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Biomedical subjects

R E Berger

Publications and source records attributed to R E Berger.

At least 19 recordsLinked to original sources
PubMed1992

Preliminary report: penile vein occlusion therapy: selection criteria and methods used for the transcatheter treatment of impotence caused by venous-sinusoidal incompetence.

Penile vein occlusion therapy is a fluoroscopic guided technique developed for treating venous-sinusoidal incompetence in patients with erectile dysfunction. We report our experience with 22 patients who have been followed for greater than 1 year. Catheterization of the veins draining the penis was technically possible in 20 of 22 patients (91%). Of these 20 patients 5 (25%) were cured and 9 (45%) had significantly improved erectile function. All 5 patients (100%) with venous-sinusoidal incompetence plus normal cavernous arterial flow, no glans or corpus spongiosal shunts, and bilateral complete coil occlusion of the crural and common crural veins were cured. No deterioration of function was noted at 1 and 2 years. Patient selection and bilateral occlusion of the penile veins are essential to achieve successful penile vein occlusion therapy.

Adult↗
PubMed1991

Controlled trial of infusion cavernosometry in impotent and potent men.

Infusion cavernosometry often is performed to diagnose venous leak impotence. However, normal values have seldom been established in proved potent men. We performed a prospective study of infusion cavernosometry on nocturnal penile tumescence confirmed potent male volunteers and impotent men. Of 20 potent male controls 19 had resistance values of greater than 5 (mm. Hg.minute)/ml. Of 38 impotent men 20 (53%) had resistance values of less than 5 (mm.Hg. minute)/ml. There was considerable overlap between resistance values and infusion rates in potent and impotent men. Impotent men with resistances of greater than 5 (mm.Hg.minute)/ml. more often had normal nocturnal penile tumescence results than men with lower resistance values. Venous leakage is a significant cause of impotence.

Blood Pressure↗
PubMed1991

Antimicrobial tissue penetration in a rat model of E. coli epididymitis.

Following induction of unilateral epididymitis by intratesticular injection of E. coli, a single intraperitoneal dose of amdinocillin, ampicillin, doxycycline, tobramycin, or trimethoprim/sulfamethoxazole was administered to five groups of rats. The animal was sacrificed serially and concentrations of antibiotic in serum, infected epididymides, and non-infected epididymides were determined by high performance liquid chromatography. The ratio of infected to non-infected tissue area under the curve values was 1.05 for trimethoprim, 1.58 for sulfamethoxazole, 1.67 for amdinocillin, 2.01 for tobramycin, 2.25 for doxycycline, and 2.58 for ampicillin. Except for trimethoprim, infected tissue concentrations were significantly greater than compared to uninfected epididymal levels (p less than 0.05). Antibiotic concentrations in infected epididymides compared to serum revealed overall penetration of 34% for amdinocillin, 66% for sulfamethoxazole, 70% for ampicillin, 76% for tobramycin, 256% for trimethoprim, and 257% for doxycycline. In a rat model of epididymitis, trimethoprim and doxycycline demonstrated the greatest degree of epididymal penetration compared to serum. All antibiotics except trimethoprim had significantly greater penetration into infected tissue when compared to non-infected epididymal tissue.

Animals↗
PubMed1991

Office-based testing for antibody to human immunodeficiency virus in urology patients.

Knowledge of the status of a patient regarding antibody to human immunodeficiency virus type 1 (HIV-1) may be important in many clinical situations. Consequently, we evaluated a rapid test for antibody to HIV-1 peptides that might be suitable for a physician office practice. We evaluated the time necessary to learn to do the test, and test performance using a reference panel and a seroconversion panel as well as 200 clinical specimens. Personnel who were previously unfamiliar with immunoassays learned the test procedure within 30 minutes. All reference specimens were interpreted correctly. One clinical sample reacted in the test but the result was not confirmed by Western blot. The rapid, peptide-based test was easy to use and performance was comparable to currently licensed tests performed at clinical laboratories.

