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Madan V, Lin TA, Reddy AV, Hill C, Sehgal S, Hacker-Prietz A, McPhaul T, He J, Zheng L, Ngwa W, Herman JM, Meyer JJ, Narang A. Characterization of DNA Damage Response-Associated Somatic Mutations in Borderline Resectable and Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e321. [PMID: 37785147 DOI: 10.1016/j.ijrobp.2023.06.2361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The role of radiation for pancreatic cancer remains controversial, with recent studies showing conflicting results, highlighting the need to develop biomarkers of radiation response. Despite its potential utility in predicting radiosensitivity, the landscape of somatic mutations in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC), as related to DNA damage response (DDR), has not been well characterized. This study aimed to characterize the frequency of such mutations in a cohort of patients with BRPC/LAPC treated with neoadjuvant chemotherapy and stereotactic body radiotherapy (SBRT). MATERIALS/METHODS Mutational data was collected from patients with BRPC/LAPC treated at a single institution with neoadjuvant chemotherapy and SBRT, followed by surgical resection from 2016-2021. Chemotherapy consisted of modified FOLFIRINOX or gemcitabine/nab-paclitaxel, and patients were treated with SBRT in 33 Gy in 5 fractions. Genomic data was obtained from either endoscopic biopsy or surgical specimens, and next-generation sequencing was performed either in-house with a Solid Tumor Panel or with FoundationOne CDx. Specific emphasis was placed on the characterization of double-strand DNA break (DSB) repair genes, as this is the type of tumor cell damage traditionally induced by radiation therapy. Genes associated with the two main pathways of DSB repair, non-homologous end joining (NHEJ) and homologous repair (HR), were analyzed. Specific HR pathway mutations assessed were BLM, BRCA1/2, MRE11, NBN, PALB2, RAD50, RAD51B-D, and RAD54L, while PRKDC mutations were assessed for the NHEJ pathway. Mutations in ATM, an important initiator of DDR pathways, were also analyzed. Additionally, the frequency of mutations in TP53, CDKN2A and SMAD4 in patients with concomitant KRAS mutations was assessed. RESULTS Eighty-five patients were included in the study. Five (5.9%) patients had mutations in the NHEJ pathway of the PRKDC gene. Twenty (23.5%) patients had mutations in the HR pathway, including BRCA2 (10/85; 11.8%), PALB2 (5/85; 5.9%), BRCA1 (3/85; 3.5%), and RAD50 (1/85; 1.2%). Six (7.1%) patients had mutations in ATM. No patients were found to have mutations in BLM, RAD51B-D, RAD54L, or NBN. Amongst patients with KRAS mutations (72/85), concomitant mutations were observed in TP53 (47/85; 55.3%), CDKN2A (16/85; 18.8%), and SMAD4 (9/85; 10.6%). CONCLUSION Herein, we characterized the frequency of somatic mutations associated with DSB repair genes in patients with BRPC/LAPC. Data analysis on outcomes related to radiation response in patients with mutations in DDR pathways is ongoing, but will likely also benefit from multi-institutional efforts to increase the power to answer this question.
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Affiliation(s)
- V Madan
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - T A Lin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A V Reddy
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Hill
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Sehgal
- Johns Hopkins Medical Institute, Department of Radiation Oncology, Baltimore, MD
| | - A Hacker-Prietz
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - T McPhaul
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L Zheng
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - W Ngwa
- John Hopkins University Hospital, Baltimore, MD
| | - J M Herman
- Department of Radiation Medicine, Northwell Health Cancer Institute, New Hyde Park, NY
| | - J J Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Olteanu R, Cuciumita A, Constantin M, Bucur S, Madan V. 069 EBA – a dermatological challenge. Clinical case. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.078] [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: 11/19/2022]
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Bucur S, Ciurduc M, Savu A, Mutu C, Serban E, Cuciumita A, Olteanu R, Madan V, Constantin M. 164 Correlations between etiopathogenic factors and persistence of anti-IL-17A biologic therapies in patients with severe psoriasis vulgaris. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.174] [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: 11/19/2022]
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Ambrose AF, Kurra A, Tsirakidis L, Hunt KC, Ayers E, Gitkind A, Yerra S, Lo Y, Ortiz N, Jamal F, Madan V, Bartels MN, Verghese J. Rehabilitation and In-Hospital Mortality in COVID-19 patients. J Gerontol A Biol Sci Med Sci 2021; 77:e148-e154. [PMID: 34679166 DOI: 10.1093/gerona/glab321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND COVID-19 guidelines endorse early rehabilitation to improve outcomes in hospitalized patients, but the evidence-base to support this recommendation is lacking. We examined the association between early rehabilitation and in-hospital deaths in COVID-19 patients. METHODS Single center retrospective study involving 990 COVID-19 patients (42·4% women, mean age 67.8 years) admitted between March 1, 2020 and May 31, 2020 to a community hospital. Association of rehabilitation during hospitalization with in-hospital mortality was examined using logistic regression analysis adjusted for demographics, length of stay, body mass index, comorbid illnesses, functional status as well as for COVID-19 presentations, treatments, and complications. RESULTS Over the 3-month study period, 475 (48·0%) in-patients were referred for rehabilitation. Patients who received rehabilitation were older (73·7 ± 14·0 vs. 62·3 ± 17·2). There were 61 hospital deaths (12·8%) in the rehabilitation group and 165 (32·0%) in the non-rehabilitation group. Receiving rehabilitation was associated with an 89% lower in-hospital mortality (OR 0·11, 95% CI 0·06-0·19) after adjusting for multiple confounders and COVID-19 disease markers. In sensitivity analyses, the results were significant in sub-populations defined by age group, sex, race, length of hospitalization, or pulmonary presentations. Each additional rehabilitation session was associated with a 29% lower risk of in-hospital mortality (OR per session 0·71, 95% CI 0·64-0·79) in the fully adjusted model. CONCLUSION Among hospitalized COVID-19 patients, receiving early rehabilitation was associated with lower in-hospital mortality. Our findings support implementation of rehabilitation services for COVID-19 patients in acute care settings, but further research from randomized clinical trials is needed.
