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At least 1,423 records · Page 79Linked to original sources
PubMed1989

[Diagnostic and therapeutic applications of intracavernous injection of vasoactive drugs in impotence. Defense for the use of facilitating drugs. Part I--Pharmacology, classification and complications of active drugs].

The article discusses drugs which promote erection when injected via the intracavernous (IC) route during consultation. The diagnostic and therapeutic applications in the treatment of impotence are discussed also. 25% of impotent patients noted an improvement after this treatment while 50% of patients suffering from impotence of psychological origin noted an improvement. Auto-injection is also discussed. IC treatment now seems justified in most cases which have not responded to traditional therapeutic approaches and this includes cases of psychological origin. Vasoactive drugs can be described as being inducers (use of these drugs induces a rigid erection, even in the presence of the doctor), facilitating drugs (which produce a rigid erection only if sexual stimulation is present also) and inhibitors (which stop the erection). The former group (which has papaverine as leader) produces a significant number of side effects, not least of these being priapism; there is a risk of lasting iatrogenic impotence which is not negligible. These risks are reduced considerably when one uses facilitating drugs which, although less powerful, suffice in treating a large proportion of cases of impotence. Papaverine can not be replaced as a diagnostic drug but facilitating drugs should be used first in therapy and inducers should be used only if these facilitating drugs have failed.

Adrenergic alpha-Antagonists↗
PubMed1989

Genitourinary imaging and procedures by the emergency physician.

Optimal imaging of the urinary tract in the Emergency Department does not require sophisticated or rare equipment. The supervising physician must review each ExU, cystogram, or RUG film as it becomes available and decide upon the proper course of action. Indications for contrast studies in injured patients continue to evolve, with a trend away from investigation of stable patients with microscopic hematuria on the first urine. Urethral catheterization and suprapubic cystostomy are complementary options for bladder drainage. Careful attention to details of anatomy and technique allow for success in the majority of patients. There are substantial pitfalls in the diagnosis and treatment of male genital emergencies. The acute treatment of priapism is rapidly changing as understanding of penile physiology becomes more complete. Acute scrotal pathology can be difficult to categorize without surgical exploration. Urologic consultation, therefore, is mandatory in these conditions.

Cystostomy↗
PubMed1989

Genitourinary emergencies.

An awareness of pitfalls and perils in diagnosis of traumatic injuries to the genitourinary tract, and indications and contraindications for studies and instrumentation, will help diagnose these sometimes underdiagnosed injuries and help minimize morbidity. Suspicion of testicular torsion should lead to prompt urologic consultation, and priapism also should be promptly treated to preserve function. The treatment of acute urinary retention consists of prompt bladder drainage with attention to etiology and methods.

Emergencies↗
PubMed1989

[Subcutaneous heparin-calcium therapy: clinical and laboratory experience].

Fifty patients with acute deep vein thrombosis, pulmonary embolism, acute myocardial infarct and priapism were treated with subcutaneous calcium heparin. Laboratory control was based on the examination of APTT. On the first day of heparin therapy only 52% of patients's APTT was 1.5 times greater than control value but the ratio increased to 82% on the fifth day of treatment. The importance of initial venous sodium heparin bolus (5-10,000 U) followed immediately by subcutaneous calcium heparin is emphasized. Injection of 500 U/kg/day calcium heparin divided in two equal doses is recommended. Four thrombotic and two haemorrhagic complications were observed. Subcutaneous calcium heparin can substitute the intravenous form of heparin (either bolus or continuous) in the treatment of thromboembolism.

Calcium↗
PubMed1986

Adverse reactions to five new antidepressants.

Postmarketing adverse drug reaction reports for amoxapine, maprotiline hydrochloride, and trazodone hydrochloride and premarketing adverse drug reaction data for bupropion hydrochloride and nomifensine maleate are reviewed, and the role of the new agents in the management of depressive illness is discussed. Nomifensine was withdrawn from markets worldwide because of reports of serious hypersensitivity reactions, especially hemolytic anemia, and marketing of bupropion in the United States was delayed after seizures occurred in bulimic patients in clinical trials. Amoxapine and maprotiline, when taken in overdose attempts, are more toxic and cause more serious central nervous system reactions than the standard tricyclics. Acute renal failure and an increased mortality rate are associated with amoxapine overdose. Amoxapine causes several acute and chronic untoward neurologic and endocrine reactions not commonly associated with the standard tricyclics. For maprotiline and bupropion, maximum doses have been established because of dose-related seizures. Trazodone has minimal effect on cardiac conduction; its main cardiovascular effects are hypotension, orthostasis, and dizziness. The trazodone package insert has been revised to warn of priapism; patients with prolonged or inappropriate penile erections are instructed to discontinue the drug and notify the physician. Serious cardiovascular and neurologic toxicities are rare with trazodone overdose. Of the newly marketed antidepressants, only trazodone offers some advantages over the tricyclic and tetracyclic agents in the areas of side effects and toxicities. The number and type of patients exposed to a new drug during clinical trials is too small for detection of rare but potentially serious adverse effects.

