Biomedical subjects

B C Mellinger

Publications and source records attributed to B C Mellinger.

11 recordsLinked to original sources

PubMed1992

New surgical approach for operative management of penile fracture and penetrating trauma.

We have seen 2 cases of penile fracture and 2 of penetrating penile trauma without urethral injury surgically managed with an incision originally described for the operative treatment of venogenic impotence. This incision afforded excellent exposure of all three corporeal bodies and facilitated operative repair. Postoperative results were excellent with return of normal erectile function, minimal edema, and a well-healed, barely visible scar. This incision represents another operative approach for the surgical management of penile fracture and penetrating trauma when urethral injury is not present.

Humans↗

PubMed1992

RP-30A: new tracer for detection of changes in testicular blood flow in rat torsion model.

RP-30A is a radioactive tracer being evaluated for the detection of regional myocardial blood flow. This study compares RP-30A to technetium 99m pertechnetate as radioactive tracers for the detection of testicular blood flow changes in early testicular torsion. The left testis of adult male Sprague-Dawley rats was subjected to either thirty or sixty minutes of 720 degrees torsion. Injections of RP-30A or 99mTc-pertechnetate followed by sacrifice and scintillation counting of the testes was performed. No significant difference was detected between the torted testes and the right control testes in both groups receiving 99mTc-pertechnetate and the thirty-minute group receiving RP-30A. The torted testes of the sixty-minute group receiving RP-30A revealed a significant difference (decrease) in uptake indicating that RP-30A may be a more sensitive tracer in detecting testicular blood flow changes in early testicular torsion.

Animals↗

PubMed1992

Fertility rates with delayed fibrin glue: vasovasostomy in rats.

OBJECTIVE: To determine if fibrin glued vasovasostomy had comparable fertility rates to sutured vasovasostomy. DESIGN: Twenty adult male Sprague-Dawley rats underwent bilateral vasectomy. Two weeks after vasectomy, 10 rats had a bilateral sutured vasal anastomosis consisting of four mucosal and four seromuscular sutures with 10-0 nylon. The second group of 10 rats underwent bilateral fibrin glue vasal anastomosis consisting of two transmural sutures with 10-0 nylon followed by application of fibrin glue. One month after vasectomy reversal, each male rat was mated with a female rat for a period of 2 weeks. SETTING: Animal laboratory. PATIENTS PARTICIPANTS: Twenty male Sprague-Dawley rats. INTERVENTIONS: Bilateral vasectomies in 20 male Sprague-Dawley rats. Two weeks after vasectomy, 10 rats had bilateral sutured vasal anastomosis, and 10 rats had bilateral glued vasal anastomosis. MAIN OUTCOME MEASURES: Pregnancy after vasectomy reversal. RESULTS: Ten of 10 rats in the sutured group produced offspring for a fertility rate of 100%. Eight of 10 rats in the fibrin glue group produced offspring for a fertility rate of 80%. There was no statistically significant difference in the pregnancy rates between the two groups at the 95% confidence interval. CONCLUSION: Fibrin glue-delayed vasectomy reversal produces comparable fertility rates compared with conventional sutured vasectomy reversal in the rat.

Adhesives↗

PubMed1992

Human papillomavirus in the male patient.

Human papillomavirus is a double-stranded DNA virus associated with a broad spectrum of clinical states including condylomata acuminata, latent and subclinical infection (acetowhitening), Bowen's disease, and carcinoma of the penis and anus. The virus is transmitted by direct contact with site-subtype specificity; additional studies are needed to elucidate the exact transmissibility and disease course of HPV infection. The association of HPV-16 and HPV-18 with anogenital malignancy increases the importance of treating such infections and raises questions about the role of HPV in oncogenesis. Treatment modalities for HPV include cytotoxic agents, surgical excision, immunotherapy, and laser ablation. Success rates appear best for laser ablation of evident disease. No therapeutic modality appears superior for treating latent disease. The public health ramifications of HPV are vast and warrant investigation to further our scientific and clinical understanding of oncogenesis and its prevention.

Bowen's Disease↗

PubMed1992

Sexually transmitted diseases and their relation to male infertility.

Controversy surrounds the role of sexually transmitted diseases in male infertility. Because our understanding of male infertility is limited, and because diagnostic tests such as semen analysis including culture and leukocyte count are variable, definitive conclusions on STDs and their effect on infertility cannot be substantiated. Prospective investigations of infertile couples using appropriate control groups, sophisticated semen collection protocols, proper microbiologic techniques, and standardization of seminal fluid analysis are required to understand the role of STDs in male infertility. Regardless of the ongoing research to delineate the role of STDs in male infertility, advocating primary prevention by increasing public awareness of the negative effects of STDs and the use of contraceptive methods to prevent the spread of STDs is mandatory for the health care professional.

Animals↗

PubMed1991

Fibrin glue vasal anastomosis compared to conventional sutured vasovasostomy in the rat.

