View allAll Photos Tagged Angiography
The leaf canopy of these plane trees, not yet overgrown, reveals an interesting view of the silhouetted network of branches, somehow reminding of an angiography.
-
Im Frühling hat sich das Blätterdach dieser Platanen noch nicht ganz geschlossen. In Kontrast zum Himmel hebt sich so das weitverzweigte Astwerk deutlich ab, und erinnert irgendwie an eine Angiographie.
Doch Vorsicht an stürmischen Frühlingstagen. Die sich lösenden Sternhaare auf Blättern und jungen Zweigen können allergische Reaktionen auslösen, den sogenannten Platanenhusten.
Well who knew that fungus could bring people together! My favourite fungal woods south of Dunkirk, Chrislock Woods, is a go to place in the Autumn. I have been exploring these woods for a few years now and there is a public footpath running trough them. I always thought at a fork in the path one turns left, well, it transpires one should turn right and I have been trespassing for some time. There I was on hands and knees taking an image of this gorgeous Purple Coral Fungus when a voice pipes up, "Have you found anything interesting?" with a wet cold nose of a black-lab smudged into my face. As we got talking I was given full access to these woods as it turns out that this lady was the owner and she loves people who are interested in all things nature, phew! Then she continued by inviting me to see the rest of her estate, five acres of meadows, woodland and pastures. Since I was trespassing I really had no choice. She showed me her stumpery that took my breathe away, a 1940's sand pit that was used to fill sandbags to protect the AKAK guns that fired over the Thames close by, transformed into a fern and stumpery wonderland. I was then taken to her meadow to see her orchid seed heads and then to her stream that feeds the Sarre Pen in Blean Woods a short distance away, the sand cliff that hosts Sand Martins and then onto the pastures and stables with her rescued donkeys and her horse. It was then that she showed me her husbands Emergency Rescue Response Vehicle which he uses for Brands Hatch meets. I told her I was part of the Emergency Response Team as the Trauma Radiographer at Brands Hatch as part of my responsibilities with the London Air Ambulance. This lady then got even more excited, this seemed a little difficult as she was already rather over excited. I was invited into her house, a name was called and there in front of me was a chap I had worked with closely at Brands Hatch as well as Advanced Trauma Life Support training sessions where he lectured on fluid and medical resuscitation and I on Trauma Radiography, CT and Angiography, we had often shared a pint or four at the now defunct Hospital Tavers outside the Royal London Hospital. He has moved on to being the ATLS trainer with the Kent and Sussex Air Ambulance and I went to St Mary's Paddington as the Trauma Specialised in charge of A/E where we both parted company. Have we arranged to meet up, of course we have and I am taking Abbey and Phoebe to see the horses and Donkeys soon, how very, very odd as it seemed it was meant to be...
An uncle of mine is in the I.C.U. as he suffered from a silent attack yesterday. His Angiography starts in another hour.I hope everything goes well and he recovers soon
A Life in the Lab: Four decades of working with Jerry Lutty
I met Jerry in the fall of 1974 when I joined Bernie Hochheimer’s lab at the Johns Hopkins Applied Physics Lab (APL) as a photographer in an NEI-funded study to examine dyes for possible use in clinical ocular angiography. Bernie, who was a brilliant physicist in optical systems, and subsequently worked on the repair of the Hubble Telescope mirror, co-developed ICG angiography in the early 70’s with Bob Flower who I would later go on to work with. Prior to joining Bernie’s lab, I had been a cinematographers assistant at APL, working on a documentary film about the life of Dr. R.E. Gibson. He was, at that time, Director Emeritus of the Johns Hopkins Applied Physics Lab and and Professor of biomedical engineering of The Johns Hopkins University School of Medicine. One day after filming wrapped, he invited me to join him for lunch in his office at APL. Dr. Gibson suggested that I would be better served if I pursued a career in science, even though I had no formal training in that field. He asked me to meet with Bernie to discuss working in his research lab at APL and Wilmer. Needless to say, when Dr. Gibson spoke, I listened.
I met with Bernie shortly thereafter, and was offered the position which I promptly accepted. Bernie was such a good man and someone who made a tremendous contribution to the field of ophthalmology. In addition to ICG angiography, he helped develop, (in collaboration with Dr. Arnall Patz), laser photocoagulation as a method for treating diabetic retinopathy. I reported to work the following week and was introduced to Jerry who was, at that time, conducting the toxicological aspect of the dye study. I later found out that Jerry also had a connection to Dr. Gibson who steered me to Bernie’s lab. His father-in-law, Dr. Alfred J. Zmuda (A.J.), was a specialist at APL in geomagnetism, ionospheric physics and space physics, and an expert on the Aurora Borealis. I had to admire Bernie for hiring two guys who looked like they could have been at a political protest or an Earth Day celebration on the National Mall the day before. We both had hair well below our shoulders and Jerry had a big beard which he wore for the remainder of the subsequent 40+ years we worked together. We hit it off immediately and would take walks around APL’s campus at lunch time discussing art, music, politics and photography. I looked up to Jerry as I found him to be a kind and gentle soul, with a passion for knowledge and a temperament for teaching.
Following the completion of the dye study in the 70’s, Jerry and I worked in different labs on the same floor of the Woods Research Building at Wilmer. Jerry became involved in ocular angiogenesis research under Dr. Arnall Patz (who was director of the Wilmer Eye Institute at the time) and I worked with Bob Flower to further develop ICG angiography for clinical use. Later, in the early 80’s, Jerry and I collaborated on studies of Retinopathy of Prematurity under Patz and Flower. Dr. Patz had received the Lasker Award in 1956 for his research showing that giving high levels of oxygen to premature infants was causing an epidemic of blindness in those babies. We felt that a key to understanding the vasculopathy of ROP was a better understanding of normal retinal vascular development. Jerry and I worked closely on the project for the next several years and developed a new technique for visualization of the retinal vasculature. In the 80’s, the number of NIH biomedical research grants to be funded was slashed by 23%. Even though we kept the project going for the following several years, primarily through the generosity of donors to Wilmer, I eventually was forced to return to APL for several years until the biomedical research funding situation improved. While Jerry was fortunate to remain at Wilmer, we did manage to collaborate part-time on several projects during that period.
In the early 90’s Jerry received an NIH grant to study sickle cell retinopathy, and an RPB grant to study diabetic retinopathy. I returned to Wilmer again on a full time basis. I was incredibly lucky to have worked with both Jerry and Dr. Morton Goldberg on the sickle cell project. Dr. Goldberg was Wilmer’s Director at the time and an expert on sickle cell retinopathy. We were very productive during that period and gained valuable insights into vaso-occlusive processes in both diabetic and sickle cell retinopathy. We identified growth factors in sickle cell retina and showed that arteriovenous crossings were a preferred site of seafan formation. Seafan was the term coined for the neovascularization that formed at the interface between perfused and nonperfused peripheral retina which resembled the marine invertebrate Gorgonia flabellum.
In diabetic retina, we showed increased levels of the cell adhesion molecule ICAM-1 in retinal vessels. This protein could contribute to the retinal microangiopathy observed in diabetics by enhancing leukocyte adhesion to endothelium and consequently the incidence of capillary obstruction. Our study and subsequent work demonstrated ICAM-1 and its binding partners are operative in diabetic retinopathy and may serve as potential targets for therapeutic interventions. The publication of that work, in The American Journal of Pathology, has been one one of our most cited papers.
In addition to our work in diabetic and sickle cell retinopathy, Jerry also received NIH funding to continue our work on Retinopathy of Prematurity during the late 90’s and early 2000’s. We demonstrated the anti-VEGF (Vascular Endothelial Growth Factor) therapy was effective in reducing neovacularization in animal models of ROP, but that therapeutic doses should be carefully considered clinically so that retinal revascularization wasn’t inhibited.
The 2000’s brought continued success and renewed interest in normal fetal development of retinal and choroidal vasculatures. The discovery that the fetal choriocapillaris formed by a process of hemovasculogenesis, a process in which vasculogenesis and hematopoiesis occur simultaneously, was intriguing. Our work in fetal choroid led us to begin studying the choroidal vasculature in disease states, particularly, in Age-Related Macular Degeneration (ARMD). We showed that choriocapillaris dropout occurs in eyes of ARMD prior to clinical manifestations of disease. Additionally, we found that mast cells in choroid may contribute to the dry form of ARMD. These studies are still ongoing by Dr.’s Malia Edwards and Imran Bhutto at Wilmer.
I officially retired from Wilmer in 2018, however, I continued working with Jerry on a part-time basis to finish up some papers for publication. I had known and worked with him for over 45 years. He had been a mentor, a collaborator and one of my dearest friends during that time. He was a remarkable human being and I consider myself extremely lucky to have been a part of his lab and his life. He mentored countless high school students, undergrads, medical students and postdocs during his career. His teaching style, patience and desire to inspire future generations in science was an attribute to his impeccable character. I was deeply saddened by his passing as many in his circle were. We lost a a giant in science, a kind human being, dear friend and a devoted family man!
For the first time in it's 110 year history the Collage of Radiographers have gone on strike to try to improve working conditions, recruitment and retention and to get a fair days pay, I am 100% behind the strike.
Having been a Radiographer for 30 years before retiring I have experienced all the issues discussed within this fabulous profession. Falling recruitment levels and retention in the profession being a major problem, especially when you consider a newly qualified Radiographer after studying in university for 3 to 4 years getting payed less than stacking shelves in a supermarket and after gaining a Superintendents position, in charge of imaging services for A/E and all unplanned admissions orthopaedics, mobiles, theatres, ITU, DSA, out-of-Hours services, in house training, CPD and lecturing and all the responsibilities this brings and getting paid the same as a Bank Clerk!
