1
|
Kheur S, Ghosal S, Desai KM. Oral Microbial and Molecular Cross Talk between SARS-CoV-2 and Diabetes Mellitus - A Mini Review. Curr Diabetes Rev 2024; 20:e260423216221. [PMID: 37170990 DOI: 10.2174/1573399819666230426152606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/29/2022] [Accepted: 01/17/2023] [Indexed: 05/13/2023]
Abstract
The oral microbiome has long been considered a measure of overall systemic health. It is often significantly altered in case of chronic inflammation or any other systemic infection. Therefore, a shift in oral microbiota and oral health is bound to be observed in diabetics infected with the coronavirus. The prognosis of COVID-19 in a diabetic individual is often worse than that in a healthy individual. The increased pathogenicity of coronavirus in diabetics is due to the peculiar ways in which it interacts with specific physiological mechanisms in a diabetic patient and vice versa. Diabetes Mellitus Type-II (DM -II) is one of the most frequently associated co-morbidities in a COVID-19 patient, and therefore it is even more pertinent that their interrelationship is understood. It is essential to recognize the above-mentioned interactions and consider their implications while treating susceptible patients. This article attempts to review and summarize the said vital interactions. Additionally, it attempts to guide and prepare oral health professionals on what to expect and how to treat diabetic patients in a future where coronavirus is, as unfortunate as it is, a regularity and not a rarity.
Collapse
Affiliation(s)
- Supriya Kheur
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, India
| | - Sushmita Ghosal
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, India
| | - Karishma Madhusudan Desai
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, India
| |
Collapse
|
2
|
Desai KM, Angadi PV, Kheur S, Datar UV. Fine needle aspiration cytology for two cases of ameloblastoma-Key highlights and diagnostic features. Cytopathology 2023; 34:91-93. [PMID: 36152010 DOI: 10.1111/cyt.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Fine needle aspiration cytology (FNAC) is a valuable, noninvasive technique for head and neck pathology diagnosis. The objective of case images was to highlight the utility of FNAC for diagnosing suspected cases of ameloblastoma. METHOD FNAC smears of suspected cases of ameloblastoma were evaluated using their cellular and stromal features. RESULTS Cellular features and background of smears exhibited characteristics of ameloblastoma. Predominant features included clusters of ameloblast-like cells and spindle cells in a myxoid background. CONCLUSION Careful evaluation of FNAC helps diagnose ameloblastomas and must be considered a vital diagnostic tool.
Collapse
Affiliation(s)
- Karishma Madhusudan Desai
- Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research [KLE University], Belagavi, India
| | - Punnya V Angadi
- Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research [KLE University], Belagavi, India
| | - Supriya Kheur
- Department of Oral Pathology and Microbiology, Dr D.Y. Patil Dental College and Hospital, Dr D.Y. Patil Vidyapeeth, Pune, India
| | - Uma V Datar
- Department of Oral Pathology and Microbiology, Dental College and Hospital, Bharati Vidyapeeth Deemed to be University, Sangli, India
| |
Collapse
|
3
|
Datar UV, Kale AD, Angadi PV, Hallikerimath S, Deepa M, Desai KM. Role of cancer-associated fibroblasts in oral squamous cell carcinomas, surgical margins, and verrucous carcinomas: An immunohistochemical study. J Clin Transl Res 2022; 8:80-85. [PMID: 35261929 PMCID: PMC8898639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/01/2021] [Accepted: 01/08/2022] [Indexed: 10/26/2022] Open
Abstract
Background and Aim Cancer-associated fibroblasts (CAFs) are among the key tumor microenvironment components that determine tumor invasion, progression, and resistance to cancer therapeutics. Histologically normal mucosa adjacent to oral squamous cell carcinoma (OSCC) has been shown to harbor CAFs which aid in the loco-regional recurrence of the lesion. Verrucous carcinoma (VC), a low-grade variant of squamous cell carcinoma, has a better clinical outcome. However, few VCs show an aggressive biological course and necessitate wide excision with strict follow-up. Scarce literature is available regarding the role of CAFs in VCs. Thus, our study aimed to evaluate the frequency of CAFs in OSCC, normal mucosa adjacent to OSCC, and VC. Methods Thirty cases of squamous cell carcinoma, normal mucosa adjacent to OSCC, and VC each were included in the study. The sections were stained with an antibody against alpha-smooth muscle actin protein and CAF frequency was evaluated. Results The CAF frequency was highest in squamous cell carcinoma, followed by VC, and least in normal mucosa adjacent to OSCC (P<0.001). Conclusion CAF frequency progressively increases with an increase in the grade or biological behavior of the lesion. Thus, screening CAF frequency in these benign and malignant oral lesions is necessary for better treatment outcomes. Relevance for Patients The immunohistochemical screening for CAFs in OSCC and VC can serve as an integrated approach for the development of a directed treatment plan that leads to a better patient prognosis. Routine assessment of CAF frequency in surgical margins can serve as an adjunct in determining clear margins and possible locoregional recurrence. Furthermore, target therapy for CAFs can be used to minimize possible recurrence and distant metastasis.
Collapse
Affiliation(s)
- Uma Vasant Datar
- 1Department of Oral Pathology and Microbiology, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India,Corresponding author: Uma Vasant Datar Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli - 416 414, Maharashtra, India.
| | - Alka Dinesh Kale
- 2Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE Deemed to be University), Belagavi, Karnataka, India
| | - Punnya V. Angadi
- 2Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE Deemed to be University), Belagavi, Karnataka, India
| | - Seema Hallikerimath
- 2Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE Deemed to be University), Belagavi, Karnataka, India
| | - Mane Deepa
- 2Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE Deemed to be University), Belagavi, Karnataka, India
| | - Karishma Madhusudan Desai
- 3Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharastra, India
| |
Collapse
|
4
|
Datar U, Desai KM, Kamat MS. COVID-19 and virtual learning in dentistry: Perspective on challenges and opportunities. J Educ Health Promot 2021; 10:2. [PMID: 33688511 PMCID: PMC7933610 DOI: 10.4103/jehp.jehp_628_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/30/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Uma Datar
- Department of Oral Pathology, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Sangli, Maharashtra, India
| | - Karishma Madhusudan Desai
- Department of Oral Pathology and Microbiology, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Mamata Sharad Kamat
- Department of Oral Pathology, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Sangli, Maharashtra, India
| |
Collapse
|
5
|
Kumbhojkar SV, Kale AD, Kumbhojkar VR, Desai KM. Salivary calcium as a diagnostic tool for screening of osteoporosis in postmenopausal women. J Oral Maxillofac Pathol 2019; 23:192-197. [PMID: 31516222 PMCID: PMC6714260 DOI: 10.4103/jomfp.jomfp_133_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Women's health undergoes physiological, pathological and psychological changes after menopause. Reduced estrogen levels have been implicated in the pathogenesis of osteoporosis in postmenopausal women. Estrogen is also known to affect the salivary gland functions. To understand the association between serum estrogen, osteoporosis and salivary calcium, the present cross-sectional study was undertaken. Aim The aim of this study is to determine salivary calcium levels and its use for the diagnosis of osteoporosis in postmenopausal women. Methodology Ninety individuals divided into three groups of healthy controls, pregnant women and postmenopausal women were selected. Serum estrogen, salivary calcium and bone mineral density (BMD) at the heel region were estimated. Statistical analysis using the Mann-Whitney U-test was done to compare the results within the groups. Results Mean estrogen levels were 115.8 ± 80.18 pg/mmol in control group, 7729.4 ± 907.6 pg/mmol in pregnant group and 51.2 ± 74.51 pg/mmol in postmenopausal group, respectively. The mean salivary calcium in control, pregnant and postmenopausal groups was 3.12 ± 0.63, 3.19 ± 0.62 and 7.12 ± 0.79 μg/dl, respectively. Paired comparison within the groups showed high statistical significance (P = 0.0000) in the salivary calcium levels. The mean BMD of -2.3 (standard deviation [SD] ± 0.83) in the postmenopausal group was significantly lower than -0.6 (SD ± 0.99) and -0.2 (SD ± 1.42) of pregnant and control groups, respectively. Conclusion A negative correlation was found between estrogen and bone density. A significant difference in salivary calcium was noted in the study groups, highlighting the role of salivary calcium in the detection of early bone changes in postmenopausal women.
