Cavernosography in conjunction with artificial erection for evaluation of venous leakage in impotent men.

Twenty men with incomplete penile erection or inability to maintain an erection were evaluated to determine if venous leakage was a cause. Cavernosography was performed in conjunction with artificial erection induced by infusion of saline into the corpus cavernosa. Thirteen patients requiring higher than normal rates of saline infusion to achieve or maintain erection showed filling of superficial veins in the flaccid state as well as during erection. In five of the seven patients with normal saline requirements there was no filling of superficial veins, and two showed filling in the flaccid state only. Of the thirteen patients whose conditions were diagnosed as venous leakage, seven underwent surgical ligation of superficial veins and deep penile vein arterialization by a saphenous vein bypass graft between the superficial femoral artery and deep penile vein. All these patients had reduced saline requirements postoperatively. When cavernosography is performed in the flaccid state only, filling of superficial veins can occur normally; therefore, these studies should be performed with artificial erection.

Deep-penile-vein arterialization for arterial and venous impotence.

Eleven impotent men underwent deep-penile-vein arterialization after preoperative assessment by a multidisciplinary team. Penile Doppler pressures, testosterone levels, and nocturnal penile tumescence were used to establish a vasculogenic etiology. Cavernosography, artificial erection by saline infusion, and selective hypogastric arteriography were obtained to delineate whether arterial, venous, or mixed (arterial/venous) factors predominated. Penile revascularization consisted of femoral artery to deep-penile-vein saphenous bypass, with ligation of superficial veins at the base of the penis in patients with venous leakage. Cumulative graft patency was 91% up to 20 months. There were no deaths. The average preoperative flow requirement of values greater than 250 mL/min was reduced to 59 mL/min postoperatively. Follow-up results of nocturnal penile tumescence were excellent in four of four patients with venous (venous leakage), two of three patients with arterial, and one of four patients with mixed factors. Deep-penile-vein arterialization appears to be beneficial for impotence secondary to venous leakage, with inconsistent results for arterial and mixed factors.

Ossification of the plantar fascia and peroneus longus tendons in diffuse idiopathic skeletal hyperostosis (DISH).

Extraspinal skeletal changes in diffuse idiopathic skeletal hyperostosis (DISH) consist of bony proliferation at ligamentous and tendinous insertions. We describe a patient with DISH who manifested ossific changes in the plantar fascia and peroneus longus tendon bilaterally at sites not immediately adjacent to the bony insertions of these structures. This observation expands the roentgenographic spectrum of DISH.

Ga-67 studies in a patient with acquired immunodeficiency syndrome and disseminated mycobacterial infection.

A well-documented case of acquired immunodeficiency syndrome (AIDS) with diffuse lymphadenopathy and disseminated mycobacteriosis in whom serial Ga-67 studies were performed is presented.

Mesenchymal chondrosarcoma of the kidney.

A case of mesenchymal chondrosarcoma of the kidney, with osseous metastases, is presented in this article, and the clinical, radiologic, and histopathologic features of this uncommon neoplasm are discussed. The addition of this case to those previously reported in the literature brings the total number of reported cases of mesenchymal chondrosarcoma of extraskeletal origin to 42. None of the previously reported cases originated from the kidney. The metastatic pattern of this case illustrates the propensity of mesenchymal chondrosarcoma to metastatize to unusual locations.

Radiographic appearance of the sternomanubrial joint in arthritis and related conditions.

The sternomanubrial joint (SMJ) was evaluated on the lateral chest radiograph in 177 patients with rheumatic disease and 69 non-rheumatic controls. Abnormalities were categorized as inflammatory changes, proliferative changes, or bone fusion. Patients with rheumatoid arthritis, psoriatic arthritis, or gout were found to have an increased incidence of inflammatory changes. Rheumatoid variants predisposed to early fusion of the SMJ. Patients with diffuse idiopathic skeletal hyperostosis (DISH) exhibited massive and unique hyperostotic changes.

Quantitative sacroiliac joint scintigraphy. A critical assessment.

With quantitative sacroiliac joint scintigraphy (QSS), sacroiliac joint-to-sacrum (SIS) ratios greater than or equal to 1.40 are abnormal for our method. High SIS ratios are associated with roentgenographically appreciated sacroiliitis and with early clinically evident sacroiliitis. Although highly sensitive, QSS abnormalities are not specific for inflammatory sacroiliac (SI) joint disease. High SIS ratios are also seen in rheumatoid arthritis, degenerative abnormalities of the lumbosacral spine, and metabolic bone disorder. Other disorders with roentgenographic SI joint abnormalities must be studied scintigraphically before QSS can be employed as a useful diagnostic test.