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Biomedical subjects

J J Bookstein

Publications and source records attributed to J J Bookstein.

At least 55 records · Page 3Linked to original sources
PubMed1988

Selective penile venography: anatomical and hemodynamic observations.

Penile venographic studies were reviewed to determine the basic radiographic anatomy and hemodynamics. A total of 14 patients underwent 17 selective deep venographic studies in association with planned transcatheter venous ablation. In addition, radiography of the glans was performed in 9 patients and superficial dorsal venography was done in 5. These studies provided a much clearer demonstration of penile venous anatomy than did cavernosography. Important new observations were that the crural perforators were discretely visualized and observed to empty into the medial portion of the internal pudendal veins; flow in the internal pudendal veins was observed to be potentially bidirectional; the confluens of veins at the base of the pre-prostatic plexus served as a conduit through which catheters and sclerosants could be directed to all major portions of the deep penile venous system; in impotent patients at least contrast medium usually refluxed from the deep veins into the erectile bodies during a Valsalva maneuver; direct communications between deep and superficial venous systems were few or nonexistent in the penis, and the glans drained primarily via the deep dorsal penile vein.

Embolization, Therapeutic↗
PubMed1988

Posttraumatic impotence: angiographic evaluation.

The onset of impotence was related to penile trauma in ten of 90 patients who underwent angiography. Angiographic results facilitated diagnosis in all patients. Trauma was secondary to a variety of injuries including fractures, soft-tissue perineal injuries without fractures, and repeated perineal pounding during long, jarring drives. The final diagnosis was arteriogenic impotence (n = 2), arteriovenogenic impotence (n = 2), venogenic impotence (n = 3), venoneurogenic impotence (n = 1), neurogenic impotence (n = 1), and psychogenic impotence (n = 1). Proper angiographic evaluation required refined angiographic techniques such as selective magnification pharmacoarteriography, pharmacocavernosography, and pharmacocavernosometry. A variety of therapeutic options were either recommended or applied, depending on the angiographic findings. These included venous ligation, arterial bypass, injections of papaverine hydrochloride, and insertion of penile prostheses.

Adult↗
PubMed1987

The veno-occlusive mechanism of the canine corpus cavernosum: angiographic and pharmacologic studies.

Studies were designed to document the normal angiography and pressure-volume characteristics of the canine corpus cavernosum, evaluate the effects of various vasoactive agents, and characterize a veno-occlusive mechanism. In fourteen dogs, baseline cavernosography demonstrated venous drainage via six to ten tributaries arising from the crura and entering the deep penile veins. Control cavernosometry during infusion of saline at 0.33 ml./sec. led to a rise in intracavernosal pressure (ICP) from 24.9 +/- 7.9 mm. Hg to 68.4 +/- 21.1 mm. Hg. Intracavernosal injection of a number of vasodilators, including papaverine, nitroglycerin, acetylcholine, and prostaglandin E2, raised baseline ICP significantly, caused extreme elevation of pressure during saline infusion (greater than 450 mm. Hg), and narrowed or obliterated the venous lumena at the site of tunica perforation, as judged angiographically. These effects could be reversed with phenoxybenzamine or norepinephrine. Our results further support the current understanding of the canine veno-occlusive mechanism.

Animals↗
PubMed1987

Pharmacoarteriography in the evaluation of impotence.

Progress in diagnosis and therapy of impotence is handicapped by the absence of a validated and objective method for evaluating the vascular system; a gold-standard for vasculogenic impotence is needed. Prior experience has indicated that conventional arteriography in unanesthetized patients is unreliable in evaluation of the penile arterial supply. We have improved our arteriographic methods by the routine application of selective pudendal injections, vasodilation pharmacoangiography with nitroglycerin and papaverine, and direct magnification. Experience in 37 impotent patients demonstrates marked improvement in the quality of visualization of distal vessels, and the frequent presence of functional vasoconstriction of medium and small arteries that can be distinguished from organic disease only with vasodilators. We believe these angiographic methods will improve the criteria against which other diagnostic and therapeutic methods can be objectively assessed.

Adult↗
PubMed1987

Penile pharmacocavernosography and cavernosometry in the evaluation of impotence.