Collapse
Affiliation(s)
- Shweta Vinayak Kumbhojkar
- Department of Oral Pathology, KLE VK Institute of Dental Sciences and Hospital, KLE Academy of Higher Education and Research, KLE University, Belagavi, Karnataka, India
| | - Alka Dinesh Kale
- Department of Oral Pathology, KLE VK Institute of Dental Sciences and Hospital, KLE Academy of Higher Education and Research, KLE University, Belagavi, Karnataka, India
| | - Vinayak R Kumbhojkar
- Department of Periodontology, KLE VK Institute of Dental Sciences and Hospital, KLE Academy of Higher Education and Research, KLE University, Belagavi, Karnataka, India
| | - Karishma Madhusudan Desai
- Department of Oral Pathology, KLE VK Institute of Dental Sciences and Hospital, KLE Academy of Higher Education and Research, KLE University, Belagavi, Karnataka, India
| |
Collapse
|
6
|
Desai KM, Angadi PV, Kale AD, Hallikerimath S. Photoclinic Diagnosis: Basal cell adenocarcinoma. Arch Iran Med 2019; 22:57-58. [PMID: 30821163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Karishma Madhusudan Desai
- Department of Oral Pathology and Microbiology, KLE Academy of Higher Education and Research [KLE University], KLE VK Institute of Dental Sciences and Hospital, Belagavi- 590010, Karnataka, India
| | - Punnya V Angadi
- Department of Oral Pathology and Microbiology, KLE Academy of Higher Education and Research [KLE University], KLE VK Institute of Dental Sciences and Hospital, Belagavi- 590010, Karnataka, India
| | - Alka D Kale
- Department of Oral Pathology and Microbiology, KLE Academy of Higher Education and Research [KLE University], KLE VK Institute of Dental Sciences and Hospital, Belagavi- 590010, Karnataka, India
| | - Seema Hallikerimath
- Department of Oral Pathology and Microbiology, KLE Academy of Higher Education and Research [KLE University], KLE VK Institute of Dental Sciences and Hospital, Belagavi- 590010, Karnataka, India
| |
Collapse
|
7
|
Abstract
The intracorporeal injection of papaverine (ICP) is now a well recognized therapeutic option in the management of impotence. The current treatment of advanced prostatic carcinoma causes erectile failure. Although intracorporeal papaverine can induce erections in these men, libido is also reduced so that the role of ICP is limited to those men complying with the wishes of a highly motivated partner.
Collapse
Affiliation(s)
- H W Gilbert
- Department of Urology, Southmead Hospital, Westbury-on-Trym, Bristol
| | | | | | | |
Collapse
|
8
|
Gardner M, Boshart ML, Yeguez CE, Desai KM, Sandberg DE. Coming Up Short: Risks of Bias in Assessing Psychological Outcomes in Growth Hormone Therapy for Short Stature. J Clin Endocrinol Metab 2016; 101:23-30. [PMID: 26583584 DOI: 10.1210/jc.2015-3256] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Two often cited assumptions for treating children with GH are that short stature (SS), as an isolated physical characteristic, is associated with psychosocial morbidity and that GH treatment may increase height and improve psychological adjustment. Findings across studies regarding the psychological consequences associated with GH management of children with SS are variable and frequently contradictory. The purpose of this systematic review is to evaluate the degree to which any conclusions about the relative risks or benefits of GH treatment on psychological outcomes can be made based on the published literature. EVIDENCE ACQUISITION Electronic databases were searched for randomized clinical trials and nonrandomized studies, published between 1958-2014, in which GH was administered for management of children with SS and psychosocial, cognitive, academic, or health-related quality of life outcomes were assessed. Methodological quality of each study was assessed using the Cochrane Collaboration's tool for assessing risk of bias. EVIDENCE SYNTHESIS Eighty studies were evaluated. No studies were rated as having a low risk of bias, the risk of bias was unclear in seven study outcome areas, and the remaining studies were judged as having a high risk of bias. CONCLUSIONS The high risk of bias present in the majority of the literature on GH treatment effects on psychological outcomes (in particular, lack of blinding) substantially weakens confidence in their results. This may serve to explain the variability of findings for these outcomes across studies.
Collapse
Affiliation(s)
- M Gardner
- Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405
| | - M L Boshart
- Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405
| | - C E Yeguez
- Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405
| | - K M Desai
- Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405
| | - D E Sandberg
- Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405
| |
Collapse
|
9
|
Westphalen RI, Desai KM, Hemmings HC. Presynaptic inhibition of the release of multiple major central nervous system neurotransmitter types by the inhaled anaesthetic isoflurane. Br J Anaesth 2012; 110:592-9. [PMID: 23213036 DOI: 10.1093/bja/aes448] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Presynaptic effects of general anaesthetics are not well characterized. We tested the hypothesis that isoflurane exhibits transmitter-specific effects on neurotransmitter release from neurochemically and functionally distinct isolated mammalian nerve terminals. METHODS Nerve terminals from adult male rat brain were prelabelled with [(3)H]glutamate and [(14)C]GABA (cerebral cortex), [(3)H]norepinephrine (hippocampus), [(14)C]dopamine (striatum), or [(3)H]choline (precursor of [(3)H]acetylcholine; striatum). Release evoked by depolarizing pulses of 4-aminopyridine (4AP) or elevated KCl was quantified using a closed superfusion system. RESULTS Isoflurane at clinical concentrations (<0.7 mM; ~2 times median anaesthetic concentration) inhibited Na(+) channel-dependent 4AP-evoked release of the five neurotransmitters tested in a concentration-dependent manner. Isoflurane was a more potent inhibitor [expressed as IC(50) (SEM)] of glutamate release [0.37 (0.03) mM; P<0.05] compared with the release of GABA [0.52 (0.03) mM], norepinephrine [0.48 (0.03) mM], dopamine [0.48 (0.03) mM], or acetylcholine [0.49 (0.02) mM]. Inhibition of Na(+) channel-independent release evoked by elevated K(+) was not significant at clinical concentrations of isoflurane, with the exception of dopamine release [IC(50)=0.59 (0.03) mM]. CONCLUSIONS Isoflurane inhibited the release of the major central nervous system neurotransmitters with selectivity for glutamate release, consistent with both widespread inhibition and nerve terminal-specific presynaptic effects. Glutamate release was most sensitive to inhibition compared with GABA, acetylcholine, dopamine, and norepinephrine release due to presynaptic specializations in ion channel expression, regulation, and/or coupling to exocytosis. Reductions in neurotransmitter release by volatile anaesthetics could contribute to altered synaptic transmission, leading to therapeutic and toxic effects involving all major neurotransmitter systems.