Radiographers are the eyes an ears of the NHS performing x-rays, ultrasounds, CT and MRi scans, Radioisotope imaging, Cardiac Angiography and other interventional work, working in the operating theatres and out on the wards with mobile imaging, breast and cancer screening, nights and unsociable hours and many many more responsibilities.
I remember being in charge of a three room A/E x-ray department, all trauma and unplanned admissions, daily fracture and orthopaedic clinics, paediatrics including emergency outreach and trauma all mobile and theatre cases with 4 to 5 Radiographers, all rooms full and lists morning and afternoon.
I clearly remember one month in the summer at St Mary's Paddington being in charge, working a long day, thats 08.00 to 20.00 and due to sickness, holidays and just not having an adequate staffing level going straight into a full night, then again due to sickness going into another full day, getting home at 23 00 to have a nights sleep until the first train back to London at 06.30 and having to do it all over again. Missing my daughters birthdays and never having Christmas Eve, Christmas Day, Boxing Day or New Years off for 4 years, missing family holidays, working over 70 hours a week, nights and weekends and in my department having myself, one more full time staff member and the rest agency who did not know the equipment or the hospital! No wonder why getting people to join the profession is failing and radiographers are leaving in droves for far easier and better payed jobs.
ER was the program to watch with smooth George Clooney. "Cosmo" magazine did a series called the "Real ER" at the Royal London Whitechapel. Here are two pages from the run with me as the Senior Trauma Radiographer at the time running the trauma imaging service and the trauma calls when a patient came to us on the London Air Ambulance. I am in the bottom left hand corner positioning the x-ray head ready to do the trauma series on a RTC brought in by HEMS
During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677. John R. Brinkley initiated a boom in male impotence cures in the U.S. in the 1920s and 1930s. His radio programs recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff. Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection. The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, and orally effective drug therapies.
Erectile dysfunction (ED), also known as impotence, is a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. Erectile dysfunction can have psychological consequences as it can be tied to relationship difficulties and self-image. The most important organic causes of impotence are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. In psychological impotence, there is a strong response to placebo treatment. Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consists of a trial of PDE5 inhibitor (such as sildenafil). In some cases, treatment can involve prostaglandin tablets in the urethra, injections into the penis, a penile prosthesis, a penis pump or vascular reconstructive surgery. Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection.
Causes
Medications (antidepressants, such as SSRIs, and nicotine[citation needed] are most common)
Neurogenic disorders
Cavernosal disorders (Peyronie's disease)
Hyperprolactinemia (e.g., due to a prolactinoma)
Psychological causes: performance anxiety, stress, and mental disorders
Surgery
Aging. It is four times more common in men aged in their 60s than those in their 40s.
Kidney failure
Diseases such as diabetes mellitus and multiple sclerosis (MS). While these two causes have not been proven they are likely suspects as they cause issues with both the blood flow and nervous systems. Lifestyle: smoking is a key cause of erectile dysfunction. Smoking causes impotence because it promotes arterial narrowing. Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Erectile dysfunction is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of patients with preoperative sexual dysfunction, while, in most cases, it does not affect patients with a preoperative normal sexual life. ED can also be associated with bicycling due to both neurological and vascular problems due to compression. The increase risk appears to be about 1.7-fold. Concerns that use of pornography can cause erectile dysfunction have not been substantiated in epidemiological studies according to a 2015 literature review. However, another review and case studies article maintains that use of pornography does indeed cause erectile dysfunction, and critiques the previously described literature review. Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Spinal cord injury causes sexual dysfunction including ED. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light. It is analyzed in several ways: Obtaining full erections at some times, such as nocturnal penile tumescence when asleep (when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working. Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy). There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease. Therefore, a thorough physical examination is helpful, in particular the simple search for a previously undetected groin hernia since it can affect sexual functions in men and is easily curable. A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.
Duplex ultrasound
Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces the erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure.
Penile nerves function
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
Nocturnal penile tumescence (NPT)
It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.
Penile biothesiometry
This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
Dynamic infusion cavernosometry (DICC)
technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.
Corpus cavernosometry
Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[20] In Digital Subtraction Angiography (DSA), the images are acquired digitally.
Magnetic resonance angiography (MRA)
This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.
lego idea:
ideas.lego.com/projects/96e4e0ef-a3a9-4690-82ff-20a9df2443d6
I have always been fascinated by ancient history, events and many objects of the old times. One of those elementswas the famous story of Thermopylae and of the King ancient Sparta Leonidas for his courage, self-denial, altruism and morality.
Thus I decided to design the ancient helmet of King Leonidas.
This famous Spartan helmet is of the Corinthian type and is definitely the most characteristic of the ancient Greek world.
The duration of the Corinthian type helmet begings at the end of the 8th c. e.g. and lasts untill the classical period, when it gradually gave way to the Pilos type helmet.
We find depictions of Corinthian helmets in angiography and sculpture not only of the archaic and classical times but even during the Roman period, although this type had ceased to be used many years ago.
This is due to the glory that the Corinthian helmet had due to its relationship with the glorious past. During the wars of the Greeks against the Persians it had become a symbol of bravery and courage.
According to ancient sources, this type of helmet has its origin in Corinth and that is why it is called Corinthian.
It completely covered the head, leaving only the eyes and mouth free. Its main disadvantage was that it limited vision and especially hearing, however it was one of the most popular helmets of all time to date.
Nowadays this helmet is used in movies and design wise we find it in the first basic design concepts in comic superheroe’s suits.
Police escort Ambulance to A&E.
Having called ahead to the Emergency Department with a “Standby” or Pre-Alert, advising Hospital staff of the imminent arrival of a patient to the Resuscitation Area, the Ambulance now arrives with an escort by; Police Scotland (PolScot), Roads Policing Unit (RPU) Audi - SV12DPZ and Scottish Ambulance Service (SAS), Paramedic Response Unit (PRU) BMW i3 - LJ66EUU.
Mossend District General Hospital, part of NHS Lanarkside is a medium sized teaching Hospital within Belshotmuir, North Lanarkside. While without Major Trauma specialists it has a 24/7 Stroke Team and Primary Percutaneous Coronary Intervention (PPCI) for the treatment of Heart Attacks, a catheter is inserted through the wrist and passes through the blood vessels to the blocked artery and removes the clot while leaving a stent to keep the vessel open and blood flowing. This facility also allows for day patient angiography. With 510 bed capacity, Mossend serves a wide catchment area including several towns, multiple villages and a major motorway connecting Glasgow and Edinburgh.
Police vehicles are a common sight at Hospitals across the country, some have their own dedicated Officers with an office to use. Again, not pictured but often seen at Hospitals across Britain are the Red Cross, between social care services, assisting with arranging post discharge home visits and care packages to assisting the Ambulance Services with low acuity discharges - those brought to Hospital by Ambulance and who require one due to mobility but don’t require treatment or interventions from a clinically trained crew. Indeed, out of shot, Mossend has a Portakabin in spare ground next to A&E for use as a crew room/rest room by SAS, Police Scotland, Red Cross.
In reality this is a diorama using Kingsway Models 1:76 scale kit of the equally fictional Holby Emergency Department from BBC shows Casualty and Holby City. The models are a mix of 1:76 and 1:64 scale from varying manufactures and include a number of Code 3 adaptions, my own work, except for the PolScot Transit which is Code 3 and bought online.
SH62XDY, a Mercedes Benz Sprinter, box body Accident & Emergency vehicle of the Scottish Ambulance Service (SAS), crewed by an Ambulance Technician & Paramedic, parked in a designated “Resus Only” bay - for the most critical and time critical patients who will be assessed and treated in the Resuscitation Area of the Emergency Department. This can include serious injuries, critical illness such as sepsis, major haemorrhage, stroke (to be met by the stroke team, window for treatment is 4 hours for clot type CVA’s). Typically the crew will have provided a “standby” or pre-alert call to the Department upon leaving the locus, providing information using a mnemonic such as ATMIST (Age, Time, Mechanism/Illness, Injuries suspected, Signs (physiological observations), Treatment given). This allows specialist teams to assemble and meet the patient, hearing the original handover from the crew, while allowing blood products and medications to be prepared in anticipation.
The crew can be seen in the background providing a handover to two Doctors waiting at the Ambulance Only door, their patient lying flat on a trolley. Upon entering they will turn right to enter Resus. Mossend District General Hospital, part of NHS Lanarkside is a medium sized teaching Hospital within Belshotmuir, North Lanarkside. While without Major Trauma specialists it has a 24/7 Stroke Team and Primary Percutaneous Coronary Intervention (PPCI) for the treatment of Heart Attacks, a catheter is inserted through the wrist and passes through the blood vessels to the blocked artery and removes the clot while leaving a stent to keep the vessel open and blood flowing. This allows for day patient angiography.
Nearby a Police Officer stands outside between the Ambulance and Main entrances, updating the Force Control Centre (FCC) by Airwave radio on the condition of a patient she escorted to hospital. Whilst not captured in this picture, Police vehicles are a common sight at Hospitals across the country, some have their own dedicated Officers with an office to use. Again, not pictured but often seen at Hospitals across Britain are the Red Cross, between social care services, assisting with arranging post discharge home visits and care packages to assisting the Ambulance Services with low acuity discharges - those brought to Hospital by Ambulance and who require one due to mobility but don’t require treatment or interventions from a clinically trained crew. Indeed, out of shot, Mossend has a Portakabin in spare ground next to A&E for use as a crew room/rest room by SAS, Police Scotland, Red Cross.
In reality the model is a 1:76 scale Oxford Diecast, with the figures being 3D printed and bought from eBay, painted by me. The Hospital is a card model made by the wonderful Kingsway Models. It is based on the Emergency Department of the equally fictional Holby City Hospital, featured in the BBC’s “Casualty” & “Holby City”. The story/background comes from my previous work experience both within hospitals and in the driver seat/attendant seat of an ambulance.
