不同月龄大鼠阴茎组织中一氧化氮合成酶的含量比较

 目的比较2月龄及18月龄Wister大鼠阴茎海绵体组织中一氧化氮合成酶(Nitrie oxide synthase,NOS)的含量,讨论其生理意义并对阴茎勃起功能障碍发病的年龄依赖性作出相应的解释。方法使用NADPH-d脱氢酶组织化学染色方法观察并进行图像分析。结果发现阴茎海绵体组织中NOS阳性成分是普遍存在的,特别是在阴茎动脉外膜层周围及血窦内皮细胞系统中的含量较多。18月龄大鼠阴茎海绵体组织总体NOS染色水平下降,进一步行图像分析,测定阴茎海绵体组织中NOS的含量,结果显示18月龄大鼠阴茎海绵体组织中NOS含量明显低于2月龄大鼠。结论 阴茎海绵体组织中NOS含量下降是阴茎勃起功能障碍(Erectile dysfunction,ED)年龄依赖性的原因之一。     

一氧化氮与阴茎勃起功能障碍的相关性

阴茎勃起既和阴茎海绵体勃起组织的结构有关 ,又牵涉到有关的神经支配。阴茎勃起的生理基础是动脉血流增加 ,同时静脉回流阻塞 ,使阴茎海绵体内压力急剧升高 ,产生勃起。在此过程中 ,动脉和海绵窦平滑肌的舒缩及静脉回流阻塞都与神经调节有关。近年来研究表明 ,一氧化氮 (Ｎｉｔｒｉｃｏｘｉｄｅ,ＮＯ)是诱发阴茎勃起的主要神经递质 ,在阴茎勃起过程中起着决定性作用。1　ＮＯ与阴茎勃起生理在人体内 ,ＮＯ是在一氧化氮合成酶 (Ｎｉ ｔｒｉｃｏｘｉｄｅｓｙｎｔｈａｓｅ,ＮＯＳ)的作用下 ,催化左旋精氨酸 (Ｌ -Ａｒｇｉｎｉｎｅ,Ｌ -ＡＲＧ)…     

慢性染铅大鼠皮层NOS和nNOS神经元数量的变化

 目的探讨铅损害大鼠大脑皮层一氧化氮合酶(Nitric oxide synthase,NOS)和神经元型一氧化氮合酶(Neural nitric oxide synthase,nNOS)阳性神经元的作用机制.方法采用NADPH-d组织化学和nNOS免疫组织化学方法,研究饮用含不同剂量醋酸铅(0.02,0.2g/L)饮水的大鼠皮层NOS和nNOS阳性神经元数量的变化.结果铅染毒大鼠皮层NOS和nNOS阳性神经元的数量明显减少.结论铅对大脑皮层NOS和nNOS阳性神经元有明显的损伤作用,并且存在明显的剂量-效应关系.     

反流性食管炎患者食管壁内NO能、VIP能神经的改变和相互关系

为探讨反流性食管炎 (RE)患者食管运动障碍的发生机制 ,应用免疫组织化学 (IHN Envision法 )结合IMS型彩色图像分析综合系统 ,对 39例RE患者及 14例正常人食管壁内一氧化氮 (NO)能及血管活性肠肽 (VIP)能神经进行了定位、定量研究。结果发现 ,RE组食管粘膜内一氧化氮合酶 (NOS)和VIP阳性产物与正常组相比显著增多 (P <0 .0 1) ,RE组NOS及VIP阳性区域的面积比和阳性强度均值与正常组相比差异均有显著性意义 (P <0 .0 1) ,NOS和VIP含量之间呈正相关 (r=0 .87,P <0 .0 1)。RE组食管粘膜肌层NOS及VIP阳性神经纤维比正常组明显增多、增粗、染色增强 ,粘膜下层易见NOS及VIP阳性神经节细胞。结果提示 ,RE患者食管壁内NO能和VIP能阳性神经纤维明显增多 ,活性增强 ,表明RE患者食管壁内NO能和VIP能神经显著增加在RE的发生机制中具有一定的作用。     

