Background: Sexual dysfunction in males is characterized by the inability to achieve or maintain an erection sufficient for a satisfactory sexual activity. Erectile dysfunction is a common disorder in males and intracavernosal injection of papaverine followed by color Doppler ultrasonography of the penis is used to diagnose and treat vascular impotence. In this study, we examined the relationship between changes in peak systolic velocity (PSV) and erectile dysfunction with vascular cause after a cavernosal injection of papaverin.Methods: We performed this self-controlled clinical trial in Shahid Hasheminejad Hospital in Tehran, Iran during 2010 and 2011. The study population consisted of 90 patients with erectile dysfunction. The peak systolic velocity (PSV) of cavernosal arteries was evaluated before and after injection of 40-80 mg papaverine and it was compared in the patients with and without response to injection.Results: The mean age of participants was 47.7±13.7 years. Response to papaverine injection was positive in 41 (45.5%) patients. The mean PSV values were 14.68+5.65 and 53.74+18.8 cm/s before and after the injection, respectively (P<0.001). A PSV cut-off point of 10 cm/s was determined for the condition before injection. The sensitivity and specificity of the value for diagnosis of arterial erectile dysfunction were calclulated as 50% and 100%, respectively.Conclusion: A PSV cut-off point of 10 cm/s in flaccid status before papaverine injection has a low sensitivity but high specificity for the diagnosis of arterial erectile dysfunction. Future studies with sufficient cases of arterial erectile dysfunction are necessary for final judgments and suggestion a new cut off point.

Background: Erection is a dynamic multi-stage neurovascular phenomenon consisting of four phases. Conventional protocol of color Doppler study can easily overlook these ongoing dynamic events. Objectives: Here, we tried to designate patterns for these dynamic spectral waveform changes of cavernosal arteries in patients with erectile dysfunction and subsequently better describe the extent of their underlying problem.Patients and Methods: We evaluated 59 men who were referred for post-intracavernosal injection (ICI) color Doppler investigation of suspected erectile dysfunction (ED). The demographic data and medical history were recorded. Afterwards, first scan injection was done.Then scanning of cavernosal arteries was started about one minute after the injection and was continued thereafter. For better description of temporal changes in the waveform of cavernosal arteries, new patterns were defined and used. Patients were also classified based on previously known etiologic categories (i.e. arterial insufficiency, venous leak, mixed type, and normal response).Results: The mean age was 45.6±13.1 (24 to 74) years. Twenty-two were normal responders [considered as non-organic causes (37.3% of all patients)], 27 were classified as venous leakage, eight had arterial insufficiency and two were mixed type. Maximum PSV occurred before the fifth minute in 47 patients (92.2%). Eight patients completed all phases of erection in the first 5 minutes. We defined 8 patterns for the temporal changes in cavernosal arterial waveform. Pattern 5 was the most common pattern of venous leak; while, patterns 3 and 4 were considered as the uncommon group. Six patients demonstrated the uncommon patterns of venous leak (22.2%). Hypertension was more prevalent in the uncommon pattern of venous leak.Conclusion: We highlight the considerable role of continuous evaluation starting one minute after ICI of the vasoactive agent for better description of the underlying pathologies of ED especially in patients with venous leak etiology.

INTRODUCTION Fistula is an abnormal connection between two hollow spaces that are lined with epithelial cells. Fistulas are usually caused by injury or surgery, but radiation, infection or inflammation may also result in fistula formation. There are quite a few different types of fistula in human body. Gastrointestinal tract fistulas (GIF) may have various clinical presentation, etiology, and morbidity. Because definitions can be various on the literature perry and colleagues recommends to categorize GIF into two groups as congenital and acquired GIF. Acquired GIF can be classified as external or cutaneous if they connect with the skin or internal if they involve other organ systems including genitourinary system. (1) Here we present anextremely unusual case of an internal gastrointestinal fistula-ileo-penilecorpus cavernosum fistula, developingafter External Beam Radiation Therapy (EBRT). To the best of our knowledge, this is the first report in the literature demonstrating an ileo-corpus cavernosum fistula after EBRT...