Within the past few years, veno-occlusion of the corpora cavernosa has become generally recognized as an essential prerequisite for adequate penile erection. Veno-occlusive incompetence is suspected to be a frequent cause of impotence. Our recent experience with cavernosography in two normal volunteers and 36 impotent patients indicates that angiography is reliable in evaluating the competence of the veno-occlusive mechanism only if both pharmacocavernosography (PCG) and pharmacocavernosometry (PCM) are applied. Twenty minutes after intracavernosal (IC) injection of a mixture of 60 mg. papaverine and one mg. phentolamine (regitine), 100 ml. of diluted radiographic contrast medium are infused at the rate of one or two ml./sec. while pressure is recorded, and radiographic films are exposed at the rate of one every eight to 15 seconds. PCM and PCG of the corpora cavernosa indicated the overall degree of competence of the cavernosal veno-occlusive mechanisms, and the sites of veno-occlusive incompetence; non-pharmacologic studies were unreliable in these regards. During non-pharmacologic infusion in normals, pressures rose to 40 to 45 mm. Hg, and free efflux could be visualized from multiple venous systems. After pharmacologic injection in normals, all venous channels closed, and pressures rapidly rose toward or above 200 mm. Hg, at which time the infusion was stopped. Veno-occlusive incompetence was defined angiographically when more than minimal efflux occurred during pharmacocavernosography from any venous system. The incompetence could involve the deep penile system, the deep dorsal system, or the spongiosal system, alone or in combination. Severe veno-occlusive incompetence was considered diagnostic of venogenic impotence, and was defined manometrically when IC pressures failed to exceed 100 mm. Hg during infusion of 100 ml. of fluid at 2 mm./second after IC papaverine and phentolamine injection. We believe these angiographic methods will improve the criteria against which other diagnostic and therapeutic methods can be assessed.

Adult↗
PubMed1987

Production of penile veno-occlusive insufficiency by arterial occlusion in a canine model.

Angiographic evaluation of impotent men revealed a frequent association between penile arterial disease and veno-occlusive insufficiency of the corpora cavernosa. In order to evaluate a possible cause-and-effect relationship, we investigated the competence of the cavernosal veno-occlusive mechanism in a canine model at various intervals after onset of cavernosal ischemia. In most dogs, the veno-occlusive mechanism could no longer be activated by papaverine after about 30 minutes of ischemia. If ischemia was relieved shortly thereafter, veno-occlusive competence returned after a further delay of one or two hours. The evidence suggests that veno-occlusive failure is not simply a hemodynamic consequence of loss of arterial inflow, but instead secondary to some ischemic injury. We conclude that arterial insufficiency may be one of the causes of cavernosal veno-occlusive insufficiency in humans.

Animals↗
PubMed1987

Fibrinolysis with intrathrombic injection of urokinase and tissue-type plasminogen activator. Results in a new model of subacute venous thrombosis.

The efficacy of intrathrombic deposition vs. parathrombic infusion of urokinase (UK) and tissue-type plasminogen activator (t-PA) was investigated in a canine model. Gianturco coils were placed by transcatheter techniques into the iliac veins of 12 dogs. Venography obtained 48 hours later showed formation of large thrombi. After heparinization, UK (24,000-48,000 IU/ml) or t-PA (12,500-25,000 IU/ml) was spray-injected at high pressure throughout test clots every half-hour using a steel catheter with multiple side holes. Between injections, the agent was infused below the clots. The contralateral thrombi received an equivalent dose of fibrinolytic agent by continuous infusion. In six cases, plasminogen was injected into test clots prior to activator treatment. Thrombi spray-injected with either activator lysed in 64 +/- 26 minutes. Four of six thrombi treated with parathrombic urokinase infusion showed partial lysis after 133 +/- 50 minutes. After parathrombic infusion of t-PA, three clots showed complete lysis, one showed partial lysis, and two demonstrated no lysis. There was no significant difference in lysis rate between intrathrombic UK and t-PA nor did prior intrathrombic injection of plasminogen accelerate lysis. In summary, intrathrombic injection of highly concentrated UK or t-PA lysed subacute thrombi more effectively than parathrombic infusion.

Animals↗
PubMed1987

Cavernosal venocclusive insufficiency in male impotence: evaluation of degree and location.

The author's experience with 72 patients with impotence, one patient with Peyronie disease (no impotence), and two healthy volunteers indicates that incompetence of the venocclusive mechanism of the corpora cavernosa is probably the most common cause of vasculogenic impotence. Manometric and angiographic studies are the key to diagnosis but only when performed while the venocclusive mechanism is activated. Activation is achieved by intracavernosal injection of a papaverine-phentolamine mixture. Pharmacomanometry, performed with the newly developed pharmacologic maintenance erectile flow (PMEF) method, enabled precise quantitation of the leak at a given cavernosal pressure. A new appreciation of the limited volume of normal flow in the cavernosal arteries indicates that cavernosal leak in the range of only 20 ml/min is probably capable of contributing to impotence. Pharmacocavernosography enabled identification of sites of leakage (key information in the planning of surgical correction) but was unreliable in the evaluation of the severity of leakage.

