Biomedical subjects
M Monga
Publications and source records attributed to M Monga.
Single-dose ampicillin prophylaxis does not eradicate enterococcus from the lower genital tract.
OBJECTIVES: To determine the carriage rate of enterococcus in the lower genital tract of women having a cesarean delivery and to determine whether a single 2-g intraoperative dose of ampicillin eradicates enterococcus from the lower genital tract. METHODS: Lower genital tract cultures were taken in 84 women who were in labor or had ruptured membranes and who were about to have an indicated cesarean delivery. The subjects were randomized to receive either a single 2-g dose of ampicillin or a cephalosporin as prophylaxis. Cultures were repeated 24 hours postpartum. RESULTS: Enterococcus was isolated preoperatively in 33 subjects (39.3%) and postoperatively in 36 (42.9%). The enterococcus was eradicated in five of 17 women (29.5%) who received ampicillin. CONCLUSION: These results suggest that a single 2-g dose of ampicillin does not eradicate enterococcus from the lower genital tract.
Surgery without adjuvant chemotherapy for early epithelial ovarian carcinoma after comprehensive surgical staging.
From January 1981 to December 1987, 82 patients with carcinoma of the ovary, Stages 1A, 1B, and 1C (cytology negative) (FIGO 1988), were enrolled in this study following accurate surgical staging. No patient received adjunctive therapy and all were followed from 2 to 6 years with a mean duration of follow-up of 4 years. Sixty-eight patients were eligible for review--thirty-nine Stage 1A, six Stage 1B, and twenty-three Stage 1C (twenty-one with tumor rupture, two with excrescences). The mean age was 48.8 years. Three patients had a recurrence of their disease (one death). Forty patients in this series were Stage 1A or 1B (well or moderately well differentiated, no excrescences, no rupture). Only 1 patient in this group (with clear cell carcinoma) has recurred, suggesting that this patient population can be followed without adjunctive therapy. Adhesions or rupture in this series did not affect outcome. Clear cell tumors may have an ominous prognosis despite apparent local disease.
Prescription of aerobic exercise during pregnancy.
Available evidence supports the existence of both risks and benefits of aerobic conditioning during human pregnancy. During intensive exertion, maternal skeletal muscle and the fetus may compete for blood flow, oxygen delivery and essential fuel substrates. Hence, the most important hypothetical risks include acute fetal hypoxia, hyperthermia and malnutrition. If exercise is repeated on a chronic basis, teratogenic effects, fetal growth retardation or altered fetal development may result if maternal/fetal adaptive reserve is exceeded. A dose-response relationship for such effects has been demonstrated in laboratory animals, but specific findings may have limited applicability to voluntary exercise in pregnant women. Although further investigation is needed, the majority of published studies suggest that fitness-type conditioning does not jeopardise fetal well-being in healthy well-nourished women. Benefits of such exercise appear to include increases in maximal aerobic power (VO2max, L/min) and enhanced cardiopulmonary reserve. It has also been proposed that exercise prevents accumulation of excess body fat, promotes psychological well-being, helps to prevent gestational diabetes and low back pain and may facilitate labour. However, these benefits remain to be confirmed by objective scientific study. Due primarily to a lack of scientific data, existing medical guidelines for exercise during pregnancy are conservative and follow a common sense approach. Good agreement exists on the need for preparticipation medical screening and continuing surveillance to verify the existence of maternal/fetal adaptive reserve. Women are advised to select safe, non-ballistic exercise modalities and to avoid thermal or hyperbaric environmental stress during exercise. Exercise in the supine position is also prudent to avoid, particularly in late gestation. The usefulness of heart rate in prescribing and monitoring exercise intensity has been questioned, with use of conventional perception of exertion scales being the most logical alternative. Prediction of maximal aerobic power (VO2max) from submaximal work rate/heart rate relationships is also problematic during pregnancy. Other areas of debate include the advisability of initiating a new exercise programme during pregnancy, methods for prevention of fetal hyperthermia, the safety of weight-training/isometric exercise and optimal methods for training of pre/postnatal fitness instructors.
Hypersexuality in stroke.
Hyposexuality is a common problem in stroke patients. Some stroke patients, however, may present with hypersexuality. We report three stroke patients who demonstrated hypersexuality and deviant sexual behavior after stroke. Abnormal sexual behavior was noted by members of the stroke rehabilitation team while the patients were in hospital. Details of pre- and poststroke sexual activity were obtained from patients and their spouses. All three patients had temporal lobe lesions on computerized tomography, and all had a history of poststroke seizure activity. The 53-year-old man reported poststroke increase in libido and coital frequency with a tendency towards priapism. The two women (47 and 55 years old) exhibited deviant sexual behavior, mood changes, and hyperphagia. The exact cause of these behavior changes is unknown but they may be related to temporal lobe involvement. Hypersexuality has previously been reported in animals and in patients with temporal lobe seizures.
Patient satisfaction with testosterone supplementation for the treatment of erectile dysfunction.
