Make a simple ppt on the topic priapism.black and white print out friendly by adding important diagrams.the ppt should be 10 pages in total with definition,etiology,pathogenesis,clinical manifestations,diagnosis,differential diagnosis and treatment.
Reading File
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Finding Sources
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Running Command
ls /home/daytona/workspace/ && mkdir -p /home/daytona/workspace/priapism-ppt
Writing File
~/priapism-ppt/build.js
const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Priapism";
pres.author = "Medical Education";
// ─── PALETTE (B&W print-friendly) ───────────────────────────────────────────
const BLACK = "000000";
const WHITE = "FFFFFF";
const DARK = "1A1A1A";
const MID = "444444";
const LIGHT = "888888";
const OFFWHITE= "F5F5F5";
const RULE = "CCCCCC";
// ─── HELPER: slide title bar ─────────────────────────────────────────────────
function addTitleBar(slide, title) {
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: DARK } });
slide.addText(title, {
x: 0.25, y: 0, w: 9.5, h: 0.75,
fontSize: 22, bold: true, color: WHITE, fontFace: "Arial",
valign: "middle", margin: 0
});
}
// ─── HELPER: horizontal rule ─────────────────────────────────────────────────
function addRule(slide, y) {
slide.addShape(pres.ShapeType.line, {
x: 0.25, y: y, w: 9.5, h: 0,
line: { color: RULE, width: 0.8 }
});
}
// ─── HELPER: bullet list ─────────────────────────────────────────────────────
function addBullets(slide, items, x, y, w, h, fontSize) {
const fs = fontSize || 13;
const textArr = items.map((item, i) => ({
text: item,
options: { bullet: { code: "25CF", indent: 10 }, breakLine: i < items.length - 1, color: DARK, fontSize: fs, fontFace: "Arial" }
}));
slide.addText(textArr, { x, y, w, h, valign: "top" });
}
// ─── HELPER: section label ───────────────────────────────────────────────────
function addLabel(slide, text, x, y, w, h) {
slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: MID } });
slide.addText(text, { x, y, w, h, fontSize: 10, bold: true, color: WHITE, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
// Full black background
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: BLACK } });
// Accent bar
s.addShape(pres.ShapeType.rect, { x: 0, y: 2.2, w: 0.15, h: 1.5, fill: { color: WHITE } });
s.addText("PRIAPISM", {
x: 0.5, y: 1.5, w: 9, h: 1.4,
fontSize: 54, bold: true, color: WHITE, fontFace: "Arial", align: "left", valign: "middle", charSpacing: 6
});
s.addText("A Comprehensive Medical Overview", {
x: 0.5, y: 3.0, w: 9, h: 0.5,
fontSize: 18, color: LIGHT, fontFace: "Arial", align: "left", italic: true
});
s.addText("Definition | Etiology | Pathogenesis | Clinical Manifestations | Diagnosis | Differential Diagnosis | Treatment", {
x: 0.5, y: 3.8, w: 9, h: 0.5,
fontSize: 11, color: LIGHT, fontFace: "Arial", align: "left"
});
s.addShape(pres.ShapeType.rect, { x: 0, y: 5.3, w: 10, h: 0.325, fill: { color: MID } });
s.addText("Smith & Tanagho's General Urology · Campbell-Walsh-Wein Urology · Rosen's Emergency Medicine", {
x: 0.25, y: 5.3, w: 9.5, h: 0.325,
fontSize: 9, color: WHITE, fontFace: "Arial", valign: "middle"
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — DEFINITION
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: WHITE } });
addTitleBar(s, "01 | DEFINITION");
// Definition box
s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.95, w: 9.4, h: 1.5, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addText([
{ text: "Priapism ", options: { bold: true, fontSize: 14, color: BLACK } },
{ text: "is a prolonged, persistent penile erection ", options: { fontSize: 14, color: DARK } },
{ text: "unrelated to sexual interest or stimulation", options: { bold: true, italic: true, fontSize: 14, color: BLACK } },
{ text: " that lasts longer than ", options: { fontSize: 14, color: DARK } },
{ text: "4 hours.", options: { bold: true, fontSize: 14, color: BLACK } }
], { x: 0.5, y: 0.95, w: 9, h: 1.5, valign: "middle" });
addRule(s, 2.6);
// Three types
s.addText("THREE RECOGNIZED TYPES", { x: 0.3, y: 2.7, w: 9.4, h: 0.35, fontSize: 11, bold: true, color: MID, fontFace: "Arial", charSpacing: 2 });
const types = [
{ title: "ISCHEMIC (Low-Flow)", desc: "Venous outflow obstruction → compartment syndrome of the penis. Most common. Urologic emergency." },
{ title: "NONISCHEMIC (High-Flow)", desc: "Unregulated arterial inflow, often post-trauma. Penis partially rigid, painless. NOT an emergency." },
{ title: "STUTTERING (Recurrent)", desc: "Recurrent self-limited episodes of ischemic priapism. Common in sickle cell disease patients." }
];
types.forEach((t, i) => {
const x = 0.3 + i * 3.15;
s.addShape(pres.ShapeType.rect, { x, y: 3.1, w: 3.0, h: 2.2, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addShape(pres.ShapeType.rect, { x, y: 3.1, w: 3.0, h: 0.38, fill: { color: DARK } });
s.addText(t.title, { x, y: 3.1, w: 3.0, h: 0.38, fontSize: 10, bold: true, color: WHITE, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
s.addText(t.desc, { x: x + 0.1, y: 3.55, w: 2.8, h: 1.65, fontSize: 11, color: DARK, fontFace: "Arial", valign: "top" });
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — ETIOLOGY
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: WHITE } });
addTitleBar(s, "02 | ETIOLOGY");
const categories = [
{
label: "Hematologic", color: BLACK,
items: ["Sickle cell disease (most common)", "Thalassemia", "Leukemia", "Polycythemia", "G6PD deficiency"]
},
{
label: "Medications", color: BLACK,
items: ["Intracavernosal injections (alprostadil)", "PDE-5 inhibitors", "Antipsychotics (chlorpromazine, risperidone)", "Antidepressants (trazodone)", "Antihypertensives (hydralazine, prazosin)"]
},
{
label: "Neurogenic", color: BLACK,
items: ["Spinal cord injury", "Cauda equina syndrome", "Multiple sclerosis", "Autonomic neuropathy", "Lumbar disc disease"]
},
{
label: "Traumatic / Other", color: BLACK,
items: ["Perineal/penile trauma (high-flow)", "Pelvic malignancy (metastatic)", "Infections (malaria, scorpion/spider toxin)", "Alcohol, cocaine, marijuana", "Idiopathic (~50%)"]
}
];
categories.forEach((cat, i) => {
const col = i % 2;
const row = Math.floor(i / 2);
const x = 0.25 + col * 4.9;
const y = 0.9 + row * 2.25;
s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 2.1, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 0.36, fill: { color: cat.color } });
s.addText(cat.label, { x, y, w: 4.6, h: 0.36, fontSize: 11, bold: true, color: WHITE, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
