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M Monga

Publications and source records attributed to M Monga.

At least 73 records · Page 4Linked to original sources
PubMed1996

The effect of cocaine on myometrial contractile activity: basic mechanisms.

Several clinical studies have reported an association between cocaine use in pregnancy and preterm labor. The mechanism by which cocaine exerts this effect is unclear. Although cocaine stimulates isolated myometrial contractile activity, results using whole animal models are conflicting. Although cocaine inhibits uterine neuronal and extraneuronal uptake of catecholamines and increases circulating levels of catecholamines in experimental animals, it is unlikely that facilitation of the alpha-adrenergic pathway is the sole mechanism of cocaine's action. Further investigation of possible indirect mechanisms of action including altered prostaglandin production, inhibition of beta-adrenergic response, and direct effects on intracellular calcium mobilization may lead to enhanced understanding of the clinical ramifications of cocaine use during pregnancy.

Animals↗
PubMed1996

Cocaine is associated with intrauterine fetal death in women with suspected preterm labor.

The objectives of this study were to determine the rate of recent cocaine use in a metropolitan population of predominantly Hispanic and African-American women with suspected preterm labor and to evaluate the impact of recent cocaine use on intrapartum complications in this population. Urine toxicology screens were prospectively obtained on 102 women with suspected preterm labor. The urine screen did not influence management decisions. Gestational age at delivery, birthweight, and intrapartum complications were compared using Student's t-test, chi-square analysis, or Fisher's exact test. The rate of positive urine drug screens for cocaine was 12.7%. Women with positive toxicology were older (27.8 +/- 5.7 versus 22.1 +/- 4.8 years, p = 0.002) and of higher parity (2 [1 to 7] versus 1 [0 to 7], p = 0.0). Women with positive toxicology were more likely to be black (92.3%) than Hispanic (7.7% [p = 0.0004]). They had more advanced cervical dilation at presentation (3 cm [0 to 6] versus 1 cm [0 to 8], p = 0.008), were more likely to be admitted (85% versus 32%, p < 0.0001), but less likely to receive tocolysis due to advanced dilation or pregnancy complication (36% versus 79%, p = 0.0002). There was no difference in gestational age or birthweight at delivery. There was a significantly higher intrauterine fetal death rate in the cocaine positive group (18.2% versus 0%, p = 0.02). These data suggest that recent cocaine use among women with suspected preterm labor is common in only some segments of an urban population and significantly impacts pregnancy outcome.

Adult↗
PubMed1996

Ureteroscopic retrograde endopyelotomy for management of ureteropelvic junction obstruction.

Despite the success of endopyelotomy, many points are still being debated. Ureteroscopic retrograde endopyelotomy was carried out in 49 adult patients with 39 available for long-term follow-up. Prestinting facilitated instrument passage and reduces morbidity. The average operating time was 90.2 minutes. Two patients underwent elective nephrectomy for poorly functioning kidneys that did not improve after treatment, and one patient underwent urgent nephrectomy for bleeding 26 days postoperatively. Improvement in drainage was documented in the successful cases. The authors consider ureteroscopic endopyelotomy the first-line approach for most cases of ureteropelvic junction obstruction.

Adolescent↗
PubMed1996

Oxytocin-stimulated responses in a pregnant human immortalized myometrial cell line.

Smooth muscle cells isolated from the myometrium of a pregnant woman at term were infected with a replication-defective adenovirus vector expressing the E6/E7 proteins of human papilloma virus 16. A clonal line, PHM1-41, was selected by resistance to Geneticin and examined for maintenance of smooth muscle phenotype and response to oxytocin. The immortalized cell line retained morphological characteristics of proliferating smooth muscle cells in culture for up to 22 passages and has been used for over 2 years. The cells expressed smooth muscle-specific alpha-actin and retained estrogen receptors. Oxytocin receptors were present, as measured by whole cell binding assay using the oxytocin antagonist 125I-d(CH2)5[Tyr-(Me)2,Thr4,-Orn8,Tyr9-NH2] as ligand and oxytocin as competitor. The data were best described by a one-site binding model, with a Kd of 0.36 nM and a binding site concentration of 37 fmol/microgram DNA. PHM1-41 cells responded to oxytocin with an increase in intracellular free calcium (EC50 15 nM) and an increase in phosphatidylinositol turnover. Oxytocin-stimulated phosphatidylinositol turnover was inhibited by preincubation with the cAMP analog CPT-cAMP. This immortalized myometrial cell line should prove useful for studies relating to human myometrial function.

