双功能超声和彩色多普勒显像对血管性阳萎的诊断分析

５９例阳萎患者海绵体内注射罂粟硷前后的双功能超声和彩色多普勒显像，与阴茎血压、灌注性阴茎海绵体造影和部分手术结果进行分析对比，发现１１例血管正常（１９％），１９例动脉功能不全（３２％），２９例静脉漏（４９％）。对阴茎海绵体双功能超声和彩色多普勒显像诊断血管性阳萎的临床价值作了探讨。     

彩色多普勒超声在血管性阴茎勃起功能障碍诊断中的应用

目的评估阴茎海绵体注射后彩色多普勒超声对男性血管性阴茎勃起功能障碍（ED）患者诊断作用。方法47例ED患者经阴茎海绵体注射PGE1 30μg诱导勃起后行彩色超声多普勒检查左、右海绵体动脉血流指标,包括收缩期最大流速（PSV）,动脉舒张末期血流速度（EDV）,阻力指数（RI）。结果非血管性ED组41例（87.2%）,其中左、右海绵体动脉PSV分别〉25 cm/s者33例,左右海绵体动脉PSV相加〉50 cm/s者8例。动脉性ED组2例（4.25%）,左右海绵体动脉PSV均〈25 cm/s,背深静脉未见血流。静脉性ED组4例（8.51%）。结论阴茎海绵体注射血管活性药物后多普勒彩色超声对男性血管性ED检查是一种微创而准确的方法。     

阴茎海绵体造影在阳萎病因诊断中的应用

对70例经阴茎海绵体注射血管活性药物检查阴性的阳萎患者进行了阴茎海绵体造影。结果表明:阴茎背深静脉是静脉漏的主要途径(75.4%)。同时还发现血管活性药物反应与静脉漏的程度和途径有关。认为动态性阴茎海绵体造影是一种简易、安全、损伤小的诊断方法。在临床诊断和治疗静脉性阳萎中具有参考价值。     

静脉性阳萎的造影诊断与分型

在8例尸体阴茎静脉解剖研究基础上,对70例阳萎患者作动态阴茎海绵体造影,发现静脉漏52例,均为罌粟碱试验阴性者。18例阳性者无静脉漏。依漏出部位及流向将静脉性阳萎分为五型。32例经手术证实了诊断。我们认为该分型方法比较客观地反映出造影征象与静脉漏解剖部位间的对应关系,有助于静脉性阳萎的诊断及手术途径的选择。并提出罌粟碱试验(一)应是选择阴茎海绵体造影的重要指征。     

静脉漏性阳萎的诊断与治疗

作者在520例主诉阳萎的患者中筛选出20例静脉漏性阳萎,筛选方法如下。通过询问病史、查体、心理学咨询、NPT研究,除外心理性阳萎。通过神经系统临床检查、球海绵体肌反射测定,除外神经性阳萎。通过测定血清睾酮,催乳素等,除外内分泌性阳萎。通过用多普勒超声测定两根阴茎动脉收缩压,计算阴茎—臂收缩压指数(PBI),并对PBI<0.8者行选择性阴部动脉造影,除外动脉供血不足性阳萎,剩余86例,行海绵体内罂粟碱注射。对25例注射后部分勃起或不勃起者,行海绵体灌流,灌流分三步:(1)以80ml/min的流量灌注盐水,并逐渐增加,直至勃起。同时测定海绵体内     

多普勒阴茎血流图在阳萎诊断中的应用(附250例报告)

应用多普勒阴茎血流图对250例阳萎病人进行测定,测定结果用阴茎海绵体造影或生理盐水灌注勃起试验加以评估。结果提示该方法能正确地诊断和区分功能性阳萎和各类血管性阳萎(包括静脉回流失衡和动脉供血不全性阳萎),为阳萎诊断提供了一个无创性的诊断方法。     