Collapse
Affiliation(s)
- R I Westphalen
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY 10065, USA
| | | | | |
Collapse
|
10
|
Abstract
INTRODUCTION Two week wait referral guidelines have been published by the UK Department of Health for suspected urological cancers. Concordance to these guidelines is variable. Our objectives were to assess the incidence of urological malignancy and the proportion of inappropriate referrals in the two-week wait pathway. PATIENTS AND METHODS Retrospective audit of all two-week wait referrals to the urology department over 6 months. Inappropriate referrals were those not satisfying the referral criteria, but referred under the two-week wait system. Detection rates were calculated for each referral criterion based on diagnosis obtained from histology, imaging reports and clinic letters. RESULTS Incidence of cancer was 90 of 400 two-week wait referrals (23%). The cancer-detection rate based on reasons for referral ranged from 50 of 122 (41%) for elevated prostate-specific antigen levels to 2 of 56 (4%) for scrotal lumps; 42 (11%) referrals were inappropriate. CONCLUSIONS The overall cancer-detection rate is acceptable. Most inappropriate referrals were for long-standing symptoms and non-specific testicular/scrotal symptoms. The testicular cancer detection rate raises questions about the two-week wait guidelines. Providing general practitioners with fast-track scrotal ultrasound and revising the guideline may reduce the disproportionately high number of patients referred with suspected testicular cancer. Other inappropriate referrals are a cause for concern as they add to the workload of the 'urgent-referral' pathway.
Collapse
|
11
|
Desai KM, Diaz S, Dorward IG, Winslow ER, La Regina MC, Halpin V, Soper NJ. Histologic results 1 year after bioprosthetic repair of paraesophageal hernia in a canine model. Surg Endosc 2006; 20:1693-7. [PMID: 17031737 DOI: 10.1007/s00464-006-0680-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of prosthetic materials for the repair of paraesophageal hiatal hernia (PEH) may lead to esophageal stricture and perforation. High recurrence rates after primary repair have led surgeons to explore other options, including various bioprostheses. However, the long-term effects of these newer materials when placed at the esophageal hiatus are unknown. This study assessed the anatomic and histologic characteristics 1 year after PEH repair using a U-shaped configuration of commercially available small intestinal submucosa (SIS) mesh in a canine model. METHODS Six dogs underwent laparoscopic PEH repair with SIS mesh 4 weeks after thoracoscopic creation of PEH. When the six dogs were sacrificed 12 months later, endoscopy and barium x-ray were performed, and biopsies of the esophagus and crura were obtained. RESULTS The mean weight of the dogs 1 year after surgery was identical to their entry weight. No dog had gross dysphagia, evidence of esophageal stricture, or reherniation. At sacrifice, the biomaterial was not identifiable grossly. Biopsies of the hiatal region showed fibrosis as well as muscle fiber proliferation and regeneration. No dog had erosion of the mesh into the esophagus. CONCLUSIONS This reproducible canine model of PEH formation and repair did not result in erosion of SIS mesh into the esophagus or in stricture formation. Native muscle ingrowth was noted 1 year after placement of the biomaterial. According to the findings, SIS may provide a scaffold for ingrowth of crural muscle and a durable repair of PEH over the long term.
Collapse
Affiliation(s)
- K M Desai
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
Mistry T, Digby JE, Chen J, Desai KM, Randeva HS. The regulation of adiponectin receptors in human prostate cancer cell lines. Biochem Biophys Res Commun 2006; 348:832-8. [PMID: 16899222 DOI: 10.1016/j.bbrc.2006.07.139] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 07/18/2006] [Indexed: 11/22/2022]
Abstract
Obesity is a risk factor for prostate cancer, and plasma levels of the adipokine, adiponectin, are low in the former but high in the latter. Adiponectin has been shown to modulate cell proliferation and apoptosis, suggesting that adiponectin and its receptors (Adipo-R1, Adipo-R2) may provide a molecular association between obesity and prostate carcinogenesis. We show for the first time, the protein distribution of Adipo-R1 and Adipo-R2 in LNCaP and PC3 cells, and in human prostate tissue. Using real-time RT-PCR we provide novel data demonstrating the differential regulation of Adipo-R1 and Adipo-R2 mRNA expression by testosterone, 5-alpha dihydrotestosterone, beta-estradiol, tumour necrosis factor-alpha, leptin, and adiponectin in LNCaP and PC3 cells. Our findings suggest that adiponectin and its receptors may contribute to the molecular association between obesity and prostate cancer through a complex interaction with other hormones and cytokines that also play important roles in the pathophysiology of obesity and prostate cancer.
Collapse
Affiliation(s)
- T Mistry
- Clinical Sciences Research Institute, University of Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, UK
| | | | | | | | | |
Collapse
|
13
|
Perrone JM, Frisella MM, Desai KM, Soper NJ. Results of laparoscopic Heller-Toupet operation for achalasia. Surg Endosc 2004; 18:1565-71. [PMID: 15931473 DOI: 10.1007/s00464-004-8912-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2004] [Accepted: 06/10/2004] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic myotomy has become the preferred treatment for achalasia. Controversy persists on the need for fundoplication and/or its type; when used, most series have utilized the Dor fundoplication. We report a large series of laparoscopic Heller-Toupet procedures. METHODS All patients operated for achalasia were entered into a prospective database. Pre and postoperative esophageal symptoms, satisfaction scores, and SF-36 variables were compared. Surgical failures were defined as recurrent or persistent dysphagia leading to secondary treatment. Data are expressed as mean +/- S.D. RESULTS One hundred consecutive cases were analyzed (61 men, 39 women, age 47 +/- 17 yr). Heller-Toupet was performed in 94, whereas six patients had a Dor fundoplication because of mucosal perforation (three) or technical difficulties performing a posterior wrap (three). Operative time was 148 +/- 21 min. There were 13 intraoperative adverse events managed laparoscopically, and no conversions. Minor postoperative complications were noted in two cases, whereas there were no major complications or deaths. Mean hospital stay was 1.2 +/- 0.5 days, (range 1-4). Follow-up was complete in 92% at 26 +/- 17 months. Failures leading to further treatment occurred in 4%. All symptom scores were significantly improved (p < 0.0001). Solid dysphagia score went from 6.4 to 1.0 postoperatively; regurgitation score went from 4.5 to 0.2 (combined frequency and severity, range 0-8). Postoperative global esophageal symptoms scale revealed improvement in 97%, and all domains of the SF-36 were improved. CONCLUSIONS Although the best surgical approach to achalasia is yet to be determined, laparoscopic Heller-Toupet operation in experienced hands is a safe and effective procedure with low rates of morbidity and failure and high patient satisfaction.