Actins↗
PubMed1996

Correlation between connexin43 expression, cell-cell communication, and oxytocin-induced Ca2+ responses in an immortalized human myometrial cell line.

The effects of 8-bromo-cAMP on gap junction expression and intracellular Ca2+ ([Ca2+]i) were examined in an immortalized human myometrial cell line (PHM1-41) generated from myometrial cells obtained from term-pregnant myometrium. PHM1-41 cells express the gap junction protein connexin43 (Cx43). Gap junction-mediated intercellular communication, monitored with a method using fluorescence recovery after photobleaching, revealed low communication rates between cells. Addition of 1.0 mM 8-bromo-cAMP to culture medium resulted in an increase in junctional communication within 5 min, while 30 microM forskolin treatment resulted in increased communication within 10 min. Cells treated with 0.1, 0.5, or 1.0 mM 8-bromo-cAMP for 24 h revealed a dose-dependent increase in communication and an increase in immunostained gap junction plaques at cell-cell contacts. A direct correlation between the rate of dye transfer and the number of plaques was detected. No effect on communication or immunoreactive Cx43 was detected in cells exposed to 10 or 50 nM estradiol-17 beta for 24 h. In experiments analyzing [Ca2+]i, a concentration-dependent increase was induced by oxytocin (1-100 nM) with half-maximal stimulation at approximately 5 nM. Treatment of PHM1-41 cells for 24 h with 0.1, 0.5, or 1.0 mM 8-bromo-cAMP reduced the magnitude of the oxytocin-induced [Ca2+]i response. Thus, 8-bromo-cAMP increased Cx43-containing cell surface gap junctional plaques and up-regulated junctional communication but attenuated the oxytocin-induced [Ca2+]i response. These data indicate that the action of 8-bromo-cAMP in PHM1-41 cells has potentially opposite effects on the contractile and conductive properties of cells, and suggest that up-regulation of myometrial conductivity by agents that increase cAMP could diminish the tocolytic benefits of these agents.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed1996

Microbiologic assessment of the transabdominal ultrasound transducer head.

The objectives of this study were to determine (1) the rate of bacterial isolation from the abdomen of women having obstetric ultrasonography, (2) the rate of bacterial transmission to the transducer head, and (3) the eradication rate after routine wiping of the transducer head. A total of 191 obstetric patients participated in this study. At the start of each day, the transducer head and the coupling gel were cultured. Aerobic cultures were obtained from each patient's periumbilical and suprapubic areas before the transabdominal scan and from the transducer head before and after wiping off the gel with a dry cloth. Daily transducer head and gel cultures were negative. Of the abdominal skin cultures, 175 (92%) were positive; 35 (18%) were positive for serious organisms, and 140 (74%) were positive for organisms of low virulence. Sixty percent of the transducer head cultures from women with abdominal skin pathogens were positive before the gel was wiped off. None of the cultures from the transducer head were positive after removal of the gel. We conclude that many women carry potentially virulent pathogens on the abdominal skin and that transmission of these organisms to the transducer head commonly occurs. Physical removal of the gel from the transducer head effectively eradicates these microorganisms, minimizing patient-to-patient transmission.

Abdomen↗
PubMed1996

Reconstruction of a total anterior urethral defect using buccal mucosa.

Extensive urethral defects in the presence of insufficient local skin can challenge the reconstructive urologist. We report a case of complete anterior urethral loss due to Fournier's gangrene that was successfully reconstructed using autologous buccal mucosa. A 17.5 x 2.5 cm tube graft was harvested, extending from the left to right buccal regions along the lower labial fold. At long-term follow-up, the patient had an acceptable cosmetic result with maintenance of potency and the ability to urinate. Buccal mucosal grafts are a viable alternative for cases of near-total urethral reconstruction.

Aged↗
PubMed1996

Effect of irrigating fluid on perioperative temperature regulation during transurethral prostatectomy.