Vasectomy reversal has become a frequently performed surgical procedure with best results obtained with the use of the operating microscope and microsurgical technique. The present study was undertaken to evaluate the use of fibrin glue ("Tisseel", Immuno U.S., Inc.) for vasovasostomy and to compare this technique to conventional sutured vasovasostomy. Utilizing 60 male Sprague Dawley rats, a conventional two layered sutured anastomosis of vasovasostomy (30 rats) was compared to a fibrin glue technique of vasal anastomosis (30 rats). The fibrin glue technique was performed with two transmural sutures, was unstented, and utilized the biological glue to seal the anastomosis. The contralateral vas of each animal underwent vasectomy and reapproximation of unligated ends so that the rate of spontaneous recanalization could be accessed. Rats were sacrificed at 24 hours, one week, four weeks, and three months postvasovasostomy. The vasal specimens were evaluated for gross patency, presence and size of sperm granuloma, mean flow rates at varying infusion pressures, tensile strength measurements and histologic studies. Combining the one and three month groups, a similar patency rate was obtained by either technique; 83% (n = 18) for the sutured group, and 90% (n = 21) for the fibrin glue group. The rate of spontaneous recanalization of the contralateral vasa in the one and three month animals was 8% (n = 38). The mean flow rates obtained at high and low infusion pressures were not statistically different for the two techniques. The tensile strength of the glue anastomosis averaged 78% of the tensile strength achieved by the conventional sutured technique. The incidence of sperm granuloma after vasovasostomy was 28% for the fibrin glue group and 61% for the sutured group. Additionally, 67% of granulomas were small (less than 3 mm.) in the glue group, compared to only 36% in the sutured group. Histology revealed similar morphological changes in the area of anastomosis with either technique. Operative time for sutured vasovasostomy averaged 24 minutes, compared to an average of 11 minutes for the glue assisted vasovasostomy. The use of fibrin glue allowed the performance of a sperm tight patent anastomosis that had the advantages of reduced incidence of sperm granuloma formation, reduced operative time, and less microsurgical skill required to perform the anastomosis.

Anastomosis, Surgical↗

PubMed1990

Penile blood flow changes in the flaccid and erect state in potent young men measured by duplex scanning.

We studied penile blood flow changes with duplex ultrasound scanning in 8 potent young men during the flaccid state and during the erect state induced by visual sexual stimulation. Measured parameters obtained from the cavernous arteries were arterial diameter, peak blood flow velocity and blood flow acceleration. The mean arterial diameter change was 72% associated with average blood flow velocity and acceleration changes of approximately 200%. Actual values for blood flow velocity and acceleration were considerably higher when compared to papaverine-induced values measured in psychogenically impotent men. Visual sexually stimulated penile arterial changes are not analogous to papaverine-induced arterial changes and these differences raise questions about the appropriateness of using psychogenically impotent men as controls for measurement of penile arterial function with duplex scanning.

Adult↗

PubMed1990

Papaverine-induced penile blood flow acceleration in impotent men measured by duplex scanning.

We assessed the value of penile blood flow acceleration as a parameter in the evaluation of the penile arteries. Duplex sonography and pulsed Doppler analysis with papaverine were performed in 50 impotent men. Measured parameters included cavernous artery diameters before and after papaverine, post-papaverine peak blood flow velocity and blood flow acceleration. Erections were graded subjectively on a scale of 1 to 4, with 4 being a full erection. Penile blood flow acceleration appeared to correlate with vessel dilatability and poor erectile response, and was subjectively more discriminating than peak blood flow velocity. This parameter provides additional measurable data about arterial function and should be obtained in addition to the other 2 parameters.

Adult↗

PubMed1990

Sexual dysfunction in elderly men.

The incidence of sexual dysfunction increases with age. In addition to normal physiologic changes of aging, the increased incidence of chronic disease and various medications affect sexual functioning. However, sexual dysfunction should be investigated and treated in a manner acceptable to the patient.

Aged↗

PubMed1989

The role of imaging in the diagnostic evaluation of impotence.

This article serves to highlight the recent advances that have been made in the workup and differential diagnosis of erectile dysfunction, focusing particularly on the role of imaging in this diagnostic assessment. Intracavernosal injection of vasoactive agents, duplex sonography with pulsed Doppler analysis, penile arteriography, and dynamic infusion pharmacocavernosometry/cavernosography are among the techniques discussed. With the development and availability of nonprosthetic treatment options, identification of the specific underlying cause of a patient's impotence (as determined by these methods) allows the formulation and institution of a therapeutic plan based on the patient's underlying pathophysiology and appropriate for the individual's case. On the basis of our experience, we present a practical and cost-effective algorithm for the diagnostic evaluation of the impotent patient.

Angiography↗

PubMed1987

Correlation between intracavernous papaverine injection and Doppler analysis in impotent men.

One hundred impotent men were evaluated with Doppler pulse-wave analysis and intracavernous papaverine. Fifty-four men with normal Doppler study response had abnormal responses to papaverine. A normal Doppler study response failed to predict the inability of papaverine to induce an erection in 54 per cent of cases. Twenty-seven patients had abnormal Doppler study responses, and only 2 of these men had a normal response to papaverine. An abnormal Doppler study response was highly predictive of a vascular abnormality.

Erectile Dysfunction↗