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Biomedical subjects

A Agarwal

Publications and source records attributed to A Agarwal.

At least 109 records · Page 6Linked to original sources
PubMed2001

Management of erectile dysfunction following radical prostatectomy.

Radical prostatectomy is the standard treatment for organ/specimen-confined prostate cancer, yet erectile dysfunction in selected series is still reported as high as 90% after this procedure. Thus, most men need adjuvant treatments to be sexually active following radical prostatectomy. These include vacuum constriction devices, intracorporeal injections of vasoactive drugs, and transurethral dilators, all of which have reported response rates of 50% to 70%. Unfortunately, long-term compliance is suboptimal, with a discontinuation rate of nearly 50% at one year. These non-oral options should be offered on an individual basis to patients who have failed oral therapy since efficacy and compliance vary. Also, these options should be considered in the early postoperative period to enhance sexual activity and penile oxygenation, which may prevent corporeal fibrosis. Early penile rehabilitation with intracavernosal injections or vacuum constriction devices should be encouraged to increase chances for recovery of rigid erections. In patients with some preservation of nerve tissue, oral sildenafil may be effective in promoting an earlier return of erectile function. The potential impact of sildenafil and other new oral therapies should encourage urologists to continue to perform and perfect the nerve-sparing approach.

Erectile Dysfunction↗
PubMed2001

DNA damage in patients with untreated cancer as measured by the sperm chromatin structure assay.

OBJECTIVE: To examine the relationship between sperm chromatin defects, evaluated by sperm chromatin structure assay (SCSA) and semen characteristics in cryopreserved semen specimens from patients diagnosed with various types of cancer. DESIGN: Prospective study. SETTING: Andrology laboratory at a tertiary care hospital. PATIENT(S): Cryopreserved semen samples from 12 healthy fertile men and 37 men diagnosed with cancer: testicular cancer (n = 20), Hodgkin's disease (n = 11), non-Hodgkin's disease (n = 4), and other neoplasm (n = 2). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The shift of green (native DNA) to red (denatured, single-stranded DNA) fluorescence in acridine orange-stained nuclei was measured and quantified using the expression alpha(t)(red fluorescence/[red + green fluorescence] per cell). Sperm DNA damage was correlated with classical semen characteristics. RESULT(S): Cancer patients as a group had significantly higher DNA damage when compared with controls. Specimens with high COMPalpha(t) values (percentage of sperm with denatured DNA) were present in all groups of cancer patients. No meaningful correlation was seen between the extent of DNA damage and classical semen measures. CONCLUSION(S): DNA damage in spermatozoa is prevalent in the majority of cancer patients. SCSA provides important information about the biochemical integrity of sperm DNA in men with cancer before their treatment.

Acridine Orange↗
PubMed2001

Creatine kinase as an indicator of sperm quality and maturity in men with oligospermia.

OBJECTIVES: To determine the differences among the creatine kinase (CK) levels in the spermatozoa of subfertile men with mild, moderate, or severe oligospermia and to examine the differences in CK activity between infertile patients with various clinical diagnoses and a group of normal healthy donors (control). CK is a marker of sperm maturity that correlates with the sperm fertilizing capacity. Elevated levels are associated with an increased rate of functional abnormalities and increased cytoplasmic retention. METHODS: We compared the CK levels in 51 oligospermic men who could not initiate a pregnancy. Patients were categorized according to their degree of oligospermia as defined by the total sperm count: mild (greater than 10 to 40 x 10(6); n = 30), moderate (5 to 10 x 10(6); n = 11), and severe (less than 5 x 10(6); n = 10). These patients were further classified according to their diagnosis (ie, varicocele, n = 24; unexplained infertility, n = 17; vasectomy reversal, n = 9; and unknown diagnosis, n = 1). A separate group consisting of 25 healthy donors was included as a control group. A computer-assisted semen analyzer assessed the sperm characteristics, and the CK levels were measured using a CK test kit after the enzyme was extracted with Triton-X. RESULTS: The CK levels were significantly higher in the sperm of the severely oligospermic group (8.8 +/- 6.5 IU/10(8) sperm) than in the moderate (0.50 +/- 0.19 IU/10(8) sperm) and mild (0.49 +/- 0.15 IU/10(8) sperm) groups (P <0.0001). The mean CK level in the severely oligospermic group was 18-fold higher than that in the moderate (P = 0.03) and mild (P <0.001) groups. The CK levels were significantly higher in all three infertile groups compared with the donor group (0.06 +/- 0.01 IU/10(8) sperm). Patients with varicocele had the highest CK level (3.42 +/- 2.56 IU/10(8) sperm) compared with patients in the vasectomy reversal group (1.73 +/- 0.98 IU/10(8) sperm) and the idiopathic infertility group (0.26 +/- 0.08 IU/10(8) sperm). CONCLUSIONS: Elevated CK levels are associated with severe oligospermia, irrespective of the clinical diagnosis. CK may be a sensitive indicator of sperm quality and maturity in the follow-up of patients treated for male factor infertility.