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Affiliation(s)
- Anne Felicia Ambrose
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY.,Montefiore Health Systems, Bronx, NY
| | - Anupuma Kurra
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY.,White Plains Hospital, White Plains, NY
| | | | | | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | - Andrew Gitkind
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY.,Montefiore Health Systems, Bronx, NY
| | | | - Yungtai Lo
- Department of Epidemiology and Population Health (Y Lo, Albert Einstein College of Medicine, Bronx, NY
| | | | - Faraz Jamal
- Montefiore Health Systems, Bronx, NY.,Rowan University, NY
| | | | - Matthew N Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY.,Montefiore Health Systems, Bronx, NY
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY.,Montefiore Health Systems, Bronx, NY
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5
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Korpe PS, Gilchrist C, Burkey C, Taniuchi M, Ahmed E, Madan V, Castillo R, Ahmed S, Arju T, Alam M, Kabir M, Ahmed T, Petri WA, Haque R, Faruque ASG, Duggal P. Case-Control Study of Cryptosporidium Transmission in Bangladeshi Households. Clin Infect Dis 2020; 68:1073-1079. [PMID: 30192924 PMCID: PMC6424084 DOI: 10.1093/cid/ciy593] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/23/2018] [Accepted: 08/06/2018] [Indexed: 01/17/2023] Open
Abstract
Background Cryptosporidium is a leading contributor to diarrheal morbidity and mortality in under-5 children worldwide. As there is no vaccine and no effective drug therapy in young children for this infection, preventing infection is critical. We undertook a pilot case-control study to define the extent of person-to-person transmission of cryptosporidiosis within an urban and a rural community in Bangladesh. Methods We enrolled 48 case families with a Cryptosporidium-infected child aged 6–18 months. Controls were age- and sex-matched Cryptosporidium-negative children in 12 households. Children and household members were followed for 8 weeks with weekly illness survey and stool testing with quantitative polymerase chain reaction for Cryptosporidium. Results In the 24 urban case families, the secondary attack rate was 35.8% (19/53) vs 0% (0/11) in controls (P = .018, χ2 test). In contrast, in the 24 rural case families, the secondary attack rate was 7.8% (5/64) vs 0% (0/21) in controls (P = .19, χ2 test). Genotyping by gp60 demonstrated infection with the same subspecies in 5 families, and evidence of transmission in 2. Serologic response to Cryptosporidium infection was associated with younger age, longer duration of infection, and Cryptosporidium hominis gp60_IbA9G3R2 infection. Conclusions In the urban site, the high rate of secondary infection and infection with the same subspecies within families suggests that person-to-person transmission is a major source of Cryptosporidium infection for young children living in this region. Molecular genotyping can be applied to determine transmission of Cryptosporidium in endemic regions. Further work is needed to understand the differences in parasite transmissibility and immunity to different genotypes.