A Scottish Ambulance Service crew, an Ambulance Technician and a Paramedic can be seen providing a handover to two Doctors waiting at the Ambulance Only door, their patient lying flat on a trolley. Upon entering they will turn right to enter the Resuscitation Area, their patient being so unwell or injured that they require immediate intensive interventions and monitoring, specialist Doctors have met the crew outside after being bleeped (“paged”) to the Emergency Dept. This would have happened as soon as the crew called by radio to provide a “Standby” or Pre-alert warning of their impending arrival, using the ATMIST mnemonic. These standby calls allow Hospital staff to prepare medications, blood products, to request specialists attend, put Radiographers on alert for X-rays, CT scans etc.
Mossend District General Hospital, part of NHS Lanarkside is a medium sized teaching Hospital within Belshotmuir, North Lanarkside. While without Major Trauma specialists it has a 24/7 Stroke Team and Primary Percutaneous Coronary Intervention (PPCI) for the treatment of Heart Attacks, a catheter is inserted through the wrist and passes through the blood vessels to the blocked artery and removes the clot while leaving a stent to keep the vessel open and blood flowing. This facility also allows for day patient angiography. With 510 bed capacity, Mossend serves a wide catchment area including several towns, multiple villages and a major motorway connecting Glasgow and Edinburgh.
Nearby a Police Officer stands outside between the Ambulance and Main entrances, updating the Force Control Centre (FCC) by Airwave radio on the condition of a patient she escorted to hospital. Whilst not captured in this picture, Police vehicles are a common sight at Hospitals across the country, some have their own dedicated Officers with an office to use. Again, not pictured but often seen at Hospitals across Britain are the Red Cross, between social care services, assisting with arranging post discharge home visits and care packages to assisting the Ambulance Services with low acuity discharges - those brought to Hospital by Ambulance and who require one due to mobility but don’t require treatment or interventions from a clinically trained crew. Indeed, out of shot, Mossend has a Portakabin in spare ground next to A&E for use as a crew room/rest room by SAS, Police Scotland, Red Cross.
In reality the model is a 1:76 scale Oxford Diecast, with the figures being 3D printed and bought from eBay, painted by me. The Hospital is a card model made by the wonderful Kingsway Models. It is based on the Emergency Department of the equally fictional Holby City Hospital, featured in the BBC’s “Casualty” & “Holby City”. The story/background comes from my previous work experience both within hospitals and in the driver seat/attendant seat of an ambulance.
I was based at Springburn Ambulance Station and so was thrilled to learn that a model was being released of Springburn’s (Glasgow Central Ambulance Station) fully electric powered BMW i3. This car was used as a Paramedic Response Unit across the city, as well as being used in the Mental Health car trial, in which it was crewed by a Paramedic and Police Officer. It is pictured here on my diorama of “Mossend District General Hospital” alongside a mix of Code 1 & 3 models.
Mossend District General Hospital, part of NHS Lanarkside is a medium sized teaching Hospital within Belshotmuir, North Lanarkside. While without Major Trauma specialists it has a 24/7 Stroke Team and Primary Percutaneous Coronary Intervention (PPCI) for the treatment of Heart Attacks, a catheter is inserted through the wrist and passes through the blood vessels to the blocked artery and removes the clot while leaving a stent to keep the vessel open and blood flowing. This facility also allows for day patient angiography. With 510 bed capacity, Mossend serves a wide catchment area including several towns, multiple villages and a major motorway connecting Glasgow and Edinburgh.
Police vehicles are a common sight at Hospitals across the country, some have their own dedicated Officers with an office to use. Again, not pictured but often seen at Hospitals across Britain are the Red Cross, between social care services, assisting with arranging post discharge home visits and care packages to assisting the Ambulance Services with low acuity discharges - those brought to Hospital by Ambulance and who require one due to mobility but don’t require treatment or interventions from a clinically trained crew. Indeed, out of shot, Mossend has a Portakabin in spare ground next to A&E for use as a crew room/rest room by SAS, Police Scotland, Red Cross.
In reality the Hospital is a card model made by the wonderful Kingsway Models. It is based on the Emergency Department of the equally fictional Holby City Hospital, featured in the BBC’s “Casualty” & “Holby City”. The story/background comes from my previous work experience both within hospitals and in the driver seat/attendant seat of an ambulance.
I was based at Springburn Ambulance Station and so was thrilled to learn that a model was being released of Springburn’s (Glasgow Central Ambulance Station) fully electric powered BMW i3. This car was used as a Paramedic Response Unit across the city, as well as being used in the Mental Health car trial, in which it was crewed by a Paramedic and Police Officer.
The model is pictured here providing an escort to SH62 XDY, a Mercedes Sprinter, box body A&E Double Crewed Ambulance. The patient is critically unwell and their details have been radioed ahead to the Resuscitation Department. The PRU Paramedic has escorted the ambulance, ready to pull over and assist should the patient have deteriorated en-route. As they were first on scene it is also helpful for them to provide the handover to Emergency Dept staff, maintaining continuity of care.
Mossend District General Hospital, part of NHS Lanarkside is a medium sized teaching Hospital within Belshotmuir, North Lanarkside. While without Major Trauma specialists it has a 24/7 Stroke Team and Primary Percutaneous Coronary Intervention (PPCI) for the treatment of Heart Attacks, a catheter is inserted through the wrist and passes through the blood vessels to the blocked artery and removes the clot while leaving a stent to keep the vessel open and blood flowing. This facility also allows for day patient angiography. With 510 bed capacity, Mossend serves a wide catchment area including several towns, multiple villages and a major motorway connecting Glasgow and Edinburgh.
Police vehicles are a common sight at Hospitals across the country, some have their own dedicated Officers with an office to use. Again, not pictured but often seen at Hospitals across Britain are the Red Cross, between social care services, assisting with arranging post discharge home visits and care packages to assisting the Ambulance Services with low acuity discharges - those brought to Hospital by Ambulance and who require one due to mobility but don’t require treatment or interventions from a clinically trained crew. Indeed, out of shot, Mossend has a Portakabin in spare ground next to A&E for use as a crew room/rest room by SAS, Police Scotland, Red Cross.
In reality the Hospital is a card model made by the wonderful Kingsway Models. It is based on the Emergency Department of the equally fictional Holby City Hospital, featured in the BBC’s “Casualty” & “Holby City”. The story/background comes from my previous work experience both within hospitals and in the driver seat/attendant seat of an ambulance.
The poor brick separator still feels unwell; now he is getting prepared for an interventional procedure using a contemporary C-arm with a flat panel detector.
Next a move to St Thomas and Guys Hospital, south of the river. I had finished my MSc in Nuclear Medicine at the Royal London and I was performing more and more Radio-isotope imaging. Head hunted to work in the innovative field of PE.T "Positron Emission Tomography" at the Clinical P.E.T Centre over both site, I spent two and a half years working in research and development before this technique was rolled out nationally. I then decided to get back into Radiography, CT, Trauma and Angiography rather than 100% Nuclear Medicine, I joined Jenny Reeves Radiography Agency spending the next eight months traveling and working, Scottish Islands and Highlands, Cornwall, Norfolk and finally back in London......
1/76 scale (OO Gauge) model replicas, a mixture of Oxford production models and Code 3 adaptions by me.
Strathclyde Police are represented with their recognisable Divisional resource, a VW Transporter cell van, with a Jaguar representing their Roads Policing/Traffic Unit.
SFRS - Strathclyde fire appliance joined by Scottish Fire and Rescue Service Aerial Rescue Pump.
Scottish Ambulance Service are represented by the Oxford released Mercedes Sprinter, bearing the registration SH62 XDY which was a Springburn (Glasgow Central Ambulance Station) vehicle. Alongside is a code 3 adaption of a Lomond Mountain Rescue ambulance into a SAS “Urgent Tier” vehicle.
Urgent Tier vehicles are regularly staffed by an Ambulance Technician (EMT, AAP) and a “D1” (blue light trained & authorised) Ambulance Care Assistant. They are used to attend Interhospital transfers and GP urgent admissions (1-4 hour, non blue light response).
As such, older urgent tier vehicles carried most but not all the equipment of a standard A&E ambulance, but could also be used as a first response to ILT (Immediately Life Threatening) calls such as; Cardiac Arrest, Unconscious, Active Seizure (treated as anoxic seizure or status epilepticus until proven otherwise), and severe Breathing Difficulties), as the Technician has intermediate life support training, including airway management (iGel, LMA, N/OPA), manual defibrillation, 4 & 12 lead ECG with interpretation skills for a restricted number of rhythms including STEMI (with telemetry to Cardiac Care Unit (CCU) facility), VT, VF, Asystole, Sinus Tach, Sinus Brady and NSR, authority to recognise life extinct in prescribed circumstances, as well as a range of medications via oral, buccal, sublingual, Inhaled, IPPV and intramuscular routes etc, and the ACA has Basic Life Support skills as well as expert manual handling and patient care and support skills, in addition to standard Advanced and Emergency Response driving skills.
Nowadays, Urgent Tier vehicles are indistinguishable from standard A&E ambulances, with fully kitted Mercedes Sprinters being the norm. With the standardisation of uniforms, an Urgent Tier crew can normally only be identified by the crew’s epaulettes. With rising call numbers, a huge proportion of which are GP requests and many more being inappropriate public requests, Urgent Tier vehicles are more and more being used for standard emergency calls. Exceptions perhaps being the dedicated PCI vehicles based at specialist heart attack centres to transfer patients for angiography, stenting etc and to repatriate post emergency PPCI patients to their local hospital for ongoing care. These vehicles are however usually funded directly by the PCI capable facility, and as such directly receive their workload from a Hospital co-ordinator, usually having little daily contact with the Ambulance Control Centres (ACC) in Cardonald, Queensferry and Inverness.