const textArr = cat.items.map((item, ii) => ({
text: " " + item,
options: { bullet: { code: "25A0", indent: 5 }, breakLine: ii < cat.items.length - 1, color: DARK, fontSize: 11, fontFace: "Arial" }
}));
s.addText(textArr, { x: x + 0.1, y: y + 0.4, w: 4.4, h: 1.65, valign: "top" });
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — PATHOGENESIS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: WHITE } });
addTitleBar(s, "03 | PATHOGENESIS");
// Ischemic pathway diagram (drawn with shapes)
s.addText("ISCHEMIC (LOW-FLOW) PATHWAY", { x: 0.25, y: 0.85, w: 5.5, h: 0.3, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
const steps = [
"Venous outflow obstruction",
"↓ Arterial inflow to corpora cavernosa",
"Hypoxia + Acidosis + Hypercapnia",
"Endothelial & smooth muscle damage",
"Fibrosis → Erectile dysfunction"
];
steps.forEach((step, i) => {
const y = 1.2 + i * 0.68;
const isLast = i === steps.length - 1;
s.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 5.3, h: 0.5, fill: { color: isLast ? DARK : OFFWHITE }, line: { color: isLast ? BLACK : RULE, width: 1 } });
s.addText(step, { x: 0.35, y, w: 5.1, h: 0.5, fontSize: 12, color: isLast ? WHITE : DARK, fontFace: "Arial", valign: "middle", bold: isLast });
if (!isLast) {
s.addText("▼", { x: 0.25, y: y + 0.5, w: 5.3, h: 0.18, fontSize: 11, color: MID, fontFace: "Arial", align: "center", valign: "middle" });
}
});
// Non-ischemic box
addRule(s, 0.85);
s.addText("NON-ISCHEMIC (HIGH-FLOW) PATHWAY", { x: 6.0, y: 0.85, w: 3.75, h: 0.3, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
s.addShape(pres.ShapeType.rect, { x: 6.0, y: 1.2, w: 3.75, h: 2.5, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
const niSteps = [
"Trauma to perineum/penis",
"Vascular injury to cavernosal / helicine artery",
"Arterio-cavernous fistula formation",
"Unregulated arterial inflow",
"Persistent tumescence (painless, oxygenated)"
];
niSteps.forEach((step, i) => {
s.addText((i === 0 ? "" : (i < 4 ? " → " : " ✓ ")) + step, {
x: 6.1, y: 1.3 + i * 0.42, w: 3.55, h: 0.38,
fontSize: 11, color: i === 4 ? MID : DARK, fontFace: "Arial", valign: "middle",
italic: i === 4, bold: i === 0
});
});
// Stuttering note
s.addShape(pres.ShapeType.rect, { x: 0.25, y: 4.65, w: 9.5, h: 0.7, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addText([
{ text: "STUTTERING PRIAPISM: ", options: { bold: true, fontSize: 11, color: BLACK } },
{ text: "Recurrent ischemia driven by aberrant PDE5 / NO / cGMP signaling; microvasculature occlusion from sickled RBCs; often occurs during sleep (hypoventilatory acidosis ↓ O₂ tension).", options: { fontSize: 11, color: DARK } }
], { x: 0.35, y: 4.65, w: 9.3, h: 0.7, valign: "middle" });
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — CLINICAL MANIFESTATIONS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: WHITE } });
addTitleBar(s, "04 | CLINICAL MANIFESTATIONS");
// Comparison table header
const cols = [
{ label: "Feature", w: 2.0, x: 0.25 },
{ label: "Ischemic (Low-Flow)", w: 3.2, x: 2.25 },
{ label: "Non-Ischemic (High-Flow)", w: 2.6, x: 5.45 },
{ label: "Stuttering", w: 1.8, x: 8.05 }
];
// Header row
cols.forEach(col => {
s.addShape(pres.ShapeType.rect, { x: col.x, y: 0.85, w: col.w - 0.05, h: 0.38, fill: { color: DARK } });
s.addText(col.label, { x: col.x, y: 0.85, w: col.w - 0.05, h: 0.38, fontSize: 10, bold: true, color: WHITE, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
});
const rows = [
["Onset", "Gradual, progressive", "After trauma", "Episodic, recurrent"],
["Pain", "YES — ischemic pain", "Usually painless", "Painful during episode"],
["Rigidity", "Fully rigid, tender", "Partial / full — soft glans", "Rigid during episode"],
["Duration", "> 4 hours", "Hours to days", "< 4 hrs; recurrent"],
["Emergency?", "YES — urologic emergency", "No — can observe", "Monitor"],
["Blood gas", "Hypoxic, acidotic, hypercapnic", "Normal / hyperoxic", "Hypoxic (ischemic)"],
["Long-term risk", "ED, fibrosis, necrosis", "Low — if treated", "Cumulative ED risk"]
];
rows.forEach((row, ri) => {
const bg = ri % 2 === 0 ? WHITE : OFFWHITE;
const y = 1.23 + ri * 0.53;
cols.forEach((col, ci) => {
s.addShape(pres.ShapeType.rect, { x: col.x, y, w: col.w - 0.05, h: 0.5, fill: { color: bg }, line: { color: RULE, width: 0.5 } });
s.addText(row[ci], {
x: col.x + 0.05, y, w: col.w - 0.15, h: 0.5,
fontSize: ci === 0 ? 10 : 10, color: (ci === 1 && ri === 4) ? BLACK : DARK,
fontFace: "Arial", valign: "middle", bold: ci === 0
});
});
});
// Footer note
s.addShape(pres.ShapeType.rect, { x: 0.25, y: 5.1, w: 9.5, h: 0.35, fill: { color: OFFWHITE }, line: { color: RULE, width: 0.5 } });
s.addText("Clinical hallmark: rigid corpus cavernosa with relatively soft glans penis. Glans is NOT engorged because corpus spongiosum usually spared.", {
x: 0.35, y: 5.1, w: 9.3, h: 0.35, fontSize: 10, color: MID, fontFace: "Arial", valign: "middle", italic: true
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — PENIS ANATOMY DIAGRAM (fetched image)
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: WHITE } });
addTitleBar(s, "05 | PENILE ANATOMY & RELEVANT STRUCTURES");
// Left: image from textbook
const imgUrls = [
"https://cdn.orris.care/cdss_images/cab7ea6f0fbb6cfd9f273021e6746b7d449c6603596d2d60c1e4fe422945b74c.png"
];
let imgData = null;
try {
const result = execSync(
`node /home/daytona/skills/shared/scripts/fetch_images.js "${imgUrls[0]}"`,
{ timeout: 30000 }
).toString();
const parsed = JSON.parse(result);
if (parsed[0] && !parsed[0].error) imgData = parsed[0].base64;
} catch(e) { console.error("Image fetch failed:", e.message); }
if (imgData) {
s.addImage({ data: imgData, x: 0.25, y: 0.9, w: 4.2, h: 4.3 });
} else {
s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.2, h: 4.3, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addText("Penile anatomy diagram\n(see textbook Fig. 168.1)", { x: 0.35, y: 2.5, w: 4.0, h: 1.0, fontSize: 11, color: MID, fontFace: "Arial", align: "center" });
}
// Right: key structures labelled
s.addText("KEY STRUCTURES IN PRIAPISM", { x: 4.7, y: 0.9, w: 5.0, h: 0.3, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
const structures = [
["Corpora Cavernosa (×2)", "Paired erectile cylinders; primary site of ischemia in priapism"],
["Corpus Spongiosum", "Surrounds urethra; usually SPARED in priapism → soft glans"],
["Tunica Albuginea", "Fibrous sheath; target of shunting procedures"],
["Cavernosal Artery", "Branch of internal pudendal artery; injured in high-flow priapism"],