Collapse
Affiliation(s)
- J M Perrone
- Washington University Institute for Minimally Invasive Surgery, St. Louis, MO 63110, USA
| | | | | | | |
Collapse
|
14
|
Winslow ER, Clouse RE, Desai KM, Frisella P, Gunsberger T, Soper NJ, Klingensmith ME. Influence of spastic motor disorders of the esophageal body on outcomes from laparoscopic antireflux surgery. Surg Endosc 2003; 17:738-45. [PMID: 12618949 DOI: 10.1007/s00464-002-8538-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2002] [Accepted: 11/07/2002] [Indexed: 01/27/2023]
Abstract
BACKGROUND The clinical outcomes of laparoscopic antireflux surgery (LARS) in patients with the spectrum of nonspecific spastic esophageal motor disorders (NSSDs) are not known. METHODS From a prospective database of patients undergoing LARS between 1997 and 2000, those with preoperative manometry at our institution and follow-up at ?6 months were identified. RESULTS Of the 121 patients, 35 had NSSDs. There were no differences in symptoms between groups preoperatively, but in the immediate postoperative period NSSD patients had more symptoms than nonspastic patients. At 18-month mean follow-up, NSSD patients reported significantly more heartburn (22% vs 7%), waterbrash (14% vs 4%), and medication usage (17% vs 5%) than nonspastic patients (p <0.05 for each). Despite this difference, nearly all patients reported subjective improvement postoperatively, and the degree of improvement was similar between groups. CONCLUSIONS Patients with NSSDs are more likely to have esophageal symptoms following LARS than subjects without these abnormalities. However, these patients still experience significant improvement in preoperative symptoms.
Collapse
Affiliation(s)
- E R Winslow
- Department of Surgery, Washington University School of Medicine, 660 South Euclid, WUMS Box 8109, St. Louis, MO 63110, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
Desai KM, Klingensmith ME, Winslow ER, Frisella P, Soper NJ. Symptomatic outcomes of laparoscopic antireflux surgery in patients eligible for endoluminal therapies. Surg Endosc 2002; 16:1669-73. [PMID: 12140637 DOI: 10.1007/s00464-002-8847-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2002] [Accepted: 05/02/2002] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study compared clinical outcomes after laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) who would be eligible for endoluminal therapies (ET) with those in patients who would be excluded from ET. METHODS From 1995 to the present, 459 patients who underwent LARS were analyzed prospectively. Of these, 117 patients (25%) without preoperative dysphagia, stricture, esophagitis worse than grade 2 or hiatal hernia larger than 2 cm were considered potential candidates for ET (group 1). By these criteria, 342 patients (75%) were not eligible for ET (group 2). Medication use and GERD symptoms were evaluated and compared between the two groups. RESULTS Perioperative outcomes including duration of operation, morbidity, length of hospital stay and return to work were similar in the two groups. Although LARS significantly reduced medication use and GERD symptoms in both groups during a mean follow-up period longer than 2 years, there were no outcome differences between groups 1 and 2. The reported improvement in esophageal symptoms and overall satisfaction was 90% or more in both groups. CONCLUSIONS The findings show that LARS is an effective treatment option in patients with GERD whether they are candidates for ET or not. In patients with uncomplicated GERD who currently meet inclusion criteria for ET, LARS provides excellent symptom relief and marked reduction in medication use during a mean follow-up period longer than 2 years.
Collapse
Affiliation(s)
- K M Desai
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | | | | | | | | |
Collapse
|
16
|
Laight DW, Desai KM, Anggård EE, Carrier MJ. Endothelial dysfunction accompanies a pro-oxidant, pro-diabetic challenge in the insulin resistant, obese Zucker rat in vivo. Eur J Pharmacol 2000; 402:95-9. [PMID: 10940362 DOI: 10.1016/s0014-2999(00)00451-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We have recently made the novel observation that a pro-oxidant challenge with hydroquinone in combination with buthionine sulfoximine (each at 50 mg/kg i.p. daily for 7 days) provokes the onset of type II diabetes mellitus in a model of insulin resistance, the obese Zucker rat. Since endothelial dysfunction in oxidant stress may aggravate in vivo insulin resistance, we have now investigated endothelium-dependent and nitric oxide (NO)-mediated vascular responses in the obese Zucker rat in vivo following this pro-oxidant insult. Pro-oxidant-treated animals exhibited defective vasodepression to the endothelium-dependent agent acetylcholine and to a lesser extent, the NO donor glyceryl trinitrate, together with a reduction in circulating levels of cGMP. Our data therefore suggest that the progression to type II diabetes mellitus in the obese Zucker rat mediated by a pro-oxidant insult is associated with impairments in agonist-stimulated, endothelium-dependent vasodilation and vascular NO signalling.
Collapse
Affiliation(s)
- D W Laight
- The William Harvey Research Institute, St Bartholomew's and the Royal London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK.
| | | | | | | |
Collapse
|
17
|
Kore RN, Dow CS, Desai KM. A new automated system for urine analysis: a simple, cost-effective and reliable method for distinguishing between glomerular and nonglomerular sources of haematuria. BJU Int 1999; 84:454-60. [PMID: 10468761 DOI: 10.1046/j.1464-410x.1999.00215.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the ability, reliability and accuracy of a new automated system of urine analysis in differentiating glomerular from nonglomerular bleeding in the initial investigation of haematuria, and compare its efficacy with conventional phase-contrast microscopy (PCM). PATIENTS AND METHODS One hundred and six urine samples from patients in whom the final diagnosis was available were analysed using electrical flow impedance to detect, enumerate and size red blood cells in a conductive fluid (the cellfacts analyser, Microbial Systems Ltd, Coventry, UK). All the samples were also tested using a dipstick method and PCM was carried out for comparison on 45 of the 106 urine specimens. The results of cellfacts analysis were correlated with the final diagnoses to assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this method; the costs were also analysed. RESULTS Sixty-nine urine samples tested positive for blood on dipstick urine analysis and all these were confirmed to have red blood cells on cellfacts analysis. The remaining 37 samples were negative for blood on dipstick testing and cellfacts analysis, although seven patients had been referred with previously detected microscopic haematuria, none of whom were found to have any detectable pathology in the urinary tract on clinical examination and investigations. The remaining 30 patients were diagnosed to have urological or nephrological conditions with no haematuria. In the positive group, 20 (29%) patients were from the glomerular group, with a mean (range) red blood cell size of 4.25 (4-5.1) micrometer, and 49 (71%) from the nonglomerular group, with red blood cells of 5.47 (4.67-5.70) micrometer. These ranges overlapped at 4.67-5.1 micrometer at the decision threshold of 4.75 micrometer, the distribution of dysmorphic and eumorphic red blood cells for the glomerular group was 18 (90%) and two (10%), respectively, and for the nonglomerular group was 2 (4%) and 47 (96%), respectively. The sensitivity, specificity, PPV and NPV were 90%, 96%, 90% and 96%, respectively. Consumable and labour costs were very low. CONCLUSIONS Cellfacts analysis is a simple, rapid, objective and cost-effective method for differentiating glomerular from nonglomerular urinary red blood cells, especially when few such cells are present.