骨盆髋臼骨折后深静脉血栓形成的诊断:彩色多普勒超声与静脉造影的比较研究

目的 比较彩色多普勒超声与静脉造影在骨盆、髋臼骨折后深静脉血栓形成(DVT)诊断中的准确性. 方法 回顾性分析2005年1月至2009年2月期间收治的73例骨盆或髋臼骨折患者资料,男54例,女19例;平均年龄为42.7岁(17 ～67岁).所有患者均通过彩色多普勒超声和静脉造影检查DVT. 结果 73例患者DVT的检查结果:彩色多普勒超声阳性37例,阴性36例;静脉造影阳性48例,阴性25例.静脉造影阳性的48例患者中,彩色多普勒超声阳性34例,阴性14例;静脉造影阴性的25例患者中,彩色多普勒超声阳性3例,阴性22例,彩色多普勒超声与静脉造影在诊断DVT方面差异无统计学意义(x2=3.407,P =0.065).以静脉造影作为诊断DVT的标准,彩色多普勒超声的敏感性为70.8％,特异性为88.0％,阳性预测值为91.9％,阴性预测值为61.1％. 结论 彩色多普勒超声可以作为骨盆、髋臼骨折后DVT的有效筛查方法.对彩色多普勒超声检查结果不确切及结果阴性而临床高度怀疑DVT的患者,可进一步行静脉造影检查.     

糖尿病性勃起功能障碍的超声研究

目的 应用彩色多普勒超声血流显像(CDFI)技术探讨动脉在糖尿病性勃起功能障碍(ED)中的作用.方法 23例糖尿病性ED患者和30例非糖尿病ED患者经阴茎海绵体注射前列地尔注射液(主要成分为PGE1)10 μg诱导勃起后,行CDFI检查双侧海绵体动脉血流动力学指标,包括收缩期最大流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)及内径(R).结果 PSV和R这两项指标在糖尿病性ED和非糖尿病ED患者中存在差异具有统计学意义,EDV和RI在两组患者中的差异没有统计学意义.糖尿病性ED患者中的动脉性ED明显多于非糖尿病性ED.结论 动脉供血不足在糖尿病性勃起功能障碍发病机制中起着重要作用.阴茎海绵体注射血管活性药物后CDFI对血管性ED检查是一种微创而准确的方法.     

静脉性阳萎的诊断与外科治疗

报告对23例静脉性阳萎的诊治体会,提出确立诊断须依据:①病史、体检和实验室检查没有提示其他类型阳萎的阳性结果;②特殊检查须有:罌粟碱试验阴性,阴茎-臂动脉血压指数≥0.75,海绵体灌注试验结果不正常,快速灌注海绵体造影显示静脉漏。治疗根据静脉漏类型选择不同的手术方法。经3～22个月的随访,性功能恢复正常或能进行性交者达76.2%。疗效不佳为筛选诊断技术不够完善、并存的心理因素未解除或静脉漏阻断不全所致。阴茎脚静脉漏尚缺乏理想疗法。作者设计的经会阴施行阴茎深静脉结扎术,对阻断阴茎脚静脉漏的疗效比较满意。     

海绵体测压结合造影诊断静脉漏性阳萎的体会

为了提高阳萎诊治水平，应用阴茎海绵体血流测量仪结合海绵体造影检查５８例阳萎病人，其中２６例被明确诊断为静脉漏性阳萎，确定静脉漏的程度并指出所在部位，为进一步治疗包括手术提供有力依据。     

Prediction of early graft failure with intraoperative completion duplex ultrasound scan

