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Dang RR, Noonan V, Chigurupati R, Henry A. Treatment of tophaceous pseudogout in the temporomandibular joint with resection and alloplastic reconstruction: a single-staged approach. Oral Maxillofac Surg 2021; 26:505-509. [PMID: 34596805 DOI: 10.1007/s10006-021-01013-2] [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] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
Tophaceous pseudogout is a rare variant of the calcium pyrophosphate dihydrate (CPPD) disorder, with predilection for the TMJ. It is characterized by calcific deposits composed of rhomboid- or rectangular-shaped crystals that exhibit birefringence when examined under polarized light. We hereby present a case of a 65-year-old man with left pre-auricular tenderness and malocclusion. CT imaging was notable for a left TMJ mineralized mass with erosion of the condylar head. Treatment involved excision of the mass with eminectomy, condylectomy, and a stock total TMJ reconstruction. In this report, important considerations for diagnosis, biopsy, and surgical treatment with emphasis on reconstruction for tophaceous pseudogout of the TMJ have been highlighted by the authors.
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Affiliation(s)
- Rushil R Dang
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA, 02118, USA.
| | - Vikki Noonan
- Division of Oral and Maxillofacial Pathology, Boston University Henry M. Goldman School of Dental Medicine, 635 Albany Street, Boston, MA, 02118, USA
| | - Radhika Chigurupati
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA, 02118, USA
| | - Andrew Henry
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA, 02118, USA
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Jalisi S, Chen AD, Gomez E, Chigurupati R, Cauley R, Olbricht S, Lee BT, Lin SJ. A Multidisciplinary Approach and Review of Safety Recommendations for Plastic Surgeons during the COVID-19 Pandemic: Are N95 Masks Enough? Plast Reconstr Surg 2021; 148:467-474. [PMID: 34398101 PMCID: PMC8312336 DOI: 10.1097/prs.0000000000008177] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/24/2021] [Indexed: 01/08/2023]
Abstract
SUMMARY The novel coronavirus disease of 2019 pandemic presents a unique challenge to the field of plastic and reconstructive surgery. Although plastic surgeons may be postponing elective operations, there are still a number of emergent or urgent procedures that may need to be performed, and surgeons may be facing the reality of returning to a new normalcy of operating with coronavirus disease of 2019. These procedures, consisting of those such as head and neck reconstruction or maxillofacial trauma, largely require a multidisciplinary approach and may be considered of higher risk to health care workers because of the involvement of areas of the body identified as sources for viral transmission. Moreover, viral transmission may potentially extend beyond respiratory secretions, which has been the main focus of most safety precautions. The authors aim to present the scope of these procedures and the means of viral transmission, and to provide safety precaution recommendations for plastic surgery and its related disciplines.
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Affiliation(s)
- Scharukh Jalisi
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Austin D. Chen
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Ernest Gomez
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Radhika Chigurupati
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Ryan Cauley
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Suzanne Olbricht
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Bernard T. Lee
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Samuel J. Lin
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
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Chigurupati R, Panchal N, Henry AM, Batal H, Sethi A, D'innocenzo R, Mehra P, Krishnan DG, Roser SM. Considerations for Oral and Maxillofacial Surgeons in COVID-19 Era: Can We Sustain the Solutions to Keep Our Patients and Healthcare Personnel Safe? J Oral Maxillofac Surg 2020; 78:1241-1256. [PMID: 32479811 PMCID: PMC7246053 DOI: 10.1016/j.joms.2020.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 01/08/2023]
Abstract
Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care.
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Affiliation(s)
- Radhika Chigurupati
- Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University Medical Center, and Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA.