Collapse
Affiliation(s)
- R N Kore
- Department of Urology, Walsgrave Hospitals NHS Trust, UK
| | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE To investigate the usefulness of serum testosterone levels as a relevant or useful indicator of sexual potency in men attending an erectile dysfunction clinic. PATIENTS AND METHODS Ninety consecutive men attending the erectile dysfunction clinic completed a sexual-activity questionnaire, and underwent a focused physical examination and questioning about their medical history. The serum testosterone level was measured in all patients and the results analysed in relation to the patient's age. Patients with low serum testosterone levels commenced replacement therapy comprising three intramuscular injections of testosterone (Sustanontrade mark, Organon, The Netherlands) 250 mg every third week. Potency status and serum testosterone were reassessed after 3 months' treatment. RESULTS Of the 90 men, 28 (31%) were aged < 50 years whilst 62 (69%) were >/=50 years old. Nineteen (21%) patients overall had low testosterone levels; four of these were < 50 and 15 were >/=50 years old. Five of 90 patients had a decreased libido; two of these also had low testosterone levels and all were < 50 years old. Testosterone levels returned to normal in all patients who received replacement therapy but potency returned in only two (10%); both were in the older group. CONCLUSION Measuring testosterone was not helpful in assessing potency or libido and low serum levels were not related to age. Correcting low testosterone did not improve either impotence or libido.
Collapse
Affiliation(s)
- A K Fahmy
- Department of Urology, Walsgrave Hospitals NHS Trust, Coventry, UK
| | | | | | | |
Collapse
|
19
|
Laight DW, Desai KM, Gopaul NK, Anggård EE, Carrier MJ. Pro-oxidant challenge in vivo provokes the onset of NIDDM in the insulin resistant obese Zucker rat. Br J Pharmacol 1999; 128:269-71. [PMID: 10510434 PMCID: PMC1571644 DOI: 10.1038/sj.bjp.0702801] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We investigated the ability of an acute pro-oxidant challenge in vivo to deteriorate glycaemic control and insulin action in the obese Zucker rat, a model of insulin resistance associated with oxidant stress. In obese animals, the daily administration for 1 week of hydroquinone (HQ) in combination with L-buthionine sulphoximine (BSO), elevated fasting plasma glycaemia and insulinaemia and markedly aggravated i.v. glucose-stimulated hyperinsulinaemia without significantly affecting i.v. glucose tolerance, suggesting exacerbated insulin resistance. Intermediate effects on hyperinsulinaemia in obese animals were determined with HQ treatment alone while BSO treatment alone had no effect. In contrast, none of the pro-oxidant treatments affected age-matched, insulin sensitive, lean Zucker rats. Our data therefore demonstrate for the first time, a vulnerability to deterioration in insulin action in an established insulin resistant state following an environmental pro-oxidative insult. This may have relevance in the conversion of insulin resistance syndrome (IRS) to non-insulin dependent diabetes mellitus (NIDDM).
Collapse
Affiliation(s)
- D W Laight
- The William Harvey Research Institute, St. Bartholomew's & the Royal London School of Medicine & Dentistry, Charterhouse Square, London, EC1M 6BQ.
| | | | | | | | | |
Collapse
|
20
|
Laight DW, Desai KM, Gopaul NK, Anggård EE, Carrier MJ. F2-isoprostane evidence of oxidant stress in the insulin resistant, obese Zucker rat: effects of vitamin E. Eur J Pharmacol 1999; 377:89-92. [PMID: 10448931 DOI: 10.1016/s0014-2999(99)00407-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have concurrently investigated oxidant stress, glucose tolerance and glucose-stimulated insulin responses in the obese Zucker rat, a widely used model of insulin resistance. The plasma level of the lipid peroxidation product 8-epi-prostaglandin F2alpha, a sensitive in vivo marker of oxidant stress, was elevated approximately 5-fold in 13-week old obese relative to age-matched, insulin-sensitive lean Zucker rats. Supplementation of the diet with vitamin E (as (+)-alpha-tocopherol acetate, 0.5% w/w) for 4 weeks, reduced plasma 8-epi-prostaglandin F2alpha and concomitantly reversed glucose-stimulated hyperinsulinaemia in the obese Zucker rat without worsening glucose tolerance. We therefore provide evidence of oxidant stress, measured as elevated plasma 8-epi-prostaglandin F2alpha, for the first time in the obese Zucker rat which now provides a rationale for the beneficial effects of antioxidants on insulin action previously reported in this model of insulin resistance.
Collapse
Affiliation(s)
- D W Laight
- The William Harvey Research Institute, St. Bartholomew's and the Royal London School of Medicine and Dentistry, UK.
| | | | | | | | | |
Collapse
|
21
|
Papapetropoulos A, Desai KM, Rudic RD, Mayer B, Zhang R, Ruiz-Torres MP, García-Cardeña G, Madri JA, Sessa WC. Nitric oxide synthase inhibitors attenuate transforming-growth-factor-beta 1-stimulated capillary organization in vitro. Am J Pathol 1997; 150:1835-44. [PMID: 9137106 PMCID: PMC1858220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Angiogenesis is a complex process involving endothelial cell (EC) proliferation, migration, differentiation, and organization into patent capillary networks. Nitric oxide (NO), an EC mediator, has been reported to be antigenic as well as proangiogenic in different models of in vivo angiogenesis. Our aim was to investigate the role of NO in capillary organization using rat microvascular ECs (RFCs) grown in three-dimensional (3D) collagen gels. RFCs placed in 3D cultures exhibited extensive tube formation in the presence of transforming growth factor-beta 1. Addition of the NO synthase (NOS) inhibitors L-nitro-arginine methylester (L-NAME, 1 mmol/L) or L-monomethyl-nitro-l-arginine (1 mmol/L) inhibited tube formation and the accumulation of nitrite in the media by approximately 50%. Incubation of the 3D cultures with excess L-arginine reversed the inhibitory effect of L-NAME on tube formation. In contrast to the results obtained in 3D cultures, inhibition of NO synthesis by L-NAME did not influence RFC proliferation in two-dimensional (2D) cultures or antagonize the ability of transforming growth factor-beta 1 to suppress EC proliferation in 2D cultures. Reverse transcriptase-polymerase chain reaction revealed the constitutive expression of all three NOS isoforms, neuronal, inducible, and endothelial NOSs, in 2D and 3D cultures. Moreover, Western blot analysis demonstrated the presence of immunoreactive protein for all NOS isoforms in 3D cultures of RFCs. In addition, in the face of NOS blockade, co-treatment with the NO donor sodium nitroprusside or the stable analog of cGMP, 8-bromo-cGMP, restored capillary tube formation. Thus, the autocrine production of NO and the activation of soluble guanylate cyclase are necessary events in the process of differentiation and in vitro capillary tube organization of RFCs.
