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Patel RK, Alagapan A, Tripathy T, Nayak HK, Pattnaik B, Dutta T, Gupta S, Mohakud S, Naik S, Deep Bag N. Bloody Bile and Rescue Intervention-A Case Series of Post-PTBD Hemorrhagic Complications With a Review of the Literature. J Clin Exp Hepatol 2024; 14:101392. [PMID: 38558862 PMCID: PMC10981119 DOI: 10.1016/j.jceh.2024.101392] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Percutaneous transhepatic biliary drainage (PTBD) is a routinely performed interventional radiological procedure. A myriad of complications can occur after PTBD, the most important being hemorrhagic complications that require immediate attention. Hemorrhage following PTBD may result from arterial, portal, or hepatic venous injury. A catheter or pull-back cholangiogram often demonstrates the venous injury. A computed tomogram angiogram aids in identifying bleeding sources and procedural planning. Catheter repositioning, upsizing, or clamping often suffice for minor venous bleeding. However, major venous injury necessitates tract embolization, portal vein embolization, or stent grafting. Arterial injury may lead to significant blood loss unless treated expeditiously. Transarterial embolization is the treatment of choice in such cases. Adequate knowledge about the hemorrhagic complications of PTBD will allow an interventional radiologist to take necessary precautionary measures to reduce their incidence and take appropriate steps in their management. This article entails four different hemorrhagic complications of PTBD and their interventional management. It also discusses the various treatment options to manage different kinds of post-PTBD hemorrhagic complications.
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Affiliation(s)
- Ranjan K. Patel
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Alamellu Alagapan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Taraprasad Tripathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Hemant K. Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Bramhadatta Pattnaik
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Tanmay Dutta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Sunita Gupta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Nerbadyswari Deep Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar 751019, India
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Dey M, Mishra B, Mohapatra PR, Mohakud S, Behera B. Microbiological profile of long COVID and associated clinical and radiological findings: a prospective cross-sectional study. Lab Med 2024:lmae010. [PMID: 38520687 DOI: 10.1093/labmed/lmae010] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE To study the frequency of microbiological etiology of respiratory infections in patients with long COVID and their associated clinical and radiological findings. METHODS Nasopharyngeal swabs and sputum specimens were collected from 97 patients with respiratory illness stemming from long COVID. The specimens were assessed for their microbiological profile (bacteria and virus) and their association with the overall clinical and radiological picture. RESULTS In total, 23 (24%) patients with long COVID had viral infection (n = 12), bacterial infection (n = 9), or coinfection (n = 2). Microorganisms were detected at significantly higher rates in hospitalized patients, patients with moderate COVID-19, and patients with asthma (P < .05). Tachycardia (65%) was the most common symptom at presentation. A statistically significant number of patients with long COVID who had viral infection presented with cough and myalgia; and a statistically significant number of patients with long COVID who had bacterial infection presented with productive coughing (P < .05). Post-COVID fibrotic changes were found in 61% of cohort patients (31/51). CONCLUSION A decreasing trend of respiratory pathogens (enveloped viruses and bacteria) was found in long COVID. An analysis including a larger group of viral- or bacterial-infected patients with long COVID is needed to obtain high-level evidence on the presenting symptoms (cough, myalgia) and their association with the underlying comorbidities and severity.
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Affiliation(s)
- Monalisa Dey
- Departments of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Baijayantimala Mishra
- Departments of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prasanta Raghab Mohapatra
- Departments of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sudipta Mohakud
- Departments of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bijayini Behera
- Departments of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
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Ganapathy A, Mohakud S, Rout S, Joy P, Alagappan A, Manokaran A. A radio-anatomical study of median arcuate ligament syndrome: unveiling the morphology and morphometry of median arcuate ligament, celiac trunk, and superior mesenteric artery. Abdom Radiol (NY) 2024:10.1007/s00261-024-04231-w. [PMID: 38494467 DOI: 10.1007/s00261-024-04231-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE In the context of medical literature, a significant lacuna exists in understanding median arcuate ligament syndrome (MALS). While clinical aspects are well documented, literature lacks a robust exploration of the anatomical relationship between the celiac trunk and the median arcuate ligament (MAL). METHODS Morphometric parameters, including the vertebral level of MAL origin, MAL thickness, celiac trunk (CeT) origin level, diameter, and distances between CeT/Superior Mesenteric Artery (SMA) and the MAL center were observed on 250 CT angiograms. Cadavers (n = 11) were dissected to examine the same parameters and histo-morphological examination of MAL tissue was done. RESULTS Radiological findings established average MAL thickness of 7.79 ± 2.58 mm. The celiac trunk typically originated at T12. The average distance between the celiac trunk and the MAL center was 1.32 ± 2.04 mm. The angle of the celiac trunk to the abdominal aorta was primarily obtuse. The average celiac trunk diameter was 5.53 ± 1.33 mm. Histological examinations revealed a diverse MAL composition, indicating variable mechanical properties. CONCLUSION This study provides comprehensive morphometric data on the anatomical relationship between the MAL and the celiac trunk. In contrast to available literature which says the average MAL thickness of > 4 mm is an indicator of increased thickness, we observed much higher average thickness in the studied population. The findings contribute to a better understanding of normal anatomical variations which can serve as reference values for accurate radiological diagnosis of MALS. The histological examination revealed the heterogeneous nature of the MAL tissue composition, suggesting variable mechanical properties and functions in different regions.
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Affiliation(s)
- Arthi Ganapathy
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
| | - Sudipta Mohakud
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sipra Rout
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Praisy Joy
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Alamelu Alagappan
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Aarthi Manokaran
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India
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Naik D, Mahalik SK, Mohakud S, Sable MN, Mohanty MK. Congenital Intraoral Dermoid and Epidermoid Cyst with Orocutaneous Fistula Presenting with Life-threatening Airway Obstruction in an Infant. J Indian Assoc Pediatr Surg 2024; 29:159-161. [PMID: 38616823 PMCID: PMC11014178 DOI: 10.4103/jiaps.jiaps_125_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 04/16/2024] Open
Abstract
Dermoid cysts and epidermoid cysts in the floor of the mouth are rare in the pediatric age group. In this case report, we have discussed the presentation, management, and literature review of a 6-month-old female child presenting with both dermoid and epidermoid cysts in the floor of the mouth with an orocutaneous fistula.
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Affiliation(s)
- Deepti Naik
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Santosh Kumar Mahalik
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mukund Namdev Sable
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manoj Kumar Mohanty
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Muduly DK, Colney L, Kar M, Imaduddin M, Patra S, Sultania M, G S, Swain PK, Sahoo B, Mohakud S, Nayak HK, Panigrahi MK. Effect of Preoperative Body Mass Index on Postoperative and Long-Term Outcomes in an East Indian Gastric Cancer Cohort. J Gastrointest Cancer 2024:10.1007/s12029-024-01018-6. [PMID: 38315330 DOI: 10.1007/s12029-024-01018-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Gastric cancer is a global health concern with varying clinical outcomes. This study aims to investigate the influence of preoperative Body Mass Index (BMI) on survival in patients who underwent curative resection for gastric cancer in Eastern India. METHODS Data from a prospectively maintained Surgical Oncology database were analysed for patients who underwent curative resection for primary gastric adenocarcinoma between May 2016 and March 2022. Patients with incomplete data were excluded. Preoperative BMI was categorised into three groups: Underweight (< 18.5 kg/m2), Normal (18.5-22.9 kg/m2), and Overweight/Obese (=23 kg/m2). Clinicopathological details, short-term outcomes, and long-term oncological outcomes were assessed. Statistical analysis included survival estimates, Cox proportional hazard models, and subgroup analysis. RESULT Of 162 patients, 145 met the inclusion criteria. Patients were predominantly male (68%) with middle or lower socioeconomic status. No significant differences amongst BMI groups were observed in performance score, tumour grade, clinical stage, or short-term outcomes. Postoperative complications and 30-day mortality were similar. However, underweight patients had poorer 4-year disease-free survival (DFS) compared to overweight/obese patients (14.3% vs. 39.7%, p = 0.03). Overweight/obese patients showed significantly better 4-year overall survival (OS) than underweight patients (47.8% vs. 20.4%, p = 0.03). CONCLUSIONS In Eastern Indian gastric cancer patients undergoing curative resection, preoperative higher BMI (overweight/obese) was associated with better long-term survival. Understanding these findings could guide tailored interventions to improve outcomes in this population.