| | - Neeraj Panchal
- Assistant Professor and Section Chief, Department of Oral and Maxillofacial Surgery, Philadelphia Veterans Affairs Medical Center, Penn Presbyterian Medical Center, University of Pennsylvania School of Dental Medicine, Philadelphia, PA
| | - Andrew M Henry
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Boston University Medical Center and Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Hussam Batal
- Clinical Associate Professor and Clinical and Financial Director, Department of Oral and Maxillofacial Surgery, Boston University and Boston Medical Center, Boston, MA
| | - Amit Sethi
- Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Richard D'innocenzo
- Clinical Professor and Vice Chairman, Departments of Dentistry and Oral and Maxillofacial Surgery, and Director, Predoctoral Education, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Pushkar Mehra
- Professor, Chair, and Chief, Department of Oral and Maxillofacial Surgery, Boston Medical Center, and Associate Dean of Hospital Affairs, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA
| | - Deepak G Krishnan
- Associate Professor, Department of Surgery; Chief and Residency Program Director, Section of Oral and Maxillofacial Surgery, University of Cincinnati Medical Center; and Chief, Section of Oral and Maxillofacial Surgery, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, and Chief, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
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Boyd SB, Chigurupati R, Cillo JE, Eskes G, Goodday R, Meisami T, Viozzi CF, Waite P, Wilson J. Maxillomandibular Advancement Improves Multiple Health-Related and Functional Outcomes in Patients With Obstructive Sleep Apnea: A Multicenter Study. J Oral Maxillofac Surg 2019; 77:352-370. [DOI: 10.1016/j.joms.2018.06.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 01/27/2023]
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Mobini A, Mehra P, Chigurupati R. Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery. J Oral Maxillofac Surg 2018; 76:2285-2295. [DOI: 10.1016/j.joms.2018.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 01/14/2023]
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Birur NP, Patrick S, Bajaj S, Raghavan S, Suresh A, Sunny SP, Chigurupati R, Wilder-Smith P, Gurushanth K, Gurudath S, Rao P, Kuriakose MA. A Novel Mobile Health Approach to Early Diagnosis of Oral Cancer. J Contemp Dent Pract 2018; 19:1122-1128. [PMID: 30287715 PMCID: PMC6455929] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM The incidence of oral cancer is high in India, which can be reduced by early detection. We aimed to empower frontline health care providers (FHP) for early detection and connect specialist to rural population through mHealth. MATERIALS AND METHODS We provided training to FHPs in examination of oral cavity, use of mobile phone for image capture, and risk factor analysis. The FHPs were selected from different cohorts in resource-constrained settings. The workflow involved screening of high-risk individuals in door-to-door and workplace settings, and capture of images of suspected lesions. Uploaded data were interpreted and recommendation was sent by specialist from a remote location. Their recommendation was intimated to FHPs who arranged for further action. Two more initiatives, one for multiple dental schools and another for private practitioners, were undertaken. RESULTS During the period from 2010 to 2018, 42,754 subjects have been screened, and 5,406 subjects with potentially malignant disorders have been identified. The prevalence of potentially malignant disorders varied from 0.8 to 62% at different cohorts; 516 biopsies have been performed at remote locations. CONCLUSION Connecting specialists to rural population was made possible through the use of mobile health. Trained FHP were able to reach out to the population. Electronic data capture facilitated efficient follow-up. The program was very cost-effective with screening completed under $1 per person. CLINICAL SIGNIFICANCE In view of the high incidence of oral cancer in India, and the resource-constrained settings, mobile health paves the way for better access to specialist care for the rural population.
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Affiliation(s)
- N Praveen Birur
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India; Oral Cancer Screening, Biocon Foundation, Bengaluru, Karnataka India, Phone: +919845136960, e-mail:
| | - Sanjana Patrick
- Department of Oral Cancer Screening, Biocon Foundation Bengaluru, Karnataka, India
| | - Suchitra Bajaj
- Department of Health Care, Biocon Foundation, Bengaluru Karnataka, India
| | - Shubhasini Raghavan
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Amritha Suresh
- Department of Head and Neck Oncology, Mazumdar Shaw Center for Translational Research, Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Sumsum P Sunny
- Department of Head and Neck Oncology, Mazumdar Shaw Center for Translational Research, Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Radhika Chigurupati
- Department of Oral and Maxillofacial Surgery, Boston University Medical Campus, Boston, Massachusetts, USA
| | - Petra Wilder-Smith
- Department of Dentistry, Beckman Laser Institute, University of California, Irvine, California, USA
| | - Keerthi Gurushanth
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Shubha Gurudath
- Department of Oral Medicine and Radiology, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Pratima Rao
- Department of Health Care, Biocon Foundation, Bengaluru Karnataka, India
| | - Moni A Kuriakose
- Department of Head and Neck Oncology, Cochin Cancer Research Center, Ernakulum, Kerala, India
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Arya V, Kadagad P, Alvarez W, Chigurupati R, Mehra P. Temporomandibular Disorders in Orthognathic Surgery Patients. J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.joms.2017.07.027] [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: 11/26/2022]
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Mehra P, Nadershah M, Chigurupati R. Is Alloplastic Temporomandibular Joint Reconstruction a Viable Option in the Surgical Management of Adult Patients With Idiopathic Condylar Resorption? J Oral Maxillofac Surg 2016; 74:2044-54. [PMID: 27186870 DOI: 10.1016/j.joms.2016.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR. PATIENTS AND METHODS A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse. RESULTS Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range, 22 to 32 yr) and mean follow-up was 6.2 years (range, 5 to 12 yr). Mean mandibular advancement at the B point was 24.3 mm and mean change in occlusal plane was -10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions. CONCLUSIONS Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.
