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Croghan S, O’Connor E, Baird O, Fallon J, Loughman P, Esoof J, Keenan R, Ryan J, Manecksha R, D’Arcy F, Vaidyanathan S, Varma R, Thursby H, Matkowski A, El Hadi S, Mahmalji W, Giri S. Use of the Transurethral Catheterisation Safety Valve (TUCSV) for the Prevention of Catheter Balloon Inflation Injury of the Urethra: A Prospective Multi-Institutional Study. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00948-x] [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: 11/28/2022] Open
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Vaidyanathan S, Ryan AL. Editorial: Genome Editing to Treat Cystic Fibrosis and Other Pulmonary Diseases. Front Genome Ed 2022; 4:917916. [PMID: 35755452 PMCID: PMC9218674 DOI: 10.3389/fgeed.2022.917916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- S. Vaidyanathan
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- *Correspondence: S. Vaidyanathan, ; A. L. Ryan,
| | - A. L. Ryan
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- *Correspondence: S. Vaidyanathan, ; A. L. Ryan,
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Zarei A, Karthik S, Chowdhury F, Patel C, Scarsbrook A, Vaidyanathan S. Multimodality imaging in primary hyperparathyroidism. Clin Radiol 2022; 77:e401-e416. [DOI: 10.1016/j.crad.2022.02.018] [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] [Received: 11/08/2021] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
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Zhong J, Frood R, Brown P, Nelstrop H, Prestwich R, McDermott G, Currie S, Vaidyanathan S, Scarsbrook AF. Machine learning-based FDG PET-CT radiomics for outcome prediction in larynx and hypopharynx squamous cell carcinoma. Clin Radiol 2020; 76:78.e9-78.e17. [PMID: 33036778 DOI: 10.1016/j.crad.2020.08.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022]
Abstract
AIM To determine whether machine learning-based radiomic feature analysis of baseline integrated 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET) computed tomography (CT) predicts disease progression in patients with locally advanced larynx and hypopharynx squamous cell carcinoma (SCC) receiving (chemo)radiotherapy. MATERIALS AND METHODS Patients with larynx and hypopharynx SCC treated with definitive (chemo)radiotherapy at a specialist cancer centre undergoing pre-treatment PET-CT between 2008 and 2017 were included. Tumour segmentation and radiomic analysis was performed using LIFEx software (University of Paris-Saclay, France). Data were assigned into training (80%) and validation (20%) cohorts adhering to TRIPOD guidelines. A random forest classifier was created for four predictive models using features determined by recursive feature elimination: (A) PET, (B) CT, (C) clinical, and (D) combined PET-CT parameters. Model performance was assessed using area under the curve (AUC) receiver operating characteristic (ROC) analysis. RESULTS Seventy-two patients (40 hypopharynx 32 larynx tumours) were included, mean age 61 (range 41-77) years, 50 (69%) were men. Forty-five (62.5%) had chemoradiotherapy, 27 (37.5%) had radiotherapy alone. Median follow-up 26 months (range 12-105 months). Twenty-seven (37.5%) patients progressed within 12 months. ROC AUC for models A, B, C, and D were 0.91, 0.94, 0.88, and 0.93 in training and 0.82, 0.72, 0.70, and 0.94 in validation cohorts. Parameters in model D were metabolic tumour volume (MTV), maximum CT value, minimum standardized uptake value (SUVmin), grey-level zone length matrix (GLZLM) small-zone low grey-level emphasis (SZLGE) and histogram kurtosis. CONCLUSION FDG PET-CT derived radiomic features are potential predictors of early disease progression in patients with locally advanced larynx and hypopharynx SCC.
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Affiliation(s)
- J Zhong
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - R Frood
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Brown
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Nelstrop
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Prestwich
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G McDermott
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Currie
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - S Vaidyanathan
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A F Scarsbrook
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research, Faculty of Medicine & Health, University of Leeds, Leeds, UK
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Adusumilli P, Nejadhamzeeigilani H, Pitts K, McDermott G, Scarsbrook AF, Vaidyanathan S, Patel CN, Chowdhury FU. Protocol-driven multidetector SPECT/CT: integration of hybrid imaging into the routine workflow of whole-body bone scintigraphy in oncology patients. Clin Radiol 2019; 75:79.e1-79.e7. [PMID: 31601386 DOI: 10.1016/j.crad.2019.09.128] [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] [Received: 06/09/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
AIM To analyse the additional clinical value of protocol-driven and selective use of multidetector single-photon-emission tomography/computed tomography (SPECT/CT) in oncology patients undergoing whole-body bone scintigraphy (BS) and to analyse reporter confidence in diagnosis with and without SPECT/CT. MATERIALS AND METHODS During a 2-year period, 2,954 whole-body BS examinations were performed in oncology patients, with 444 (15%) undergoing additional protocol-driven SPECT/CT. Retrospective evaluation of planar BS and SPECT/CT images was performed by two experienced dual-trained nuclear medicine radiologists. The BS and SPECT/CT images were graded blindly using a five-point scale designed to evaluate the likelihood of a lesion being benign or malignant. Interpretation was applied on a per-patient basis. RESULTS There was a 74.5% increase in definitive diagnostic classification and a 26.6% reduction in equivocal findings with SPECT/CT when compared to BS alone (p<0001). Of cases initially classified as "probably benign" on BS, 5.1% (10/193) were reclassified to "probably malignant" (1%) or "malignant" (4.1%) using the SPECT/CT data. The highest impact in reporter confidence was seen with SPECT/CT in the interpretation of lesions within the pelvis (34%), ribs (23%), lumbar spine (22%), and thoracic spine (21%). CONCLUSION Protocol-driven, selective use of SPECT/CT imaging to augment planar BS reduces equivocal findings and improves reporter confidence whilst minimising the impact on patient and reporting workflows.