Collapse
Affiliation(s)
- A Papapetropoulos
- Department of Pharmacology, Boyer Center for Molecular Medicine, Yale University School of Medicine, New Haven, CT 06536-0812, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Shesely EG, Maeda N, Kim HS, Desai KM, Krege JH, Laubach VE, Sherman PA, Sessa WC, Smithies O. Elevated blood pressures in mice lacking endothelial nitric oxide synthase. Proc Natl Acad Sci U S A 1996; 93:13176-81. [PMID: 8917564 PMCID: PMC24066 DOI: 10.1073/pnas.93.23.13176] [Citation(s) in RCA: 712] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/1996] [Indexed: 02/03/2023] Open
Abstract
Nitric oxide produced in endothelial cells affects vascular tone. To investigate the role of endothelial nitric oxide synthase (eNOS) in blood pressure regulation, we have generated mice heterozygous (+/-) or homozygous (-/-) for disruption of the eNOS gene. Immunohistochemical staining with anti-eNOS antibodies showed reduced amounts of eNOS protein in +/- mice and absence of eNOS protein in -/- mutant mice. Male or female mice of all three eNOS genotypes were indistinguishable in general appearance and histology, except that -/- mice had lower body weights than +/+ or +/- mice. Blood pressures tended to be increased (by approximately 4 mmHg) in +/- mice compared with +/+, while -/- mice had a significant increase in pressure compared with +/+ mice (approximately 18 mmHg) or +/- mice (approximately 14 mmHg). Plasma renin concentration in the -/- mice was nearly twice that of +/+ mice, although kidney renin mRNA was modestly decreased in the -/- mice. Heart rates in the -/- mice were significantly lower than in +/- or +/+ mice. Appropriate genetic controls show that these phenotypes in F2 mice are due to the eNOS mutation and are not due to sequences that might differ between the two parental strains (129 and C57BL/6J) and are linked either to the eNOS locus or to an unlinked chromosomal region containing the renin locus. Thus eNOS is essential for maintenance of normal blood pressures and heart rates. Comparisons between the current eNOS mutant mice and previously generated inducible nitric oxide synthase mutants showed that homozygous mutants for the latter differ in having unaltered blood pressures and heart rates; both are susceptible to lipopolysaccharide-induced death.
Collapse
Affiliation(s)
- E G Shesely
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill 27599, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Sessa WC, García-Cardeña G, Liu J, Keh A, Pollock JS, Bradley J, Thiru S, Braverman IM, Desai KM. The Golgi association of endothelial nitric oxide synthase is necessary for the efficient synthesis of nitric oxide. J Biol Chem 1995; 270:17641-4. [PMID: 7543089 DOI: 10.1074/jbc.270.30.17641] [Citation(s) in RCA: 207] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The particulate enzyme, endothelial nitric oxide synthase (eNOS), produces nitric oxide to maintain normal vasodilator tone in blood vessels. In this study, we demonstrate that eNOS is a Golgi-associated protein in cultured endothelial cells and intact blood vessels. Using a heterologous expression system in HEK 293 cells, we show that wild-type myristoylated and palmitoylated eNOS, but not mutant, non-acylated eNOS targets to the Golgi. More importantly, HEK 293 cells expressing wild-type eNOS release substantially more NO than cells expressing the mutant, non-acylated enzyme. Thus, eNOS is a novel Golgi-associated protein, and Golgi compartmentalization is necessary for the enzyme to respond to intracellular signals and produce NO.
Collapse
Affiliation(s)
- W C Sessa
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut 06536, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Desai KM, Warner TD, Bishop AE, Polak JM, Vane JR. Nitric oxide, and not vasoactive intestinal peptide, as the main neurotransmitter of vagally induced relaxation of the guinea pig stomach. Br J Pharmacol 1994; 113:1197-202. [PMID: 7534182 PMCID: PMC1510477 DOI: 10.1111/j.1476-5381.1994.tb17124.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
1. Nitric oxide synthase (NOS) was localized in the guinea pig stomach by immunocytochemistry. In vitro experiments were carried out on the isolated stomach of the guinea pig to study any possible links between nitric oxide (NO) and vasoactive intestinal peptide (VIP) in mediating relaxations induced by vagal stimulation. 2. NOS was localized to nerve cell bodies and nerve fibre varicosities of the myenteric plexus in wholemounts of the longitudinal muscle-myenteric plexus of the stomach fundus. The NOS-positive cells had a Dogiel type I morphology characteristic of motor neurones. 3. The cross-sections of the stomach wall showed NOS-positive neurones mainly in the myenteric plexus ganglia and NOS-positive nerve fibre varicosities in the circular muscle layer. 4. Relaxations induced by vagal stimulation were almost completely prevented by L-NAME with an IC50 value of 5.5 x 10(-6) M. This inhibition was reversed by L-arginine (2 mM). 5. VIP (100 nM) induced reproducible relaxations of the stomach. These were unaffected by tetrodotoxin (2 microM) or N omega-nitro-L-arginine methyl ester (L-NAME, 100 microM). 6. Desensitization to the relaxant effect of VIP partially reduced relaxations induced by vagal stimulation, glyceryl trinitrate or sodium nitroprusside but not noradrenaline. 7. These results show that NO has a neuronal origin in the guinea pig stomach, and support NO, and not VIP, as the major neurotransmitter of vagally induced gastric relaxation in the guinea pig.
Collapse
Affiliation(s)
- K M Desai
- Department of Pharmacology, Boyer Center for Molecular Medicine, Yale University, New Haven, CT 06536-0812
| | | | | | | | | |
Collapse
|
25
|
Abstract
1. We have tested whether 5-HT3 receptors mediate vagally-induced relaxation or contraction of the isolated stomach of the guinea-pig. 2. The antagonists of 5-HT3 receptors, ondansetron (1-10 microM) or metoclopramide (1-30 microM) did not inhibit vagally-induced relaxations at low concentrations but partially inhibited them at 30 microM or 60 microM, respectively. These higher concentrations of ondansetron and metoclopramide also inhibited relaxations induced by 1,1-dimethyl-4-phenylpiperazinium iodide (30 microM) but did not affect those induced by glyceryl trinitrate (0.7-1.1 microM). 3. Desensitization to 5-HT (100 microM) or 2-Me-5-HT (100 microM) did not affect relaxations or contractions induced by vagal stimulation. 4. Ondansetron (30 microM) or metoclopramide (60 microM) did not inhibit vagally-induced gastric contraction. 5. Thus, 5-HT3 receptors do not mediate vagally-induced relaxation or contraction in the guinea-pig stomach.