急性肺栓塞后osteoglycin的表达及对胶原代谢的影响

目的 研究大鼠急性肺栓塞模型肺组织中osteoglycin(OGN)的表达变化及其对胶原代谢的影响.方法 建立大鼠急性肺栓塞模型,分别在急性肺栓塞后1、8、24和48h开胸取出肺组织,提取总RNA和总蛋白.以正常大鼠为对照组,采用半定量RT-PCR研究OGN mRNA的表达变化,采用Western blot进一步验证OGN蛋白表达的变化,采用免疫组织化学方法检测肺栓塞前后大鼠肺组织中OGN的表达变化及组织分布情况,采用Masson染色观察急性肺栓塞4周后肺组织内的胶原沉积状况.结果 在大鼠急性肺栓塞后,OGN在mRNA及蛋白水平均逐渐降低.免疫组化染色显示OGN主要分布在支气管黏膜上皮细胞下层、软骨组织和肺泡周围,且在肺动脉内皮细胞下层、外膜和肺静脉的内膜、中膜以及外膜均有分布.急性肺栓塞后OGN在上述组织内的表达均明显降低.急性肺栓塞4周后肺组织内的胶原沉积明显增加.结论 大鼠急性肺栓塞后肺组织内OGN表达降低,促进了胶原在肺部的沉积.     

血红素加氧酶-一氧化碳系统舒张离体大鼠阴茎海绵体平滑肌作用的研究

 目的 探讨血红素加氧酶-一氧化碳(HO-CO)系统对离体大鼠阴茎海绵体平滑肌的舒张效应,并初步探讨其舒张作用的机制.方法 采用离体大鼠阴茎海绵体肌条张力记录法,观察氯高铁血红素(Hemin)诱导的HO-CO系统对去氧肾上腺素(PE)预收缩的阴茎海绵体肌条的舒张作用;采用放射免疫法,观察Hemin诱导的HO-CO系统对离体大鼠阴茎海绵体组织中cGMP和cAMP水平的影响.结果 Hemin对10 μmol/L PE诱导收缩的离体大鼠阴茎海绵体肌条具有浓度依赖性松弛作用,1、3、10、30、100 μmol/L的Hemin对PE诱导收缩的阴茎海绵体肌条的松弛效应分别为(3.2±1.2)%、(10.6±2.2)%、(21.5±2.7)%、(38.0±3.1)%和(66.5±3.8)%(P<0.01);100 μmol/L的Hemin对大鼠阴茎海绵体组织中cGMP和cAMP的水平均无影响.结论 HO-CO系统能有效舒张离体大鼠阴茎海绵体平滑肌,其机制可能与CO- cGMP或CO-cAMP通路无关.     

肠淤血大鼠肠神经系统内胆碱能和氮能神经的改变

目的研究肠淤血大鼠肠神经系统内乙酰胆碱酯酶（AchE）神经元和一氧化氮合酶（NOS）神经元的改变,以探讨肠淤血影响肠道运动功能的神经机制。方法SD大鼠分成实验组（依据肠道淤血时间分为肠淤血20min组、60min组）和对照组,取各组相同部位的回肠,制作肠肌间神经丛铺片标本,采用AchE和NADPH-d组化染色,观察比较各组AchE、NOS阳性神经元的分布密度和染色情况。结果与对照组比较,实验组大鼠的回肠肌间神经丛内AchE阳性神经元数量减少（P〈0．01）,阳性表达减弱,而NOS阳性神经元数量增多（P〈0．01）,阳性表达增强;与肠淤血20min组比较,60min组AchE阳性神经元较少（P〈0．01）,胞体染色较浅,而NOS阳性神经元数量较多（P〈0．01）,胞体大而染色深,但节间束NOS阳性神经纤维稀少。结论肠淤血会影响或损伤肠神经系统的胆碱能和氮能神经,这可能是肠淤血后肠道运动功能障碍发生的神经机制。     