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Affiliation(s)
- P Adusumilli
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - K Pitts
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G McDermott
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A F Scarsbrook
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Health Research, University of Leeds, Leeds, UK
| | - S Vaidyanathan
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C N Patel
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F U Chowdhury
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Al-Chalabi H, Karthik S, Vaidyanathan S. Radiological-pathological correlation of the British Thyroid Association ultrasound classification of thyroid nodules: a real-world validation study. Clin Radiol 2019; 74:702-711. [PMID: 31272599 DOI: 10.1016/j.crad.2019.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
AIM To evaluate the real-world performance of the British Thyroid Association (BTA) U classification, specifically focusing on radiology-pathology correlation and to glean learning points. METHODS AND MATERIALS Adults undergoing a neck ultrasound for thyroid nodules were reviewed over a period of 1-year. Data including demographics, nodule characteristics, BTA grading, and cytology/histopathology were retrieved with a minimum 24-month follow-up. RESULTS Of 1,225 graded nodules in 964 patients, cytology and/or histology were available for 300 (24%). 57 cancers were detected. Of 24 (2%) U5 nodules, 14 were malignant, of 51 (4%) U4, 22 were malignant, of 256 (21%) U3, 20 were malignant, and from 894 (73%) U2 nodules, one cancer was discovered. BTA U grading with fine-needle aspiration (FNA)/core biopsy achieved 96.5% sensitivity, 93.7% specificity, and 93.9% accuracy compared to excision. There was no association between nodule size and rate of malignancy. CONCLUSION This is the first study to validate the use of the BTA U-grading system in UK clinical practice. The BTA U-grading system is a robust and reliable method of evaluating the risk of malignancy in thyroid nodules with a high negative predictive value. Key learning points gleaned from the study were accurate assessment of nodule echogenicity, careful evaluation of solid-cystic nodules, optimising ultrasound technique, and the low-risk nature of U3 nodules.
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Affiliation(s)
- H Al-Chalabi
- Leeds Cancer Centre, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK; Department of Radiology, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - S Karthik
- Leeds Cancer Centre, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - S Vaidyanathan
- Leeds Cancer Centre, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
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Arunsingh M, Vaidyanathan S, Dyker K, Sen M, Scarsbrook A, Prestwich R. Accuracy of Response Assessment Positron Emission Tomography-Computed Tomography Following Definitive Radiotherapy Without Chemotherapy for Head and Neck Squamous Cell Carcinoma. Clin Oncol (R Coll Radiol) 2019; 31:212-218. [DOI: 10.1016/j.clon.2018.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 12/26/2022]
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Philip J, Ermiş E, Slevin F, Vaidyanathan S, Sen M, Scarsbrook AF, Prestwich RJD. Accuracy of FDG PET-CT response assessment following radiotherapy alone for head and neck squamous cell carcinoma: Retrospective analysis of 45 patients. Clin Otolaryngol 2018; 43:931-934. [PMID: 29325231 DOI: 10.1111/coa.13063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 12/30/2022]
Affiliation(s)
- J Philip
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - E Ermiş
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - F Slevin
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - S Vaidyanathan
- Department of Radiology, Yorkshire Cancer Centre, Leeds, UK.,Department of Nuclear Medicine, Yorkshire Cancer Centre, Leeds, UK
| | - M Sen
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
| | - A F Scarsbrook
- Department of Radiology, Yorkshire Cancer Centre, Leeds, UK.,Department of Nuclear Medicine, Yorkshire Cancer Centre, Leeds, UK
| | - R J D Prestwich
- Department Of Clinical Oncology, Yorkshire Cancer Centre, Leeds, UK
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Vaidyanathan S, Cato K, Tang L, Pavey S, Haass NK, Gabrielli BG, Duijf PHG. In vivo overexpression of Emi1 promotes chromosome instability and tumorigenesis. Oncogene 2016; 35:5446-5455. [DOI: 10.1038/onc.2016.94] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 01/25/2016] [Accepted: 02/19/2016] [Indexed: 12/19/2022]
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Gangadharan A, Vaidyanathan S, St. Clair CC. Categorizing species by niche characteristics can clarify conservation planning in rapidly-developing landscapes. Anim Conserv 2016. [DOI: 10.1111/acv.12262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Gangadharan
- Department of Biological Sciences; University of Alberta; Edmonton AB Canada
- Foundation for Ecological Research, Advocacy and Learning; Morattandi Tamil Nadu India
| | - S. Vaidyanathan
- Foundation for Ecological Research, Advocacy and Learning; Morattandi Tamil Nadu India
| | - C. C. St. Clair
- Department of Biological Sciences; University of Alberta; Edmonton AB Canada
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Al-Ameri A, Malhotra P, Thygesen H, Vaidyanathan S, Karthik S, Scarsbrook A, Callister M. S74 Assessing the diagnostic accuracy of the British Thoracic Society algorithm for investigation of solid pulmonary nodules. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.80] [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]
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Lakshminarayanan N, Karanth KK, Goswami VR, Vaidyanathan S, Karanth KU. Determinants of dry season habitat use by Asian elephants in the Western Ghats of India. J Zool (1987) 2015. [DOI: 10.1111/jzo.12298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N. Lakshminarayanan
- Post‐Graduate Programme in Wildlife Biology and Conservation Wildlife Conservation Society India Program National Centre for Biological Sciences Bangalore India
| | - K. K. Karanth
- Centre for Wildlife Studies Bangalore India
- Wildlife Conservation Society Bronx NY USA
- Duke University Durham NC USA
| | - V. R. Goswami
- Centre for Wildlife Studies Bangalore India
- Wildlife Conservation Society – India Program Bangalore India
| | - S. Vaidyanathan
- Foundation for Ecological Research, Advocacy and Learning Puducherry India
| | - K. Ullas Karanth
- Centre for Wildlife Studies Bangalore India
- Wildlife Conservation Society Bronx NY USA
- Wildlife Conservation Society – India Program Bangalore India
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Prestwich R, Vaidyanathan S, Scarsbrook A. Functional Imaging Biomarkers: Potential to Guide an Individualised Approach to Radiotherapy. Clin Oncol (R Coll Radiol) 2015; 27:588-600. [DOI: 10.1016/j.clon.2015.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 02/03/2023]
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Al-Ameri A, Malhotra P, Thygesen H, Vaidyanathan S, Karthik S, Scarsbrook A, Plant P, Callister M. 37: The added value of positron emission tomography to a clinical prediction model for pulmonary nodules. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50037-8] [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: 11/25/2022]
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Al-Ameri A, Malhotra P, Thygesen H, Vaidyanathan S, Plant P, Karthik S, Scarsbrook A, Callister M. S72 Clinical Prediction Models For Malignancy In Solitary Pulmonary Nodules - A Validation Study In A Uk Population. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.78] [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: 11/03/2022]
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van Dongen MA, Vaidyanathan S, Banaszak Holl MM. PAMAM Dendrimers as Quantized Building Blocks for Novel Nanostructures. Soft Matter 2013; 9:10.1039/C3SM52250D. [PMID: 24319491 PMCID: PMC3852679 DOI: 10.1039/c3sm52250d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The desire to synthesize soft supramolecular structures with size scales similar to biological systems has led to work in assembly of polymeric nanomaterials. Recent advances in the isolation of generationally homogenous poly(amidoamine) (PAMAM) dendrimer enables their use as quantized building blocks. Here, we report their assembly into precise nanoclusters. In this work, click-functional ligands are stochastically conjugated to monomeric generation 5 PAMAM dendrimer and separated via reverse-phase HPLC to isolate dendrimers with precise numbers of click ligands per dendrimer particle. The click-ligand/dendrimer conjugates are then employed as modular building blocks for the synthesis of defined nanostructures. Complimentary click chemistry employing dendrimers with 1, 2, 3, or 4 ring-strained cyclooctyne ligands and dendrimers with 1 azide ligand were utilized to prepare megamer structures containing 2 to 5 ~30,000 kDa monomer units as characterized by mass spectrometry, size exclusion chromatography, and reverse-phase liquid chromatography. The resulting structures are flexible with masses ranging from 60,000 to 150,000 kDa, and are soluble in water, methanol, and dimethylsulfoxide.
