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Pande A, Ghosh S. The Hawthorne Effect: Quality and Outcomes in Neurosurgery. Acta Neurochir Suppl 2023; 130:207-216. [PMID: 37548741 DOI: 10.1007/978-3-030-12887-6_25] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Measure something, and it gets better-this is what is called as the Hawthorne effect (also known as the observer effect). The Hawthorne factory experiments in 1920s were remarkable industrial data collection and analysis exercises that lead to Edwards Deming's quality revolution. The Harvard Medical Practice Study (1991), Leape's "Error in Medicine" (1994), and the Bristol pediatric cardiac report (2001) are among many documents that have revealed the huge gap between best practices and actual medical practice. Alarmed by the poor standards of quality at the most respected institutions, the medical fraternity therefore began visiting facilities in different fields and observing their quality assessment processes. The next leap for neurosurgery is to realize that it is unacceptable to treat patients with no regard for the standard of clinical outcomes. The traditional neurosurgery residency training has long ignored the most important issues of self-assessment, reappraisal, relearning, and measurement of skill and surgical outcomes. However, the experience taken from disparate fields, especially cardiac surgery, may encourage research and progress in measurement and improvement of quality in neurosurgery. Like cardiac surgeons, neurosurgeons must examine and analyze the results of their interventions. The concept of quality measurement is the most important single advance we can make in neurosurgery practice. Meticulous and precise measurement of outcomes will allow future progress of our specialty.
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Affiliation(s)
- Anil Pande
- Institute of Neurosciences, Apollo Hospitals OMR and Vanagaram, Chennai, Tamil Nadu, India.
| | - Siddhartha Ghosh
- Institute of Neurosciences, Apollo Hospitals OMR and Vanagaram, Chennai, Tamil Nadu, India
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Ryu M, Pande A, Kim J, Kang YK. 1237P Phase I study to evaluate the safety, tolerability and preliminary efficacy of rivoceranib plus paclitaxel in advanced gastric or gastroesophageal junction (GEJ) cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1355] [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: 11/01/2022] Open
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Pande A. Prof B Ramamurthi Centenary Commemorative Issue March April 2022. Neurol India 2022; 70:473-474. [PMID: 35532605 DOI: 10.4103/0028-3886.344683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Anil Pande
- Adjunct Professor of Neurosurgery, Apollo Hospitals Education and Research Foundation, Sr Consultant Neurosurgeon, Apollo Hospitals Chennai and PGINS ALNC VHS Hospitals Chennai, Tamil Nadu, India
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Nury T, Yammine A, Ghzaiel I, Sassi K, Zarrouk A, Brahmi F, Samadi M, Rup-Jacques S, Vervandier-Fasseur D, Pais de Barros J, Bergas V, Ghosh S, Majeed M, Pande A, Atanasov A, Hammami S, Hammami M, Mackrill J, Nasser B, Andreoletti P, Cherkaoui-Malki M, Vejux A, Lizard G. Attenuation of 7-ketocholesterol- and 7β-hydroxycholesterol-induced oxiapoptophagy by nutrients, synthetic molecules and oils: Potential for the prevention of age-related diseases. Ageing Res Rev 2021; 68:101324. [PMID: 33774195 DOI: 10.1016/j.arr.2021.101324] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/18/2022]
Abstract
Age-related diseases for which there are no effective treatments include cardiovascular diseases; neurodegenerative diseases such as Alzheimer's disease; eye disorders such as cataract and age-related macular degeneration; and, more recently, Severe Acute Respiratory Syndrome (SARS-CoV-2). These diseases are associated with plasma and/or tissue increases in cholesterol derivatives mainly formed by auto-oxidation: 7-ketocholesterol, also known as 7-oxo-cholesterol, and 7β-hydroxycholesterol. The formation of these oxysterols can be considered as a consequence of mitochondrial and peroxisomal dysfunction, leading to increased in oxidative stress, which is accentuated with age. 7-ketocholesterol and 7β-hydroxycholesterol cause a specific form of cytotoxic activity defined as oxiapoptophagy, including oxidative stress and induction of death by apoptosis associated with autophagic criteria. Oxiaptophagy is associated with organelle dysfunction and in particular with mitochondrial and peroxisomal alterations involved in the induction of cell death and in the rupture of redox balance. As the criteria characterizing 7-ketocholesterol- and 7β-hydroxycholesterol-induced cytotoxicity are often simultaneously observed in major age-related diseases (cardiovascular diseases, age-related macular degeneration, Alzheimer's disease) the involvement of these oxysterols in the pathophysiology of the latter seems increasingly likely. It is therefore important to better understand the signalling pathways associated with the toxicity of 7-ketocholesterol and 7β-hydroxycholesterol in order to identify pharmacological targets, nutrients and synthetic molecules attenuating or inhibiting the cytotoxic activities of these oxysterols. Numerous natural cytoprotective compounds have been identified: vitamins, fatty acids, polyphenols, terpenes, vegetal pigments, antioxidants, mixtures of compounds (oils, plant extracts) and bacterial enzymes. However, few synthetic molecules are able to prevent 7-ketocholesterol- and/or 7β-hydroxycholesterol-induced cytotoxicity: dimethyl fumarate, monomethyl fumarate, the tyrosine kinase inhibitor AG126, memantine, simvastatine, Trolox, dimethylsufoxide, mangafodipir and mitochondrial permeability transition pore (MPTP) inhibitors. The effectiveness of these compounds, several of which are already in use in humans, makes it possible to consider using them for the treatment of certain age-related diseases associated with increased plasma and/or tissue levels of 7-ketocholesterol and/or 7β-hydroxycholesterol.
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Chidambaram S, Vasudevan MC, Pande A, Chidambaram S, Pannullo SC. Dr. Thanjavur Santhanakrishna Kanaka-A Pioneer and Neurosurgical Innovator. World Neurosurg 2021; 150:84-88. [PMID: 33757884 DOI: 10.1016/j.wneu.2021.03.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thanjavur Santhanakrishna Kanaka, M.B.B.S., M.S. (General Surgery), M.S. (Neurosurgery), Ph.D., and former Captain, Indian Army Medical Corps, was born on March 31, 1932. She became the first woman neurosurgeon in India and all of Asia. METHODS This manuscript was compiled through a combination of interviews and references to other articles and some of the published manuscripts of Dr. Kanaka and her colleagues. RESULTS Dr. Kanaka was a trailblazer for women in neurosurgery and a pioneer in functional and stereotactic neurosurgery. During her long and productive career, she authored dozens of articles reported in prestigious neurosurgical journals worldwide and helped inspire and train the next generations of neurosurgeons in India and abroad. Even after retirement, Dr. Kanaka continued to focus on serving the medical community through her Sri Santhanakrishna Padmavathi Health Care and Research Foundation in Chennai with the mission of serving underprivileged and senior citizens in the local community. In addition to her accomplishments as a practicing neurosurgeon, Dr. Kanaka's career was notable for her successful collaborations with biomedical engineers on medical device development using locally sourced materials and talent in India. CONCLUSIONS Through her innovative thinking, compassion for her patients, and unwavering resilience, Dr. Kanaka has continued to serve as an inspiration to all pursuing a career in academic medicine and neurosurgery.