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Affiliation(s)
- Pushkar Mehra
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston; Chief, Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA.
| | - Mohammed Nadershah
- Former Resident, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine and Boston Medical Center, Boston, MA; Assistant Professor, Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Radhika Chigurupati
- Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, Boston, MA
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Arya V, Chigurupati R. Treatment Algorithm for Intracranial Intrusion Injuries of the Mandibular Condyle. J Oral Maxillofac Surg 2016; 74:569-81. [DOI: 10.1016/j.joms.2015.09.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 11/26/2022]
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Chigurupati R. Do we have the resources and right ecosystem to channel the Indian work force to accelerate research and innovation? Indian J Dent Res 2015; 26:337-8. [PMID: 26481875 DOI: 10.4103/0970-9290.167637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Radhika Chigurupati
- Department of Oral and Maxillofacial Surgery, Boston University, 100 East Newton Street, Suite G-407, Boston, MA-02118, USA
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Chigurupati R, Aloor N, Salas R, Schmidt BL. Quality of Life After Maxillectomy and Prosthetic Obturator Rehabilitation. J Oral Maxillofac Surg 2013; 71:1471-8. [DOI: 10.1016/j.joms.2013.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Abstract
Orthognathic surgery is a critical component of surgical management of craniofacial deformities such as cleft lip and palate, craniofacial dysostoses, and mandibulofacial dysostoses. These operations can correct discrepancy in jaw relationship and malocclusion, relieve airway obstruction, correct facial asymmetry, optimize facial aesthetics, improve speech articulation, improve ability to masticate, and enhance psychological development and social interaction. Oral and maxillofacial surgeons who treat these deformities should be part of a craniofacial team to provide interdisciplinary care for patients. Distraction osteogenesis is a useful technique in the management of severe craniofacial deformities but does not replace conventional orthognathic surgery, which is safe and predictable. Recent advances in three-dimensional imaging and planning tools have made it possible to plan surgery more accurately and predictably.
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Affiliation(s)
- Radhika Chigurupati
- Department of Oral and Maxillofacial Surgery, University of California-San Francisco, 521 Parnassus Avenue, C-522, San Francisco, CA 94143-0440, USA
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Behar J, Newton A, Dafoulas G, Celi LA, Chigurupati R, Naik S, Paik K. Sana: democratizing access to quality healthcare using an open mhealth architecture. Int J Integr Care 2012. [PMCID: PMC3571126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introduction Aims and objectives Results Conclusion
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Affiliation(s)
| | - Alice Newton
- Sana, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, USA
| | | | - Leo Anthony Celi
- Sana, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, USA
| | - Radhika Chigurupati
- Sana, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, USA
| | - Shreesh Naik
- Sana, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, USA
| | - Kenneth Paik
- Sana, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, USA
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Van Loon K, Gill RM, McMahon P, Chigurupati R, Siddiqi I, Fox L, Damon L, McCalmont TH, Jordan R, Wolf J. 20q- clonality in a case of oral sweet syndrome and myelodysplasia. Am J Clin Pathol 2012; 137:310-5. [PMID: 22261459 DOI: 10.1309/ajcp9i7nrwyltjhv] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
We report the case of a patient with myelodysplasia who had Sweet syndrome of the oral cavity. An atypical myeloid immunophenotype was present in the gingival biopsy specimen and in a concurrent bone marrow specimen. Fluorescence in situ hybridization performed on the gingival biopsy specimen demonstrated the same del(20q) cytogenetic abnormality present in the bone marrow, confirming the presence of a clonally related myeloid proliferation in both tissues. This is the first reported case of Sweet syndrome and myelodysplasia in which the chromosomal abnormality was identified in the neutrophilic infiltrate, confirming the neutrophilic infiltrate to be clonally related to the underlying myeloid neoplasm.