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Affiliation(s)
- Mallory A. van Dongen
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - S. Vaidyanathan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mark M. Banaszak Holl
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
- Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Michigan Nanotechnology Institute for Medicine and Biological Sciences, University of Michigan, Ann Arbor, MI 48109, USA
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Chowdhury FU, Vaidyanathan S, Bould M, Marsh J, Trickett C, Dodds K, Clark TPR, Sapsford RJ, Dickinson CJ, Patel CN, Thorley PJ. Rapid-acquisition myocardial perfusion scintigraphy (MPS) on a novel gamma camera using multipinhole collimation and miniaturized cadmium-zinc-telluride (CZT) detectors: prognostic value and diagnostic accuracy in a 'real-world' nuclear cardiology service. Eur Heart J Cardiovasc Imaging 2013; 15:275-83. [DOI: 10.1093/ehjci/jet149] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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de Mey C, Sechaud R, Dumitras S, Drollmann A, Hara H, Karan R, Pal P, Vaidyanathan S, Kaiser G. Keine relevanten Arzneistoffinteraktionen zwischen inhalativem NVA237 und oralem Cimetidin. Pneumologie 2013. [DOI: 10.1055/s-0033-1334778] [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: 10/27/2022]
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Robson JM, Vaidyanathan S, Callister MEJ. S94 Stereotactic Radiotherapy for Stage 1 Non Small Cell Lung Cancer: How much occult nodal disease are we missing? Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.100] [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]
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Williamson PA, Vaidyanathan S, Clearie K, Barnes M, Lipworth BJ. Airway dysfunction in nasal polyposis: a spectrum of asthmatic disease? Clin Exp Allergy 2011; 41:1379-85. [PMID: 21676042 DOI: 10.1111/j.1365-2222.2011.03793.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents an interesting model to investigate the existence of a non-allergic unified airway. The factors associated with airway dysfunction in CRSwNP are not fully understood. OBJECTIVE To assess the impact of nasal disease on lower airway dysfunction in CRSwNP. METHODS Fifty-seven patients with CRSwNP underwent spirometry, nasal endoscopy, exhaled nitric oxide, methacholine bronchial challenge, blood sampling for total IgE, eosinophil count and radioallergosorbent testing (NCT00788749). Three phenotypic groups were identified: 'asthma group' (asthma diagnosis); 'inflammatory group' [no asthma diagnosis, but elevated fractionated exhaled nitric oxide (FE(NO)) and/or bronchial-hyperreactivity (BHR)]; and 'non-inflammatory group' (no asthma diagnosis, no BHR and normal FE(NO)). Group comparisons, univariate and multivariate analyses were performed to examine associations with airway dysfunction. RESULTS FEV(1) and FEF(25-75%) were reduced in asthma, but there was no difference between the non-asthmatic groups. Total IgE and eosinophils were elevated in asthma vs. the non-inflammatory group, but there was no difference for asthma vs. inflammatory groups. BHR was the only significant predictor of FEV(1) (P<0.001). For FEF(25-75), BHR and eosinophil count were independent predictors (P<0.001 and P=0.04). Nasal outcomes were not predictors of spirometry. CONCLUSION AND CLINICAL RELEVANCE In CRSwNP there is asymptomatic airway dysfunction suggestive of an asthmatic phenotype. Impairment of lung function is significantly associated with BHR and eosinophilia but not parameters of nasal disease suggesting that severity of airway dysfunction relates to the spectrum of asthma rather than rhinosinusitis. Lower airway dysfunction is common in CRSwNP but does not correlate to the severity of nasal disease. Signs and symptoms of asthma should be sought and treated in CRSwNP.
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Affiliation(s)
- P A Williamson
- Asthma & Allergy Research Group, Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
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Williamson PA, Menzies D, Clearie KL, Vaidyanathan S, Lipworth BJ. Dose-response for inhaled fluticasone on airway and systemic inflammation in COPD. Eur Respir J 2010; 37:206-9. [DOI: 10.1183/09031936.00062210] [Citation(s) in RCA: 8] [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: 11/05/2022]
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Clearie KL, Jackson CM, Fardon TC, Williamson PA, Vaidyanathan S, Burns P, Lipworth BJ. Supervised step-down of inhaled corticosteroids in the community--an observational study. Respir Med 2010; 105:558-65. [PMID: 21144723 DOI: 10.1016/j.rmed.2010.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 09/01/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Current asthma guidelines recommend step-down of inhaled corticosteroids (ICS) to the minimum dose required for control of symptoms. AIM To determine if supervised step-down of (ICS) in the community has any effect on asthmatic inflammation. METHODS 119 Community based asthmatics underwent progressive step-down of therapy until they became unstable or reached an (ICS) dose of ≤200 μg beclomethasone dipropionate (BDP) or equivalent. Once unstable, participants stepped back up to the last stable dose of ICS. Exhaled nitric oxide (NO) and mannitol challenge were performed at the start and end of step-down. Asthma Quality of Life Questionnaire (AQLQ) and spirometry were recorded at each step-down visit. RESULTS The median (interquartile range) BDP equivalent dose was significantly higher pre vs. post step-down: 400 μg (400-800) and 250 μg (200-400) per day respectively (P < 0.05). Examination of change in PD(10) in individual patients revealed that 34% had an improvement (>+1 dd), 47% had no change (±-1 dd), and 19% had a worsening (<-1 dd). The geometric mean fold ratio in NO for pre vs. post was 0.96 (95% CI 0.87 to 1.06, P = 0.43). Mean (SEM) values for FEV(1) were 86.2% (1.51) vs. 84.5% (1.46) (P = 0.04). There was a significant improvement in AQLQ. CONCLUSIONS We have demonstrated that a significant reduction in ICS dose may be achieved in a community setting without any worsening of airways inflammation or lung function, and with an associated improvement quality of life in the majority of patients. This apparent disconnect may reflect enhanced adherence due to supervision of step-down.
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Affiliation(s)
- K L Clearie
- Asthma and Allergy Research Group, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK.