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Affiliation(s)
- Swathi Chidambaram
- Graduate School of Business, Stanford University, Stanford, California, USA
| | - Madabushi C Vasudevan
- Postgraduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, India
| | - Anil Pande
- Postgraduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, India
| | | | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Biomedical Engineering, College of Engineering, Cornell University, Ithaca, New York, USA.
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Abou-Alfa G, Borbath I, Cohn A, Goyal L, Lamarca A, Macarulla T, Oh DY, Roychowdhury S, Sadeghi S, Shroff R, Howland M, Li A, Cho T, Pande A, Javle M. 1014TiP PROOF: A multicenter, open-label, randomized, phase III trial of infigratinib vs gemcitabine + cisplatin in patients with advanced cholangiocarcinoma with FGFR2 gene rearrangements. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abou-Alfa G, Borbath I, Cohn A, Goyal L, Lamarca A, Macarulla T, Oh D, Roychowdhury S, Sadeghi S, Shroff R, Howland M, Li A, Cho T, Pande A, Javle M. P-144 Infigratinib versus gemcitabine plus cisplatin as first-line therapy in patients with advanced cholangiocarcinoma with FGFR2 gene fusions/translocations: phase 3 PROOF trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nigam P, Krishnan SS, Pande A, Vasudevan MC. A system of radiological criteria for grading and prognosticating temporal lobe contusions. Neuroradiol J 2020; 33:179-185. [PMID: 31964226 PMCID: PMC7140305 DOI: 10.1177/1971400919893114] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Temporal contusions are common in patients with head injuries and require close monitoring due to the propensity of these patients to deteriorate rapidly and fatally. This study attempts to introduce a radiological grading system for temporal lobe contusions and analyse its prognostic value so as to better identify patients at risk of deterioration. METHODS The study was conducted as a cross-sectional observational study from April 2011-March 2017 on 42 patients with temporal lobe contusion. Each patients was graded according to the proposed system from a minimum of four to a maximum of 13 and then further grouped in three grades - grade 1 (score = 4), grade 2 (score 5-7) and grade 3 (score > 7) - and their clinical course was closely observed. RESULTS The minimum and maximum scores observed were four and 11 respectively. The proposed grading system has statistically significant correlation to the Glasgow Coma Scale (p-value < 0.05). All patients in grade 1 (17) could be managed conservatively, while all those in grade 3 (five) needed immediate surgical intervention. Of 20 patients in grade 2, 11 had a score of 5-6 and did not require surgery, whereas nine patients had a score of seven and of these eight required delayed surgical intervention. This correlation was statistically significant (p-value < 0.05). CONCLUSION The proposed temporal lobe contusion grading system is a good radiological tool to predict the clinical course of patients and thereby identify patients at higher risk of delayed deterioration.
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Affiliation(s)
| | | | | | - MC Vasudevan
- Post-Graduate Institute of Neurological
Surgery, Dr Achanta Lakshmipathi Neurosurgical Centre, India
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Pande A, Nambi PS, Pandian S, Subramanian S, Ghosh S. Melioidosis mimicking tuberculous vertebral osteitis: Case report and review of literature. Neurol India 2019; 66:1100-1105. [PMID: 30038101 DOI: 10.4103/0028-3886.236976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Whitmore's disease or melioidosis is an infectious disease caused by Burkholderia pseudomallei. The reported cases are but the tip of the iceberg. This pathogenic saprophyte is commonly found in wet soil and water. An accidental or occupational exposure (in field workers, farmers, gardeners or villagers) to B. pseudomallei contaminated soil or pooled water is the primary source of infection. Neurosurgeons need to consider this as a possible rare cause of back pain and possible neurological deterioration. A diabetic type 2 rice farmer with severe lumbago and fever, misdiagnosed as vertebral tuberculous osteitis based on his radiological findings, was confirmed to harbour Burkholderia Pseudomallei, which was diagnosed using laboratory cultures. He made a remarkable recovery with antibiotic therapy. The empiric anti-tuberculous (ATT) drugs were stopped. The rare differential diagnosis of melioidosis should be thought of in diabetic patients with a psoas abscess and vertebral osteitis, especially in rice farmers from endemic regions that includes India.
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Affiliation(s)
- Anil Pande
- Department of Neurosurgery, Institute of Neurosciences, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - P Senthur Nambi
- Department of Infectious Diseases, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | | | - Siddhartha Ghosh
- Department of Neurosurgery, Institute of Neurosciences, Apollo Hospitals, Chennai, Tamil Nadu, India
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Sridhar K, Vasudevan MC, Krishnan SS, Pande A, Jain PK. Forty years of clinical excellence at the Dr A Lakshmipathi Neurosurgical Centre and Post-Graduate Institute of Neurological Surgery, Voluntary Health Services (VHS) Hospital. Neurol India 2019; 67:516-529. [PMID: 31085870 DOI: 10.4103/0028-3886.257984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Achanta Lakshmipathi Neurosurgical Center (ALNC) and Post Graduate Institute of Neurological Surgery is a private teaching neurosurgical institution located in the VHS (Voluntary Health Services) Hospital Chennai. It has been a leader and trendsetter among the private academic neurosurgical training institutions, and because of its unique legacy, has influenced the progress of Neurosurgery in India. The center was the second neurosurgical Institute to be created by Prof. B Ramamurthi and has trained neurosurgeons in the unique ALNC school of Neurosurgery. The Institute has grown to become a centre of excellence in microsurgery, and spinal surgery and has become a training centre for neurosurgery since 1985. The unique humanitarian aspects of the Voluntary Health Services Hospital helped in bringing the best of Neurosurgery to all strata of society. Forty years after its inception, the ALNC continues its delivery of excellence in clinical neurosurgery and academics.
