1
|
Purandare CN, Nazareth AK, Ryan G, Purandare NC. Role of Balloon Tamponade as a Therapeutic Non-Surgical Tool in Controlling Obstetric and Gynecological Hemorrhage in Low-Resource Countries. J Obstet Gynaecol India 2022; 72:285-290. [PMID: 35923509 PMCID: PMC9339450 DOI: 10.1007/s13224-022-01662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022] Open
|
2
|
Ganeriwal SA, Ryan GA, Geary M, Purandare NC. Caesarean section rates in primigravid women categorised by age and BMI. J OBSTET GYNAECOL 2021; 42:941-945. [PMID: 34704524 DOI: 10.1080/01443615.2021.1962820] [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: 10/20/2022]
Abstract
The rising caesarean section (CS) rate is a complex issue, particularly in an increasingly heterogenous nulliparous population. The study aim was to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. This was a retrospective review of CS procedures of nulliparous women in two centres in Ireland (2014 through 2017). Data were obtained for 17,177 women from the hospital databases and CS procedures determined for each age and BMI category. Significant differences were observed when CS rates were stratified in this manner. The CS rates for women <20 years/BMI < 18.5 was 8.8 versus 57.6% for women 35 - 39 years/BMI 30 - 34 and 76 - 100% for all women >45 years (p<.005). The development of customised charts subdivided by age and BMI may be a useful counselling tool and assist in the comparison of rates between units.Impact statementWhat is already known on this subject? It is well known that along with rising CS rates globally, there have also been significant changes in maternal demographics-with increasing maternal age at first birth and increasing maternal BMI. It is well established that both of these factors affect the rate of CS in a population.What do the results of this study add? This study sought to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. The results of the study showed an increasing CS rate for increasing age and BMI categories that was statistically significant.What are the implications of these findings for clinical practice and/or further research? Additional research using larger population data sets could allow the development of customised charts for nulliparous women subdivided by age and BMI which could act as a useful counselling tool in clinical practice, as well as assist in the comparison of CS rates between units.
Collapse
Affiliation(s)
| | - Gillian A Ryan
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | - Michael Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
| | - Nikhil C Purandare
- Department of Obstetrics and Gynaecology, University Hospital Galway, Galway, Ireland
| |
Collapse
|
3
|
Purandare NC, Rangarajan V, Shah S. Case report: Right vocal cord paralysis detected by PET/CT in a case of esophageal cancer. Indian J Radiol Imaging 2021. [DOI: 10.4103/0971-3026.34722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- NC Purandare
- Bio-Imaging Unit, Tata Memorial Hospital, Dr Ernest Borges Road, Parel, Mumbai - 400 012, Maharashatra, India
| | - V Rangarajan
- Bio-Imaging Unit, Tata Memorial Hospital, Dr Ernest Borges Road, Parel, Mumbai - 400 012, Maharashatra, India
| | - Sneha Shah
- Bio-Imaging Unit, Tata Memorial Hospital, Dr Ernest Borges Road, Parel, Mumbai - 400 012, Maharashatra, India
| |
Collapse
|
4
|
Ryan GA, Purandare NC, Ganeriwal SA, Purandare CN. Conservative Management of Pelvic Organ Prolapse: Indian Contribution. J Obstet Gynaecol India 2021; 71:3-10. [PMID: 33814793 PMCID: PMC7960828 DOI: 10.1007/s13224-020-01406-5] [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: 08/26/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022] Open
Abstract
Pelvic organ prolapse (POP) is a very common condition which can greatly impact a woman's quality of life. Treatment options are individualized and typically involve a combination of physiotherapy, pessary insertion and surgical treatments. It is well known that nulliparous prolapse in India constitutes 1.5-2% of genital prolapse, while the incidence is even higher (5-8%) for young women who have delivered one or two children, thus making it one of the highest rates in the world. This has necessitated the development of numerous conservative surgical treatment options for POP, which allows women to retain their sexual and reproductive function and therefore allows for subsequent pregnancies. With the controversy surrounding the use of mesh, a variety of surgical treatment options should be considered. Such alternative treatments include the use of surgical sling procedures, which have been used widely in Indian practice for the treatment of POP for over 60 years. This review outlines some of the well-established conservative treatment options for POP. It also highlights the unique contribution of Indian Obstetricians in the development of these conservative surgical treatment options, from prominent Indian Gynecologists including Dr VN Shirodkar, Dr BN Purandare, VN Purandare, RP Soonawala, Brigadier SD Khanna and Dr RM Nadkarni.