Acute Kidney Injury↗
PubMed1987

[Intracavernous injections of vasoactive drugs. Contribution to the study of their value in erectile impotence].

The obtention of an artificial erection with a single intracavernous injection (ICI) of vasoactive drugs, has upset our conceptions about erection and the approach for erectile failure. If this pharmacologic stimulation increases the reliability of some erection tests, their diagnosis value is still questioned. The complexity of both erection and vasomotricity pharmacology, make difficult the understanding of the mechanisms of these ICI. Their therapeutic value is reduced to the method by self injections, new treatment for impotence, even if it concerns only few impotent patients. Finally, the experimental feature and the unquestionable morbidity of these ICI, mainly priapism, impede their large diffusion. However, in spite of these doubts, this intracavernous pharmacology is a real progress for erection and its troubles.

Adult↗
PubMed1987

[Intracavernosa injections of drugs in erection disorders. Their clinical value apropos of 100 cases].

Several centers of interest have been stimulated by the true progress represented by the use of intracavernous injections (ICI) for disorders of erection. First, we have become conscious of our uncertainties concerning the physiology of erection. Second, they serve to orientate the etiologic diagnosis and prognosis when positive responses are obtained in cases of impotence. Third, they are of therapeutic interest as auto-injections in impotence with, however, the risk of secondary cavernous fibrosis. Lastly, they represent a new treatment for priapism. However, these ICI procedures are still in the experimental stage, and should be used with some caution because of their potential morbidity and unknown long-term effects.

Erectile Dysfunction↗
PubMed1984

[A case of pseudopriapism: pericavernous hematoma of the penis].

A case is reported of a hematoma developing between the tunica albuginea of the cavernous bodies and the deep fascia of the penis, following traumatic avulsion of the region of insertion of the adductor muscles of the right lower limb. The interesting feature of this case, a type apparently not reported previously, was the suggested differential diagnosis of early priapism.

Adult↗
PubMed1984

Metastatic prostate carcinoma manifesting as penile nodules.

In three patients with prostate carcinoma, metastasis was manifested as nodular lesions about the corona and glans penis. One patient had priapism in addition. The patients had no other cutaneous metastatic lesions. Two of the patients died within two years of the appearance of the penile nodules, but the lesions in the third patient, followed up for one year to date, responded to intravenously administered mitomycin.

Adenocarcinoma↗
PubMed1983

Corpus cavernosography.

The cavernous spaces of the penis can be demonstrated by injecting 20 cm3 contrast agent (Urografin 60%) dorsolaterally behind the gland penis. By injecting the contrast agent into one corpus cavernosum, both corpora become visible by X-ray. Pathologic conditions (trauma, Peyronie's disease, priapism, malignancy, etc.) cause typical changes in the cavernous spaces and blood drainage. The literature has been reviewed.

Diatrizoate Meglumine↗
PubMed1982

Problems and complications in the adolescent with sickle cell disease.

The period of adolescence in the patient with sickle cell disease seems to be a period of relative calm, medically speaking. The current 5-year prospective Cooperative Study of the Clinical Course of Sickle Cell Disease should demonstrate the actual spectrum of disease in this age group. The recent literature documents with significant relationship between retardation of growth and sexual maturation in the child with sickle cell disease, an effect which seems independent of the severity of the disease. Several other major problems in the adolescent are discussed, including psychological disturbances, leg ulcers, aseptic necrosis, pulmonary disease, priapism, stroke, cholelithiasis, and birth control. A retrospective series of 76 cases of sickle cell disease is briefly presented and the complication occurring during the second decade of life are reviewed.

Adolescent↗
PubMed1994

Intracavernous self-injection of papaverine and verapamil: a clinical experience.

In the years 1992-1993 40 impotent men received treatment with a combination of papaverine and verapamil as intracavernous self-injection (ISPV). Patients' age was between 40 and 75 years. Average injection doses were 5 mg verapamil and 20 mg papaverine. Among those patients no priapism was encountered. Scarring was documented in one patient. Combination therapy is reliable, well accepted and applicable with minimum local risks in erectile dysfunction men.

Adult↗
PubMed1993

[Role of nitric oxide in the erectile mechanism].