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Affiliation(s)
- K Sridhar
- Department of Neurosurgery, Institute of Neurosciences and Spinal Disorders, MGM Healthcare, Chennai, Tamil Nadu, India
| | - M C Vasudevan
- Department of Neurosurgery, Post-Graduate Institute of Neurological Surgery, Dr A Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, Tamil Nadu, India
| | - Shyam Sundar Krishnan
- Department of Neurosurgery, Post-Graduate Institute of Neurological Surgery, Dr A Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, Tamil Nadu, India
| | - Anil Pande
- Department of Neurosurgery, Institute of Neurosciences, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Pradeep Kumar Jain
- Department of Neurosurgery, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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Sadiya N, Pande A, Salapathi S, Ghosh S. Recurrent atypical meningioma of the lumbosacral spine. Neurol India 2019; 67:300-302. [PMID: 30860143 DOI: 10.4103/0028-3886.253643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- N Sadiya
- Department of Histopathology, Apollo Speciality Hospital, Vanagaram, Chennai, Tamil Nadu, India
| | - Anil Pande
- Department of Neurosurgery, Apollo Speciality Hospital, Vanagaram, Chennai, Tamil Nadu, India
| | - S Salapathi
- Department of Histopathology, Apollo Speciality Hospital, Vanagaram, Chennai, Tamil Nadu, India
| | - Siddhartha Ghosh
- Department of Neurosurgery, Apollo Speciality Hospital, Vanagaram, Chennai, Tamil Nadu, India
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Ross PM, Pande A, Jones JB, Cope J, Flowers G. First detection of gas bubble disease and Rickettsia-like organisms in Paphies ventricosa, a New Zealand surf clam. J Fish Dis 2018; 41:187-190. [PMID: 28708277 DOI: 10.1111/jfd.12684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 06/07/2023]
Affiliation(s)
- P M Ross
- University of Waikato, Coastal Marine Field Station, Tauranga, New Zealand
| | - A Pande
- Animal Health Laboratory, Ministry for Primary Industries, Upper Hutt, New Zealand
| | - J B Jones
- Animal Health Laboratory, Ministry for Primary Industries, Upper Hutt, New Zealand
| | - J Cope
- University of Waikato, Coastal Marine Field Station, Tauranga, New Zealand
| | - G Flowers
- University of Waikato, Coastal Marine Field Station, Tauranga, New Zealand
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Brosnahan CL, Humphrey S, Knowles G, Ha HJ, Pande A, Jones JB. Nocardiosis in freshwater reared Chinook salmon (Oncorhynchus tshawytscha). N Z Vet J 2017; 65:214-218. [DOI: 10.1080/00480169.2017.1314794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- CL Brosnahan
- Animal Health Laboratory, Ministry for Primary Industries, 66 Ward Street, Upper Hutt, New Zealand
| | - S Humphrey
- Animal Health Laboratory, Ministry for Primary Industries, 66 Ward Street, Upper Hutt, New Zealand
| | - G Knowles
- Vetman Animal Health, 25 Fruitgrowers Rd, PO Box 44, Clyde, New Zealand
| | - HJ Ha
- Animal Health Laboratory, Ministry for Primary Industries, 66 Ward Street, Upper Hutt, New Zealand
| | - A Pande
- Animal Health Laboratory, Ministry for Primary Industries, 66 Ward Street, Upper Hutt, New Zealand
| | - JB Jones
- Animal Health Laboratory, Ministry for Primary Industries, 66 Ward Street, Upper Hutt, New Zealand
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Pande A, Vasudevan M, Ramamurthi R, Kapu R. Primary interhemispheric subdural empyemas: A report of three cases and review of literature. IJNS 2017. [DOI: 10.4103/2277-9167.110227] [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: 11/04/2022] Open
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Abstract
An aneurysmal bone cyst (ABC) is a benign, locally proliferative vascular disorder of non-neoplastic osseous lesions in children and young adults. Seventy-five percent of ABCs occur before the age of 20 years. They comprise 1.4% of all primary bone tumors, and commonly occur in the long bones. Spinal ABCs are much rarer. We present to you one such rare case of ABC involving the lumbar spine which was successfully treated with surgery. The clinical pathological and radiological features are described. The treatment options available are discussed.
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Affiliation(s)
- Goutham Cugati
- Department of Neurosurgery, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - Anil Pande
- Department of Neurosurgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, V.H.S Hospital, Taramani, Chennai, India
| | - Pradeep K Jain
- Department of Neurosurgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, V.H.S Hospital, Taramani, Chennai, India
| | - Nigel Peter Symss
- Department of Neurosurgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, V.H.S Hospital, Taramani, Chennai, India
| | - Ravi Ramamurthi
- Department of Neurosurgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, V.H.S Hospital, Taramani, Chennai, India
| | - Chakravarthy M Vasudevan
- Department of Neurosurgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, V.H.S Hospital, Taramani, Chennai, India
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Cugati G, Singh M, Pande A, Symss NP, Chakravarthy VM, Ramamurthi R. Isolated skull base primary Ewing's sarcoma: an extremely rare location. J Cancer Res Ther 2014; 9:741-2. [PMID: 24518733 DOI: 10.4103/0973-1482.126479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 16-year-old boy presented with history of headache and blurring of distant vision. He had UMN facial paresis and papilledema. Imaging revealed a heterogenous space occupying lesion in the middle cranial fossa base with mass effect and midline shift and non homogenous contrast enhancement with erosion of the petrous bone. He underwent gross total excision of the lesion. Histopathology and immunohistochemistry were suggestive of skull base Ewing's sarcoma. Bone scan was done to rule out primary involvement of other extracranial location. We have discussed the epidemiology, presentation, management and prognosis of such cases.
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Affiliation(s)
- Goutham Cugati
- Department of Neurosurgery, JSS Medical College and Hospital, Mysore, Karnataka, India
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Chi K, Higano C, Reeves J, Feyerabend S, Gravis G, Ferrero J, Jacobs C, Barnett-Griness O, Pande A, de Bono J. A Randomized Phase 3 Study Comparing First-Line Docetaxel/Prednisone (Dp) to Dp Plus Custirsen in Men with Metastatic Castration-Resistant Prostate Cancer (Mcrpc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.3] [Citation(s) in RCA: 4] [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: 11/14/2022] Open
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Symss NP, Ramamurthi R, Kapu R, Rao SM, Vasudevan MC, Pande A, Cugati G. Complication avoidance in transcallosal transforaminal approach to colloid cysts of the anterior third ventriclen: An analysis of 80 cases. Asian J Neurosurg 2014; 9:51-7. [PMID: 25126118 PMCID: PMC4129577 DOI: 10.4103/1793-5482.136708] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Object: The objective of the present study is to analyze the complications and their avoidance in a series of 80 patients operated by transcallosal transforaminal approach to colloid cysts of the anterior third ventricle. Materials and Methods: The surgical outcome and complications of 80 patients operated by transcallosal transforaminal approach for colloid cysts in the anterior third ventricle was analyzed. A detailed pre- and post-operative neurological assessment was done in all patients. Neurocognitive assessment of corpus callosal function was done in the last 22 cases. CT scan of the brain was done in all patients, before and after surgery. Results: All patients underwent transcallosal transforaminal approach. Total excision of the lesion was achieved in 79 patients and subtotal in one. The complications encountered were postoperative seizures in six, acute hydrocephalus in four, venous cortical infarct in four, transient hemiparesis in four, transient memory impairment, especially for immediate recall in nine, mutism in one, subdural hematoma in one, meningitis in three, and tension pneumocephalus in one patient. There were two mortalities. There was no incidence of postoperative disconnection syndrome. Conclusion: Colloid cyst is surgically curable. With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease. With increasing experience, most of the complications are avoidable. The limited anterior callosotomy does not result in disconnection syndromes.