Explored [5dmk2, 50mm f1.4, CS3]
This is the last of my “medical series” (for now). This fellow is a cardiologist with a sense of humour (which is quite rare). So, here is a joke which he may enjoy if he sees this:
In a car garage, where a famous heart surgeon was waiting for the service manager to take a look at his Mercedes, there was a loud mouthed mechanic who was removing the cylinder heads from the motor of a car. He saw the surgeon waiting and lured him into an argument.
He asked the doc after straightening up and wiping his hands on a rag, "Look at this car i'm working on. I also open hearts, take valves out, grind them, put in new parts, and when I finish this baby will purr like a kitten. So how come you get the big bucks, when you and I are doing basically the same work?"
The surgeon very calmly leaned over and whispered to the loudmouth mechanic, "Try doing it with the engine running."
[Side note: this picture really made me appreciate the 5dmk2's low light capabilities, very impressive. This was 1/125 at f2.2, ISO 800, no flash]
Volume Rendering of a contrast enhanced cranial CT angiography.
Normal findings.
Stereoscopic view.
Rendering done with a Carestream workstation.
Without the pain killing effect of 'anaesthesia' very few medical procedures would be taking place today.
In past history physical methods like compression of blood vessels or the nerves by means of clamps applied over the limbs were used to numb the area; however, that was just short of torture.
In Ancient Cultures:
The Chinese used cannabis.
The Greek used herbs like hemp.
The Romans used the extract of the mandragora plant to alleviate pain.
And the ancient Egyptians used poppy seeds (from which opium is derived) during their simple operating procedures.
fun fact: 'refrigeration anaesthesia' meant using cold water or snow to numb the region which gave rise to hypnosis to render the patient unconscious as a means of anaesthetizing someone are all in a way similarly artificially induced today.
Copyright © 2009 - 2025 Tomitheos Photography - All Rights Reserved
mouth cancer radiation therapy caused massive beard hair loss after three weeks. notice how they tried to spare his right salivary gland (parotid gland), which results in a largely undisturbed hair growth in the area (right ear and below). on the irradiated area, however, there's only a few working hair follicles left. also notice how the patient still has a thick moustache, but very few hair left on the chin.
the right cervical incision that has been made to remove to "lump" is healing well; however, the histology results are not good, at all.
seems like it was not a "fogotten" lymph node, but instead a "stand-alone" tumor, a squamous cell carcinoma, a metastasis. histology showed that the mutated cells extend to the edge of the preparation, which means there are cancer cells left in the patient's neck, and the tumor could not be fully removed. as this thing grew very fast and just randomly distributed itself into tissue WHILE the patient had radiation treatment in the very area, this is an extremely bad sign. the patient will receive a central venous catheter implantation on monday and undergo aggressive chemotherapy from tuesday on. this is his absolute last chance to survive. if he develops e.g. lung metastasis, he's as good as dead.
exposure to 56 Gray during radiation treatment for mouth cancer and accompanying damage to the salivary glands inflicted the local immune system severely, so the patient has developed oral candidiasis. the fungal infection is spreading to the back of his throat, which causes severe discomfort / gagging. local anti-fungal therapy has been started, which can be accompanied by systemic treatment if not successful.
as the patient is receiving chemotherapy, damage to the immune system (indicated by a drop in leucocytes) may be dangerous, as in this case, the fungal infection may spread to the oesophagus area and other organs, which would be very dangerous. in this case, the patient would be hospitalized and placed in an isolation room to prevent him coming in contact with any further germs.
in some cases, the immune status of chemotherapy patients may be as bad as in people with HIV/AIDS; luckily, the immune system usually recovers once chemotherapy is stopped, though. however, in rare cases, leukemia may develop as a side-effect of chemotherapy.
Highlighting the former Lomond Mountain Rescue ambulance, now a Scottish Ambulance Service Urgent Tier vehicle.
Scottish Ambulance Service are represented by the Oxford released Mercedes Sprinter, bearing the registration SH62 XDY which was a Springburn (Glasgow Central Ambulance Station) vehicle. Alongside is a code 3 adaption of a Lomond Mountain Rescue ambulance into a SAS “Urgent Tier” vehicle.
Urgent Tier vehicles are regularly staffed by an Ambulance Technician (EMT, AAP) and a “D1” (blue light trained & authorised) Ambulance Care Assistant. They are used to attend Interhospital transfers and GP urgent admissions (1-4 hour, non blue light response).
As such, older urgent tier vehicles carried most but not all the equipment of a standard A&E ambulance, but could also be used as a first response to ILT (Immediately Life Threatening) calls such as; Cardiac Arrest, Unconscious, Active Seizure (treated as anoxic seizure or status epilepticus until proven otherwise), and severe Breathing Difficulties), as the Technician has intermediate life support training, including airway management (iGel, LMA, N/OPA), manual defibrillation, 4 & 12 lead ECG with interpretation skills for a restricted number of rhythms including STEMI (with telemetry to Cardiac Care Unit (CCU) facility), VT, VF, Asystole, Sinus Tach, Sinus Brady and NSR, authority to recognise life extinct in prescribed circumstances, as well as a range of medications via oral, buccal, sublingual, Inhaled, IPPV and intramuscular routes etc, and the ACA has Basic Life Support skills as well as expert manual handling and patient care and support skills, in addition to standard Advanced and Emergency Response driving skills.
Nowadays, Urgent Tier vehicles are indistinguishable from standard A&E ambulances, with fully kitted Mercedes Sprinters being the norm. With the standardisation of uniforms, an Urgent Tier crew can normally only be identified by the crew’s epaulettes. With rising call numbers, a huge proportion of which are GP requests and many more being inappropriate public requests, Urgent Tier vehicles are more and more being used for standard emergency calls. Exceptions perhaps being the dedicated PCI vehicles based at specialist heart attack centres to transfer patients for angiography, stenting etc and to repatriate post emergency PPCI patients to their local hospital for ongoing care. These vehicles are however usually funded directly by the PCI capable facility, and as such directly receive their workload from a Hospital co-ordinator, usually having little daily contact with the Ambulance Control Centres (ACC) in Cardonald, Queensferry and Inverness.
Researchers have found that anti-inflammatory biologic therapies used to treat moderate to severe psoriasis can significantly reduce coronary inflammation in patients with the chronic skin condition. Scientists said the findings are particularly notable because of the use of a novel imaging biomarker, the perivascular fat attenuation index (FAI), that was able to measure the effect of the therapy in reducing the inflammation.
The study published online in JAMA Cardiology, has implications not just for people with psoriasis, but for those with other chronic inflammatory diseases, such as lupus and rheumatoid arthritis. These conditions are known to increase the risk for heart attacks and strokes. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
In this image: Coronary CT angiography image of the coronary arteries depicting the perivascular fat attenuation index before and after biologic therapy at one-year follow-up for patients with excellent response to biologic therapy.
Read more: www.nih.gov/news-events/news-releases/psoriasis-therapy-l...
Credit: Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI.
Swelling (known as oedema) of the groin of a 42-year-old man. Oedema is the build-up of fluids in a tissue or organ. The oedema developed one day after the angiography was performed.
Angiography injects a contrast medium into an artery to highlight blood vessels on an X- ray. Treatment may include the use of diuretic drugs to remove excess fluids.
Having obtained a rather good and large dataset from the recently instated Greek geodata portal, i was looking for a way to quickly visualise its extent.
I admit to having in my mind those images you sometimes see at doctors practices, where, for example, they would have posters of the muscular or circulatory system, trying (a bit harder than i would feel comfortable with) to convince you of their...interests.
Fortunately, each road segment had a characterisation field attached to it so it was relatively easy to "paint" the highways thicker than smaller streets within populated areas.
The slight detail here is that the thickness of the "arteries" is decreased following a power-law...a little trick that was inspired by the circulatory network itself.
This image appears in this blog post (in Greek, you have been warned :-) ) which talks briefly about road safety in Greece....Yeah, sometimes the street is literally bloody...
1887 - A stranger named Gerhardt is injured in an accident at the railroad yard. He is taken to a boarding house and left. The rector of St. John's Episcopal Church, Rev. George Degen, finds him in a worsened condition with no one to care for him. Degen collects $500 from merchants along Garrison Avenue, rents a building and sets up a hospital. It is named St. John's after the church people who established the hospital.
1888 - St. John's Church ladies form the Woman's Board of Managers to help care for the patients.
1888 - St. John's Hospital moves to 302 North 2nd Street--the old Atkinson home, which has three rooms. A portable house is added, making space for 12 more beds. A nurse training school opens.
1890 - On November 21, St. John's is incorporated by the state and a nine-man board is established with Judge Isaac Parker as president.
1892 - St John's moves to a better and more commodious building at the corner of 4th and Oak Street (the former residence of L. Rogers). There are 10 large rooms and modern conveniences so the staff can handle 19 patients.
1896 - City Charity Hospital opens September 9 in a building on North 4th Street and organizes a training school for nurses.
1899 - St. John's and Charity consolidate under the name of Belle Point (after the beautiful spot at the junction of the Arkansas and Poteau Rivers) and move into a two-story house at North 10th and B Streets. Mrs. George Sparks suggested the name.
1903 - Belle Point moves into new two-story red brick building at 916 South 12th Street, valued at $35,000.
1903 - Twelve young ladies organize as a volunteer group and call themselves the Sparks Young Ladies Guild.
1908 - George Sparks bequeaths $25,000 in memory of his wife, Ann Dibrell Sparks, and Belle Point changes its name to Sparks Memorial Hospital on June 2.
1910 - A new wing, funded by Mr. Sparks' bequest, is opened. Sparks can care for 100 patients.