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Cox DP, Solar A, Huang J, Chigurupati R. Pseudotumor of the mandible as first presentation of hemophilia in a 2-year-old male: a case report and review of jaw pseudotumors of hemophilia. Head Neck Pathol 2011; 5:226-32. [PMID: 21567186 PMCID: PMC3173544 DOI: 10.1007/s12105-011-0267-x] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 04/22/2011] [Indexed: 12/15/2022]
Abstract
Pseudotumor of hemophilia (PTH) is a rare complication seen in approximately 1-2% of cases of hemophilia. Although much more common in long bones, the pelvis, and small bones of the hands and feet than in the jaws, occasionally hemorrhage in the jaws occurs with this result. We present a case in a two-year-old male with a one-month swelling of the right mandible without significant medical history or diagnosis of hemophilia who was subsequently diagnosed as having Factor IX deficiency, or hemophilia B. A review of the literature revealed only 15 reported cases of PTH of the jaws and salient features of PTH in the jaws are discussed. The differential diagnosis of masses occurring in the jaws of children is limited and PTH should be considered when a mass presents with rapid growth and the histopathologic features are not diagnostic for a neoplastic process, even in the absence of a prior diagnosis of hemophilia as PTH may be the initial manifestation of this disease.
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Affiliation(s)
- D P Cox
- University of California San Francisco (UCSF), San Francisco, CA, USA.
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16
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Shen YF, Vargervik K, Oberoi S, Chigurupati R. Facial skeletal morphology in growing children with Pierre Robin sequence. Cleft Palate Craniofac J 2010; 49:553-60. [PMID: 21121765 DOI: 10.1597/09-154] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose was to compare the jaw size, jaw relationship, and facial proportions of children with nonsyndromic Pierre Robin sequence with children with nonsyndromic or isolated cleft palate. DESIGN This is a retrospective cohort study comparing radiographic findings in children with Pierre Robin sequence or isolated cleft palate at two time intervals: ages 4 to 7 years (T1) and ages 10 to 13 years (T2). Linear and angular measurements were obtained using cephalograms; the cephalometric values were compared with unpaired t tests, assuming unequal variances. SETTING The study was conducted at the Center for Craniofacial Anomalies at the University of California, San Francisco. PATIENTS The sample included 13 children with Pierre Robin sequence and 14 children with isolated cleft palate who were followed at University of California, San Francisco, craniofacial anomalies clinic during the period from 1971 to 2007 and met the inclusion criteria. MAIN OUTCOME MEASURES The outcome measures were mandibular length, maxillary length, and sagittal jaw relationship in Pierre Robin sequence and isolated cleft palate children at T1 and T2. RESULTS During early childhood (T1: 4 to 7 years), mandibular length (Co-Gn) was similar in both Pierre Robin sequence and isolated cleft palate groups, as was the maxillary length (Co-A). In older children (T2: 10 to 13 years) mandibular length was significantly shorter in the Pierre Robin sequence group compared with the isolated cleft palate group (difference = 10.9 mm, p = .009). Maxillary length in Pierre Robin sequence and isolated cleft palate groups was similar at T2 but significantly shorter in comparison to age-matched norms with a difference of 14.5 mm (p = .037) for Pierre Robin sequence and 12.4 mm (p = .045) for isolated cleft palate. Children with Pierre Robin sequence did not show a sagittal jaw discrepancy due to a proportionate deficiency in maxillary and mandibular length; whereas, children with isolated cleft palate showed a greater sagittal jaw discrepancy due to normal mandibular length and deficiency in maxillary length. CONCLUSION Our study confirms the findings of some previous studies that suggest that children with nonsyndromic Pierre Robin sequence have a proportionate retrusion of the maxilla and mandible, resulting in a convex facial profile by early adolescence.