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Affiliation(s)
- Nigel P Symss
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Ravi Ramamurthi
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Ravindranath Kapu
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Santhosh Mohan Rao
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Madabushi Chakravarthy Vasudevan
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Anil Pande
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
| | - Goutham Cugati
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India
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Abstract
India being a tropical country, parasitic infections especially with Plasmodium species are very common in this region. The present case report is that of Plasmodium vivax, Plasmodium falciparum and dengue co-infection in a 6 months pregnant lady who was timely diagnosed and appropriately treated followed by a complete recovery along with feto-maternal well-being.
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Affiliation(s)
- A Pande
- Department of Medicine, Subharti Institute of Medical Sciences, Subhartipuram, Meerut, Uttar Pradesh, India
| | - D Guharoy
- Department of Medicine, Subharti Institute of Medical Sciences, Subhartipuram, Meerut, Uttar Pradesh, India
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Cugati G, Singh M, Symss NP, Pande A, Vasudevan MC, Ramamurthi R. Primary spinal intradural extramedullary lymphoma causing cauda equina syndrome. J Craniovertebr Junction Spine 2013; 3:58-61. [PMID: 24082685 PMCID: PMC3777313 DOI: 10.4103/0974-8237.116538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of lumbar intradural extramedullary lesion in an 11-year-old boy who presented with cauda equina syndrome and acute bladder disturbance. He underwent emergency surgical resection of the lesion, which was proved to be a lymphoma by histopathology and immunohistochemistry. He has improved neurologically and after 1 year, he is leading a normal life with near normal neurological functions. This is the second case of primary spinal intradural extramedullary lymphoma. This is the first such case in the pediatric age group and causing cauda equina syndrome. We describe the characteristics of such tumors along with pathogenesis and management.
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Affiliation(s)
- Goutham Cugati
- Department of Neurosurgery, Narayana Hrudayalaya Multispeciality Hospitals, Mysore, Karnataka, India
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Kapu R, Singh M, Pande A, Vasudevan MC, Ramamurthi R. Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication. J Craniovertebr Junction Spine 2013; 3:19-22. [PMID: 23741125 PMCID: PMC3669469 DOI: 10.4103/0974-8237.110121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a patient with congenital anomaly of cervical spine, who presented with clinical features suggestive of cervical compressive spondylotic myelopathy. He underwent C3 median corpectomy, graft placement, and stabilization from C2 to C4 vertebral bodies. Postoperative period was uneventful and he improved in his symptoms. Eight years later, he presented with a difficulty in swallowing and occasional regurgitation of feeds of 2 months duration and oral extrusion of screw while having food. On oral examination, there was a defect in the posterior pharyngeal wall through which the upper end of plate with intact self-locking screw and socket of missed fixation screw was seen. This was confirmed on X-ray cervical spine. He underwent removal of the plate system and was fed through nasogastric tube and managed with appropriate antibiotics. This case is presented to report a very rare complication of anterior cervical plate fixation in the form of very late-onset dislodgement, migration of anterior cervical plate, and oral extrusion of screw through perforated posterior pharyngeal wall.
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Affiliation(s)
- Ravindranath Kapu
- Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, Tamil Nadu, India
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Kapu R, Pande A, Vasudevan MC, Ramamurthi R. Giant colloid cyst of third ventricle with microhemorrhages causing neurological deterioration: a very rare presentation. Neurol India 2013; 60:557-8. [PMID: 23135054 DOI: 10.4103/0028-3886.103226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kapu R, Symss NP, Pande A, Vasudevan MC, Ramamurthi R. Management of pediatric colloid cysts of anterior third ventricle: A review of five cases. J Pediatr Neurosci 2012; 7:90-5. [PMID: 23248682 PMCID: PMC3519091 DOI: 10.4103/1817-1745.102563] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Object: Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiological picture in children than in adults. We present our experience in management of five pediatric patients with colloid cyst of the anterior third ventricle. They have an excellent chance of surgical cure, or they can be devastating and even fatal, if not recognized on time and treated. Materials and Methods: Five pediatric patients (aged 16 years or less) who were surgically treated for a colloid cyst, between 1987 and 2011 were analyzed. The clinical features included raised intracranial pressure in all five cases, of which one patient was brought unconscious with decerebrate posturing. Computed Tomography (CT) scan of the brain was done in all patients. The density of the lesion, enhancement with contrast and the presence of hydrocephalus were analyzed. Four patients underwent a detailed postoperative neurological assessment. Results: Three patients underwent the transcallosal-transforaminal approach and total excision of the lesion. One patient underwent revision of the pre-existing ventriculoperitoneal shunt. One patient who was brought in an unconscious state, an external ventricular drain was inserted and she was ventilated. She died 4 hours after the admission. On follow-up, none of the three patients who underwent the transcallosal-transforaminal approach had disconnection syndromes or behavioral disturbances. Conclusion: Colloid cysts in children are rarer and more aggressive than their adult counterparts. It is surgically curable. Early detection and total excision of the lesion is a permanent cure with minimum morbidity, when compared with the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
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Affiliation(s)
- Ravindranath Kapu
- Department of Neurosurgery, Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, Tamil Nadu, India
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Yajnik CS, Kantikar V, Pande A, Deslypere JP, Dupin J, Calvet JH, Bauduceau B. Screening of cardiovascular autonomic neuropathy in patients with diabetes using non-invasive quick and simple assessment of sudomotor function. Diabetes Metab 2012; 39:126-31. [PMID: 23159130 DOI: 10.1016/j.diabet.2012.09.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 02/07/2023]
Abstract
AIM Cardiovascular autonomic neuropathy (CAN) is a common but often overlooked complication of diabetes. Sympathetic C-fibers innervating sweat glands can be impaired early on in patients with diabetes. In this study, SUDOSCAN, a new non-invasive device that assesses sudomotor function was compared to methods generally used for the investigation of CAN. PATIENTS A total of 232 patients with diabetes were measured for heart rate variability (HRV) at rest and during moderate activity. Time and frequency domain analysis techniques, including measurement of the low-frequency (LF) domain component, were assessed during HRV testing. Ewing tests, as recommended by the French Health Authority, were also done. Electrochemical sweat conductance (ESC) was measured on the hands and feet, and a risk-score was calculated. RESULTS Using two abnormal Ewing tests as a reference for the area under the curve (AUC) of the receiver operating characteristics (ROC) curve for SUDOSCAN, the risk-score was 0.74, with a sensitivity of 92% and specificity of 49% for a risk-score cut-off value of 35%. For the ROC curve analysis using the LF power component during moderate activity at a threshold of 90 ms(2) (first quartile) as reference, the AUC was higher for the SUDOSCAN risk-score (0.77) compared with the standard Ewing tests [E:I ratio (0.62), 30:15 ratio (0.76) and blood pressure change on standing (0.55)]. Using a cut-off value of 35%, risk-score sensitivity and specificity were 88 and 54%, respectively. CONCLUSION SUDOSCAN, which allows quick quantitative assessment of sudomotor function, may be used for early screening of CAN in everyday clinical practice before resorting to the more sophisticated and specific, but ultimately more time-consuming, Ewing tests.