AIDS Serodiagnosis↗
PubMed1991

Repair of a traumatically amputated penis with return of erectile function.

Repair of the amputated penis may be successful using macroscopic and microscopic surgical realignments. However, to date, no one has reported return of erectile function documented by nocturnal penile tumescence. We report a case of traumatically amputated penis with microscopic repair and return of erectile function documented by nocturnal penile tumescence. In addition, the current literature regarding microscopic versus nonmicroscopic repair is reviewed.

Adult↗
PubMed1991

Assessment of normal and abnormal erectile function: color Doppler flow sonography versus conventional techniques.

The penile arteries were studied with color Doppler flow sonography in 10 subjects with normal and 39 patients with abnormal erectile function. The relationships of systolic and diastolic velocities to spectral waveform changes in the penile arteries in response to tumescence were studied before and after intracorporal injection of vasoactive medications that induce erection. In normal subjects, a characteristic spectral waveform pattern corresponded to increasing intracorporal pressure. Patients with abnormal arterial inflow and/or abnormal venous sinusoidal leakage demonstrated deviation from the patterns noted in normal subjects. Patients with abnormal arterial inflow had lower mean peak systolic velocities than normal subjects. Patients with severe venous sinusoidal incompetence had an arrest of waveform progression with evolution to but not beyond phases 1 or 2 (diastolic flow remained positive). Patients with abnormal arterial inflow and abnormal venous sinusoidal outflow had waveform changes that reflected both processes. Systolic/diastolic velocity and waveform relationships can be used to define the integrity of both the cavernosal artery inflow and venous sinusoidal outflow occlusion mechanisms.

Adult↗
PubMed1990

Bacterial epididymitis in the rat: a model for assessing the impact of acute inflammation on epididymal antibiotic penetration.

A rat model of bacterial epididymitis was developed and characterized for use in assessing the impact of acute epididymal inflammation on antibiotic penetration into the epididymis. A 0.2 ml. intratesticular injection of a 0.5 McFarland standard suspension of E. coli resulted in histologically confirmed acute epididymitis in all animals studied. Inflammatory changes were detectable as early as 24 hours following inoculation and were progressive to the last assessment point at 11 days. Early testicular infarction was observed in association with epididymal inflammation. Serial transcrotal ultrasounds of infected animals showed progressive increase in epididymal size and a late decrease in testicular size. Serum and epididymal drug concentrations were assayed following a single dose of the antibiotic amdinocillin. Fifteen minutes following the peak serum level, the drug concentration in infected epididymis was 2.3-fold higher than the contralateral, non-infected epididymis. These data suggest that acute inflammation enhances antibiotic penetration into the infected epididymis. The model described provides a rapid, reproducible method to study epididymal drug delivery in normal and diseased states.

Amdinocillin↗
PubMed1990

Cigarettes, alcohol and marijuana are related to pyospermia in infertile men.

The relationship of current use of cigarettes, marijuana and alcohol to the parameters of seminal fluid analysis, sperm penetration assay and sperm autoimmunity was studied in 164 men from infertile couples. Current cigarette smokers, marijuana users and heavy alcohol users showed greater numbers of leukocytes in the seminal fluid than did nonusers (p less than 0.02, less than 0.007 and less than 0.01, respectively). In addition, cigarette smokers had lower sperm penetration assay scores than nonsmokers (median 2.5 versus 8.0, p = 0.05). Users of cigarettes, marijuana or alcohol showed no decrease in sperm count, motility or percentage of oval sperm, and no difference in prevalence of antisperm antibodies compared to nonusers. After controlling for past sexually transmitted diseases and multiple substance exposures in a multivariate model, use of cigarettes (p = 0.006), marijuana (p = 0.12) or alcohol (p = 0.098) continued to be associated with a trend toward increased number of seminal fluid leukocytes. Cigarette smoking continued to show a significant decrease in sperm penetration assay score (p = 0.03).