["Helicine Arteries", "Regulate blood flow; fistula formation causes non-ischemic type"],
["Penile Veins", "Outflow obstruction → ischemic priapism"]
];
structures.forEach((st, i) => {
const y = 1.3 + i * 0.65;
s.addShape(pres.ShapeType.rect, { x: 4.7, y, w: 5.0, h: 0.58, fill: { color: i % 2 === 0 ? OFFWHITE : WHITE }, line: { color: RULE, width: 0.5 } });
s.addText(st[0], { x: 4.8, y: y + 0.02, w: 4.8, h: 0.25, fontSize: 11, bold: true, color: BLACK, fontFace: "Arial", valign: "top" });
s.addText(st[1], { x: 4.8, y: y + 0.28, w: 4.8, h: 0.25, fontSize: 10, color: MID, fontFace: "Arial", valign: "top" });
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — DIAGNOSIS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: WHITE } });
addTitleBar(s, "06 | DIAGNOSIS");
// Left column — Clinical + Lab
s.addText("CLINICAL DIAGNOSIS", { x: 0.25, y: 0.85, w: 4.5, h: 0.3, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
const clinItems = [
"History: duration, sexual activity, medications, trauma, SCD",
"Physical exam: rigid corpora, soft glans, tenderness",
"Priapism is primarily a CLINICAL diagnosis"
];
addBullets(s, clinItems, 0.25, 1.2, 4.5, 1.0, 11);
addRule(s, 2.3);
s.addText("LABORATORY TESTS", { x: 0.25, y: 2.35, w: 4.5, h: 0.3, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
const labs = [
"CBC + reticulocyte count (hemoglobinopathy screen)",
"Hemoglobin electrophoresis (SCD, thalassemia)",
"Coagulation studies",
"Urine toxicology screen",
"Cavernosal blood gas (definitive subtype differentiation)"
];
addBullets(s, labs, 0.25, 2.7, 4.5, 1.6, 11);
// Blood gas table
s.addText("CAVERNOSAL BLOOD GAS — KEY VALUES", { x: 5.0, y: 0.85, w: 4.7, h: 0.3, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
const bgHeaders = ["Parameter", "Ischemic", "Non-Ischemic"];
const bgData = [
["pO₂", "< 30 mmHg", "> 90 mmHg"],
["pCO₂", "> 60 mmHg", "< 40 mmHg"],
["pH", "< 7.25", "7.38 – 7.40"],
["Color", "Dark, deoxygenated", "Bright red"],
["Flow", "Little or none", "Pulsatile, high"]
];
bgHeaders.forEach((h, i) => {
const x = 5.0 + i * 1.55;
s.addShape(pres.ShapeType.rect, { x, y: 1.2, w: 1.5, h: 0.38, fill: { color: DARK } });
s.addText(h, { x, y: 1.2, w: 1.5, h: 0.38, fontSize: 10, bold: true, color: WHITE, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
});
bgData.forEach((row, ri) => {
row.forEach((cell, ci) => {
const x = 5.0 + ci * 1.55;
const y = 1.58 + ri * 0.42;
s.addShape(pres.ShapeType.rect, { x, y, w: 1.5, h: 0.38, fill: { color: ri % 2 === 0 ? OFFWHITE : WHITE }, line: { color: RULE, width: 0.5 } });
s.addText(cell, { x: x + 0.05, y, w: 1.4, h: 0.38, fontSize: 10, color: DARK, fontFace: "Arial", valign: "middle" });
});
});
// Imaging
s.addText("IMAGING", { x: 0.25, y: 4.4, w: 9.5, h: 0.28, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
s.addShape(pres.ShapeType.rect, { x: 0.25, y: 4.7, w: 9.5, h: 0.65, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addText([
{ text: "Color Duplex Ultrasonography (CDU): ", options: { bold: true, fontSize: 11, color: BLACK } },
{ text: "Identifies absence of cavernosal blood flow (ischemic) vs. high-flow fistula (non-ischemic). Always consider post-treatment to confirm resolution. Can differentiate resolved ischemia, persistent ischemia, and conversion to high-flow state.", options: { fontSize: 11, color: DARK } }
], { x: 0.35, y: 4.7, w: 9.3, h: 0.65, valign: "middle" });
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — DIFFERENTIAL DIAGNOSIS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: WHITE } });
addTitleBar(s, "07 | DIFFERENTIAL DIAGNOSIS");
s.addText("The underlying etiology must be differentiated. Priapism itself is a clinical diagnosis — the differential concerns TYPE and CAUSE.", {
x: 0.25, y: 0.82, w: 9.5, h: 0.4, fontSize: 11, color: MID, fontFace: "Arial", valign: "middle", italic: true
});
const ddCols = [
{
head: "ISCHEMIC CAUSES", items: [
"Sickle cell disease / thalassemia",
"G6PD deficiency",
"Leukemia / lymphoma",
"Infection (malaria, UTI)",
"Neurogenic (SCI, cauda equina)",
"Toxin (scorpion, spider bite)",
"Henoch-Schönlein purpura"
]
},
{
head: "NON-ISCHEMIC CAUSES", items: [
"Perineal / penile trauma",
"Post-surgical arteriocavernous fistula",
"Hematologic (SCD, leukemia) — rare",
"Fabry disease",
"Iatrogenic (surgical injury)"
]
},
{
head: "MEDICATION-INDUCED", items: [
"Intracavernosal alprostadil / papaverine",
"PDE-5 inhibitors (sildenafil, tadalafil)",
"Testosterone / anabolic steroids",
"Antipsychotics (trazodone, chlorpromazine)",
"Antidepressants (SSRIs)",
"Antihypertensives (prazosin, hydralazine)",
"Alcohol, cocaine, marijuana"
]
}
];
ddCols.forEach((col, i) => {
const x = 0.25 + i * 3.2;
s.addShape(pres.ShapeType.rect, { x, y: 1.3, w: 3.1, h: 3.95, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addShape(pres.ShapeType.rect, { x, y: 1.3, w: 3.1, h: 0.38, fill: { color: DARK } });
s.addText(col.head, { x, y: 1.3, w: 3.1, h: 0.38, fontSize: 10, bold: true, color: WHITE, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
const textArr = col.items.map((item, ii) => ({
text: item,
options: { bullet: { code: "25CF", indent: 8 }, breakLine: ii < col.items.length - 1, color: DARK, fontSize: 11, fontFace: "Arial" }
}));
s.addText(textArr, { x: x + 0.1, y: 1.75, w: 2.9, h: 3.4, valign: "top" });
});
// Neonatal note
s.addShape(pres.ShapeType.rect, { x: 0.25, y: 5.1, w: 9.5, h: 0.3, fill: { color: OFFWHITE }, line: { color: RULE, width: 0.5 } });
s.addText([
{ text: "NEONATAL PRIAPISM: ", options: { bold: true, fontSize: 10, color: BLACK } },
{ text: "Polycythemia, infection, forceps-assisted delivery, respiratory distress syndrome, UAC manipulation.", options: { fontSize: 10, color: DARK } }
], { x: 0.35, y: 5.1, w: 9.3, h: 0.3, valign: "middle" });
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — TREATMENT
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: WHITE } });
addTitleBar(s, "08 | TREATMENT");
// Fetch management flowchart image
const flowUrl = "https://cdn.orris.care/cdss_images/8e9973b1867bd6ec17b0b5162757489d46fc2578c48adac73e2296cc045e19f7.png";
let flowData = null;
try {
const result = execSync(
`node /home/daytona/skills/shared/scripts/fetch_images.js "${flowUrl}"`,
{ timeout: 30000 }
).toString();
const parsed = JSON.parse(result);
if (parsed[0] && !parsed[0].error) flowData = parsed[0].base64;
} catch(e) { console.error("Flow image fetch failed:", e.message); }
// Left: step-by-step treatment
