Different hemodynamic responses by color Doppler ultrasonography studies between sildenafil non-responders and responders

Aim： To determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography. Methods： A total of 69 erectile dysfunction （ED） patients aged 22-79 years were enrolled into the present study. Thirty-eight （55.1%） men with ED who did not respond to four attempts of treatment with 100 mg sildenafil after re-education were classified as sildenafil non-responders. A com- bination of three vasodilator drugs, 1.25 mg papaverine, 0.4 mg phentolamine and 5 ug prostaglandin E1, was given by intracavernous injection before penile Doppler ultrasonography was carried out. The erectile response to intracavernous injection and vascular parameters including peak systolic velocity （PSV）, resistance index （RI）, end diastolic velocity （EDV） and cavernosa artery diameter （CD） were measured and the results between sildenafil nonresponders and responders were compared. Results： No statistical difference in vascular parameters measured by Doppler ultrasonography studies between non-responders and responders was noted. Sildenafil non-responders had a poorer penile rigidity response to intracavernous injection than responders （P 〈 0.05）. Among patients with adequate PSV （〉 30 cm/s） and abnormal EDV （〉 5 cm/s）, individuals in the non-responder group had fewer positive responses to intracavernous vasodilator injection than in the responder group （35.3% vs. 72.2%, P 〈 0.05）. Advanced age and comorbidity with diabetes mellitus were significantly associated with sildenafil non-response （P 〈 0.05）. Conclusion： Sildenafil non-responders were characterized by a poorer penile rigidity response to intracavernous injection and had an associated impaired veno-occlusive mechanism. Advanced age and comorbidity with diabetes mellitus were two common factors associated with non-response.

Prospective Study of Color Doppler Ultrasonography in the Diagnosis of Breast Disease.

One hundred and four cases of breast disease were examined by color Doppler ultrasonography (CDUS). Malignant lesions were rich in blood blow signal and 56% of +++-++++grade while benign lesions had little blood flow signal

Early hemodynamics after tibial transverse transport in patients with nonarterial stenosis and arterial stenosis diabetic foot

BACKGROUND The diagnosis of peripheral arteriopathy in the diabetic foot is complicated by diabetes and its advanced complications.It has been found that diabetic foot can be categorized into arterial stenosis and non-arterial stenosis,both of which have significant differences in hemodynamic characteristics.AIM To evaluate the early hemodynamic changes in diabetic foot patients with nonarterial stenosis and arterial stenosis treated by tibial transverse transport(TTT)using high-frequency color Doppler ultrasonography(HFCDU)and a laser Doppler flowmeter.METHODS Twenty-five patients with Wagner grades 3-5 diabetic foot ulcers were treated with TTT,and the wound healing time and rate were recorded.Patients were grouped according to the results of preoperative lower-extremity ultrasonography.Cases with≥50%stenosis in any of the femoral,popliteal,posterior tibial,anterior tibial,and peroneal arteries of the affected limb were classified as the arterial stenosis group(n=16);otherwise,they were classified as the nonarterial stenosis group(n=9).Before and one month after surgery,HFCDU was used to evaluate the degree of lower limb artery lesions and hemodynamic changes in patients.The degree of femoral-popliteal atherosclerotic stenosis,the degree of vascular stenosis and occlusion of the lower-knee outflow tract,and the degree of medial arterial calcification were scored;the three scores were added together to obtain the total score of lower extremity arteriopathy.PeriScanPIM3,a laser Doppler flowmeter system,was used to detect alterations in plantar microcirculation before and 1 mo after surgery.Wound healing and hemodynamic indices were compared between the two groups.RESULTS The wound healing time of the diabetic foot was significantly shorter in the nonarterial stenosis group than in the arterial stenosis group(47.8±13 vs 85.8±26,P<0.05),and the wound healing rate of both groups was 100%.The preoperative total lower extremity arteriopathy scores were lower in the nonarterial stenosis group than those in the arterial stenosis group(18.89±8.87 vs 24.63±3.52,P<0.05).The nonarterial stenosis group showed higher preoperative popliteal artery(POA)blood flow than the arterial stenosis group(204.89±80.76 cc/min vs 76.75±48.49 cc/min,P<0.05).Compared with the baseline(before surgery),the postoperative POA blood flow of the affected limb in the nonarterial stenosis group decreased one month after surgery(134.11±47.84 cc/min vs 204.89±80.76 cc/min,P<0.05),while that in the arterial stenosis group increased(98.44±30.73 cc/min vs 61.69±21.70 cc/min,P<0.05).Although the POA blood flow in the arterial stenosis group was obviously improved one month after surgery,it was still lower than that in the nonarterial stenosis group(98.44±30.73 cc/min vs 134.11±47.84 cc/min,P<0.05).The nonarterial stenosis group had higher preoperative plantar microcirculation than the arterial stenosis group(56.1±9.2 vs 33.2±7.5,P<0.05);compared with the baseline,the plantar microcirculation in the arterial stenosis group was significantly improved one month after surgery(51.9±7.2,P<0.05),while that in the nonarterial stenosis group was reduced(35.9±7.2,P<0.05).CONCLUSION Based on preoperative HFCDU findings,diabetic foot patients can be divided into two categories:Those with nonarterial stenosis and those with arterial stenosis,with obvious differences in hemodynamic changes in the early postoperative period between them.In the early stage after TTT,the blood flow volume and velocity and the plantar microcirculation perfusion of the affected limb of the diabetic foot with nonarterial stenosis decreased compared with the baseline,while those of the diabetic foot with arterial stenosis improved significantly compared with the baseline,although both had smoothly healed diabetic foot ulcers.