Aged↗
PubMed1987

Penile magnification pharmacoarteriography: details of intrapenile arterial anatomy.

To establish a base of normality against which state-of-the-art penile arteriograms can be assessed, we analyzed selective magnification penile pharmacoarteriograms from 23 men who were not believed to have arteriogenic impotence. The penile arteries showed no evidence of acquired obstructive disease, and all individuals had had normal sexual function in the recent past. The vascular patterns were highly variable and frequently differed from classic descriptions found in textbooks of anatomy. Normal variations that could be easily confused with arterial obstruction were unilateral origin of all cavernosal branches, unilateral hypoplasia of a dorsal penile artery, and aberrant origin of bulbar or cavernosal arteries. Multiple potential collateral routes were shown, including transverse collaterals at the root of the penis and communications between cavernosal and dorsal penile arteries. Appreciation of the type and frequency of anatomic variants and potential collateral routes is important in correctly interpreting penile angiograms and in evaluating the hemodynamic significance of suspected stenoses.

Arterial Occlusive Diseases↗
PubMed1987

Thrombosed dialysis grafts: efficacy of intrathrombic deposition of concentrated urokinase, clot maceration, and angioplasty.

Forty-one thrombosed polytetrafluoroethylene hemodialysis grafts in 26 patients were treated by a modified method of fibrinolytic therapy and transluminal angioplasty. The modifications included the use of highly concentrated urokinase, intrathrombic injection of urokinase into mechanically macerated thrombi, use of a crossed two-catheter technique, observation of the patient in the angiography suite during the entire procedure, and transluminal angioplasty to correct underlying stenosis immediately after partial or complete thrombolysis. Lysis was initially successful in 37 (90%) of 41 procedures. Successful treatment, defined as a functional graft for longer than 6 months without intervening surgery, was achieved in 16 (62%) of 26 patients. In comparison with previous transluminal or surgical regimens, this modified method permits marked acceleration of thrombolysis, immediate transluminal angioplasty, and sparing of potential future graft sites.

Angioplasty, Balloon↗
PubMed1986

Chronic pernio. A historical perspective of cold-induced vascular disease.

Chronic pernio, or cold-induced vascular disease, is an uncommon syndrome with a clinical resemblance to vasculitis or peripheral cholesterol embolization. We studied a case of chronic pernio in which the angiogram revealed extensive vascular changes indistinguishable from vasculitis; pathologic studies of previously reported cases have revealed a primary vasculopathy. The pathophysiology of chronic pernio may be cold-induced vessel damage leading to a secondary dermopathy. Our patient's condition improved once the correct diagnosis was established and appropriate therapy was instituted.

Aged↗
PubMed1986

Streptokinase, urokinase, and tissue plasminogen activator: pharmacokinetics, relative advantages, and methods for maximizing rates and consistency of lysis.

Early reperfusion of occluded coronary arteries offers great promise as a method for minimizing myocardial damage after acute myocardial infarction. Such reperfusion is usually attempted via administration of fibrinolytic agents. Urokinase may hold marginal advantages over streptokinase, especially in patients with high preexisting titers of antistreptokinase antibodies. These minor differences, however, pale in comparison to important advantages demonstrated by the newly developed agent, tissue plasminogen activator (t-PA). The advantages of t-PA derive primarily from its property of binding to, and being activated by, fibrin. Consequently the generated plasmin is also fibrin-bound, the bound plasmin is protected from circulating antiplasmin and therefore more efficiently utilized, and circulating fibrinogen is spared. Preliminary clinical experience indicates that the frequency of favorable response after intravenous administration of t-PA is considerably greater than after SK. A major determinant of clinical benefit after reperfusion is the brevity of ischemia. Selective intracoronary infusion of fibrinolytic agent produces faster lysis than does intravenous infusion, and rate of lysis may be further accelerated by transcatheter disruption of clot and intrathrombic injections of highly concentrated urokinase or t-PA. Even maximally accelerated lysis, however, cannot fully compensate for the inherent delay imposed by catheterization. For that reason, prompt intravenous infusion of fibrinolytic agents, presumably t-PA, seems preferable to the intracoronary route. In the effort to initiate fibrinolytic therapy at the earliest feasible time after infarction, administration by paramedics, or even home administration after training, is a program worthy of exploration.

Coronary Thrombosis↗
PubMed1986

Pharmacologic studies of intra-hepatic artery chemotherapy with degradable starch microspheres.

