Combined technetium radioisotope penile plethysmography and xenon washout: a technique for evaluating corpora cavernosal inflow and outflow during early tumescence.

Combined technetium radioisotope penile plethysmography and xenon washout is a new technique that measures both corporal arterial inflow and venous sinusoidal outflow during early tumescence in patients with erectile dysfunction. Fourteen patients were studied using 99mTc-RBCs to measure inflow and 133Xe or 127Xe in saline to measure outflow. Tumescence was induced by injecting papaverine intracorporally. Peak corporal rates corrected for outflow (r = 0.88) and uncorrected for outflow (r = 0.91) and change in volume over 2 min centered around peak flow [corrected] (r = 0.96) all correlated with angiography. Outflow measurements did not correlate with intracorporal resistance. Thus, outflow rates alone could not be used to predict venous sinusoidal competence. Normal inflow rate is greater than 20 ml/min; probable normal 12-20; indeterminate inflow 7-12; and abnormal inflow less than 7 ml/min. Technetium-99m radioisotope penile plethysmography and xenon washout can be performed together and both provide a method for simultaneously evaluating the relationship between corporal inflow and outflow rates in patients with erectile dysfunction.

Radioisotope penile plethysmography: a technique for evaluating corpora cavernosal blood flow during early tumescence.

Radioisotope penile plethysmography is a nuclear medicine technique which assists in the evaluation of patients with erectile dysfunction. This technique attempts to noninvasively quantitate penile corpora cavernosal blood flow during early penile tumescence using technetium-99m-labeled red blood cells. Penile images and counts were acquired in a steady-state blood-pool phase prior to and after the administration of intracorporal papaverine. Penile counts, images, and time-activity curves were computer analyzed in order to determine peak corporal flow and volume changes. Peak corporal flow rates were compared to arterial integrity (determined by angiography) and venosinusoidal corporal leak (determined by cavernosometry). Peak corporal flow correlated well with arterial integrity (r = 0.91) but did not correlate with venosinusoidal leak parameters (r = 0.01). This report focuses on the methodology and the assumptions which form the foundation of this technique. The strong correlation of peak corporal flow and angiography suggests that radioisotope penile plethysmography could prove useful in the evaluation of arterial inflow disorders in patients with erectile dysfunction.

Soft-tissue changes after head and neck radiation: CT findings.

To identify possible soft-tissue changes of the head and neck after radiation therapy, 102 CT scans from 78 patients with head and neck tumors were reviewed to assess (1) skin thickening, (2) epiglottic thickening, (3) stranding of subcutaneous fat, and (4) stranding of deep cervical fat. Scans were obtained after radiation therapy alone (10 cases), after radiation and surgery (27 cases), after surgery alone (24 cases), or before either surgery or radiation (41 cases). Skin thickening, epiglottic thickening, and stranding of subcutaneous fat were seen more frequently after radiation therapy than before such treatment. However, skin thickening and stranding of subcutaneous fat were sometimes also associated with tumor involvement and/or previous surgery, while epiglottic thickening was only occasionally associated with tumor involvement. Stranding of deep cervical fat was noted with increased frequency after radiation or surgery, but postradiation effects could not be reliably distinguished from postsurgical or tumor effects. We conclude that soft-tissue changes of the head and neck on CT may commonly be associated with previous radiation therapy, but these postradiation effects are not always distinguishable from postsurgical effects or tumor.

Aberrant carotid artery. Presentation in the near midline pharynx.

Three cases of an aberrant internal carotid artery presenting at or near the midline in the posterior part of the pharynx occurred. In all three cases, the anomalous finding was not correlated with the presenting symptoms of the patient. In two of the three cases intraoral pulsations were detected during initial examination. In the third case, pulsations were appreciated on reexamination after roentgenographic evaluation. Intraoral photographs, computed tomographic scan, magnetic resonance imaging, and arteriography of these findings are shown. A review of the literature and the embryology of the lateral pharyngeal carotid artery are presented along with the rare finding of the near midline carotid artery and the clinical implications of this anomaly.

Nursing home staff and residents' families role expectations.

This study evaluates role expectancies in essential nursing services of nursing home professionals and relatives of residents. Whereas previous studies have indicated substantial role ambiguity, the present research indicates significant agreement between the groups. Even so, areas exist where families deem themselves responsible for a task, but staff expectations are incongruent. Analysis of this process and steps to ameliorate this problem are discussed.

Radiographic diagnosis and treatment of erectile dysfunction.

Within the past 10 years, the study of erectile function has witnessed a rapid expansion of knowledge. New anatomic and physiologic theories, diagnostic procedures, and treatments have all been developed. As with all new medical concepts, there is active and healthy controversy. The papers reviewed demonstrate an early consensus of opinion for some ideas and a difference of opinion for others. Published ideas and conclusions have been strongly influenced by the incomplete evolution of the diagnostic methods, by patient psychologic inhibition interfering with objective testing, and by particular perspectives of the investigator biasing the final interpretation. This update of the radiologic assessment and therapy of erectile dysfunction presents recently published works and background related to their development.

Trumpet maneuver for visual and CT examination of the pyriform sinus and retrocricoid area.

The trumpet maneuver, a technique to inflate the hypopharynx with air, allows visualization of the pyriform sinuses and retrocricoid area during both fiberoptic examination and CT scanning. The technique is useful in delineating both normal and abnormal anatomy, and is especially useful in the evaluation of patients with hypopharyngeal symptoms in whom there is a low suspicion of anatomic disease. The methods, endoscopic photographs, and CT scan images are presented.

Neonatal tension pulmonary interstitial emphysema in bronchopulmonary dysplasia: treatment with lateral decubitus positioning.