Evaluation of penile hemodynamic status and adjustment of treatment alternatives in Peyronie's disease

Aim: Erectile dysfunction may be observed in up to 80% of patients with Peyronie's disease. An objective evaluation of the erectile function is attempted to work out in patients with Peyronie's disease. Methods: Penile deformity, sexual function and penile vascular status were analyzed in 123 patients with Peyronie's disease, who had not received any pertinent treatment. Results: Penile deformity, palpable plaque and pain on erection were seen in 112 (91%), 97(78.8%) and 27 (21.9%) of the 123 patients, respectively. Of the 76 patients evaluated by color Doppler ultrasounography, veno-occlusive dysfunction as the vascular component for erectile dysfunction was found in 17 (22.3%), arterial insufficiency in 10(13.1%) and a mixed picture in 23 (30.2%). Conclusion: The documentation of penile erectile function and the determination of the vascular status using color Doppler ultrasonography can guide the appropriate therapeutic choice.

Laparoscopic splenectomy： color Doppler flow imaging for preoperative evaluation

Background Laparoscopic splenectomy （LS） is currently the standard approach for resection of a normal-sized spleen. However, this method becomes technical challenge in cases of splenomegaly due to intraoperative hemorrhage. A complete understanding of the splenic vessel anatomy is important to facilitate the difficult laparoscopic procedure. In this retrospective study, we examined the role of color Doppler flow imaging （CDFI） in splenic vessel anatomy and evaluated its value for LS. Methods Forty-eight patients who underwent splenectomy for various hematologic and autoimmune disorders from May 2004 to December 2007 were enrolled in this study. Twenty-three patients underwent preoperative CDFI examination that included examination of the anatomic type of splenic pedicle, the adjacent relationship between the splenic vessel and pancreas, and spleen size （CDFI group）. In the remaining 25 patients, ultrasonic inspections of the splenic vessel were not performed （non-CDFI group）. Laparoscopic splenectomies in the CDFI group were performed in accordance with the information provided by the preoperative CDFI in each patient. In the non-CDFI group, LS was performed according to the conventional method. In the CDFI group, the constituent ratios of the above-mentioned parameters by CDFI were compared with those recorded during LS using the chi square test. The effectiveness of the technique on surgery in both groups was compared with an independent sample Student＇s ttest. Results All laparoscopic splenectomies in both groups were performed successfully. However, 2 cases in the non-CDFI group were converted to LS with the assistance of micro-incision because the branches of the splenic vein were inadvertently torn. Two anatomic types of splenic pedicle and four different adjacent relationships between the splenic vessel and pancreas were detected by CDFI. About 80% of spleens fit the criteria of megalosplenia. There were no statistically significant differences between the constituent ratios of the parameters by CDFI and those by intraoperative telerecording in the CDFI group （χ^2=0.383, 1.072, 0.119, P=0.536, 0.784, 0.730）. However, statistically significant differences were observed in the operative time （（158.70±42.51） minutes vs （200.65±47.89） minutes, P=0.003）, intraoperative blood loss （（55.87±17.36） ml vs （101.83±62.21） ml, P=0.001）, and recovery time of gastrointestinal function （（24.39±8.88） hours vs （30.60±9.45） hours, P=0.024） between the groups. Conclusions The individual operative route and schedule can be successfully determined on the basis of various kinds of reproducible anatomic frameworks of the spleen provided by preoperative CDFI. This technique facilitates the surgical procedure, shortens the operative time, reduces intraoperative blood loss and decreases the risk of LS in splenomegaly cases.