1922 - Sparks Auxiliary organizes through the efforts of Mrs. H. C. King, wife of a staff physician.
1934 - On April 2, Dr. Charles Holt agrees to merge his private hospital (also called St. John's) with Sparks and takes over the management of Sparks.
1945 - Marvin Altman succeeds Dr. Holt as administrator.
1953 - Sparks dedicates new 150-bed facility at 1311 South I Street.
1956 - Sparks School of Radiologic Technology opens.
1958 - Sparks Manor - a model for geriatric care - opens.
1966 - Sparks builds East Wing and increases bed capacity to 326.
1970 - Sparks changes name to Sparks Health System.
1971 - Sparks dedicates West Wing; making Sparks the largest hospital in Arkansas.
197l - Sparks School of Nursing closes.
1971 - Sparks Foundation is organized to carry out long-range fund development.
1972 - Sparks inaugurates Heartmobile.
1972 - Sparks Board of Advisory Trustees is organized.
1973 - Marvin Altman is named president.
1976 - Sparks dedicates Julia Welch Yantis Spire, gift from John Yantis in memory of his wife.
1978 - Charles Shuffield succeeds Altman as president.
1979 - Sparks opens Ambulatory Surgery Center and east patient tower.
1984 - Sparks Manor closes.
1984 - Stanley Evans Heart Institute is established as an umbrella for all heart services.
1986 - Sparks opens co-generation plant to produce own electricity.
1987 - Sparks celebrates 100th anniversary.
1988 - Sparks opens the Mabee Health Fitness Complex, which houses the Marvin Altman Fitness Center.
1989 - Sparks dedicates the Hennessy Cancer Institute.
1990 - Sparks dedicates the maternity, pediatric and gynecological areas as The Nancy Orr Family Center.
1990 - The Heartmobile is retired.
1991 - Sparks expands Ambulatory Surgery Center and dedicates the R. C. Goodman Institute for Pain Management.
1994 - Labor, delivery and recovery area is named the Kelsey Birthing Suite in honor of Dr. J. F. Kelsey
1994 - Sparks and Holt-Krock Clinic establish PremierCare Health Systems.
1996 - Sparks completes new Education Center.
1996 - New gift shop is dedicated and renamed Jennifer's at Sparks.
1997 - Sparks completes renovation of lobby and front of Medical Center.
1997 - Degen Chapel is renovated through a gift from Charlotte Donald in memory of her sister, Zola Lancaster.
1997 - Nursing administration suite is dedicated as the Mr. and Mrs. Collier Wenderoth, Sr., Nursing Center.
1997 - Michael Helm succeeds Shuffield as president.
1998 - Sparks establishes Sparks Medical Foundation to keep doctors from leaving the area.
1999 - Education Center is named Charles Shuffield Education Center.
1999 - Sparks establishes the Sparks Health System, a fully integrated healthcare delivery system.
2000 - Sparks opens Women's Center at Sparks Medical Plaza.
2000 - Sparks inaugurates the area's first totally bilingual medical clinic.
2001 - Sparks opens The Women's Center at Sparks.
2001 - CT heartscan is used as an effective screening tool for future heart disease.
2002 – Sparks doctors perform the region’s first coronary brachytherapy (radioactive “seeds” used to prevent re-blockage of arteries).
2002 - The Women's Center becomes the first facility in the area and only the second in the state to introduce digital mammography.
2002 - Extensive renovations/expansions are made to the Emergency Department, Labor and Delivery, Mother/Baby and Nursery areas.
2002 - meals@home, a home-delivered meal program, is sponsored by Sparks Food and Nutrition Services and Sparks Home Health.
2002 - The Women's Group, the first all-woman obstetrics/gynecology practice in the area, opens in Sparks Medical Plaza.
2002 - Kyphoplasty, a minimally invasive procedure to provide relief from spinal compression fractures, is introduced at Sparks.
2003 – Sparks is the first in Arkansas to acquire a computerized IV system that greatly reduces opportunities for potential medication errors.
2003 – Sparks introduces PET scanning services to the region. PET is a valuable diagnostic tool for cancer and neurological studies.
2003 - Sparks embarks on exploration of possible new venture (building a new hospital in a different location)with Triad Hospitals of Plano, Texas.
2004 – Sparks is the first hospital in Arkansas to achieve Disease-Specific Care certifications for stroke care and congestive heart failure from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
2004 - After more than a year of talks, Sparks' proposed venture with Triad Hospitals is called off.
2004 - Sparks enters a hospital advisory services agreement with Triad subsidiary Quorum Health Resources (QHR), and chooses John A. Guest of Houston as Sparks Health System's new CEO.
2006 – Sparks introduces PET/CT scanning services to the region. PET/CT merges the metabolic imaging of PET with the anatomical detail of CT, to produce a more precise image.
2006 – The Sparks stroke and CHF programs are re-certified by JCAHO.
2006 - Sparks breaks ground on the $40.4 million Sparks Renaissance Project (a 142,000-square-foot Emergency/Critical Care Center).
2006 - Eight Sparks primary care physicians achieve recognition in the National Council on Quality Assurance (NCQA) Heart/Stroke Recognition Program for meeting quality standards in the treatment of heart/stroke patients. They are the only physicians in Arkansas to attain the honor.
2007 – Sparks adds 64-slice CT scanning and CT Angiography, which provides a non-invasive means of acquiring highly-detailed images of the heart and coronary arteries.
2007 - Frederick D. "Ted" Woodrell of Florida, a 30-year veteran of healthcare administration, is named as Sparks Health System's new CEO.
2007 - Sparks successfully launches Stage 1 of Sparks OneChart, a $17 million electronic medical record system.
2008 - Sparks opens the $40.4 million Sparks Renaissance Project (a 142,000-square-foot Emergency/Critical Care Center).
after exposure to 56 Gray, the area of irradiation shows severe skin damage, which appears like a sunburn. the brown/red skin will likely become moist and start to peel off within the next week or two.
An X-ray (diagnostic radiography) is a non-invasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body.
X-rays are the oldest and the second most frequently used medical imaging tests.
Used to detect joint dislocation or broken bones, guide orthopaedic surgery, look for injury, infection, arthritis, abnormal bone growth, detecting and diagnosing bone cancer.
Fluoroscopy and angiography are special applications of X-ray imaging.
Fluoroscopy is mainly performed to view movement (of tissue or a contrast agent), or to guide a medical intervention, such as angioplasty, pacemaker insertion, or joint repair/replacement. Can be used to examine the digestive system using a substance which is opaque to X-rays, (usually barium sulphate or gastrografin), which is introduced into the digestive system either by swallowing or as an enema.
Angiography is the use of fluoroscopy to view the cardiovascular system. Used to find aneurysms, leaks, blockages (thromboses), new vessel growth, and placement of catheters and stents
"hey, i got a central venous catheter today, just woke up from general anesthesia a few hours ago, i'm gonna receive chemotherapy tomorrow, but let's escape the hospital, go to a bar, and drink some beer... and i dont mean the alcohol-free kind!"
what am i supposed to reply?
"no, you cannot drink alcohol now... wait, maybe it's the last time we ever get the chance to go to a bar together, but... nooo, alcohol is bad, mmmkay?" - yeah right. fuck that. we had some lovely beer tonight.
Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships. The term erectile dysfunction does not encompass other erection-related disorders, such as priapism.
The majority of ED cases are attributed to physical risk factors and predictive factors. These factors can be categorized as vascular, neurological, local penile, hormonal, and drug-induced. Notable predictors of ED include aging, cardiovascular disease, diabetes mellitus, high blood pressure, obesity, abnormal lipid levels in the blood, hypogonadism, smoking, depression, and medication use. Approximately 10% of cases are linked to psychosocial factors, encompassing conditions such as depression, stress, and problems within relationships.[14] ED is reported in 18% of males aged 50 to 59 years, and 37% in males aged 70 to 75.[14]
Treatment of ED encompasses addressing the underlying causes, lifestyle modification, and addressing psychosocial issues.[4] In many instances, medication-based therapies are used, specifically PDE5 inhibitors such as sildenafil.[13] These drugs function by dilating blood vessels, facilitating increased blood flow into the spongy tissue of the penis, analogous to opening a valve wider to enhance water flow in a fire hose. Less frequently employed treatments encompass prostaglandin pellets inserted into the urethra, the injection of smooth-muscle relaxants and vasodilators directly into the penis, penile implants, the use of penis pumps, and vascular surgery.[4][15]
Signs and symptoms
ED is characterized by the persistent or recurring inability to achieve or maintain an erection of the penis with sufficient rigidity and duration for satisfactory sexual activity.[14] It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months."[4]
Psychological impact
ED often has an impact on the emotional well-being of both males and their partners.[14] Many males do not seek treatment due to feelings of embarrassment. About 75% of diagnosed cases of ED go untreated.[16]
Causes
Causes of or contributors to ED include the following:
Diets high in saturated fat are linked to heart diseases, and males with heart diseases are more likely to experience ED.[7][8] By contrast, plant-based diets show a lower risk for ED.[17][18][19]
Prescription drugs (e.g., SSRIs,[20] beta blockers, antihistamines,[21][22][23] alpha-2 adrenergic receptor agonists, thiazides, hormone modulators, and 5α-reductase inhibitors)[3][4]
Neurogenic disorders (e.g., diabetic neuropathy, temporal lobe epilepsy, multiple sclerosis, Parkinson's disease, multiple system atrophy)[3][4][5]
Cavernosal disorders (e.g., Peyronie's disease)[3][24]
Hyperprolactinemia (e.g., due to a prolactinoma)[3]
Psychological causes: performance anxiety, stress, and mental disorders[6]
Surgery (e.g., radical prostatectomy)[25]
Ageing: after age 40 years, ageing itself is a risk factor for ED, although numerous other pathologies that may occur with ageing, such as testosterone deficiency, cardiovascular diseases, or diabetes, among others, appear to have interacting effects[1][26]
Kidney disease: ED and chronic kidney disease have pathological mechanisms in common, including vascular and hormonal dysfunction, and may share other comorbidities, such as hypertension and diabetes mellitus that can contribute to ED[9]
Lifestyle habits, particularly smoking, which is a key risk factor for ED as it promotes arterial narrowing.[27][28][29] Due to its propensity for causing detumescence and erectile dysfunction, some studies have described tobacco as an anaphrodisiacal substance.[30]
COVID-19: preliminary research indicates that COVID-19 viral infection may affect sexual and reproductive health.[31][32]
Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply.[25] ED is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life.[33]
ED can also be associated with bicycling due to both neurological and vascular problems due to compression.[34] The increased risk appears to be about 1.7-fold.[35]
Concerns that use of pornography can cause ED[36] have little support[37][38] in epidemiological studies, according to a 2015 literature review.[39] According to Gunter de Win, a Belgian professor and sex researcher, "Put simply, respondents who watch 60 minutes a week and think they're addicted were more likely to report sexual dysfunction than those who watch a care-free 160 minutes weekly."[40][41]
In seemingly rare cases, medications such as SSRIs, isotretinoin (Accutane) and finasteride (Propecia) are reported to induce long-lasting iatrogenic disorders characterized by sexual dysfunction symptoms, including erectile dysfunction in males; these disorders are known as post-SSRI sexual dysfunction (PSSD), post-retinoid sexual dysfunction/post-Accutane syndrome (PRSD/PAS), and post-finasteride syndrome (PFS). These conditions remain poorly understood and lack effective treatments, although they have been suggested to share a common etiology.[42]
Rarely impotence can be caused by aromatase being active. See Androgen replacement therapy.