Collapse
Affiliation(s)
- Gillian A. Ryan
- Department of Obstetrics and Gynecology, The National Maternity Hospital, Holles St, Dublin 2, Ireland
| | - Nikhil C. Purandare
- Department of Obstetrics and Gynecology, National University of Ireland Galway, Galway University Hospital, Galway, Ireland
| | | | | |
Collapse
|
5
|
Ganeriwal SA, Ryan GA, Purandare NC, Purandare CN. Examining the role and relevance of the critical analysis and comparison of cesarean section rates in a changing world. Taiwan J Obstet Gynecol 2021; 60:20-23. [PMID: 33495002 DOI: 10.1016/j.tjog.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
Cesarean section (CS) is one of the most commonly performed surgical operations in the world and has resulted in improved maternal and neonatal morbidity and mortality rates internationally. However, concerns have been raised regarding the ever increasing CS rates to what has been described as 'epidemic' proportions. Global CS rates have increased from 6.7% in 1990 to 19.1% in 2014. However, there is a vast variation in the CS rates between countries with CS rates of 44.3% reported across Latin America & the Caribbean and CS rates as low as 4.1% in central and West Africa. There is much controversy regarding the optimal figure for CS in a population. The optimal CS rates for a population have been recommend in various studies, ranging from 10% to 19%, above which no reported improvement in maternal and neonatal mortality rates is observed. This review examines the evolution of the changing indications for CS and increasing CS rates in a world where family sizes are reducing and maternal age at first pregnancy is increasing. Efforts must be made to agree on an appropriate classification system whereby CS rates can be compared accurately between units and countries as a useful tool to audit and monitor our practice. Obstetricians should consider the indications for each CS performed, be conscious of the CS rate in our own countries and institutions and most importantly, be cognizant of how the CS rate impacts the maternal and perinatal morbidity and mortality rates and adjust our practice accordingly, to minimize harm.
Collapse
Affiliation(s)
- Simran A Ganeriwal
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gillian A Ryan
- Department of Obstetrics and Gynecology, National Maternity Hospital, Holles St, Dublin 2, Ireland.
| | - Nikhil C Purandare
- Department of Obstetrics and Gynecology, National University of Ireland Galway, Galway University Hospital, Ireland
| | | |
Collapse
|
6
|
Abstract
The data pertaining to the COVID-19 pandemic has been rapidly evolving since the first confirmed case in December 2019. This review article presents a comprehensive analysis of the current data in relation to COVID-19 and its effect on pregnant women, including symptoms, disease severity and the risk of vertical transmission. We also review the recommended management of pregnant women with suspected or confirmed COVID-19 and the various pharmacological agents that are being investigated and may have a role in the treatment of this disease. At present, it does not appear that pregnant women are at increased risk of severe infection than the general population, although there are vulnerable groups within both the pregnant and nonpregnant populations, and clinicians should be cognizant of these high-risk groups and manage them accordingly. Approximately 85% of women will experience mild disease, 10% more severe disease and 5% critical disease. The most common reported symptoms are fever, cough, shortness of breath and diarrhea. Neither vaginal delivery nor cesarean section confers additional risks, and there is minimal risk of vertical transmission to the neonate from either mode of delivery. We acknowledge that the true effect of the virus on both maternal and fetal morbidity and mortality will only be evident over time. We also discuss the impact of social isolation can have on the mental health and well-being of both patients and colleagues, and as clinicians, we must be mindful of this and offer support as necessary.