乳腺浸润性导管癌的超声诊断分析

目的:分析乳腺浸润性导管癌的声像图特征、彩色多普勒血流特点及临床意义。方法:对61例经手术、病理证实为乳腺浸润性导管癌患者的声像图、彩色多普勒表现及临床资料进行分析。结果:超声诊断恶性肿块61例,超声声像图上大多数有典型恶性特征,但也有肿块小、超声表现不典型者。形态不规则的低回声结节、伴有钙化及丰富的血流信号为浸润性导管癌的特征性表现。其血流具有一定的形态特征,脉冲多普勒频谱呈现高阻力指数。结论:利用高频超声结合彩色多普勒在乳腺浸润性导管癌中的特有表现,可以提高乳腺浸润性导管癌的诊断符合率,有利于临床制定合理的治疗方案。

Serum Total Testosterone Levels Pre- and Post-Subinguinal Microsurgical Varicocelectomy in Men with Clinical Varicoceles

Background: Varicocele is abnormal dilation and tortousity of the scrotal venous pampiniform plexus that drain blood from each testicle. Recently, it has been linked to low serum total testosterone (TT) levels by affecting the optimal functioning of the leydig cell via increasing the scrotal temperature. Varicocele repair has been found post-operatively to increase the serum levels of TT. This study looks at the pre and post-subinguinal microsurgical varicocelectomy serum TT levels in male patients with clinical varicocele. Methods: The study involved 88 male patients with clinical varicoceles who met the inclusion criteria. These patients after good history taking and physical examination had their serum TT levels measured pre varicocelectomy and 6 months post-subinguinal microsurgical varicocelectomy. The varicoceles were diagnosed by physical examination and use of scrotal color Doppler ultrasonography (US). Results: The number of patients with varicocele were 88 males. The mean age of the patients was 33.43 ± 7.82 years. There was isolated left varicocele in 57 (64.8%) patients and bilateral varicocele in 27 (30.7%) patients. Pre varicocelectomy, 61 (69.3%) patients had serum TT of between 100 - 290 nanogram/deciliter (ng/dl) and a mean value of 241 ± 0.91 ng/dl. Post varicocelectomy 56 (63.6%) patients had serum TT in the range of 300 - 490 ng/dl with a mean of 482 ± 2.87 ng/dl, showing a robust significant increase in the serum TT post-operatively (P < 0.001). Conclusion: There was statistically significant improvement in the serum TT levels with 55 (79%) patients exhibiting normalization of serum TT levels after subinguinal microsurgical varicocelectomy.

Dorsal hand reconstruction with radial artery perforator-based adipofascial flap

Reconstruction of dorsal hand soft tissue defects after severe injury is challenging for surgeons.Depending on the degree of defect,extensor tendon reconstruction may also be necessary.Various reconstruction methods are commonly performed to cover dorsal hand defects,such as skin grafting and distant,free,or local flaps.Among them,free vascularized flap transplantation is an ideal procedure because the major vessels that feed the local flap may have been damaged,and the affected limb can be reconstructed using a flow-through method.Although free flap surgery has advanced,few surgeons can choose this option due to its technical difficulty and uncertainty.On the other hand,distant flaps have been commonly used for the reconstruction of dorsal hand defects,and local flaps,such as reverse forearm flaps and retrograde posterior interosseous flaps,do not require microvascular anastomosis.However,they have some problems;distant flaps require at least two surgeries,reverse forearm flaps sacrifice major vessels and leave a scar at the donor site,and retrograde posterior interosseous flaps require meticulous dissection of the vascular pedicle.The radial artery perforator-based adipofascial flap is a versatile flap that is safe and easy to elevate without sacrificing the radial artery.In addition,elevating it as an adipofascial flap enables surgeons to avoid an unacceptable donor scar.We present two cases,demonstrating the usefulness of this pedicled perforator flap.