ACUTE RENAL FAILURE associated with nontraumatic rhabdomyolysis has been well documented in several studies'-' and represents between 5 to 7 percent of the cases of acute renal failure treated at two institutions},2 However, a review of the literature has described only 11 cases of rhabdomyolysis and renal failure in conjunction with viral infections.1,3-12 The majority of documented cases have been associated with Influenza A virus.5-&dquo;,&dquo; There is only one previous case reported in the literature that described Epstein-Barr virus infection as the etiology of acute rhabdomyolysis and acute renal failure.' We would like to report another case of rhabdomyolysis and nonoliguric renal failure in a child with Epstein-Barr virus infection. Case ReportA 6-year old American-born Ugandan girl was hospitalized with a 36-hour history of vomiting and severe watery diarrhea. Three days prior to admission the patient reported weakness, myalgia, pharyngitis, and fever up to 104.4°F. She was brought to the local emergency room because of continuous diarrhea and dehydration.Review of systems revealed no history of toxic material or drug ingestion, exposure to similarly sick individuals, contaminated food ingestion, or travel abroad. There was no family history of muscle disease. On admission, physical examination revealed an apathetic but oriented child weighing 46 pounds with a pulse of 180/minute, respiratory rate of 40/minute, blood pressure not obtainable at this time, and palpable pulses present only in femoral arteries. Her pharynx was erythematous, the mucous membranes were dry, and enlarged tender cervical lymph nodes were noted. Her skin showed poor perfusion. Her abdomen was diffusely tender without organomegaly. The remainder of the examination was unremarkable.Laboratory data on admission included the following : hematocrit 43.9%, hemoglobin 14.3 gm/dl, WBC 9,900/mm!l with 8% neutrophils, 61% bands, 13% monocytes, 1% eosinophils, 13% lymphocytes, 3% metamelocytes, 1 % myelocytes. Platelet count was 145,000/mms, BUN 79 mg/dl, creatinine 2.9 mg/dl, sodium 130 mEq/1, potassium 4.8 mEq/1, C02 6 mEq/ I, SGOT 171 IU/1, SGPT 40 IU/1, LDH 454 IU/1, and alkaline phosphatase 182 It/1.The patient was clinically assessed as being severely dehydrated and in shock. Treatment was begun with intravenous saline solution and fresh frozen plasma, after which blood pressure returned to 100 mmHg systolic. Approximately 8 hours after admission, the patient voided dark-colored urine. The urine was reddish brown, positive for protein ( 1 +) and occult blood (3+) with 0 RBC/hpf and 0-3 WBC/hpf and a specific gravity of 1.011. The urine output in the first 8 hours was 1.8 ml/kg/hr, increasing to 3.9 ml/kg/hr over the next 24 hours.She was started on antibiotics, but these were discontinued after 5 days when the initial urine, stool, blood, and throat cultures revealed no pathogenic organisms.The patient continued to have dark-colored urine and a repeat urinalysis on the second day of hospitalization showed 3+ occult blood, 1 + protein...

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SUMMARYPenile duplex Doppler ultrasound (PDDU) assesses the etiology of erectile dysfunction. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) are common PDDU parameters. We assessed whether stretched penile length (SPL) in the flaccid state and measured penile length at peak erection after intracavernosal injection (ICI) of a vasodilator during PDDU correlated with the etiology of erectile dysfunction. We performed a retrospective review of 93 patients who underwent PDDU for erectile dysfunction. Normal and stretched penile length were measured, both at a flaccid state prior to ICI and at peak erection during PDDU. Collected data included patient demographics, vascular, and anatomic parameters. The mean age was 52 years. SPL was equivalent to peak penile length after ICI in 60 patients (65%, group 1) and did not match in 33 (35%, group 2). There were no significant differences between the two groups in terms of flaccid, stretched, and post-ICI erect penile lengths, IIEF score, PSV, percent rigidity or tumescence, and vasodilator dose used. Patients in group 2 had less of a change in penile length from flaccid to erect state (36% vs. 44%, p = 0.02), higher EDV (12.0 vs. 8.5, p = 0.041), lower RI (0.6 vs. 1.0, p = 0.046), and more veno-occlusive dysfunction (82% vs. 53%, p = 0.001). On multivariate analysis, failure to reach maximum SPL at peak ICI erection (OR 2.255, CI 1.191-4.271, p = 0.0126), EDV (OR 1.281, CI 1.115-1.471, p < 0.001) and RI (OR 0.694,, p = 0.009) predicted veno-occlusive dysfunction. Failure to reach maximal SPL during PDDU using ICI with a vasodilator agent predicted veno-occlusive dysfunction, which is independent of both penile rigidity and tumescence. This measurement could serve as another diagnostic tool for predicting venoocclusive dysfunction when PDDU is not readily available. Limitations include the subjective nature of penile measurements and different PGE1 doses used.

In colloquial English, a "grower" is a man whose phallus expands significantly in length from the flaccid  to the erect state; a "shower" is a man whose phallus does not demonstrate such expansion. We sought to investigate various factors that might predict a man being either a grower or a shower. A retrospective review of 274 patients who underwent penile duplex Doppler ultrasound (PDDU) for erectile dysfunction between 2011 and 2013 was performed. Penile length was measured, both in the flaccid state prior to intracavernosal injection (ICI) of a vasodilating agent (prostaglandin E1), and at peak erection during PDDU. The collected data included patient demographics, vascular, and anatomic parameters. The median change in penile length from flaccid to erect state was 4.0  cm (1.0-7.0), and was used as a cut-off value defining a grower (≥4.0 cm) or a shower (4.0 cm). A total of 73 men (26%) fit the definition of a grower (mean change in length of 5.3 cm [SD 0.5]) and 205 (74%) were showers (mean change in length of 3.1 cm [SD 0.9]). There were no differences between the groups with regards to race, smoking history, co-morbidities, erectile function, flaccid penile length, degree of penile rigidity after ICI, or PDDU findings. Growers were significantly younger (mean age 47.5 vs. 55.9 years, p < 0.001), single (37% vs. 23%, p  =  0.031), received less vasodilator dose (10.3  mcg vs. 11.0  mcg, p  =  0.038) and had a larger erect phallus (15.5 cm vs. 13.1 cm, p < 0.001). On multivariate analysis, only younger age was significantly predictive of being a grower (p < 0.001). These results suggest that younger age and single status could be predictors of a man being a grower, rather than a shower. Larger, multicultural and multinational studies are needed to confirm these results.

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