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A case of posttraumatic fistula of the internal pudendal artery-urethra is reported. The patient was referred with prolonged pulsatile gross hematuria requiring multiple blood transfusions after a motor vehicle accident. Associated injuries included a comminuted pubic ramus fracture. Initial uroradiographic evaluations did not identify the site of origin of hematuria but eventually selective angiography allowed diagnosis. Selective arterial embolization of the internal pudendal artery provided definitive treatment.

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Placement of an intracaval device is the treatment of choice for failure of, or contraindication to, anticoagulation therapy. A retrospective study of 111 patients from 1980 to 1986 was undertaken to identify the incidence and degree of related complications or problems regarding placement of the device. Ninety seven of 111 (87.4%) patients had no complications or problems in placement; 14/111 (12.6%) patients did have problems. Of the latter group, mechanical problems included eccentric filter placement, insertional difficulty, problems in filter carrier removal, premature discharge, and misplacement. A total of four patients required a second filter. A single instance of worsening renal insufficiency was noted. Of the total group (ages 24 to 97 [means = 62.4] years), other medical problems including diabetes, smoking, malignancy, sepsis, hypertension, and alcoholism had no influence on the complications or problems. The Greenfield filter remains the method of choice for the listed indications; however, an awareness of potential problems may lessen the technical complications. The operative problems did not adversely impact hospital morbidity or cost.

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A study was done in 21 men to identify individuals with venous leakage as a cause of impotence. Combined pressure flow measurement and cinecavernosography were performed before and after the injection of papaverine into the corpora. After papaverine injection, erections and/or higher pressures occurred at lower flow rates in all the men. The venous drainage of the corpora decreased or disappeared in most subjects while the corpora became larger and contained more contrast material. The findings suggest that an active venous obstructive mechanism is important during erection, can be induced by the administration of papaverine, and should be evaluated in impotent men.

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There is no correlation between penile-brachial index (PBI) and thermography. While it has been shown to be of significant value in other areas of medicine, thermography is non-contributory to the diagnosis of vasculogenic impotence.

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Until recently, a defect in the capability of blood to be trapped in the corpus cavernosum so that adequate penile turgidity can be maintained for successful intercourse has not been considered a major etiology for impotence. A diagnostic test called dynamic cavernosography was developed that consists of a cine-taped cavernosogram in conjunction with intracavernous pressure measurements at 3 different cavernous infusion rates. The results of 104 of these tests are presented. More recently, 17 of these patients also have undergone papaverine tests. Of the patients 59 per cent had no or only partial erections at all infusion rates and pressure did not increase to greater than 50 mm. Hg. The papaverine test showed only partial or no tumescence when 60 mg. were injected into the corpora. As a result, 25 patients underwent a penile operation to remove some venous outflow channels. Of the patients who underwent an operation for absent tumescence at any flow rate and who had a large number of venous channels draining the corpora cavernosa on the cavernosogram 59 per cent were potent postoperatively.

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Fibrinolytic therapy has been reported as a limited aid in limb salvage. It is allegedly fraught with complications and pitfalls; however, the usage of low-dose streptokinase has never totally been explored. The purpose of this study was to examine the role of low-dose streptokinase in arterial occlusion. Nineteen patients (12 men and 7 women) with an average age of 68 years (range 37 to 79 years) and a total of 22 limbs under study were treated with low-dose streptokinase (initial intravenous dose of 10,000 units and a subsequent dose of 5,000 to 10,000 units/hour) for 1 to 3 days. Seven of the patients underwent further operative intervention and four underwent angioplasty. Seven patients had diabetes controlled by insulin. Results were assessed clinically by angiography and by noninvasive measurement of distal pressure. Within 30 days of low-dose streptokinase therapy, four patients died from a myocardial infarction that was thought to be part of their total disease process. Limited salvage occurred in 19 of 22 limbs at risk. Ten patients (12 extremities) underwent subsequent balloon angioplasty or bypass surgery. There were three amputations. One patient received a below-knee amputation rather than an expected above-knee amputation, one had a below-knee amputation, and one had an above-knee amputation. In all cases, the patency or lack thereof was confirmed by angiography. The mean ankle to brachial pressure indices increased from 0.07 +/- 0.15 to 0.64 +/- 0.14 after therapy. There were no prolonged hospital stays due to complications in any of the patients. Selective infusions of low-dose streptokinase lyse thrombi, open collaterals, and provide an opportunity for extended surgery and angioplasty, increasing limb salvage without the risks of coagulopathy and bleeding that may occur in full-dose thrombolysis.