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Affiliation(s)
- C S Yajnik
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, India
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Cugati G, Singh M, Symss NP, Pande A, Chakravarthy VM, Ramamurthi R. Extra-axial cerebello pontine angle medulloblastoma: A rare site of tumor. Indian J Med Paediatr Oncol 2012; 32:123-4. [PMID: 22174507 PMCID: PMC3237181 DOI: 10.4103/0971-5851.89801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Goutham Cugati
- Department of Neurosurgery, Voluntary Health Services, Adyar, Chennai, Tamil Nadu, India
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Cugati G, Jain PK, Pande A, Symss NP, Chakravarthy V, Ramamurthi R. Pediatric multifocal glioblastoma multiforme with fulminant course. J Neurosci Rural Pract 2012; 3:174-7. [PMID: 22865971 PMCID: PMC3409990 DOI: 10.4103/0976-3147.98224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM in children is less common than in adults and has a better prognosis. Pediatric GBM is a rare entity, and a multifocal development in a pediatric GBM is much rarer. We report to you one such rare case of pediatric multifocal GBM in a 5-year-old child who developed rapidly increasing multiple lesions after radiotherapy. More studies are required to study the genetic analysis, tumor behavior, management and outcome of these rare tumors.
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Affiliation(s)
- Goutham Cugati
- Department of Neurosurgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, V.H.S Hospital, Taramani, Chennai, Tamil Nadu, India
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Kapu R, Singh MK, Pande A, Vasudevan MC, Ramamurthi R. Intradural extramedullary cysticercal abscess of spine. Trop Parasitol 2012; 2:131-4. [PMID: 23767023 PMCID: PMC3680876 DOI: 10.4103/2229-5070.105181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/28/2012] [Indexed: 11/29/2022] Open
Abstract
Neurocysticercosis (NCC) is one of the most common parasitic diseases affecting the central nervous system. Typically spinal NCC involvement has a concomitant cranial involvement. Spinal involvement by NCC, either intramedullary or extramedullary is very uncommon. The authors report a case of D12-L1 intradural extramedullary lesion in a 38-year-old female patient who presented with complaints of back pain and weakness of lower limbs. She underwent laminectomy and excision of the lesion. Histopathology revealed extramedullary cysticercal abscess. Post-operatively she was treated with albendazole. She had a successful recovery post-operatively and at 8 months follow up had no neurological deficits. This current case presents a very rare case of cysticercal abscess of dorsolumbar spine, without any evidence of cranial involvement. This report is to reemphasize the importance of including NCC as a differential diagnosis in intradural extramedullary lesion at the conus level in endemic areas like India.
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Affiliation(s)
- Ravindranath Kapu
- Department of Neurosurgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, India
| | - Manish Kumar Singh
- Department of Neurosurgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, India
| | - Anil Pande
- Department of Neurosurgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, India
| | | | - Ravi Ramamurthi
- Department of Neurosurgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, India
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Affiliation(s)
- Goutham Cugati
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Hospital, Chennai, Tamil Nadu, India
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Abstract
An epidural location for lymphoma is observed in 0.1-6.5% of all the lymphomas. Primary spinal epidural lymphoma (PSEL) is a subset of lymphomas, where there are no other recognizable sites of lymphomas at the time of diagnosis. The incidence of this subset of lymphomas is much less. It, however, is increasingly diagnosed, due to the increased use of more sensitive imaging modalities. For the electronic search, Pubmed was used to identify journals that enlisted and enumerated PSEL from 1961 to January 2011. The following combination of terms: "primary," "spinal," "epidural," and "lymphoma" were used. The most significant articles and their bibliographies were analyzed by the authors. The symptoms, pathogenesis, diagnostic workup, histopathology, treatment, and outcome have been analyzed in a systematic manner.
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Affiliation(s)
- Goutham Cugati
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Medical Centre, Taramani, India
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Symss NP, Ramamurthi R, Rao SM, Vasudevan MC, Jain PK, Pande A. Management outcome of the transcallosal, transforaminal approach to colloid cysts of the anterior third ventricle: an analysis of 78 cases. Neurol India 2011; 59:542-7. [PMID: 21891930 DOI: 10.4103/0028-3886.84334] [Citation(s) in RCA: 14] [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: 11/04/2022]
Abstract
BACKGROUND Colloid cysts are not common brain lesions and account for 0.2-2.0% of all brain lesions. Transcallosal, transforaminal approach is a safe route and the most direct path to excise third ventricular colloid cyst, without dependence on hydrocephalus. AIM To assess the surgical outcome of patients with colloid cysts of the anterior third ventricle treated by the transcallosal, transforaminal approach. PATIENTS AND METHODS Seventy-eight patients operated by the above approach over a period of 20 years were analyzed. A pre- and postoperative neurological assessment was done in all the patients. Neuro-cognitive evaluation of corpus callosum function was done in the last 20 patients. Computer tomography scan of the brain was done in all patients pre- and postoperatively. RESULTS Clinical features of raised intracranial pressure without localizing signs were the commonest presenting feature in 52 (66.7%) patients. Hydrocephalus was present in 65 (83.3%) patients. All patients underwent the transcallosal, transforaminal approach, and total excision of the lesion was achieved in 77 patients and subtotal in 1. Four patients required a postoperative shunt for acute hydrocephalus. There was no incidence of postoperative disconnection syndrome. In two patients, there was recurrence of the lesion after 2 and 6 years, respectively. Two patients died in the postoperative period. CONCLUSION Colloid cyst is surgically curable. Early detection and total excision of the lesion can be a permanent cure with low mortality and minimum morbidity, when compared to the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
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Affiliation(s)
- Nigel Peter Symss
- Dr. A. Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, India.
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Kapu R, Symss NP, Cugati G, Pande A, Vasudevan CM, Ramamurthi R. Multiple burr hole surgery as a treatment modality for pediatric moyamoya disease. J Pediatr Neurosci 2011; 5:115-20. [PMID: 21559155 PMCID: PMC3087986 DOI: 10.4103/1817-1745.76102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To re-emphasize that indirect revascularization surgery alone, where multiple burr holes and arachnoid openings are made over both cerebral hemispheres, is beneficial in the treatment of moyamoya disease (MMD) in children. Clinical Presentation: We report a 10-year-old boy who presented with complaints of episodic headache for the last 5 years. At the peak of his headache he had visual disturbances and acute onset weakness of left-sided limbs, recovering within a few minutes. He had no focal neurological deficits. Radiological investigations revealed abnormal findings, demonstrating the features of MMD. Surgical Management: He underwent bilateral multiple burr holes, dural and arachnoid opening over the frontal, parietal and temporal regions of each hemisphere. The elevated periosteal flap was placed in contact with the exposed brain through each burr hole. Results: On 6-months follow-up he had only one episode of transient ischemic attack. Postoperative four vessel angiogram demonstrated excellent cerebral revascularization around the burr hole sites, and single photon emission computerized tomography imaging showed hypoperfusion in the right temporo-occipital area suggestive of an old infarct with no other perfusion defect in the rest of the brain parenchyma. Conclusion: In children with MMD this relatively simple surgical technique is effective and safe, and can be used as the only treatment without supplementary revascularization procedures. This procedure can be done in a single stage on both sides and the number of burr holes made over each hemisphere depends on the extent of the disease.