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Affiliation(s)
- Poonum S Korpe
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Cecelia Burkey
- University of Virginia School of Medicine, Charlottesville
| | - Mami Taniuchi
- University of Virginia School of Medicine, Charlottesville
| | - Emtiaz Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Vikram Madan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Rachel Castillo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tuhinur Arju
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Masud Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mamun Kabir
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - A S G Faruque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Priya Duggal
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Müller A, Mould WA, Freeman WD, McBee N, Lane K, Dlugash R, Thompson R, Nekoovaght-Tak S, Madan V, Ali H, Stadnik A, Awad I, Hanley D, Ziai WC. The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial. Neurocrit Care 2019; 29:23-32. [PMID: 29294223 DOI: 10.1007/s12028-017-0492-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Incidence of catheter tract hemorrhage (CTH) after initial ventriculostomy placement ranges from 10 to 34%. We investigated CTH incidence in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III trial. METHODS Prospective observational analysis of 1000 computer tomography (CT) scans from all 500 patients enrolled in the trial. All catheters were evaluated on first CT post-placement and on last CT prior to randomization for placement location and CTH size, location, and severity. Clinical variables were assessed for association with CTH with multivariable logistic regression. RESULTS Of 563 catheters, CTH was detected in 14 and 21% of patients on first and last CT (median 3.7 and 43.4 h after catheter placement, respectively). All, but one were asymptomatic. Majority of CTH (86%) occurred within 24 h after placement, were located within 1 cm of the skull, and had at least one diameter > 5 mm. Most catheters (71%) terminated in the third or lateral ventricle ipsilateral to insertion site. Factors significantly associated with CTH were pre-admission use of antiplatelet drugs, accuracy of catheter placement, non-operating room catheter placement, Asian race, and intraventricular hemorrhage expansion. CONCLUSIONS CTH incidence on initial catheter placement and during stabilization was relatively low, despite emergent placement in a high-risk population. Catheter placement accuracy was similar or better than convenience samples from the published literature. Decreasing risk of CTH may be achieved with attention to catheter placement accuracy and placement in the operating room. Antiplatelet agent use was an independent risk factor for CTH.
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Affiliation(s)
- Achim Müller
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W Andrew Mould
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W David Freeman
- Department of Neurology, Neurosurgery, and Critical Care, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Nichol McBee
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lane
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Dlugash
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rick Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saman Nekoovaght-Tak
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vikram Madan
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hasan Ali
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Agnieszka Stadnik
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Issam Awad
- Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Daniel Hanley
- Division of Brain Injury Outcomes, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy C Ziai
- Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe St./Phipps 455, Baltimore, MD, 21287, USA.
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7
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Chien W, Sun QY, Ding LW, Mayakonda A, Takao S, Liu L, Lim SL, Tan KT, Garg M, De Sousa Maria Varela A, Xiao J, Jacob N, Behrens K, Stocking C, Lill M, Madan V, Hattori N, Gery S, Ogawa S, Wakita S, Ikezoe T, Shih LY, Alpermann T, Haferlach T, Yang H, Koeffler HP. Diagnosis and relapse: cytogenetically normal acute myelogenous leukemia without FLT3-ITD or MLL-PTD. Leukemia 2016; 31:762-766. [PMID: 27881871 DOI: 10.1038/leu.2016.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- W Chien
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Q-Y Sun
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - L-W Ding
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - A Mayakonda
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - S Takao
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - L Liu
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - S L Lim
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - K T Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - M Garg
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - A De Sousa Maria Varela
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - J Xiao
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - N Jacob
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - K Behrens
- Heinrich Pette Institute, Hamburg, Germany
| | - C Stocking
- Heinrich Pette Institute, Hamburg, Germany
| | - M Lill
- Department of Hematology-Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - V Madan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - N Hattori
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - S Gery
- Department of Hematology-Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - S Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Wakita
- Department of Internal Medicine, Division of Hematology, Nippon Medical School, Tokyo, Japan
| | - T Ikezoe
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
| | - L-Y Shih
- Department of Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - T Alpermann
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - T Haferlach
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - H Yang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - H P Koeffler
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Hematology-Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,National University Cancer Institute, National University Hospital, Singapore, Singapore
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8