PURPOSE: The purpose of this study was to determine intraoperative hemodynamic parameters that predict early failure of infragenicular vein grafts with intraoperative completion duplex ultrasound scan. METHODS: We reviewed the results of intraoperative duplex scans that were selectively performed after completion of 45 tibial/pedal vein bypass grafts at high risk for failure. Bypass was performed for rest pain (39%) or tissue loss (61%), and 60% of the cases were disadvantaged because of compromised vein quality or poor arterial outflow. A 10-MHz low-profile transducer was used to scan the entire graft at bypass completion. All grafts were determined to be technically adequate (absence of retained valves, arteriovenous fistulas, or localized velocity increases and the presence of bypass-dependent distal pulses). Peak systolic velocity (PSV) and end diastolic velocity (EDV) were also measured at each anastomosis, in the outflow artery and in the proximal and distal portions of each graft. Resistive indices (RI) were calculated at each measurement point (PSV-EDV/PSV). Statistical analysis was performed with unpaired t test, chi(2) test, and multivariate analyses. RESULTS: Twenty infragenicular vein bypass grafts (44%) thrombosed within 12 months. Intraoperative hemodynamic parameters were significantly different between grafts that remained patent or thrombosed. EDV was lower (5 +/- 1 cm/s versus 13 +/- 3 cm/s; P =.02) and RI was higher (0.90 versus 0.81; P <.01) in the proximal portions of grafts that thrombosed within 12 months. Distal EDV was also lower (6 +/- 1 cm/s versus 15 +/- 2 cm/s; P <.01) and distal RI was higher (0.89 versus 0.78; P <.01) in grafts that thrombosed. With multivariate analysis, only low distal EDV was predictive of early graft failure (P <.05). Distal bypass EDV of less than 8 cm/s predicated early graft thrombosis with 76% sensitivity and 75% specificity (positive predictive value, 71%; negative predictive value, 78%). Absence of diastolic flow (EDV of 0 cm/s) predicted early graft failure with 100% specificity and 100% positive predictive value. CONCLUSION: In this initial experience, low EDV measured with intraoperative duplex scan was associated with early thrombosis of tibial level vein grafts. When such values are observed, measures should be taken to improve graft hemodynamic parameters. Prospective study of infragenicular vein bypass grafts may better define hemodynamic parameters predictive of early graft thrombosis.     

Role of duplex Doppler sonography in diagnosis of acute allograft dysfunction—time to stop measuring the resistive index?

Measurement of vascular resistive index (RI) by duplex Doppler sonography (DDS) has been proposed as a non-invasive technique to detect the presence of acute rejection in renal allograft recipients. Our aim was to evaluate the clinical utility of this technique. From 107 patients we reviewed 159 biopsies that were performed from 1993 to 2001 for the investigation of acute allograft dysfunction. Histological findings were correlated with RI measurements by contemporaneously performed DDS. The majority of biopsies were carried out within the first 3 months post-transplantation (111/159). Sixty-eight biopsies showed acute rejection, 91 biopsies had findings other than rejection (acute tubular necrosis, CyA toxicity, recurrent GN). Using a threshold mean RI value of 0.9, the test had a specificity for acute rejection of 89%, but a sensitivity of just 6%. If the threshold was lowered the sensitivity rose, but specificity declined sharply. Average RI in the rejection group was not higher than in controls (0.73+/-0.11 vs 0.74+/-0.11, respectively). We conclude that measurement of RI by DDS does not contribute to the diagnosis of acute allograft dysfunction.     

A comparison between portable ultrasound (MIDUS) and nocturnal RigiScan when confirming the diagnosis of vascular organic erectile disorder

In recent years, the use of RigiScan and ultrasound to assess erectile dysfunction has fallen from favour. However, in a small minority of specialist cases, where a vascular, neurogenic or psychogenic aetiology requires confirmation, there remains a need for further investigation. To establish if in a preliminary assessment the use of nocturnal RigiScan or male impotence diagnostic ultrasound system (MIDUS) represents best practice as a diagnostic investigation in patients with a history suggestive of vascular organic erectile disorder. Men attending both urological and psychosexual therapy clinics with erectile dysfunction were assessed using a generic assessment schedule. Patients with a history suggestive of vascular erectile disorder were offered the opportunity of dual investigation of their condition. After screening using a provocative RigiScan using visual stimuli that gleaned inconclusive results, patients were offered the chance to enter a study with both nocturnal RigiScan and MIDUS investigation. These were confined for the purposes of this study to RigiScan events, peak systolic flow velocity (PSV) and end-diastolic flow velocity (EDV) from ultrasound examination where an abnormal EDV is defined as in excess of 4.5 cm/s and a normal PSV is variously defined as being greater than 35 cm/s. In all, 38/43 (88%, 95% CI: 76-95%) of men had a nocturnal event exceeding 3 min on the RigiScan investigation. This compares with 17/43 (40%, 95% CI: 26-54%) of men with a normal EDV blood flow of less than 4.5 cm/s (P<0.017) and 32/43 (74%, CI: 60-85%) of men with a normal PSV flow greater than 35 cm/s (NS). Rigiscan and ultrasonography of the cavernosal vessels are of equal usefulness in suspected arterial penile disease although where veno-occlusive disease is suspected, ultrasonography is more specific.     