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Affiliation(s)
- Yoshi F Shen
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA 94143, USA
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Oberoi S, Gill P, Chigurupati R, Hoffman WY, Hatcher DC, Vargervik K. Three-Dimensional Assessment of the Eruption Path of the Canine in Individuals with Bone-Grafted Alveolar Clefts Using Cone Beam Computed Tomography. Cleft Palate Craniofac J 2010; 47:507-12. [DOI: 10.1597/08-171] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the eruption path of the permanent maxillary canine during a 1-year period after secondary alveolar bone grafting and to (1) compare the canine eruption path on the cleft and noncleft side, (2) examine the number of congenially missing lateral incisors and the rate of canine impaction, and (3) examine the relationship between the eruption status of the canine and timing of alveolar bone grafting relative to age and canine root development using cone beam computed tomography (CBCT). Methods Cone beam computed tomography scans for 17 nonsyndromic unilateral cleft lip and palate (UCLP), and four bilateral cleft lip and palate (BCLP) consecutive cases of alveolar bone grafting surgery were obtained after orthodontic expansion and before alveolar bone grafting and at least 1 year postsurgery on the Hitachi MercuRay CBCT machine. The DICOM files were imported into Dolphin 3D Imaging 10.5 and reoriented for consistency. The X, Y, and Z coordinates were determined for the canine cusp tip and root tip on both the cleft and noncleft sides. The direction of movement of the canine in 1 year was determined. Results Most canines on both the cleft and noncleft sides moved incisally, facially, and mesially. Twelve percent of the canines on the cleft side appeared to require surgical exposure. Eighty percent of the canines had less than half root development at the time of bone grafting. The amount of root development did not affect the outcome in terms of eruption amount or direction. Conclusions Most canines on both the cleft and noncleft side moved incisally, facially, and mesially.
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Affiliation(s)
- Snehlata Oberoi
- Center for Craniofacial Anomalies, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, California
| | - Pawandeep Gill
- University of California at San Francisco, San Francisco, California
| | - Radhika Chigurupati
- Center for Craniofacial Anomalies, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, California
| | - William Y. Hoffman
- Division of Plastic Surgery, Department of Surgery, School of Medicine, University of California San Francisco, San Francisco, California
| | | | - Karin Vargervik
- Center for Craniofacial Anomalies, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, California
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Oberoi S, Chigurupati R, Gill P, Hoffman WY, Vargervik K. Volumetric assessment of secondary alveolar bone grafting using cone beam computed tomography. Cleft Palate Craniofac J 2009; 46:503-11. [PMID: 19929098 DOI: 10.1597/08-153.1] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the radiographic outcome of secondary alveolar bone grafting in individuals with nonsyndromic unilateral or bilateral cleft lip and palate using cone beam computed tomography. METHODS This prospective study was conducted at the University of California at San Francisco Center for Craniofacial Anomalies on 21 consecutive nonsyndromic complete cleft lip and palate individuals between 8 and 12 years of age who required alveolar bone grafting. Seventeen unilateral and four bilateral cleft lip and palate individuals had preoperative and postoperative cone beam computed tomography scans that were analyzed using Amira 3.1.1 software. RESULTS The average volume of the preoperative alveolar cleft defect in unilateral cleft lip and palate was 0.61 cm(3), and the combined average volume of the right and left alveolar cleft defects in bilateral cleft lip and palate was 0.82 cm(3). The average percentage bone fill in both unilateral cleft lip and palate and bilateral cleft lip and palate was 84%. The outcome of alveolar bone grafting was assessed in relation to (1) type of cleft, (2) size of preoperative cleft defect, (3) presence or absence of lateral incisor, (4) root development stage of the maxillary canine on the cleft side, (5) timing, and (6) surgeon. None of these parameters significantly influenced the radiographic outcome of alveolar bone grafting. CONCLUSIONS Secondary alveolar bone grafting of the cleft defect in our center was successful, based on radiographic outcome using cone beam computed tomography scans. Volume rendering using cone beam computed tomography and Amira software is a reproducible and practical method to assess the preoperative alveolar cleft volume and the adequacy of bone fill postoperatively.