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Madan V, Shyamsunder P, Han L, Mayakonda A, Nagata Y, Sundaresan J, Kanojia D, Yoshida K, Ganesan S, Hattori N, Fulton N, Tan KT, Alpermann T, Kuo MC, Rostami S, Matthews J, Sanada M, Liu LZ, Shiraishi Y, Miyano S, Chendamarai E, Hou HA, Malnassy G, Ma T, Garg M, Ding LW, Sun QY, Chien W, Ikezoe T, Lill M, Biondi A, Larson RA, Powell BL, Lübbert M, Chng WJ, Tien HF, Heuser M, Ganser A, Koren-Michowitz M, Kornblau SM, Kantarjian HM, Nowak D, Hofmann WK, Yang H, Stock W, Ghavamzadeh A, Alimoghaddam K, Haferlach T, Ogawa S, Shih LY, Mathews V, Koeffler HP. Comprehensive mutational analysis of primary and relapse acute promyelocytic leukemia. Leukemia 2016; 30:2430. [PMID: 27713533 PMCID: PMC7609306 DOI: 10.1038/leu.2016.237] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Madan V, Shyamsunder P, Han L, Mayakonda A, Nagata Y, Sundaresan J, Kanojia D, Yoshida K, Ganesan S, Hattori N, Fulton N, Tan KT, Alpermann T, Kuo MC, Rostami S, Matthews J, Sanada M, Liu LZ, Shiraishi Y, Miyano S, Chendamarai E, Hou HA, Malnassy G, Ma T, Garg M, Ding LW, Sun QY, Chien W, Ikezoe T, Lill M, Biondi A, Larson RA, Powell BL, Lübbert M, Chng WJ, Tien HF, Heuser M, Ganser A, Koren-Michowitz M, Kornblau SM, Kantarjian HM, Nowak D, Hofmann WK, Yang H, Stock W, Ghavamzadeh A, Alimoghaddam K, Haferlach T, Ogawa S, Shih LY, Mathews V, Koeffler HP. Comprehensive mutational analysis of primary and relapse acute promyelocytic leukemia. Leukemia 2016; 30:1672-81. [PMID: 27063598 PMCID: PMC4972641 DOI: 10.1038/leu.2016.69] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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: 12/01/2015] [Revised: 02/12/2016] [Accepted: 03/15/2016] [Indexed: 12/16/2022]
Abstract
Acute promyelocytic leukemia (APL) is a subtype of myeloid leukemia characterized by differentiation block at the promyelocyte stage. Besides the presence of chromosomal rearrangement t(15;17), leading to the formation of PML-RARA (promyelocytic leukemia-retinoic acid receptor alpha) fusion, other genetic alterations have also been implicated in APL. Here, we performed comprehensive mutational analysis of primary and relapse APL to identify somatic alterations, which cooperate with PML-RARA in the pathogenesis of APL. We explored the mutational landscape using whole-exome (n=12) and subsequent targeted sequencing of 398 genes in 153 primary and 69 relapse APL. Both primary and relapse APL harbored an average of eight non-silent somatic mutations per exome. We observed recurrent alterations of FLT3, WT1, NRAS and KRAS in the newly diagnosed APL, whereas mutations in other genes commonly mutated in myeloid leukemia were rarely detected. The molecular signature of APL relapse was characterized by emergence of frequent mutations in PML and RARA genes. Our sequencing data also demonstrates incidence of loss-of-function mutations in previously unidentified genes, ARID1B and ARID1A, both of which encode for key components of the SWI/SNF complex. We show that knockdown of ARID1B in APL cell line, NB4, results in large-scale activation of gene expression and reduced in vitro differentiation potential.
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Affiliation(s)
- V Madan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - P Shyamsunder
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - L Han
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - A Mayakonda
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Y Nagata
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - J Sundaresan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - D Kanojia
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - K Yoshida
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Ganesan
- Department of Haematology, Christian Medical College, Vellore, India
| | - N Hattori
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - N Fulton
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - K-T Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - T Alpermann
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - M-C Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - S Rostami
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - J Matthews
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Sanada
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - L-Z Liu
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Y Shiraishi
- Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - S Miyano
- Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - E Chendamarai
- Department of Haematology, Christian Medical College, Vellore, India
| | - H-A Hou
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - G Malnassy
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - T Ma
- Division of Hematology, Oncology and Stem Cell Transplantation, Department of Internal Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - M Garg
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - L-W Ding
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Q-Y Sun
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - W Chien
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - T Ikezoe
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - M Lill
- Cedars-Sinai Medical Center, Division of Hematology/Oncology, UCLA School of Medicine, Los Angeles, CA, USA
| | - A Biondi
- Paediatric Haematology-Oncology Department and 'Tettamanti' Research Centre, Milano-Bicocca University, 'Fondazione MBBM', San Gerardo Hospital, Monza, Italy
| | - R A Larson
- Department of Medicine, University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - B L Powell
- Department of Internal Medicine, Section on Hematology and Oncology, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - M Lübbert
- Division of Hematology, Oncology and Stem Cell Transplantation, Department of Internal Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - W J Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Hematology-Oncology, National University Cancer Institute of Singapore (NCIS), The National University Health System (NUHS), Singapore, Singapore
| | - H-F Tien
- Department of Internal Medicine, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - A Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - M Koren-Michowitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel Hashomer, Israel
| | - S M Kornblau
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - H M Kantarjian
- Section of Molecular Hematology and Therapy, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Nowak
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - W-K Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - H Yang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - W Stock
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - A Ghavamzadeh
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - K Alimoghaddam
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - T Haferlach
- Munich Leukemia Laboratory (MLL), Munich, Germany
| | - S Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - L-Y Shih
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - V Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - H P Koeffler
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Cedars-Sinai Medical Center, Division of Hematology/Oncology, UCLA School of Medicine, Los Angeles, CA, USA.,Department of Hematology-Oncology, National University Cancer Institute of Singapore (NCIS), The National University Health System (NUHS), Singapore, Singapore
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Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol 2015; 171:937-58. [PMID: 25409999 DOI: 10.1111/bjd.13358] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 12/12/2022]
Affiliation(s)
- M Ameen
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, U.K
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Ali FR, Madan V. Facial angiolymphoid hyperplasia with eosinophilia: sustained remission following treatment with carbon dioxide laser. Clin Exp Dermatol 2015; 41:96-8. [PMID: 25917269 DOI: 10.1111/ced.12648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- F R Ali
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK.