s.addText("ISCHEMIC PRIAPISM — STEPWISE MANAGEMENT", { x: 0.25, y: 0.82, w: 5.4, h: 0.3, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
const steps = [
{ num: "1", text: "CONSERVATIVE (< 4 hrs): exercise, urination, cold packs (avoid in SCD)" },
{ num: "2", text: "PAIN CONTROL + HYDRATION + dorsal penile nerve block (lidocaine without epi)" },
{ num: "3", text: "CORPORAL ASPIRATION: 19–23G butterfly needle at 3 or 9 o'clock; aspirate in 5 mL aliquots until bright red" },
{ num: "4", text: "INTRACAVERNOSAL PHENYLEPHRINE: 100–500 mcg q5 min (preferred α-agonist; cardiac monitoring required)" },
{ num: "5", text: "SURGICAL SHUNT (if fails): Distal → Ebbehoj / Winter / T-shunt → Al-Ghorab; Proximal → Quackels; Tunneling (Lue/Burnett)" },
{ num: "6", text: "PENILE PROSTHESIS: for ischemia > 48–72 hrs; early implant preferred (< 4 weeks)" }
];
steps.forEach((step, i) => {
const y = 1.2 + i * 0.68;
s.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 0.38, h: 0.5, fill: { color: DARK } });
s.addText(step.num, { x: 0.25, y, w: 0.38, h: 0.5, fontSize: 13, bold: true, color: WHITE, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
s.addShape(pres.ShapeType.rect, { x: 0.63, y, w: 5.0, h: 0.5, fill: { color: i % 2 === 0 ? OFFWHITE : WHITE }, line: { color: RULE, width: 0.5 } });
s.addText(step.text, { x: 0.73, y, w: 4.85, h: 0.5, fontSize: 10, color: DARK, fontFace: "Arial", valign: "middle" });
});
// Right: image or non-ischemic + sickle cell
if (flowData) {
s.addImage({ data: flowData, x: 5.85, y: 0.82, w: 3.9, h: 3.5 });
s.addText("Fig: Management algorithm for ischemic priapism\n(Smith & Tanagho's General Urology)", {
x: 5.85, y: 4.3, w: 3.9, h: 0.35, fontSize: 8, color: MID, fontFace: "Arial", italic: true, align: "center"
});
} else {
s.addShape(pres.ShapeType.rect, { x: 5.85, y: 0.82, w: 3.9, h: 3.0, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addText("Management algorithm\n(see Fig 39-7, Smith & Tanagho's)", { x: 5.85, y: 2.0, w: 3.9, h: 1.0, fontSize: 11, color: MID, fontFace: "Arial", align: "center" });
}
// Non-ischemic + SCD footer
s.addShape(pres.ShapeType.rect, { x: 0.25, y: 5.0, w: 9.5, h: 0.5, fill: { color: OFFWHITE }, line: { color: RULE, width: 1 } });
s.addText([
{ text: "NON-ISCHEMIC: ", options: { bold: true, fontSize: 10, color: BLACK } },
{ text: "Observation → androgen ablation (1–3 months) → selective arterial embolization → surgery (last resort). ", options: { fontSize: 10, color: DARK } },
{ text: "SCD STUTTERING: ", options: { bold: true, fontSize: 10, color: BLACK } },
{ text: "Hydration, O₂, alkalisation, analgesia, exchange transfusion; pseudoephedrine at bedtime; PDE5 inhibitor (long-term, low-dose) may prevent recurrence.", options: { fontSize: 10, color: DARK } }
], { x: 0.35, y: 5.0, w: 9.3, h: 0.5, valign: "middle" });
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — SUMMARY / KEY POINTS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: BLACK } });
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: DARK } });
s.addText("09 | KEY TAKEAWAYS", {
x: 0.25, y: 0, w: 9.5, h: 0.75, fontSize: 22, bold: true, color: WHITE, fontFace: "Arial", valign: "middle", margin: 0
});
const keyPoints = [
["1", "Priapism = penile erection > 4 hours, unrelated to sexual stimulation; three types: ischemic, non-ischemic, stuttering."],
["2", "Ischemic priapism is a UROLOGIC EMERGENCY — time-sensitive; delays cause fibrosis and permanent erectile dysfunction."],
["3", "Sickle cell disease is the most common identifiable cause (65% pediatric cases; up to 89% of SCD males affected)."],
["4", "Cavernosal blood gas differentiates types: ischemic = hypoxic, acidotic; non-ischemic = hyperoxic, normal pH."],
["5", "First-line treatment: phenylephrine intracavernosal injection after corporal aspiration; surgical shunts for refractory cases."],
["6", "Long-term PDE5 inhibitor therapy (paradoxical) may prevent stuttering priapism by correcting NO/cGMP dysregulation."]
];
keyPoints.forEach((kp, i) => {
const y = 0.85 + i * 0.72;
s.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 0.45, h: 0.52, fill: { color: WHITE } });
s.addText(kp[0], { x: 0.25, y, w: 0.45, h: 0.52, fontSize: 16, bold: true, color: BLACK, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
s.addShape(pres.ShapeType.rect, { x: 0.7, y, w: 9.0, h: 0.52, fill: { color: DARK }, line: { color: MID, width: 0.5 } });
s.addText(kp[1], { x: 0.8, y, w: 8.8, h: 0.52, fontSize: 12, color: WHITE, fontFace: "Arial", valign: "middle" });
});
s.addText("References: Smith & Tanagho's General Urology 19e · Campbell-Walsh-Wein Urology 12e · Rosen's Emergency Medicine 9e · Goldman-Cecil Medicine", {
x: 0.25, y: 5.3, w: 9.5, h: 0.25, fontSize: 8, color: LIGHT, fontFace: "Arial", italic: true
});
}
// ─── Write file ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/priapism-ppt/Priapism.pptx" })
.then(() => console.log("SUCCESS: Priapism.pptx created"))
.catch(err => { console.error("ERROR:", err); process.exit(1); });
Running Command
cd /home/daytona/workspace/priapism-ppt && node build.js 2>&1
Running Command
ls -lh /home/daytona/workspace/priapism-ppt/Priapism.pptx
Your presentation is ready! Here's the download link:
Priapism
Presentation · PPTX
What's inside (10 slides, black & white print-friendly):
| Slide | Content |
|---|---|
| 1 | Title Slide - Bold black cover with topic overview |
| 2 | Definition - Full definition + three types (Ischemic / Non-Ischemic / Stuttering) in labeled boxes |
| 3 | Etiology - 4 categories: Hematologic, Medications, Neurogenic, Traumatic/Other |
| 4 | Pathogenesis - Visual step-by-step flow diagrams for both ischemic and non-ischemic pathways |
| 5 | Clinical Manifestations - Side-by-side comparison table of all 3 types across 7 features |
| 6 | Penile Anatomy Diagram - Textbook image (Fig. 168.1) + key structures labeled with clinical relevance |
| 7 | Diagnosis - Clinical approach, labs, cavernosal blood gas table (ischemic vs. non-ischemic values), CDU |
| 8 | Differential Diagnosis - Three-column table: Ischemic causes / Non-ischemic causes / Medication-induced |
| 9 | Treatment - Numbered stepwise management (conservative → aspiration → phenylephrine → shunts → prosthesis) + management algorithm image + non-ischemic/SCD notes |
| 10 | Key Takeaways - 6 high-yield summary points on dark background |
All content is sourced from Smith & Tanagho's General Urology (19e), Campbell-Walsh-Wein Urology, Rosen's Emergency Medicine, and Goldman-Cecil Medicine.