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Affiliation(s)
- Ravindranath Kapu
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, V.H.S Hospital, Chennai, India
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Singh M, Cugati G, Symss NP, Pande A, Vasudevan MC, Ramamurthi R. Extra axial adult cerebellopontine angle medulloblastoma: An extremely rare site of tumor with metastasis. Surg Neurol Int 2011; 2:25. [PMID: 21427791 PMCID: PMC3050070 DOI: 10.4103/2152-7806.77178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 02/03/2011] [Indexed: 11/25/2022] Open
Affiliation(s)
- Manish Singh
- Department of Neurosurgery, Voluntary Health Services, Adyar, Chennai-600 113, India
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33
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Bhanuprakash V, Venkatesan G, Balamurugan V, Hosamani M, Yogisharadhya R, Chauhan RS, Pande A, Mondal B, Singh RK. Pox outbreaks in Sheep and Goats at Makhdoom (Uttar Pradesh), India: Evidence of Sheeppox Virus Infection in Goats. Transbound Emerg Dis 2010; 57:375-82. [DOI: 10.1111/j.1865-1682.2010.01158.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Symss NP, Cugati G, Vasudevan MC, Ramamurthi R, Pande A. Intracranial Rosai Dorfman Disease: report of three cases and literature review. Asian J Neurosurg 2010; 5:19-30. [PMID: 22028755 PMCID: PMC3201083] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Rosai-Dorfman Disease (RDD) is a rare idiopathic non-neoplastic histioproliferative disease characterized clinically by massive painless cervical lymphadenopathy, fever and weight loss. Extranodal involvement has also been recognized. Central nervous system (CNS) manifestations are extremely rare and patients with intracranial involvement usually present with clinical and radiological findings suggestive of a meningioma. CASE DESCRIPTION We report our experience in the management of three patients with RDD. Two patients had dural based lesions, radiologically in favour of a meningioma, and one patient had a parenchymal lesion suggestive of a tuberculous granuloma. Treatment consisted of total excision in one case, and subtotal excision followed by conventional radiotherapy in two cases. The diagnosis was confirmed by histopathology and immunochemistry which is essential for a definite diagnosis of RDD.
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Affiliation(s)
- Nigel Peter Symss
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Hospital, Chennai.,Correspondence: Nigel Peter Symss, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Hospital, TTTI Post, I T Corridor, Taramani, Chennai-600113, Phone (hosp): +91-44-22542107 Fax: +91-44-22542160 Mobile: +91 -9841455083
| | - Goutham Cugati
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Hospital, Chennai.
| | - Mathabushi C Vasudevan
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Hospital, Chennai.
| | - Ravi Ramamurthi
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Hospital, Chennai.
| | - Anil Pande
- Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Hospital, Chennai.
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Affiliation(s)
- Vikram Muthusubramanian
- Post Graduate Institute of Neurological Surgery, Dr Achanta Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai, India.
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38
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Angevin E, Lopez JA, Pande A, Moldovan C, Shi M, Soria JC, Wang X, Harzstark A, Saro J, Escudier B. TKI258 (dovitinib lactate) in metastatic renal cell carcinoma (mRCC) patients refractory to approved targeted therapies: A phase I/II dose finding and biomarker study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3563] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3563 Background: TKI258 is a potent receptor tyrosine kinase inhibitor (TKI) that selectively targets VEGFR, PDGFR, FGFR, CSF1R, c-KIT, RET, TrKA, and FLT3. Compared to other TKI agents, TKI258 additionally targets FGFR. FGF has been reported as an important escape mechanism of anti-VEGFR therapies. Methods: The primary objective of this phase I was to determine the maximum tolerated dose (MTD) of TKI258, administered orally on a 5 days on / 2 days off schedule in repeated 28 day cycles, in mRCC pts refractory to standard therapies. A two-parameter Bayesian logistic regression model and safety data for at least 21 pts will be used to determine MTD. Results: A phase I study is ongoing. As of December 2008, 11 pts (9 m, 2 f), median age: 55 (29–66 yrs) have been enrolled. Four pts have been treated at 500 mg/day (start dose): 2 are ongoing at cycle (C) 7; 1 pt discontinued due to PD and 1 due to sinus bradycardia. Five pts received 600 mg/day: 2 DLTs (G4 hypertension and G3 fatigue - pts discontinued) leading to dose reduction of all patients to 500mg/day; 2 pts in C5 and C4, 1 pt discontinued for PD. Two pts just entered the extension cohort at 500 mg. Other toxicities ≥G2 included fatigue, nausea, vomiting, diarrhea, neutropenia, folliculitis and dizziness. PK data showed CMax range (180–487 ng/mL, n = 8), and AUC range (2200–8251 ng/mL*h). Preliminary biomarker data indicated pts had high baseline VEGF (506 ± 203 pg/ml, n=6) and bFGF (220 ± 185 pg/ml, n = 6) levels, which may reflect failure of previous anti-VEGF agents. Induction of plasma FGF23 levels, a pharmacodynamic biomarker of FGFR1 inhibition, was observed in pts from the first 500 mg/day dosing cohort. Preliminary evidence of efficacy is observed with one minor response (-17% at C4), 4 stable disease and 1 dramatic shrinkage/necrosis of some target lesions (lymph node & suprarenal mass). Conclusions: TKI258 500mg/day seems a feasible schedule in heavily pre-treated mRCC patients with some indications of clinical benefit. These preliminary findings will be confirmed in the extension cohort. [Table: see text]
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Affiliation(s)
- E. Angevin
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - J. A. Lopez
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - A. Pande
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - C. Moldovan
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - M. Shi
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - J. C. Soria
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - X. Wang
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - A. Harzstark
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - J. Saro
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
| | - B. Escudier
- Institut Gustave Roussy, Villejuif, France; Hospital 12 de Octubre, Madrid, Spain; Novartis Oncology, East Hannover, NJ; University of California, San Francisco, CA
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Affiliation(s)
- S Muralimohan
- Department of Neurosurgery, Post Graduate Institute of Neurological Surgery, ALNC, VHS Hospital, Taramani, Chennai-600 113, India.