Collapse
Affiliation(s)
- Gillian A. Ryan
- Department of Obstetrics and GynaecologyThe National Maternity HospitalDublinIreland
| | - Nikhil C. Purandare
- Department of Obstetrics and GynaecologyUniversity Hospital GalwayGalwayIreland
| | - Fionnuala M. McAuliffe
- Department of Obstetrics and GynaecologyThe National Maternity HospitalDublinIreland,UCD Perinatal Research Centre, School of MedicineUniversity College Dublin, National Maternity HospitalDublinIreland
| | - Moshe Hod
- Mor Women Health Care Center, Tel Aviv UniversityTel AvivIsrael
| | | |
Collapse
|
7
|
Ryan GA, Purandare NC, McAuliffe FM, Hod M, Purandare CN. Clinical update on COVID-19 in pregnancy: A review article. J Obstet Gynaecol Res 2020; 46:1235-1245. [PMID: 32500549 PMCID: PMC7300676 DOI: 10.1111/jog.14321] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
The data pertaining to the COVID-19 pandemic has been rapidly evolving since the first confirmed case in December 2019. This review article presents a comprehensive analysis of the current data in relation to COVID-19 and its effect on pregnant women, including symptoms, disease severity and the risk of vertical transmission. We also review the recommended management of pregnant women with suspected or confirmed COVID-19 and the various pharmacological agents that are being investigated and may have a role in the treatment of this disease. At present, it does not appear that pregnant women are at increased risk of severe infection than the general population, although there are vulnerable groups within both the pregnant and nonpregnant populations, and clinicians should be cognizant of these high-risk groups and manage them accordingly. Approximately 85% of women will experience mild disease, 10% more severe disease and 5% critical disease. The most common reported symptoms are fever, cough, shortness of breath and diarrhea. Neither vaginal delivery nor cesarean section confers additional risks, and there is minimal risk of vertical transmission to the neonate from either mode of delivery. We acknowledge that the true effect of the virus on both maternal and fetal morbidity and mortality will only be evident over time. We also discuss the impact of social isolation can have on the mental health and well-being of both patients and colleagues, and as clinicians, we must be mindful of this and offer support as necessary.
Collapse
Affiliation(s)
- Gillian A. Ryan
- Department of Obstetrics and GynaecologyThe National Maternity HospitalDublinIreland
| | - Nikhil C. Purandare
- Department of Obstetrics and GynaecologyUniversity Hospital GalwayGalwayIreland
| | - Fionnuala M. McAuliffe
- Department of Obstetrics and GynaecologyThe National Maternity HospitalDublinIreland
- UCD Perinatal Research Centre, School of MedicineUniversity College Dublin, National Maternity HospitalDublinIreland
| | - Moshe Hod
- Mor Women Health Care Center, Tel Aviv UniversityTel AvivIsrael
| | | |
Collapse
|
8
|
Purandare NC, Pramesh CS, Agarwal JP, Agrawal A, Shah S, Prabhash K, Karimundackal G, Jiwnani S, Tandon S, Rangarajan V. Solitary pulmonary nodule evaluation in regions endemic for infectious diseases: Do regional variations impact the effectiveness of fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Cancer 2018; 54:271-275. [PMID: 29199704 DOI: 10.4103/0019-509x.219563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a preferred imaging modality for the evaluation of solitary pulmonary nodule (SPN), particularly in the developed world. Since FDG can concentrate in infective/inflammatory lesions, the diagnostic utility of FDG-PET can be questioned, particularly in regions endemic for infectious decisions. AIM To evaluate the accuracy of FDG-PET/CT in evaluation of SPNs in a population endemic for infectious disease and to assess if regional variations have an impact on its effectiveness. MATERIALS AND METHODS All patients who underwent an FDG/PET-CT with a clinico-radiological diagnosis of SPN categorized as indeterminate were included. Based on a maximum standardized uptake values (SUVmax) cut-off of 2.5, lesions were classified as benign (<2.5) or malignant (>2.5) and compared with gold standard histopathology. The diagnostic accuracy of PET-CT to detect malignancy was calculated. On the basis of final histopathology, lesions were grouped as (a) malignant nodules (b) infective/granulomatous nodules with a specific diagnosis and (c) nonspecific inflammatory nodules. The SUVmaxbetween these groups was compared using nonparametric statistical tests. RESULTS A total of 191 patients (129 males, 62 females) with a median age of 64 years (range: 36-83) were included. Totally, 144 nodules (75.3%) were malignant and 47 were benign (24.7%). Adenocarcinoma (n = 84) was the most common malignancy. Tuberculosis (n = 16) and nonspecific infections (n = 24) were the two most common benign pathologies. There was a significant overlap in the metabolic uptake of malignant (median SUVmax-11.2, range: 3.3-34.6) and tuberculous nodules (median SUVmax-10.3, range: 2.7-22.5) with no statistically difference between their SUVmaxvalues (P = 0.43). The false-positive rate was 65.2% and the false-negative rate was 5.5%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT for detecting malignancy were 94.4%, 34.7%, 81.9%, 66.6%, and 79.5%, respectively. CONCLUSIONS Though FDG-PET scans show a very high sensitivity for malignant nodules, it has a high false-positive rate and reduced specificity when characterizing SPNs in an infectious endemic region. Physicians must be aware of this limitation in the workup of lung nodules, and regional variations must be considered before further management decisions are taken.
