PURPOSE: Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism. MATERIALS AND METHODS: This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention. RESULTS: Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases. CONCLUSIONS: The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.
Alprostadil/adverse effects/diagnostic use ; Drug Evaluation/methods ; Humans ; Male ; Middle Aged ; Penile Erection ; Penile Induration/*ultrasonography ; Phenylephrine/*therapeutic use ; Pilot Projects ; Priapism/chemically induced/*prevention & control ; Retrospective Studies ; Ultrasonography, Doppler, Duplex/adverse effects/methods ; Vasoconstrictor Agents/*therapeutic use ; Vasodilator Agents/adverse effects/diagnostic use

OBJECTIVESTo explore the diagnostic value of color Doppler flow imaging (CDFI) in monitoring portal vein complications (PVC) following orthotopic liver transplantation (OLT).

METHODSFive hundred and four patients received OLT and had CDFI examinations before and after their transplantations. CDFI monitoring parameters before the operation included portal vein diameter, blood flow velocity and the presence of thrombi within the portal vein. Monitoring parameters after the operation included portal vein diameters of donor and receiver sides, and the diameter of the mouth of anastomosis, inner side of blood vessel echo, the direction of blood flow and its speed.

RESULTSOf the 504 patients examined, the median velocity of the portal blood flow was 46.27 cm/s (range: 15.8 to 110.8) on the day of the operation. The blood flow speed of 358 cases (71.03%) was higher than 40 cm/s. Of the 358 patients, 347 (68.85%) had a blood flow speed lower than 40 cm/s one month after the operation. Sixty-four patients (12.70%) showed hepatofugal blood flow once, and only one case had a total hepatofugal blood flow. Thirteen patients (2.58%) had portal vein complications, including 4 cases with portal vein thrombosis and 9 with portal vein stenosis.

CONCLUSIONNot all abnormal portal vein blood flow signals will lead to complications. It is worthwhile to monitor the portal blood flows. CDFI plays an important role in the diagnosis of portal vein complications after orthotopic liver transplantation.

Adolescent ; Adult ; Aged ; Blood Flow Velocity ; physiology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Liver Cirrhosis ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation ; adverse effects ; diagnostic imaging ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; Ultrasonography, Doppler, Duplex ; methods ; Ultrasonography, Interventional ; Venous Thrombosis ; diagnostic imaging ; etiology