This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.
Objective To evaluate our policy of managing priapism for the success rate of the treatments, potency afterward, complications, and the risk factors responsible for erectile dysfunction in these patients. Patients and methods The study included 50 patients (mean age 37.1 years, range 22±66) with a diagnosis of priapism (1981±1999). Their records were reviewed; 35 patients were available for a long-term evaluation. Factors assessed were the duration of priapism, history of previous recurrent attacks, possible underlying causes (e.g. haematological disorders, medications or trauma), relation to sexual stimulation, pain, and any attempt at previous management. A complete blood screen and blood gases were assessed in corporal aspirates. Duplex ultrasonography was used in all impotent patients at their follow-up. Early and late complications were reviewed, and patients asked about their erectile function before priapism, and any recurrence. Results The median (range) duration of priapism was 48 (6±240) h; almost half the patients presented >48 h after the onset of priapism. Sixteen patients (32%) reported a history of previous recurrent attacks, of whom seven had a history of previous treatments. The main cause of priapism was idiopathic or intracavernosal injection with papaverine. All patients were initially treated by corporal blood aspiration and injection with ephedrine; if this failed or if the priapism was prolonged (>48 h) various shunts were used. The hospital stay was signi®cantly shorter among patients with papaverine-induced or brief priapism. In the long-term follow-up of 35 patients (mean 66.4 months, range 3±220) only 15 (43%) reported preserved erectile function, and this was more likely in patients with brief priapism (<48 h). Eight patients (23%) reported subsequent recurrent attacks of priapism; all were managed successfully as they presented shortly after their onset. Penile ®brosis was detected in 20 patients (57%), and was signi®cantly more common in those with prolonged priapism (>48 h) or from causes other than papaverine. The 20 impotent men evaluated by Doppler ultrasonography had severe echo-dense penile ®brosis and high end-diastolic velocities suggesting veno-occlusive incompetence in all except two. In ®ve men with shunts cavernosography showed extensive venous leakage irrespective of site of the shunt. MRI in ®ve patients with penile ®brosis showed heterogeneous areas of low signal intensity, corresponding with haemosiderin deposition and ®brosis. On univariate analysis the ®nal result of management (complete detumescence or not), the duration of priapism and the presence of penile ®brosis signi®cantly in¯uenced erectile function. On multivariate logistic regression only the ®rst remained signi®cant. Conclusions Low-¯ow priapism for >48 h, failure to maintain complete detumescence after management, and marked penile ®brosis during the follow-up are the most signi®cant risk factors responsible for erectile dysfunction, with failure to achieve complete detumescence the most detrimental.
Renal transplantation has varying effects on erectile function. In the majority of cases it has no negative effect on the quality of erection. In the absence of associated vascular risk factors unilateral interruption of the internal iliac artery decreases arterial penile blood flow but not to a degree that compromise erectile function.
In non-cardioembolic stroke patients, the cardiac manifestations of high blood pressure are of particular interest. Emerging data suggest that echocardiographically determined left ventricular hypertrophy is independently associated with risk of ischemic stroke.The primary objective of this study was to evaluate the frequency of different patterns of left ventricular (LV) remodeling and hypertrophy in a group of consecutive patients admitted with non-cardioembolic stroke or transient ischemic attack (TIA). In particular, we were interested in how often the relative wall thickness (RWT) was abnormal in patients with normal LV mass index (LVMI). As both abnormal RWT and LVMI indicate altered LV remodeling, the secondary objective of this research was to study whether a significant number of patients would be missing the diagnosis of LV remodeling if the RWT is not measured.All patients were referred within 48 hours after a stroke or a TIA for a clinically indicated transthoracic echocardiogram. The echocardiographic findings of consecutive patients with non-cardioembolic stroke or TIA were analyzed.All necessary measurements were performed in 368 patients, who were enrolled in the study. Mean age was 63.7 ± 12.5 years, 64.4% men. Concentric remodeling carried the highest frequency, 49.2%, followed by concentric hypertrophy, 30.7%, normal pattern, 15.5%, and eccentric hypertrophy, 4.1%. The frequency of abnormal left ventricular RWT (80.4%) was significantly higher than that of abnormal LVMI (35.3%), (McNemar P < 0.05).In this group of non-cardioembolic stroke patients, abnormal LV remodeling as assessed by relative wall thickness is very frequent. As RWT was often found without increased LV mass, the abnormal left ventricular geometry may be missed if RWT is not measured or reported.
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