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Abstract
BACKGROUND Treating allergic rhinitis may have a downstream anti-inflammatory effect on the lower airways. We conducted a dose ranging study in asthma and persistent allergic rhinitis to evaluate if intranasal corticosteroids exhibit a sparing effect on the dose of inhaled corticosteroid. METHODS Twenty five participants were randomized to receive two weeks of 100 microg/day (Low dose) or 500 microg/day (High dose) of inhaled fluticasone propionate both with intranasal placebo; or inhaled fluticasone 100 microg/day with intranasal fluticasone 200 microg/day (Combined) in a double-blind cross-over fashion. RESULTS Low dose fluticasone produced a shift of 1.20 doubling-dilutions (95% CI, 0.63, 1.77); Combined fluticasone, 1.79 doubling-dilutions (95% CI, 0.77, 2.80) and high dose fluticasone, 2.01 doubling-dilutions (95% CI, 1.42, 2.61) in methacholine PC(20) from respective baselines. There was a significant difference between high and low doses: 0.82 doubling dilutions (95%CI, 0.12, 1.50) but not between combined and low dose 0.58 doubling dilutions (95% CI, -0.78, 1.95). Combined treatment alone produced improvements in peak nasal inspiratory flow (P < 0.001), rhinitis quality of life (P = 0.004) and nasal NO (P = 0.01); reduced blood eosinophil count (P = 0.03), and serum eosinophil cationic protein (P = 0.02). All treatments significantly improved tidal NO, FEV(1) and asthma quality of life. CONCLUSIONS High-dose fluticasone was superior to low dose fluticasone for methacholine PC20, demonstrating room for further improvement. Combined treatment was not significantly different from low dose fluticasone and we could not demonstrate a steroid sparing effect on methacholine PC20. Combined treatment alone produced improvements in upper airway outcomes and suppressed systemic inflammation but not adrenal function.
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Affiliation(s)
- A Nair
- Asthma & Allergy Research Group, Department of Medicine and Therapeutics, Ninewells Hospital and Medical School and Perth Royal Infirmary, University of Dundee, Dundee, UK
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Clearie KL, Williamson PA, Vaidyanathan S, Short P, Goudie A, Burns P, Hopkinson P, Meldrum K, Howaniec L, Lipworth BJ. Disconnect between standardized field-based testing and mannitol challenge in Scottish elite swimmers. Clin Exp Allergy 2010; 40:731-7. [PMID: 20214665 DOI: 10.1111/j.1365-2222.2010.03461.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Elite swimmers have high rates of rhinoconjunctivitis and exercise-induced bronchoconstriction. Moreover, exposure to chlorine and chlorine metabolites is known to induce bronchial hyper-reactivity. OBJECTIVE To assess the early and late effects of chlorine and exercise on the unified airway of elite swimmers, and to compare the response to mannitol and field-based exercise challenge. METHODS The Scottish national squad underwent exhaled tidal (FE(NO)) and nasal (N(NO)) nitric oxide measurement, peak nasal inspiratory flow (PNIF), and forced expiratory volume in 1 s before, immediately after, and 4-6 h post-swimming. A sport-specific exercise test was carried out during an intensive lactate set (8 min at >/=80% maximum hear rate). All swimmers underwent mannitol challenge, and completed a health questionnaire. RESULTS N=61 swimmers were assessed: 8/59 (14%) of swimmers had a positive mannitol challenge. Nine out of 57 (16%) of swimmers had a positive exercise test. Only one swimmer was positive to both. Swimmers with a positive mannitol had a significantly higher baseline FE(NO) (37.3 vs. 18.0 p.p.b., P=0.03) than those with a positive exercise challenge. A significant decrease in FE(NO) was observed pre vs. immediate and delayed post-chlorine exposure: mean (95% CI) 18.7 (15.9-22.0) p.p.b. vs. 15.9 (13.3-19.1) p.p.b. (P<0.01), and 13.9 (11.5-16.7) p.p.b. (P<0.01), respectively. There were no significant differences in N(NO.) Mean PNIF increased from 142.4 L/min (5.8) at baseline to 162.6 L/min (6.3) immediately post-exposure (P<0.01). Delayed post-exposure PNIF was not significantly different from pre-exposure. CONCLUSIONS No association was found between mannitol and standardized field-based testing in elite swimmers. Mannitol was associated with a high baseline FE(NO); however, exercise/chlorine challenge was not. Thus, mannitol may identify swimmers with a 'traditional' inflammatory asthmatic phenotype, while field-based exercise/chlorine challenge may identify a swimmer-specific bronchoconstrictor response. A sustained fall in FE(NO) following chlorine exposure suggests that a non-cellular, perhaps neurogenic, response may be involved in this group of athletes.
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Affiliation(s)
- K L Clearie
- Asthma & Allergy Research Group, Department of Medicine and Therapeutics, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, UK
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Clearie KL, Vaidyanathan S, Williamson PA, Goudie A, Short P, Schembri S, Lipworth BJ. Effects of chlorine and exercise on the unified airway in adolescent elite Scottish swimmers. Allergy 2010; 65:269-73. [PMID: 19793061 DOI: 10.1111/j.1398-9995.2009.02173.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chlorine metabolites and high training load may produce exercise-induced bronchospasm (EIB) in elite swimmers. The aim of this study was to assess the combined effects of chlorine and exercise on the unified airway of adolescent elite swimmers. METHODS The Scottish Midlands District squad were assessed during an indoor pool session at the National Swimming Academy. Athletes trained at least 8 h per week. Subjects underwent tidal (T(NO)) and nasal (N(NO)) exhaled NO and peak nasal inspiratory flow (PNIF) pre and post a 2 h session. A physiological exercise challenge assessed EIB in n = 36 swimmers (>10% fall in forced expiratory volume in 1 s (FEV(1))). RESULTS Combined and free chlorine levels (mg/l) were 1.66 and 0.3 respectively. n = 36 swimmers (mean age 13.3 years) were assessed: n = 8 (22%) had known asthma; n = 13 (36%) had a positive physiological challenge; 18 (50%) complained of symptoms suggestive of EIB. n = 10/28 (36%) who did not have asthma were found to have a positive exercise challenge. There was no significant association between reported exercise symptoms and positive exercise test. There was no significant change in T(NO) or N(NO) for pre vs postexposure, irrespective of asthma diagnosis or AHR. n = 15 (42%) swimmers complained of worsening nasal symptoms postexposure, but only n = 7 (14%) had a demonstrable fall in PNIF (mean 33 l/min). No significant association was found between PNIF and symptoms. CONCLUSIONS Combined exposure to chlorine and exercise did not affect surrogate markers of inflammation in the unified airway. There was a high prevalence of undiagnosed EIB.
