Risk factors for papaverine-induced priapism.

Intracorporeal administration of papaverine hydrochloride is frequently used in the diagnosis and treatment of impotence. Priapism is the most serious potential complication of its use. The historical characteristics of 400 consecutive men receiving a standardized dose of papaverine were reviewed in an effort to determine the risk factors for prolonged erections. Younger men (p less than 0.0001) with better baseline erectile function (p less than 0.023) were more likely to have priapism. Despite use of a significantly lower dose, patients with overt neurological disease also had an increased rate of priapism. Patients with a history of coronary artery disease had a significantly lower risk of priapism (p less than 0.05). Patients with a final diagnosis of either psychogenic or neurogenic impotence had a much greater risk of priapism than those with vasculogenic impotence (p less than 0.001). The initial dosage in pharmacological erection therapy may be adjusted according to these risk factors. However, not all patients with psychogenic or neurogenic impotence had priapism and some patients with vascular disease did have priapism. Therefore, all impotent patients are potentially at risk for pharmacologically induced priapism.     

Heterotopic bone formation in the corpus cavernosum: a complication of papaverine-induced priapism

Priapism is a recognized complication of intracavernous self-injection of vasoactive agents for the management of impotence. We report a case of heterotopic bone formation in the corpus cavernosum of a patient with papaverine-induced priapism.     

Purulent corporeal cavernositis secondary to papaverine-induced priapism

Intracavernous autoinjection of vasoactive substances is used to treat erectile dysfunction. Infection of the corpora cavernosa can be a serious life-threatening complication with this treatment modality. Cavernositis is an unusual complication, especially in otherwise healthy men. In diabetic patients with altered blood supply to the penis and a change of cavernous tissue ischemia can lead to a fulminant infection. We report on a 63-year-old diabetic patient who presented with purulent cavernositis a few weeks after beginning intracavernous injection of papaverine. Treatment included bilateral corporotomy, debridement, and placement of intracorporeal irrigation and suction drains. The patient survived this serious infection leaving both corpora cavernosa with severe fibrosis.     

High-flow priapism as a complication of a veno-occlusive priapism: two case reports

The presentation of two cases of veno-occlusive priapism, in patients of 36 and 58 years, in whom the different medical and surgical techniques employed, failed. The suspicion that high-flow priapism had been provoked by said surgical intervention was confirmed by bilateral arteriographs of the pudendal artery. The treatment, selective embolisation of the affected cavernosal artery with reabsorbable material, led to a rapid return of penile detumescence.     

The actual incidence of papaverine-induced priapism in patients with erectile dysfunction following penile colour Doppler ultrasonography

Penile color Doppler sonography is a valuable method for evaluating erectile dysfunction. However, there are some concerns about the safety of this method due to the intracorporeal pharmacological injection, which may cause priapism as a complication, resulting in penile fibrosis. To evaluate the actual incidence of papaverine-induced priapism in patients with erectile dysfunction (ED) who underwent penile colour Doppler sonography and to determine the safety of this diagnostic tool, a retrospective study was conducted using the database of our institution. A total of 672 men with ED underwent penile color Doppler ultrasonography with the intracorporeal injection of 60 mg papaverine hydrochloride. The patient characteristics of priapism cases were retrospectively evaluated. Priapism in 18 of the 672 patients (2.68%) was successfully treated with blood aspiration, irrigation and injection of an α-agonist medication, when needed. Patients with priapism were younger compared with those without priapism; mean age 45 ± 12.51 (20–68) versus 50.93 ± 12.04 (17–78) ( P  < 0.001). Penile Doppler ultrasound is a safe procedure in evaluating erectile dysfunction. The incidence of priapism, which is the most important complication of this procedure, is low and can be managed successfully with conservative approaches.     

Late cardiac tamponade in children. A lethal complication.