Creatine Kinase↗
PubMed2001

Measurements and analysis of criteria pollutants in New Delhi, India.

Ambient concentrations of carbon monoxide (CO), nitrogen oxides (NOx), sulfur dioxide (SO2), and total suspended particulates (TSP) were measured from January 1997 to November 1998 in the center of downtown [the Income Tax Office (ITO) located on B.S.G. Marg] New Delhi, India. The data consist of 24-h averages of SO2, NOx, and TSP as well as 8 and 24-h averages of CO. The measurements were made in an effort to characterize air pollution in the urban environment of New Delhi and assist in the development of an air quality index. The yearly average CO, NOx, SO2, and TSP concentrations for 1997 and 1998 were found to be 4810+/-2287 and 5772+/-2116 microg/m3, 83+/-35 and 64+/-22 microg/m3, 20+/-8 and 23+/-7 microg/m3, and 409+/-110 and 365+/-100 microg/m3, respectively. In general, the maximum CO, SO2, NOx, and TSP values occurred during the winter with minimum values occurring during the summer, which can be attributed to a combination of meteorological conditions and photochemical activity in the region. The ratio of CO/NOx (approximately 50) indicates that mobile sources are the predominant contributors for these two compounds in the urban air pollution problem in New Delhi. The ratio of SO2/NOx (approximately 0.6) indicates that point sources are contributing to SO2 pollution in the city. The averaged background CO concentrations in New Delhi were also calculated (approximately 1939 microg/m3) which exceed those for Eastern USA (approximately 500 microg/m3). Further, all measured concentrations exceeded the US National Ambient Air Quality Standards (NAAQS) except for SO2. TSP was identified as exceeding the standard on the most frequent basis.

Air Pollutants↗
PubMed2001

Posterior repositioning of glaucoma implants for anterior segment complications.

OBJECTIVE: To assess the efficacy of repositioning Baerveldt aqueous implant tubes from the anterior chamber into the vitreous cavity in the management of anterior chamber tube-related complications. DESIGN: Noncomparative case series. PARTICIPANTS: Nine eyes of eight consecutive subjects with anterior segment problems (corneal decompensation with a shallow anterior chamber or recurrent tube erosion unresponsive to conventional revision). INTERVENTION: Baerveldt implant tubes were repositioned from the anterior chamber into the vitreous cavity after pars plana vitrectomy. MAIN OUTCOME MEASURES: Preservation of visual acuity, maintenance of intraocular pressure (IOP) control, and resolution of the anterior segment problem. RESULTS: Nine eyes of eight subjects were collaboratively managed by the operating glaucoma and vitreoretinal surgeons and followed postoperatively for an average time of 17 months (range, 2-42 months). Visual acuity remained stable or improved in seven of the nine eyes. IOP remained controlled in all eyes, with an average IOP of 14.3 +/- 3.0 standard deviation mmHg (range, 10-18 mmHg). Progression of the anterior segment problem, which dictated the revision, was halted in three of five eyes with corneal decompensation and shallow anterior chambers and in all eyes with recurrent tube erosion. Postoperative complications included one successfully repaired retinal detachment occurring 9 months postoperatively. CONCLUSIONS: Repositioning of an anterior chamber Baerveldt shunt tube into the vitreous cavity is a viable option for resolving recalcitrant tube-related anterior segment complications.

Aged↗
PubMed2001

No-anesthesia clear corneal phacoemulsification versus topical and topical plus intracameral anesthesia. Randomized clinical trial.