The long-term efficacy of testosterone supplementation for erectile dysfunction was evaluated using standardized questionnaires and differences between testosterone delivery systems analyzed. Forty-four patients receiving parenteral depo-testosterone, Testoderm scrotal patches, or Testoderm-TTS nonscrotal patches were evaluated with the Erectile Dysfunction Inventory of Treatment Satisfaction and International Index of Erectile Function questionnaires. Global questions regarding libido, energy, and improved erections demonstrated a significantly better response with depo-testosterone and Testoderm-TTS nonscrotal patches as compared to Testoderm scrotal patches. Testoderm-TTS nonscrotal patches and depo-testosterone resulted in significantly higher overall treatment satisfaction (p <.001), confidence in ability to engage in sexual activity (p <.001), and total Erectile Dysfunction Inventory of Treatment Satisfaction and International Index of Erectile Function scores (p <.001). Testoderm-TTS nonscrotal patches were significantly better than depo-testosterone with regard to satisfaction with sexual intercourse (International Index of Erectile Function question 5, p <.05). Testosterone replacement improved the quality of erections and level of libido in patients with erectile dysfunction. Treatment delivery systems appear to impact the success of therapy.
Extracorporeal shockwave therapy for peyronie disease.
While surgery is the mainstay of therapy for Peyronie disease requiring correction of angulation, interest has grown in the application of extracorporeal shockwave therapy (ESWT) as a minimally invasive approach. This article reviews the current literature reporting the use of ESWT for Peyronie disease.
Erectile dysfunction: current concepts and future directions.
Major advances in science and medicine have led to improved understanding of the pathophysiology of erectile dysfunction. The development of reliable pharmacological therapy for erectile dysfunction has led to heightened awareness in the public and medical communities. This article reviews recent clinical advances and future research directions.
Observations on the use of music in rehabilitation of stroke patients.
A preliminary investigation was initiated to explore the use of music as a means of improving general mobility, social interaction, and emotional stability in patients who have suffered a stroke. A literature search had revealed very little information on the use of music in the rehabilitation of such patients. The investigators videotaped a series of sessions involving group movement-to-music, group music-making, and individual movement-to-music. An individual case study in music-making was carried out as well. All videotapes were reviewed and we observed that an increase in the range and ease of movement of the patients occurred during weight-shifting activities, when appropriate music with a tempo of 58 to 63 beats per minute was used. Our observations supported the findings of recent research concerning preferred tempi for certain activities and reinforcement of movement by appropriate tempi. Other factors in our study, such as size of group, placement, cueing, and the opportunity to touch, appeared to affect the responses obtained in group situations. As the result of our observations, we have concluded that music enhances the general mobility and social interaction of patients who have sustained a cerebrovascular accident and that it may also improve a patient's emotional stability.
Cellular and molecular causes of male infertility in spinal cord injury.
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Withered Yang: a review of traditional Chinese medical treatment of male infertility and erectile dysfunction.
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Spermagglutination by bacteria: receptor-specific interactions.
The influence of genital infection on infertility has yet to be elucidated. We examined receptor-ligand interactions between sperm and Escherichia coli from patients with prostatitis. Two E. coli surface adhesins (P-fimbriae, type 1 fimbriae) and their specific receptor saccharides (alpha-galp-1-4-beta-galp-O-methyl [gal-gal], mannose) were evaluated. Bacterial concentrations of 10(4) caused spermagglutination. P-fimbriae caused tail-tail spermagglutination that was inhibited by gal-gal. D-mannose concentrations are highest in the acrosomal region and type 1 fimbriae caused head-head agglutination that was inhibited by mannose. Strains with both fimbriae caused head-head and tail-tail agglutination that was inhibited by a mannose/gal-gal combination. E. coli agglutinated 40-75% of motile sperm. Seminal fluid provided 50-100% protection, with lower effectiveness against type 1 fimbriae. Understanding bacteria-spermatozoa interactions at the receptor-ligand level holds potential for treatment of infertility and development of spermagglutinating contraceptives.
Tunica vaginalis sperm reservoir in a monkey model of vas deferens obstruction.
Repeat microscopic epididymal sperm aspiration (MESA) is used to treat congenital absence of the vas deferens (CAVD). Use of alloplastic implants as reservoirs results in poor sperm motility and pregnancy rates. An autoplastic tunica vaginalis reservoir for epididymal sperm has been used in four patients, with one resultant pregnancy. We studied this technique in a monkey model. Eight reservoirs were created in four monkeys (Cercopithecus aethiops). The vas deferens was ligated close to the epididymis. A transverse incision was made in the caput epididymis, and sperm were aspirated for analysis. Cut margins of the epididymal duct were sutured open to the visceral layer of the tunica vaginalis. The defect in the parietal layer of the tunica vaginalis was repaired, and sterile Tyrode's solution was instilled in the potential space between the parietal and visceral layers. Initial epididymal sperm obtained at the creation of the sperm reservoir demonstrated adequate mean motility (60.5%, grade 1.5), morphology (82.8% normal), and viability by Eosin-Y exclusion (69.9%). At 4 weeks, no reservoirs were palpable. Percutaneous aspiration (25-gauge angiocatheter) yielded no fluid. Surgical exposure of the reservoirs demonstrated significant adhesions and scar formation between the parietal and visceral layers of the tunica vaginalis, obliterating the potential space. No sperm were detected in irrigant fluids at this time. In conclusion, adhesion and scar formation may prevent use of the tunica vaginalis reservoir as an alternative to repeat MESA in treatment of CAVD.