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Biomedical subjects

M M Lakin

Publications and source records attributed to M M Lakin.

23 records · Page 2Linked to original sources
PubMed1991

Infusion pharmacocavernosometry and nocturnal penile tumescence findings in men with erectile dysfunction.

Infusion pharmacocavernosometry and nocturnal penile tumescence findings were compared in 50 men with erectile dysfunction of either organic or psychogenic etiology. Of the men 29 had abnormal and 21 had normal nocturnal penile tumescence. Infusion pharmacocavernosometry parameters (equilibrium pressure, maintenance flow rate and 30-second pressure fall) were compared to nocturnal penile tumescence status (normal versus abnormal). When traditional normal values were used for infusion pharmacocavernosometry parameters poor correlation with nocturnal penile tumescence status was found. When new cutpoints for infusion pharmacocavernosometry parameters were chosen a stronger correlation was noted. This study suggests that when vasoactive drugs are injected intracavernously for diagnostic purposes, anxiety and/or the absence of sexual stimulation following the injection may prevent complete cavernous smooth muscle relaxation resulting in falsely abnormal values. Therefore, over reliance on infusion pharmacocavernosometry as a single test for evaluation and treatment decisions concerning erectile dysfunction should be avoided.

Adult↗
PubMed1990

Intracavernous injection therapy: analysis of results and complications.

Experience with 100 patients who used intracavernous injection therapy with a combination of papaverine with or without phentolamine for 29 months is analyzed in detail. The largest group of patients had vasculogenic erectile failure (56%). At the end of followup 50% of the patients were no longer performing injection. Those who discontinued injection therapy were slightly older and had more vasculogenic erectile failure. The nonfibrotic complications were mild in all instances and did not result in discontinuation of injection therapy. These complications consisted of small hematomas in 20.9% of the patients, mild discomfort in 13.6% and mild liver enzyme abnormalities in 9.8%. No episode of priapism or infection occurred during therapy. Fibrotic complications consisted of nodules or plaques, and correlated significantly with the number of months on injection and the number of injections. At 12 months the fibrotic complication rate was 31 +/- 8.6%. Our study suggests caution regarding the long-term complication rate of intracavernous injection therapy with these compounds and underscores the importance of routine followup examinations. While injection therapy is an effective form of treatment for erectile failure, it is not a satisfactory alternative for many patients and is associated with a significant fibrotic complication rate.

Drug Therapy, Combination↗
PubMed1989

Intracavernous injections of papaverine and phentolamine: correlation with penile brachial index.

Eighty-two patients were evaluated for erectile failure with a comprehensive history, physical examination, hormonal testing, noninvasive Doppler examination (PBI), and nocturnal penile tumescence (NPT). After these studies all patients received intracavernous injection with a combination of papaverine (50 mg) and phentolamine (1.66 mg), and both tumescence and rigidity were monitored. Rigidity response was compared with the PBI. The number of patients with a poor rigidity response in each PBI category were: 3 of 5 with a PBI of less than 0.6 (vasculogenic), 7 of 11 with a PBI of 0.6-0.75 (ambiguous), and 25 of 66 with a PBI of 0.75-1.0 (normal). These results indicate only a marginally significant association between PBI and intracavernous injection. The procedure was safe with no long-term sequelae from injection observed, and no surgical intervention was required. Complications of injections included reversible priapism in 11 patients (13.4%), transient dizziness in 10 patients (12.2%), and hematoma in 5 patients (6.2%). This study suggests that intracavernous injection with a drug combination may be a more sensitive screening test for vasculogenic impotence than noninvasive Doppler studies because it more closely simulates the erectile response.

Adult↗
PubMed1989

MR imaging characteristics of tuberculous spondylitis vs vertebral osteomyelitis.

Retrospective evaluation was made of four patients with tuberculous spondylitis who had been studied by MR with T1- and T2-weighted images in the sagittal plane and spin-density-weighted images in the axial plane. Evaluation was made of the distribution of abnormal signals within the body and posterior elements of the vertebrae, the intervertebral disk, and the associated paraspinal and epidural areas. In two of the cases, three-level involvement was seen with noninvolvement of intervening disks; metastases were misdiagnosed. One patient had anterior/inferior erosion of the vertebral body without visualization of the disk. The last patient had the more typical MR characteristics of intervertebral disk infection. Plain film examination showed only degenerative changes in three of the four cases. MR revealed more extensive involvement than the plain films did. Involvement of the posterior element and posterior vertebral body was prominent in three of the four cases. This is a significant finding since these patients are more likely to have neurologic symptoms and require laminectomy. Follow-up examinations in two cases showed increased signal on T1-weighted images, suggesting infiltration of hemopoietic marrow with fat, as has been described for degenerative osteoarthritis. The anatomy of the microcirculation of the vertebral body is related to the patterns of vertebral osteomyelitis, and discrepancies can be seen between the findings in our cases and the MR criteria previously noted for pyogenic vertebral osteomyelitis. The MR findings in our patients generally were more typical of neoplasm than of infection. These findings may reflect the characteristics of the tuberculous organism relative to the age-dependent pattern of vertebral microcirculation. Correct diagnosis of tuberculous spondylitis in young to middle-aged adults requires correlation of MR and clinical findings.

Adolescent↗