Can you make it simple white pages
Reading File
Writing File
~/priapism-ppt/build_simple.js
const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Priapism";
// Simple white palette
const BLACK = "000000";
const WHITE = "FFFFFF";
const DARK = "222222";
const MID = "555555";
const LIGHT = "888888";
const RULE = "BBBBBB";
const HEADBG = "F0F0F0"; // very light grey for headers
const ALTROW = "FAFAFA"; // near-white alt rows
// ── Title bar: simple bottom border line, white bg ──────────────────────────
function addTitleBar(slide, title) {
slide.addText(title, {
x: 0.35, y: 0.12, w: 9.3, h: 0.6,
fontSize: 24, bold: true, color: BLACK, fontFace: "Arial",
valign: "middle", margin: 0
});
slide.addShape(pres.ShapeType.line, {
x: 0.35, y: 0.72, w: 9.3, h: 0,
line: { color: BLACK, width: 1.5 }
});
}
// ── Thin rule ────────────────────────────────────────────────────────────────
function addRule(slide, y) {
slide.addShape(pres.ShapeType.line, {
x: 0.35, y, w: 9.3, h: 0,
line: { color: RULE, width: 0.8 }
});
}
// ── Bullet list ──────────────────────────────────────────────────────────────
function addBullets(slide, items, x, y, w, h, fontSize) {
const fs = fontSize || 13;
const textArr = items.map((item, i) => ({
text: item,
options: { bullet: true, breakLine: i < items.length - 1, color: DARK, fontSize: fs, fontFace: "Arial" }
}));
slide.addText(textArr, { x, y, w, h, valign: "top" });
}
// ── Section heading ──────────────────────────────────────────────────────────
function addSectionHead(slide, text, x, y, w) {
slide.addText(text, {
x, y, w, h: 0.28,
fontSize: 10, bold: true, color: MID, fontFace: "Arial",
charSpacing: 2, underline: false
});
slide.addShape(pres.ShapeType.line, {
x, y: y + 0.28, w, h: 0,
line: { color: RULE, width: 0.6 }
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
// All white bg — no fill needed (default)
// Large title
s.addText("PRIAPISM", {
x: 0.5, y: 1.2, w: 9, h: 1.2,
fontSize: 52, bold: true, color: BLACK, fontFace: "Arial", align: "left"
});
// Subtitle line
s.addShape(pres.ShapeType.line, {
x: 0.5, y: 2.5, w: 9, h: 0,
line: { color: BLACK, width: 2 }
});
s.addText("A Comprehensive Medical Overview", {
x: 0.5, y: 2.6, w: 9, h: 0.45,
fontSize: 16, color: MID, fontFace: "Arial", align: "left", italic: true
});
s.addText("Definition | Etiology | Pathogenesis | Clinical Manifestations\nDiagnosis | Differential Diagnosis | Treatment", {
x: 0.5, y: 3.1, w: 9, h: 0.7,
fontSize: 12, color: LIGHT, fontFace: "Arial", align: "left"
});
// Footer
s.addShape(pres.ShapeType.line, {
x: 0.5, y: 5.2, w: 9, h: 0,
line: { color: RULE, width: 0.8 }
});
s.addText("Sources: Smith & Tanagho's General Urology 19e · Campbell-Walsh-Wein Urology 12e · Rosen's Emergency Medicine 9e · Goldman-Cecil Medicine", {
x: 0.5, y: 5.25, w: 9, h: 0.28,
fontSize: 8, color: LIGHT, fontFace: "Arial", align: "left"
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — DEFINITION
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "DEFINITION");
// Definition quote box
s.addShape(pres.ShapeType.rect, {
x: 0.35, y: 0.85, w: 9.3, h: 1.05,
fill: { color: HEADBG }, line: { color: RULE, width: 1 }
});
s.addShape(pres.ShapeType.rect, { x: 0.35, y: 0.85, w: 0.08, h: 1.05, fill: { color: BLACK } });
s.addText([
{ text: "Priapism ", options: { bold: true, fontSize: 14, color: BLACK } },
{ text: "is a prolonged, persistent penile erection ", options: { fontSize: 14, color: DARK } },
{ text: "unrelated to sexual interest or stimulation", options: { bold: true, fontSize: 14, color: BLACK } },
{ text: " lasting longer than ", options: { fontSize: 14, color: DARK } },
{ text: "4 hours.", options: { bold: true, fontSize: 14, color: BLACK } }
], { x: 0.55, y: 0.85, w: 9.0, h: 1.05, valign: "middle" });
// Three types
s.addText("THREE RECOGNIZED TYPES", {
x: 0.35, y: 2.05, w: 9.3, h: 0.3,
fontSize: 11, bold: true, color: MID, fontFace: "Arial", charSpacing: 2
});
addRule(s, 2.35);
const types = [
{ title: "ISCHEMIC (Low-Flow)", num: "01", desc: ["Most common type", "Venous outflow obstruction", "Compartment syndrome of penis", "Urologic EMERGENCY", "Painful, fully rigid corpora"] },
{ title: "NON-ISCHEMIC (High-Flow)", num: "02", desc: ["Result of perineal/penile trauma", "Arterio-cavernous fistula", "Unregulated arterial inflow", "NOT an emergency", "Painless, partial rigidity"] },
{ title: "STUTTERING (Recurrent)", num: "03", desc: ["Recurrent ischemic episodes", "< 4 hours each, self-limited", "Common in sickle cell disease", "Aberrant NO/cGMP signaling", "Risk of cumulative ED"] }
];
types.forEach((t, i) => {
const x = 0.35 + i * 3.15;
// Header
s.addShape(pres.ShapeType.rect, { x, y: 2.45, w: 3.05, h: 0.38, fill: { color: HEADBG }, line: { color: RULE, width: 1 } });
s.addText(t.title, { x: x + 0.08, y: 2.45, w: 2.9, h: 0.38, fontSize: 10, bold: true, color: BLACK, fontFace: "Arial", valign: "middle" });
// Body
s.addShape(pres.ShapeType.rect, { x, y: 2.83, w: 3.05, h: 2.5, fill: { color: WHITE }, line: { color: RULE, width: 1 } });
const textArr = t.desc.map((d, ii) => ({
text: d,
options: { bullet: true, breakLine: ii < t.desc.length - 1, color: DARK, fontSize: 12, fontFace: "Arial" }
}));
s.addText(textArr, { x: x + 0.1, y: 2.9, w: 2.85, h: 2.3, valign: "top" });
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — ETIOLOGY
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "ETIOLOGY");
const cats = [
{ label: "Hematologic", items: ["Sickle cell disease (most common)", "Thalassemia", "Leukemia / lymphoma", "Polycythemia", "G6PD deficiency"] },
{ label: "Medications", items: ["Intracavernosal injections (alprostadil, papaverine)", "PDE-5 inhibitors (sildenafil, tadalafil)", "Antipsychotics (chlorpromazine, risperidone, trazodone)", "Antidepressants (SSRIs)", "Antihypertensives (prazosin, hydralazine)"] },
{ label: "Neurogenic", items: ["Spinal cord injury", "Cauda equina syndrome", "Multiple sclerosis", "Autonomic neuropathy", "Lumbar disc herniation"] },
{ label: "Traumatic / Other", items: ["Perineal or penile trauma → high-flow", "Pelvic / penile malignancy", "Infections (malaria, scorpion/spider toxin)", "Alcohol, cocaine, marijuana", "Idiopathic (~50% of cases)"] }
];
cats.forEach((cat, i) => {
const col = i % 2;
const row = Math.floor(i / 2);
const x = 0.35 + col * 4.75;
const y = 0.9 + row * 2.3;
// Header