PURPOSE: To compare the intraoperative pain scores during clear corneal phacoemulsification under no anesthesia, topical anesthesia, and topical plus intracameral anesthesia. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Center, Chennai, India. METHODS: Seventy-five patients were randomized to have phacoemulsification under no anesthesia, topical anesthesia, or topical plus intracameral anesthesia. Uncooperative or illiterate patients and those with hard cataract, a shallow anterior chamber, or small pupils were excluded. A protocol was established for supplemental anesthesia in case of breakthrough pain during the surgery. Each patient was asked to grade the overall severity of intraoperative pain immediately after surgery on a 10-point visual analog scale. Also evaluated were the general discomfort during surgery, discomfort from the microscope lights, surgeon stress during surgery, and total surgical time. Comparison among the 3 groups was performed using an analysis of variance. RESULTS: No supplemental anesthesia was required in any group. No significant difference was noted in the mean scores of the subjective sensation of pain with or without topical anesthesia (P =.610). The mean scores of patient discomfort from the microscope lights and surgical time were also statistically insignificant. Patient discomfort and surgeon stress during surgery were significantly greater in the no-anesthesia group than in the topical and topical plus intracameral groups (P =.0235 and P = 0.0206, respectively). CONCLUSION: No-anesthesia clear corneal phacoemulsification was performed by a highly experienced, skilled surgeon without causing an unacceptable level of pain. However, this technique is not suitable for every cataract surgeon or patient.

Adult↗
PubMed2001

Laser in situ keratomileusis for residual myopia after primary LASIK.

PURPOSE: To analyze the results of secondary laser in situ keratomileusis (LASIK) for residual myopia after primary LASIK. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: A retrospective study of 50 eyes of 29 patients who had a secondary LASIK procedure was carried out. After a mean follow-up of 5.84 months +/- 3.24 (SD) after the primary procedure, the mean myopic residual refraction was -4.30 +/- 1.83 diopters (D). In 10 eyes, the primary corneal flap was lifted by blunt dissection. In 40 eyes, the flap was made with a second cut. The secondary LASIK was performed using the Chiron Technolas Keracor 217 excimer laser and the Automated Corneal Shaper microkeratome (Bausch & Lomb). RESULTS: The mean follow-up was 16.58 +/- 3.06 months. At 12 months, the mean spherical equivalent was -0.45 +/- 0.68 D (P <.05). Thirty-one eyes were emmetropic, 13 eyes were within +/-1.00 D of emmetropia, and 5 eyes were within +/-2.00 D. The mean uncorrected visual acuity improved from 20/80 (range 20/60 to 20/200) to 20/40 (range 20/20 to 20/200) (P <.005). Seventeen eyes gained 1 line of best spectacle-corrected visual acuity; 1 eye lost 1 line because of a decentered ablation with an induced postoperative astigmatism of -3.50 D cylinder. No sight-threatening complications such as a free cap, flap irregularity, corneal ectasia, or retinal complication occurred postoperatively. Epithelial ingrowth developed in 5 eyes and corneal thinning, in 1 eye. Three eyes had night glare. CONCLUSION: Secondary LASIK was a safe, stable, and effective method for the treatment of residual myopia after primary LASIK.

Adult↗
PubMed2001

Laser in situ keratomileusis for residual myopia after radial keratotomy and photorefractive keratectomy.

PURPOSE: To evaluate the visual outcome, stability, and complications of laser in situ keratomileusis (LASIK) for residual myopia after radial keratotomy (RK) and photorefractive keratectomy (PRK). SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: Twenty eyes that had LASIK treatment for residual myopia after RK (10 eyes) or PRK (10 eyes) were retrospectively analyzed. Laser in situ keratomileusis was performed after a mean period of 24.3 months +/- 0.75 (SD) in the RK group and 22.0 +/- 1.07 months in the PRK group. RESULTS: At the last follow-up, the mean spherical equivalent was reduced from -6.05 +/- 1.98 diopters (D) to -1.26 +/- 0.32 D (P <.05) in the RK group and from -3.38 +/- 1.30 D to -0.55 +/- 0.40 D (P <.005) in the PRK group. The mean uncorrected visual acuity improved from 20/300 (range 20/600 to 20/200) to 20/40 (range 20/60 to 20/20) (P <.05) and from 20/200 (range 20/800 to 20/80) to 20/25 (range 20/40 to 20/20) (P <.05), respectively. Two eyes in the RK group and 3 in the PRK group gained 1 line of best corrected visual acuity, and 2 eyes in the RK group lost 1 line. No sight-threatening complications such as a free flap, corneal ectasia, or a retinal complication occurred. There was no statistically significant difference in corneal haze before and after LASIK. Two eyes in the RK group required repositioning of the flap because of irregular apposition to the stromal bed. CONCLUSION: Laser in situ keratomileusis was safe, effective, and stable in the treatment of residual myopia after RK and PRK.