| | - V Madan
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK
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Yiu ZZN, Madan V, Griffiths CEM. Acne conglobata and adalimumab: use of tumour necrosis factor-α antagonists in treatment-resistant acne conglobata, and review of the literature. Clin Exp Dermatol 2014; 40:383-6. [PMID: 25545016 DOI: 10.1111/ced.12540] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 11/27/2022]
Abstract
Acne conglobata (AC) is a chronic, severe, inflammatory variant of acne characterized by development of cystic nodules, abscesses and sinus tracts. AC may prove resistant to conventional acne therapy. The off-label use of adalimumab for the treatment of AC has been reported recently. We present a 26-year-old man with AC resistant to conventional treatment, who was treated with 40 mg adalimumab every other week, with significant clinical improvement. We review the evidence for the use of tumour necrosis factor antagonists in AC and related conditions. This case provides further evidence supporting the role of adalimumab in the treatment of AC.
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Affiliation(s)
- Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - V Madan
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Affiliation(s)
- W Bakkour
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, M6 8HD, U.K.
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Gerloff D, Grundler R, Wurm AA, Bräuer-Hartmann D, Katzerke C, Hartmann JU, Madan V, Müller-Tidow C, Duyster J, Tenen DG, Niederwieser D, Behre G. NF-κB/STAT5/miR-155 network targets PU.1 in FLT3-ITD-driven acute myeloid leukemia. Leukemia 2014; 29:535-47. [PMID: 25092144 DOI: 10.1038/leu.2014.231] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/11/2014] [Accepted: 07/21/2014] [Indexed: 01/07/2023]
Abstract
Almost 30% of all acute myeloid leukemias (AML) are associated with an internal tandem duplication (ITD) in the juxtamembrane domain of FMS-like tyrosine kinase 3 receptor (FLT3). Patients with FLT3-ITD mutations tend to have a poor prognosis. MicroRNAs (miRNAs) have a pivotal role in myeloid differentiation and leukemia. MiRNA-155 (MiR-155) was found to be upregulated in FLT3-ITD-associated AMLs. In this study, we discovered that FLT3-ITD signaling induces the oncogenic miR-155. We show in vitro and in vivo that miR-155 expression is regulated by FLT3-ITD downstream targets nuclear factor-κB (p65) and signal transducer and activator of transcription 5 (STAT5). Further, we demonstrate that miR-155 targets the myeloid transcription factor PU.1. Knockdown of miR-155 or overexpression of PU.1 blocks proliferation and induces apoptosis of FLT3-ITD-associated leukemic cells. Our data demonstrate a novel network in which FLT3-ITD signaling induces oncogenic miR-155 by p65 and STAT5 in AML, thereby targeting transcription factor PU.1.
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Affiliation(s)
- D Gerloff
- Division of Hematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - R Grundler
- Department of Internal Medicine III, Technical University Munich, Munich, Germany
| | - A A Wurm
- Division of Hematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - D Bräuer-Hartmann
- Division of Hematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - C Katzerke
- Division of Hematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - J-U Hartmann
- Division of Hematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - V Madan
- Cancer Science Institute, National University of Singapore, Singapore
| | - C Müller-Tidow
- Department of Medicine IV, Hematology and Oncology, University of Halle, Halle, Germany
| | - J Duyster
- Department of Hematology/Oncology 1, University Medical Center Freiburg, Freiburg, Germany
| | - D G Tenen
- 1] Cancer Science Institute, National University of Singapore, Singapore [2] Harvard Stem Cell Institute, Harvard Medical School, Boston, MA, USA
| | - D Niederwieser
- Division of Hematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - G Behre
- Division of Hematology and Oncology, Leipzig University Hospital, Leipzig, Germany
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Rai S, Madan V, August P, Ferguson J. Favre-Racouchot syndrome: a novel two-step treatment approach using the carbon dioxide laser. Br J Dermatol 2014; 170:657-60. [DOI: 10.1111/bjd.12742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- S. Rai
- The Laser Division; Salford Royal Hospital; Stott Lane Salford Manchester M6 8HD U.K
| | - V. Madan
- The Laser Division; Salford Royal Hospital; Stott Lane Salford Manchester M6 8HD U.K
| | - P.J. August
- The Laser Division; Salford Royal Hospital; Stott Lane Salford Manchester M6 8HD U.K
| | - J.E. Ferguson
- The Laser Division; Salford Royal Hospital; Stott Lane Salford Manchester M6 8HD U.K