Pathophysiology
Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former involves the peripheral nerves and the lower parts of the spinal cord, whereas the latter involves the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of the smooth muscles of the corpora cavernosa (the main erectile tissue of the penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[2]
Diagnosis
In many cases, the diagnosis can be made based on the person's history of symptoms. In other cases, a physical examination and laboratory investigations are done to rule out more serious causes such as hypogonadism or prolactinoma.[4]
One of the first steps is to distinguish between physiological and psychological ED. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED.[4] Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is, when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.[43][44] Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED.[4]
Another factor leading to ED is diabetes mellitus, a well known cause of neuropathy.[4] ED is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease, such as coronary artery disease and peripheral vascular disease.[4] Screening for cardiovascular risk factors, such as smoking, dyslipidemia, hypertension, and alcoholism, is helpful.[4]
In some cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in males and is relatively easily curable.[33]
The current – as of April 2025[45] – edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) lists Erectile Disorder (ICD-10-CM code: F52.21) as a diagnosis.[46] According to the DSM, it "is the more specific DSM-5 diagnostic category in which erectile dysfunction persists for at least 6 months and causes distress in the individual."[46] The ICD-10, to which the DSM refers regarding Erectile dysfunction,[46] lists it under Failure of genital response (F52.2).[47] The latest edition of the ICD – namely, the ICD-11 – lists the condition as Male erectile dysfunction (HA01.1).
Ultrasonography
Transverse ultrasound image, ventral view of the penis. Image obtained after induction of an erection, 15 min after injection of prostaglandin E1, showing dilated sinusoids (arrows).[48]
Penile ultrasonography with doppler can be used to examine the erect penis. Most cases of ED of organic causes are related to changes in blood flow in the corpora cavernosa, represented by occlusive artery disease (in which less blood is allowed to enter the penis), most often of atherosclerotic origin, or due to failure of the veno-occlusive mechanism (in which too much blood circulates back out of the penis). Before the Doppler sonogram, the penis should be examined in B mode, in order to identify possible tumors, fibrotic plaques, calcifications, or hematomas, and to evaluate the appearance of the cavernous arteries, which can be tortuous or atheromatous.[48]
Erection can be induced by injecting 10–20 μg of prostaglandin E1, with evaluations of the arterial flow every five minutes for 25–30 min (see image). The use of prostaglandin E1 is contraindicated in patients with predisposition to priapism (e.g., those with sickle cell anemia), anatomical deformity of the penis, or penile implants. Phentolamine (2 mg) is often added. Visual and tactile stimulation produces better results. Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial.[48]
Before the injection of the chosen drug, the flow pattern is monophasic, with low systolic velocities and an absence of diastolic flow. After injection, systolic and diastolic peak velocities should increase, decreasing progressively with vein occlusion and becoming negative when the penis becomes rigid (see image below). The reference values vary across studies, ranging from > 25 cm/s to > 35 cm/s. Values above 35 cm/s indicate the absence of arterial disease, values below 25 cm/s indicate arterial insufficiency, and values of 25–35 cm/s are indeterminate because they are less specific (see image below). The data obtained should be correlated with the degree of erection observed. If the peak systolic velocities are normal, the final diastolic velocities should be evaluated, those above 5 cm/s being associated with venogenic ED.[48]
Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.[48]
Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.[48]
Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection (A, B, and C, respectively). The cavernous artery flow remains below the expected levels (at least 25–35 cm/s), which indicates ED due to arterial insufficiency.[48]
Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection (A, B, and C, respectively). The cavernous artery flow remains below the expected levels (at least 25–35 cm/s), which indicates ED due to arterial insufficiency.[48]
Other workup methods
Penile nerves function
Tests such as the bulbocavernosus reflex test are used to ascertain whether there is enough nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger in the anus.[49]
Nocturnal penile tumescence (NPT)
It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion[quantify] of males who have no sexual dysfunction nonetheless do not have regular nocturnal erections.[citation needed]
Penile biothesiometry
This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.[50]
Dynamic infusion cavernosometry (DICC)
Technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.[citation needed]
Corpus cavernosometry
Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[51] In Digital Subtraction Angiography (DSA), the images are acquired digitally.[citation needed]
Magnetic resonance angiography (MRA)
This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. The doctor may inject into the patient's bloodstream a contrast agent, which causes vascular tissues to stand out against other tissues, so that information about blood supply and vascular anomalies is easier to gather.[citation needed]
Erection Hardness Score
This section is an excerpt from Erection Hardness Score.[edit]
The Erection Hardness Score (EHS) is a single-item Likert scale used to assess the subjective hardness of the penis as reported by the patient. It ranges from 0 (indicating the penis does not enlarge) to 4 (indicating the penis is completely hard and fully rigid). Developed in 1998, the EHS is widely used in clinical trials and is recognized for its ease of administration and strong association with sexual function outcomes. It has been validated across various causes of erectile dysfunction and in patients treated with phosphodiesterase type 5 inhibitors (PDE5), showing robust psychometric properties and responsiveness to treatment.[52]
Treatment
One ad from 1897 claims to restore "perfect manhood. Failure is impossible with our method".[53] Another "will quickly cure you of all nervous or diseases of the generative organs, such as Lost Manhood, Insomnia, Pains in the Back, Seminal Emissions, Nervous Debility, Pimples, Unfitness to Marry, Exhausting Drains, Varicocele and Constipation".[53] The U.S. Federal Trade Commission warns that "phony cures" exist even today.[54]
Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing ED during midlife.[10] Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex.[12] Medications by mouth and vacuum erection devices are first-line treatments,[10]: 20, 24 followed by injections of drugs into the penis, as well as penile implants.[10]: 25–26 Vascular reconstructive surgeries are beneficial in certain groups.[55] Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex.[56]
Medications
See also: List of investigational sexual dysfunction drugs
The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken by mouth.[10]: 20–21 As of 2018, sildenafil is available in the UK without a prescription.[57] Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for ED.[58] Penile injections, on the other hand, can involve one of the following medications: papaverine, phentolamine, and prostaglandin E1, also known as alprostadil.[10] In addition to injections, there is an alprostadil suppository that can be inserted into the urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour.[12] Medications to treat ED may cause a side effect called priapism.[12]
Prevalence of medical diagnosis
In a study published in 2016, based on US health insurance claims data, out of 19,833,939 US males aged ≥18 years, only 1,108,842 (5.6%), were medically diagnosed with erectile dysfunction or on a PDE5I prescription (μ age 55.2 years, σ 11.2 years). Prevalence of diagnosis or prescription was the highest for age group 60–69 at 11.5%, lowest for age group 18–29 at 0.4%, and 2.1% for 30–39, 5.7% for 40–49, 10% for 50–59, 11% for 70–79, 4.6% for 80–89, 0.9% for ≥90, respectively.[59]
Focused shockwave therapy
Focused shockwave therapy involves passing short, high frequency acoustic pulses through the skin and into the penis. These waves break down any plaques within the blood vessels, encourage the formation of new vessels, and stimulate repair and tissue regeneration.[60][61]
Focused shockwave therapy appears to work best for males with vasculogenic ED, which is a blood vessel disorder that affects blood flow to tissue in the penis. The treatment is painless and has no known side effects. Treatment with shockwave therapy can lead to a significant improvement of the IIEF (International Index of Erectile Function).[62][63][64]
Testosterone
Men with low levels of testosterone can experience ED. Taking testosterone may help maintain an erection.[65] Males with type 2 diabetes are twice as likely to have lower levels of testosterone, and are three times more likely to experience ED than non-diabetic men.[65]
Pumps
Main article: penis pump
A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.[11]
Vibrators
Main article: Vibrator (sex toy)
The vibrator was invented in the late 19th century as a medical instrument for pain relief and the treatment of various ailments. Sometimes described as a massager, the vibrator is used on the body to produce sexual stimulation. Several clinical studies have found vibrators to be an effective solution for Erectile Dysfunction.[66][67] Examples of FDA registered vibrators for erectile dysfunction include MysteryVibe's Tenuto[68] and Reflexonic's Viberect.[69]
Surgery
Main article: Penile implant
Often, as a last resort, if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[10]: 26 Some sources show that vascular reconstructive surgeries are viable options for some people.[55]
Alternative medicine
The Food and Drug Administration (FDA) does not recommend alternative therapies to treat sexual dysfunction.[70] Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products.[71][72][73][74][75] The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.[76] A 2021 review indicated that ginseng had "only trivial effects on erectile function or satisfaction with intercourse compared to placebo".[77]
History
Further information: Impotence and marriage
Further information: Medicalisation of sexuality
An unhappy wife is complaining to the qadi about her husband's impotence. Ottoman miniature.