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Affiliation(s)
- Dillip Kumar Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India.
| | - Lalchhandami Colney
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Sudhakar G
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Phanindra Kumar Swain
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Hemanta Kumar Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
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Das H, Satapathy A, John J, Kar M, Mohakud S. Endothelial Dysfunction in Children With Nephrotic Syndrome: A Cross-Sectional Study. Cureus 2024; 16:e53628. [PMID: 38449929 PMCID: PMC10917071 DOI: 10.7759/cureus.53628] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background Children with nephrotic syndrome (NS) have a higher risk of cardiovascular morbidity. Studies on the evaluation of arterial stiffness and endothelial function and its predictive risk factors in these children are limited. Objective The primary objective of the study was to determine arterial stiffness by measuring carotid intimal medial thickness, flow-mediated dilatation, and physiological parameters in children with nephrotic syndrome to predict the risk of premature atherosclerosis as compared to controls. Participants A total number of 33 children with NS in the age group of 2-14 years in remission and 39 healthy controls were enrolled in the study. Out of 33 children with nephrotic syndrome, five were infrequently relapsing NS, eight were frequently relapsing, 16 were steroid dependent, and four were steroid-resistant NS. Intervention Relevant history, physical examination, anthropometric measurements, and laboratory investigations were done. Carotid intimal medial thickness (cIMT), flow-mediated dilatation (FMD), and other physiological parameters were measured in both children with NS and control groups. Outcome Carotid intimal medial thickness (cIMT), flow-mediated dilatation (FMD), and other physiological parameters were compared between children with NS and healthy controls for detecting arterial stiffness and endothelial dysfunction. Results Dyslipidaemia was seen in more than 50% of children during remission. There was neither significant difference in mean cIMT in the common carotid artery nor FMD between the control and study groups. There was a trend of lower Reactive Hyperemia Index (RHI) in children with NS. Conclusion Dyslipidemia persists even during the remission phase in NS. No statistically significant difference is observed in cIMT and percentage proportionate change in FMD in both the study and control groups. Nevertheless, RHI is notably lower in children with NS. These findings need further validation in future studies.
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Affiliation(s)
- Harapriya Das
- Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Amit Satapathy
- Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Joseph John
- Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Manisha Kar
- Physiology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Sudipta Mohakud
- Radiology, All India Institute of Medical Sciences, Bhubaneswar, IND
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Fatima K, Naik S, Jain M, Bhoi SK, Padhi S, Bag ND, Panigrahi A, Mohakud S. Diffusion-Weighted Imaging and Chemical Shift Imaging to Differentiate Benign and Malignant Vertebral Lesion: A Hospital-Based Cross-Sectional Study. Indian J Radiol Imaging 2024; 34:76-84. [PMID: 38106853 PMCID: PMC10723945 DOI: 10.1055/s-0043-1772848] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Objective The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) and chemical shift imaging (CSI) for the differentiation of benign and malignant vertebral lesions. Methods Patients with vertebral lesions underwent routine magnetic resonance imaging (MRI) along with DWI and CSI. Qualitative analysis of the morphological features was done by routine MRI. Quantitative analysis of apparent diffusion coefficient (ADC) from DWI and fat fraction (FF) from CSI was done and compared between benign and malignant vertebral lesions. Results Seventy-two patients were included. No significant difference was noted in signal intensities of benign and malignant lesions on conventional MRI sequences. Posterior element involvement, paravertebral soft-tissue lesion, and posterior vertebral bulge were common in malignant lesion, whereas epidural/paravertebral collection, absence of posterior vertebral bulge, and multiple compression fractures were common in benign vertebral lesion ( p < 0.001). The mean ADC value was 1.25 ± 0.27 mm 2 /s for benign lesions and 0.9 ± 0.19 mm 2 /s for malignant vertebral lesions ( p ≤ 0.001). The mean value of FF was 12.7 ± 7.49 for the benign group and 4.04 ± 2.6 for the malignant group ( p < 0.001). A receiver operating characteristic (ROC) curve analysis showed that an ADC cutoff of 1.05 × 10 -3 mm 2 /s and an FF cutoff of 6.9 can differentiate benign from malignant vertebral lesions, with the former having 86% sensitivity and 82.8% specificity and the latter having 93% sensitivity and 96.6% specificity. Conclusion The addition of DWI and CSI to routine MRI protocol in patients with vertebral lesions promises to be very helpful in differentiating benign from malignant vertebral lesions when difficulty in qualitative interpretation of conventional MR images arises.
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Affiliation(s)
- Kaneez Fatima
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanjeev Kumar Bhoi
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Somnath Padhi
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashutosh Panigrahi
- Department of Haematology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Choudhury S, Jena SK, Mitra S, Padhy BM, Mohakud S. Comparison of efficacy between levonorgestrel intrauterine system and dienogest in adenomyosis: a randomized clinical trial. Ther Adv Reprod Health 2024; 18:26334941241227401. [PMID: 38283750 PMCID: PMC10812097 DOI: 10.1177/26334941241227401] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/20/2023] [Indexed: 01/30/2024] Open
Abstract
Background Medical management of adenomyosis is an emerging perspective in modern gynecology. Though levonorgestrel intrauterine system (LNG-IUS) and dienogest (DNG) effectively relieve symptoms in adenomyosis, neither has been approved for the same indication. Our study aims to compare the efficacy and safety of these progestins in treating adenomyosis. Objective To study the efficacy and safety of LNG-IUS versus DNG in patients with symptomatic adenomyosis. Design Open-labeled, parallel, single-centered, randomized clinical trial. Methods Patients with adenomyosis-associated pain with or without abnormal uterine bleeding were randomly allocated to either LNG-IUS group or DNG group. The primary outcome was a reduction in painful symptoms after 12 weeks of treatment measured by visual analog scale (VAS) score. Changes in menstrual blood loss (MBL), improvement in quality of life (QoL), and adverse drug reactions were also analyzed. Results The VAS score significantly decreased from baseline in both groups. The baseline and post-treatment VAS scores in the LNG-IUS group were 6.41 ± 1.07 and 3.41 ± 1.04 (p = <0.001) and in the DNG group, were 6.41 ± 0.95 and 3.12 ± 1.40 (p = <0.001), respectively. A significantly greater proportion of patients in the LNG-IUS group experienced lighter MBL as compared to the DNG group [27/30 (90%) in the LNG-IUS group versus 17/22 (77.2%) in the DNG group (p = 0.006)]. Both the groups had improvement in QOL scores calculated by the World Heath Organisation QOL scale (WHOQOL BREF) questionnaire; however, it was more pronounced in the DNG group [(28.76 ± 30.47 in the LNG-IUS group versus 48.26 ± 44.91 in the DNG group (p = 0.04)]. Both the agents were safe as there were no reported major adverse drug reactions. Conclusion DNG can be an effective and safe alternative to LNG-IUS for the medical management of adenomyosis. Trial registration The trial was prospectively registered at the clinical trial registry - India (CTRI) vide CTRI number CTRI/2020/05/025186.
