Pharmacoarteriography in the evaluation of impotence

Progress in diagnosis and therapy of impotence is handicapped by the absence of a validated and objective method for evaluating the vascular system; a gold-standard for vasculogenic impotence is needed. Prior experience has indicated that conventional arteriography in unanesthetized patients is unreliable in evaluation of the penile arterial supply. We have improved our arteriographic methods by the routine application of selective pudendal injections, vasodilation pharmacoangiography with nitroglycerin and papaverine, and direct magnification. Experience in 37 impotent patients demonstrates marked improvement in the quality of visualization of distal vessels, and the frequent presence of functional vasoconstriction of medium and small arteries that can be distinguished from organic disease only with vasodilators. We believe these angiographic methods will improve the criteria against which other diagnostic and therapeutic methods can be objectively assessed.     

Resolution of DNA linkage discrepancies through analysis of a VNTR locus in a family study of cystic fibrosis

First-trimester prenatal diagnosis of a fetus at 25 per cent risk for cystic fibrosis (CF) was performed by indirect linkage analysis of polymorphic markers using Southern blotting and polymerase chain reaction (PCR) amplification. The results revealed discrepancies in the allelic patterns between the father and the affected child, thereby complicating the prediction of fetal outcome. Analysis of a highly polymorphic VNTR locus within the human retinoblastoma (RB) gene on chromosome 13 showed that the affected child and the fetus did not have the same biological father, and therefore the affected child could not be used to determine linkage of markers in the father of the fetus. The analysis of VNTR loci can be an effective method of resolving conflicting data during prenatal diagnosis of monogenic diseases.     

Transluminal angioplasty in the treatment of arteriogenic impotence

Factors bearing on the role of transluminal angioplasty in the management of arteriogenic impotence are considered. Our clinical experience indicates that arteriogenic impotence is frequent, either alone or combined with venogenic impotence. High quality diagnostic angiographic studies and their accurate interpretation are the prime requirements for proper patient selection. Numerous areteriographic adjuncts are required: vasodilation with intracavernosal injection of a papaverine-phenotolamine mixture, selective internal pudendal injections, direct magnification, nonionic contrast agents, and tailored radiographic projections. Venogenic impotence must be excluded by cavernosometry and cavernosography. In impotent patients with bilateral leg and hip claudication, dilation of common or internal iliac stenoses should benefit many cases with pure arteriogenic impotence. In the absence of claudication, angioplasty will be most frequently indicated for distal internal pudendal lesions, using 2–3 mm balloon-catheter systems. Stenoses of intrapenile branches, while common, must await further technological developments before they too may become amenable to transluminal recanalization. Unilateral transluminal angioplasty, when technically successful, should prove clinically successful when patients have been properly selected. Transluminal angioplasty can reduce the cost and morbidity of penile revascularization and may assume a modest role in the treatment of arteriogenic impotence.     

A pilot study of the relationship between caries experience and surface enamel fluoride in man

Fourteen hundred and forty-seven 12–16-yr-old subjects in selected fluoridated and non-fluoridated areas were assessed for caries experience (DMFS index) and enamel fluoride (biopsy technique). Fluoride was measured as log_e mass F corrected to a standardized depth. A square root transformation of decayed, missing and filled surfaces (DMFS) was carried out in order to achieve homogeneity of variance for this variable across all levels of fluoride. A simple, linear relationship was found between log_e mass F and √(DMFS). Taking age into account, the Pearsonian correlation was R = 0.40, corresponding to 16 per cent of the variance explained. Within communities the fluoride-caries relationship was consistent with the overall model but could not be demonstrated as securely because of the smaller sample sizes and the limited range of fluoride values at this level of disaggregation.     

Mediastinal lymph node detection and sizing at CT and autopsy

Although CT has assumed a major role in the preoperative evaluation of the mediastinum in patients with lung carcinoma, there is no consensus as to its accuracy or efficacy in this setting. A potential source of CT error is inaccurate detection or sizing of lymph nodes in particular mediastinal locations because of inadequate contrast with surrounding tissue or partial volume effects. We imaged five cadavers with CT and then meticulously dissected the mediastinal nodes. The nodes were measured and categorized by using the lymph node mapping scheme of the American Thoracic Society. The short axis nodal diameter was the best CT predictor of nodal volume. Excellent correlation was found between CT and autopsy for lymph node detection in right-sided mediastinal lymph nodes; poorer CT/autopsy correlation was found for left-sided lymph nodes, especially in the lower left peribronchial region. These findings suggest that CT may be less accurate in identifying left-sided mediastinal metastases.     

A three-dimensional morphometric study of craniofacial shape in schizophrenia

BACKGROUND: Subtle dysmorphogenesis of the craniofacial region constitutes important corroborating evidence of the neurodevelopmental origins of schizophrenia. Advances in facial visualization now allow for three-dimensional anthropometric evaluations of potentially greater discriminatory power in examining the complex geometric relationships of facial topography. METHOD: Sixty-five anthropometrically derived landmarks were identified from three-dimensional facial images collected from 14 patients with schizophrenia and 11 comparison subjects, imaged with a high-resolution, portable laser scanner. RESULTS: Using the Procrustes morphometric approach for shape analysis, the difference in mean shapes was highly significant, with patients exhibiting superoinferior elongation of the face. CONCLUSIONS: The topography of craniofacial anomalies in schizophrenia is not random and points to midline deformation.