Hypothermia in the immediate postoperative period is associated with postoperative instability, prolonged recovery and increased risk of myocardial ischemia in the subsequent 24 h. This study examined the effect of irrigating-fluid temperature during transurethral resection of the prostate on perioperative temperature regulation. A randomized prospective study was conducted on twenty-eight consecutive patients undergoing transurethral resections of the prostate. The control group received room-temperature irrigant. The study group received irrigant warmed through the Abbott level-one fluid warmer or in the Ohio Servocare incubator. Fluid temperatures were 17 degrees C for unwarmed fluid, 37 degrees C for level-one fluid, and 35 degrees C for incubator fluid. The incidence of hypothermia (< or = 36 degrees C) in the immediate postoperative period was 95% in the cold-irrigant group and 38% in the warm-irrigant group (p = 0.001). The decrease from pre- to postoperative temperature was greater with cold (0.95 +/- 0.47 degrees C) than with warm (0.42 +/- 0.64 degrees C) irrigant (p = 0.01). The type of anesthesia (spinal versus general) and method of fluid warming (incubator versus level-one) did not have a significant effect on the perioperative temperature drop. Regression analysis demonstrated that the time of resection, amount of prostate resected, volume of irrigant fluid, and volume of intravenous fluid administered were not independent predictors of intraoperative temperature change.

Aged↗
PubMed1996

Priapism in sickle cell disease: the case for early implantation of the penile prosthesis.

OBJECTIVES: Recurrent ischemic priapism in sickle cell (SS) patients often leads to impotence. Blockage of venous outflow by sickle cells leads to anoxia of the cavernosal smooth muscle with subsequent replacement of the erectile tissue with dense fibrosis. This study evaluates the efficacy of early penile prosthesis implantation in patients with priapism associated with sickle cells disease. METHODS: Our recent experience includes 6 SS patients with impotence resulting from repeated episodes of priapism and 1 SS patient who suffered penile autoamputation from prolonged tricorporeal low flow priapism. The average age was 26 years. Six patients underwent excision of fibrotic cavernosal sinusoidal tissue and placement of a malleable prosthesis. The autoamputation case was managed with a one-stage penile reconstruction using a forearm free-flap and a two-piece inflatable penile prosthesis. RESULTS: All patients in our series are currently potent. Because of infection, 1 patient required removal and subsequent reinsertion of his prosthesis, and another has required revision. CONCLUSION: Potency in the young SS patient with recurrent episodes of ischemic priapism may best be managed by a penile prosthesis. Early implantation may lessen the psychological trauma of repeated priapisms, and reduce the technical difficulties and complications associated with penile prosthetic insertion in the presence of dense fibrosis.

Adolescent↗
PubMed1996

Benign Scrotal Masses in the Adolescent Male: Varicoceles, Spermatoceles, and Hydroceles.

Because scrotal masses may be a source of embarrassment for adolescents concerned about fertility and sexual prowess, supportive counseling should be included in treatment. The authors summarize the history, pathophysiology, epidemiology, natural history, signs and symptoms, laboratory tests, diagnostic problems, treatment, and prognosis of these masses.

Journal Article↗
PubMed1996

Testicular Trauma.

This chapter stresses the importance of prompt diagnostic staging and management of testicular trauma to preserve testicular function. Types of injuries are described, as well as the role of the physical examination, radiographic studies, and operative and conservative treatment.

Journal Article↗
PubMed1996

Effects of anesthesia on urodynamic studies in the primate model.

PURPOSE: To elucidate the effect of anesthesia on bladder function and urodynamic studies by performing controlled comparisons of the effects of 2 anesthetics on urodynamics in a primate model. MATERIALS AND METHODS: Cystometrograms were performed in 4 awake adult female Rhesus monkeys (Macaca mulatta) via implantable transducer for continuous monitoring and compared with cystometrograms obtained under anesthetic agents. A total of 183 cystometric studies was performed (48 in the awake group, 74 under ketamine anesthesia and 61 under flurane anesthesia. RESULTS: Maximum detrusor contraction pressure [Pdet(max)] was significantly lower under flurane than under ketamine anesthesia (33.1 +/- 2.5 versus 49.1 +/- 8.1 cm.H2O). In the awake state Pdet(max) (47.7 +/- 25.2 cm.H2O) was equal to that obtained under ketamine anesthesia. Cystometric bladder capacity was significantly larger under flurane (101.5 +/- 81.8 ml.) than under ketamine (70.3 +/- 56.1 ml.) anesthesia. It was only (32.9 +/- 15.9 ml.) in the awake state. Cystometric bladder capacity under both anesthetics was larger than the mean voided volume (43.3 +/- 6.3 ml.), but was comparable to the largest voided volume (102.3 +/- 31 ml.). Cystometric reflex contractions with bladder filling occurred more frequently with ketamine (96%) than with flurane anesthesia (66%). CONCLUSIONS: These findings show that anesthesia has profound effects on the bladder, and careful interpretation of urodynamic data is suggested. These findings also suggest that ketamine is a suitable anesthetic for urodynamic studies in the subhuman primate.