Introduction: Our aim was to investigate the association of corporeal cavernosal pathology with venoocclusive erectile dysfunction (ED) and whether preoperative corporeal biopsy can help predict postoperative results. Materials and Methods: A total of 36 patients with venoocclusive ED underwent corporeal cavernosal biopsy and venous ligation. Preoperative assessment included complete physical examination, international index of erectile dysfunction (IIEF) scoring, nocturnal penile tumescence, penile Doppler ultrasonography, cavernosography, and, if needed, cavernosometry. Three months after surgery, all patient parameters were reevaluated and compared with the preoperative results. Biopsy results of 43 patients with penile fracture were used for controls. Results: The mean follow-up was 49.0 ± 24.1 months. The mean age of the patients with ED was 32.1 ± 8.6 years. Venous leakage was clearly revealed by cavernosography in all patients, preoperatively. The IIEF score and peak systolic velocity of the cavernosal artery in the patients did not differ postoperatively. The mean end diastolic velocity (EDV), however, decreased from 11.0 cm/s to 5.1 cm/s (P = .023). Only 2 patients had satisfactory penile rigidity after venous ligation, 2 were helped by intracorporeal injection to achieve full rigidity, and 1 used oral sildenafil to achieve full rigidity. Pathologically, 23 patients had a slight decrease of cavernosal smooth muscle cells, while in 9 patients, the cavernosal smooth muscles were markedly decreased and replaced by collagen fibers. Four patients had normal histologies, and all responded either partially or completely to surgical therapy. In the control group, 41 of 43 patients had a normal histologies, and 2 had a slight decrease of smooth muscle cell mass. Conclusion: Decreased cavernosal smooth muscle mass may impair erectile function. Its association with venoocclusive ED may be a poor prognostic factor of the outcome of surgical therapy. For the preoperative evaluation of patients, we propose cavernosal biopsy.

Sexual impotent is very common entity and define as inability to induce or maintaining penile erection during sexual intercourse. Studies reveals about 10% of men aged 40-70 years have complete, 17% have mild and 25% have moderate amount of erectile dysfunction.The sexual impotence has different etiology including psychogenic, neurogenic, arteriogenic and venogenic causes.Current studies reveal that organic cause of impotent is a bout 50-90% cases.Among them vascular reasons including arterial insufficiency or venous incompetence contributed 50-70% cases (arteriogenic impotence 30%, venogenic impotence 15% and 25% mixed Venus and arterial).Diagnosis of an organic cause of impotence is very important because is could be curable.The cavernosal arteries are the main feeders to penis and where the erection is performed. Selective angiography with selective internal pudendal is an invasive but the gold standard in evaluation of penile arteries in evaluating arteriogenic impotence.This technique is invasive and is not suitable as a first step or screening examination.Color doppler imaging could be a suitable technique inassessement of vasculogenic impotence during injection of an intra cavernosal vasodilating pharmacological agent and observing the response.By color doppler imaging blood velocity mof cavernosal arteries could be measured before and after intracavernosal injection of vasodilating agents.Also increase in size of the vessel diameter (0.75%) is an indication of normal arterial flow. A suitable vasodilator could be intrcavernosal injection of 60 mg of Papavarine in a 2 ml solution into right or left corpus cavernosum.Alternative drugs are cocktail of triple agent consisting of Papavarine 4.4 mg, phentolamine 0.15 mg and PG-E1.Drug induced priapism may occur in 2-3% of the patients.The patient can be divided into normal, with an average PSV of 47 cm/second, B. Mild to moderate with average peak systolic velocity (PSV) of 35 cm/second and C. Severe arterial insufficiency with an average PSV of 7 cm/second.Generally peak systolic velocity of 40 cm/second was normal.The parameters that indicate the presence of arterial disease are a subnormal clinical response to vasoactive agents, a less than 60% increase in the diameter of the cavernosal artery, and a peak systolic velocity of the cavernosal arteries less than 25 cm/second.In the presence of normal arterial function, doppler findings suggestive of an abnormal venous leak are persistent end diastolic velocity of the cavernosal artery greater than 5 cm/second and demonstration of flow in the deep dorsal vein.The development of diastolic flow reversal after an injection has been found to be a reliable indicator of venous competence.In conclusion color duplex doppler ultrasoung with intracavernosla injection of vasodilator. Sonography is an excellent and accurate means of assessing patients with erectile dysfunction. It is a minimal invasive test with low complication rate and can produce good results and should replace angiography and cavernosometry as primary or screening test.