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Stephanides S, Rai S, August P, Ferguson J, Madan V. Treatment of refractory keloids with pulsed dye laser alone and with rotational pulsed dye laser and intralesional corticosteroids: A retrospective case series. Laser Ther 2013; 20:279-86. [PMID: 24155538 DOI: 10.5978/islsm.12-or-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 07/29/2011] [Accepted: 10/11/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The limited available effective treatments make the management of keloids challenging. Intralesional triamcinolone and pulsed dye laser have been used for the treatment of keloids. We sought to assess the efficacy of a treatment regime using rotational intralesional triamcinolone and pulsed dye laser in the management of keloids. Materials (Subjects) and Methods: Case notes and photographic records of 99 patients with keloids treated with pulsed dye laser (PDL) alone or rotational PDL and intralesional triamcinolone (ILT) at our centre between 2005 and 2010 were reviewed. Patients with raised, erythematous and/or symptomatic keloids unresponsive to ILT alone (usually 6 treatments) are referred for consideration of PDL. Patients are offered repeated rotational treatments of three PDL (4-15 J/cm(2), 7 mm spot, 1.5 msec pulse duration, 595 nm wavelength, DCD, 30 msec spray: 20 msec delay; spaced at 6-8 weeks intervals) followed by one ILT (10 mg or 40 mg/dl). ILT-treated flat but erythematous and/or symptomatic keloids are treated with PDL alone at 6-8 week intervals. Response after each laser treatment is documented as a percentage improvement from baseline. Based on the improvement in redness, thickness and pruritus the operator classified the response to treatment as mild (0-49%), moderate (50-75%) or excellent (>75%). Patients are reviewed at 6 months following last treatment. A patient satisfaction questionnaire was also sent out to all patients who received treatments between 2005 and 2010 and this was compared with the information gathered from the notes. RESULTS Of the 99 patients, 58 were women and 41 were men and most were Caucasian (n=84). A total of 755 keloids were treated. The average number of PDL treatments to achieve a moderate-excellent result was 14 in male and 12 in females. Moderate-excellent improvement was seen in 76% patients. The average number of ILT required to achieve a moderate-excellent result was 5 in males and 4 in females. All patients were sent a satisfaction questionnaire and 33 responses were received wherein patients reported an average of 70% improvement in the redness and thickness of the keloids. Localised cutaneous atrophy, self-limiting erythema and injection site discomfort were noted in 3 female patients whilst no side-effects noted in the male cohort. CONCLUSIONS Pulsed dye laser with or without intralesional triamcinolone is a moderately effective treatment of keloid scars with a very good side-effect profile and high patient satisfaction.
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Affiliation(s)
- S Stephanides
- Salford Royal NHS Foundation Trust, Laser Division, The Dermatology Centre, Manchester, UK
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Spinu D, Bratu O, Madan V, Farcas C, Radulescu A, Popescu R, Mischianu D. Left renal cyst - left duplex kidney with compromised superior renal unit and ectopic ureteral orifice in the prostatic urethra. J Med Life 2013; 6:176-9. [PMID: 23904879 PMCID: PMC3725444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/20/2013] [Indexed: 12/02/2022] Open
Abstract
UNLABELLED The urinary abnormalities are an important health problem. If they are not recognized in due time, they usually lead to the loss of the renal unit function. In many cases, the diagnosis is late and incidental. CASE PRESENTATION We present the case of M.I., a 74-year-old male admitted in our surgical unit with diffuse left lumbar pain, low urinary tract symptoms and slow increase in abdomen volume in the past 4 years. Computer tomography scan and ecography showed a large left lumbar cyst like mass with a dilated supernumerary ureter with ectopic ureteral orifice in the prostatic urethra and apparently normal anatomic inferior renal unit. The goal was the excision of the "cyst like" mass (superior left renal unit) but because of the anatomical particularities (extensive fibrosis and local topographical changes) total nephrectomy was performed. CONCLUSIONS Given a normal contralateral kidney, the discovery of a urinary abnormality can be a real challenge, their evolution being a silent one. This type of disease can be suspected only with the development of clinical symptoms. The anatomic particularities (duplex kidney) together with the long evolution of the disease changed the local topography making the preservation of the inferior left renal unit a difficult, almost impossible task for the surgeon.
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Affiliation(s)
- D Spinu
- “Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Urology Ward
| | - O Bratu
- “Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Urology Ward
| | - V Madan
- “Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Urology Ward
| | - C Farcas
- “Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Urology Ward
| | - A Radulescu
- “Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Urology Ward
| | - R Popescu
- “Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Urology Ward
| | - D Mischianu
- “Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Urology Ward
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Smith E, May K, Madan V. An unusually coloured lesion on the thigh. Clin Exp Dermatol 2012; 38:212-4. [PMID: 22924667 DOI: 10.1111/j.1365-2230.2012.04389.x] [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: 11/28/2022]
Affiliation(s)
- E Smith
- Departments of Dermatology, University Hospital of Wales, Cardiff, UK.
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Affiliation(s)
- E V Smith
- Departments of Dermatology, University Hospital of Wales, Cardiff, UK.