Anesthesia, General↗
PubMed1995

The possible role of granulocyte elastase in renal damage from acute pyelonephritis.

During acute inflammatory processes, extracellular release of granulocyte elastase can contribute to subsequent tissue damage. To test our hypothesis that extracellular elastase release during acute pyelonephritis may contribute to subsequent renal parenchymal damage, we compared the intracellular and extracellular activities of the lysozyme elastase of human polymorphonuclear cells (PMN) when incubated in vitro with bacterial strains causing renal infection that led to either renal damage or no damage. Urine bacterial cultures were obtained from patients with acute pyelonephritis (flank pain, costovertebral angle tenderness, fever > 38 degrees C, bacteriuria, pyuria, and leukocytosis). Renal damage was demonstrated by cortical scarring on followup intravenous pyelography and/or diminished function on 131iodine hippuran renal scan. Mean extracellular elastase activity (mu units/PMN) was 0.15 for unstimulated PMN, 0.07 for PMN stimulated by bacteria not associated with renal damage, and 1.20 for the PMN stimulated by strains associated with renal damage. Mean intracellular elastase activity (mu units/PMN) was 3.73 for unstimulated PMN, 3.48 for PMN stimulated by bacteria not associated with renal damage, and 3.31 for the PMN stimulated by strains associated with renal damage. Extracellular granulocyte elastase activity was thus significantly higher (P = 0.0001) in PMN stimulated by bacterial strains associated with renal damage. Extracellular release of elastase may contribute to the pathogenesis of renal damage in pyelonephritis.

Acute Disease↗
PubMed1995

Femoral neuropathy following percutaneous nephrolithotomy of a pelvic kidney.

Management of nephrolithiasis within a pelvic kidney presents a novel challenge to the urologist. We report on a patient who underwent ureteral stent placement prior to extracorporeal shock-wave lithotripsy (ESWL). Following ESWL, the ureteral stent calcified at the vesical and renal ends, requiring "sandwich therapy" of percutaneous nephrolithotripsy, ESWL, and percutaneous nephroscopy. Percutaneous access to the pelvic kidney through a posterior approach was complicated by femoral neuropathy manifested by an ability to walk. With 6 months of aggressive physical therapy, the patient is now able to ambulate with difficulty using a walker.

Adult↗
PubMed1995

Renal cell carcinoma presenting as hemolytic anemia in pregnancy.

A patient presented at 29 weeks' gestation with severe hemolytic anemia. She was subsequently diagnosed as having renal cell carcinoma and had a radical nephrectomy at 31 weeks' gestation, which demonstrated stage I disease. This was followed by a normal vaginal delivery of a healthy infant at term and complete resolution of her anemia. This unusual presentation of renal cell carcinoma in pregnancy is discussed.

Adult↗
PubMed1995

Gallbladder perforation in pregnancy.

Gallbladder perforation is an infrequent but potentially fatal disease. It is extremely rare during pregnancy. We report two cases of gallbladder rupture in the immediate postpartum period and review the literature. The first patient was a 28-year-old polysubstance abuser who presented at 29 weeks' gestation with generalized abdominal pain and ascites. Over a 48-hour period, her abdominal pain increased, and preterm labor and delivery occurred. She had an exploratory laparotomy the day after delivery for persistent abdominal pain and ascites, and a ruptured, gangrenous gallbladder was found. This patient died secondary to complications of the disease. Our second patient had a history of cholelithiasis and developed abdominal pain on the third postpartum day. Three days later, she was taken for exploratory laporatomy and was found to have a ruptured gallbladder. She did well postoperatively. The signs and symptoms of a ruptured gallbladder can be quite confusing in pregnancy. Ultrasonography, ascitic fluid analysis, computed tomography, and magnetic resonance imaging are useful adjuncts in diagnosis. A high index of suspicion, prompt recognition, and early surgical intervention are the mainstays of therapy.

Adult↗