Adult↗
PubMed1990

A comparison of penile brachial index and angiography: evaluation of corpora cavernosa arterial inflow.

We studied 32 impotent patients with angiography. The penile branchial index was calculated from the maximal penile arterial pressure measured from any penile artery. In 15 of the 32 patients an attempt was made to isolate the cavernous artery pressure (cavernous artery penile brachial index). There was a poor correlation between angiography and penile branchial index (r equals 0.314) and between angiography and cavernous penile brachial index (r equals 0.637). We also evaluated 15 normal individuals and a wide range of penile brachial index values was found (0.7 to 1.0). Penile brachial index values from normal patients overlapped with those from impotent patients. Penile brachial index values from impotent patients with normal and abnormal arteries (as determined by angiography) overlapped. The fact that penile brachial index measurements are performed in the flaccid state and without direct visualization of the cavernous arteries accounts for some of the variability of the penile brachial index test.

Adult↗
PubMed1989

Studies of polyglycolic acid hollow self-retaining vasal stent in vasovasostomy.

A simple method of vasovasostomy using a unique hollow, biflanged, hydrolyzable, self-retaining intraluminal stent made of polyglycolic acid (PGA) was evaluated in rat and dog animal models. The stented vasovasostomy was compared with a modified two-layer technique in a randomized prospective trial in rats. Twenty of 22 vasovasostomies using the 0.8890 mm and 0.9398 mm stents were patent, whereas only 4 of 22 vasovasostomies using a modified two-layer anastomosis without a stent were patent (P less than 0.01). Eight dogs underwent implantation of the absorbable vasovasostomy stent on one side and two-layer vasovasostomy on the other. Scanning electron microscopy showed superior re-epithelialization and closer return to normal morphology in the stented vasovasostomies than with the conventional two-layer technique.

Animals↗
PubMed1989

Case-control study of men with suspected chronic idiopathic prostatitis.

We studied prospectively 50 asymptomatic men (24 men from infertile couples and 26 normal volunteers) with no history of genitourinary infection and 34 men referred for symptoms of chronic prostatitis. Both groups were evaluated by urethral and prostatic secretion cultures for Chlamydia trachomatis, 4-glass prostatic localization cultures for facultative aerobic bacteria (Ureaplasma urealyticum, Mycoplasma hominis and selected fungi) and counts of prostatic fluid leukocytes. The men with symptoms of prostatitis had more than 1,000 leukocytes per mm. in prostatic secretions more often than did controls (11 of 27 versus 0 of 44, p less than 0.001). The concentration of Ureaplasma urealyticum in prostatic secretions was 1 log higher in prostatic fluid localization cultures than in first voided urine in 0 of 30 patients versus 13 of 50 controls (p equals 0.0014). Chlamydia trachomatis was not isolated from any patient or control. No other significant differences were found between patients and controls. We did not identify an infectious cause of chronic nonbacterial prostatitis.

Adult↗
PubMed1989

Evaluation of normal erectile function with color flow Doppler sonography.

To understand better the vascular events that occur during normal erection, we used color flow Doppler sonography to examine the erectile process in seven normal subjects. The relationship of systolic/diastolic velocities and spectral waveform changes in the penile arteries was studied in response to increasing pressure within the corpora cavernosa (tumescence) before and after the intracorporal administration of drugs to induce erection. A characteristic spectral waveform pattern was identified throughout the erectile cycle, and the pattern was correlated with increasing pressure. Both systolic and diastolic velocities were elevated during the initiation of erection, at which time the pressure within the corpora cavernosa was low (11-25 mm Hg). Systolic velocities remained elevated until the last phase of erection (83-106 mm Hg). Diastolic velocity decreased as the intracorporal pressure increased from 25 to 40 mm Hg. Between 40 and 63 mm Hg, diastolic velocity approximated zero. With increasing pressure (63-83 mm Hg), diastolic flow reversed. As the corpora cavernosa approached full erection (83-105 mm Hg), both the forward systolic and reverse diastolic flow components diminished. At approximately 106 mm Hg (systolic occlusion pressure), flow ceased. Systolic/diastolic velocity and waveform phase relationships could be used to define the integrity of both the cavernosal artery inflow and the venous sinusoidal outflow occlusion mechanisms. Color flow Doppler sonography enhanced our ability to observe and quantify dynamic erectile events and provided new insights into understanding normal erectile function.