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Affiliation(s)
- Satish Choudhury
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, MIG 08, Housing Board Colony, Athgarh, Cuttack, Bhubaneswar, Odisha 754029, India
| | - Saubhagya Kumar Jena
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Subarna Mitra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Biswa Mohan Padhy
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Mohakud S, Das R, Bag ND, Mohapatra PR, Mishra P, Naik S. A Prospective Observational Study of Diagnostic Reliability of Semiquantitative and Quantitative High b-Value Diffusion-Weighted MRI in Distinguishing between Benign and Malignant Lung Lesions at 3 Tesla. Indian J Radiol Imaging 2024; 34:6-15. [PMID: 38106852 PMCID: PMC10723977 DOI: 10.1055/s-0043-1771530] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Aim The aim of this study was to evaluate the usefulness of high b-value diffusion-weighted imaging (DWI) to differentiate benign and malignant lung lesions in 3 Tesla magnetic resonance imaging (MRI). Materials and Methods Thirty-one patients with lung lesions underwent a high b-value (b= 1000 s/mm 2 ) DW MRI in 3 Tesla. Thirty lesions were biopsied, followed by histopathological analysis, and one was serially followed up for 2 years. Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of different DWI parameters in distinguishing benign and malignant lesions. Receiver operating characteristic (ROC) curves were used to determine the cutoff values of different parameters. Results The qualitative assessment of signal intensity on DWI based on a 5-point rank scale had a mean score of 2.71 ± 0.75 for benign and 3. 75 ± 0.60 for malignant lesions. With a cutoff of 3.5, the sensitivity, specificity, and accuracy were 75, 86, and 77.6%, respectively. The mean ADC min (minimum apparent diffusion coefficient) value of benign and malignant lesions was 1. 49 ± 0.38 × 10-3 mm 2 /s and 1.11 ± 0.20 ×10-3 mm 2 /s, respectively. ROC curve analysis showed a cutoff value of 1.03 × 10-3 mm 2 /s; the sensitivity, specificity, and accuracy were 87.5, 71.4, and 83.3%, respectively. For lesion to spinal cord ratio and lesion to spinal cord ADC ratio with a cutoff value of 1.08 and 1.38, the sensitivity, specificity, and accuracy were 83.3 and 87.5%, 71.4 and 71.4%, and 80.6 and 83.8%, respectively. The exponential ADC showed a low accuracy rate. Conclusion The semiquantitative and quantitative parameters of high b-value DW 3 Tesla MRI can differentiate benign from malignant lesions with high accuracy and make it a reliable nonionizing modality for characterizing lung lesions.
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Affiliation(s)
- Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rasmibala Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari D. Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta R. Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pritinanda Mishra
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Sarangi PK, Lumbani A, Swarup MS, Panda S, Sahoo SS, Hui P, Choudhary A, Mohakud S, Patel RK, Mondal H. Assessing ChatGPT's Proficiency in Simplifying Radiological Reports for Healthcare Professionals and Patients. Cureus 2023; 15:e50881. [PMID: 38249202 PMCID: PMC10799309 DOI: 10.7759/cureus.50881] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Background Clear communication of radiological findings is crucial for effective healthcare decision-making. However, radiological reports are often complex with technical terminology, making them challenging for non-radiology healthcare professionals and patients to comprehend. Large language models like ChatGPT (Chat Generative Pre-trained Transformer, by OpenAI, San Francisco, CA) offer a potential solution by translating intricate reports into simplified language. This study aimed to assess the capability of ChatGPT-3.5 in simplifying radiological reports to facilitate improved understanding by healthcare professionals and patients. Materials and methods Nine radiological reports were taken for this study spanning various imaging modalities and medical conditions. These reports were used to ask ChatGPT a set of seven questions (describe the procedure, mention the key findings, express in a simple language, suggestions for further investigation, need of further investigation, grammatical or typing errors, and translation into Hindi). A total of eight radiologists rated the generated content in detailing, summarizing, simplifying content and language, factual correctness, further investigation, grammatical errors, and translation to Hindi. Results The highest score was obtained for detailing the report (94.17% accuracy) and the lowest score was for drawing conclusions for the patient (85% accuracy); case-wise scores were similar (p-value = 0.97). The Hindi translation by ChatGPT was not suitable for patient communication. Conclusion The current free version of ChatGPT-3.5 was able to simplify radiological reports effectively, removing technical jargon while preserving essential diagnostic information. The free version adeptly simplifies radiological reports, enhancing accessibility for healthcare professionals and patients. Hence, it has the potential to enhance medical communication, facilitating informed decision-making by healthcare professionals and patients.
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Affiliation(s)
| | - Amrita Lumbani
- Physiology, Mayo Institute of Medical Sciences, Barabanki, IND
| | - M Sarthak Swarup
- Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Suvankar Panda
- Radiodiagnosis, SCB (Srirama Chandra Bhanja) Medical College and Hospital, Cuttack, IND
| | - Smruti Snigdha Sahoo
- Radiodiagnosis, SCB (Srirama Chandra Bhanja) Medical College and Hospital, Cuttack, IND
| | - Pratisruti Hui
- Radiodiagnosis, All India Institute of Medical Sciences, Kalyani, Kalyani, IND
| | - Anish Choudhary
- Radiodiagnosis, Central Institute of Psychiatry, Ranchi, IND
| | - Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Ranjan Kumar Patel
- Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Mishra S, Naik S, Bhoi SK, Kumar M, Deep (Bag) N, Dey A, Mohakud S, Mahapatro S. Comparison of post contrast fluid attenuated inversion recovery, 3D T1-SPACE, and T1W MRI sequences with fat suppression in the diagnosis of infectious meningitis. Neuroradiol J 2023; 36:572-580. [PMID: 36908255 PMCID: PMC10569188 DOI: 10.1177/19714009231163563] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To assess the usefulness of post contrast Fluid attenuated inversion recovery (FLAIR), 3D T1-SPACE, and T1W magnetic resonance imaging (MRI) sequences with fat suppression in diagnosis of infectious meningitis. METHODS 75 patients with clinical suspicion of meningitis were evaluated with post contrast FLAIR (PC-FLAIR), post contrast T1-SPACE (PC-T1-SPACE), and post contrast T1WI (PC-T1WI). Sensitivity, specificity, positive predictive value, and negative predictive value of individual sequences were assessed. RESULTS The sensitivity of PC-FLAIR (88.4%) was greater than PC-T1-SPACE (85.5%) and PC-T1WI (82.6%), considering cerebrospinal fluid (CSF) analysis as gold standard (p < 0.05). Kappa inter-rater agreement between two radiologists was 0.921 for PC-T1-SPACE, 0.921 for PC-T1WI, and 1.0 for PC-FLAIR with a p value <0.05. Both PC-T1-SPACE and PC-FLAIR performed equally in sulcal space enhancement. PC-T1-SPACE and PC-T1WI performed better in evaluation of pachymeningeal enhancement, ependymal enhancement in cases of ventriculitis, whereas PC-FLAIR was more sensitive in assessment of basal cistern enhancement and enhancement along the cerebellar folia. CONCLUSION Meningeal enhancement could be better appreciated in PC-FLAIR image than PC-T1WI and PC-T1-SPACE. Enhancement in PC-T1-SPACE was comparable to that of PC-T1WI. Being a T1 based spin echo sequence, PC-T1-SPACE has all the advantages of PC-T1WI in addition to its ability to differentiate meningeal enhancement from leptomeningeal vessels. Hence, PC-T1WI can be replaced by PC-T1-SPACE and PC-FLAIR can be added to routine MRI protocol in suspected case of meningitis.
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Affiliation(s)
- Satyakam Mishra
- Department of Radiodiagnosis, All India Institute of Medical Sciences, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, India
| | | | - Mukesh Kumar
- Department of Neurology, All India Institute of Medical Sciences, India
| | | | - Anupam Dey
- Department of General Medicine, All India Institute of Medical Sciences, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, India
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Naik S, Shri A, Sidhu S, Lahre Y, Bag ND, Bhoi SK, Mohakud S. Multidetector computed tomography evaluation of normal thymus and variations with age. J Minim Access Surg 2023:380827. [PMID: 37706407 DOI: 10.4103/jmas.jmas_25_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Background Thymus is a T-cell-producing lymphoid organ that appears prominent in the paediatric population and involutes in size with ageing. The gland shows a wide variety of appearances across different age groups. The purpose of the study is to evaluate the computed tomography (CT) appearance of thymus gland in the normal population with a focus on size, CT attenuation and fatty infiltration in different age groups. Patients and Methods This is a retrospective study done after taking approval from the Institutional Ethics Committee. Patients undergone CT scans of the thorax were identified from our database. All evaluations were done in non-contrast CT scans. Patients having underlying diseases that may have associated thymic abnormality were excluded. The appearance of thymus and the presence of fatty replacement were assessed. The size of thymus (length and thickness of right limb and left limb) and non-contrast CT Hounsfield unit (HU) value of thymic tissue were measured and compared in various age groups. Results Four hundred and fifty patients were included, 262 (58.2%) were male. Mean age was 33.6 ± 17.1 years, range (3 months-80 years). The size of thymus was observed to decrease with increasing age. The mean age of complete fatty replacement in our study was 45 years. Complete fatty replacement was noted in all cases with an age of more than 60 years. The most common shape was arrowhead, and the most common location was pre-aortic and para-aortic location. Non-contrast CT HU value was maximum in infants and gradually decreased with advancing age. Conclusion Even normal thymus can show varied appearance on CT which changes with the age of the patient being imaged. A comparison with normative data could help differentiate normal from abnormal glands to avoid unnecessary intervention.