s.addShape(pres.ShapeType.rect, { x, y, w: 4.55, h: 0.35, fill: { color: HEADBG }, line: { color: RULE, width: 1 } });
s.addText(cat.label, { x: x + 0.1, y, w: 4.35, h: 0.35, fontSize: 11, bold: true, color: BLACK, fontFace: "Arial", valign: "middle" });
// Body
s.addShape(pres.ShapeType.rect, { x, y: y + 0.35, w: 4.55, h: 1.85, fill: { color: WHITE }, line: { color: RULE, width: 1 } });
const textArr = cat.items.map((item, ii) => ({
text: item,
options: { bullet: true, breakLine: ii < cat.items.length - 1, color: DARK, fontSize: 11, fontFace: "Arial" }
}));
s.addText(textArr, { x: x + 0.1, y: y + 0.4, w: 4.35, h: 1.75, valign: "top" });
});
// Footer note
s.addShape(pres.ShapeType.line, { x: 0.35, y: 5.28, w: 9.3, h: 0, line: { color: RULE, width: 0.6 } });
s.addText("Note: Sickle cell disease accounts for up to 65% of pediatric priapism cases. ~50% of all adult cases are idiopathic.", {
x: 0.35, y: 5.3, w: 9.3, h: 0.25, fontSize: 9, color: LIGHT, fontFace: "Arial", italic: true
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — PATHOGENESIS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "PATHOGENESIS");
// ── Ischemic flow ──────────────────────────────────────────────────────────
s.addText("ISCHEMIC (LOW-FLOW)", { x: 0.35, y: 0.85, w: 4.5, h: 0.28, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
addRule(s, 1.13);
const ishSteps = [
"Venous outflow obstruction from corpora cavernosa",
"Arterial inflow halts → blood stasis",
"Hypoxia + Hypercapnia + Acidosis",
"Endothelial & smooth muscle damage",
"Fibrosis of corpora → Erectile dysfunction"
];
ishSteps.forEach((step, i) => {
const y = 1.2 + i * 0.68;
const isLast = i === ishSteps.length - 1;
s.addShape(pres.ShapeType.rect, {
x: 0.35, y, w: 4.5, h: 0.5,
fill: { color: isLast ? HEADBG : WHITE },
line: { color: isLast ? BLACK : RULE, width: isLast ? 1.5 : 1 }
});
s.addText(step, {
x: 0.45, y, w: 4.3, h: 0.5,
fontSize: 11, color: BLACK, fontFace: "Arial", valign: "middle",
bold: isLast
});
if (!isLast) {
s.addText("▼", { x: 0.35, y: y + 0.5, w: 4.5, h: 0.18, fontSize: 10, color: LIGHT, fontFace: "Arial", align: "center", valign: "middle" });
}
});
// ── Non-ischemic flow ──────────────────────────────────────────────────────
s.addText("NON-ISCHEMIC (HIGH-FLOW)", { x: 5.15, y: 0.85, w: 4.5, h: 0.28, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
addRule(s, 1.13);
const niSteps = [
"Trauma to perineum or penis",
"Injury to cavernosal / helicine artery",
"Arterio-cavernous fistula forms",
"Unregulated arterial inflow to sinusoids",
"Persistent tumescence — oxygenated, painless"
];
niSteps.forEach((step, i) => {
const y = 1.2 + i * 0.68;
const isLast = i === niSteps.length - 1;
s.addShape(pres.ShapeType.rect, {
x: 5.15, y, w: 4.5, h: 0.5,
fill: { color: isLast ? HEADBG : WHITE },
line: { color: isLast ? BLACK : RULE, width: isLast ? 1.5 : 1 }
});
s.addText(step, {
x: 5.25, y, w: 4.3, h: 0.5,
fontSize: 11, color: BLACK, fontFace: "Arial", valign: "middle",
bold: isLast, italic: isLast
});
if (!isLast) {
s.addText("▼", { x: 5.15, y: y + 0.5, w: 4.5, h: 0.18, fontSize: 10, color: LIGHT, fontFace: "Arial", align: "center", valign: "middle" });
}
});
// Vertical divider
s.addShape(pres.ShapeType.line, { x: 4.9, y: 0.85, w: 0, h: 4.6, line: { color: RULE, width: 1 } });
// Stuttering note
addRule(s, 4.75);
s.addText([
{ text: "STUTTERING PRIAPISM: ", options: { bold: true, fontSize: 11, color: BLACK } },
{ text: "Aberrant PDE5 / NO / cGMP signaling; microvascular occlusion by sickled RBCs; episodes triggered during sleep (hypoventilatory acidosis ↓ O₂ tension in corpora).", options: { fontSize: 11, color: DARK } }
], { x: 0.35, y: 4.8, w: 9.3, h: 0.6, valign: "middle" });
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — CLINICAL MANIFESTATIONS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "CLINICAL MANIFESTATIONS");
const headers = ["Feature", "Ischemic (Low-Flow)", "Non-Ischemic (High-Flow)", "Stuttering"];
const colW = [1.8, 2.7, 2.7, 1.8];
const colX = [0.35, 2.15, 4.85, 7.55];
// Header row
headers.forEach((h, i) => {
s.addShape(pres.ShapeType.rect, { x: colX[i], y: 0.85, w: colW[i] - 0.05, h: 0.4, fill: { color: HEADBG }, line: { color: RULE, width: 1 } });
s.addText(h, { x: colX[i] + 0.05, y: 0.85, w: colW[i] - 0.1, h: 0.4, fontSize: 10, bold: true, color: BLACK, fontFace: "Arial", valign: "middle", align: "center" });
});
const rows = [
["Onset", "Gradual, progressive", "After trauma", "Episodic, recurrent"],
["Pain", "Yes — ischemic pain", "Usually painless", "Painful each episode"],
["Rigidity", "Fully rigid, tender corpora", "Partial; soft glans", "Rigid during episode"],
["Duration", "> 4 hours", "Hours to days", "< 4 hrs; recurrent"],
["Emergency?", "YES", "No — observe", "Monitor"],
["Blood gas", "Hypoxic, acidotic, hypercapnic", "Normal / hyperoxic", "Hypoxic (ischemic)"],
["Complication", "ED, fibrosis, necrosis", "Low risk if treated", "Cumulative ED risk"]
];
rows.forEach((row, ri) => {
const y = 1.25 + ri * 0.53;
const bg = ri % 2 === 0 ? WHITE : ALTROW;
row.forEach((cell, ci) => {
s.addShape(pres.ShapeType.rect, { x: colX[ci], y, w: colW[ci] - 0.05, h: 0.5, fill: { color: bg }, line: { color: RULE, width: 0.5 } });
s.addText(cell, {
x: colX[ci] + 0.05, y, w: colW[ci] - 0.1, h: 0.5,
fontSize: 10, color: DARK, fontFace: "Arial", valign: "middle",
bold: ci === 0,
color: (ci === 1 && ri === 4) ? BLACK : DARK
});
});
});
addRule(s, 5.12);
s.addText("Clinical hallmark: rigid corpora cavernosa with relatively SOFT GLANS — corpus spongiosum is typically spared.", {
x: 0.35, y: 5.16, w: 9.3, h: 0.28, fontSize: 10, color: MID, fontFace: "Arial", italic: true
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — PENILE ANATOMY DIAGRAM
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "PENILE ANATOMY — KEY STRUCTURES");
// Fetch anatomy image
const imgUrl = "https://cdn.orris.care/cdss_images/cab7ea6f0fbb6cfd9f273021e6746b7d449c6603596d2d60c1e4fe422945b74c.png";
let imgData = null;
try {
const result = execSync(`node /home/daytona/skills/shared/scripts/fetch_images.js "${imgUrl}"`, { timeout: 30000 }).toString();
const parsed = JSON.parse(result);
if (parsed[0] && !parsed[0].error) imgData = parsed[0].base64;
} catch(e) {}
if (imgData) {
s.addImage({ data: imgData, x: 0.35, y: 0.88, w: 4.3, h: 4.4 });
} else {
s.addShape(pres.ShapeType.rect, { x: 0.35, y: 0.88, w: 4.3, h: 4.4, fill: { color: ALTROW }, line: { color: RULE, width: 1 } });