Attempts to treat the symptoms described by ED date back well over 1,000 years. In the 8th century, males of Ancient Rome and Greece wore talismans of rooster and goat genitalia, believing these talismans would serve as an aphrodisiac and promote sexual function.[78] In the 13th century, Albertus Magnus recommended ingesting roasted wolf penis as a remedy for impotence.[78] During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677.[79][80]
The first major publication describing a broad medicalization of sexual disorders was the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1952.[81] In the early 20th century, medical folklore held that 90-95% of cases of ED were psychological in origin, but around the 1980s research took the opposite direction of searching for physical causes of sexual dysfunction, which also happened in the 1920s and 30s.[82] Physical causes as explanations continue to dominate literature when compared with psychological explanations as of 2022.[83]
Treatments in the 80s for ED included penile implants and intracavernosal injections.[82] The first successful vacuum erection device, or penis pump, was developed by Vincent Marie Mondat in the early 1800s.[78] A more advanced device based on a bicycle pump was developed by Geddings Osbon, a Pentecostal preacher, in the 1970s. In 1982, he received FDA approval to market the product.[84] John R. Brinkley initiated a boom in male impotence treatments in the U.S. in the 1920s and 1930s, with radio programs that recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff.
Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience showing his papaverine-induced erection.[85] The current most common treatment for ED, the oral PDE5 inhibitor known as sildenafil (Viagra) was approved for use for Pfizer by the FDA in 1998, which at the time of release was the fastest selling drug in history.[81][86][87] Sildenafil largely replaced SSRI treatments for ED at the time[88] and proliferated new types of specialised pharmaceutical marketing which emphasised social connotations of ED and Viagra rather than its physical effects.[89][90]
Anthropology
Anthropological research presents ED not as a disorder but, as a normal, and sometimes even welcome sign of healthy aging. Wentzell's study of 250 Mexican males in their 50s and 60s found that "most simply did not see decreasing erectile function as a biological pathology".[91] The males interviewed described the decrease in erectile function "as an aid for aging in socially appropriate ways".[91] A common theme amongst the interviewees showed that respectable older males shifted their focus toward the domestic sphere into a "second stage of life".[91] The Mexican males of this generation often pursued sex outside of marriage; decreasing erectile function acted as an aid to overcoming infidelity thus helping to attain the ideal "second stage" of life.[91] A 56-year-old about to retire from the public health service said he would now "dedicate myself to my wife, the house, gardening, caring for the grandchildren—the Mexican classic".[91] Wentzell found that treating ED as a pathology was antithetical to the social view these males held of themselves, and their purpose at this stage of their lives.
In the 20th and 21st centuries, anthropologists investigated how common treatments for ED are built upon assumptions of institutionalized social norms. In offering a range of clinical treatments to 'correct' a person's ability to produce an erection, biomedical institutions encourage the public to strive for prolonged sexual function. Anthropologists argue that a biomedical focus places emphasis on the biological processes of fixing the body thereby disregarding holistic ideals of health and aging.[92] By relying on a wholly medical approach, Western biomedicine can become blindsided by bodily dysfunctions which can be understood as appropriate functions of age, and not as a medical problem.[93] Anthropologists understand that a biosocial approach to ED considers a person's decision to undergo clinical treatment more likely a result of "society, political economy, history, and culture" than a matter of personal choice.[92] In rejecting biomedical treatment for ED, males can challenge common forms of medicalized social control by deviating from what is considered the normal approach to dysfunction.
Lexicology
The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of ED within medicine is covered by andrology, a sub-field within urology. Research indicates that ED is common, and it is suggested that approximately 40% of males experience symptoms compatible with ED, at least occasionally.[94] The condition is also on occasion called phallic impotence.[95] Its antonym, or opposite condition, is priapism.[96][97]
en.wikipedia.org/wiki/Erectile_dysfunction
Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended.[3] There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent).[3] Most cases are ischemic.[3] Ischemic priapism is generally painful while nonischemic priapism is not.[3] In ischemic priapism, most of the penis is hard; however, the glans penis is not.[3] In nonischemic priapism, the entire penis is only somewhat hard.[3] Very rarely, clitoral priapism occurs in women.[4]
Sickle cell disease is the most common cause of ischemic priapism.[3] Other causes include medications such as antipsychotics, SSRIs, blood thinners and prostaglandin E1, as well as drugs such as cocaine.[3][5] Ischemic priapism occurs when blood does not adequately drain from the penis.[3] Nonischemic priapism is typically due to a connection forming between an artery and the corpus cavernosum or disruption of the parasympathetic nervous system resulting in increased arterial flow.[3] Nonischemic priapism may occur following trauma to the penis or a spinal cord injury.[3] Diagnosis may be supported by blood gas analysis of blood aspirated from the penis or an ultrasound.[3]
Treatment depends on the type.[3] Ischemic priapism is typically treated with a nerve block of the penis followed by aspiration of blood from the corpora cavernosa.[3] If this is not sufficient, the corpus cavernosum may be irrigated with cold, normal saline or injected with phenylephrine.[3] Nonischemic priapism is often treated with cold packs and compression.[3] Surgery may be done if usual measures are not effective.[3] In ischemic priapism, the risk of permanent scarring of the penis begins to increase after four hours and definitely occurs after 48 hours.[3][6] Priapism occurs in about 1 in 20,000 to 1 in 100,000 males per year.[3]
Classification
Priapism is classified into three groups: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic.[3] The majority of cases (19 out of 20) are ischemic in nature.[3]
Some sources give a duration of four hours as a definition of priapism, but others give six. Per the University Hospital Schleswig Holstein, "The duration of a normal erection before it is classifiable as priapism is still controversial. Ongoing penile erections for more than 6 hours can be classified as priapism."[7]
In women
Priapism in women (continued, painful erection of the clitoris) is significantly rarer than priapism in men and is known as clitoral priapism or clitorism.[4] It is associated with persistent genital arousal disorder (PGAD).[8] Only a few case reports of women experiencing clitoral priapism exist.[4]
Signs and symptoms
Complications
Because ischemic priapism causes the blood to remain in the penis for unusually long periods of time, the blood becomes deprived of oxygen, which can cause damage to the penile tissue. Such damage can result in erectile dysfunction or disfigurement of the penis.[9] In extreme cases, if the penis develops severe vascular disease, the priapism can result in penile gangrene.[10]
Low-flow priapism
Causes of low-flow priapism include sickle cell anemia (most common in children), leukemia, and other blood dyscrasias such as thalassemia and multiple myeloma, and the use of various drugs, as well as cancers.[11] A genome-wide association study on Brazilian patients with sickle cell disease identified four single nucleotide polymorphisms in LINC02537 and NAALADL2 significantly associated with priapism.[12]
Other conditions that can cause priapism include Fabry's disease, as well as neurologic disorders such as spinal cord lesions and spinal cord trauma (priapism has been reported in people who have been hanged; see death erection).
Priapism can also be caused by reactions to medications. The most common medications that cause priapism are intra-cavernous injections for the treatment of erectile dysfunction (papaverine, alprostadil). Other medication groups reported are antihypertensives (e.g. Doxazosin), antipsychotics (e.g., chlorpromazine, clozapine), antidepressants (most notably trazodone), anti-convulsant and mood stabilizer drugs such as sodium valproate.[13] Anticoagulants, cantharides (Spanish Fly) and recreational drugs (alcohol, heroin and cocaine) have been associated. Priapism is also known to occur from bites of the Brazilian wandering spider.[14]
High-flow priapism
Causes of high-flow priapism include:
blunt trauma to the perineum or penis, with laceration of the cavernous artery, which can generate an arterial-lacunar fistula.[11]
Anticoagulants (heparin and warfarin).
Antihypertensives (i.e., hydralazine, guanethidine and propranolol).
Hormones (i.e., gonadotropin releasing hormone and testosterone).
Diagnosis
The diagnosis is often based on the history of the condition as well as a physical exam.[3]
Blood gas testing the blood from the cavernosa of the penis can help in the diagnosis.[3] If the low-flow type of priapism is present, the blood typically has a low pH, while if the high-flow type is present, the pH is typically normal.[3] Color Doppler ultrasound may also help differentiate the two.[3] Testing a person to make sure they do not have a hemoglobinopathy may also be reasonable.[3]
Ultrasonography
Color Doppler ultrasound demonstrating a hypoechoic collection that corresponds to hematoma with arteriovenous fistula secondary to traumatic injury of the penis due to impact with bicycle handlebars, resulting in high-flow priapism[11]
Penile ultrasonography with Doppler is the imaging method of choice, because it is noninvasive, widely available, and highly sensitive. By means of this method, it is possible to diagnose priapism and differentiate between its low- and high-flow forms.[11]
In low-flow (ischemic) priapism the flow in the cavernous arteries is reduced or absent. As the condition progresses, there is an increase in echogenicity of the corpora cavernosa, attributed to tissue edema. Eventually, changes in the echotexture of the corpora cavernosa can be observed due to the fibrotic transformation generated by tissue anoxia.[11]
In high-flow priapism normal or increased, turbulent blood flow in the cavernous arteries is seen. The area surrounding the fistula presents a hypoechoic, irregular lesion in the cavernous tissue.[11]
Treatment
Medical evaluation is recommended for erections that last for longer than four hours. Pain can often be reduced with a dorsal penile nerve block or penile ring block.[3] For those with nonischemic priapism, cold packs and pressure to the area may be sufficient.[3]
Pseudoephedrine
Orally administered pseudoephedrine is a first-line treatment for priapism.[15] Erection is largely a parasympathetic response, so the sympathetic action of pseudoephedrine may serve to relieve this condition. Pseudoephedrine is an alpha-agonist agent that exerts a constriction effect on smooth muscle of corpora cavernosum, which in turn facilitates venous outflow. Pseudoephedrine is no longer available in some countries.