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Affiliation(s)
- Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Aishvarya Shri
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Simran Sidhu
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Yuvraj Lahre
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanjeev Kumar Bhoi
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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13
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Muduly DK, Kar M, Sultania M, Shahin M, Patra S, Singh V, Imaduddin M, Mohakud S, Nayak HK, Panigraphi MK, Das Majumdar SK, Parida DK. Inclusion of Perineural Invasion with AJCC-TNM Staging: Outcomes from a South Asian Cohort of Curatively Treated Gastric Cancer Patients. J Gastrointest Cancer 2023; 54:606-613. [PMID: 35749055 DOI: 10.1007/s12029-022-00838-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of perineural invasion (PNI) in patients with gastric cancer (GC) is high, and patients with PNI positive disease have a poor prognosis compared to PNI-negative disease. The present study aims to study the incidence and evaluate the impact of PNI on the survival outcome of a cohort of South Asian GC patients. MATERIAL AND METHODS All consecutive patients undergoing curative gastrectomy were included in the study. The incidence of PNI and correlation with different clinico-pathological features and overall survival was performed. RESULTS A total of 59.54% had PNI-positive disease and the median OS of PNI + ve patients was 29.3 months, while it was not reached in PNI-ve patients. The PNI positivity was a significant prognostic factor for overall survival both on univariate and multivariate analysis. On TNM-PNI staging, those with TNM stage I/II patients with PNI + ve disease had similar OS to all stage III patients (p = 0.835) and were worse than that of PNI-ve patients (p < 0.05). CONCLUSION The incidence of PNI in gastric cancer is high. The inclusion of PNI with AJCC-TNM staging may better stratify prognostic staging in curatively treated gastric cancer patients.
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Affiliation(s)
- Dillip Kumar Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Mohammed Shahin
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Susama Patra
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vishwajeet Singh
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Hemant Kumar Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manas Kumar Panigraphi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Dilip Kumar Parida
- Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, India
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14
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Patel R, Tripathy TP, Debbarma R, Mohakud S, Mohanty S, Bag ND. Percutaneous Thrombin Injection with Balloon Protection for a Large Iatrogenic Femoral Artery Pseudoaneurysm: A Case Report with Review of Literature. Acta Med Litu 2023; 30:80-85. [PMID: 37575377 PMCID: PMC10417016 DOI: 10.15388/amed.2023.30.1.9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/31/2023] [Accepted: 03/08/2023] [Indexed: 08/15/2023] Open
Abstract
Iatrogenic femoral artery pseudoaneurysms (IFAPs) are not uncommon due to the increase in various minimally-invasive endovascular procedures. Percutaneous thrombin injection is an established technique for large pseudoaneurysms. When ultrasound-guided compression of an aneurysmal neck is not feasible, percutaneous thrombin injection can be combined with endovascular balloon occlusion to prevent leakage of thrombin into the parent artery. We describe a large IFAP following the removal of the femoral dialysis catheter after an inadvertent arterial puncture, which was managed with percutaneous ultrasound-guided (USG) thrombin injection with simultaneous balloon occlusion at the level of the aneurysmal neck without any complications. Follow-up imaging showed thrombosed IFAP without any recurrence.
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Affiliation(s)
- Ranjan Patel
- Department of Radiodiagnosis, AIIMS, Bhubaneswar, India
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15
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Naik S, Mahanty S, Bhoi SK, Lahre Y, Bag ND, Mohakud S. MRI of wrist and diffusion tensor imaging of the median nerve in patients with carpal tunnel syndrome. J Neurosci Rural Pract 2023; 14:302-307. [PMID: 37181193 PMCID: PMC10174157 DOI: 10.25259/jnrp_57_2022] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/25/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives Diagnosis of carpal tunnel syndrome (CTS) is based on the clinical symptoms and nerve conduction study. Magnetic resonance imaging (MRI) is non-invasive objective tool for assessing the median nerve and carpal tunnel. The purpose of this study was to evaluate MRI changes in patients with CTS, and compare them with healthy subjects. Materials and Methods Forty-three CTS patients and 43 age matched control were included and scanned in a 3T MRI scanner. Cross-sectional areas (CSA) of median nerve were measured at the level of distal radio-ulnar joint level (CSA1), proximal row of carpal bone (CSA2), and hook of hamate (CSA3). Flattening ratio (FR) of median nerve, thickness of flexor retinaculum, median nerve signal intensity, and thenar muscles were assessed. Fractional anisotropy (FA), average diffusion coefficient (ADC), and radial diffusivity (RD) of median nerve of CTS patients were obtained from diffusion tensor imaging (DTI) and compared with those of controls. Results Thirty-three patients (76.7%) were female. Mean duration of the pain was 7.4 ± 2.6 months. The mean CSA1 (13.2 ± 4.2 mm2), CSA2 (12.5 ± 3.5 mm2), and CSA3 (9.2 ± 1.5 mm2) in CTS patients were significantly higher compared to control group: CSA1 (10.15 ± 1.64 mm2), CSA2 (9.38 ± 1.37 mm2), and CSA3 (8.4 ± 0.9 mm2), (P = 0.001 in all). The mean FR of median nerve and thickness of flexor retinaculum were increased in CTS patients. The mean FA was reduced in CTS patients compared to control proximal to carpal tunnel and within the tunnel. Mean ADC and RD values were higher in CTS patients as compared to control for both levels. Conclusion MRI can detect subtle changes in the median nerve and thenar muscles in CTS and may be useful in equivocal cases and to exclude secondary causes of CTS. DTI shows reduced FA and increased ADC and RD in CTS patients.
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Affiliation(s)
- Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Siladitya Mahanty
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanjeev Kumar Bhoi
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Yuvraj Lahre
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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16
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Kar M, Singh A, Swain JR, Muduly DK, Sultania M, Sethi SK, Mahapatra J, Baisakh MR, Mohakud S. Laparoendoscopic hybrid procedure - Oncologically safe and feasible option for gastrointestinal stromal tumours of the stomach. J Minim Access Surg 2023; 19:326-328. [PMID: 37056094 PMCID: PMC10246647 DOI: 10.4103/jmas.jmas_237_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 05/30/2022] [Accepted: 12/15/2022] [Indexed: 02/16/2023] Open
Abstract
Minimally invasive resection of gastrointestinal stromal tumours of the stomach is a feasible alternative to the traditional open approach, without the need for advanced laparoscopic training, as lymph node dissection is not necessary and excision with a negative margin is the only requirement. The loss of tactile feedback is a known drawback of laparoscopic surgery, causing difficulty in assessing the margin of resection. Earlier described laparoendoscopic techniques require advanced endoscopic procedures, which are not readily available in all places. We present a novel method wherein we use an endoscope to guide the resection margins during laparoscopic surgery. In our experience of five patients, we were able to successfully use this technique to get the negative margins pathologically. This hybrid procedure can thus be used to ensure adequate margin, keeping all the benefits of laparoscopic surgery.
