Gynura root induces hepatic veno-occlusive disease:A case report and review of the literature

Gynura root has been used extensively in Chinese folk medicine and plays a role in promoting microcirculation and relieving pain.However,its hepatic toxicity should not be neglected.Recently,we admitted a 62-year old female who developed hepatic veno-occlusive disease(HVOD)after ingestion of Gynura root.Only a few articles on HVOD induced by Gynura root have been reported in the literature.It is suspected that pyrrolizidine alkaloids in Gynura root might be responsible for HVOD.In this paper,we report a case of HVOD and review the literature.

A case report of hepatic veno-occlusive disease after ingesting dainties

Hepatic veno-occlusive disease (HVOD) is rarely encountered and easily misjudged as Budd-Chiari syndrome. It is often related to stem cell transplantation in recent years. We report a case of HVOD that is related to ingestion of some palatable local dishes. The diagnosis was confirmed by liver biopsy pathology with specific observation of inflammatory changes and fibrosis of venules intima, dilated sinusoids and central veins. Chronic diarrhea is unique for this case as a result of ingesting harmful stuffs. This case demonstrated that supervision and instruction of food recipe and traditional medicine are crucial, and prompt diagnosis, supportive care and specific treatment are essential to decreasing the morbidity and mortality of HVOD.

Hepatic veno-occlusive disease induced by Gymura segetum: report of two cases

BACKGROUND: Hepatic veno-occlusive disease (VOD) or sinusoidal obstruction syndrome is associated with a high mortality because of its severity. Gymura segetum, a Chinese herbal medicine, is always used to cure injury and bleeding in rural areas in China. This study was undertaken to better understand VOD and its relations to the effect of Gymura segetum. METHODS: Between 2000 and 2002,two patients were admitted to our department because of VOD. Before admission, both of them had been injured and taken oral decoction of patent drug Gymura segetum. We analyzed the clinical manifestations, diagnosis and therapy of the two patients. RESULTS: Pyrrolizidine in Panax notginseng was proved to induce VOD. The diagnosis of VOD depended on hepatic biopsy. CONCLUSION: Gymura segetum can induce VOD. More attention should be paid to its unsuscepted side effects.

Reliable experimental model of hepatic veno-occlusive disease caused by monocrotaline

BACKGROUND:Hepatic veno-occlusive disease(HVOD)is a severe complication of chemotherapy before hematopoietic stem cell transplantation and dietary ingestion of pyrrolizidine alkaloids.Many experimental models were established to study its mechanisms or therapy,but few are ideal.This work aimed at evaluating a rat model of HVOD induced by monocrotaline to help advance research into this disease. METHODS:Thirty-two male rats were randomly classified into 5 groups,and PBS or monocrotaline was administered (100 mg/kg or 160 mg/kg).They were sacrificed on day 7(groups A,B and D)or day 10(groups C and E).Blood samples were collected to determine liver enzyme concentrations.The weight of the liver and body and the amount of ascites were measured.Histopathological changes of liver tissue on light microscopy were assessed by a modified Deleve scoring system.The positivity of proliferating cell nuclear antigen(PCNA)was estimated. RESULTS:The rats that were treated with 160 mg/kg monocrotaline presented with severe clinical symptoms (including two deaths)and the histopathological picture of HVOD.On the other hand,the rats that were fed with 100 mg/kg monocrotaline had milder and reversible manifestations.Comparison of the rats sacrificed on day 10 with those sacrificed on day 7 showed that the positivity of PCNA increased,especially that of hepatocytes.CONCLUSIONS:Monocrotaline induces acute,dose- dependent HVOD in rats.The model is potentially reversible with a low dose,but reliable and irreversible with a higher dose.The modified scoring system seems to be more accurate than the traditional one in reflecting the histopathology of HVOD.The enhancement of PCNA positivity may be associated with hepatic tissue undergoing recovery.

Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: Prophylaxis and treatment controversies

Hepatic veno-occlusive disease(VOD), also known as sinusoidal obstruction syndrome, is a major complication of hematopoietic stem cell transplantation and it carries a high mortality. Prophylaxis for hepatic VOD is commonly given to transplant recipients from the start of conditioning through the early weeks of transplant. However, high quality evidence from randomized controlled trials is scarce with small sample sizes and the trials yielded conflicting results. Although various treatment options for hepatic VOD are available, most have not undergone stringent evaluation with randomized controlled trial and therefore it remains uncertain which treatment offers real benefit. It remains controversial whether VOD prophylaxis should be given, which prophylactic therapy should be given, who should receive prophylaxis, and what treatment should be offered once VOD is established.

Higher plasma bilirubin predicts veno-occlusive disease in early childhood undergoing hematopoietic stem cell transplantation with cyclosporine

AIM: To analyze the association between plasma bilirubin levels and veno-occlusive disease(VOD) in non-adult patients undergoing hematopoietic stem cell transplantation(HSCT) during cyclosporine therapy.METHODS: A total of 123 patients taking cyclosporinewere evaluated using an electronic medical system at the Seoul National University Children's Hospital from the years 2004 through 2011. Patients were grouped by age and analyzed for incidence and type of adverse drug reactions(ADRs) including VOD. RESULTS: The HSCT patients were divided into three age groups: G#1 ≥ 18; 9 ≤ G#2 ≤ 17; and G#3 ≤ 8 years of age). The majority of transplant donor types were cord blood transplantations. Most prevalent ADRs represented acute graft-vs-host disease(a GVHD) and VOD. Although the incidences of a GVHD did not vary among the groups, the higher frequency ratios of VOD in G#3 suggested that an age of 8 or younger is a risk factor for developing VOD in HSCT patients. After cyclosporine therapy, the trough plasma concentrations of cyclosporine were lower in G#3 than in G#1, indicative of its increased clearance. Moreover, in G#3 only, a maximal total bilirubin level(BILmax) of ≥ 1.4 mg/d L correlated with VOD incidence after cyclosporine therapy. CONCLUSION: HSCT patients 8 years of age or younger are more at risk for developing VOD, diagnosed as hyperbilirubinemia, tender hepatomegaly, and ascites/weight gain after cyclosporine therapy, which may be represented by a criterion of plasma BILmax being ≥ 1.4 mg/d L, suggestive of more sensitive VOD indication in this age group.

One patient of hepatic veno-occlusive disease with an increased cancer antigen-125 expression caused by misuse of Sedum aizoon

Nowadays hepatic veno-occlusive disease is mainly caused by Sedum aizoon in China,and its prognosis dependents on the dosage and courses of the Sedum aizoon treatment but lacks other objective indicators.There are a lot relationships between CA125 level and liver cirrhosis,this case had a obvious increased CA125 level in the serum,hydrothorax and ascites,following by the liver cirrhosis in a short time,and then died of upper gastrointestinal bleeding.By now we guess that CA125 level could forecast the liver cirrhosis following by hepatic veno-occlusive,which will become the prognosis of the hepatic veno-occlusive.