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August P, Ferguson J, Madan V. A study of the efficacy of carbon dioxide and pigment-specific lasers in the treatment of medium-sized congenital melanocytic naevi. Br J Dermatol 2011; 164:1037-42. [DOI: 10.1111/j.1365-2133.2011.10236.x] [Citation(s) in RCA: 35] [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: 11/29/2022]
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Madan V, Jamieson L, F Wynn R, Shabani A, Judge MR. Multifocal vascular lesions and thrombocytopenia in a 10-year-old boy: retrospective review of a recently recognized rare congenital disorder. Clin Exp Dermatol 2010; 35:942-4. [DOI: 10.1111/j.1365-2230.2010.03858.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Madan V, Kingston H, Jamieson LA, Goyal N, Ead R. Muckle-Wells syndrome/neonatal-onset multisystem inflammatory disease overlap associated with myelodysplasia and cerebrovascular accident. Clin Exp Dermatol 2010; 35:752-5. [PMID: 20456407 DOI: 10.1111/j.1365-2230.2010.03817.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe a patient with overlapping clinical features of Muckle-Wells syndrome and neonatal-onset multisystem inflammatory disease with an absence of mutation in exon 3 of the CIAS1 ⁄ PYPAF1 ⁄ NALP3 gene. Myelodysplasia and cerebrovascular accident were additional features in this patient, which to our knowledge have not been previously described in association with these disorders. The urticarial rash, myelodysplasia and raised inflammatory markers responded to treatment with the interleukin-1 receptor antagonist, anakinra.
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Affiliation(s)
- V Madan
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
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Madan V, August PJ. Letter: Regarding lentigo maligna: outcomes of treatment with Q-switched neodymium-doped yttrium aluminum garnet and alexandrite lasers. Dermatol Surg 2010; 36:437. [PMID: 20402954 DOI: 10.1111/j.1524-4725.2009.01508.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Madan V, West C, Murphy J, Lear J. Sequential treatment of giant basal cell carcinomas. J Plast Reconstr Aesthet Surg 2009; 62:e368-72. [DOI: 10.1016/j.bjps.2007.12.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 12/23/2007] [Accepted: 12/29/2007] [Indexed: 11/28/2022]
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Madan V, Jamieson LA, Bhogal BS, Wong CS. Inflammatory epidermolysis bullosa acquisita mimicking toxic epidermal necrolysis and dermatitis herpetiformis. Clin Exp Dermatol 2009; 34:e705-8. [PMID: 19663858 DOI: 10.1111/j.1365-2230.2009.03439.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report a patient with a spectrum of clinical features simulating toxic epidermal necrolysis, bullous erythema multiforme and later, dermatitis herpetiformis (DH). The histological features were suggestive of DH, bullous pemphigoid (BP) and epidermolysis bullosa acquisita (EBA). Direct immunofluorescence results suggested BP or EBA. Indirect immunofluorescence on salt-split skin and immunoblotting analysis on normal human dermal extracts gave results that were diagnostic for EBA.
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Affiliation(s)
- V Madan
- Dermatology Centre, Salford Royal Hospital NHS Foundation Trust, Salford, Manchester, UK.
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Madan V, Chinoy H, Griffiths CEM, Cooper RG. Defining cancer risk in dermatomyositis. Part II. Assessing diagnostic usefulness of myositis serology. Clin Exp Dermatol 2009; 34:561-5. [PMID: 19508476 DOI: 10.1111/j.1365-2230.2009.03227.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In part 1 of this review, we examined the evidence behind the association between idiopathic inflammatory myopathies (IIM) and cancers. In view of the well-recognized association between cancer and myositis (hence the term cancer-associated myositis, or CAM), clinicians responsible for the management of patients with myositis must make important decisions regarding how intensively they undertake searches for malignancy. Clinicians must also decide how often such searches are repeated, and again how intensively, to optimize both cancer detection and treatment, and thus patient survival. As the risks of CAM are greatest in dermatomyositis, this is an issue of obvious importance to dermatologists. In this second of two reviews, we examine the role of autoantibodies as potential predictors of cancer risk in patients with IIM.
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Affiliation(s)
- V Madan
- Dermatology, Salford Royal Hospital NHS Foundation Trust, University of Manchester, Manchester, UK.
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Madan V, August PJ, Chalmers RJG. Efficacy of topical tacrolimus 0.3% in clobetasol propionate 0.05% ointment in therapy-resistant cutaneous lupus erythematosus: a cohort study. Clin Exp Dermatol 2009; 35:27-30. [PMID: 19549244 DOI: 10.1111/j.1365-2230.2009.03351.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite a range of available topical and systemic therapies, treatment of cutaneous lupus erythematosus (CLE) can be challenging. Objectives. To evaluate the efficacy of a specially formulated preparation of tacrolimus 0.3% in clobetasol propionate 0.05% ointment (TCPO) in the treatment of CLE. METHODS Case notes of 13 patients with treatment-resistant CLE (11 discoid LE, 1 systemic LE and 1 subacute cutaneous LE) who had used twice-daily TCPO (TCPO group) were reviewed. These were compared with five similar patients with resistant CLE who had been given 0.1% tacrolimus ointment alone (TO group). RESULTS In the TCPO group (mean treatment duration 20 months, range 1-72), a good or excellent response was seen in five and six patients, respectively; one patient showed slight improvement. Telangiectasia and acne were observed in two patients. No systemic side-effects were noted. In the TO group (mean treatment duration 6 months, range 1-24), one patient showed good improvement and two showed slight improvement. CONCLUSION The results of our small retrospective study suggest that TCPO may be more effective than either 0.1% tacrolimus or clobetasol propionate 0.05% ointment monotherapy in the treatment of recalcitrant CLE. Randomized controlled trials are needed to confirm these preliminary findings.