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Affiliation(s)
- Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Abhitesh Singh
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jyoti Ranjan Swain
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Dillip Kumar Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sushant Kumar Sethi
- Department of Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | | | | | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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17
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Mohakud S, Sharma P. Ethical issues with MS (Ayurved) Shalya Tantra/Shalakya Tantra: Need for public debate. Indian J Med Ethics 2023; VIII:163-164. [PMID: 36880465 DOI: 10.20529/ijme.2022.058] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In November 2020, the Central government amended the Central Council of Indian Medicine Regulations, 2016, to introduce formal training in Shalya (general surgery) and Shalakya (diseases of ear, nose, throat, ENT, eye, head, oro-dentistry) specialisations for postgraduate students of Ayurveda [1].
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Affiliation(s)
- Sudipta Mohakud
- Associate Professor, Department of Radio Diagnosis, AIIMS Bhubaneshwar, Odisha 751019 INDIA
| | - Pradeep Sharma
- Consultant Biochemist, Department of Biochemistry, Central Laboratory AMRI Hospital, Bhubaneshwar, Odisha 751019 INDIA
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18
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Deep N, Mohakud S, Jain M, Naik S, Baisakh M. Large Intraosseous Haemangioma of the Sacral Vertebra: The radiological imaging findings. Sultan Qaboos Univ Med J 2023; 23:125-126. [PMID: 36865413 PMCID: PMC9974040 DOI: 10.18295/squmj.3.2022.024] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nerbadyswari Deep
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manas Baisakh
- Department of Pathology, Prolife Diagnostic, Bhubaneswar, India
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19
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Singla A, Deep N, Naik S, Mohakud S, Nayak P, Sable M. Correlation of multiparametric MRI with histopathological grade of peripheral zone prostate carcinoma. J Cancer Res Ther 2023; 19:S569-S576. [PMID: 38384020 DOI: 10.4103/jcrt.jcrt_280_22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/06/2022] [Indexed: 02/23/2024]
Abstract
BACKGROUND Prostatic cancer is the second most common malignant tumor in men. Preoperative grading of prostate cancer is important for its management. Our objective is to compare individual and combined detection rates of T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI), and magnetic resonance spectroscopy (MRS) for prostate cancer with histopathological diagnosis as its golden standard. METHODS Forty-four patients with positive digital rectal examination (DRE) findings and elevated prostate specific antigen (PSA), underwent multiparametric MRI (Mp-MRI). T2WI, DWI, DCE-MRI and MRS were done in all the patients. Cognitive magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy was done in all the patients. Sensitivity and specificity of T2WI, DWI, DCE-MRI, and Prostate Imaging - Reporting and Data System PIRADS version 2 was obtained. Apparent diffusion coefficient (ADC) value and choline/citrate ratio were obtained for each lesion and correlated with histopathological grade. RESULTS The mean age of the patients was 68.7 ± 10.1 years, and the mean serum PSA level was 58.1 ± 22.4 ng/dL. Of the 38 lesions in peripheral zone, 33 (87%) had histopathologically proven prostate cancer. T2WI had a sensitivity and specificity of 75.8% and 80% and DWI had a sensitivity and specificity of 90.9% and 80%, respectively, for detection of malignant prostatic lesion. The mean ADC values for prostate cancer, prostatitis, and normal prostatic parenchyma were 0.702 ± 0.094 × 10-3 mm2/sec, 0.959 ± 0.171 × 10-3 mm2/sec, and 1.31 ± 0.223 × 10-3 mm2/sec, respectively. Type 3 curve has lower sensitivity (45.5%) but high specificity (80%) for diagnosing prostate cancer. CONCLUSION DWI can be useful to differentiate benign from malignant prostatic lesions, and low-grade from high-grade prostate carcinoma. ADC value has a positive correlation with histopathological grade of prostate cancer.
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Affiliation(s)
- Amit Singla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasant Nayak
- Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mukund Sable
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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20
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Muduly DK, Imaduddin M, Sultania M, Houghton T, G PKC, Rao PB, Mitra JK, Behera BK, Mohakud S, Kar M. Prophylactic Drain Versus No Drain in Curative Gastric Cancer Surgery-A Randomized Controlled Trial. J Gastrointest Surg 2022; 26:2470-2476. [PMID: 36279088 DOI: 10.1007/s11605-022-05480-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/03/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The adoption of enhanced recovery after surgery protocols has questioned the placement of prophylactic drain after curative gastrectomy. A 2015 Cochrane meta-analysis did not find convincing evidence of routine drain placement in gastrectomy, but the quality of evidence was questioned. The present study compared short-term outcomes of prophylactic drain placement versus no drain in gastrectomy. METHODOLOGY The study is a prospective, non-inferiority, and randomized controlled trial. Histologically proven adenocarcinoma of the stomach undergoing curative gastrectomy with D2 lymphadenectomy was included in the study. Randomization was done intra-operatively. The primary outcome was a postoperative hospital stay. Secondary outcomes included the return of bowel function, achieving adequate enteral feeding, re-surgery, morbidity, and mortality. RESULTS One hundred fifty-seven patients were registered, of which 108 patients underwent curative surgery, and were randomized to 54 patients in each group. The median age was 55 years (range: 23-78) and 58.5 years (range: 35-80) in the drain and no drain group. No significant difference was noticed in primary or secondary outcomes in both groups. CONCLUSION Avoid placing a prophylactic drain is not inferior to drain placement following gastrectomy with D2 lymphadenectomy for stomach adenocarcinoma. So, routine prophylactic drain placement can be avoided.
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Affiliation(s)
- Dillip Kumar Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India.
| | - Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Tim Houghton
- Department of Surgical Oncology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Pavan Kumar C G
- Department of Surgical Oncology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - P Bhaskar Rao
- Department of Anaesthesiology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Jayanta Kumar Mitra
- Department of Anaesthesiology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Bikram Kishore Behera
- Department of Anaesthesiology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
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21
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Jain M, Mohapatra A, Tripathy SK, Mohakud S, Das A, Sethy SS. Do Spinopelvic Parameters Relate with Secondary Hip Spine Syndrome in Secondary Hip Arthritis? Indian J Orthop 2022; 56:1937-1943. [PMID: 36310546 PMCID: PMC9561438 DOI: 10.1007/s43465-022-00741-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023]
Abstract
Background The prevalence of low back pain (LBP) with primary osteoarthritis (OA) hip undergoing total hip replacement (THA) has been studied. However, secondary OA hip affects younger individuals where changes in the sagittal spinal parameters (SSPs) could be reversible to reduce LBP. The study aims to document changes in clinical and radiological parameters following THA. Methods Thirty patients with secondary OA hip were included in the prospective analysis, excluding anyone with previous spine/hip surgery of known spinal diseases, including deformity, inflammatory or infective pathology. Visual analog scale for (VAS) hip and LBP, Oswestry disability index (ODI), and Harris core (HHS) along with SSPs were measured at baseline and three months and analyzed. Results Mean age was 42.8 ± 8.9 years which 17 unilateral (U/L) and 13 bilateral (B/L) OA. Overall, no significant changes were seen in SSPs that included pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), pelvic incidence-lumbar lordosis (PI-LL) was seen except for an improvement in the sagittal vertical axis (SVA) [40.22 ± 36.67 to 24.06 ± 21.93, p < 0.001]. However, clinical variables such as VAS hip and LBP, ODI, and HHS improved post-hip THA. Similar findings were seen in sub-group analysis when U/L affected were compared to B/L affected. Conclusion The sagittal SSPs except SVA does not change significantly following THA in patients with secondary OA, though LBP improves clinically. Hence, we assume routine measurement of these parameters is not mandatory when planning for THA in these patients.