Collapse
Affiliation(s)
- N C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - A Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Tandon
- Department of Chest Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| |
Collapse
|
9
|
Mathew AS, Agarwal JP, Munshi A, Laskar SG, Pramesh CS, Karimundackal G, Jiwnani S, Prabhash K, Noronha V, Joshi A, Rangarajan V, Purandare NC, Jambhekar N, Tandon S, Mahajan A, Kumar R, Deodhar J. A prospective study of telephonic contact and subsequent physical follow-up of radically treated lung cancer patients. Indian J Cancer 2017; 54:241-252. [PMID: 29199699 DOI: 10.4103/0019-509x.219599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND We tested the hypothesis that telephonic follow-up (FU) may offer a convenient and equivalent alternative to physical FU of radically treated lung cancer patients. DESIGN Prospective study carried out at a tertiary referral cancer care institute, Mumbai. MATERIALS AND METHODS Two hundred consecutive lung cancer patients treated with curative intent were followed up regularly with telephonic interviews paired with their routine physical FU visits. Patient satisfaction with the telephonic call and the physical visit, the anxiety level of the patient after meeting the physician and the economic burden of the visit to the patient were noted in a descriptive manner. Kappa statistics was used to assess concurrence between the telephonic and physical impression of disease status. RESULTS With a median FU duration of 21.5 months, the median satisfaction scores for telephonic and physical FU were 8 and 9, respectively. The prevalence and bias adjusted kappa (PABAK) score of the entire cohort of patients was 0.64 (95% confidence interval [CI] =0.58-0.70). Data analyzed up to first disease progression/relapse on FU had a PABAK score of 0.71 (95% CI = 0.64-0.77) indicating substantial agreement. Patients with disease controlled at the FU had a significant PABAK score of 0.88 (95% CI = 0.80-0.94) indicating excellent concurrence. On average, each patient spent Rs. 5117.10 on travel and Rs. 3079.06 on lodging per FU visit. CONCLUSION Telephonic FU is substantially accurate in assessing disease status until the first relapse. In a resource-constrained country like India, it is worthwhile to further explore the benefits of such an alternative strategy.
Collapse
Affiliation(s)
- A S Mathew
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Munshi
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N C Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N Jambhekar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Tandon
- Department of Pulmonary Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Mahajan
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - R Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J Deodhar
- Department of Clinical Psychology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
10
|
Purandare NC, Pramesh CS, Karimundackal G, Jiwnani S, Agrawal A, Shah S, Agarwal JP, Prabhash K, Noronha V, Joshi A, Kumar R, Rangarajan V. Thymic epithelial tumors: Can fluorodeoxyglucose positron emission tomography help in predicting histologic type and stage? Indian J Cancer 2017; 53:270-273. [PMID: 28071625 DOI: 10.4103/0019-509x.197717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study the utility of fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting (1) the World Health Organization (WHO) histologic type and differentiating low-risk from high-risk types. (2) Tumor stage and differentiate early from advanced stage disease. MATERIALS AND METHODS Patients with thymic epithelial neoplasia who underwent a pretreatment FDG-PET study were included. Tumor maximum standardized uptake value (SUVmax) was correlated with the WHO histologic type and also with the Masaoka-Koga (MK) staging system. Patients with WHO Type A, AB, and B1 were classified as low risk and those with B2 and B3 as high risk. Thymic carcinomas belonged to Type C. Patients with MK Stage I and II disease were grouped as early stage and those with Stage III and IV as an advanced stage. Differences in SUVmax between the various groups were calculated. RESULTS The SUVmax of thymic carcinomas was significantly higher as compared to low-risk (P = 0.001) and high-risk groups (P = 0.007). The SUVmax of high-risk group was also significantly higher than the low-risk group (P = 0.002). SUVmax cutoff of 6.5 was able to differentiate thymic carcinomas from thymomas with 100% sensitivity and 87.2% specificity. The SUVmax in patients with advanced stage disease showed a higher trend compared to those with early stage, but the difference was not significant (P = 0.167). CONCLUSION PET can differentiate thymic carcinomas from rest of the thymoma subtypes by the virtue of their higher FDG uptake. It can also provide valuable information in differentiating high-risk from low-risk thymomas and in predicting disease stage.