Adult↗
PubMed2001

Phakonit: phacoemulsification through a 0.9 mm corneal incision.

Advances in technique and equipment have led to a significant increase in the popularity of phacoemulsification and have increased its safety and efficiency. We describe a technique, phakonit, in which the lens is emulsified through a 0.9 mm clear corneal temporal incision. A cortical wash with bimanual irrigation/aspiration is followed by enlarging the incision to 2.0 mm and inserting a Staar sub-2.0 mm foldable intraocular lens. Phakonit is a safe, precise method of phacoemulsification with minimal intraoperative or postoperative complications.

Aged↗
PubMed2001

Management of dislocated intraocular implants.

Implant dislocation may occur in the absence of appropriate capsular or zonular support (PCIOL) (11,35,53) or following traumatic injury to anterior ocular tissues (ACIOL). (11,19,20) Other factors (e.g., advanced patient age, high myopia, previous vitrectomy, pseudoexfoliation syndrome, and certain connective tissue disorders) also may predispose implant dislocation. (9,52) Although reported for all types of IOLs, implant dislocation is becoming more manageable because of the advancement of surgical techniques. A dislocated ACIOL or PCIOL may be explanted, exchanged, or repositioned. (11,48,71) Repositioning the dislocated PCIOL in the ciliary sulcus with modern vitreoretinal techniques provides an optimal environment for visual recovery. (11,71) Implant repositioning techniques generally may be categorized into the external or the internal approaches. (8,11) The former involves external suturing methods for a primary or secondary implant in the absence of adequate capsular or zonular support (15,16,31,42,56,60,61,64,66,73,76) and the latter is achieved through modern pars plana techniques. 8,11,62,69) Recently, several implant repositioning methods gaining increasing acceptance include the scleral loop fixation, (45) the snare approach, (43) the use of the 25-gauge implant forceps, (13) temporary haptic externalization, (8,11,36,71) and the use of perfluorocarbon liquids. (1,28,40,41,44) The temporary haptic externalization method combines the best features of the external and the internal approaches, avoids complex intraocular maneuvers, and allows precise scleral fixation of the dislocated IOL on a consistent basis. (8,11,71) Endoscopy provides the surgeon with optimal viewing of the anterior retropupillary anatomy that is often difficult to appreciate (e.g., capsular-zonular complex, ciliary sulcus, anterior retina, and vitreous base). (6,11) As a result, precise haptic placement is possible during the repositioning process. (6,11) However, a three-dimensional birds-eye view is lacking, and there may be a steep learning curve with endoscopy. (11) Certain characteristics of a silicone plate implant may enhance implant dislocation. (11,33,34,46,49,58) Capsular contraction following an Nd:YAG posterior capsulotomv may result in a posterior dislocation of the silicone plate implant. (11,33,34,46,49,50,58) Special techniques are available for the retrieval of the slippery dislocated silicone plate implant from the retinal surface without causing injury. (33,58) Repositioning the plate implant anterior to capsular remnants or in the ciliary sulcus may lead to recurrent dislocation, and its removal is frequently the best option. (11) Placing a second implant in the presence of a disLocated implant is ill advised because subsequent surgical management becomes more complex. (11) Surgical options include removing the dislocated implant through a Limbal or pars plana incision with special techniques, (74,75) repositioning the dislocated implant after removing the second implant," and explanting both implants. (11) Considering the increased morbidities and complications associated with the management of double implants, the surgeon should avoid the placement of a second implant in the setting of a dislocated implant. (11)

Cataract Extraction↗
PubMed2001

Superovulation and intrauterine insemination in cases of treated mild pelvic disease.

