Biomedical subjects

K D Desai

Publications and source records attributed to K D Desai.

9 recordsLinked to original sources

PubMed1999

Characterization of autonomic dysfunction in patients with irritable bowel syndrome by means of heart rate variability studies.

OBJECTIVE: Our aim was to characterize autonomic dysfunction in patients with irritable bowel syndrome (IBS) using heart rate variability (HRV) studies. METHODS: EKG signals were obtained from 35 patients (mean age, 39.1 +/- 9.5 yr, M:F ratio = 2.9:1) and 18 healthy controls (mean age, 38.2 +/- 6.5 yr, M:F ratio = 2:1) in supine, standing, and deep-breathing modes. Fast Fourier transformation and autoregressive techniques were used to analyze the HRV power spectra in very low (VLF, 0.0078-0.04 Hz), low (LF, 0.04-0.14 Hz), and high (HF, 0.14-0.4 Hz) frequency bands. RESULTS: In the supine position, the VLF power spectral density (PSD) in IBS was significantly higher than normal (3 vs 1.3 beats per minute [bpm]2/Hz, p < 0.01). On changing from the supine to standing position, the normals (NC) had raised median PSDs in the VLF (1.3 vs 12.8 bpm2/Hz, p < 0.01) and LF (1.6 vs 6.1 bpm2/Hz, p < 0.01) bands, as a sign of increased sympathetic tone, whereas the median HF PSDs (parasympathetic tone) remained unchanged (1.8 bpm2/Hz each, p = 0.8). Similarly, the IBS patients had increased VLF (3.04 vs 14.93 bpm2/Hz, p < 0.01) and LF (2.8 vs 8.7 bpm2/Hz, p < 0.01) PSDs on standing up, but the HF PSD was also raised (from 2.4 to 5.7 bpm2/Hz, p = 0.04). On changing from standing to the deep-breathing mode, the normals had a significant increase in the HF (from 1.8 to 10.3 bpm2/Hz, p < 0.001) and a significant reduction of the VLF (from 12.8 to 2.2 bpm2/Hz, p < 0.01) PSDs. The reduction of the LF PSD was not significant (from 6.1 to 5.6 bpm2/Hz, p = 0.6). In IBS, HF PSD remained constant (5.7 bpm2/Hz each, p = 0.6), whereas the LF PSD increased from 8.7 to 24.2 bpm2/Hz (p < 0.0001). The VLF PSD was reduced (from 14.9 to 4.1 bpm2/Hz, p < 0.0001). In IBS, the median sympathovagal outflow ratio was significantly lower in the standing position (1.4 vs 2.8, p < 0.02) and higher in the deep-breathing mode (7.33 vs 0.42, p < 0.0001) than normal. CONCLUSIONS: IBS patients have reduced sympathetic influence on the heart period in response to orthostatic stress and diminished parasympathetic modulation during deep breathing.

Adult↗

PubMed1993

Experience with penile venous surgery.

Venogenic impotence was detected in 37 out of 141 patients who attended our clinic with a complaint of erectile dysfunction. Eighteen patients presented with primary impotence and the rest had progressive secondary impotence. All 37 patients have shown partial or poor response to 60 mg of intracavernosal papaverine. The corporovenous leak (CVL) was diagnosed on the careful workup of dynamic pharmacocavernosometry and cavernosography. Concomitant arterial cause was noted in 10% cases on the basis of penile duplex Doppler ultrasound study. 24 patients in the age group of 23-60 years underwent the penile venous surgery. The CVL was noted in the deep dorsal vein (23 cases), cavernous vein (16) and in the crural vein (2). The operation consisted of deep dorsal vein (DDV) ligation and excision with all tributaries (8 cases) or DDV ligation and excision+cavernous vein ligation (13 cases), through an infrapubic curvilinear incision. One patient had crural vein ligation and corporoplasty through a perineal incision, one had direct corporeal revascularization for associated arteriogenic impotence with venous leak and another had distal spongiolysis and closure of a corporospongiosal shunt. The results were excellent in 11 cases, improved in 6 and 7 had failures. Surgical intervention is effective in CVL in selected cases but limiting factors in the form of increasing age, concomitant arteriogenic cause, significant crural leak, missing tributaries, recurrent venous leak and unknown factors may also be present to prevent total cure.

Adult↗

PubMed1991

Transvesical vesicovaginal fistula repair: a revival.

Vesicovaginal fistulae are usually traumatic in nature, following obstetric or gynecologic trauma. Here, our experience with vesicovaginal fistula repair in 68 cases, performed transvesically (58 cases) or transperitoneally-transvesically, with pedicled omental interposition in 10 cases over the last 8 years is described. The size of fistulae ranged from 1 to 5 cm, and most were situated near or above the trigone. Two cases required ureteric reimplantation. Recurrent fistulae were found in 4 cases. We attribute our success to the simple access, the construction of a vascularized flap, the tension-free grid-iron closure, and the utilization of Vicryl suture.

Cesarean Section↗

PubMed1991