Georgios Salpiggidis

Management Strategy for Arterial Priapism: Therapeutic Dilemmas

PURPOSE We present 7 cases of arterial high flow priapism and propose management algorithms for the condition. MATERIALS AND METHODS We studied 2 children and 5 adults with posttraumatic arterial priapism. Blood gas analysis and color Doppler ultrasonography of the corpora cavernosa confirmed the diagnosis in 4 adults, while 1 patient had already undergone cavernous artery ligation in elsewhere. In the children perineal compression resulted in detumescence, a sign that is proposed to be indicative of the diagnosis of arterial priapism (piesis sign) complementing physical examination. Mechanical compressive force was applied to the perineum of 1 boy, while the other received a watchful waiting program. All adults participated in an observation regimen except 1, who decided to undergo immediate embolization of the internal pudendal artery. RESULTS Perineal compression led to the resolution of priapism in 1 child, while spontaneous resolution was noted in the other. An adult noticed spontaneous penile detumescence 3 to 4 months after trauma, which was attributable to site specific venous leakage and decreased, inflow in the contralateral cavernous artery. The patient underwent venous surgery and is on an intracavernous injection regimen. Successful embolization of the internal pudendal artery was performed immediately in 1 man and in the other 4 months after trauma due to social inconvenience. Adult patient 3 is still on the watchful waiting protocol (42 months), while the one who underwent cavernous artery ligation is receiving treatment for erectile dysfunction. CONCLUSIONS Absent of long-term damaging effects of arterial priapism on erectile tissue combined with the possibility of spontaneous resolution or progressive concomitant hemodynamic abnormalities associated with blunt perineal trauma are suggestive of the introduction of an observation period in the management algorithm of high flow priapism. Such a period may help avoid unnecessary intervention and determine the impact of priapism on patient personal life. Perineal compression may be also added as part of the physical examination as a sign specifically indicative of arterial priapism.

Agronomic techniques to controlLobesia botrana

The grapevine mothLobesia botrana (Denis & Schiffermüller) (Lepidoptera: Tortricidae) is a key pest of grapevines in Greece. As part of a broader study on integrated pest management, the effects were investigated of different cultural methods on the establishment and survival ofL. botrana, specifically: application of different nitrogen levels (30 and 100 units of ammonium sulfate or 70 units of Agrobiosol); summer leaf and shoot pruning; application of growth regulators (Regalis, prohexadione-calcium; or Falgro, gibberellic acid). There were significant differences among the three levels of N application. The lowestL. botrana infestation rates were found in plots treated with 30 units of (NH4)2SO4 and plots that received some summer pruning. Following the application of plant growth regulators, the lowestL. botrana infestation levels occurred in the plots treated with Regalis or Falgro at the manufacturers’ recommended concentrations. On vines where growth regulators had been applied, the clusters had fewer berries than those not treated with growth regulators.