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Affiliation(s)
- Snehlata Oberoi
- Center for Craniofacial Anomalies, Department of Orofacial Sciences, University of California at San Francisco, 94143, USA.
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Chigurupati R, Schendel SA, Sh JM. S335: Distraction Osteogenesis for Craniofacial Anomalies. J Oral Maxillofac Surg 2008. [DOI: 10.1016/j.joms.2008.05.332] [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: 11/30/2022]
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Oberoi S, Chigurupati R, Vargervik K. Morphologic and Management Characteristics of Individuals with Unilateral Cleft Lip and Palate Who Required Maxillary Advancement. Cleft Palate Craniofac J 2008; 45:42-9. [DOI: 10.1597/06-053.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To delineate factors that may contribute to maxillary hypoplasia requiring maxillary advancement surgery in individuals with nonsyndromic unilateral cleft lip and palate (UCLP). Methods: This retrospective, longitudinal study used lateral cephalometric radiographs and chart reviews of 16 nonsyndromic UCLP individuals who underwent Le Fort I maxillary advancement and 16 controls matched for cleft type, age, and gender. Cephalometric measurements were made at three time points (T1, T2, and T3): mean ages of 10.7, 13.3, and 15.8 years for the Le Fort group and 10.11, 12.9, and 15.7 years, respectively, for the control group. Information regarding team care, timing and number of surgical procedures, and number of congenitally missing teeth were determined from clinical records. Results: The Le Fort group had significant maxillary hypoplasia at all time points compared to the UCLP controls, indicated by midface length measurements, ANB and Wit's analysis ( p < .001). The Le Fort group had twice the number of palatal surgical procedures and number of missing teeth in the maxillary arch as compared with the cleft controls. Most of the control group had consistent team care, while most of the surgical group did not. Conclusions: Maxillary hypoplasia that will require a Le Fort I advancement can be determined as early as age 10. Multiple missing maxillary teeth, secondary palate procedures including pharyngeal flaps, and inconsistent team care with delayed orthodontic intervention are contributing factors to maxillary underdevelopment.
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Affiliation(s)
- Snehlata Oberoi
- Center for Craniofacial Anomalies, Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California
| | - Radhika Chigurupati
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California, San Francisco, California
| | - Karin Vargervik
- Craniofacial Anomalies, Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California
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Lee JS, Chigurupati R. Management and Repair of Alveolar Clefts. J Oral Maxillofac Surg 2005. [DOI: 10.1016/j.joms.2005.05.128] [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: 11/27/2022]
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Affiliation(s)
- Radhika Chigurupati
- Department of Oral and Maxillofacial Surgery, University of California-San Francisco, San Francisco, CA 94143, USA.
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Chigurupati R, Massie J, Dargaville P, Heggie A. Internal mandibular distraction to relieve airway obstruction in infants and young children with micrognathia. Pediatr Pulmonol 2004; 37:230-5. [PMID: 14966816 DOI: 10.1002/ppul.10426] [Citation(s) in RCA: 29] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Micrognathia may cause upper airway obstruction requiring complex medical interventions and sometimes tracheostomy. The role of distraction techniques to lengthen the mandible is yet to be clarified. The aim of this paper is to present a series of five cases in which mandibular lengthening by osteotomy and internal distraction was used to relieve airway obstruction. Five patients whose ages ranged from 4-39 months (mean, 15 months) were managed at our center with internal distraction osteogenesis to relieve airway obstruction. Three patients had a tracheostomy, and two patients had refractory airway obstruction prior to distraction. Following osteotomy and insertion of internal distraction devices, the mandible was distracted a mean of 17 mm (range, 15-25 mm). The distraction devices were removed at the end of a consolidation period ranging from 3-10 weeks. Two of 3 patients with a tracheostomy were decannulated, while the third patient with tracheostomy is awaiting choanal atresia repair before being decannulated. The two patients who were not managed with a tracheostomy but who had persistent upper airway obstruction have not required further airway intervention after mandibular distraction. In conclusion, mandibular lengthening by distraction osteogenesis can relieve airway obstruction in infants and small children. This is a promising new technique that may avoid the need for tracheostomy in some infants with micrognathia, and facilitate early decannulation in those who have a tracheostomy.