外伤后高流入性阴茎异常勃起的诊断与治疗

目的 探讨高流入性阴茎异常勃起的病因与发病机制,提高其诊断和治疗水平。方法 分析总结2例外伤后动脉性高流入性阴茎异常勃起病人的临床资料。2例均经多功能彩色多谱勒检查确诊。其中1例行选择性阴部内动脉造影,并用明胶海绵行右侧海绵体动脉栓塞术。结果 本组2例患者中,行超选择性海绵体动脉栓塞术治疗的病例术后阴茎变软,术后随访阴茎勃起功能恢复正常;另1例仅行海绵体穿刺放血后向海绵体内注入阿拉明治疗,阴茎暂时变软,很快又恢复至原来状态,治疗效果不佳。结论 阴茎海绵体血气分析及选择性阴部内动脉造影是诊断海绵体动脉窦状隙瘘的主要依据。超选择性海绵体动脉栓塞术治疗动脉性高流入性阴茎异常勃起是安全而有效的方法。     

11例闭合性阴茎海绵体破裂的诊治

目的总结外伤性阴茎海绵体破裂的诊断与治疗。方法回顾性分析我院2000～2009年收治的11例阴茎海绵体破裂患者的临床资料。结果11例均急诊行白膜修补手术治疗,术后随访2～26个月,发生1例阴茎勃起后疼痛、1例尿道狭窄、1例勃起功能障碍,均经恰当的治疗后在不同的时间内得以恢复。结论急诊手术是外伤性阴茎海绵体破裂恰当的治疗方法。     

牛黄酸锌对染汞大鼠皮质NOS活力和nNOS阳性神经元的影响

 目的观察牛黄酸锌对染汞大鼠皮质一氧化氮合酶活力和神经元型一氧化氮合酶阳性神经元的变化,探讨TZC对汞神经毒性拮抗的作用机制.方法采用NADPH-d组织化学和ABC免疫组织化学方法,观察了饮用含4.3mg/(kg·d)氯化汞(HgCl2)和不同剂量(0.23,0.46g/L)TZC溶液的大鼠皮质NOS活性和nNOS阳性神经元数目的变化.结果TZC可缓解汞所致的皮质NOS活力增强,并明显增加nNOS阳性神经元的数目.结论汞中毒时TZC可通过减少皮质NOS活力和增加nNOS水平来发挥其拮抗作用.     

Radioisotope penile plethysmography: a technique for evaluating corpora cavernosal blood flow during early tumescence

Radioisotope penile plethysmography is a nuclear medicine technique which assists in the evaluation of patients with erectile dysfunction. This technique attempts to noninvasively quantitate penile corpora cavernosal blood flow during early penile tumescence using technetium-99m-labeled red blood cells. Penile images and counts were acquired in a steady-state blood-pool phase prior to and after the administration of intracorporal papaverine. Penile counts, images, and time-activity curves were computer analyzed in order to determine peak corporal flow and volume changes. Peak corporal flow rates were compared to arterial integrity (determined by angiography) and venosinusoidal corporal leak (determined by cavernosometry). Peak corporal flow correlated well with arterial integrity (r = 0.91) but did not correlate with venosinusoidal leak parameters (r = 0.01). This report focuses on the methodology and the assumptions which form the foundation of this technique. The strong correlation of peak corporal flow and angiography suggests that radioisotope penile plethysmography could prove useful in the evaluation of arterial inflow disorders in patients with erectile dysfunction.     

Quantitation of pharmacologically-induced penile erections: the value of radionuclide phallography in the objective evaluation of erectile haemodynamics

This study combines the pharmacologically-induced penile erection (PIPE) technique with radionuclide phallography (RNP) for the non-invasive study of penile haemodynamic changes during erection. Penile erections produced by the intracavernosal injections of two different vasoactive drugs, prostaglandin E1 (PGE1) and papaverine HCl (PPV) were assessed by quantitation of the dynamic RNP and parameters of erection were defined and compared. PGE1 intracavernosal injections were seen to elicit a better erectile response than PPV. Dynamic radionuclide phallography was performed using 99Tcm-labelled autologous RBCs in five normally potent volunteers, sixteen patients with psychogenic impotence, seven patients with vasculogenic impotence (three arteriogenic, four venous leakage) and one patient with neurogenic impotence. Physical parameters of erection including the penile length and circumference changes during erection and the erectile angle were compared with the indices of penile blood flow and volume derived through quantitation of the RNP. There was a close correlation between the penogram index (an index of penile blood volume) and penile circumference increase during erection (r = 0.77, p less than 10(-6). The erectile angle, a measure of penile rigidity, correlated strongly (r = 0.82, p less than 10(-6) with the flow index, a measure of penile blood volume. Patterns specific to various categories of impotence were observed and these aided in the diagnosis, especially in equivocal cases with a suboptimal clinical response to the intracavernosal injection. Quantitative RNP offers a non-invasive method which allows direct objective assessment of the erectile response providing several quantitative parameters for analysis.     