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Hosamani M, Bhanuprakash V, Kallesh DJ, Balamurugan V, Pande A, Singh RK. Cell culture adapted sheeppox virus as a challenge virus for potency testing of sheeppox vaccine. Indian J Exp Biol 2008; 46:685-689. [PMID: 19024165] [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: 05/27/2023]
Abstract
Sheeppox virus from an outbreak of sheeppox that occurred in Srinagar (Jammu and Kashmir, India) in 2000 was isolated by inoculation of susceptible sheep and further re-isolated in cell culture. The field virus, adapted to grow in lamb testes culture, was evaluated for its potential use as challenge virus in potency testing of sheeppox vaccine currently in use. The virus (passage 6) produced severe disease in susceptible sheep when inoculated subcutaneously with a dose of 106.2 TCID50. The virus identity was confirmed by PCR, sequencing of P32 gene and species-specific signature residues identified in deduced aa sequence of the gene. The virus was successfully evaluated for its virulence using two batches of sheep pox vaccines. Use of this field virus enables consistent potency experiments of sheeppox vaccines avoiding use of animals for its propagation and titration.
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Affiliation(s)
- M Hosamani
- Division of Virology, Indian Veterinary Research Institute, Campus Mukteswar 263 138, India
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Mohan S M, Symss NP, Pande A, Chakravarthy VM, Ramamurthi R. Intracranial epithelioid hemangioendothelioma. Childs Nerv Syst 2008; 24:863-8. [PMID: 18478237 DOI: 10.1007/s00381-008-0634-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Revised: 02/22/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Epithelioid hemangioendothelioma (EHE) is an uncommon soft-tissue vascular neoplasm. Although a well-defined entity outside the neuraxis, its intracranial occurrence is rare. Literature review revealed 35 reported cases till date. CASE REPORT The authors report a case of intracranial EHE in a 15-year-old girl, who presented with a short history and unusual radiology. Following radical removal, the lesion recurred within 1 month and progressed to terminal stages. This tumor is thought to have an indolent intermediate malignancy potential and such rapid progression has not been reported so far.
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Affiliation(s)
- Murali Mohan S
- Post Graduate Institute of Neurological Surgery, ALNC, VHS Hospital, Taramani, Chennai, 600 113, India.
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Muthusubramanian V, Pande A, Vasudevan MC, Ramamurthi R. Concomitant cervical and lumbar intradural intramedullary lipoma. ACTA ACUST UNITED AC 2008; 69:314-7. [PMID: 17765954 DOI: 10.1016/j.surneu.2007.01.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2006] [Accepted: 01/16/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lipomas of the spinal cord are often a component of spinal dysraphic states. Nondysraphic intramedullary spinal cord lipomas are rare, and concomitant isolated cervical and lumbar intradural intramedullary lipomata are very rare. One patient with concomitant isolated nondysraphic cervical and lumbar spinal cord lipomata has been reported and management options discussed. CASE DESCRIPTION A young girl presented with insidious-onset diffuse neck pain and early myelopathic signs. Conventional radiographs were normal. Magnetic resonance imaging of the whole neuraxis revealed concomitant cervical and lumbar intradural intramedullary lipoma. Subtotal resection of the lesion was performed at both levels, after which the patient improved symptomatically and was ambulant independently. CONCLUSION Concomitant intradural lipomas at 2 different locations unassociated with a dysraphic state is very rare. Magnetic resonance imaging with fat suppression study is the investigation of choice. Adequate decompression with subtotal removal is the treatment of choice.
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Affiliation(s)
- Vikram Muthusubramanian
- Post Graduate Institute of Neurological Surgery, Dr Achanta Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai 600113, India.
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Muthusubramanian V, Pande A, Vasudevan MC, Ravi R. Surgical management of brainstem hydatid cyst--an unusual site. ACTA ACUST UNITED AC 2008; 71:103-6; discussion 106. [PMID: 18262629 DOI: 10.1016/j.surneu.2007.06.077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 06/18/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND The authors describe their surgical experience of a hydatid cyst in the brainstem, which is an unusual site. The cyst was internally decompressed and totally excised. Although the Dowling technique has been described to be the ideal method for removal of hydatid cysts, it may not be possible when the cyst is in a deep-seated, vital, and eloquent location. We report the use of internal decompression by aspiration followed by total excision as an alternative method when the cyst is located in vital areas of the brain. CASE DESCRIPTION A 40-year-old female presented with headache, progressive right-sided weakness, double vision, and unsteadiness of gait of 1-month duration. On examination, she had left one-and-a-half syndrome, right hemiparesis of 3/5, and left cerebellar signs. Computed tomographic and MRI scans of the brain revealed a solitary, stenciled-out cystic lesion in the brainstem more toward the left side with features suggestive of hydatid cyst. A left retromastoid craniectomy followed by left middle cerebellar peduncle approach, aspiration of the cyst, and total excision of the cyst was performed. Postoperatively, the patient improved progressively and was asymptomatic with minimal left cerebellar signs at 1-year follow-up. CONCLUSION Hydatid cyst is a benign lesion. Appropriate management is mandatory for reducing the morbidity. Although the Dowling technique with its modifications is appropriate for cerebral parenchymal surfacing or superficial hydatid cysts, in deep-seated cysts located in eloquent and vital areas such as the brainstem, management by internal decompression by aspiration followed by extirpation of the cyst wall, protecting the surrounding cisterns and CSF spaces, is an alternative option.
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Affiliation(s)
- Vikram Muthusubramanian
- Post Graduate Institute of Neurological Surgery, Dr Achanta Lakshmipathi Neurosurgical Centre, VHS Hospital, Taramani, Chennai 600 113, India.