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Affiliation(s)
- Radhika Chigurupati
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Australia
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Dawson KH, Chigurupati R. Fixation of mandibular fractures: a tincture of science. Ann R Australas Coll Dent Surg 2002; 16:118-22. [PMID: 14507154] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
AIM To critically review the literature regarding the fixation of mandibular fractures to gain direction on which type of fixation is indicated in which clinical setting. METHODS A critical review of the literature based on computer searches using the Medline and Cochrane databases. The years searched were 1987 to 2002. Keywords used were: mandibular, fracture, fixation and osteosynthesis. RESULTS Eight hundred and thirty-four citations were obtained of which 127 were for case reports, orthognathic surgery or veterinary science. Thirty-nine citations dealt with non-clinical testing and four examined cost related to different treatment modalities. Six hundred and sixty-four citations were for articles reporting clinical experience, technical variations, comparative series, or proposed treatment protocols. Only a handful of papers reported studies sufficiently well designed to permit conclusions to be drawn on the relative success of various treatment approaches. CONCLUSION The published literature on the fixation of mandibular fractures falls well short of that required for evidence based surgery.
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Chigurupati R, Alfatooni A, Myall RWT, Hawkins D, Oda D. Orofacial rhabdomyosarcoma in neonates and young children: a review of literature and management of four cases. Oral Oncol 2002; 38:508-15. [PMID: 12110348 DOI: 10.1016/s1368-8375(01)00087-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rhabdomyosarcoma (RMS) is an aggressive malignant skeletal muscle neoplasm arising from embryonal mesenchyme. It accounts for over 50% of all pediatric soft tissue sarcomas. The head and neck region is the most common site for this tumor in children. Neonatal presentation of this tumor is rare. We present the management of one neonatal case and three additional cases of orofacial RMS in children under the age of 7 years. All four patients were seen in the department of oral and maxillofacial surgery at Children's Hospital and Regional Medical Center (CHRMC) in Seattle between 1992-2000. Three of the four cases were alveolar RMS and one was botryoid sub-type of embryonal RMS. Three patients were treated with a combination of surgery, chemotherapy and radiation, while the patient with botryoid RMS was treated with surgery and chemotherapy only. The patient with congenital RMS died at 2.5 years of age due to recurrent metastatic disease. The other three patients are alive without evidence of recurrent with a mean follow up was 5.5 years (range 2.5-8.5 years). We discuss the current management, diagnosis, biological behavior, histopathology, prognosis and survival of head and neck RMS in neonates and young children.
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Affiliation(s)
- R Chigurupati
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Washington, Seattle, USA
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Studen-Pavlovich D, Chigurupati R. Oral manifestations in HIV-infected children. Pa Dent J (Harrisb) 1997; 64:17-23. [PMID: 9526251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D Studen-Pavlovich
- Department of Pediatric Dentistry, University of Pittsburgh, School of Dental Medicine, USA
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Chigurupati R, Raghavan SS, Studen-Pavlovich DA. Pediatric HIV infection and its oral manifestations: a review. Pediatr Dent 1996; 18:106-13. [PMID: 8710710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Frischer H, Kennedy EJ, Chigurupati R, Sivarajan M. Glutathione, cell proliferation, and 1,3-bis-(2-chloroethyl)-1-nitrosourea in K562 leukemia. J Clin Invest 1993; 92:2761-7. [PMID: 8254030 PMCID: PMC288475 DOI: 10.1172/jci116894] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We have pursued our findings of glutathione reductase (GSSG-R) deficiency and disturbed glutathione in cancer patients treated with 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU), by investigating how thiol metabolism, cell proliferation, and the nitrosourea interact in human K562 leukemia. Fasting cells arrested in G greatly increased their reduced glutathione (GSH) in response to growth factors. The rise in thiol began after several hours, peaked before DNA synthesis, and resulted from increased production. BCNU inactivated GSSG-R rapidly, and later retarded, doubled, and greatly prolonged GSH formation before stopping DNA synthesis. Pretreatment unlike post treatment with buthionine-S-R-sulfoximine (BSO) diminished BCNU's ability to block GSSG-R. Enzyme inhibition decreased with falling cellular GSH. In the leukemia system as in vivo, sequential BCNU-induced thiol alterations heralded delayed antiproliferative effects. Drug timing markedly affected both thiol and DNA syntheses. By destroying GSSG-R and delaying the upregulation of thiol synthesis while escalating GSH utilization and requirements, the nitrosourea created a striking and previously unrecognized window of vulnerability for GSH-dependent processes. During this period, altered GSH metabolism could contribute indirectly to BCNU's pleiotropic effects by interfering with DNA alkylation repair, glucose decarboxylation, deoxyribose formation, and possibly by influencing other aspects of proliferation. Acquired GSSG-R deficiency was also an early and sensitive marker for prodrug breakdown and activation.