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Affiliation(s)
- K L Clearie
- Department of Medicine and Therapeutics, Ninewells Hospital, University of Dundee, UK
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Abstract
BACKGROUND When presented with results from clinical measurements or research findings, clinicians must first make an interpretation of their importance, not only in statistical terms, but also the 'clinical importance' given the size of the change observed. To do this, they require an understanding of the relationship between their outcome measures, and the patient's perception of change. The minimal clinically important difference (MCID) illustrates this relationship by calculating the smallest change in a given outcome that is meaningful to a patient. There are few reports of calculated MCIDs in the Rhinology literature. OBJECTIVE To calculate MCIDs for common subjective and objective outcome measures in allergic rhinitis (AR). METHODS Nine randomized, blinded, placebo-controlled clinical trials in intermittent and persistent AR (pooled subjects, n=204) were analysed using anchor- and distribution-based approaches, applying regression and meta-analysis techniques. RESULTS MCIDs were obtained for the Mini Rhinoconjunctivitis Quality of Life Questionnaire: 0.4 units, peak nasal inspiratory flow: 5 L/min and total nasal symptoms score: 0.55 units. Nasal NO measurement changes had no correlation with patient perceptions of benefit. CONCLUSION Estimates of MCIDs were obtained for common subjective and objective rhinological outcomes. MCIDs can and should be applied by physicians interpreting research findings, as well as researchers reporting their findings. We can then be confident that our changes in practice will be of perceptible benefit to the patient.
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Affiliation(s)
- M L Barnes
- Asthma & Allergy Research Group, Department of Medicine and Therapeutics, Ninewells Hospital & Medical School, University of Dundee, Scotland, UK.
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Anderson D, Vaidyanathan S, Namovic M, Donnelly-Roberts D, Lee L, Gopalakrishnan M. Radioligand binding characterization of [3H]-A-998679: A novel positive allosteric modulator of α4β2 nAChRs. Biochem Pharmacol 2009. [DOI: 10.1016/j.bcp.2009.06.040] [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: 11/15/2022]
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Williamson PA, Clearie K, Vaidyanathan S, Lipworth B. Effects of methacholine challenge on alveolar nitric oxide. Thorax 2009; 64:549-50. [PMID: 19478127 DOI: 10.1136/thx.2009.113548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vaidyanathan S, Nair A, Barnes ML, Meldrum K, Lipworth BJ. Effect of levocetirizine on nasal provocation testing with adenosine monophosphate compared with allergen challenge in allergic rhinitis. Clin Exp Allergy 2009; 39:409-16. [PMID: 19187327 DOI: 10.1111/j.1365-2222.2008.03166.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND End-organ hyperreactivity is an important feature of the allergic airway. There are no data directly comparing the responsiveness to treatment of different nasal provocation tests (NPT). OBJECTIVE We compared the effect of levocetirizine on nasal adenosine 5'-monophosphate (AMP) with specific allergen challenge in patients with intermittent and persistent allergic rhinitis (AR). METHODS Patients with AR were randomized in double-blind cross-over fashion to receive single doses of levocetirizine 5 mg or identical placebo, with nasal challenge performed 12 h after dosing. Sixteen participants completed per protocol. Nasal AMP or allergen challenge was conducted on separate days with 1- and 2-week washout periods in between, respectively. Measurements of peak nasal inspiratory flow (PNIF) were made over 60 min after each challenge. The primary end-point was the provocative concentration of AMP or allergen causing a 20% drop in the PNIF (PC(20)). RESULTS The time-profile for PNIF recovery [area under the 60 min time-response curve as % PNIF change (min)] were significantly attenuated for AMP challenge, as mean difference [95% confidence interval (CI)]: 11.57 (3.87, 19.25), P=0.005 and for allergen challenge: 17.82 (0.11, 35.53), P=0.04. A highly significant correlation was shown between methods for the area under the curve: (R=0.86, P<0.001). A statistically significant correlation was also seen for the PC(20): (R=0.94, P<0.001). PC(20) improvement amounted to a 1.26 (95% CI 0.16, 2.35) and 0.16 (95% CI -0.41, 0.73) doubling-dilution shifts for allergen and AMP challenges, respectively. Bland-Altman plots confirmed good agreement between methods. CONCLUSION A high correlation and statistical agreement has been demonstrated between AMP and allergen challenge for all outcome measures. In particular, the recovery profile after NPT is a sensitive and discriminatory measure of anti-allergic treatment.
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Affiliation(s)
- S Vaidyanathan
- Asthma & Allergy Research Group, Department of Medicine and Therapeutics, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, UK.
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Vaidyanathan S, Williamson P, Lipworth BJ. Comment on: nitric oxide evaluation in upper and lower respiratory tracts in nasal polyposis. Delclaux C, et al. Clin Exp Allergy 2008; 38:1697. [DOI: 10.1111/j.1365-2222.2008.03078.x] [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: 11/28/2022]
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Huang HLA, Vaidyanathan S, Yeh CM, Bizot MN, Dieterich HA, Dole WP, Howard D. Effect of aliskiren, an oral direct renin inhibitor, on the pharmacokinetics and pharmacodynamics of a single dose of acenocoumarol in healthy volunteers. Curr Med Res Opin 2008; 24:2449-56. [PMID: 18662494 DOI: 10.1185/03007990802285763] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Aliskiren is a direct renin inhibitor approved for the treatment of hypertension. This study investigated the effects of aliskiren on the pharmacokinetics and pharmacodynamics of a single dose of acenocoumarol in healthy volunteers. METHODS This two-sequence, two-period, randomized, double-blind crossover study recruited 18 healthy subjects (ages 18-45) to receive either aliskiren 300 mg or placebo once daily on days 1-10 of each treatment period and a single dose of acenocoumarol 10 mg on day 8. Treatment periods were separated by a 10-day washout. Blood samples were taken frequently for determination of steady-state plasma concentrations of aliskiren (LC-MS/MS) and of R(+)- and S(-)-acenocoumarol (HPLC-UV), prothrombin time (PT) and international normalized ratio (INR). RESULTS Co-administration with aliskiren had no effect on exposure to R(+)-acenocoumarol. Geometric mean ratios (GMR; aliskiren:placebo co-administration) for R(+)-acenocoumarol AUC(0-t) and C(max) were 1.08 and 1.04, respectively, with 90% CI within the range 0.80-1.25. Co-administration of aliskiren resulted in a 19% increase in S(-)-acenocoumarol AUC(0-t) (GMR 1.19; 90% CI 0.92, 1.54) and a 9% increase in C(max) (GMR 1.09; 90% CI 0.88, 1.34). The anticoagulant effect of acenocoumarol was not affected by co-administration of aliskiren. Geometric mean ratios were 1.01 for all pharmacodynamic parameters (AUC(PT), PT(max), AUC(INR) and INR(max)), with 90% CI within the range 0.97-1.05. CONCLUSION Aliskiren has no clinically relevant effect on the pharmacokinetics or pharmacodynamic effects of a single dose of acenocoumarol in healthy volunteers, hence no dosage adjustment of acenocoumarol is likely to be required during co-administration with aliskiren.
