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Priapism

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181. Recurrent idiopathic high-flow priapism treated with selective arterial embolization after repeated initial treatments for low-flow priapism (Full text)

Recurrent idiopathic high-flow priapism treated with selective arterial embolization after repeated initial treatments for low-flow priapism High-flow priapism is most often seen following perineal and penile trauma. We report the case of a 32-year-old man who presented with recurrent idiopathic priapism initially treated as low-flow priapism on 8 previous emergency department visits. Pelvic angiography revealed an abnormal communication between the left cavernosal artery and the left corpus (...) cavernosum and led to the diagnosis of high-flow priapism. Treatment involved embolization of the left common penile artery, which resulted in successful resolution of the recurrent priapism. Our patient's case highlights the importance of an appropriate work-up, including imaging, to distinguish high- and low-flow priapism and to provide appropriate care.

2009 Canadian Urological Association Journal PubMed

182. Blast crisis

focal neurological signs priapism confusion or stupor history of chronic myelogenous leukaemia (CML) exposure to ionising radiation exposure to alkylating chemotherapeutic agents Diagnostic investigations FBC and differential peripheral blood smear bone marrow aspiration and biopsy karyotype fluorescent in situ hybridisation quantitative PCR serum leukocyte alkaline phosphatase serum vitamin B12 T315I gene mutation test Treatment algorithm ACUTE ONGOING Contributors Authors Professor of Medicine

2017 BMJ Best Practice

184. Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion

with lifestyle modi?cations, substituting alternative medications in place of those that can exacerbate ED, and moving on to PDE5i in patients who have organic causes of ED such as spinal cord injuries, radical pelvic surgery, severe atherosclerosis, or those who fail lifestyle therapy or desire rapid improvement in their ED. Typically,thesemenmaybestartedonaPDE5itrial,with appropriate counseling about risk of priapism (de?ned as an erection lasting longer than 4 hours). Contraindications for PDE5i use (...) include use of nitrates and inadequate cardiac reserve for sexual activity requiring clearance by a cardiolo- gist.Further,thesemedicationsshouldbeusedwithcautionin menonanalphablocker astheycancauseanunsafedropin bloodpressure.SideeffectsofPDE5iagentsincludeheadache, facial?ushing,muscleaches,nasalcongestion,abluetingein vision, dizziness, dyspepsia, and priapism. Typical doses of PDE5iaresildena?l50–100mg,tadala?l5–20mg,vardena?l 10–20 mg, and avana?l50–200 mg. All of these drugs are expensive, $10

2018 Society for Assisted Reproductive Technology

186. CRACKCast E143 – Diving Injuries and Dysbarism

marmorata – patchy cyanotic marbling of the skin (trunk and torso) – may first show up as pruritus, then erythema, then mottling. This is due to venous stasis. Lymphatic obstruction presents with edema. Spinal cord at high risk – lumbar region: ● Limb weakness/paralysis ● Paresthesias – distal to proximal migration ● Numbness ● Low back/abdominal pain ● Bladder symptoms, fecal incontinence, priapism ● Patchy symptoms Cerebral symptoms: ● Headache, blurred vision, diplopia, dysarthria, fatigue, behaviour

2018 CandiEM

188. Guidelines for the use of hydroxycarbamide in children and adults with sickle cell disease (Full text)

, ), significant improved aerobic exercise tolerance and physical fitness (Wali & Moheeb, ). These cardiovascular benefits may be due to the associated increase in haemoglobin. Priapism Case reports suggest some benefit of hydroxycarbamide to prevent recurrent ischaemic priapism (Al Jam'a & Dabbous, ; Saad et al , ) through its mechanism of enhancing NO bioavailability, but there is no evidence to support its role in acute episodes (Uzoma et al , ). Avascular necrosis (AVN) A prospective non‐randomised study (...) prevent priapism (2D) In children and adults with SS/Sβ 0 and symptomatic chronic anaemia that interferes with daily activities or quality of life, recommend treatment with hydroxycarbamide (1C) Use in other genotypes Hydroxycarbamide has been less well investigated in SCD phenotypes other than SS/Sβ 0 thalassaemia genotypes. Although there are no completed randomised clinical trials of hydroxycarbamide use in patients with sickle cell/HbC (SC) disease, cohort studies suggest a beneficial role

2018 British Committee for Standards in Haematology PubMed

189. CRACKCast E174 – Genitourinary and Renal Tract Disorders

CRACKCast E174 – Genitourinary and Renal Tract Disorders CRACKCast E174 – Genitourinary and Renal Tract Disorders - CanadiEM CRACKCast E174 – Genitourinary and Renal Tract Disorders In , , by Adam Thomas May 3, 2018 This episode of CRACKCast covers Rosen’s Chapter 173, Genitourinary and Renal Tract Disorders. Torsion, phimosis, UTIs, stones, and priapism are some of the high-yield topics covered here. Shownotes: Core Questions [1] List a DDx for priapism and describe treatment . Priapism

2018 CandiEM

190. Testosterone Replacement Guidelines

Advantages Disadvantages Intramuscular - Cheap - Known efficacy - Lots of experience of use - Long-acting - Easy dose titration - Licensed in UK - Can monitor compliance - Fluctuating drug levels resulting in fluctuating symptoms (mood and libido – which may be an issue in boys with learning difficulties) - Local problems with injections (pain, inflammation, sterile abscess) - Attending to healthcare services - Priapism potentially if excess administered - Potential paroxysms of coughing and dyspnoea