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Affiliation(s)
- H Frischer
- Department of Medicine (Hematology), Rush-Presbyterian-St-Luke's Medical Center, Rush University, Chicago, Illinois 60612
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Abstract
We have previously demonstrated that receptors to both mineralocorticoids (MC) and glucocorticoids (GC) exist in the arterial wall and that treatment with GC markedly increases Na+ and Ca2+ influx in cultured aortic vascular smooth muscle (VSM) cells, whereas treatment with MC increases only Na+ influx. We now report the results of the study aimed at the elucidation of the mechanism(s) of these effects. Unidirectional influx of Na+ and Ca2+ was measured in cultured cells of rabbit aortic media, using 22Na and 45Ca as tracers, in the presence of ouabain. The cells were treated for different periods with dexamethasone (DEX) or aldosterone (ALDO) in physiologic or supraphysiologic concentrations, in the presence or absence of competitive inhibitors of GC-receptor binding, RU 486, or MC-receptor binding, K-prorenoate. DEX in 50 nM concentration increased Na+ influx by 98 +/- 18% and Ca2+ influx by 100 +/- 20%, and the maximum effect was seen after 48 hour cell-treatment. ALDO in 5 nM concentration increased Na+ influx by 90 +/- 12% and had no effect on Ca2+ influx, and the maximum effect was seen after 7-10 days of cell-treatment. The enhancing effect of both DEX and ALDO on the influx rate of Na+ was prevented by actinomycin D and by cycloheximide. RU 486 completely inhibited DEX from exercising its enhancing effect on Na+ influx, but diminished influx rate of Na+ increased by ALDO only by 25%. Prorenoate (PRN) did not have any effect on DEX-increased Na+ influx, but completely inhibited ALDO from exercising its effect.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Kornel
- Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center Chicago, IL 60612
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Hegyvary C, Chigurupati R, Mahoney D. Do membrane lipids modify the ouabain-sensitivity of cardiac (Na,K)ATPase? Res Commun Chem Pathol Pharmacol 1981; 31:195-203. [PMID: 6261316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We investigated whether membrane lipids can alter the affinity of cardiac (Na,K)ATPase (ATP phosphohydrolase, EC 3.6.1.6) for ouabain. We recombined partially (80-95%) delipidated membrane proteins from a digitalis-sensitive species (dog) with membrane lipids from a relatively digitalis-insensitive species (rat) or vice versa, and estimated the affinity of (Na,K)ATPase for ouabain in these hybrid membranes by measuring the half-maximal inhibitory concentration (I50). Delipidation reduced the enzyme activity by 90-95%, but 40-60% of the original activity could be restored with lipids from the same or from the other species and distribution of [14C]phosphatidylcholine showed complete mixing between the native and foreign lipids. In these hybrid cardiac membranes affinity (I50) for ouabain was determined by the origin of the (Na,K)ATPase protein and was not modified by the change in membrane lipids.
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Hegyvary C, Chigurupati R, Kang K, Mahoney D. Reversible alterations in the kinetics of cardiac sodium- and potassium-activated adenosine triphosphatase after partial removal of membrane lipids. J Biol Chem 1980; 255:3068-74. [PMID: 6244306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Hegyvary C, Chigurupati R, Kang K, Mahoney D. Reversible alterations in the kinetics of cardiac sodium- and potassium-activated adenosine triphosphatase after partial removal of membrane lipids. J Biol Chem 1980. [DOI: 10.1016/s0021-9258(19)85853-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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