Collapse
Affiliation(s)
- K M Desai
- William Harvey Research Institute, St. Bartholomew's Hospital Medical College, Charterhouse Square, London
| | | | | |
Collapse
|
26
|
Gingell JG, Desai KM, Floyd TJ. Re: Gluteal device for penile injection. A. M. Helmy. Br. J. Urol., 68, 400-403, 1991. Br J Urol 1992; 69:668. [PMID: 1638363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
27
|
Desai KM, Zembowicz A, Sessa WC, Vane JR. Nitroxergic nerves mediate vagally induced relaxation in the isolated stomach of the guinea pig. Proc Natl Acad Sci U S A 1991; 88:11490-4. [PMID: 1684865 PMCID: PMC53161 DOI: 10.1073/pnas.88.24.11490] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Here we show that the relaxation induced by stimulation of the vagus nerve in the presence of cholinergic (muscarinic) and adrenergic blockade in the isolated stomach of the guinea pig is mediated by nitric oxide (NO). This is substantiated by inhibition of vagal relaxation by NG-monomethyl-L-arginine, an inhibitor of NO synthesis. The effect of NG-monomethyl-L-arginine was partially reversed by coincubation with L-arginine but not with D-arginine. NO activates soluble guanylate cyclase, and relaxation of the stomach induced by vagal stimulation was prevented by an inhibitor of soluble guanylate cyclase, methylene blue, further supporting our conclusions. The relaxant effect of vagal stimulation was also ablated by hexamethonium, an inhibitor of ganglionic nicotinic receptors, thereby showing that ganglionic transmission did not rely on NO, through its release from preganglionic neurons. However, hexamethonium did not inhibit the gastric relaxation brought about by increasing the intragastric pressure, which is also mediated by NO as previously described by us. The selective inhibition by hexamethonium of only the vagally mediated relaxation but not of the pressure-induced relaxation of the stomach indicates the existence of at least two separate neuronal pathways able to generate NO and bring about gastric accommodation of food or fluid.
Collapse
Affiliation(s)
- K M Desai
- William Harvey Research Institute, Saint Bartholomew's Hospital Medical College, London, United Kingdom
| | | | | | | |
Collapse
|
28
|
Abstract
The fundus of the guinea-pig stomach actively dilates in response to low increases in intragastric pressure. This physiological response, now called adaptive relaxation, accommodates the intake of liquid or food. It is independent of external innervation, resistant to ganglion blockade, but reflex in origin. The nerves involved are neither adrenergic nor cholinergic in nature. Non-adrenergic, non-cholinergic (NANC) nerves have now been recognized in many parts of the gastrointestinal tract and have recently been linked with release of nitric oxide (NO) on electrical stimulation. Here we show that adaptive relaxation in isolated stomach of the guinea pig is mediated by a NANC neurotransmitter substance indistinguishable from NO derived from L-arginine. This is substantiated by inhibition of adaptive relaxation by NG-monomethyl-L-arginine or N omega-nitro-L-arginine methyl ester, both inhibitors of NO synthesis, and by methylene blue, an inhibitor of soluble guanylate cyclase. There are two distinct neuronal pathways signalling NO-dependent adaptive relaxation, as evidenced by tetrodotoxin sensitivity. The first is a local reflex arc, the afferent fibres of which sense changes in intragastric pressure. The second is stimulated by an agonist for ganglionic nicotinic receptors. Thus, the functional significance of NO release from NANC nerves in the stomach is to bring about adaptive relaxation through a reflex response to increases in intragastric pressure.
Collapse
Affiliation(s)
- K M Desai
- William Harvey Research Institute, St Bartholomew's Hospital Medical College, London, UK
| | | | | |
Collapse
|
29
|
Abstract
This study was undertaken to determine the relative accuracy of computerised Doppler waveform analysis and colour coded duplex ultrasonography in the diagnosis of arteriogenic impotence. Twenty men with ostensibly normal penile haemodynamics were compared with 50 men whose impotence was considered due to compromised penile haemodynamics. In each patient the penile arterial inflow was assessed by both methods of investigation, which were performed at an interval of 2 weeks. The results demonstrated both techniques to be sensitive in detecting penile artery insufficiency but colour coded duplex ultrasonography was significantly more accurate.
Collapse
Affiliation(s)
- H W Gilbert
- Department of Urology, Southmead Hospital, Bristol
| | | | | |
Collapse
|
30
|
Gingell JC, Desai KM. Male Erectile Dysfunction. Med Chir Trans 1989; 82:453-4. [PMID: 2778777 PMCID: PMC1292246 DOI: 10.1177/014107688908200803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
31
|
Affiliation(s)
- K M Desai
- Department of Urology, Southmead Hospital, Bristol
| | | |
Collapse
|
32
|
Affiliation(s)
- J C Gingell
- Department of Urology, Southmead Hospital, Bristol
| | | |
Collapse
|
33
|
|
34
|
Desai KM, Gingell JC. Saline-induced artificial erection without papaverine: a potential source of error in diagnosing cavernosal venous leakage. Br J Urol 1988; 62:176-8. [PMID: 3408890 DOI: 10.1111/j.1464-410x.1988.tb04302.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The diagnosis of venous leakage as a cause of impotence, based on failure to induce an artificial erection by means of rapid saline infusion alone, may be invalid. Our recent experience with 2 men whose impotence was subsequently found to be psychogenic in nature suggests that saline erection cavernosometry should routinely incorporate the intracavernosal administration of papaverine, in order to avoid a falsely positive diagnosis of venous leakage.
Collapse
Affiliation(s)
- K M Desai
- Department of Urology, Southmead Hospital, Bristol
| | | |
Collapse
|
35
|
Desai KM, Abrams PH, White LO. A double-blind comparative trial of short-term orally administered enoxacin in the prevention of urinary infection after elective transurethral prostatectomy: a clinical and pharmacokinetic study. J Urol 1988; 139:1232-4. [PMID: 2453683 DOI: 10.1016/s0022-5347(17)42875-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A double-blind randomized comparative study was done to investigate the efficacy of enoxacin in the prevention of urinary infection after elective transurethral prostatectomy, as well as its ability to penetrate the prostate. A total of 40 patients received 200 mg. enoxacin and 40 received a placebo, given orally the night before the operation, 2 to 4 hours preoperatively and every 12 hours postoperatively for 36 hours. Urine samples for bacterial culture were obtained within 1 week preoperatively, at operation and at 48 hours, 5 days, and 2 and 6 weeks postoperatively. Samples of the serum and prostate were taken at operation and assayed for enoxacin levels. Of the placebo patients 15 had a urinary infection postoperatively (38 per cent) compared to 3 enoxacin patients (8 per cent) (p less than 0.01). Enoxacin penetrated well into prostatic tissue; the mean levels in tissue and serum were 3.1 +/- 1.8 mg. per kg. (standard deviation) and 1.26 +/- 0.48 mg. per l., respectively, with a mean tissue-to-serum ratio of 2.53 +/- 1.8.