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Ashraf S, Andrews C, Kuvshinoff B, Pande A, Javle M, Gibbs JF. Surgical resection for pancreatic cancer: Correlates of margin positivity. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4097 Background: Positive surgical margins (PSMs) occur in 20–40% of pancreatic cancer cases treated surgically. PSMs are associated with local recurrence and poor survival. Objectives: Correlate clinicopathological parameters with PSMs in pancreatic cancer patients (pts) undergoing surgical resection. Methods: Clinicopathological data for 71 pts who underwent surgical resection for pancreatic cancer from 1999–2005 were obtained. Data including location, AJCC stage, tumor size, type of resection, use of neoadjuvant therapy, grade, morphology, perineural and angiolymphatic invasion were correlated with PSMs and survival using logistic regression, Fisher-exact test and log-rank test. Results: There were 29 males; median age was 65 years and median follow-up 14 months. Histologies were: adenocarcinoma (n = 67), sarcomatoid (n = 2), adenosquamous (n = 1) and mucinous cystadenocarcinoma (n = 1). Sites of disease were: head only (n = 56), head/uncinate (n = 7) and body/tail (n = 8). Surgical treatments included Whipple (n = 43), pylorus preserving Whipple (n = 18) distal pancreatectomy (n = 8) and total pancreatectomy (n = 2). Pathological AJCC stages were: ΙA (n = 4), ΙB (n = 2), ΙΙA (n = 14), ΙΙB (n = 48), and ΙΙΙ (n = 3). Neoadjuvant chemoradiation (CRT) was administered in 10 cases; 38 other pts received postoperative adjuvant therapy including CRT (n = 36)/chemotherapy only (n = 2). Overall median survival was 30 months and disease free survival 18.6 months. Nineteen cases (27%) had PSMs. PSMs were pancreatic transection line (n = 11), retroperitoneal margin (n = 9), bile duct (n = 1) and peripancreatic soft tissue (n = 2). On univariate analysis, PSM was associated with advanced AJCC stage (p = 0.02) and tumor location other than pancreatic head (p = 0.02). PSM rate was 10% (1/10) and 31% (18/61) for pts with/without neoadjuvant therapy, respectively (p = 0.27). On multivariate analysis, PSM correlated with AJCC stage (p = 0.04) and tumor location (p = 0.05). PSMs were not significantly related to survival or recurrence (p = 0.09). Conclusions: Advanced AJCC stage and tumor in pancreatic body/tail or uncinate are associated with PSMs following pancreatic cancer resection. Strategies to “downstage” with novel therapies prior to surgery should be investigated to facilitate a complete surgical resection. [Table: see text]
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Affiliation(s)
- S. Ashraf
- SUNY at Buffalo, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - C. Andrews
- SUNY at Buffalo, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - B. Kuvshinoff
- SUNY at Buffalo, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - A. Pande
- SUNY at Buffalo, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - M. Javle
- SUNY at Buffalo, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - J. F. Gibbs
- SUNY at Buffalo, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
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Yosuico VD, Khoury T, Yu J, Pande A, Javle M. Epithelial-mesenchymal transition (EMT) in resected pancreatic cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4094 Background: EMT plays an important role in tumor invasion and metastases; its detection may have prognostic significance. We examined expression of EMT related proteins in resected pancreatic cancers and correlated results with clinical outcome. Methods: Clinical data/surgical specimens from 34 consecutive pancreatic cancer patients (pts) who underwent pancreatectomy from 1996–2002 were included. Immunohistochemical staining for vimentin (Vim 3B4), E-cadherin (36B5), MIB1 and cytokeratin (CK-AE1/AE3) was performed on formalin fixed paraffin embedded tissues. Percentages of stained cells (cytoplasmic for vimentin and CK, nuclear for MIB1 and membranous for E-cadherin) were recorded. The results were correlated with clinicopathological parameters and survival. Survival analysis (log-rank test, Cox-proportional hazard model), categorical data analysis (Pearson’s chi-square, logistic regression) and Kendall’s tau were performed at the significance level of 0.05. Results: Clinical data/specimens from 34 pts were included: 13 males, median age 66 (range 38–84); SEER stage 1 (2 pts), 2 (27 pts), 3 (5 pts); histological grade 1 (4), 2 (13), 3 (16), 4 (1). Median survival was 15 months (95% CI: 11–24 months). Sixteen pts had adjuvant chemoradiotherapy, 4 pts had chemotherapy, 1 pt had radiation. IHC Results: vimentin (11.8%), MIB1 (100%), E-cadherin (91%) and CK (100%). There was a significant negative association between vimentin and E-cadherin expression (Kendall’s tau = −0.47, p = 0.0024). Vimentin expression correlated with histological grade (exact chi-square p = 0.0247). No associations were found between these proteins and SEER stage, age, treatment or smoking. Univariate analysis revealed histological grade 50% (p = 0.0039) and MIB1 expression >10% (p = 0.0224) were related to better survival. Multivariate analysis using Cox-proportional hazard model revealed the following significant variables: histological grade (hazard ratio (HR) = 11.8, p = 0.0001), age (HR = 1.1, p = 0.0053), MIB1 (HR = 0.9, p = 0.0003) and adjuvant chemotherapy (HR = 0.2, p = 0.0288). Conclusion: Decreased E-cadherin expression (<50% expression) was associated with poorer survival; E-cadherin expression had an inverse correlation with vimentin. Acknowledgement: Supported by OSI Pharmaceuticals. [Table: see text]
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Affiliation(s)
| | - T. Khoury
- Roswell Park Cancer Institute, Buffalo, NY
| | - J. Yu
- Roswell Park Cancer Institute, Buffalo, NY
| | - A. Pande
- Roswell Park Cancer Institute, Buffalo, NY
| | - M. Javle
- Roswell Park Cancer Institute, Buffalo, NY
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Symss N, Pande A, Chakravarthy M, Ramamurthi R. Glioblastoma multiforme occurring in a child with acute lymphoblastic leukemia. J Pediatr Neurosci 2006. [DOI: 10.4103/1817-1745.27456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Muthusubramanian V, Pande A, Vasudevan M, Ravi R. Suprasellar arachnoid cyst with bobble-head doll movements: A management option. J Pediatr Neurosci 2006. [DOI: 10.4103/1817-1745.22944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pande A, Carr BV, Wong SYC, Dalton K, Jones IM, McCauley JW, Charleston B. The glycosylation pattern of baculovirus expressed envelope protein E2 affects its ability to prevent infection with bovine viral diarrhoea virus. Virus Res 2005; 114:54-62. [PMID: 15993973 DOI: 10.1016/j.virusres.2005.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 05/18/2005] [Accepted: 05/27/2005] [Indexed: 10/25/2022]
Abstract
We have investigated the role of glycosylation of the envelope glycoprotein E2 of bovine viral diarrhoea virus (BVDV), produced in insect cells, in BVDV infection. When amino acids predicated to code for the C-terminal N-linked glycosylation site were mutated the resulting protein was less efficient than wild type protein at preventing infection of susceptible cells with BVDV. In addition, mutational analysis showed that a further two predicted N-terminal N-linked glycosylation sites of E2 are required for efficient production of recombinant protein.
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Affiliation(s)
- A Pande
- Institute for Animal Health, Compton, Newbury, Berkshire RG20 7NN, UK
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Pande JN, Pande A, Singh SPN. Acetylator status, drug metabolism and disease. Natl Med J India 2003; 16:24-6. [PMID: 12715953] [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: 03/02/2023]
Abstract
Acetylation polymorphism, although discovered 40 years ago, still holds interest not only because many drugs and carcinogens are metabolized by acetylation in the liver but also because advances have been made in the understanding of the molecular genetics of acetylation. It is this genetic variation of drug metabolism that is one of the causes of inter-individual variation of the effect of a drug. Acetylation polymorphism relates to the metabolism of a number of arylamine and hydrazine drugs and carcinogens by cytosolic N-acetyltransferase--NAT2. In humans, 2 genes--NAT1 and NAT2--are responsible for the N-acetyltransferase activity. Studies have revealed several allelic variants of both NAT1 and NAT2. It has been suggested that some of these variants modify the individual susceptibility to disease.
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Affiliation(s)
- J N Pande
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Hauser H, Haering G, Pande A, Luisi PL. Interaction of water with sodium bis(2-ethyl-1-hexyl) sulfosuccinate in reversed micelles. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100360a029] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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