Collapse
Affiliation(s)
- N C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - R Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
11
|
Vaish R, Venkatesh R, Chaukar DA, Deshmukh AD, Purandare NC, D'cruz AK. Positron emission tomography thyroid incidentaloma: Is it different in Indian subcontinent? Indian J Cancer 2016; 53:186-9. [PMID: 27146775 DOI: 10.4103/0019-509x.180860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Positron emission tomography (PET) forms an integral part in work-up and follow-up of various malignancies. With the increased use of PET in oncology, finding of an incidental focal thyroid uptake (incidentaloma) is not unusual and presents a diagnostic challenge. AIM The aim of the following study is to evaluate the frequency and radio-pathologic correlation of focal 18-fluoro deoxyglucose uptake (FDG) on PET within the thyroid from a large series. MATERIALS AND METHODS Retrospective review of 37,000 consecutive patients who underwent FDG-PET at tertiary cancer center in India. Radiological, pathological, PET scan and follow-up details were evaluated. Statistical analyzes were carried out using Mann Whitney test and Pearson correlation. RESULTS Abnormal thyroid uptake was seen in 78 (0.2%) patients. Nearly 61 (0.16%) scans had focal and 17 (0.04%) had diffuse FDG uptake. A total of 57 patients with focal uptake were available for further evaluation. No further evaluation was done in 24 (42.1%) patients who had advanced index malignancy. Of the remaining 33 patients 26 were benign and seven were a cause for concern (four primary thyroid cancers, one follicular neoplasm with hurthle cell change and two metastatic cancers). There was no significant correlation in Standardized uptake value (SUV) max of benign and malignant lesion (P = 0.5 on Mann Whitney) or size (r = 0.087 Pearson correlation co-efficient P= 0.667). CONCLUSION Incidence of PET incidentaloma is low in this large cohort of Indian patients. Nearly 27% of focal incidentaloma were malignant. There was no correlation between the SUVmax, size and malignancy.
Collapse
Affiliation(s)
| | | | | | | | | | - A K D'cruz
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
12
|
Purandare NC, Patel II, Trevisan J, Bolger N, Kelehan R, von Bünau G, Martin-Hirsch PL, Prendiville WJ, Martin FL. Biospectroscopy insights into the multi-stage process of cervical cancer development: probing for spectral biomarkers in cytology to distinguish grades. Analyst 2013; 138:3909-16. [DOI: 10.1039/c3an36527a] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
13
|
Dandekar MR, Kannan S, Rangarajan V, Purandare NC, Chaukar DA, Deshmukh A, D'cruz AK. Utility of PET in unknown primary with cervical metastasis: a retrospective study. Indian J Cancer 2011; 48:181-6. [PMID: 21768663 DOI: 10.4103/0019-509x.82882] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND FDG-PET is recommended as an investigation in unknown primary tumors, but its definitive role and cost effectiveness are yet to be established. AIMS dditional value of FDG-PET over conventional imaging in unknown primary tumors with cervical metastasis. SETTING AND DESIGN Retrospective study in a tertiary level oncology centre. MATERIALS AND METHODS A total of 112 patients were divided into three groups; 53 with conventional modalities (either computed tomography or magnetic resonance imaging) (group I), 59 with FDG-PET (group II), and group III (subgroup of group II) with both (40 patients). STATISTICAL ANALYSIS Sensitivity and specificity of both conventional modality and PET were calculated. Association between neck nodes and distant metastasis was analysed using multivariate logistic regression analysis. RESULTS Sensitivity and specificity for conventional modalities was 92.3% and 50% and sensitivity and specificity of FDG-PET was 92.8% and 71.4%, respectively. FDG-PET detected metastasis in 52.54% of patients. Multivariate logistic regression analysis showed statistically significant association between distant metastasis and multiplicity of nodes (N2b, N2c) (P = 0.007). Among all patients with low neck nodes in group II, FDG-PET detected primaries in 12 patients, 9 of which were infraclavicular (75%). FDG-PET added information to conventional imaging in 32.5% of patients and influenced an overall change in management in 38.9% of patients. CONCLUSIONS FDG-PET is a valuable tool influencing change of management in unknown primary with cervical metastasis. It is recommended especially in the presence of low or multiple neck nodes in view of high incidence of infraclavicular primary and distant metastasis, respectively.