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Affiliation(s)
- H-L A Huang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Abstract
We report an unusual case of lateral medullary syndrome which presented with symptoms of acute upper airway obstruction mimicking angioneurotic oedema. Although dysphonia and dysphagia are common symptoms of lateral medullary syndrome, we have found no other reports of this condition presenting as stridor. This case highlights the importance of maintaining a high index of suspicion for central causes of common otolaryngological symptoms in the absence of local signs.
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Affiliation(s)
- S Vaidyanathan
- Departments of Otolaryngology and Stroke Medicine, Doncaster Royal Infirmary, Doncaster, UK.
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Vaidyanathan S, Valencia J, Kemp C, Zhao C, Yeh CM, Bizot MN, Denouel J, Dieterich HA, Dole WP. Lack of pharmacokinetic interactions of aliskiren, a novel direct renin inhibitor for the treatment of hypertension, with the antihypertensives amlodipine, valsartan, hydrochlorothiazide (HCTZ) and ramipril in healthy volunteers. Int J Clin Pract 2006; 60:1343-56. [PMID: 17073832 DOI: 10.1111/j.1742-1241.2006.01164.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aliskiren is a novel, orally active direct renin inhibitor that lowers blood pressure alone and in combination with existing antihypertensive agents. As aliskiren does not affect cytochrome P450 enzyme activities, is minimally metabolised, and is not extensively protein bound, the potential for drug interactions is predicted to be low. Four open-label studies investigated the pharmacokinetic interactions between aliskiren 300 mg and the antihypertensive drugs amlodipine 10 mg (n = 18), valsartan 320 mg (n = 18), hydrochlorothiazide 25 mg (HCTZ, n = 22) and ramipril 10 mg (n = 17) in healthy subjects. In each study, subjects received multiple once-daily doses of aliskiren and the test antihypertensive drug alone or in combination in two dosing periods separated by a drug-free washout period. Plasma concentrations of drugs were determined by liquid chromatography and mass spectrometry methods. At steady state, relatively small changes in exposure to aliskiren were observed when aliskiren was co-administered with amlodipine (AUC(tau) increased by 29%, p = 0.032), ramipril (C(max,ss) increased by 31%, p = 0.043), valsartan (AUC(tau) decreased by 26%, p = 0.002) and HCTZ (C(max,ss) decreased by 22%, p = 0.039). Co-administration with aliskiren resulted in small changes in exposure to ramipril (AUC(tau) increased by 22%, p = 0.002), valsartan (AUC(tau) decreased by 14%, p = 0.062) and HCTZ (AUC(tau) decreased by 10% and C(max,ss) by 26%, both p < 0.001). All other changes in pharmacokinetic parameters were also small, and not statistically significant. None of the observed pharmacokinetic changes was considered clinically relevant. Aliskiren inhibited plasma renin activity (PRA) and also prevented the reactive rise in PRA induced by valsartan. The most commonly reported adverse events were headache, dizziness and gastrointestinal symptoms (all mild in severity), which were similar in frequency during antihypertensive drug treatment alone and in combination with aliskiren except for an increase in dizziness during treatment with the combination of aliskiren and HCTZ. In conclusion, aliskiren shows no clinically relevant pharmacokinetic interactions and is generally well tolerated when administered in combination with amlodipine, valsartan, HCTZ or ramipril.
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Affiliation(s)
- S Vaidyanathan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Vaidyanathan S, Mansour P, Soni BM, Hughes PL, Singh G. Chronic lymphocytic leukaemia, synchronous small cell carcinoma and squamous neoplasia of the urinary bladder in a paraplegic man following long-term phenoxybenzamine therapy. Spinal Cord 2006; 44:188-91. [PMID: 16130025 DOI: 10.1038/sj.sc.3101789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A case report. OBJECTIVE To raise awareness among spinal cord clinicians of the possible carcinogenic effect of phenoxybenzamine and of the rare occurrence of small cell carcinoma in the neuropathic bladder. SETTING Regional Spinal Injuries Centre and District General Hospital, Southport, Merseyside, United Kingdom. CASE REPORT A 28-year-old man sustained a fracture dislocation of L-1 with consequent paraplegia (ASIA impairment scale A). Phenoxybenzamine treatment enabled his indwelling catheter to be discarded in favour of a penile sheath, but it caused unacceptable dizziness and was stopped after 7 years. After 20 years, he developed chronic lymphocytic leukaemia, which was treated with chlorambucil and fludarabine. After 2 years, investigation of bilateral hydronephrosis revealed a primary small cell carcinoma of the bladder with coexistent squamous dysplasia. Uraemia supervened and, declining active treatment, the patient died 3 weeks after diagnosis. CONCLUSION Phenoxybenzamine, a known carcinogen in rodents, is likely also to be carcinogenic in humans, and patients with spinal cord injury who have received the drug for any significant period of time, need close follow-up to allow early detection of cancer. Phenoxybenzamine should not be prescribed on a long-term basis, and should instead be replaced with a selective alpha-blocker.
