Christian Delcour

Cavernometry-cavernography: its role in organic impotence.

The intracavernous pressure necessary to produce a passive erection was recorded in 35 patients suffering from impotence. Among these patients, 5 presented psychogenic impotence. The intracavernous pressure was also recorded at rest during inflow and in the state of erection. The 5 psychogenically impotent patients had passive erections with a flow of 80-120 ml/min. 18 patients suffering from organic impotence developed passive erections at a flow of 80-120 ml/min, while the remaining 12 men needed a flow between 160 and 300 ml/min with visualization of a venous leak. The intracavernous pressure varied between 90 and 110 mm Hg in the state of erection. Artificial erection, induced in impotent men, allows to classify patients with vascular organic impotence into three categories: those with pure arterial insufficiency; those with pure venous leak, and patients with both.

Mesenteric vein thrombosis: Early CT and US diagnosis and conservative management

We report a case of isolated superior mesenteric vein thrombosis with acute ischemic bowel disease, diagnosed early by a screening ultrasound scan of the upper abdomen and definitively assessed by computed tomography and angiography.This report stresses the contribution of crosssectional techniques in the early diagnosis and management of venous occlusive disease of the small bowel.

The erectile angle: Objective criterion to evaluate the papaverine test in impotence

Intracavernous papaverine injection may be the first diagnostic step in the assessment of the impotent patient. However, the appreciation of its effect must rely on the evaluation of penile rigidity. Since measurement of rigidity requires a sophisticated procedure that may not be available to the majority of practitioners, we attempted to find a simple and objective method to evaluate the results of this common test. We tested 50 patients complaining of impotence with intracavernous injection of 60 mg. papaverine. The length and circumference of the penis were measured before and after papaverine injection. The rigidity was determined by measuring the angle between the penis and the legs with the patient in the standing position. Afterwards, each patient underwent vascular (Doppler ultrasound and cavernometry) and neurological examinations. A total of 27 patients with no vascular abnormalities had an erectile angle of 96 degrees (range 90 to 130 degrees), while 23 patients had some vascular disorders (9 arterial lesions, 8 venous leakage and 6 combined lesions) and an erectile angle of 36 degrees (range 0 to 60 degrees). There was no significant difference between the groups in the increase of length and circumference of the penis after intracavernous injection of papaverine. The papaverine test can distinguish between patients with vascular and psychogenic problems. A negative papaverine test associated with a normal Doppler examination is characteristic of venous leakage. Measurement of the erectile angle after intracavernous injection of papaverine with the patient in the standing position is a simple, objective and reliable method to evaluate patients with vascular impotence.

Investigation of the venous system in impotence of vascular origin

Vascular pathology is responsible for about 25% of cases of male impotence. Pudendal arteriography has been the object of numerous publications. Venous conditions explain the majority of erectile dysfunctions in patients with normal arterial anatomy.We have performed cavernography in 30 patients, with monitoring of intracavernous pressure and flow measurement. Cavernograms allowed study of the corpora cavernosa and the venous drainage. Cavernography not only helps in understanding the mechanism of erection but also is essential to the successful treatment of pathologic venous drainage.

Impotence due to corporeal veno-occlusive dysfunction: Long-term follow-up of venous surgery

Corporeal veno-occlusive dysfunction is an important cause of organic impotence and is characterized by increased flow rates to create and to maintain erection during artificial erection produced by intracavernous saline infusion. Sixty-seven patients with this erectile insufficiency underwent penile ligature-resection of deep dorsal vein between 1982 and 1986, and were evaluated by nocturnal plethysmography, pharmacocavernometry as well as a questionnaire about their sexual life for long-term follow-up. The surgical procedure was controlled in the operating room by reduction of the erectile flow rates. Thirty-one patients were potent postoperatively and were able to have satisfactory intercourse. Results after resection were slightly better than after simple ligation of the deep dorsal vein. Four patients had penile glans insensibility resulting from the surgical dissection. There were 7 relapses several months after the procedure due to leakage through other deeper veins. Eight failures were due to additional psychogenic disorders or to neurologic disease not accurately diagnosed before the treatment because they all developed normal papaverine-induced erection after venous surgery while before it they only developed a slight tumescence. Reduction of the erectile flow rates within normal values was impossible during surgery in 3 patients. Eleven failures were due to concomitant arterial disease. Resection of the deep dorsal vein can restore penile erection in patients with cavernovenous leakage in about 50% of well-selected patients.

