SIMPLE, NONINVASIVE, RISK-FREE DIFFERENTIAL DIAGNOSIS OF VASCULOGENIC IMPOTENCE

血管生成障碍可以通过注射血管活性药物盐酸罂粟碱来诊断，但这不能使诊断人员确定传入动脉或传出静脉系统是否受损。在这项研究中，我们开发了一种技术，使US能够确定这两个系统中的哪一个是血管生成系统。为了测试传入动脉系统，将TC-99M标记的人血清白蛋白注射到阴茎海绵体，使用伽马相机产生时间依赖的SCINTIGRAM。建立感兴趣区来描述阴茎血流动力学，作为PEA NOGURM循环。AFTER同位素注射，将罂粟碱注入阴茎海绵体，同时记录阴茎曲线和阴茎周长的变化。第二代抗生素头孢替安不能与帕拉维林一起在体内代谢，呈传出模式(r=0.82，p&lt；在阴茎内注入与罂粟碱极为相似的药物，以测量其在外周血中的时间依赖浓度。PENOGRAM曲线对罂粟碱负荷的反应同时以PENOGRAM指数(PI)表示，而CEFOTIAM传出以A CEFOTIAM清除指数(CCI)表示。勃起完全组和未勃起组的PI分别为75.5±8.4和46.8±16.0，未勃起组的PI为40.5±10.4。与完全勃起组相比，勃起不全组和非勃起组的PI显著降低。根据彩色多普勒血流仪显示的阴茎动脉的变化，我们诊断为当PI小于正常值60时，患者患有动脉生理性阳萎。相反，CCI在两组之间没有显著差异，可能是因为CCI受传入血流量和速度的影响。

VASCULOGENIC IMP0TENCE CAN BE DIAGNOSED BY INJECTING THE VASOACTIVE DRUG, PAPAVERINE HYDROCHLORIDE, INTRACAVERNOUSLY, BUT THIS DOES NOT ENABLE THE DIAGNOSTICIAN TO DETERMINE WHETHER THE AFFERENT ARTERIAL OR EFFERENT VENOUS SYSTEM IS IMPAIRED.IN THIS STUDY, WE DEVELOPED A TECHNIQUE THAT ENABLES US TO DETERMINE WHICH OF THESE TWO SYSTEMS IS INVOLVED.TO TEST FOR THE AFFERENT ARTERIAL SYSTEM, TC-99m LABELED HUMAN SERUM ALBUMIN WAS ADMINISTERED INTRAVENOUSLY TO THE CORPUS CAVERNOSUM PENIS TO PRODUCE A TIME-DEPENDENT SCINTIGRAM USING A GAMMA CAMERA.THE REGION OF INTEREST WAS SET UP TO DELINEATE PENILE HEMODYNAMICS AS A PENOGRAM CURVE.AFTER ISOTOPE INJECTION, PAPAVERINE WAS ADMINISTERED INTO THE CORPUS CAVERNOSUM PENIS TO SIMULTANEOUSLY RECORD CHANGES IN BOTH THE PENOGRAM CURVE AND PENILE CIRCUMFERENCE AND RIGIDITY.THE SECOND GENERATION ANTIBIOTIC CEFOTIAM, WHICH CANNOT BE METABOLIZED IN VIVO TOGETHER WITH PARAVERINE AND SHOWS AN EFFERENT PATTERN (r=0.82, p<0.01) EXTREMELY SIMILAR TO THAT OF PAPAVERINE, WAS ADMINISTERED INTO THE PENIS TO MEASURE ITS TIME-DEPENDENT CONCENTRATIONS IN PERIPHERAL BLOOD.THE RESPONSE OF THE PENOGRAM CURVE TO PAPAVERINE LOADING WAS EXPRESSED SIMULTANEOUSLY IN A PENOGRAM INDEX (PI), AND THE CEFOTIAM EFFERENCE INDICATED AS A CEFOTIAM CLEARANCE INDEX (CCI). THESE INDICES WERE COMPARED WITH THE DEGREE OF ERECTION.THE PI WAS 75.5 (〕SY.+-.〔) 8.4 FOR THE COMPLETE -ERECTION GROUP AND 46.8 (〕SY.+-.〔) 16.0 FOR THE INCOMPLETE-ERECTION GROUP.THE PI OF THE NON-ERECTION GROUP WAS 40.5 (〕SY.+-.〔) 10.4. THE PI DECREASED SIGNIFICANTLY FOR THE INCOMPLETE-ERECTION AND NON-ERECTION GROUPS, COMPARED TO THE COMPLETE-ERECTION GROUP.WITH REFERENCE TO CHANGES IN PENILE ARTERIES SHOWN USING A COLOR DOPPLER FLOWMETER, WE DIAGNOSED PATIENTS AS HAVING ARTERIOGENIC IMPOTENCE WHEN THEIR PI WAS LESS THAN THE NORMAL VALUE OF 60. IN CONTRAST, THE CCI SHOWED NO SIGNIFICANT DIFFERENCE BETWEEN GROUPS, PROBABLY BECAUSE THE CCI WAS AFFECTED BY THE AFFERENT BLOOD FLOW VOLUME AND RATE.