Selective embolization of bilateral arterial cavernous fistulas for posttraumatic penile arterial priapism.

A 22-year-old man suffered a hiking accident with perineal trauma and developed a nonpainful priapism secondary to bilateral arterial-cavernosal fistulas. To minimize the risk of impotence in this young patient, successive selective embolizations with autologous blood clot were performed to close the fistulas. This led to an uncomplicated full recovery. No fistula was detectable on Doppler ultrasonography at 1-year follow-up. Review of the literature confirms the safety of embolization with autologous clot.

Prophylaxis of deep venous thrombosis after total hip arthroplasty by using intermittent compression of the plantar venous plexus.

A randomized, prospective, blinded study comparing the efficacy of prophylaxis of deep venous thrombosis by using (A) heparin-aspirin therapy, (B) intermittent pulsatile pneumatic-pump compression of the plantar venous plexus, or (C) both methods, was conducted in patients undergoing elective total hip replacement arthroplasty. Duplex ultrasonography was obtained in all 75 patients before surgery, at 1 week, and 2 weeks after surgery, to detect the presence or absence of deep venous thrombosis, with venograms confirming all positive results. Five of 25 patients in group A (heparin-aspirin) developed deep vein thrombosis. No deep venous thrombi were detected in groups B or C. One pulmonary embolus was detected in group A. The reduction in detectable deep venous thrombosis by the use of intermittent compression of the plantar venous plexus was significant. Wound drainage was decreased by 2 to 3 days (P < 0.05) in group B. It is concluded that, in this group of 75 consecutive patients, intermittent pulsatile compression of the plantar venous plexus was superior to heparin/aspirin pharmacologic prophylaxis for the prevention of deep venous thrombosis proximal to the calf.

Delayed development of mid-ileal conduit stenosis: the importance of life-long urologic follow-up.

Mid-ileal conduit stenosis is an unusual yet morbid complication following ileal conduit urinary diversion. We report the cases of four patients who developed mid-ileal stenosis at an average interval of 19.5 years after urinary diversion, with the longest interval being 25 years. This series emphasizes the importance of life-long follow-up of patients who have had urinary-intestinal diversion.

Characterization of focal fatty change in the liver with a fat-enhanced inversion-recovery sequence.

A T1-weighted inversion-recovery (IR) sequence was used to study 15 patients with possible fatty change in the liver. The inversion time (TI) was calculated for optimal suppression of normal liver signal (t-null). Conventional spin-echo (SE) and short TI IR (STIR) sequences were also performed. For seven documented benign focal fatty liver lesions, the T1-weighted IR (fat-enhanced) sequence clearly enabled differentiation of normal from fat-infiltrated liver, whereas three of these lesions were isointense to normal liver with all other sequences. The livers of the other nine patients (two normal, one with diffuse fatty change, two with metastatic disease, one with hemangioma, one with focal nodular hyperplasia, one with simple cyst, and one with micronodular cirrhosis) showed homogeneous reduction of liver signal with the fat-enhanced IR sequence.

Computed tomography of xanthogranulomatous cholecystitis.

A case is presented of xanthogranulomatous cholecystitis that resembled carcinoma of the gallbladder on computed tomography. The large, infiltrating mass satisfied the criteria for massive carcinoma of the gallbladder.

Apophyseolysis and osteochondrosis of the ischial tuberosity. Criteria of differential diagnosis.

The authors describe three pathological entities affecting the apophysis of the ischial tuberosity observed in young athletes. Acute and chronic apophyseolysis and osteochondrosis are studied separately in terms of their clinical characteristics, radiographic aspects, and treatment. A rare case of bilateral apophyseolysis is also reported. Unless correctly diagnosed and treated, these lesions may in the long term affect the sporting activity of the patient. Six cases are presented illustrating each of these syndromes.

Intraluminal mass of the left pulmonary artery.

Intravenous digital subtraction angiography demonstrated a polypoid carcinosarcoma invading the left main pulmonary artery, The angiographic criteria of inoperability of patients with central pulmonary tumors are discussed.

Mechanisms of ionophore-induced catecholamine secretion.

A number of carboxylic ionophores stimulate the secretion of norepinephrine from cell suspensions prepared from a transplantable rat pheochromocytoma. The divalent-cation ionophore ionomycin stimulates catecholamine secretion by a mechanism that is dependent upon the presence of extracellular Ca++. It is likely that ionomycin-induced catecholamine secretion results from the ionophore-mediated entry of Ca++ into the cells. The monovalent-cation ionophore monensin stimulates catecholamine secretion by a mechanism that is independent of extracellular Ca++, but is markedly dependent upon extracellular Na+. Monensin probably transports Na+ into the pheochromocytoma cells and increases the intracellular concentration of Na+ in these cells. This rise in intracellular Na+ may cause the release of Ca++ from some intracellular store. Lasalocid stimulates catecholamine secretion by a mechanism that is independent of extracellular Ca++ and is only slightly dependent upon extracellular Na+. The action of lasalocid, in contrast to the actions of ionomycin and monensin, is potentiated by decreased pH. It is likely that lasalocid enters the cells in its uncharged, protonated form. Once inside the cells, lasalocid may promote the release of intracellular Ca++. Alternatively, lasalocid and monensin may stimulate catecholamine secretion by the process which is independent of Ca++. These experiments show that ionophores can stimulate catecholamine secretion by at least three distinct ionic mechanisms.