Techniques for performing cavernosometry and cavernosography

We have performed cavernosography and cavernosometry in more than 400 impotent patients and in 10 normal volunteers. In patients without abnormal venous leakage, intracavernosal infusion at a flow rate of 80–140 ml/min produces a complete rigid erection with an intracavernous pressure greater than 90 mm Hg; 25–50 ml/min is necessary to maintain the erection. Abnormal venous leakage is characterized by the absence of erection without a significant increase in intracavernous pressure under the maximum standardized perfusion rate of 140 ml/min. Cavernosography provides good morphologic studies of the cavernous bodies and the penile venous network, but must always be associated with flow rate measurement and intracavernous pressure monitoring for reliable assessment of venous leakage.

Spontaneous Renal Artery Dissection in an Otherwise Healthy Male

Abstract Dissection of a renal artery is rare and, in most cases, associated with underlying arterial diseases. Spontaneous renal artery dissection (RAD) is exceptional. We report the case of a young and otherwise healthy man with an isolated dissection of the right renal artery without any obvious origin. Diagnosis was made by angiography. He received medical treatment and rapidly recovered. Renal artery dissection can be misdiagnosed because its clinical presentation may be confusing. Selective renal angiog-raphy is essential to evaluate the extent of the dissection and the suitability for repair. Control of the hypertension and renal function preservation are the two main goals of the treatment. The place of surgical repair remains unclear because of the poor results on hypertension improvement and high complication rate.

Predictive value of the RIFLE urine output criteria on contrast-induced nephropathy in critically ill patients

BackgroundTo investigate the predictive value of decreased urine output based on the Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage renal disease (RIFLE) classification on contrast- induced acute kidney injury (CA-AKI) in intensive care (ICU) patients.MethodsAll patients who received contrast media (CM) injection for CT scan or coronary angiography during a 3-year period in a 24 bed medico-surgical ICU were reviewed.ResultsDaily serum creatinine concentrations and diuresis were measured for 3 days after CM injection. We identified 23 cases of CA-AKI in the 149 patients included (15.4xa0%). Patients who developed CA-AKI were more likely to require renal replacement therapy and had higher ICU mortality rates. At least one RIFLE urine output criteria was observed in 45 patients (30.2xa0%) and 14 of these 45 patients (31.1xa0%) developed CA-AKI based on creatinine concentrations. In 30xa0% of these cases, urine output decreased or didn’t change after the increase in creatinine concentrations. The RIFLE urine output criteria had low sensitivity (39.1xa0%) and specificity (67.9xa0%) for prediction of CA-AKI, a low positive predictive value of 50xa0% and a negative predictive value of 87.2xa0%. The maximal dose of vasopressors before CM was the only independent predictive factor for CA-AKI.ConclusionsCA-AKI is a frequent pathology observed in ICU patients and is associated with increased need for renal replacement therapy and increased mortality. The predictive value of RIFLE urine output criteria for the development of CA-AKI based on creatinine concentrations was low, which limits its use for assessing the effects of therapeutic interventions on the development and progression of AKI.

Two rare cases of posttraumatic peripheral artery pseudoaneurysm

Posttraumatic pseudoaneurysms of the lower limb are increasingly recognized due to the development of cross-sectional imaging. Two cases of anterior tibial artery pseudoaneurysm after blunt trauma are presented. The diagnostic technique of choice is Doppler ultrasound (US). In some cases, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) is needed to identify the feeding vessel. The treatment of choice is not yet determined. Ultrasound-guided thrombin injection is widely used as first-line treatment, but some cases are refractory to this treatment. Further investigation and optimization of therapeutic technique to definitely exclude the pseudoaneurysm from the circulation may result in faster and more cost-effective treatment than US-guided thrombin injection.

Role of the captopril test in renovascular hypertension: a case report.

This article reports the case of a rapidly severe stenosis of the right renal artery, causing uncontrolled hypertension. After failure of a percutaneous transluminal renal angioplasty, which provoked the thrombosis of the vessel, a surgical revascularization was performed after ± eighteen hours of renal ischemia. Blood pressure, blood urea nitrogen and serum creatinine returned to normal values. A dramatic improvement of the right renal function was attested at the hippuran scintigraphy after a dose test of captopril. The results of renographic studies obtained in this clinical case underline the role of the captopril radionuclide test in detection and follow-up after treatment of renovascular hypertension.