Priapism: etiology, treatment, and results in series of 35 presentations

Of 35 cases of priapism a successful outcome with detumescence of the erection and preservation of potency was achieved in only 6 instances. Patients with sickle cell disease enjoyed a more optimistic outcome, and early presentation appeared to be the key factor. The different therapeutic approaches did not have great impact on the outcome, and we advise an initial conservative approach progressing to glans-cavernosa fistula creation and subsequently to cavernosum-spongiosum shunting for patients failing to respond.     

Compartment syndrome. Definition, etiology, pathophysiology

A compartment syndrome is a condition in which increased pressure a confined fascial space causes decreased capillary blood flow and tissue function below a level necessary for viability. There are a variety of possible etiologies, such as increased compartment content (hematoma, edema, exertion, intoxication) and decreased compartment size (constrictive dressings and casts, closure of fascial defects). The pathophysiology of compartment syndrome is based on the arteriovenous gradient theory. The high pressure within the compartment leads to a decrease in the arteriovenous gradient, to a lowering of tissue PO2 and finally to a metabolic deficit. The tolerance of increased pressure by nerve and muscle is defined by the relationship of mean arterial pressure to tissue pressure and not by absolute tissue pressure.     

Psoriatic arthritis - update on pathophysiology, assessment, and management

Psoriatic arthritis (PsA) is classified as a spondyloarthropathy and characterized by synovitis, enthesitis, dactylitis, and spondylitis, usually manifesting in a person with skin and nail psoriasis. Our understanding about the PsA disease state, its genetics, pathophysiology, and comorbidities, as well as our ability to assess and treat the disease, has advanced as a result of significant collaborative efforts by rheumatologists and dermatologists. This work has been primarily in the development of classification criteria, outcome measures to assess the various clinical domains, and treatment trials with agents also used for diseases such as rheumatoid arthritis (RA) and psoriasis. Biologic agents, especially the anti-TNFs, have demonstrated significant efficacy and reasonable safety in all clinical domains of the disease, resulting in amelioration of clinical symptoms, inhibition of structural damage, and improvement of function and quality of life. A number of advances in assessment and treatment have occurred in the last few years, which are highlighted in this update. This article reviews assessment and treatment of PsA, with an emphasis on recent data.     

Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management

AIM: To summarize the most common etiologic factors and describe the pathophysiology in the formation of peritoneal adhesions, to outline their clinical significance and consequences, and to evaluate the pharmacologic, mechanical, and surgical adjuvant strategies to minimize peritoneal adhesion formation. METHODS: We performed an extensive MEDLINE search of the internationally published English literature of all medical and epidemiological journal articles, textbooks, scientific reports, and scientific journals from 1940 to 1997. We also reviewed reference lists in all the articles retrieved in the search as well as those of major texts regarding intraperitoneal postsurgical adhesion formation. All sources identified were reviewed with particular attention to risk factors, pathophysiology, clinical manifestations, various methods, and innovative techniques for effectively and safely reducing the formation of postsurgical adhesions. RESULTS: The formation of postoperative peritoneal adhesions is an important complication following gynecological and general abdominal surgery, leading to clinical and significant economical consequences. Adhesion occur in more than 90% of the patients following major abdominal surgery and in 55-100% of the women undergoing pelvic surgery. Small-bowel obstruction, infertility, chronic abdominal and pelvic pain, and difficult reoperative surgery are the most common consequences of peritoneal adhesions. Despite elaborate efforts to develop effective strategies to reduce or prevent adhesions, their formation remains a frequent occurrence after abdominal surgery. CONCLUSIONS: Until additional information and findings from future clinical investigations exist, only a meticulous surgical technique can be advocated in order to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery.     

Chronic achilles peritendinitis: etiology, pathophysiology, and treatment

Overuse injuries represent a significant percentage of injuries seen in a sports medicine setting. Sports medicine health professionals evaluate and treat patients with the overuse injury of chronic Achilles peritendinitis. This paper reviews the anatomy of the Achilles tendon and presents recent literature concerning the etiology, pathophysiology, and rehabilitation of chronic Achilles peritendinitis. A rehabilitation program is outlined addressing the specific demands of the chronically injured Achilles tendon. J Orthop Sports Phys Ther 1991;13(4):171-176.     