Ultrasound criteria for severe in-stent restenosis following carotid artery stenting

PURPOSE: In-stent restenosis (ISR) is a known complication following carotid artery stenting (CAS). However, ultrasound criteria determining ISR are not well established. We evaluated alternative ultrasound velocity criteria for >70% ISR in our institution. METHODS: Clinical records of 256 patients undergoing 282 consecutive CAS procedures over a 42-month period were reviewed. Follow-up ultrasounds were available for analysis in 237 patients. Selective angiograms and repeat interventions were performed for >70% ISR. Ultrasound criteria including peak systolic velocity (PSV), end diastolic velocity (EDV), and internal carotid to common carotid artery ratios (ICA/CCA) were examined. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for PSV (200, 250, 300, 350, and 400 cm/s), EDV (70, 80, 90, 100 cm/s), and CCA/ICA (3, 3.5, 4, 4.5, 5). RESULTS: Twenty-two carotid angiograms were performed and 18 lesions had confirmations of >70% ISR in 11 patients including prior CEA in five patients and neck irradiation in two patients. Receiver operator characteristics (ROC) was analyzed for PSV, EDV, and CCA/ICA ratio. For 70% or greater angiographic ISR, PSV > 300 cm/s correlated to a 94% sensitivity, 50% specificity, 90% positive predictive value (PPV), and 67% negative predictive value (NPV); EDV > 90 cm/s correlated to an 89% sensitivity, 100% specificity, 100% PPV, and 67% NPV; and ICA/CCA > 4 had a 94.4% sensitivity, 75% specificity, 94% PPV, and 75% NPV. A significant color flow disturbance was detected in one patient who did not meet the aforementioned ultrasound velocity criteria. Further statistical analysis showed that an EDV of 90 cm/s provided the best discriminant value. CONCLUSION: Our study demonstrated that PSV > 300 cm/s, EDV > 90 cm/s, and ICA/CCA > 4 correlated well with >70% ISR. Although still rudimentary, these velocity criteria combined with color flow patterns can reliably predict severe ISR in our vascular laboratory. However, due to the relatively infrequent cases of severe ISR following CAS, a multicentered study is warranted to establish standard post-CAS ultrasound surveillance criteria for severe ISR.     

Efficacy of virtual glasses in audio-visual sexual stimulation during penile color duplex Doppler ultrasonography

OBJECTIVE: To examine whether audio-visual sexual stimulation (AVSS) with virtual glasses is effective in improving the recording of penile hemodynamics during penile color duplex Doppler ultrasonography. PATIENTS AND METHODS: A total of 64 consecutive patients with erectile dysfunction underwent penile color duplex Doppler ultrasonography after intracavernosal injection of 10-20 microg prostaglandin El and subsequent genital stimulation. AVSS with virtual glasses and earphones was applied when peak systolic velocities (PSV) were less than 35 cm/s or end diastolic velocities (EDV) were more than 5 cm/s. PSV, EDV and the resistive index of both cavernosal arteries were continuously monitored. Clinical erectile response was assessed with visual inspection and manual palpation. RESULTS: AVSS with virtual glasses was performed on 40 of 64 patients. AVSS improved the clinical erectile response in 26 (65%) of 40 patients. Doppler ultrasonography without AVSS identified 11 (27.5%), 5 (12.5%), and 24 (60%) patients with arteriogenic, veno-occlusive, and mixed-type impotence, respectively. However, after real-time AVSS 15 (37.5%), 7 (17.5%), 8 (20%), and 10 (25%) patients demonstrated non-vasculogenic, arteriogenic, veno-occlusive, and mixed-type impotence, respectively. Real-time AVSS improved the Doppler wave forms in 65% of cases. CONCLUSION: AVSS with virtual glasses improves the recording of physiologic erectile response and may be used as a valuable tool during penile color duplex Doppler ultrasonography.     

