Our results indicate that age and erectile dysfunction duration alone are the most important variables affecting the results of an intracavernous injection test. However, in patients older than 40 years with a greater than 2-year history of erectile dysfunction failure to respond to intracavernous injection testing is most closely associated with venous insufficiency, as evidenced by the high ROC values for variables indicative of venous insufficiency, namely maintenance flow, pressure loss and the resistive index. Therefore, nonresponse to an office intracavernous injection test in an older patient with erectile dysfunction of long duration is most likely due to venous leakage. If only 1 confirmatory test is possible, cavernosometry provides the most information.

No abstract

Background:Takayasu Arteritis is a chronic, large vessel arteritis that commonly involves the aorta and its major branches, mostly the ascending/descending aorta, subclavian arteries, and carotids [1].Herein, we report a case of a 23 year-old medically free Indian male who presented to our hospital in acute distress complaining of cough, hemoptysis and shortness of breath for one week as well as intermittent fever and fatigue for five months. He presented with a BP of 140/100 mmHg as well was both systolic and early diastolic murmurs in the mitral and aortic areas, respectively. He also had a paraumbilical bruit and unilateral clubbing in the left hand with digital ischemia of the left index finger. Doppler ultrasound of the left arm showed monophasic flow pattern with low velocity in left distal radial, distal ulnar, and all digital arteries, except the second digital arteries; low velocity in the median artery; and no flow in the lateral artery of second digit (Figure 1). Computed tomography angiogram (CT Angio) (Figure 2) of the chest, abdomen, and pelvis showed fusiform aneurysm dilatation of the thoracic aorta extending into the right braciocephalic and subclavian arteries as well as the right common carotid artery.Figure 1.Figure 2.Unilateral clubbing in patients with TA occurs as a result of subclavian artery stenosis that leads to tissue ischemia and hypoxia [2-4]. In turn, the bone marrow release megakaryocytes, which enter the systemic circulation when an A-V shunt exists [5]. Platelet-derived growth factor (PDGF) (release from megakaryocytes) and vascular endothelial growth factor (VEGF) levels are highly expressed in the connective tissues of nail beds, leading to its proliferation and platelets clumps‘ accumulation [6, 7].Objectives:To report the fourth case worldwide and third case of an adult, respectively, with Takayasu’s arteritis who presents with unilateral clubbing.Methods:Our patient was started on pulse steroid therapy of methylprednisolone 1 gram IV od for 5 days and later switched to prednisolone 20 mg po BID. He also received methotrexate 10 mg PO once weekly and rituximab 750 mg IV stat; another dose of rituximab was given two weeks later.Results:His clubbing has significantly improved within 2 weeks of starting immunosuppressive therapy. He was discharged with follow up on methotrexate 12.5 mg PO once weekly and prednisilone 20 mg PO OD (to be tapered). Clubbing improved by a rate of 60% two weeks following discharge in two weeks.Conclusion:In all four cases of Takayasu arteries presenting with unilateral clubbing, patients’ clinical condition including presence of clubbing improved after initiation of immunosuppressive therapy.References:[1]Alibaz-Öner, F., Aydin, S. Z., & Direskeneli, H. (2015). Recent advances in Takayasu’s arteritis.European Journal of Rheumatology,2(1), 24–30.[2]Kaditis AG, Nelson AM, Driscoll DJ. Takayasu\’s arteritis presenting with unilateral digital clubbing. J Rheumatol 1995;22:2346-8.[3]Ishikawa M, Okada J, Kondo H. Takayasu’s arteritis with transient clubbed finger. Clin Exp Rheumatol 1999;17:629-30.[4]Bivilibal M, Duru N, Dogdu G, Elevli M, Ayta S. A Takayasu’s Arteritis Case with Unilateral Digital Clubbing. Turk J Rheumatol. 2011;26(2):163–166.[5]Martínez-Lavín M. Hypertrophic osteoarthropathy. Curr Opin Rheumatol. 1997 Jan;9(1):83-6. Review. PubMed PMID: 9110140.[6]Dickinson CJ, Martin JF. Megakaryocytes and platelet clumps as the cause of finger clubbing. Lancet 1987;2:1434-5.[7]Atkinson S, Fox SB. Vascular endothelial growth factor (VEGF)-A and platelet-derived growth factor (PDGF) play a central role in the pathogenesis of digital clubbing. J Pathol 2004;203:721-8.Disclosure of Interests:None declared

Objectives: To investigate the relationship between early T-wave inversion after thrombolytic therapy and the likelihood of successful epicardial coronary reperfusion. Subjects and Methods: Thrombolytic therapy was given to 195 patients with ST segment elevation due to acute anterior myocardial infarction (AMI). Coronary angiography was performed. Receiver operating characteristic (ROC) curve (grade of sensitivity versus false positive) was calculated using likelihood ratio method to identify the ideal cut-off values of the ventricular repolarization variables. Results: Predictive indices showed 80% sensitivity, 83% specificity, 81% accuracy, 88% positive predictive value and 71% negative predictive value for early T-wave inversion after thrombolytic therapy. A good concordant agreement was noted between the data of coronary angiography and early T-wave inversion in the infarct-related ECG leads after thrombolysis (kappa coefficient ĸ= 0.876). Stepwise multivariate analysis revealed that early T-wave inversion after thrombolytic therapy of AMI was significantly associated with a history of preinfarction angina, residual infarct-related coronary artery stenosis >50%, short time to thrombolytic therapy <90 min, and evening time for occurrence of thrombolysis (p < 0.05). The ROC curve data analysis showed that early T-wave inversion amplitude after AMI had 87% sensitivity and 84% specificity for predicting successful reperfusion, with an ideal cut-off value of 7.2 mm, while time of T-wave inversion had 80% sensitivity and 79% specificity, with an ideal cut-off value of 120 min. Conclusion: The data indicate that early inversion of T wave after AMI is a statistically significant independent variable in predicting successful epicardial coronary thrombolysis status.