Collapse
Affiliation(s)
- M R Dandekar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Parel, Mumbai, India
| | | | | | | | | | | | | |
Collapse
|
14
|
Dua SG, Purandare NC, Shah S, Rangarajan V. FDG positron emission tomography/computed tomography in the detection of aortic endograft infection. J Postgrad Med 2011; 57:52-3. [PMID: 21206120 DOI: 10.4103/0022-3859.74292] [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] [Indexed: 11/04/2022] Open
Affiliation(s)
- S G Dua
- Tata Memorial Hospital, Parel, Mumbai, India
| | | | | | | |
Collapse
|
15
|
Kulkarni AV, Purandare NC, Kulkarni S, Dua SG. Isolated left innominate vein aneurysm: A rare cause of mediastinal widening. J Postgrad Med 2011; 57:40-1. [DOI: 10.4103/0022-3859.74286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
16
|
Abstract
Diagnostic imaging plays a pivotal role in cancer management. Imaging has made rapid strides in the past few years with new modalities and new indications getting added all the time. Molecular and metabolic imaging with 18F Flurodeoxyglucose Positron Emission Tomography (FDG PET) and other non-FDG isotopes have revolutionized oncologic imaging and changed our approach towards cancer diagnosis, staging and imaging surveillance. The evidence for the use of FDG PET is mounting every day with newer indications getting added to the literature. The main focus of our discussion will be to understand the basic principles of FDG PET imaging and to study a few of its clinical applications in oncology.
Collapse
Affiliation(s)
- N C Purandare
- Bio-Imaging Unit, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai-400 012, Maharashtra, India
| | | |
Collapse
|
17
|
Gota VS, Purandare NC, Gujral S, Shah S, Nair R, Rangarajan V. Positron emission tomography / computerized tomography evaluation of primary Hodgkin's disease of liver. Indian J Cancer 2009; 46:237-9. [PMID: 19574678 DOI: 10.4103/0019-509x.52960] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Occurrence of primary Hodgkin's lymphoma (PHL) of the liver is extremely rare. We report on a case of a 60-year-old male who presented with liver mass and B-symptomatology. Hepatoma or hepatic metastasis from a gastrointestinal primary was initially suspected. Tumor markers like AFP, CEA, Total PSA, and CA-19.9 were within normal limits. Positron Emission Tomography / Computerized Tomography (PET/CT) revealed a large hepatic lesion and a nodal mass in the porta hepatis. A liver biopsy was consistent with Hodgkin's lymphoma. There was complete regression of the hepatic lesion and evidence of shrinkage of the nodal mass following four cycles of chemotherapy. 18F Fluro -de-oxy Glucose (FDG) PET / CT in this case helped in establishing a primary hepatic lymphoma by demonstrating the absence of pathologically hypermetabolic foci in any other nodes or organs. PET / CT scan is a useful adjunct to conventional imaging and histopathology, not only to establish the initial diagnosis, but also to monitor treatment response in PHL.