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MESH Headings
- Adult
- CD56 Antigen/metabolism
- Carcinoma, Small Cell/chemically induced
- Carcinoma, Small Cell/pathology
- Humans
- Immunohistochemistry/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/chemically induced
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukocyte Common Antigens/metabolism
- Magnetic Resonance Imaging/methods
- Male
- Neoplasms, Squamous Cell/chemically induced
- Neoplasms, Squamous Cell/pathology
- Paraplegia/drug therapy
- Paraplegia/rehabilitation
- Phenoxybenzamine/adverse effects
- Time
- Urinary Bladder Neoplasms/chemically induced
- Urinary Bladder Neoplasms/pathology
- Vasodilator Agents/adverse effects
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Affiliation(s)
- S Vaidyanathan
- Regional Spinal Injuries Centre, District General Hospital, Southport, Merseyside, UK
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Holdaas H, Hagen E, Asberg A, Lund K, Hartman A, Vaidyanathan S, Prasad P, He YL, Yeh CM, Bigler H, Rouilly M, Denouel J. Evaluation of the pharmacokinetic interaction between fluvastatin XL and cyclosporine in renal transplant recipients. Int J Clin Pharmacol Ther 2006; 44:163-71. [PMID: 16625985 DOI: 10.5414/cpp44163] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the pharmacokinetic interaction between cyclosporine and extended-release fluvastatin (fluvastatin XL), 80 mg for 7 days, in stable renal transplant recipients. METHODS This was a single-center, open-label study. 17 renal transplant recipients received their standard cyclosporine therapy (Days 1 - 9) plus a once-daily single oral dose of fluvastatin XL, 80 mg (Days 2 - 8). Blood samples were collected and cyclosporine (whole blood) and fluvastatin (plasma) concentrations determined by radioimmunoassay and HPLC fluorescence detection, respectively. Pharmacokinetic parameters were calculated using non-compartment analysis and fluvastatin results were compared with historical controls. RESULTS Treatment with fluvastatin XL, 80 mg for 7 days, had no significant effect on either the AUC0-12 (3,644 ng x h/ml in the absence of fluvastatin vs. 3,534 ng x h/ml in the presence of fluvastatin) or the Cmax of cyclosporine (983 ng/ml in the absence of fluvastatin vs. 945 ng/ml in the presence of fluvastatin). Co-administration of fluvastatin XL also had no effect on the tmax, t1/2 or apparent clearance (CL/F) of cyclosporine in renal transplant patients. The AUC and Cmax for fluvastatin XL in the presence of cyclosporine (AUC0-24 1,192 ng. x h/ml, Cmax 271 ng/ml) were approximately 2-fold higher compared with historical data for fluvastatin XL alone in healthy volunteers (AUC0-24 630 ng x h/ml, Cmax 102 ng/ml) but lower than the historical data for fluvastatin IR, 40 mg b.i.d. alone in healthy volunteers (AUC0-24 1,340 ng x h/ml, Cmax 443 ng/ml). Tmax, t1/2 and trough levels of fluvastatin in the presence of cyclosporine were also similar to the historical controls. Concomitant administration of cyclosporine and fluvastatin XL was well tolerated by renal transplant recipients. CONCLUSIONS Fluvastatin XL, 80 mg, and cyclosporine do not show clinically relevant pharmacokinetic interactions.
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Affiliation(s)
- H Holdaas
- Department of Medicine, National Hospital, Sognsvannsveien 20, 0027 Oslo, Norway.
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Pradeep PV, Mishra SK, Vaidyanathan S, Nair CG, Ramalingam K, Basnet R. Telementoring in Endocrine Surgery: Preliminary Indian Experience. Telemed J E Health 2006; 12:73-7. [PMID: 16478416 DOI: 10.1089/tmj.2006.12.73] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Telemedicine is starting to play an important role in the health field in India. In this case report we describe the successful use of telementoring to remove a parathyroid tumor in a patient with residual hyperparathyroidism after two previous unsuccessful attempts in tumor excision. A 21-yr-old patient crippled with advanced hyperparathyroidism was taken up for third-time exploration at Amrita Institute of Medical Sciences (AIMS), Kochi, with guidance from the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, using telemedicine technology. These two centers are located 2,500 km apart, and telementoring from the more experienced endocrine surgeons at SGPGIMS resulted in successful tumor localization and removal. For this session both the institutions were provided with a dedicated 512 Kbps very small aperture terminal (VSAT) link and two-way video-audio connectivity. Even though two previous explorations were unsuccessful, with the help of telemedicine technology the same surgeon was successful in locating and removing the tumor. The video and audio quality was of good enough quality for the expert at SGPGIMS to guide the team at AIMS satisfactorily. The patient benefited since he did not have to travel to a far-off specialized center for surgery. This case report testifies to the usefulness of telemedicine in the field of surgery, especially in developing countries, which have few medical experts in certain specialized areas.
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Affiliation(s)
- P V Pradeep
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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Dieterle W, Corynen S, Vaidyanathan S, Mann J. Pharmacokinetic interactions of the oral renin inhibitor aliskiren with lovastatin, atenolol, celecoxib and cimetidine. Int J Clin Pharmacol Ther 2006; 43:527-35. [PMID: 16300168 DOI: 10.5414/cpp43527] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Aliskiren is the first in a new class of orally effective renin inhibitors for the treatment of hypertension. This study investigated the interaction profile of aliskiren, which is of clinical importance because hypertensive patients often require concomitant drug therapy for associated comorbidities. METHODS Four separate studies investigated the pharmacokinetic interaction between single oral doses of aliskiren and lovastatin, atenolol, celecoxib or cimetidine, respectively. All studies involved healthy male volunteers aged 18-45 years. In 3 studies, subjects (n = 15 in each study) received single doses of aliskiren 150 mg alone, the test drug alone (lovastatin 40 mg, atenolol 100 mg or celecoxib 200 mg), or both drugs in combination, according to a 3-period crossover design. In the cimetidine study (n = 12), aliskiren 150 mg was administered alone or concomitantly with cimetidine 800 mg according to a two-period crossover design. Plasma concentrations of aliskiren and test drugs were determined by liquid chromatography and mass spectrometry methods. Pharmacokinetic parameters were derived from these data. RESULTS Mean AUC and t1/2 for aliskiren were not significantly changed by lovastatin, atenolol or celecoxib (< 10% difference between treatments). Aliskiren mean Cmax was not affected by either lovastatin or atenolol, although a non-significant 36% increase was observed with celecoxib. Modest, non-significant increases in aliskiren systemic availability followed coadministration with cimetidine (aliskiren mean AUC, Cmax and t1/2 increased by 17%, 19% and 15%, respectively). Aliskiren coadministration had no significant effect on the disposition of lovastatin, atenolol or celecoxib. CONCLUSIONS Overall, single doses of aliskiren showed no evidence of clinically important pharmacokinetic interactions with lovastatin, atenolol, celecoxib or cimetidine.
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Affiliation(s)
- W Dieterle
- Drug Disposition Consultants, Lörrach, Germany
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Abstract
We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of Pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases.
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Affiliation(s)
- S Vaidyanathan
- Pediatric Intensive Care Unit, Department of Pediatrics, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai, Maharashtra, India
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Abstract
STUDY DESIGN Two case reports of male football players who sustained injury to cervical spinal cord as a direct result of the sport. OBJECTIVE To raise the awareness that playing football (soccer), a very popular sport, may cause injury to the cervical spinal cord with dire consequences, albeit rarely. SETTING North West Regional Spinal Injuries Centre, Southport, UK. CASE REPORT We report two male football players, who sustained injury to the cervical spine and developed tetraplegia as a direct result of the sport. Case 1: A 21-year-old football player was tackled from behind while running with the football, he lost his balance and landed on his head resulting in burst fracture dislocation of C5/C6 associated with immediate onset of complete tetraplegia (ASIA-A). Case 2: A 24-year-old football player collided, head first, with his own team goalkeeper, causing a hyperextension of neck. He developed motor complete tetraplegia at C5 level, with some sensation sparing below the level of injury (ASIA-B). CONCLUSION Injury to the cervical spinal cord is known to occur in some team contact sports such as rugby and American football. Over time the laws and the preparation of the athletes for these games have been changed in order to minimize the neck injuries. What might not be appreciated is that playing football (soccer), a very popular sport worldwide, may cause injury to cervical spinal cord with dire consequences.