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Affiliation(s)
- Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Ayesha Mohapatra
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Sujit Kumar Tripathy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Ashish Das
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Siddharth S. Sethy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
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22
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Singh S, Mohakud S. Giant Prolactinoma with Pituitary Apoplexy in Pregnancy: High Fetomaternal Risk. J Obstet Gynaecol India 2022; 72:458-459. [PMID: 36458062 PMCID: PMC9568636 DOI: 10.1007/s13224-022-01671-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/18/2022] [Indexed: 10/16/2022] Open
Affiliation(s)
- Sweta Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
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23
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Naik S, Bhoi SK, Deep N, Mohakud S, Mishra B, Dey A, Kumar R, Saharia GK, Kumar M. Vascular Manifestations of Tuberculous Meningitis: MR Angiography and Venography Study. J Neurosci Rural Pract 2022; 13:529-536. [PMID: 35946000 PMCID: PMC9357502 DOI: 10.1055/s-0042-1748175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose
The purpose of this study is to evaluate magnetic resonance (MR) angiography (MRA) and venography (MRV) findings in tuberculous meningitis (TBM).
Methods
Thirty consecutive patients of clinically diagnosed TBM were enrolled. Apart from T2-weighted imaging, T1-weighted imaging (T1WI), diffusion-weighted imaging, susceptibility-weighted imaging, fluid-attenuated inversion recovery, and postcontrast T1WI, time-of-flight (TOF) MRA and postcontrast MRV were done in all the patients. MRV was done after intravenous administration of gadolinium-based contrast agent followed by postcontrast T1WI. MRA and MRV findings were analyzed.
Results
Mean age of the patients was 33.13 ± 14.93 years. Duration of symptom was 34.90 ± 33.82 (range: 10–150) days. Out of 30 patients, 11 were categorized as definite TBM and 19 probable TBM. Eighteen (60%) were grade I, 7 (23%) grade II, and 5 (16%) grade III TBM based on severity. MR abnormalities were in varying combinations of leptomeningeal enhancement in 24 (80%), pachymeningeal in 2, both in 3, tuberculomas in 13 (43.3%), ventriculitis in 1, hydrocephalus in 16 (53.3%), and infarcts in 10 (33.3%) patients out of which the tubercular zone infarct in 9 patients. TOF MRA showed arterial abnormality in 13 patients. Anterior cerebral artery and middle cerebral artery have commonly involved vessels. Dural sinus thrombosis was noted in two patients. Both were female. One patient had subacute thrombus in the posterior part of superior sagittal sinus, left transverse sinus, and proximal right transverse sinus. The second patient had a filling defect in the transverse sinus.
Conclusion
In TBM, there is predominant arterial involvement causing infarcts which are usually seen in the tubercular zone. However, occasionally, there may be venous involvement causing cerebral venous sinus thrombosis.
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Affiliation(s)
- Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanjeev Kumar Bhoi
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anupam Dey
- Department of Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rajesh Kumar
- Department of Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Gautom Kumar Saharia
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mukesh Kumar
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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24
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Mohakud S, Rajasimman AS, Purkait S, Naik S. Intracranial extraosseous dural-based Ewing’s sarcoma with fluid-haematocrit levels: imaging findings of a rare tumour. BMJ Case Rep 2022; 15:15/6/e247056. [DOI: 10.1136/bcr-2021-247056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extraosseous dural-based primary Ewing’s sarcoma of the central nervous system is a rare tumour posing a diagnostic challenge. On cross-sectional radiological imaging, the lesion has an extra-axial location with heterogeneous appearance. These lesions are usually multicystic with internal haemorrhage causing fluid-haematocrit levels. It mimics conditions like an aneurysmal bone cyst, microcystic meningioma, telangiectatic osteosarcoma or cystic metastasis. Exclusion of primary Ewing’s sarcoma or malignancy elsewhere in the body is required to rule out a secondary. Surgery along with adjuvant chemotherapy and focal radiotherapy is the preferred mode of treatment. Due to the presence of non-specific small round blue cells on H&E stain, these tumours are also confused with lymphoma, osteosarcoma, rhabdomyosarcoma, Merkel cell carcinoma, ependymoblastoma and neuroendocrine carcinoma. Immunohistochemistry provides a definitive diagnosis. A high degree of suspicion in the preoperative scans is crucial for prognostication and early management of this aggressive tumour leading to improved patient survival.
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25
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Jain P, Rebba E, Muduly D, Sultania M, Mishra P, Sable M, Mohakud S, Kar M. 249P Significance of intraoperative frozen assessment of cavity shave margins in patients undergoing breast conservation surgery: A tertiary care centre experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.271] [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: 11/24/2022] Open
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26
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Nayak HK, Pattnaik B, Mohakud S, Mitra JK, Krishna EV, Sethi S, Samal SC. Rescue Devascularization in Coronavirus Disease 19 (COVID-19) Induced Early Shunt Thrombosis After Emergency Proximal Spleno-renal Shunt for Extrahepatic Portal Vein Obstruction. J Clin Exp Hepatol 2022; 12:721-722. [PMID: 34226804 PMCID: PMC8241577 DOI: 10.1016/j.jceh.2021.06.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hemanta K Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bramhadatta Pattnaik
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jayanta K Mitra
- Department of Anaesthesiology and Critical Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Edla V Krishna
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Shivam Sethi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Subash C Samal
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
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27
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Banik S, Mohakud S, Sahoo S, Tripathy PR, Sidhu S, Gaikwad MR. Comparative Morphometry of the Sacrum and Its Clinical Implications: A Retrospective Study of Osteometry in Dry Bones and CT Scan Images in Patients Presenting With Lumbosacral Pathologies. Cureus 2022; 14:e22306. [PMID: 35350522 PMCID: PMC8933651 DOI: 10.7759/cureus.22306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Morphometric measurement of the sacrum is crucial due to its active involvement in the instrumentation for lumbar pathologies. From screw placement to stabilization procedures for the spine, the sacrum remains a site of surgical importance. Thus, the purpose of this study was to generate baseline data by comparing two techniques, namely, osteometry in dry bones and CT scan imaging. Methodology In this study, 30 dry, fully ossified, disarticulated sacra were studied for osteometry, and 60 CT scan reports of patients with lumbar pathologies were retrospectively evaluated. In both cases, similar parameters were measured. The mean values were determined, the two methods were compared, and statistical analysis was performed. Results Among the 30 dry bone samples, 33.3% (10 out of 30) were males, while 55% of the CT scan group were males. Correlation between the different measurements in the CT scan group suggested that the vertebral body maximum width of S1 had a significant positive correlation with the vertebral body height of S1, sacral height, sacral breadth, transverse diameter of auricular surface, and vertical diameter of auricular surface. Statistically significant higher values (P < 0.001) were observed for the vertebral body mid diameter of S1, vertebral body height of S1, pedicle width, and pedicle depth measurements in the dry bone group compared to the CT scan group. Conclusions The efficiency of anaesthetic blocks can be increased if the parameters are evaluated beforehand. Moreover, sexual dimorphism of the bone can account for the varied results of the parameters, indicating the necessity to conduct gender-based studies in a wider population.
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28
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Vigneshwaran B, Bhoi SK, Sable MN, Muduly D, Sultania M, Jha M, Mohakud S, Kar M. Factors predicting perioperative outcomes in patients with myasthenia gravis or thymic neoplasms undergoing thymectomy by video-assisted thoracoscopic approach. J Minim Access Surg 2022; 18:111-117. [PMID: 35017401 PMCID: PMC8830562 DOI: 10.4103/jmas.jmas_261_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The purpose of this study was to identify the factors which predict the perioperative outcomes after video-assisted thoracoscopic surgery (VATS) thymectomy in patients with myasthenia gravis (MG) or thymic neoplasms Patients and Methods: Data of consecutive patients who had undergone VATS thymectomy in our institution from August 2016 to April 2018 were collected retrospectively from a prospectively maintained database followed by prospective recruitment of patients who underwent VATS thymectomy from April 2018 to February 2020. Results: A total of 31 patients were included. Females were more common (51.6%), and 29 patients (93.5%) had MG. The most common indication for thymectomy was the presence of both MG and thymoma (51.6%). Most MG patients had moderate disease (55.2%) or severe (24.1%) disease preoperatively. Mean operative time and blood loss were 196.9 ± 63.5 min and 122.5 ± 115.3 ml, respectively. Mean hospital stay was 7.9 ± 6.7 days. The rate of major and minor complications was 16.18% and 35.4%, respectively. Multivariate linear regression analysis established that MG symptoms >12 months, prolonged invasive ventilation (intubation ≥24 h), and complications were associated significantly with a prolonged hospital stay. Adjusting for outliers, pre-operative disease severity (MG Foundation of America class), and intubation ≥24 h were the only factors that had a significant impact on perioperative outcomes. Conclusion: Pre-operative disease severity and post-operative invasive ventilation are strong determinants of perioperative outcomes. Pre-operative optimisation and early extubation protocols can further reduce morbidity in patients undergoing thymectomy by the VATS approach.