Introduction: Ischemic heart disease is the most common cause of mortality in developed countries. CABG (Coronary Artery Bypass Graft) is one of the therapeutic methods in ischemic heart disease.Methods and Materials: Considering the increased incidence of coronary artery disease in Iran, and with increased rate of CABG, we performed a cross sectioned study (1996-1999). In 635 patients 467 male (73.5 percent), 168 female (26.5 percent) about risk factors of mortality after CABG in cardiac surgery department "Imam Khomeini hospital. 20 risk factors were included in our study: age, gender, smoking, family history, diabetes mellitus, morbid obesity, hypercholesterolemia, hypertension, palpitation, renal failure COPD, (chronic obstructive pulmonary disease), history of myocardial infarction, CHF, angina, cerebral vascular disease, pace maker, Ejection fraction<40 percent, history of PTCA, history of CPR, and coronary endarterectomy. Results: Cigarette smoking (P=0.40), CHF in female (P=0.003). Endarterectomy in both gender (P=0.0001). Pace maker in both gender (P=0.00006), palpitation in both gender (P=0.0001). CPR in both gender (P=0.0000001), were associated with increased risk of mortality after CABG. Conclusion: We found that, endarterctomy, cigarette smoking, CHF. Pace maker, CPR, and palpitation are important risk factors for mortality after CABG.

Objective(s): To determine One-month survival after CABG in Shariati Hospital.Methods: We followed 340 patients who underwent Isolated-CABG in Shariati Hospital and used survival analysis to compare common coronary risk factors and to assess surgical factors related to survival after CABG.Results: Smoking was more prevalent in males than in females but prevalence of hypertension, diabetes and hperlipidemia was greater in women. Female subjects were older, had greater Body Mass Index (BMI) and left ventricular ejection fraction (LVEF) and had undergone more non-elective surgery compared to males. Most patients had received 3 or 4 grafts (range 1-6 grafts). There was no difference in aortic cross clamp and anesthesia time between the two genders. Females were hospitalized for longer periods after surgery and their mortality rates were greater. One-month survival ratio estimated by the Kaplan Meier method was 97.1% and 88.4% in males and females respectively. The overall survival rate was 95.3%.Conclusion: The factors related to poor survival were: female gender, non-elective surgery, lengthy aortic cross clamp and anesthesia time and the history of: hypertension, hyperlipidemia, previous CABG and CCU hospitalization.

Considering that more than 85 percent of ischemic strokes take place in the territory of middle cerebral artery and Transcranial Doppler Sonography (TCD) is a sensitive and non aggressive method for detection of flow of cranial vessels, the aim was assessing flow alterations of these arteries in ischemic strokes of middle cerebral artery (MCA) to enable an accurate and quick method to for cast happening of any stroke and it's Prognosis. In this study, designed in descriptive method, the anterior circulation arteries of 44 patients who suffered ischemic infarction in the territory of MCA were insonated by TCD. Patients with first stroke were included and sampling was non probability testing on consecutive patients. Brain axial CTS can was performed on all patients on first and third days of stroke and TCD was performed on days 3 to 6 and the results were as following: Peak Systolic Velocity (PSV) and Mean Flow Velocity (MFV) of ipsilateral MCA were reduced resulting in asymmetry of flow more than 15% in 61.4% of cases (P value <0.005) . PSV and MFV of ACA were increased resulting in increased ratio of ipsilateral to contralateral ACA (ACAVR) in 72.2% of cases. (P value < 0.005) Pulsatility index (PI) of ipsilateral MCA to contralateral MCA had a significant increase. (P value=p.005) indicating distal vascular resistance. Resistance Index (RI) of ipsilateral MCA and contralateral MCA didn't have any significant difference (P value = 0.05) 1- Ischemic MCA infarcts reduce PSV, MFV in ipsilateral MCA and increase PSV, MFV in ipsilateral ACA, resulting in increased ipsilateral ACAYR. 2- The most valuable parameter in determining MCA infarct is ACAVR (Sensitivity=72.2%), the next one being MCA flow asymmetry> 15% (Sensitivity=61.4%) 3- RI Value had no relation to the final size of infarct. Further studies evaluating normal values of TCD parameters in Iranian people are recommended to compare these indexes with normal ones.