s.addText("[Penile anatomy diagram — Fig. 168.1]", { x: 0.35, y: 2.8, w: 4.3, h: 0.5, fontSize: 11, color: MID, fontFace: "Arial", align: "center" });
}
s.addText("Fig. 168.1 — Anatomy of the penis showing flaccid vs. erect state\n(Rosen's Emergency Medicine, 9e)", {
x: 0.35, y: 5.3, w: 4.3, h: 0.3, fontSize: 8, color: LIGHT, fontFace: "Arial", align: "center", italic: true
});
// Divider
s.addShape(pres.ShapeType.line, { x: 4.85, y: 0.88, w: 0, h: 4.5, line: { color: RULE, width: 1 } });
// Right: structures table
s.addText("STRUCTURE & CLINICAL RELEVANCE", { x: 5.0, y: 0.9, w: 4.7, h: 0.28, fontSize: 10, bold: true, color: MID, charSpacing: 2, fontFace: "Arial" });
addRule(s, 1.18);
const structs = [
["Corpora Cavernosa (×2)", "Primary erectile cylinders; site of ischemia, aspiration, and shunting"],
["Corpus Spongiosum", "Surrounds urethra; usually SPARED → glans remains soft"],
["Tunica Albuginea", "Fibrous sheath encasing corpora; incised during shunt procedures"],
["Cavernosal Artery", "Branch of internal pudendal artery; injured in high-flow priapism"],
["Helicine Arteries", "Regulate sinusoidal flow; fistula formation → non-ischemic type"],
["Penile Dorsal Vein", "Outflow vessel; obstruction drives ischemic priapism"]
];
structs.forEach((st, i) => {
const y = 1.25 + i * 0.65;
s.addShape(pres.ShapeType.rect, { x: 5.0, y, w: 4.7, h: 0.58, fill: { color: i % 2 === 0 ? WHITE : ALTROW }, line: { color: RULE, width: 0.5 } });
s.addText(st[0], { x: 5.1, y: y + 0.02, w: 4.5, h: 0.26, fontSize: 11, bold: true, color: BLACK, fontFace: "Arial" });
s.addText(st[1], { x: 5.1, y: y + 0.28, w: 4.5, h: 0.26, fontSize: 10, color: MID, fontFace: "Arial" });
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — DIAGNOSIS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "DIAGNOSIS");
// Left column
addSectionHead(s, "CLINICAL APPROACH", 0.35, 0.85, 4.55);
addBullets(s, [
"History: duration, sexual activity, medications, trauma, sickle cell disease",
"Physical exam: rigid corpora cavernosa, soft glans, tenderness",
"Priapism is primarily a CLINICAL diagnosis"
], 0.35, 1.2, 4.55, 0.95, 11);
addSectionHead(s, "LABORATORY TESTS", 0.35, 2.25, 4.55);
addBullets(s, [
"CBC + reticulocyte count",
"Hemoglobin electrophoresis (SCD, thalassemia)",
"Coagulation studies",
"Urine toxicology screen",
"Cavernosal blood gas — gold standard for subtype"
], 0.35, 2.6, 4.55, 1.55, 11);
addSectionHead(s, "IMAGING", 0.35, 4.28, 4.55);
s.addText("Color Duplex Ultrasonography (CDU): identifies absence of flow (ischemic) vs. high-flow fistula (non-ischemic); confirms resolution post-treatment.", {
x: 0.35, y: 4.58, w: 4.55, h: 0.7, fontSize: 11, color: DARK, fontFace: "Arial", valign: "top"
});
// Divider
s.addShape(pres.ShapeType.line, { x: 5.15, y: 0.85, w: 0, h: 4.5, line: { color: RULE, width: 1 } });
// Right: blood gas table
addSectionHead(s, "CAVERNOSAL BLOOD GAS — DIFFERENTIATING SUBTYPES", 5.3, 0.85, 4.35);
const bgHeaders = ["Parameter", "Ischemic", "Non-Ischemic"];
const bgW = [1.3, 1.5, 1.5];
const bgX = [5.3, 6.6, 8.1];
bgHeaders.forEach((h, i) => {
s.addShape(pres.ShapeType.rect, { x: bgX[i], y: 1.2, w: bgW[i] - 0.05, h: 0.38, fill: { color: HEADBG }, line: { color: RULE, width: 1 } });
s.addText(h, { x: bgX[i] + 0.05, y: 1.2, w: bgW[i] - 0.1, h: 0.38, fontSize: 10, bold: true, color: BLACK, fontFace: "Arial", valign: "middle", align: "center" });
});
const bgRows = [
["pO₂", "< 30 mmHg", "> 90 mmHg"],
["pCO₂", "> 60 mmHg", "< 40 mmHg"],
["pH", "< 7.25", "7.38 – 7.40"],
["Color", "Dark, deoxygenated", "Bright red"],
["Flow", "Absent / minimal", "Pulsatile, high"]
];
bgRows.forEach((row, ri) => {
const bg = ri % 2 === 0 ? WHITE : ALTROW;
row.forEach((cell, ci) => {
const y = 1.58 + ri * 0.44;
s.addShape(pres.ShapeType.rect, { x: bgX[ci], y, w: bgW[ci] - 0.05, h: 0.4, fill: { color: bg }, line: { color: RULE, width: 0.5 } });
s.addText(cell, { x: bgX[ci] + 0.05, y, w: bgW[ci] - 0.1, h: 0.4, fontSize: 10, color: DARK, fontFace: "Arial", valign: "middle", bold: ci === 0 });
});
});
addSectionHead(s, "NOTE", 5.3, 3.88, 4.35);
s.addText("Send aspirated blood for gas analysis before saline irrigation. CDU should always follow treatment to confirm resolution or detect conversion to high-flow state.", {
x: 5.3, y: 4.2, w: 4.35, h: 0.8, fontSize: 11, color: DARK, fontFace: "Arial", valign: "top"
});
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — DIFFERENTIAL DIAGNOSIS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "DIFFERENTIAL DIAGNOSIS");
s.addText("Priapism is a clinical diagnosis. The differential concerns identifying the TYPE and UNDERLYING CAUSE.", {
x: 0.35, y: 0.82, w: 9.3, h: 0.32, fontSize: 11, color: MID, fontFace: "Arial", italic: true
});
const ddCols = [
{
head: "ISCHEMIC CAUSES",
items: ["Sickle cell disease / thalassemia", "G6PD deficiency", "Leukemia / lymphoma", "Infection (malaria, UTI)", "Neurogenic (SCI, cauda equina)", "Toxin (scorpion, spider bite)", "Henoch-Schönlein purpura"]
},
{
head: "NON-ISCHEMIC CAUSES",
items: ["Perineal / penile trauma", "Post-surgical arteriocavernous fistula", "Hematologic (SCD, leukemia) — rare", "Fabry disease", "Iatrogenic (surgical injury)", "", ""]
},
{
head: "MEDICATION-INDUCED",
items: ["Intracavernosal alprostadil / papaverine", "PDE-5 inhibitors", "Testosterone / anabolic steroids", "Antipsychotics (trazodone, chlorpromazine)", "Antidepressants (SSRIs)", "Antihypertensives (prazosin, hydralazine)", "Alcohol, cocaine, marijuana"]
}
];
ddCols.forEach((col, i) => {
const x = 0.35 + i * 3.2;
s.addShape(pres.ShapeType.rect, { x, y: 1.25, w: 3.1, h: 0.38, fill: { color: HEADBG }, line: { color: RULE, width: 1 } });
s.addText(col.head, { x: x + 0.1, y: 1.25, w: 2.9, h: 0.38, fontSize: 10, bold: true, color: BLACK, fontFace: "Arial", valign: "middle" });
s.addShape(pres.ShapeType.rect, { x, y: 1.63, w: 3.1, h: 3.3, fill: { color: WHITE }, line: { color: RULE, width: 1 } });
const validItems = col.items.filter(it => it.trim() !== "");
const textArr = validItems.map((item, ii) => ({
text: item,
options: { bullet: true, breakLine: ii < validItems.length - 1, color: DARK, fontSize: 11, fontFace: "Arial" }
}));
s.addText(textArr, { x: x + 0.1, y: 1.7, w: 2.9, h: 3.15, valign: "top" });
});
addRule(s, 5.1);
s.addText([
{ text: "NEONATAL: ", options: { bold: true, fontSize: 10, color: BLACK } },