Adult↗
PubMed1988

Experimental Escherichia coli epididymitis in rabbits.

We describe an experimental model of bacterial epididymitis in New Zealand white rabbits. Inoculation of 10(7) colony-forming units of Escherichia coli in a retrograde fashion into the vas deferens reliably produced clinical, bacteriologic, and pathologic epididymitis. Inflammation was maximum at two weeks and subsided by one month without treatment. E. coli could be reisolated from the epididymides for up to two weeks post inoculation. We detected loss of spermatogenesis in both the ipsilateral and contralateral testes and the appearance of antisperm antibodies subsequent to the infection in some animals. There were 2 cases (11%) of histologic bilateral epididymitis after unilateral inoculation; one of these had bilateral clinical epididymitis with E. coli recovered from both epididymides at two weeks.

Animals↗
PubMed1988

Risk factors for urethral injuries in men with traumatic pelvic fractures.

Urethral injuries are commonly associated with pelvic fractures. The prompt recognition and appropriate management of these injuries may significantly impact subsequent morbidity, yet few studies have addressed the identification of the risk factors for urethral injury in men with pelvic fractures. We reviewed retrospectively the records of 405 men with pelvic fractures seen at our medical center, including 21 (5 per cent) with urethral injuries. Of the 21 men 14 (67 per cent) had fractures involving a pubic ramus and a sacroiliac joint, and 12 (57 per cent) had no physical signs (blood at the urethral meatus, perineal hematoma or a high-riding prostate) that would suggest a urethral injury. The likelihood for the presence of physical signs is directly related to the interval since injury. We believe that men with the combination of rami fractures and sacroiliac disruption should undergo retrograde urethrograms before urethral instrumentation, and that physical signs are unreliable indications for urethral injuries, especially soon after the injury.

Fractures, Bone↗
PubMed1987

Chlamydia trachomatis epididymitis diagnosed by fluorescent monoclonal antibody.

Two cases are described of atypical presentation of epididymitis requiring surgical exploration to rule out the presence of testicular tumor. In each case epididymal biopsy confirmed the diagnosis of epididymitis, and the causative organism, Chlamydia trachomatis was identified by fluorescent monoclonal antibody technique.

Adolescent↗
PubMed1987

The relationship of infection with Chlamydia trachomatis to the parameters of male fertility and sperm autoimmunity.

The relationship of past exposure to C. trachomatis to the parameters of male fertility was examined in men from infertile couples whose wives had no known female fertility factors. In this population, the frequency of C. trachomatis antibody was low. Past infection with C. trachomatis was associated with a history of nonspecific urethritis, and with the presence of sperm agglutinating antibodies in serum. We found no difference in the seminal fluid analyses, physical examinations, or sperm penetration assays of the men with or without chlamydial antibody.

Antibodies, Bacterial↗
PubMed1987

Quantitation of corporeal venous outflow resistance in man by corporeal pressure flow evaluation.

We describe a technique that allows us to quantify intracorporeal penile venous resistance in papaverine-induced erections. By increasing intracorporeal pressure to greater than the mean arterial pressure by cavernous perfusion with Ringer's lactate solution we can control and measure cavernous flow and pressure, and, therefore, calculate venous resistance. We evaluated 78 impotent men and 6 controls with this method. The most important measure of the integrity of the venous resistance mechanism and of the ability to obtain an adequate erection was a post-distension steady state pressure of 50 mm. Hg or more and a venous outflow resistance of 20 mm. Hg minute per cc or more. Our method aids in the clinical evaluation of the etiology of erectile impotence.

Adult↗