Experience on the Management of Priapism at the Yaounde Central Hospital

Introduction: Priapism is a urological emergency defined as a prolonged penile erection for more than 6 hours, painful and sustained, occurring without any sexual stimulation. The diagnosis is essentially clinical. However, the management is often late because of the delay in consultation, which is characteristic in our context. The purpose of our study is to describe the clinical and therapeutic aspects of patients who presented with priapism at the Yaoundé Central Hospital as well as to propose a present synthesis concerning the management of priapism. Methodology: We conducted a descriptive cross-sectional study with a retrospective recruitment method in the urology department of the YCH. It extended over a period of 6 months from January 2022 to June 2022. We reviewed the files of patients seen within a period spanning 10 years from January 1st, 2011 to January 31st, December 2021. The study population consisted of patients who had been hospitalized and treated for priapism. We carried out consecutive and non-exhaustive sampling. Results: During the study, we collected data from the medical files of 13 patients. The median age was 25 years, with extremes of 12 and 82 years. Most of the patients were between 20 and 30 years old (38.5%). Most of the patients were single (69.2%). Sickle cell disease was the main comorbidity encountered during the study (76.9%). The median time from onset of symptoms to consultation was 10 [6 - 20.5] hours, with extremes of 1 and 264 hours. All patients presented with painful penile erection (100%). There was concomitant multifocal pain in 38.5% of cases suggestive of vaso-occlusive crises (VOC). The symptoms occurred in a non-traumatic context in the majority of cases (92.3%). The T-shunt was the most used surgical technique (84.6%). The median duration of surgery was 36 [35 - 40] minutes with extremes of 25 and 60 minutes, the majority being operated in less than 45 minutes (84.6%). The frequency of postoperative complications was 46.2%, dominated by weak erections/loss of erections (38.5%). The median duration of hospitalisation was 4 [3 - 5.5] days, with extremes 2 and 20 days of hospitalisation. Resumption of sexual activity was reported in 8 patients (61.5%). The time to recovery was mostly greater than 6 weeks (62.5%). Conclusion: Priapism remains a urological emergency. The prognosis depends on the patients’ promptness in consulting. The T-Shunt is an effective surgical technique in the event of failure of medical treatment.

Medical management of ischemic stuttering priapism： a ：ontemporary review of the literature

Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder. Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction （ED）. Stuttering priapism, though relatively rare, affects a high prevalence of men with sickle-cell disease （SCD） and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED. The mechanisms involved in the development of priapism in this cohort are poorly characterized; therefore, medical management of priapism represents a therapeutic challenge to urologists. Additional research is warranted, so we can effectively target treatments for these patients with prevention as the goal. This review gives an introduction to stuttering priapism and its clinical significance, specifically with regards to the patient with SCD. Additionally, the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.

Insights of priapism mechanism and rationale treatment for recurrent priapism

Priapism is defined as abnormal prolonged penile erection occurring beyond or unrelated to sexual interest. The disorder is enigmatic yet devastating because of its elusive etiology, irreversible erectile tissue damage, and resultant erectile dysfunction （ED）. Current management strategies suffer from a poor understanding of the pathophysiology, especially at the molecular level. The traditional treatments are based more on empirical rather than evidence-based knowledge. The outcomes for restoration of normal erectile function are poor, especially for stuttering priapism. Therefore, it is critical to understand priapism from a molecular level, to formulate treatment strategies and to establish rational prevention strategies for high-risk populations, such as sickle cell disease （SCD） patients and cases of the stuttering variant. This review focuses on the recent advances at the molecular level in priapism and penile erection, and applies the recent knowledge to the treatment of stuttering priapism.

Unsatisfactory outcomes of prolonged ischemic priapism without early surgical^shunts： our clinical experience and a review of the literature

Ischemic priapism is a rare occurrence which can cause severe erectile dysfunction （ED） without timely treatment. This retrospective study reports our experience in treating prolonged ischemic priapism and proposes our further considerations. In this paper, a total of nine patients with prolonged ischemic priapism underwent one to three types of surgical shunts, including nine Winter shunts, two AI-Ghorab shunts and one Grayhack shunt. During the follow-up visit （after a mean of 21.11 months）, all patients＇ postoperative characters were recorded, except one patient lost for death. Six postoperative patients accepted a 25-mg oral administration of sildenafil citrate. The erectile function of the patients was evaluated by their postoperative 5-item version of International Index of Erectile Function Questionnaire （IIEF-5）, which were later compared with their premorbid scores. All patients had complete resolutions, and none relapsed. The resolution rate was 100%. Seven patients were resolved with Winter shunts, one with an AI-Ghorab shunt and one with a Grayhack shunt. The mean hospital stay was 8.22 days. There was only one urethral fistula, and the incidence of postoperative ED was 66.67%. Four patients with more than a 72-h duration of priapism had no response to the long-term phosphodiesterase type 5 （PDE-5） inhibitor treatment. These results suggest that surgical shunts are an efficient approach to make the penis flaccid after prolonged priapism. However, the severe ED caused by prolonged duration is irreversible, and long-term PDE-5 inhibitor treatments are ineffective. Thus, we recommend early penile prosthesis surgeries for these patients.