Persistent foci of tension pulmonary interstitial emphysema (TPIE) may represent a clinically significant threat to the neonate with bronchopulmonary dysplasia. A 5-year experience with 21 cases of TPIE is reported. These patients were treated with lateral decubitus positioning (LDP). The emphysematous side was placed down approximately 70% of the time for an average of slightly over 3 days. Progress was followed by serial chest radiographs. The overall success rate of LDP was 90%. Respiratory status either improved or remained stable in all responding neonates, and no proved complications were observed. The authors recommend lateral decubitus positioning as the initial treatment of choice in managing neonatal tension pulmonary emphysema.

Nonselective angiography after intracorporal papaverine injection: an alternative technique for evaluating penile arterial integrity.

Forty patients with impotence were evaluated by means of nonselective angiography after intracorporal papaverine injection. The penile arterial network was visualized in 39 patients (97%). The technique was technically simple, and there were no complications. The most common sites of arterial disease were the arteries at the base of the penis (58%) and the internal pudendal artery (31%). In patients with advanced atherosclerotic disease, formation of collaterals within the penile arterial network appears to be important in maintaining flow to the cavernosal arteries. Asymmetry of arterial disease was frequently encountered (54%), indicating the importance of bilateral visualization of the arteries supplying the cavernosal arteries. Penile arteries were not visualized adequately in any of the patients studied nonselectively without intracorporal papaverine.

Controlled trial of infusion cavernosometry in impotent and potent men.

Infusion cavernosometry often is performed to diagnose venous leak impotence. However, normal values have seldom been established in proved potent men. We performed a prospective study of infusion cavernosometry on nocturnal penile tumescence confirmed potent male volunteers and impotent men. Of 20 potent male controls 19 had resistance values of greater than 5 (mm. Hg.minute)/ml. Of 38 impotent men 20 (53%) had resistance values of less than 5 (mm.Hg. minute)/ml. There was considerable overlap between resistance values and infusion rates in potent and impotent men. Impotent men with resistances of greater than 5 (mm.Hg.minute)/ml. more often had normal nocturnal penile tumescence results than men with lower resistance values. Venous leakage is a significant cause of impotence.

Recent advances in diagnosis and treatment of gastrointestinal hemorrhage in infants and children.

Gastrointestinal bleeding is a common and occasionally life-threatening problem in infants and children. A careful history and physical examination as well as the application of new endoscopic and radiographic techniques will reveal the source of hemorrhage in most patients. The utility of recently introduced pharmacologic agents and endoscopic techniques in the treatment of peptic disease and variceal hemorrhage in children remains to be determined. A cooperative effort among pediatricians, radiologists, and surgeons should minimize the morbidity and mortality from gastrointestinal tract bleeding in this population.

Gastroesophageal reflux in children: results of a standardized fluoroscopic approach.

This retrospective study of 470 children undergoing barium upper gastrointestinal examinations was performed with three goals in mind: (1) to document the incidence of gastroesophageal reflux discovered during standardized upper gastrointestinal examination; (2) to compare the amount of gastroesophageal reflux detected in patients with symptoms suggestive of reflux as opposed to those who had no such symptoms; and (3) to ascertain the effect on reflux of the presence of a lower esophageal "beak." About 65% of the children studied had gastroesophageal reflux. Reflux was seen more commonly when symptoms of reflux were present (75.9%) than when not (36.8%). The amount of reflux seen over 5 min was greater if symptoms were present (mean incidence 2.72 bouts) than when not (mean incidence 0.76 bouts). Most importantly, there was a significant decrease in the amount of reflux seen with increase in patient age; age-related criteria for "acceptable" gastroesophageal reflux are presented. The presence of an esophageal "beak" is associated with an increased amount of reflux (94.4%) as opposed to no such "beak" (67.8%). The data suggest that gastroesophageal reflux is present in a large percentage of pediatric patients, whether there are symptoms to suggest reflux or not. Since reflux diminishes with increasing age, age-related criteria for an "acceptable" amount of reflux should be used rather than a universal judgment based on three episodes. Reflux to the cervical esophagus occurs frequently, both with and without symptoms of reflux, and may not be a reliable solitary indication for therapy. An esophageal "beak" is associated with an increase in reflux and may have important prognostic implications.

Acalculous cholecystitis in Crohn's disease.

A 15-year-old boy with Crohn's ileocolitis developed marked gallbladder enlargement. Ultrasonographic findings were consistent with acalculous cholecystitis (AAC) or hydrops. At laparotomy a gangrenous gallbladder was found. The diagnostic modalities currently used to distinguish between hydrops, a benign condition generally treated expectantly, and AAC, a potentially life-threatening condition requiring surgical treatment are reviewed. Failure to distinguish between these two conditions with acalculous gallbladder enlargement and similar clinical and radiologic features may have serious consequences.

Preliminary report: penile vein occlusion therapy: selection criteria and methods used for the transcatheter treatment of impotence caused by venous-sinusoidal incompetence.

Penile vein occlusion therapy is a fluoroscopic guided technique developed for treating venous-sinusoidal incompetence in patients with erectile dysfunction. We report our experience with 22 patients who have been followed for greater than 1 year. Catheterization of the veins draining the penis was technically possible in 20 of 22 patients (91%). Of these 20 patients 5 (25%) were cured and 9 (45%) had significantly improved erectile function. All 5 patients (100%) with venous-sinusoidal incompetence plus normal cavernous arterial flow, no glans or corpus spongiosal shunts, and bilateral complete coil occlusion of the crural and common crural veins were cured. No deterioration of function was noted at 1 and 2 years. Patient selection and bilateral occlusion of the penile veins are essential to achieve successful penile vein occlusion therapy.