The effect of degradable starch microspheres (DSM) on the pharmacokinetics of 4 drugs administered via the hepatic artery was studied in 5 patients with colon carcinoma metastatic to the liver. The 4 drugs were 99m-technetium diethylenetriamine pentaacetic acid (99mTc-DTPA), an agent which is not metabolized in the liver, and floxuridine, doxorubicin, and mitomycin, agents which undergo hepatic metabolism to varying extents. DSM transiently decreased arterial blood flow to normal liver an average of 64% and to hepatic tumor an average of 78%. DSM increased tumor exposure to DTPA by a mean of 1.71-fold, and increased hepatic exposure by 1.46-fold, but did not affect total plasma exposure. In contrast, DSM did reduce total plasma exposure to floxuridine by a mean of 34%, and to mitomycin by 20%. No information was available on the effect of DSM on plasma doxorubicin levels which never exceeded the limits of detection. Variation in the injection rate of DSM did not appear to influence the relative advantages produced in tumor or plasma AUCs. The estimated increase in tumor exposure produced by DSM was 3.8-fold for floxuridine, and 3.0-fold for mitomycin. These results reflect the differences in extent of hepatic metabolism of these agents, and agree closely with predictions made from mathematical models. Although DSM improved the therapeutic index, the increase in tumor exposure was insufficient to produce significant tumor regression.

Adult↗
PubMed1985

Hypothenar hammer syndrome. Form of reversible Raynaud's phenomenon.

Hypothenar hammer syndrome is a reversible yet uncommonly encountered cause of Raynaud's phenomenon. Characteristic findings include coldness in the dominant hand of a male, absence of triphasic color change and thumb involvement, and occupational or recreational use of the hand as a hammer. Angiography demonstrates the specific findings of irregularity or occlusion of the ulnar artery, downstream occluded proper digital arteries, and intraluminal emboli at the sites of distal obstruction. A vulnerable area of traumatic occlusion is provided by the anatomic relationship of the superficial branch of the ulnar artery to the hamate bone and the palmar aponeurosis. Pathologic studies separate the hypothenar hammer syndrome from clinically similar vasculitis. It is important to recognize the hypothenar hammer syndrome as a distinct entity because treatment is curative and consists of resection of the affected vascular segment and avoidance of the aggravating conditions.

Adult↗
PubMed1985

Pilot study of intra-arterial floxuridine, mitomycin and doxorubicin in combination with degradable starch microspheres to treat primary and metastatic tumors of the liver.

Concurrent administration of degradable starch microspheres and cytostatic agents into the hepatic artery results in decreased systemic exposure and increased hepatic exposure to drug compared to intra-arterial administration of drug alone. Degradable starch microspheres 210 mg/m2 mixed with floxuridine 500 mg/m2, doxorubicin 40 gm/m2, and mitomycin 10 mg/m2 were administered through hepatic artery catheters to eleven patients with primary or metastatic cancer of the liver. Toxicity was acceptable and consisted of severe myelosuppression (5%), duodenal/gastric ulceration (9%), mild to moderate nausea and vomiting (17%) and alopecia (86%). There were no responses among the eleven patients; 7 of 7 patients with colo-rectal carcinoma had stable disease while on study. Minimal activity was observed in 7 patients with colo-rectal carcinoma. The use of degradable starch microspheres offers a new approach to the regional treatment of cancer and warrants further study.

Adult↗
PubMed1985

Accelerated thrombolysis. In vitro evaluation of agents and methods of administration.

Three groups of experiments were conducted in vitro to determine the relative rates of thrombolysis produced by current clinically-relevant concentrations of streptokinase (SK), urokinase (UK), tissue-type plasminogen activator (t-PA), and plasmin; the concentration-response curves for each agent; and the advantages of mechanical admixture of fibrinolytic agents over simple soak. For Group 1 and 2 experiments, thrombolysis was quantitated by weighing freshly prepared clots before and after 2-hour fibrinolytic soaks. For experiments in Group 3, radio-labeled fibrinogen clots were used, and the amount of lysis was determined by measuring radioactivity in residual clot and supernatant fluid. Results indicated that SK, UK, plasmin, and t-PA in saline all produced roughly equivalent rates of lysis at molarity of 10(-6). Concentrations of SK above this level (corresponding to above 5000 units/ml) slowed lysis markedly; progressively increasing concentrations of UK and t-PA produced faster lysis, with slope of about 17 and 37%, respectively, per log10 of concentration. The efficacy of fibrinolytic agents was significantly enhanced by admixing clot and agent, using intrathrombic injections or clot maceration. With clot volumes of 0.5 ml, residual clot was frequently only 1/2 to 1/3 as much from macerated clots as from clots that were soaked whole. With the further addition of intrathrombic plasminogen, lysis was nearly completed after 30 minutes.

Fibrinolysin↗