Correlation of invasive Doppler flow wire with renal duplex ultrasonography in the evaluation of renal artery stenosis: the Renal Artery Stenosis Invasive Doppler (RAIDER) study

OBJECTIVE: Determining renal resistive index (RI) in the setting of renal artery stenosis may predict which patients benefit from revascularization. Renal duplex ultrasonography (RDUS) is the traditional method of assessing RI, but it is not available in most invasive endovascular laboratories. Conversely, endovascular techniques to assess RI are available but not well validated. The primary goal was to determine if an invasive approach using an endovascular Doppler flow wire correlates with RI assessment using traditional noninvasive RDUS. METHODS: In a single-center prospective trial, patients were enrolled if they had known or suspected renovascular disease. A Doppler flow wire was placed in multiple segments of the renal artery, and peak (PSV) and end-diastolic velocities (EDV) were measured. RI was calculated using the formula: RI = [1 - (EDV/PSV)] x 100. Similarly, RI was also derived using standard RDUS. All patients underwent both RI techniques before any revascularization procedure. Secondary end points included assessing the correlation for pole-to-pole renal length assessment and PSV and EDV velocities using both invasive and noninvasive techniques. Pearson correlation coefficient calculations were used to determine degree of correlation. RESULTS: The study enrolled 20 patients, and 35 renal arteries were studied. Overall, Pearson correlation coefficient for invasive vs noninvasive RI assessment was 0.86 (95% confidence interval [CI], 0.73 to 0.93). The r values were 0.43 (95% CI, 0.11 to 0.67) for pole-to-pole renal length, 0.66 (95% CI, 0.54 to 0.76) for PSV, and 0.61 (95% CI, 0.48 to 0.72) for EDV determination. No major complications occurred during this study. Average time to perform invasive Doppler assessment was 10.4 +/- 7.4 minutes per artery. CONCLUSIONS: Invasive RI assessment using an endovascular flow wire technique correlates well with traditional noninvasive RDUS. A moderate statistical correlation also exists for pole-to-pole renal length, PSV, and EDV determinations. The procedure is safe and can be performed rapidly.     

Duplex ultrasonography in the diagnosis of celiac and mesenteric artery occlusive disease

Duplex ultrasound criteria for the diagnosis of celiac and superior mesenteric artery (SMA) occlusive disease have not been well defined. We performed a blinded retrospective comparison of mesenteric duplex data with arteriography in 24 consecutive patients who underwent both studies. Arteriography revealed that eight superior mesenteric arteries were normal; five were minimally stenotic; eight had stenoses greater than or equal to 50%, and three were occluded. Nine celiac arteries were normal or minimally stenotic; 12 had stenoses greater than or equal to 50%, and three were occluded. Duplex scans were obtained after an overnight fast. In normal superior mesenteric arteries, peak systolic velocity (PSV) was 134 +/- 18 cm/sec and end-diastolic velocity (EDV) was 24 +/- 4 cm/sec. Superior mesenteric artery PSV in patients with minimal or no stenosis (171 +/- 22 cm/sec) was less than PSV in patients with severe (greater than 50%) stenosis (299 +/- 40 cm/sec, p = 0.006), and less than PSV in patients with patent superior mesenteric arteries who underwent revascularization (366 +/- 86 cm/sec, p = 0.017). Similarly, EDV was elevated in superior mesenteric arteries with severe stenosis (78 +/- 11 cm/sec, p = 0.001) and in patients who underwent revascularization (111 +/- 19 cm/sec, p less than 0.001) compared to those with less than 50% stenosis (30 +/- 6 cm/sec, p = 0.001). An EDV greater than 45 cm/sec was the best indicator of severe stenosis (sensitivity, 1.0; specificity, 0.92). Peak systolic velocity greater than 300 cm/sec was less sensitive (0.63), but highly specific (1.0) for severe superior mesenteric artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Experimental study with Doppler ultrasound in partial chronic obstructive uropathy