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Affiliation(s)
- B Vigneshwaran
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanjeev Kumar Bhoi
- Department of Neurology, All India Institute of Medical Sciences, Odisha, India
| | - Mukund Namdev Sable
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Dillip Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Menkha Jha
- Department of Neurology, All India Institute of Medical Sciences, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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29
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Ravi P, Patnaik M, Mohakud S, Gaikwad M. A case of accessory anterior hepatic fissure: Cadaveric study with retrospective radiological investigation into its vascularity. Natl J Clin Anat 2022. [DOI: 10.4103/njca.njca_91_21] [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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30
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Mohakud S, Sidhu S, Deep N, Naik S. Panorama of multidetector-row computed tomography findings of carcinoma gall bladder - A retrospective observational study. J Cancer Res Ther 2022; 18:661-667. [DOI: 10.4103/jcrt.jcrt_235_21] [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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31
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Mohakud S, Tripathy S, Bag ND, Mishra N. Multidisciplinary management of solitary hypervascular metastatic recurrence of renal cell carcinoma presenting with pathological femoral fracture. BMJ Case Rep 2021; 14:e245422. [PMID: 34753726 PMCID: PMC8578956 DOI: 10.1136/bcr-2021-245422] [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] [Accepted: 10/07/2021] [Indexed: 02/05/2023] Open
Abstract
Renal cell carcinoma (RCC) frequently presents with osseous metastasis, predominantly lytic and prone to pathological fracture. The metastatic lesion in the extremity presents with local swelling, pain and immobility due to pathological fracture. The solitary or oligometastatic lesions should be treated with curative intent, which can help the patient to lead a more prolonged and disability-free life. The RCCs and their metastases are hypervascular with an exuberant arterial supply. Surgery can lead to uncontrolled life-threatening haemorrhage. Preoperative transarterial embolisation reduces tumour vascularity significantly and reduces intraoperative blood loss. We present a 46-year-old male patient with solitary hypervascular metastatic recurrence of RCC with a pathological femoral fracture with an infeasible initial surgery due to profuse haemorrhage. He was successfully treated by preoperative transarterial embolisation, followed by surgical resection and implantation of a megaprosthesis. Multidisciplinary management reduces patient morbidity and mortality with successful treatment in solitary hypervascular metastasis from RCC.
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Affiliation(s)
- Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Sujit Tripathy
- Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Nerbadyswari Deep Bag
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Nitasha Mishra
- Anaesthesia, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Orissa, India
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32
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Mohakud S, Naik S, Deep N, Singh A, Mishra TS, Sinha M. Transmesenteric Internal Abdominal Hernia: Multi-detector row computed tomography findings. Sultan Qaboos Univ Med J 2021; 21:502-503. [PMID: 34522423 PMCID: PMC8407917 DOI: 10.18295/squmj.4.2021.025] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari Deep
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arshdeep Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tushar S Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mithilesh Sinha
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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33
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Mohakud S, Sasmal PK, Das D, Kumar P. Post-traumatic hepatic artery pseudoaneurysm with recurrent hemoperitoneum and repeated laparotomies treated by endovascular coil embolization. J Postgrad Med 2021; 67:186-187. [PMID: 34427281 PMCID: PMC8445127 DOI: 10.4103/jpgm.jpgm_6_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- S Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - P K Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - D Das
- Department of Cardiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - P Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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34
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Colney L, Muduly D, Imaduddin M, Ambre S, Kumar CG P, Sultania M, Swain J, Majumdar S, Mohakud S, Patra S, Kar M. P-244 Role of preoperative contrast-enhanced computed tomography in staging of gastric cancer in patients undergoing upfront surgery with curative intent. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.298] [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] Open
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35
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Kumar CG P, Muduly D, Imaduddin M, Ambre S, Colney L, Sultania M, Swain J, Majumdar S, Mohakud S, Patra S, Kar M. P-282 Factors predicting response to neoadjuvant chemotherapy in gastric cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.336] [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] Open
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36
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Dash C, Mohakud S, Satapathy A, Sahu RN. Simulation in Endovascular Neurosurgery Using Skull Bone: A Novel Concept. Neurol India 2021; 68:1479-1480. [PMID: 33342898 DOI: 10.4103/0028-3886.304130] [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)
- Chinmaya Dash
- Division of Neurosurgery, Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | | | - Ayusman Satapathy
- Division of Neurosurgery, Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Rabi N Sahu
- Division of Neurosurgery, Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
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37
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Affiliation(s)
- S Mohakud
- Department of Radiodiagnosis, Pathology and Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - S Purkait
- Department of Radiodiagnosis, Pathology and Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - S Patel
- Department of Radiodiagnosis, Pathology and Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - A K Satapathy
- Department of Radiodiagnosis, Pathology and Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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38
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Mohapatra P, Bhuniya S, Panigrahi M, Bal S, Patra S, Majumdar SD, Mishra P, Mohakud S, Naik S, Kar M, Muduly D, Padmaja S, K M, Ghosh S, Panigrahi S, Durgeshwar G, Acharyulu V, Parida D. P38.14 Demographic and Molecular Epidemiologic Profile of Primary Lung Cancer in Eastern India. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.795] [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: 11/16/2022]
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39
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Bag ND, Mohakud S, Naik S, Shri A. Recurrent giant simple hepatic cyst: an unusual cause of dyspnoea in an elderly man. BMJ Case Rep 2021; 14:14/2/e238882. [PMID: 33541987 PMCID: PMC7868208 DOI: 10.1136/bcr-2020-238882] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An 88-year-old man presented to the emergency department with exertional dyspnoea and orthopnoea. Clinical examination revealed mildly raised jugular venous pressure, increased respiratory rate, palpable non-tender hepatomegaly and reduced right basal breath sounds. Ultrasonography showed a large right simple hepatic cyst, multiple small left hepatic and renal cysts. A non-contrast CT scan revealed a large, right hepatic thin-walled cyst of volume 4.2 L, exhibiting few thin septae and tiny nodular mural calcifications. Pressure effects were elevated right haemidiaphragm, right atrial compression and adjacent atelectasis. He had a similar episode 2 years ago, treated by percutaneous needle aspiration. Giant simple hepatic cysts are rare and present when symptomatic due to pain, mass effect on adjacent organs, infection or rupture. These may unusually cause dyspnoea or orthopnoea by compressing cardiac chambers. Simple aspiration has a high recurrence rate. Percutaneous sclerosant injection, laparoscopic deroofing and cystectomy are better treatment modalities.
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Affiliation(s)
- Nerbadyswari Deep Bag
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Suprava Naik
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Aishvarya Shri
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
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40
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R E, Ambre S, Muduly DK, Sultania M, Swain JR, Majumdar SK, Sable M, Mishra P, Mohakud S, Kar M. Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer and its prognostic impact – A Single Centre Experience. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.255] [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: 11/26/2022] Open
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41
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Singh A, Jain A, Muduly D, Sultania M, Swain JR, Mohakud S, Das Majumdar SK, Patra S, Kar M. Short term outcome for colorectal cancer patients undergoing surgery in Tertiary care center in Eastern India. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.277] [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: 10/22/2022] Open
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42
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Abstract
A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.