Collapse
Affiliation(s)
- K M Desai
- Department of Urology, Southmead Hospital, Bristol, United Kingdom
| | | | | |
Collapse
|
36
|
Desai KM, Floyd TJ, Follett DH, Peake DR, Gingell JC. Development of a penile rigidity indicator and new concepts in the quantification of rigidity. Br J Urol 1988; 61:254-60. [PMID: 3359131 DOI: 10.1111/j.1464-410x.1988.tb06390.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A new non-invasive device has been developed for the continuous measurement of penile rigidity. We describe its design and performance in experimental and clinical studies, both of which have demonstrated its high degree of sensitivity, reliability and reproducibility. We also report two new concepts in quantifying penile rigidity.
Collapse
Affiliation(s)
- K M Desai
- Department of Urology, Southmead Hospital, Bristol
| | | | | | | | | |
Collapse
|
37
|
|
38
|
Desai KM, Dembny K, Morgan H, Gingell JC, Prothero D. Neurophysiological investigation of diabetic impotence. Are sacral response studies of value? Br J Urol 1988; 61:68-73. [PMID: 3342304 DOI: 10.1111/j.1464-410x.1988.tb09165.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The role of electrophysiologically elicited sacral responses in the detection of the neurological component of diabetic impotence has been evaluated in a detailed study using properly defined diagnostic criteria. The results prove that these tests are not reliable indicators of neuropathy and their relevance in the routine investigation of diabetic impotence is of questionable value.
Collapse
Affiliation(s)
- K M Desai
- Department of Urology, Southmead Hospital, Bristol
| | | | | | | | | |
Collapse
|
39
|
Abstract
A case of loclaised penile corporeal fibrosis is described in a psychogenically impotent diabetic, following a short course of self-injection therapy with papaverine. The possible aetiology and implications of this complication are discussed together with the need to obtain informed written consent from patients undergoing this form of treatment.
Collapse
Affiliation(s)
- K M Desai
- Department of Urology, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | | |
Collapse
|
40
|
Desai KM, Gingell JC. Points: Impotence: treatment by autoinjection of vasoactive drugs. West J Med 1987. [DOI: 10.1136/bmj.295.6611.1488-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
41
|
Affiliation(s)
- K M Desai
- Department of Urology, Southmead General Hospital, Bristol
| | | |
Collapse
|
42
|
Desai KM, Gingell JC, Skidmore R, Follett DH. Application of computerised penile arterial waveform analysis in the diagnosis of arteriogenic impotence. An initial study in potent and impotent men. Br J Urol 1987; 60:450-6. [PMID: 3322474 DOI: 10.1111/j.1464-410x.1987.tb05013.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A new method is described for evaluating arteriogenic impotence by means of noninvasive quantification of penile Doppler arterial waveforms using computerised analysis based on the Laplace Transform model. The haemodynamic changes occurring during a papaverine-induced erection in healthy potent volunteers have been recorded by this technique, which has also been shown to be capable of discriminating between a normal and an abnormal penile arterial supply in an initial study of potent and impotent men.
Collapse
Affiliation(s)
- K M Desai
- Department of Urology, Southmead Hospital, Bristol
| | | | | | | |
Collapse
|
43
|
|
44
|
Desai KM, Gingell JC, Floyd TJ. Preliminary report of a new concept in the pharmacological treatment of erectile impotence using an implantable drug delivery system. Br J Urol 1987; 60:267-70. [PMID: 3676676 DOI: 10.1111/j.1464-410x.1987.tb05498.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A new approach in the treatment of erectile impotence by means of pharmacologically induced erections using a totally implantable drug delivery system is described. This method allows administration of the appropriate drug at a site remote from the penis, thereby overcoming the pain and discomfort associated with direct intrapenile injection.
Collapse
Affiliation(s)
- K M Desai
- Department of Urology, Southmead Hospital, Bristol
| | | | | |
Collapse
|
45
|
|
46
|
Abstract
The progress of 33 men suffering from acute epididymitis, the majority of whom were treated as hospital inpatients, was prospectively monitored in order to determine the incidence of complications, and to assess the prognostic implications of clinical and scrotal ultrasound features found at initial presentation. Serious testicular complications resulting in frank infarction, suppurative necrosis and late atrophy developed in 39%. Three factors were shown to have significant discriminant value in predicting an adverse outcome: severe degree of inflammation with induration of the spermatic cord; the presence of a coexistent bacterial urinary infection; and a uniformly reduced testicular echo pattern on the affected side as visualized on ultrasound. A more aggressive approach in addition to medical measures appears to be indicated in these patients. The rationale of early surgical decompression by epididymotomy and spermatic fasciotomy is discussed. Scrotal ultrasound should be considered as a routine investigation in the management of epididymitis.
Collapse
|
47
|
Desai KM, Gingell JC, Haworth JM. Localised intratesticular abscess complicating epididymo-orchitis: the use of scrotal ultrasonography in diagnosis and management. Br Med J (Clin Res Ed) 1986; 292:1361-2. [PMID: 3085847 PMCID: PMC1340369 DOI: 10.1136/bmj.292.6532.1361-a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
48
|
Abstract
We report a case of urinary fistula after scrotal vasectomy for recurrent epididymo-orchitis. The etiology of this rare complication is discussed and the literature is reviewed.
Collapse
|
49
|
Hull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, Coulson C, Lambert PA, Watt EM, Desai KM. Population study of causes, treatment, and outcome of infertility. BMJ 1985; 291:1693-7. [PMID: 3935248 PMCID: PMC1418755 DOI: 10.1136/bmj.291.6510.1693] [Citation(s) in RCA: 635] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Specialist infertility practice was studied in a group of 708 couples within a population of residents of a single health district in England. They represented an annual incidence of 1.2 couples for every 1000 of the population. At least one in six couples needed specialist help at some time in their lives because of an average of infertility of 21/2 years, 71% of whom were trying for their first baby. Those attending gynaecology clinics made up 10% of new and 22% of all attendances. Failure of ovulation (amenorrhoea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (two year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0-27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilisation could benefit 80% of cases of tubal damage and 25% of unexplained infertility--that is, 18% of all cases, representing up to 216 new cases each year per million of the total population.
Collapse
|
50
|
Abstract
Scrotal ultrasonography has been performed in 105 men with a variety of intrascrotal conditions. The range of pathology interpreted by this technique is presented and its diagnostic accuracy evaluated. The clinical application and usefulness of this noninvasive method of imaging scrotal contents is discussed.
Collapse
|