2019 British Society for Paediatric Endocrinology and Diabetes

191. CRACKCAST E121 – Anemia, Polycythemia, and White Blood Cell Disorders

sequestration, cholestasis Gallbladder – increased bilirubin gallstone production Spleen – acute sequestration Urinary – hematuria, hyposthenuria Genital – decreased fertility, impotence, priapism Skeletal – bone infarcts, osteomyelitis, aseptic necrosis Placenta – insufficiency with fetal wastage Leukocytes – relative immunodeficiency Erythrocytes – chronic hemolysis [21] Describe the management of a sickle cell pain crisis Acute: analgesia (patient dependent/directed) with opioids +/- NSAIDS Chronic (...) sequestration, cholestasis Gallbladder – increased bilirubin gallstone production Spleen – acute sequestration Urinary – hematuria, hyposthenuria Genital – decreased fertility, impotence, priapism Skeletal – bone infarcts, osteomyelitis, aseptic necrosis Placenta – insufficiency with fetal wastage Leukocytes – relative immunodeficiency Erythrocytes – chronic hemolysis [6] What is leukostasis? An extreme form of leukocytosis (WBC >100,000/microL). Characterized by abnormal intravascular WBC aggregation

2017 CandiEM

192. CRACKCast E106 – Spinal Cord

they are mediated by the spinal levels; examples would be: DTR’s Autonomic dysfunction: Neurogenic shock Priapism If you have a bulbocavernosus reflex = spinal shock is over; if you don’t have a BC reflex the spinal injury has likely led to spinal shock. “Spinal shock refers to the loss of muscle tone and reflexes with complete cord syndrome during the acute phase of injury. Spinal shock typically lasts less than 24 hours but has been reported occasionally to last days to weeks. A marker of spinal shock is loss

2017 CandiEM

193. CRACKCast E066 – Child Maltreatment

– hypopigmentation with adjacent skin developing blood blisters and petechiae Hymen is unaffected May involve the anus or perihymenal areas Impetigo, Urethral prolapse Usually african american girls aged 5-8 yrs Should get urology consultation for ligation Anal fissures Infectious causes: STI’s Shigella Group A beta-hemolytic strep – causing perianal strep infection Candida Pinworm infestation Chigger infestation Vaginal foreign bodies Priapism (due to sickle cell disease) 4) What are some conditions that may

2017 CandiEM

194. Investigation and Management of Erectile Dysfunction and Male Hypogonadism

the side of the penis. The success rate is high, but problems may include pain, prolonged erections or priapism, and penile fibrosis and plaques. 23 It is recommended to start with the minimal effective dose and titrate upwards. Spinal cord injury patients often have an exaggerated response and require lower doses. The recommended maximal frequency of usage is three times weekly with 48 hours between dosages. Urologic consultation is recommended for patients in whom this treatment is being considered

2016 Toward Optimized Practice

195. Management of Suspected Spinal Injury

the limbs (paralysis) • nausea • headache or dizziness • altered or absent skin sensation. 2.2 Signs Signs of spinal injury include: • head or neck in an abnormal position • signs of an associated head injury • altered conscious state • breathing difficulties • shock • change in muscle tone, either flaccid or stiff • loss of function in limbs • loss of bladder or bowel control • priapism (erection in males). ANZCOR Guideline 9.1.6 January 2016 Page 3 of 6 3 Management The priorities of management

2016 Australian Resuscitation Council

196. Red cell transfusion in sickle cell disease Part l

of stroke (Adams and Brambilla 2005, Adams, et al 1998, DeBaun, et al 2014), vaso-occlusive crises, acute chest syndrome, priapism and new symptomatic avascular necrosis (DeBaun, et al 2014). However, other randomised trials have shown higher targets of 100 g/l). For chronically transfused patients, the post-transfusion Hb may be set at a higher level if the pre-transfusion HbS is low; in these circumstances, the patient has a higher percentage of normal affinity haemoglobin A, and the risk

2016 British Committee for Standards in Haematology

197. Red cell transfusion in sickle cell disease Part II

transplantation in the peri-transplant setting (Blinder, et al 2013, Gardner, et al 2014). Blood transfusion in the treatment of pulmonary hypertension seems theoretically reasonable, with the aim of decreasing haemolysis and thereby nitric oxide scavenging and consequent pulmonary vasoconstriction, and has been recommended for this purpose (Cho and Hambleton 2011, Machado and Gladwin 2005). The incidence of priapism and symptomatic avascular necrosis was significantly decreased by transfusion (...) , A.K., Shehata, N., D'Souza, R., Kuo, K.H., Ward, R., Shah, P.S. & Murphy, K. (2015) Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis. Blood, 126, 2424-2435. McCarthy, L.J., Vattuone, J., Weidner, J., Skipworth, E., Fernandez, C., Jackson, L., Rothenberger, S., Waxman, D., Miraglia, C., Porcu, P. & Danielson, C.F. (2000) Do automated red cell exchanges relieve priapism in patients with sickle cell anemia? Ther Apher, 4, 256-258. McKinney

2016 British Committee for Standards in Haematology

199. CRACKCast E038 – Pediatric Trauma

incomplete ossification at multiple bony sites anterior surfaces of the vertebral bodies are more wedge shaped Epiphytes of spinous processes tips mimic fractures Narrow predontoind space Pseudosubluxation of C2-3 seen on 40% of children 8-12 yrs Pre vertebral space varies with respiration Clinical features need to consider MOI; standard trauma primary survey C-spine injury indicators tenderness in the body c-spine area paralysis or paresthesias ptosis priapism incomplete (some motor or sensory function

2016 CandiEM

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