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Affiliation(s)
- Sujata Devi
- General Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Nilanjan Kar
- General Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Divya Muthuvel
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
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43
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Sinha MK, Mohakud S. Traumatic Splenic Infarction and Pulmonary Embolism: A Case Report of Rare Radiological Finding. Cureus 2021; 13:e12514. [PMID: 33564519 PMCID: PMC7863074 DOI: 10.7759/cureus.12514] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Focused abdominal sonography in trauma (FAST) and contrast-enhanced computed tomography (CECT) abdomen are important radiological tests for evaluating the abdomen in polytrauma cases. When vitals are stable, they help to reach a diagnosis in the majority of patients. However, in a small number of cases they fail to explain the clinical scenario. A continued serial clinical assessment may be helpful in these circumstances. A polytrauma patient was found to be FAST positive. The CT scan revealed pulmonary embolism, splenic infarction, perisplenic and perihepatic hematoma. The patient was complaining of pain abdomen and it worsened on day three of the injury. An exploratory laparotomy was performed. A circumferential intestinal wall hematoma with a tear in mesentery was found. This is a rare case of traumatic splenic infarction with evidence of pulmonary embolism. The serial clinical assessment was helpful as it indicated the need for intervention.
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Affiliation(s)
| | - Sudipta Mohakud
- Radiology, All India Institute of Medical Sciences, Bhubaneswar, IND
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Kar M, Imaduddin M, Muduly DK, Sultania M, Houghton T, Panigrahi MK, Misra S, Patra S, Mohakud S. Minimally invasive esophagectomy: Preservation of arch of Azygos vein in prone position. J Minim Access Surg 2021; 17:405-407. [PMID: 33885015 PMCID: PMC8270036 DOI: 10.4103/jmas.jmas_267_20] [Citation(s) in RCA: 1] [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] [Indexed: 11/08/2022] Open
Abstract
Minimally invasive esophagectomy (MIE) for oesophageal cancer has gained wide popularity in recent years due to its improved morbidity and mortality outcomes. We describe our modified technique of MIE in prone position with preservation of the arch of azygos vein. In our experience with 14 patients, the mean operative duration was 378 min (standard deviation [SD] 378 ± 59 min) and the mean blood loss was 390 ml (SD 390 ± 142 ml). The mean lymph node count was 28 (range 17–54). The Visick score was I in 12 (85.7%) patients and II in 2 (14.3%) patients at follow-up. The preservation of azygos vein arch is a technically feasible procedure and may be associated with a better quality of life outcome.
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Affiliation(s)
- Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Dillip K Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tim Houghton
- Department of Surgical Oncology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satyajeet Misra
- Department of Anaethesiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Susama Patra
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Singh S, Pati A, Mohakud S, Behera DR. Takayasu’s Arteritis in Pregnancy: Challenges During the Ongoing Coronavirus Disease 2019 Pandemic for Optimal Maternal and Neonatal Outcomes. Cureus 2020; 12:e12386. [PMID: 33532151 PMCID: PMC7845754 DOI: 10.7759/cureus.12386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Naik S, Singh S, Mohakud S, Jena S. Uterine artery pseudoaneurysm: A rare complication of cesarean section. J Postgrad Med 2020; 66:174-175. [PMID: 32675457 PMCID: PMC7542062 DOI: 10.4103/jpgm.jpgm_625_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- S Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - S Singh
- Department of Obstetrics and Gyaenacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - S Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - S Jena
- Department of Obstetrics and Gyaenacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Begum J, Maharana N, Behera SS, Ali M, Mohakud S. Laparoscopic Approach Towards Non-Communicating Functional Rudimentary Uterine Horn: A Report of Two Cases. Cureus 2020; 12:e11419. [PMID: 33312815 PMCID: PMC7727771 DOI: 10.7759/cureus.11419] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A unicornuate uterus is a relatively rare Müllerian anomaly with an incidence of 2.5-13%. It may lead to various gynecological or obstetric complications, and diagnosis can often be confusing and delayed. It is associated with varying clinical presentations depending on the presence of functional endometrium, which requires immediate surgical resection on the diagnosis. We report two cases of the unicornuate uterus in young women who presented with severe progressive dysmenorrhoea. These cases highlight the challenges in diagnosing the condition by ultrasound, which was confirmed later by MRI. Both cases were managed by laparoscopic resection of the functional non-communicating uterine horn. On follow-up, both patients were found asymptomatic with normal menstrual cycles. In patients of young age who present with abdominal pain, adnexal masses of unknown origin, and severely painful periods, we should consider Müllerian duct anomalies as one of the differential diagnoses. Early and proper preoperative diagnosis of these cases is essential to prevent complications and to offer adequate treatment. Operative laparoscopy is an excellent alternative to laparotomy for their management, particularly in young unmarried girls.
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Affiliation(s)
- Jasmina Begum
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Nibedita Maharana
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Shashi Shankar Behera
- Obstetrics and Gynecology, The Advanced Medical Research Institute, Bhubaneswar, IND
| | - Manwar Ali
- Surgery, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Sudipta Mohakud
- Radiology, All India Institute of Medical Sciences, Bhubaneswar, IND
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Jain M, Doki S, Gantaguru A, Mohakud S, Jha S. Osteoid Osteoma of the Body of the Vertebrae Causing Painful Scoliosis. Asian J Neurosurg 2020; 15:1037-1040. [PMID: 33708686 PMCID: PMC7869284 DOI: 10.4103/ajns.ajns_228_20] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/14/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Abstract
Osteoid osteoma (OO) affecting the spine is one of the common causes of painful scoliosis in the growing age group. The involvement is usually in the posterior elements involving the lumbar and cervical spine. We report a case of OO affecting the body of the thoracic vertebral body. A 15-year-old male presented with painful left thoracolumbar scoliosis. Computed tomography (CT) and magnetic resonance imaging (MRI) and MRI showed a lucent area with central dense focus (nidus) suggesting OO. Surgical excision was done under image intensifier and void filled with a mesh cage having bone graft reinforced posteriorly with pedicle screws. Postoperatively, the patient was relieved of his diffuse pain and CT scan revealed complete excision of the lesion. At the follow-up, the patient has an active, unconstrained life. OO in the spine presents as scoliosis which can be painful or painless. The diagnosis can be missed on a plain radiograph and complete radiographic evaluation includes a CT scan and MRI. Spinal management includes curettage or radiofrequency ablation. Recurrence is a known but rare complication.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | - Sunil Doki
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | - Amrit Gantaguru
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, AIIMS, Bhubaneswar, Odisha, India
| | - Shilpy Jha
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, Odisha, India
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Mohakud S, Sethy M, Naik S, Mohapatra PR. Giant cervicomediastinal thymic cyst in an elderly: diagnosis by multimodality imaging and fine-needle aspiration cytology with immunocytochemistry. BMJ Case Rep 2020; 13:13/7/e235425. [PMID: 32636229 DOI: 10.1136/bcr-2020-235425] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 65-year-old woman, a non-smoker, presented to the pulmonary medicine outpatient department with chest pain, mild dyspnoea, right side neck swelling and mild facial puffiness. The cervical swelling was soft, non-tender and fluctuant on palpation. Multimodality imaging revealed a large, thin-walled cervicomediastinal cystic lesion with septations, haemorrhage, septal calcification and without any solid component. Image-guided fine-needle aspiration cytology from the septa with immunocytochemistry helped to establish the thymic origin and benign nature of the cyst preoperatively and differentiate it from cystic thymoma, lymphangioma, thymic carcinoma or lymphoma with confidence. As the haemorrhage resolved, the size of the swelling was significantly reduced, and the patient became asymptomatic due to which she deferred surgery but remained on close follow-up and was doing well. Thymic cysts can occur in a cervicomediastinal location, rare in elderly age, usually asymptomatic and clinically apparent when intracystic haemorrhage leads to an increase in size and chest pain.
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Affiliation(s)
- Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Madhusmita Sethy
- Pathology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, India
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Mohakud S, Ranjan A, Naik S, Deep N. COVID-19 preparedness for portable x-rays in an Indian hospital - Safety of the radiographers, the frontline warriors. Radiography (Lond) 2020; 26:270-271. [PMID: 32327384 PMCID: PMC7167544 DOI: 10.1016/j.radi.2020.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/23/2022]
Affiliation(s)
- S Mohakud
- Dept. of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - A Ranjan
- Dept. of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - S Naik
- Dept. of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - N Deep
- Dept. of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India.
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