{ text: "Polycythemia, infection, forceps-assisted delivery, respiratory distress syndrome, umbilical arterial catheter (UAC) manipulation.", options: { fontSize: 10, color: DARK } }
], { x: 0.35, y: 5.14, w: 9.3, h: 0.28, valign: "middle" });
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — TREATMENT
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "TREATMENT");
// Left: stepwise management
addSectionHead(s, "ISCHEMIC PRIAPISM — STEPWISE MANAGEMENT", 0.35, 0.82, 5.4);
const steps = [
{ n: "1", t: "CONSERVATIVE (< 4 hrs): exercise, urination, cold packs (avoid cold in SCD)" },
{ n: "2", t: "PAIN CONTROL + HYDRATION + dorsal penile nerve block (lidocaine without epinephrine)" },
{ n: "3", t: "CORPORAL ASPIRATION: 19–23G butterfly at 3 or 9 o'clock; aspirate 5 mL aliquots until bright red" },
{ n: "4", t: "INTRACAVERNOSAL PHENYLEPHRINE: 100–500 mcg q5 min (preferred α-agonist; requires cardiac monitoring)" },
{ n: "5", t: "SURGICAL SHUNT: Distal (Ebbehoj / Winter / T-shunt / Al-Ghorab) → Proximal (Quackels) → Tunneling (Lue / Burnett)" },
{ n: "6", t: "PENILE PROSTHESIS: for ischemia > 48–72 hrs; early implantation (< 4 weeks) preferred" }
];
steps.forEach((step, i) => {
const y = 1.18 + i * 0.66;
s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.42, h: 0.52, fill: { color: HEADBG }, line: { color: RULE, width: 1 } });
s.addText(step.n, { x: 0.35, y, w: 0.42, h: 0.52, fontSize: 14, bold: true, color: BLACK, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
s.addShape(pres.ShapeType.rect, { x: 0.77, y, w: 5.0, h: 0.52, fill: { color: i % 2 === 0 ? WHITE : ALTROW }, line: { color: RULE, width: 0.5 } });
s.addText(step.t, { x: 0.87, y, w: 4.85, h: 0.52, fontSize: 10, color: DARK, fontFace: "Arial", valign: "middle" });
});
// Right: management flowchart image
s.addShape(pres.ShapeType.line, { x: 6.05, y: 0.85, w: 0, h: 4.5, line: { color: RULE, width: 1 } });
const flowUrl = "https://cdn.orris.care/cdss_images/8e9973b1867bd6ec17b0b5162757489d46fc2578c48adac73e2296cc045e19f7.png";
let flowData = null;
try {
const result = execSync(`node /home/daytona/skills/shared/scripts/fetch_images.js "${flowUrl}"`, { timeout: 30000 }).toString();
const parsed = JSON.parse(result);
if (parsed[0] && !parsed[0].error) flowData = parsed[0].base64;
} catch(e) {}
if (flowData) {
s.addImage({ data: flowData, x: 6.15, y: 0.82, w: 3.55, h: 3.3 });
s.addText("Fig. 39-7: Ischemic priapism management algorithm\n(Smith & Tanagho's General Urology, 19e)", {
x: 6.15, y: 4.15, w: 3.55, h: 0.35, fontSize: 8, color: LIGHT, fontFace: "Arial", italic: true, align: "center"
});
} else {
s.addShape(pres.ShapeType.rect, { x: 6.15, y: 0.82, w: 3.55, h: 3.0, fill: { color: ALTROW }, line: { color: RULE, width: 1 } });
s.addText("Management algorithm\n(Fig. 39-7, Smith & Tanagho's)", { x: 6.15, y: 2.1, w: 3.55, h: 0.7, fontSize: 11, color: MID, fontFace: "Arial", align: "center" });
}
// Footer: non-ischemic + SCD
addRule(s, 5.05);
s.addText([
{ text: "NON-ISCHEMIC: ", options: { bold: true, fontSize: 10, color: BLACK } },
{ text: "Observation → androgen ablation (1–3 months) → selective arterial embolization → surgery (last resort). ", options: { fontSize: 10, color: DARK } },
{ text: "STUTTERING / SCD: ", options: { bold: true, fontSize: 10, color: BLACK } },
{ text: "Hydration, O₂, alkalisation, analgesia, exchange transfusion; pseudoephedrine at bedtime; long-term low-dose PDE5 inhibitor to prevent recurrence.", options: { fontSize: 10, color: DARK } }
], { x: 0.35, y: 5.08, w: 9.3, h: 0.4, valign: "middle" });
}
// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — KEY TAKEAWAYS
// ════════════════════════════════════════════════════════════════════════════
{
const s = pres.addSlide();
addTitleBar(s, "KEY TAKEAWAYS");
const points = [
"Priapism = penile erection > 4 hours, unrelated to sexual stimulation; three types: ischemic, non-ischemic, stuttering.",
"Ischemic priapism is a UROLOGIC EMERGENCY — every hour of delay increases risk of permanent erectile dysfunction and fibrosis.",
"Sickle cell disease is the most common identifiable cause (65% pediatric; up to 89% of SCD males affected by age 20).",
"Cavernosal blood gas is the gold standard: ischemic = pO₂ < 30, pCO₂ > 60, pH < 7.25; non-ischemic = hyperoxic, normal pH.",
"First-line treatment: corporal aspiration + intracavernosal phenylephrine; surgical shunts for refractory cases.",
"Long-term low-dose PDE5 inhibitors (paradoxically) prevent stuttering priapism by restoring NO/cGMP regulation."
];
points.forEach((pt, i) => {
const y = 0.88 + i * 0.72;
s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.42, h: 0.55, fill: { color: HEADBG }, line: { color: RULE, width: 1 } });
s.addText(String(i + 1), { x: 0.35, y, w: 0.42, h: 0.55, fontSize: 15, bold: true, color: BLACK, fontFace: "Arial", align: "center", valign: "middle", margin: 0 });
s.addShape(pres.ShapeType.rect, { x: 0.77, y, w: 8.9, h: 0.55, fill: { color: i % 2 === 0 ? WHITE : ALTROW }, line: { color: RULE, width: 0.5 } });
s.addText(pt, { x: 0.87, y, w: 8.75, h: 0.55, fontSize: 12, color: DARK, fontFace: "Arial", valign: "middle" });
});
addRule(s, 5.2);
s.addText("References: Smith & Tanagho's General Urology 19e · Campbell-Walsh-Wein Urology 12e · Rosen's Emergency Medicine 9e · Goldman-Cecil Medicine", {
x: 0.35, y: 5.25, w: 9.3, h: 0.25, fontSize: 8, color: LIGHT, fontFace: "Arial", italic: true
});
}
// ─── Write ────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/priapism-ppt/Priapism_Simple.pptx" })
.then(() => console.log("SUCCESS: Priapism_Simple.pptx created"))
.catch(err => { console.error("ERROR:", err); process.exit(1); });
Running Command
cd /home/daytona/workspace/priapism-ppt && node build_simple.js 2>&1
Running Command
ls -lh /home/daytona/workspace/priapism-ppt/Priapism_Simple.pptx
Done! Here's your clean white version:
Priapism Simple
Presentation · PPTX
What changed:
- All slides are pure white backgrounds
- No dark/black filled boxes or colored backgrounds
- Titles use a simple bold text with a thin black underline
- Tables use very light grey (#F0F0F0) for headers and near-white alternating rows
- All text in black/dark grey - clean and print-friendly
- Diagrams and structure tables remain, just on white backgrounds
- Same 10-slide structure with all content intact
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