PURPOSE: Our purpose was to examine the effect of treated mild pelvic disease on the outcome of superovulation with intrauterine insemination (SO/IUI). METHODS: Three hundred cycles of SO/IUI were retrospectively reviewed for 118 women with laparoscopically treated minimal/mild endometriosis and 67 cycles for 28 women with minimal/mild distal tubal disease/adnexal adhesions and compared with 265 cycles in 111 couples with idiopathic infertility. RESULTS: The monthly fecundity rate (MFR) of 6.8% and live birth rate (LBR) of 6% in the endometriosis group were significantly lower (P = 0.002) than those in the idiopathic infertility group (MFR = 13.5%, LBR = 12.1%). The 10.9% MFR and 7.5% LBR in the minimal/mild tubal/adnexal disease were not significantly different from those in the other two groups. CONCLUSIONS: MFR and LBR were higher after SO/IUI in idiopathic infertility compared to those for treated mild/minimal endometriosis or mild/minimal tubal/adnexal adhesions. However, SO/IUI still remains a reasonable option for both these groups prior to IVF-ET.

Adnexal Diseases↗
PubMed2001

Functioning adrenal tumours in children and adolescents: an institutional experience.

BACKGROUND: The purpose of the present paper was to carry out an audit of clinicopathological profile and treatment outcome in 13 children with functioning adrenal tumours. METHODS: The medical records of 13 children with functioning adrenal tumours who were managed between June 1990 and January 1999 were reviewed. Demographic data, clinical features, biochemical and localization studies, operative details and follow-up records were studied. Children with neuroblastoma were excluded. RESULTS: The mean age was 7.4 +/- 5.3 years. Seven patients had Cushing's syndrome (CS), two patients had virilizing tumours, three patients had phaeochromocytoma (PCC) and one patient had Conn's syndrome. All patients (except one child with CS) were treated surgically. Two children with adrenocortical carcinoma (ACCa) died during the perioperative period. Histopathological diagnosis was adrenal cortical adenoma (ACAd) in four patients, ACCa in five patients and PCC in three patients. Two ACCa patients died of metastases at 12 and 14 months, respectively, while the third is alive and well at 30 months. Children with ACAd are alive and well at 91, 56, 32 and 27 months postoperatively. Children with PCC are free of disease (normal urinary metanephrines) at 63, 18 and 8 months after surgery but require antihypertensive drugs in low doses. CONCLUSION: The outcome of surgery is good in cases of ACAd and PCC. Although outcome is poor in ACCa, surgery remains the mainstay of treatment and offers good palliation.

Adolescent↗
PubMed2001

Two-photon laser scanning microscopy of epithelial cell-modulated collagen density in engineered human lung tissue.

Tissue remodeling is a complex process that can occur in response to a wound or injury. In lung tissue, abnormal remodeling can lead to permanent structural changes that are characteristic of important lung diseases such as interstitial pulmonary fibrosis and bronchial asthma. Fibroblast-mediated contraction of three-dimensional collagen gels is considered an in vitro model of tissue contraction and remodeling, and the epithelium is one factor thought to modulate this process. We studied the effects of epithelium on collagen density and contraction using two-photon laser scanning microscopy (TPLSM). TPLSM was used to image autofluorescence of collagen fibers in an engineered tissue model of the human respiratory mucosa -- a three-dimensional co-culture of human lung fibroblasts (CCD-18 lu), denatured type I collagen, and a monolayer of human alveolar epithelial cell line (A549) or human bronchial epithelial cell line (16HBE14o(-)). Tissues were imaged at days 1, 8, and 15 at 10 depths within the tissue. Gel contraction was measured concurrently with TPLSM imaging. Image analysis shows that gels without an epithelium had the fastest rate of decay of fluorescent signal, corresponding to highest collagen density. Results of the gel contraction assay show that gels without an epithelium also had the highest degree of contraction (19.8% +/- 4.0%). We conclude that epithelial cells modulate collagen density and contraction of engineered human lung tissue, and TPLSM is an effective tool to investigate this phenomenon.

Biomedical Engineering↗