Arterial anatomy and arteriographic diagnosis of arteriogenic impotence

One hundred twenty-six bilateral selective arteriographic examinations of the iliopudendal vascular tree were performed after comprehensive multidisciplinary evaluation in patients with chronic erectile dysfunction. Best imaging results were obtained by performing the arteriography under epidural anesthesia after intracavernous injection of a vasoactive drug combination. The arteriography is mandatory prior to revascularization procedures. It is further indicated in primary erectile dysfunction and posttraumatic erectile failure. The importance of cavernosography and selective arteriography in primary erectile dysfunction is stressed. Increasing knowledge about the influence of vasoactive drugs on penile hemodynamics has led to its application in diagnosis and therapy of erectile dysfunction. Pharmacocovernosography, Doppler-ultrasound of penile arteries after intracavernous injection of a vasoactive drug combination, and pharmacoarteriography are refined techniques to prove a vascular etiology of erectile dysfunction. The results of the morphologic studies of the vascular system are correlated with functional testing of erectile capacity by intracavernous application of a papaverinephentolamine drug combination.     

Quantification of penile fat infiltration using the mDIXON Quant sequence: a pilot study on the correlation with penis hardness and erectile dysfunction

Objective:The purpose of this study was to determine fat/water signal ratios using the mDIXON Quant sequence, quantitatively assess fat infiltration in the penis, and explore its possible relationship with penile hardness and erectile dysfunction.Methods:Routine pelvic MRI with the mDIXON Quant sequence was performed in 62 subjects, including 22 people in the normal group, 20 people in the normal erectile hardness group, and 20 people in the erectile dysfunction (ED) group. The fat/water signal ratio in the penis was measured using the mDIXON Quant sequence. Shear wave elastography was used to evaluate the hardness of the corpus cavernosa of the penis.Results:The fat/water signal ratio of the corpus spongiosum was significantly lower than that of the corpus cavernosa in the normal group (p = 0.03) and ED group (p < 0.01). There was no significant difference in the fat/water signal ratios between the normal group and the normal erectile hardness group. Fat infiltration was significantly lower, and erectile hardness was significantly higher in the normal erectile hardness group than in the ED group, and the fat infiltration in the left and right corpus cavernosa was inversely proportional to the erectile hardness of the penis.Conclusion:This study suggests that mDIXON Quant can be used as a non-invasive, quantitative, and objective method for evaluating penile fat infiltration. This method could help diagnose penile fat infiltration in patients with erectile dysfunction and varying body mass indexes. Our results could also allow for a more accurate diagnosis and monitoring of erectile hardness function by quantitatively measuring penile fat infiltration.Advances in knowledge:(1) The proton density fat fraction technology is a new tool for the objective, quantitative and non-invasive evaluation of penile fat infiltration. (2) The quantitative measurement of fat infiltration in the corpora cavernosa might help diagnose and monitor penile erection hardness and its function more accurately.     

Penile blood flow by xenon-133 washout

Penile erectile failure is often attributed to abnormalities of vascular supply or drainage, but few direct measurements of penile blood flow have been made. We describe the xenon washout method for measurement of penile blood flow, and present the results obtained in a group of normal and impotent subjects. The procedure was performed with standard nuclear imaging equipment. Flaccid-state penile blood flow in the impotent patients studied was not significantly different from the normal group, suggesting that flaccid-state measurements may not be helpful in evaluation of erectile failure. However, this method can be used to measure penile venous outflow with stimulated or induced erection, and may provide a method for detecting abnormal venous leakage.     