Nitric oxide has been identified as an Endothelium-Derived Relaxing Factor (EDRF). Non adrenergic-non cholinergic nerves synthesise and release nitric oxide, thus modulating the arterial tone. Nitric oxide synthase exists either as a constitutive enzyme in many cell types and as an inducible form expressed under immunological stimulation. Nitric oxide is also involved in the non adrenergic-non cholinergic neurotransmission that leads to smooth muscle relaxation in the corpus cavernosum. Similarly nitric oxide induces reduction of cytosolic free Ca++ as a result of activation of the soluble form of guanylyl cyclase. VIP and nitric oxide may function as co-transmitters. Relaxation of the corpus cavernosum is blocked by methylene blue which inhibits cyclic GMP synthesis; so, high flow priapism refractory to medical and surgical treatments can be managed successfully by intracavernous methylene blue. Moreover it is suggested that enhanced alpha 1-adrenergic mediated constrictor tone and penile flaccidity in diabetic men may respond to exogenous generators of nitric oxide. We postulate that relaxation of the corpus cavernosum, started by nitric oxide in response to non adrenergic-non cholinergic neurotransmission, could be amplified and maintained by nitric oxide production as a result of platelet trapping in the corpus cavernosum during the first phase of the penile erection.

Amino Acid Oxidoreductases↗
PubMed1994

[Management of drug-induced prolonged erection].

Prolonged pharmacological erection (PPE) is a blocked erection lasting for more than 4 hours after intracavernosal injection (ICI) of an erectogenic drug. This form of priapism is the commonest complication of ICI in the diagnosis and treatment of impotence. It carries a potential risk of acute ischaemia of the corpora cavernosa with subsequent destruction of the erectile tissues. Any blocked erection must therefore be treated within 4 hours. Medical treatment is sufficient in the very great majority of cases, provided it is performed early. The indication for each medical method (simple measures, oral or, more especially, intracavernosal alpha-stimulant treatment, decompressive cavernosal puncture) depends on the duration of PPE and/or the presence of signs of tissue ischaemia (pain). Surgery is only indicated in the rare cases of failure of medical treatment. PPE can now be prevented by means of selection and information of patients and the recent introduction of less dangerous drugs.

Humans↗
PubMed1997

[Prevention of prolonged drug-induced erection by intracavernous injection of etilefrine].

Here in we report the results of intracavernous injection of etilefrine hydrochloride in a group of 12 patients who developed rigid erection after a diagnostic test with intracavernous PGE1 injection or cavernosometry. Etilefrine reversed erection in all cases. No side-effects or significant changes in blood pressure were noted. Etilefrine is believed to be a safe and low cost alternative to other alpha-adrenergic agents in the prevention of drug-induced priapism.

Adrenergic alpha-Agonists↗
PubMed1979

Heparin therapy for sudden sensorineural hearing loss.

Twenty-three patients with sudden unilateral sensorineural hearing loss were treated with a course of intravenous heparin sodium within one week of the onset of the hearing loss. Complete or good recovery developed in a total of 69.6% of these patients, but this is very similar to previously reported criteria of 66% spontaneous recovery. There was one complication in the series, ie. priapism.

Female↗
PubMed1988

Undiagnosed spinal cord injuries in brain-injured children.

Four children with brain injury were later found to have coexisting spinal cord injury (SCI). Findings that warrant investigation for coexisting SCI include a dermatome pattern sensory loss; absence of movement and reflexes in either both arms or both legs with preservation in the remaining extremities; flaccidity; absence of sacral reflexes; diaphragmatic breathing without use of accessory respiratory muscles; bradycardia with hypotension; autonomic hyperreflexia; poikilothermia; unexplained urinary retention; history of neck pain; unexplained ileus; priapism; and the presence of clonus in an unconscious patient without decerebrate rigidity. If any of the above are present, the spine should be stabilized until either further diagnostic studies confirm SCI with treatment instituted or serial neurologic examinations confirm the absence of SCI.

Brain Injuries↗
PubMed1998

Hereditary spherocytosis, thrombocytosis, and chronic pulmonary emboli: a case report and review of the literature.

Thrombocytosis in post-splenectomy patients with hereditary spherocytosis (HS) is usually not attended by an increased risk of thrombosis. Review of the literature revealed HS in association with pulmonary thrombosis, portal vein thrombosis, and cerebral infarction in two brothers, TTP in an asplenic patient and a patient with corpora cavernosum thrombosis causing segmental priapism. We report a case of a 30-year-old white male with HS who presented with hemoptysis 29 years after splenectomy. Work-up revealed a hypercoagulable state with thrombocytosis and recurrent pulmonary emboli resulting in severe pulmonary hypertension, cor pulmonale, atrial flutter, and syncope.

Adult↗