IntroductionThis study has aimed to assess the hemodynamic parameters, Renal Resistive Index (RI), Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV) and Blood Flow of the Renal Artery (FR) by Doppler Ultrasound for diagnosis and monitoring postsurgical partial chronic obstructive uropathy.Material and methodsFifty pigs were used. The experiment was divided into three phases. Phase I consisted of a duplex-Doppler evaluation of the both kidneys to determine the parameters under study. The ratio of each index is calculated as the difference between the value of study kidney and the contralateral. After, a fluoroscopic examination was performed by compressive cystography, excretory urography and retrograde ureteropyelography. Finally, a model of partial right ureteral obstruction was created. After six weeks of the obstructive model, Phase II was begun with the diagnosis of the uropathy, by means of the aforementioned diagnostic methods and the endourological treatment was completed. Phase III is a follow-up performed at 6 months of treatment using the same methods as in the previous phases.ResultsOf the parameters studied, the EDV and its ratio showed greater sensitivity and specificity as a diagnostic marker of obstructive uropathy. In the postoperative monitoring, it was observed that the RI and the EDV returned to baseline levels, with the baseline values.ConclusionsThe ΔEDV and its ratio is the parameter that shows the greater efficacy for the diagnosis of chronic partial obstructive uropathy, however, it is insufficient to avoid conventional diagnostic techniques. All the parameters, mainly the EDV, have proven useful as complementary tests for monitoring after endourologic resolution of obstructive uropathy.     

The noninvasive diagnosis of vasculogenic impotence

One hundred eleven impotent men and 25 potent men were prospectively evaluated with a standardized exercise treadmill test (SETT) used to noninvasively define their pelvic hemodynamics. Fifty-six men had vasculogenic impotence, whereas the remaining 55 had erectile dysfunction resulting from undetermined causes (31), psychogenic factors (10), or other identifiable reasons (14). Arteriography was performed on 40 (71%) of the patients with vasculogenic impotence without false positive results, as well as in 11 (44%) of the potent control patients and in six (11%) of the patients with nonvasculogenic impotence without false negative results, confirming the validity of the SETT. The distinction between vasculogenic and nonvasculogenic impotence can be accurately made with the SETT. Patients with vasculogenic impotence had a resting penile-brachial index (PBI) equal to 0.60 +/- 0.022 (mean +/- SEM) and a PBI after exercise equal to 0.45 +/- 0.019 with a fall in the mean PBI of -0.15 (p less than 0.001). Patients with nonvasculogenic impotence had a resting PBI equal to 0.80 +/- 0.024 and a PBI after exercise equal to 0.88 +/- 0.019 with a rise in mean PBI of 0.08 (p less than 0.001). This response was not significantly different between the control group and the nonvasculogenic impotence patients. The addition of PBI determinations after treadmill exercise revealed that 18% of the patients with vasculogenic impotence would have been incorrectly diagnosed, because their resting PBI was greater than the traditional standard of 0.70. Furthermore, 18% of the patients with nonvasculogenic impotence would have been incorrectly diagnosed as having vasculogenic impotence because their resting PBI was less than 0.70.(ABSTRACT TRUNCATED AT 250 WORDS)     

Peritoneal lavage enzyme determinations following blunt and penetrating abdominal trauma.

Diagnostic peritoneal lavage (DPL) provides a rapid and sensitive means of investigating the peritoneal cavity following blunt and penetrating trauma. However, its shortcomings include insensitivity in the early identification of isolated hollow viscus injuries. We have routinely assayed lavage amylase (LAM) and alkaline phosphatase (LAP) in acutely injured patients for more than 4 years to assess the contribution of lavage enzyme analysis to the overall accuracy of DPL. From 1,969 DPLs, LAM was analyzed in 1,881 (96%) and LAP in 1,734 (88%) of 1,536 blunt and 433 penetrating trauma cases. Of 28 patients with negative lavage by LRBC but LAM greater than or equal to 20 IU/L, 13 (46%) had clinically significant injury requiring laparotomy. Seventy-seven percent of these cases involved the small bowel. In this group, LAM greater than or equal to 20 IU/L had a sensitivity of 87%, specificity of 75%, and positive predictive value of 46% for significant intra-abdominal injury. Seven patients had LAM greater than or equal to 20 IU/L and LAP greater than or equal to 3 IU/L. These values had a sensitivity of 54%, specificity of 98%, and positive predictive value of 88% for significant abdominal injury. Elevations of LAM (greater than or equal to 20 IU/L) and LAP (greater than or equal to 3 IU/L) mandate laparotomy where the history is consistent with possible small bowel injury. Elevation of either enzyme alone should raise the suspicion of hollow visceral organ injury and warrant close observation.