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Affiliation(s)
- P Silva
- North West Regional Spinal Injuries Centre, Southport, Merseyside, UK
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Vaidyanathan S, Tullu MS, Lahiri KR, Deshmukh CT. Pseudomonas sepsis with Noma: an association? Indian J Med Sci 2005; 59:357-60. [PMID: 16129930] [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: 05/04/2023]
Abstract
We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of Pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases.
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Affiliation(s)
- S Vaidyanathan
- Pediatric Intensive Care Unit, Department of Pediatrics, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai, Maharashtra, India
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Vaidyanathan S, Bowley JA, Soni BM, Watt JWH, Singh G, Hughes PL, Sett P. Superinfection of perinephric abscess by Stenotrophomonas maltophilia in a tetraplegic patient. Spinal Cord 2005; 43:394-5. [PMID: 15672091 DOI: 10.1038/sj.sc.3101724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vaidyanathan S, Watson ID, Jonsson O, Buczynski AZ, Grases F, Heilberg IP, Yasui T, Wyndaele JJ, Tozawa K, Kohri K, Schurch B, Hughes PL, Singh G, Soni BM, Sett P, Fraser WD. Recurrent vesical calculi, hypercalciuria and biochemical evidence of increased bone resorption in an adult male with paraplegia due to spinal cord injury: is there a role for intermittent oral disodium etidronate therapy for prevention of calcium phosphate bladder stones? Spinal Cord 2005; 43:269-77. [PMID: 15655568 DOI: 10.1038/sj.sc.3101713] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Clinical case report with comments by colleagues from Sweden, Poland, Spain, Brazil, Japan, Belgium and Switzerland. OBJECTIVES To discuss the role of disodium etidronate therapy for prevention of calcium phosphate vesical calculi in persons with spinal cord injury, who have hypercalciuria and biochemical evidence of increased bone resorption. SETTING Regional Spinal Injuries Centre, Southport, UK. METHODS A 21-year-old male sustained paraplegia (T-10; ASIA scale: A) in a road traffic accident in June 2001. He had an indwelling urethral catheter until the end of August 2001, when he started self-catheterisation. He developed bladder stones and electrohydraulic lithotripsy (EHL) was performed in May 2002. All stone fragments were removed. Recurrence of vesical calculi was noted in October 2002. These stones were fragmented by lithoclast lithotripsy in two sessions, in December 2002 and February 2003; all stone fragments were removed at the end of the second session. This patient reverted to indwelling catheter drainage when vesical calculi recurred. In September 2003, X-ray of the abdomen showed recurrence of vesical calculi. By February 2004, the stones had increased in size and number. EHL of vesical calculi was again performed in April 2004. Complete clearance was achieved. RESULTS A 24-h urinalysis detected hypercalciuria--18.7 mmol/day (reference range: 2.5-7.5). Biochemical analysis of vesical calculus revealed calcium phosphate (85%) and magnesium ammonium phosphate (15%). Plasma C-terminal telopeptide (CTX) was increased - 1.06 ng/ml (reference range: 0.1-0.5 ng/ml). Free deoxypyridinoline/creatinine ratio (fDPD/Cr) in urine was also increased - 20.2 (reference range: 2.3-5.4). In April 2004, this patient was prescribed disodium etidronate 400 mg day. Nearly 3 months after commencing therapy with etidronate, plasma CTX decreased to 0.87 ng/ml. fDPD/Cr in urine also decreased to 12.4. After 4 months of etidronate therapy, 24-h urinary calcium excretion had decreased to 6.1 mmol/day. CONCLUSION Etidronate (400 mg daily) is a very effective inhibitor of calcium phosphate crystallisation. Etidronate decreased urinary excretion of calcium, an important factor in prevention of calcium phosphate bladder stones. Etidronate therapy is not a substitute for other well-established methods for prevention of vesical calculi in spinal cord injury patients, for example, large fluid intake, avoiding long-term catheter drainage. Intermittent therapy with etidronate may be considered in selected patients, in whom hypercalciuria persists after instituting nonpharmacological therapy for an adequate period, for example, early mobilisation, weight-bearing exercises, and functional electrical stimulation. However, possible side effects of etidronate, and the fact that etidronate is not licensed in United Kingdom for prevention of urolithiasis, should be borne in mind.
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Affiliation(s)
- S Vaidyanathan
- Regional Spinal Injuries Centre, District General Hospital, Southport, UK
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Rajaram PC, Lakshmikanthan, Thanikachalam S, Vaidyanathan S, Subramanian N. Plan radiographic anticipation of adequacy of left ventricular size in patients with tetralogy of fallot by studying the level of diaphragmatic domes a new sign. A catheter correlated study of hundred patients. Indian J Radiol Imaging 2005. [DOI: 10.4103/0971-3026.28757] [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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Vaidyanathan S, Soni BM, Singh G, Sett P, Brown E, Markey S. Possible use of BioDerm External Continence Device in selected, adult, male spinal cord injury patients. Spinal Cord 2004; 43:260-1. [PMID: 15611787 DOI: 10.1038/sj.sc.3101699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vaidyanathan S, Hughes PL, Singh G, Soni BM, Watt JWH. Severe kyphoscoliosis causing marked displacement and rotation of right kidney with acute kinking of right ureter resulting in hydronephrosis. Spinal Cord 2004; 43:195-6. [PMID: 15558080 DOI: 10.1038/sj.sc.3101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
STUDY DESIGN A case report. SETTING Regional Spinal Injuries Centre, Southport, UK. CASE REPORT A 56-year-old male with complete paraplegia at T-4 underwent visual internal urethrotomy of bulbous urethral stricture with a cold knife at 12 o'clock position. There was brisk arterial bleeding. Despite receiving antibiotics, this patient developed hypotension, tachycardia and tachypnoea. He was resuscitated and mechanical ventilation was instituted. After he recovered from this life-threatening episode of urinary tract-related sepsis, colour Doppler ultrasound imaging of bulbous urethra was performed to locate urethral arteries. In the bulbous urethra, single urethral artery was seen at 12 o'clock position. CONCLUSION Since the sites of urethral arteries vary among patients, it is advisable to assess individually the location of urethral arteries preoperatively and plan the site of incision accordingly. Persons with injury to cervical or upper dorsal spinal cord have decreased cardiac and respiratory reserve as well as alteration in immune function. Therefore, all possible measures should be taken to prevent acute blood loss and bacteraemia in this group of patients.
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Affiliation(s)
- S Vaidyanathan
- Regional Spinal Injuries Centre, District General Hospital, Southport, Merseyside, UK
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