Collapse
Affiliation(s)
- V S Gota
- Departments of Medical Oncology and Bioimaging, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai - 400 012, India
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
Ureal metastases (although an uncommon site of metastatic involvement) are seen with primary tumours of the lung and breast and, very rarely, in other primary tumours. Undescended testis predisposes to malignancy. We present a rare case of choroidal metastasis from a non-seminomatous germ cell tumour arising in an undescended testis, and describe its clinical, ultrasound and MRI findings together with a relevant review of the literature.
Collapse
Affiliation(s)
- N C Purandare
- Tata Memorial Hospital, Dr E Borges Marg, Parel, Mumbai 400 012, India
| | | | | |
Collapse
|
19
|
Sanghvi DA, Purandare NC, Jambhekar NA, Agarwal MG, Agarwal A. Diffuse-type giant cell tumor of the subcutaneous thigh. Skeletal Radiol 2007; 36:327-30. [PMID: 16565836 DOI: 10.1007/s00256-006-0112-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 02/02/2006] [Accepted: 02/03/2006] [Indexed: 02/02/2023]
Abstract
Diffuse-type giant cell tumor is an extra-articular form of pigmented villonodular synovitis. The localized form of this lesion (tenosynovial giant cell tumor) is frequent, representing the most common subset arising from the synovium of a joint, bursa or tendon sheath, with 85% of cases occurring in the fingers. The less frequent diffuse-type giant cell tumors are commonly located in the periarticular soft tissues, but on rare occasions these lesions can be purely intramuscular or subcutaneous We report the case of a 26-year-old female with diffuse-type giant cell tumor of the subcutaneous thigh, remote from a joint, bursa or tendon sheath. A review of the literature did not reveal any similar description of a diffuse-type giant cell tumor completely within the subcutaneous thigh, remote from a joint, bursa or tendon sheath. These lesions were initially regarded as inflammatory or reactive processes, but since the identification of clonal abnormalities in these patients, and in view of their capacity for autonomous growth, they are now widely considered to represent benign neoplasms.
Collapse
Affiliation(s)
- D A Sanghvi
- Department of Radiology, KEM Hospital, Parel, Mumbai 400 012, India.
| | | | | | | | | |
Collapse
|
20
|
Purandare NC, Medhi S, Shah S, Luthra K. Intrapancreatic portal cavernoma. J Assoc Physicians India 2006; 54:792. [PMID: 17214275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- N C Purandare
- Bio-Imaging Unit, Tata Memorial Hospital, Parel, Mumbai
| | | | | | | |
Collapse
|
21
|
Abstract
We report a case of bilateral persistent hyperplastic primary vitreous (PHPV) in a 5-month-old infant who presented with bilateral leukokoria. The child was referred for ocular ultrasound with a clinical suspicion of retinoblastoma. Grey-scale evaluation revealed an echogenic band in the posterior segment of the left globe extending from the posterior surface of the lens capsule to the optic disc. Doppler examination revealed the presence of blood flow in the band. Ultrasound assessment of the contralateral globe showed an elevated mass of echogenic tissue in the posterior segment, in contact with the optic disc. Most cases of PHPV are sporadic and unilateral. Bilateral PHPV is rare. In a study by Pollard of 83 cases, only two patients (2.4%) had bilateral PHPV. The imaging features in this case point toward the diagnosis of bilateral PHPV. We suggest that this entity, although rare, should be considered in the differential diagnosis while evaluating bilateral leukokoria.
Collapse
Affiliation(s)
- D A Sanghvi
- Department of Radiology, Tata Memorial Hospital, Mumbai, India.
| | | | | |
Collapse
|
22
|
Sanghvi DA, Purandare NC, Joshi MS. Venous infarct of jejunum. J Assoc Physicians India 2004; 52:402. [PMID: 15656031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
|
23
|
Abstract
Sarcomas of the seminal vesicle are very rare and poorly documented; as it is not always possible to pinpoint a truly vesicular origin of the pelvic mass due to local spread at the time of presentation. The purpose of the article is to document and characterize a rhabdomyosarcoma of the seminal vesicle of which to the knowledge of the authors there has been no previous report in the English literature.
Collapse
Affiliation(s)
- D A Sanghvi
- Department of Radiodiagnosis, Tata Memorial Hospital, Dr Ernest Borges Road, Parel, Mumbai 400 012, India
| | | | | | | | | |
Collapse
|