Priapism secondary to penile metastasis of rectal cancer

Metastatic penile carcinoma is rare and usually originates from genitourinary tumors. The presenting symptoms or signs have been described as nonspecific except for priapism. Rectal adenocarcinoma is a very unusual source of metastatic penile carcinoma. We report a case of metastatic penile carcinoma that originated from the rectum. Symptomatic improvement occurred with palliative radiotherapy.

A pathophysiology-based approach to the management ot early priapism

Priapism is a rare condition that involves persistent penile erection for greater than 4 h. Distinct variants exist, each with unique characteristics. Ischemic priapism is a painful medical emergency that may occur as a result of veno-occlusion leading to hypoxia and tissue death. Recurrent bouts of ischemic priapism, or stuttering priapism, require treatment for individual attacks as well as long-term prevention. Non-ischemic priapism is associated with trauma and may be managed conservatively. Recent advances into the pathophysiology of priapism have allowed the development of treatment algorithms that specifically target the mechanisms involved. In this review, we outline the basics of smooth muscle contraction and describe how derangement of these pathways results in priapism. A pathophysiological approach to the treatment of priapism is proposed with duration-based algorithms presented to assist in management.

Management of Venous Priapism: Experience of Sylvanus Olympio University Hospital in Lomé(TOGO)

Objective: To study the diagnostic, etiological, therapeutic and evolutionary aspects of patients received at the Sylvanus Olympio Hospital in Lomé for venous priapism. Patients and Methods: A cross sectional study, over 5 years (2012-2016), of 27 cases of low flow priapism treated at the Chu Sylvanus Olympio in Lomé. Results: The mean age of the patients was 28.14 years ± 8.6. The average time of consultation was 106 hours (04 days 10 hours) ± 208.02. In our study, 4 (14.81%) patients consulted before the 6th hour and 20 (74%) patients consulted after the 24th hour. The blood count required in all patients revealed a case of chronic myeloid leukemia. Hemoglobin electrophoresis resulted in 23 (85.1%) cases of sickle cell disease. The management was medico-surgical. After an average follow-up of 11 months, erectile function was evaluated in 18 patients, and erectile dysfunction was noted in 10 (55.5%) patients.

Oral Phosphodiesterase Type 5 Inhibitors in Recurrent Priapism Complicating Thalassemia Intermedia: A Case Report

Recurrent priapism is a rare, serious and difficult to treat complication of some hematological disorders, for which no standard therapy exists. This study reports a case of a 42-year-old man with thalassemia intermedia complicated by recurrent episodes of priapism. To prevent priapism recurrences, a trial of PDE5is use was initiated. One day after initiation of a PDE5i (25 mg sildenafil repeated every 8 hours), priapism was improved. For 3 weeks, the patient reported improvement, without experiencing any episodes of priapism and a normal physiologic erectile function. Four weeks after treatment he experienced priapism reoccurrence and doubling of the Sildenafil was not effective. Gonadotropin-releasing hormone agonist initiated and one week after initiatin of new drug he improved. He was free of priapism episodes for more than 2 years afterward. PDE5 deregulation seems to be an underling pathologic mechanism of recurrent priapism at least in thalassemia intermedia patients. It appears that PDE5is may have a role in the management of such patients and further testing in clinical trials is needed.

Management of Priapism in Sickle Cell Patients: Experience of the Urology Department of the University Hospital Centre of Libreville

Introduction: Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. Material and Methods: This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. Result: We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. Conclusion: Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.

