A newly diagnosed Wegener's disease as the underlying cause for a disseminated coccidioidomycosis.

In most cases coccidioidomycosis presents as a benign mildly severe respiratory disease with a benign course and spontaneous resolution. Rarely dissemination can lead to complications. We believe this is the first published case of a patient with a disseminated coccidioidomycosis, as shown on a urinary sample, in association with Wegener's disease. It was a challenge to diagnose and consecutively treat the patient as therapies seem to be conflictual. This case illustrates how migration, changing habits and attitudes, travelling, changing geo-ecological circumstances can lead to a change in medical environment. It is therefore essential that the microbiologist becomes a clinical microbiologist who communicates intensively with his fellow clinicians.

The correlation among cavernous pressure, penile rigidity and resistance index.

PURPOSE: We define the precise meaning and diagnostic significance of the resistance index generated by duplex scanning. MATERIALS AND METHODS: In 80 patients penile rigidity was clinically evaluated and a penile duplex scan was performed after intracavernous injection of 10 microg. prostaglandin E1. The intracavernous equilibrium pressure was measured in 34 of these patients. RESULTS: We found a statistically highly significant linear relationship among cavernous pressure, resistance index and penile rigidity (p <0.001). CONCLUSIONS: The resistance index and clinical degree of penile rigidity are 2 expressions of intracavernous pressure. Clinical observation of erection is equivalent to the resistance index in screening for cavernous leakage.

The effect of re-dosing of vasodilators on the intracavernosal pressure and on the penile rigidity.

PURPOSE: To study the effect of re-dosing of vasodilators on cavernous smooth muscle relaxation. METHODS: The intracavernosal pressure (ICP) was measured in 48 patients undergoing an intracavernosal injection test followed by gravity cavernosometry before and after administration of 1 or 2 booster injections with 20 micrograms prostaglandin E1 after an initial injection of a trimix of vasodilators. When submitted to Duplex scanning on another occasion, the injection of the trimix was followed by squeeze of the corpora. The occurrence of clinical full erection during the examinations was registered. RESULTS: The mean values of the ICP changed little, albeit statistically significant, after the first booster injection (+3.47 mm Hg) but not after the second one. With cavernosometry, a false diagnosis of cavernous leakage was made in at least 14 patients. During Duplex scanning, after the corpora were squeezed, 12 patients developed a clinical full erection, but none did during the intracavernosal injection test, even after re-dosing. A minimal drop in blood pressure was observed in 15 subjects after a booster injection. CONCLUSIONS: Administration of booster injections of 20 micrograms prostaglandin E1 after an initial injection of trimix did not induce sufficient cavernous smooth muscle relaxation. Squeezing of the corpora after injection of trimix was more successful.

The evaluation of arterial inflow by gravity cavernosometry.

PURPOSE: We determined whether the comparison between equilibrium pressure after intracavernous injection of vasodilators and maximal corporeal pressure at gravity cavernosometry could provide information about the relative contribution of arterial inflow and cavernous wall resistance to the erection process. MATERIALS AND METHODS: The results of gravity cavernosometry performed in 68 impotent patients were compared to those of duplex scanning in 53 and penile angiography in 10. RESULTS: A highly statistically significant (p < 0.01) but nonlinear correlation was observed between the equilibrium pressure after injection and maximal corporeal pressure, which indicates a paramount role of the corporeal veno-occlusive mechanism in the development of penile rigidity. However, in most patients with a pressure increase of more than 30 mm. Hg from the equilibrium pressure after injection to the maximal corporeal pressure, arterial insufficiency was diagnosed by duplex scanning and/or arteriography, and seemed to be the main limiting factor in the development of penile rigidity. CONCLUSIONS: Gravity cavernosometry provides functional information about the corporeal veno-occlusive mechanism and arterial inflow and, therefore, about the relative roles of these mechanisms in the development of penile rigidity.

The resistance index represents the corporeal pressure and not the cavernous wall resistance.

PURPOSE: We compare the results of the resistance index generated by duplex scanning and the corporeal pressure generated by the intracavernous injection test followed by gravity cavernosometry. MATERIALS AND METHODS: We examined 40 impotent subjects with duplex scanning and gravity cavernosometry. RESULTS: For the entire group a significant correlation (r = 0.77, p < 0.001) was found between the resistance index and intracavernous injection test, and between the resistance index and the gravity cavernosometry (r = 0.62, p < 0.01). Excluding the results of patients who had a full erection during scanning, the correlation between the resistance index and intracavernous injection test remained but the correlation between the resistance index and gravity cavernosometry disappeared (r = -0.02, p > 0.05). CONCLUSIONS: There was no relationship between the value of the resistance index and the cavernous wall resistance, except in patients capable of developing a full erection after vasodilator injection.