Late cardiac tamponade is an infrequent complication of pediatric cardiac surgery. It is usually accompanied by the postcardiotomy syndrome and can occur after open or closed cardiac operations. It may occur despite treatment of the postcardiotomy syndrome. Five children were treated for late cardiac tamponade. All were treated initially with anti-inflammatory drugs; four also required pericardiocentesis, and two of these required subsequent creation of a pericardial window. One patient died due to delay in performing operative decompression. Late cardiac tamponade can be a lethal complication in children.     

Odontoid metastasis: a potential lethal complication

Nearly one third of cervical spine metastasis has a primary breast malignancy. Patients with cervical metastasis have higher mortality due to advanced stage of the malignancy. Treatment is palliative to relieve pain, prevent pathological fracture, improve mobility and function, and prolong survival. We describe a 40-year-old woman with a history of breast cancer who presented with neck and shoulder pain of 1 week duration with no neurological deficit. Following clinical examination, radiographs taken of the cervical spine was normal. Radiographs repeated 3 weeks later revealed a large lytic lesion of the odontoid occupying 70–80% of the peg. Further investigation including magnetic resonance imaging and bone scan showed no further spinal lesions. She underwent cyclical radiotherapy with complete resolution of the odontoid peg lesion and clinically was asymptomatic at 2 years. Metastatic lesions of the odontoid are atypical, and this case reinforces the necessity of early detection to evade disastrous consequences.     

Enterococcal burn sepsis. A highly lethal complication in severely burned patients

A retrospective study was undertaken to examine the incidence and clinical significance of enterococcal bacteremia in burned patients with enterococcal burn-wound infections. During a 26-month period from 1983 to 1985, 38 patients were found to have enterococcal burn-wound infections. Twenty of these patients developed positive blood cultures for enterococcus with no other identifiable source for the bacteremia. Cases occurred sporadically during the study period without evidence of a specific epidemic. Ten patients died within ten days of the bacteremia, while nine others eventually died from other complications. Only one patient survived to discharge. Prior antibiotic therapy did not appear to increase the risk for enterococcal infection, and specific therapy against the enterococcus after the bacteremia was identified appeared to have no effect on mortality. Mortality was significantly greater for bacteremic patients than for patients with enterococcal wound infection alone or for burned patients without enterococcal infections. Although previously not considered pathogenic, enterococcal burn-wound infections should prompt aggressive therapy to prevent the development of enterococcal sepsis with its associated high mortality.     

A case of traumatic priapism

We report a case of high flow priapism secondary to arteriovenous fistula produced by perineal trauma in a 43-year-old patient. Diagnosis was based on the result of gasometry in cavernous blood and color doppler sonography. Superselective embolization of the deep artery of the penis was performed with good results. After 6 months of treatment, erection and sexual function were normal. Our case demonstrates that this procedure is a safe and effective therapy for high flow priapism.     

坏疽性胆囊炎——重症急性胰腺炎的严重并发症之一

目的 探讨重症急性胰腺炎（SAP）并发坏疽性胆囊炎的临床特点,为早期诊断和外科处理提供依据。方法 回顾2008年1月至2009年12月上海交通大学医学院附属瑞金医院外科ICU收治的4例SAP并发坏疽性胆囊炎的病历资料,分析其发病因素、临床表现、外科处理及预后。结果 4例病人均伴有严重腹腔内感染、感染性休克及多器官功能障碍综合征（MODS）;体征主要表现为程度不同的意识障碍,但腹部体征无特异性;肝脏转氨酶和黄疸指数仅轻度异常;CT检查有明显的胆囊增大、囊壁增厚及囊内结石,胆囊与肝脏的分界模糊甚至囊壁缺失。均未及时外科处理胆道。手术指征主要是根据病人难以控制的全身感染、脏器功能损害和意识障碍加重。1例经手术切除坏疽胆囊后治愈,另3例行胆囊引流,疗效差,2例死亡。结论 SAP急性反应期内尽早识别坏疽性胆囊炎并积极手术切除胆囊,有助于改善预后。