Penile Metastasis of Colorectal Cancer Mimicking Priapism with Acute Urinary Retention: A Rare Case

Background: Penile metastasis of colorectal carcinoma is a rare phenomenon in clinical setting. They normally manifest as penile lesion and acute urinary retention. However, presentation of priapism is exceedingly rare. Aims: Discussion of this rare presentation as well as the diagnostic processes and subsequent management. Case Presentation: A 54-year-old male with a history of colorectal cancer presents with acute urinary retention. Examination of the patient demonstrates a semi-erect penis, with multiple palpable nodules on the shaft and penile meatus. Histological and imaging findings indicate penile metastasis of colorectal cancer. Conclusion: Biopsy via cystoscopy is used to obtain definitive diagnosis of penile metastasis. Urinary drainage followed by further cancer intervention or palliative care is crucial for effective management.

Non-ischemic priapism in dog: Case report

Bulldog with unilateral cryptorchidism was admitted to our clinic suffering from a persistent erection for 2 d. The animal was left for the first time for breeding without observation. Penis was hyperaemic, oedematous with area of mucous membrane necrosis and swollen bulbus glandis. Doppler ultrasound was optimized to allow adequate recognition of blood flow sensitive for slow flow on the head, shaft of the penis and bulbus glandis. Penis showed unsymmetrical blood flow that started in the left side of the bulbus glandis, and continue to the shaft until the gland penis;whereas, the other half of the penis showed no blood flow. Using Doppler ultrasonography was useful for diagnosis of the blood flow pattern that was beneficial to give the appropriate treatment.

Perioperative anticoagulation and open distal corpora cavernosa shunt in the management of a case of stuttering idiopathic persistent childhood ischaemic priapism

Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management.The use of perioperative anticoagulation and open distal corporaglandular shunt procedure in the management of childhood priapism has not been reported in the literature.We present a stuttering case of a 13-year-old boy who presented with idiopathic ischaemic priapism lasting 13 h in duration,which recurred despite corporal aspiration and alpha-adrenergic agonist injections,percutaneous distal shunt surgery,and revision of percutaneous distal shunt surgery.He was eventually successfully managed with perioperative subcutaneous enoxaparin,oral aspirin and clopidogrel in conjunction with an Al-Ghorab shunt,which led to sustained detumescence but with spontaneous morning erections.In paediatric patients with sustained childhood priaprism failing stepwise treatments,an Al-Ghorab shunt with perioperative anticoagulation is a viable option.

Ischemic Priapism Management at the University Hospital, Brazzaville

Background: Priapism is defined as a prolonged and painful erection that persists beyond or is unrelated to sexual stimulation. Its frequency is high in sickle cell patients in our regions. Despite being a urological emergency, many patients are diagnosed at a late stage, increasing their risk of sequelae. In this article, we assessed the management of priapism in our department, with the aim of improving our daily clinical practices. Patients and Methods: We conducted a monocentric retrospective descriptive study from January 2005 to December 2020. All patients admitted and treated for priapism in our emergency department during the study period were included. The following variables were considered: age, sex, etiology, consultation delay, treatment type and outcomes. A follow-up visit was scheduled once at 1, 6 and 12 months post-treatment and the erectile function was evaluated during this visit. Results: In total 97 patients were treated during the study period. Priapism represented the 4th urological emergency after urinary retention, renal colic and hematuria. The mean age was 23.63 ± 11.5 years old. Sickle cell disease was observed in 59.8% of patients. Sixteen patients (16.50%) who consulted within 12 hours of priapism onset were successfully treated by oral or injectable etilefrine. Forty-three patients (44.33%) who consulted between 12 and 36 hours were successfully treated using distal spongio-cavernous fistula. After treatment, detumescence was obtained in 86 patients (88.66%). Eleven patients (11.34%), who consulted after the 36th hour, developed cavernous fibrosis with subsequent erectile dysfunction. Conclusion: Priapism represents the 4th cause of admission at our emergency department. Sickle cell disease was the main cause of ischemic priapism in our context. One patient in 2 consulted after 36 hours following the onset of symptoms. Medical treatment was effective in patients who consulted before 12 hours, while surgical treatment resulted in good outcomes in most of the patients who consulted after 36 hours.