Aspiration
For those with ischemic priapism, the initial treatment is typically aspiration of blood from the corpus cavernosum.[3] This is done on either side.[3] If this is not sufficiently effective, then cold normal saline may be injected and removed.[3]
Medications
If aspiration is not sufficient, a small dose of phenylephrine may be injected into the corpus cavernosum.[3] Side effects of phenylephrine may include: high blood pressure, slow heart rate, and arrhythmia.[3] If this medication is used, it is recommended that people be monitored for at least an hour after.[3] For those with recurrent ischemic priapism, diethylstilbestrol (DES) or terbutaline may be tried.[3]
Surgery
Distal shunts, such as the Winter's,[clarification needed] involve puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside. Winter's shunts are often the first invasive technique used, especially in hematologically induced priapism, as it is relatively simple and repeatable.[16]
Proximal shunts, such as the Quackel's,[clarification needed] are more involved and entail operative dissection in the perineum where the corpora meet the spongiosum while making an incision in both and suturing both openings together.[17] Shunts created between the corpora cavernosa and great saphenous vein called a Grayhack shunt can be done though this technique is rarely used.[18]
As the complication rates with prolonged priapism are high, early penile prosthesis implantation may be considered.[3] As well as allowing early resumption of sexual activity, early implantation can avoid the formation of dense fibrosis and, hence, a shortened penis.
Sickle cell anemia
In sickle cell anemia, treatment is initially with intravenous fluids, pain medication, and oxygen therapy.[19][3] The typical treatment of priapism may be carried out as well.[3] Blood transfusions are not usually recommended as part of the initial treatment, but if other treatments are not effective, exchange transfusion may be done.[19][3]
History
Persistent semi-erections and intermittent states of prolonged erections have historically been sometimes called semi-priapism.[20]
Terminology
The name comes from the Greek god Priapus (Ancient Greek: Πρίαπος), a fertility god, often represented with a disproportionately large phallus.[21
St. George's University alumnus Dr. Mark Lanzieri returns to Grenada to perform the first-ever angiogram procedure at the island's General Hospital.
Dr. Lanzieri performed two angiograms through the St. George’s University Visiting Cardiology Program, calling them “the most invasive procedures we have ever done here.” In the past, residents have had to travel to larger Caribbean islands or the United States to undergo the diagnostic procedure.
See more at: www.sgu.edu/news-events/news-archives13-first-angiograms.....
One of the many benefits of working in healthcare: Free Food!
Seriously, earlier in the day, a drug rep (one of the most despised jobs in all of healthcare) came by to promote a new anticoagulant, and had groceries delivered for all the staff. Naturally, there was plenty left over for the Night Shift folks.
So, what's the rap on being a pharmaceutical sales rep, and why are they despised?
Read a news report on the matter from 2008:
"Shahram Ahari, who spent two years selling Prozac and Zypraxa for Eli Lily, told a Senate Aging Committee chaired by Sen. Herb Kohl, D-Wisc., that his job involved "rewarding physicians with gifts and attention for their allegiance to your product and company despite what may be ethically appropriate."
"Ahari said that drug companies like hiring former cheerleaders and ex-models, as well as former athletes and members of the military, many of whom have no background in science.
"During their five-week training class, Ahari claims that instructors teach sales tactics, including how to exceed spending limits for important clients, being generous with free samples to leverage sales, using friendships and personal gifts to foster a "quid pro quo" relationship, and how to exploit sexual tension.
""The nature of this business is gift-giving," says Ahari. He claims that he's heard stories about sales reps helping to pay the cost of a doctor's swimming pool and another doctor who was routinely taken to a nightclub where a hostess was paid to keep him company.
"Drug reps develop a positive view of their drug and a negative view of the competitors, according to Ahari. "You drink the Kool-Aid. We were taught to minimize the side effects and how to use conversational ploys to minimize it or to change the topic.""
Oh... and what was the med?
Brilinta (brand), aka Ticagrelor.
It has a "black box" warning, which follows
Oral (Tablet)
Ticagrelor, can cause significant, sometimes fatal, bleeding. Do not use in patients with active pathological bleeding or history of intracranial hemorrhage. Do not start in patients planned to undergo urgent CABG. When possible, discontinue at least 5 days prior to any surgery. Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention, CABG, or other surgical procedures in the setting of ticagrelor. If possible, manage bleeding without discontinuing ticagrelor. Stopping ticagrelor increases the risk of subsequent cardiovascular events. Maintenance doses of aspirin above 100 mg reduce the effectiveness of ticagrelor and should be avoided.
this is getting to be quite an angryography, i'm not gonna do that again!
it really takes too much effort to color these images. >_<
Hybrid Operating Room
Siemens Healthcare Artis Zeego
Siemens Healthcare Artis Zee Angiography
Siemens Healthcare Imaging Table
Skytron Surgical Lights
Skytron Equipment Booms
Skytron Surgical Monitors
Skytron Anesthesia Booms
Hybrid Operating Room
Siemens Healthcare Artis Zeego
Siemens Healthcare Artis Zee Angiography
Siemens Healthcare Imaging Table
Skytron Surgical Lights
Skytron Equipment Booms
Skytron Surgical Monitors
Skytron Anesthesia Booms
kidney failure and in a coma. not the nicest situation to end up in. good thing at least this one is just a simulator doll!
Hybrid Operating Room
Toshiba Healthcare
Toshiba Healthcare Infinix Angiography
Toshiba Healthcare Imaging Table
Skytron LED Surgical Lights
Skytron Equipment Booms
Skytron Surgical Monitors
Skytron Anesthesia Booms
Hybrid Operating Room
Toshiba Healthcare
Toshiba Healthcare Infinix Angiography
Toshiba Healthcare Imaging Table
Skytron LED Surgical Lights
Skytron Equipment Booms
Skytron Surgical Monitors
Skytron Anesthesia Booms
For the first time in it's 110 year history the Collage of Radiographers have gone on strike to try to improve working conditions, recruitment and retention and to get a fair days pay, I am 100% behind the strike.
Having been a Radiographer for 30 years before retiring I have experienced all the issues discussed within this fabulous profession. Falling recruitment levels and retention in the profession being a major problem, especially when you consider a newly qualified Radiographer after studying in university for 3 to 4 years getting payed less than stacking shelves in a supermarket and after gaining a Superintendents position, in charge of imaging services for A/E and all unplanned admissions orthopaedics, mobiles, theatres, ITU, DSA, out-of-Hours services, in house training, CPD and lecturing and all the responsibilities this brings and getting paid the same as a Bank Clerk!
Radiographers are the eyes an ears of the NHS performing x-rays, ultrasounds, CT and MRi scans, Radioisotope imaging, Cardiac Angiography and other interventional work, working in the operating theatres and out on the wards with mobile imaging, breast and cancer screening, nights and unsociable hours and many many more responsibilities.
I remember being in charge of a three room A/E x-ray department, all trauma and unplanned admissions, daily fracture and orthopaedic clinics, paediatrics including emergency outreach and trauma all mobile and theatre cases with 4 to 5 Radiographers, all rooms full and lists morning and afternoon.
I clearly remember one month in the summer at St Mary's Paddington being in charge, working a long day, thats 08.00 to 20.00 and due to sickness, holidays and just not having an adequate staffing level going straight into a full night, then again due to sickness going into another full day, getting home at 23 00 to have a nights sleep until the first train back to London at 06.30 and having to do it all over again. Missing my daughters birthdays and never having Christmas Eve, Christmas Day, Boxing Day or New Years off for 4 years, missing family holidays, working over 70 hours a week, nights and weekends and in my department having myself, one more full time staff member and the rest agency who did not know the equipment or the hospital! No wonder why getting people to join the profession is failing and radiographers are leaving in droves for far easier and better payed jobs.
ER was the program to watch with smooth George Clooney. "Cosmo" magazine did a series called the "Real ER" at the Royal London Whitechapel. Here are two pages from the run with me as the Senior Trauma Radiographer at the time running the trauma imaging service and the trauma calls when a patient came to us on the London Air Ambulance. I am in the middle left positioning the x-ray head for a "Shoot through T-Spine" on a patient brought in by by HEMS
Hybrid Operating Room
Toshiba Healthcare
Toshiba Healthcare Infinix Angiography
Toshiba Healthcare Imaging Table
Skytron LED Surgical Lights
Skytron Equipment Booms
Skytron Surgical Monitors
Skytron Anesthesia Booms
Hybrid Operating Room
Siemens Healthcare Artis Zeego
Siemens Healthcare Artis Zee Angiography
Siemens Healthcare Imaging Table
Skytron Surgical Lights
Skytron Equipment Booms
Skytron Surgical Monitors
Skytron Anesthesia Booms
Hybrid Operating Room
Toshiba Healthcare
Toshiba Healthcare Infinix Angiography
Toshiba Healthcare Imaging Table
Skytron LED Surgical Lights
Skytron Equipment Booms
Skytron Surgical Monitors
Skytron Anesthesia Booms