Diagnostic value of radionuclide phallography with intravenous vasodilator stress in the evaluation of arteriogenic impotence

Arteriogenic impotence is a major cause of organic erectile dysfunction. We evaluated the diagnostic value of quantitative radionuclide phallography with intravenous pharmacological stress in screening impotent patients for penile arterial inadequacy. Using technetium-99m labelled autologous erythrocytes, dynamic scintigraphy of the penile blood pool was performed. Penile haemodynamic changes following intravenous injection of the vasodilator isoxsuprine hydrochloride were assessed by quantitation of penile blood flow and volume. Forty-seven impotent patients (11 psychogenic, 24 arteriogenic, 10 venogenic, 2 endocrine) were studied. Arteriogenic impotent patients demonstrated a lesser degree of increase in penile blood flow and volume than impotent patients with uncompromised penile arterial inflow. Quantitation of penile blood flow and volume yielded a high diagnostic accuracy (>90%). Radionuclide phallography with intravenous vasodilator stress forms a simple and accurate method for evaluating the functional integrity of penile arterial inflow.     

Color Doppler appearance of penile cavernosal-spongiosal communications in patients with severe Peyronie's disease

Our objective was to investigate the prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC) in patients with severe Peyronie's disease. These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Twenty patients with severe Peyronie's disease underwent penile color Doppler US after intracavernous injection of prostaglandin E(1). Study inclusion criteria were penile curvature or shortening which made intercourse difficult or impossible. The quality of erectile response was subjectively scored. The spectral characteristics of CSC were evaluated in comparison with waveform changes in cavernosal artery. There were 4 patients with normal erectile response, 10 with discrepancy in rigidity of the penile base and tip, 4 with veno-occlusive dysfunction and 2 with arteriogenic dysfunction. The CSC just proximal to the plaques had peak systolic velocity (PSV) significantly higher and resistance index (RI) significantly lower than the other CSC. The PSV in CSC near the plaques of patients with base-tip discrepancy and with veno-occlusive dysfunction were significantly higher than in the other patients. In patients with severe Peyronie's disease CSC near the plaques remain patent with low-resistance flow supporting the hypothesis that blood leakage can occur through these vessels.     

Percutaneous penile venoablation for treatment of impotence

Percutaneous penile venoablation with sclerosing agents and coils was performed in 58 patients. Of 104 ablations attempted, 44 of 51 (86%) transpenile, and 46 of 53 (86.7%) retrograde interventions were technically successful. In 40 patients (69%) erectile function improved (intercourse was possible in 21 without additional measures). Initially improved erectile function deteriorated in 24 patients during follow-up (in an average of 6 months); in 15 of these, intercourse was still possible with injection of vasoactive drugs. In 7 patients, repeat venoablation improved erectile function again. Hot contrast medium was slightly superior to sodium morrhuate as a sclerosing agent. In successfully treated patients, the average decrease in venous leakage was 30 ml/min vs 13 ml/min in treatment failures, with considerable overlap between both groups. Only minor complications were observed. We conclude that percutaneous penile venoablation is technically feasible, and safe. Whether the procedure will have a definite role in the treatment of venogenic impotence, however, still has to be determined.     

Assessment of normal and abnormal erectile function: color Doppler flow sonography versus conventional techniques

The penile arteries were studied with color Doppler flow sonography in 10 subjects with normal and 39 patients with abnormal erectile function. The relationships of systolic and diastolic velocities to spectral waveform changes in the penile arteries in response to tumescence were studied before and after intracorporal injection of vasoactive medications that induce erection. In normal subjects, a characteristic spectral waveform pattern corresponded to increasing intracorporal pressure. Patients with abnormal arterial inflow and/or abnormal venous sinusoidal leakage demonstrated deviation from the patterns noted in normal subjects. Patients with abnormal arterial inflow had lower mean peak systolic velocities than normal subjects. Patients with severe venous sinusoidal incompetence had an arrest of waveform progression with evolution to but not beyond phases 1 or 2 (diastolic flow remained positive). Patients with abnormal arterial inflow and abnormal venous sinusoidal outflow had waveform changes that reflected both processes. Systolic/diastolic velocity and waveform relationships can be used to define the integrity of both the cavernosal artery inflow and venous sinusoidal outflow occlusion mechanisms.