Priapism: New concepts in the pathophysiology and new treatment strategies

Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process, and we have little information on the etiology and pathophysiology of this erectile disorder. Two main types of priapism exist: low-flow (ischemic) and high-flow (nonischemic) priapism. When the physician first diagnoses which type of priapism exists, distinguishing the type of priapic event is paramount in order to choose the correct treatment options. Until recently, we had not sufficiently understood the pathogenesis of this erectile disorder and therefore, could not effectively manage its pathologic consequences of erectile tissue damage and erectile dysfunction. In this review, the proposed pathogenesis of ischemic priapism is reviewed, and a survey regarding novel treatment modalities is given.     

Male hypogonadism. Part II: etiology, pathophysiology, and diagnosis

Male hypogonadism has a multifactorial etiology that includes genetic conditions, anatomic abnormalities, infection, tumor, and injury. Defects in the hypothalamic-pituitary-gonadal axis may also result from type II diabetes mellitus and treatment with a range of medications. Circulating testosterone levels have been associated with sexual function, cognitive function, and body composition. Apart from reduced levels of testosterone, clinical hallmarks of hypogonadism include absence or regression of secondary sex characteristics, reduced fertility (oligospermia, azoospermia), anemia, muscle wasting, reduced bone mass (and bone mineral density), and/or abdominal adiposity. Some patients, particularly those with partial androgen deficiency of the aging male, also experience sexual dysfunction, reduced sense of vitality, depressed mood, increased irritability, difficulty concentrating, and/or hot flushes in certain cases of acute onset. As many patients with male hypogonadism-like patients with erectile dysfunction-do not seek medical attention, it is important for clinicians to be acquainted with the signs and symptoms of hypogonadism, and to conduct appropriate laboratory testing and other assessments to determine the causes and inform the treatment of this condition.     

Hyponatremia: pathophysiology,classification, manifestations and management

Hyponatremia has complex pathophysiology, is frequent and has potentially severe clinical manifestations, and its treatment is associated with high risks. Hyponatremia can be hypertonic, isotonic or hypotonic. Hypotonic hyponatremia has multiple etiologies, but only two general mechanisms of development, defective water excretion, usually because of elevated serum vasopressin levels, or excessive fluid intake. The acute treatment of symptomatic hypotonic hyponatremia requires understanding of its targets and risks and requires continuous monitoring of the patient’s clinical status and relevant serum biochemical values. The principles of fluid restriction, which is the mainstay of management of all types of hypotonic hyponatremia, should be clearly understood and followed. Treatment methods specific to various categories of hyponatremia are available. The indications and risks of these treatments should also be well understood. Rapid correction of chronic hypotonic hyponatremia may lead to osmotic demyelination syndrome, which has severe clinical manifestations, and may lead to permanent neurological disability or death. Prevention of this syndrome should be a prime concern of the treatment of hypotonic hyponatremia.     

慢加急性肝衰竭病因及其病理生理机制研究进展

慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)是国内最常见的肝衰竭类型,其临床表现复杂,病死率极高.ACLF的病理生理学改变目前尚不明确,深入了解ACLF的病理生理学改变有助于临床治疗工作的改善.近年来ACLF的病理生理学研究取得了一定的成就.本文就ACLF的概念、病因及其病理生理学改变作一综述.     

Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance.

The roentgenographic finding hepatic--portal venous gas (HPVG) has been reported extensively in the pediatric and radiology literature. The surgical implications and clinical significance have yet to be fully defined. This study reviews the 60 reported cases in the literature and adds four new cases. HPVG appears as a branching radiolucency extending to within 2 cm of the liver capsule. HPVG is associated with necrotic bowel (72%), ulcerative colitis (8%), intra abdominal abscess (6%), small bowel obstruction (3%), and gastric ulcer (3%). Mucosal damage, bowel distention and sepsis predispose to HPVG. The current mortality rate of 75% represents an improvement from previous experience. Analysis of survivors indicates that the finding of HPVG requires urgent surgical exploration except when it is observed in patients with stable ulcerative colitis.     

Priapism: new concepts in medical and surgical management

Advances have recently been made in both medical and surgical management of priapism, and these offer improvements in the level of care afforded such patients. Further developments can be expected based on ongoing progress, particularly in the area of molecular science, which is the primary source for driving novel therapeutic approaches. Continued action to address the health care administrative concerns of those most commonly affected by priapism, specifically individuals with sickle cell disease, is also appropriate. All successes in these arenas ensure that afflicted individuals avoid the health burdens of priapism and preserve sexual function.