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A 64-year-old female treated with a Dacron aortobifemoral graft for atherosclerotic vascular disease sought medical evaluation for abdominal pain 6 months later. Studies including ultrasound, radionuclide, angiography, and CT scan suggested a diagnosis of false aneurysm. Surgical intervention subsequently confirmed the diagnosis of lymphocele.

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The value of contrast dye to the planning and evaluation of cardiovascular disease cannot be overestimated. However, adverse renal sequellae may cause the surgeon to hesitate in obtaining an arteriogram, especially in patients with compromised renal function. The purpose of this study was to evaluate the incidence of renal dysfunction in patients requiring angiography. Standard contrast angiography for cerebral or peripheral vascular disease was administered to 150 consecutive patients (89 men and 61 women), with an average age of 63.3 years (range 49 to 89 years). All patients received 100 to 150 ml of dye, with a concentration of approximately 50% iodine. Patients were hydrated with 0.5 N saline/5% dextrose, intravenously, for 8 hours before the procedure (1 to 3 ml/kg/hr). In 31 patients (11 women and 20 men) the serum BUN and/or creatinine levels were elevated (mean BUN value of 48 +/- 9 mg/dl; mean creatinine level of 2.8 +/- 0.6 mg/dl). The patients with abnormal renal function received an additional 300 to 500 ml of intravenous fluid, plus 20 to 40 mg intravenous furosemide, 1 hour before roentgenography to establish a diuresis. All patients were hydrated for 6 hours after angiography with the same solution at the same rate (1 to 3 ml/kg/hr). There were no episodes of compromised renal or cardiopulmonary dysfunction because of contrast angiography. In no patient did the BUN or creatinine level rise, nor was there evidence of acute tubular necrosis, as documented by oliguria and abnormal cells in the urine. Angiography is a safe procedure, even with patients who may have compromised renal function, if appropriate prehydration/posthydration and diuretic measures are undertaken.

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Computed tomography was performed in two cases of blood-brain barrier (BBB) disruption due to cerebral arteriography. The first case showed diffuse contrast enhancement in the right frontotemporal region in the distribution of the middle cerebral artery; in the second case patchy contrast enhancement in both gray and white matter of both hemispheres was demonstrated. The possible mechanism for BBB disruption in these patients is discussed.

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The successful dilatation of postsurgical concentric stenosis of an internal carotid artery using percutaneous transluminal angioplasty (PTA) is reported here. Only one such case has been previously documented. Review of the literature disclosed 16 patients who received transluminal angioplasty for stenosis of carotid arteries by percutaneous or open arteriotomy techniques. The authors feel that PTA may be the treatment of choice for postoperative concentric stenosis of a short segment of the carotid artery as opposed to surgical repair.

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Corpus cavernosograms and pressure flow dynamics were used to evaluate 28 impotent men. The rises in pressure during saline infusion and development of artificial erection were the criteria used to divide the men into three groups. The cavernosograms were graded as to filling of venous channels, staining of glans and spongiosum, completeness of filling, filling defects, and tunica thickening. The seven men who had the lowest rises in intracavernous pressure failed to develop erection and had the greatest evidence of prominent venous drainage. The seven men who developed artificial erection at 120 ml/min had the least evidence of venous drainage, while the remaining 14 men, who developed partial erection, had intermediate findings. Eight patients had abnormal arteriograms; two had no erection, four had partial erection, and two had full erection. Artificial erection can be induced in some impotent men. Prominent venous drainage will prevent artificial erection in some impotent men.

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Extensive serum lipid analyses, with specific emphasis on the concentration of serum beta and pre-beta-lipoproteins, were made on 93 patients who had a clinical diagnosis of angina pectoris and were undergoing coronary angiographic studies. Those individuals with abnormal angiographic evidence of obstructive coronary artery disease, including a group with a prior myocardial infarction, have almost uniformly elevated serum beta-lipoprotein levels when related to an arbitrary division based on the mean values for a "normal" adult population at a similar age level. Compared to serum cholesterol and serum triglycerides, the serum lipoprotein concentrations, specifically beta-lipoproteins, appear to be a more useful parameter for predicting the existence of coronary artery disease. Further studies relating clinical risk factors to coronary artery disease might be better approached by using angiography of coronary vessels rather than myocardial infarction or sudden death from coronary artery disease as an endpoint of morbid data.

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