and no ischemia. Injury to a cavernous artery leads to a fistula between the artery and the corpora cavernosa. Treatment is either conservative with immediate ice pack and compression, or delayed selective embolization of the fistula.
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PMID:[Priapism. Etiology, diagnosis and treatment]. 901 77

Quantitative measurements of the collagen types (I, II, and IV) in the corpora cavernosa of potent and impotent men were carried out to investigate whether quantitative immunohistochemistry might contribute additional information as to the cause of erectile dysfunction. The study group consisted of 22 men with various etiologies of impotence and 4 normal, potent men. The quantitative immunohistochemistry measurements were performed by means of a cell-image processor. Three variables for each of the three types of collagen were studied, namely, the mean optical density (MOD), which relates to histochemical staining intensity; the labeling index (LI), which is positively related to the percentage of immunostaining; and the quick score (QS) index, which takes into account both LI and MOD values. None of the quantitative parameters taken individually (monovariate statistical analyses) made it possible to obtain any statistically significant difference between the types of collagen of the group under study. The mean QS value recorded for collagen type IV was significantly lower than that noted for collagen type I in the psychogenic (P = 0.019), arteriogenic (P = 0.012), and venogenic (P = 0.001) groups, whereas the MOD value was significantly lower in the normal (P = 0.043), arteriogenic (P = 0.013), and venogenic (P = 0.001) groups but not in the psycogenic group. The mean MOD of collagen type III was intermediate between that of the other types. In contrast, the mean LI value recorded for collagen type IV was significantly lower only in the venogenic (P = 0.032) and psychogenic (P = 0.049) groups as compared with the other groups. No objective qualitative change in the collagen types was observed that could be correlated to the etiology of erectile dysfunction. The significant difference seen in the quantitative parameters with regard to collagen type IV and the observed increase in the type I/III collagen ratio might attest to the notion that the response of the erectile tissue to ischemia is similar to that of other organs. The net effect of these changes is a restricted capacity for corporal expansion and alteration of the veno-occlusive mechanism.
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PMID:Objective measurement of the different collagen types in the corpus cavernosum of potent and impotent men: an immunohistochemical staining with computerized-image analysis. 906 95

Revascularization of the hypogastric artery often tends to be neglected in aortoiliac reconstructive surgery; however, its incomplete revascularization can result in unfavorable complications such as buttock claudication or necrosis, vascular impotence, and colonic ischemia. Multiple vascular lesions in the abdominal aorta and bilateral iliac arteries were reconstructed using a newly designed double bifurcated graft in five male patients. All five patients demonstrated excellent graft limb patency and postoperative improvement of the ankle-brachial pressure index without any clinical signs of ischemia in regions of the hypogastric artery. Thus, we conclude that an aggressive approach toward hypogastric circulation maintenance is essential in aortoiliac reconstructive surgery. By using this double bifurcated graft, rapid and safe revascularization of the bilateral hypogastric arteries concomitant with the external iliac or femoral arteries can be performed.
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PMID:A double bifurcated graft for abdominal aorta and bilateral iliac artery reconstruction. 1021 60

Priapism is a prolonged, painful, penile erection that fails to subside despite orgasm. An erection lasting longer than 4-6 h is considered to be priapic; nevertheless, pain does not usually ensue until 6-8 h have elapsed. Priapism is considered a failure of the detumescence mechanism, which may be due to excess release of contractile neurotransmitters, obstruction of draining venules, malfunction of the intrinsic detumescence mechanism, or prolonged relaxation of intracavernosal smooth muscle. There are essentially two main types of priapism: high flow (non-ischemic) and low flow (ischemic). Low flow priapism is the more common form, and it is associated with a decrease in venous outflow and vascular stasis that, in turn, cause tissue hypoxia and acidosis. This form of priapism is usually quite painful because of tissue ischemia. Penile blood aspirated from cavernous spaces appears dark in color. Immediate treatment is necessary or penile fibrosis will ensue. High flow priapism is usually due to trauma, although, on rare occasions it has been idiopathic or due to sickle cell disease. The hallmark of this type of priapism is an increase in arterial inflow in the setting of normal venous outflow. Aspirated penile blood is noted to be bright red and has a high pO(2). This form of priapism is not usually painful because it is non-ischemic. Treatment is dependent on the wishes of the patient but is not mandatory. International Journal of Impotence Research (2000) 12, Suppl 4, S133-S139.
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PMID:Priapism. 1103 1


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