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Affiliation(s)
- V Madan
- The Dermatology Centre, Salford Royal Hospitals NHS Foundation Trust, Salford, UK.
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Madan V, Gangopadhyay M, Dawn G. Itchy papules on the neck. Clin Exp Dermatol 2009; 34:541-2. [PMID: 19522985 DOI: 10.1111/j.1365-2230.2008.02699.x] [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: 11/29/2022]
Affiliation(s)
- V Madan
- Department of Dermatology, Cumberland Infirmary, Carlisle, Cumbria, UK.
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Madan V, Cox NH. Rash on the legs: thin plaques with peripheral accentuation. Clin Exp Dermatol 2009; 34:543-4. [PMID: 19522986 DOI: 10.1111/j.1365-2230.2008.02700.x] [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: 11/30/2022]
Affiliation(s)
- V Madan
- Department of Dermatology, Cumberland Infirmary, Carlisle, UK.
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Affiliation(s)
- V Madan
- Dermatology Centre, Salford Royal Hospitals Foundation Trust, Hope Hospital, Salford, Manchester, UK.
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Abstract
The idiopathic inflammatory myopathies (IIMs) comprise polymyositis, myositis overlapping with another connective tissue disease, dermatomyositis (DM) and inclusion-body myositis (IBM). IIMs are characterized by the presence of proximal muscle weakness, increased levels of muscle-specific enzymes, specific electromyographic abnormalities, and the presence of inflammatory cell infiltrates in skeletal muscle. Clinical, serological and histological criteria can be used to define individual IIM subtypes. In the first of this two-part review series, we examine the evidence for the existence of cancer-associated myositis (CAM), and in part 2, we discuss recent discoveries that provide insight into identification of patients with DM, who may be most at risk of developing CAM.
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Affiliation(s)
- V Madan
- Dermatology Centre, Salford Royal Hospital NHS Foundation Trust, University of Manchester, Manchester, UK.
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Affiliation(s)
- V Madan
- Department of Dermatology, Cumberland Infirmary, Carsile, UK.
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Madan V, Hindle E, Hussain W, August PJ. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol 2009; 159:1309-14. [PMID: 19036028 DOI: 10.1111/j.1365-2133.2008.08932.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic and often a recalcitrant inflammatory skin condition. OBJECTIVES To present the results of carbon dioxide (CO2) laser treatment of recalcitrant HS in nine patients who had failed to improve on medical and other surgical treatments. METHODS HS lesions consisting of abscesses, sinuses and granulation tissue were completely excised using the cutting mode of a CO2 laser, leaving only healthy residual subcutaneous fat. The wounds were closed by primary intention where possible and left to granulate otherwise. Outcomes were determined by clinical review and questionnaire. RESULTS Twenty-seven sites were treated in 19 sessions on nine patients. Seven procedures were performed under general anaesthesia and 12 under local. All patients rated their postoperative discomfort as less or equal to their preoperative state. Seven of the nine patients had complete remission for 12 months or longer after their last laser treatment and ceased all medications. High levels of patient satisfaction were reported with CO2 laser treatment. The main complication was axillary scar contracture in two patients but this was insufficient to limit limb movement. CONCLUSIONS CO2 laser treatment should be considered as a treatment option in recalcitrant HS, where multiple medical treatments have been ineffective.
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Affiliation(s)
- V Madan
- Laser Division, The Dermatology Centre, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Salford, Manchester M6 8HD, UK.
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Madan V, Gangopadhyay M, Dawn G. A collection of blue papules. Clin Exp Dermatol 2008; 34:121-2. [PMID: 19076819 DOI: 10.1111/j.1365-2230.2008.02701.x] [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: 11/28/2022]
Affiliation(s)
- V Madan
- Department of Dermatology, Cumberland Infirmary, Carlisle, UK
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Cox N, Madan V, Sanders T. The U.K. skin cancer ‘two-week rule’ proforma: assessment of potential modifications to improve referral accuracy. Br J Dermatol 2008; 158:1293-8. [DOI: 10.1111/j.1365-2133.2008.08519.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mischianu D, Bratu 0, Ilie C, Madan V. Notes concerning the peritonitis of urinary aetiology. J Med Life 2008; 1:66-71. [PMID: 20108482 PMCID: PMC3018956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Urinary peritonitis (the uroperitoneum) is categorized as a difficult to diagnose clinical entity due to its poor manifestations. Vesical trauma following pelvis bone fracture is the most frequently involved in the uroperitoneum aetiology, followed by spontaneous vesical rupture and intraoperative iatrogenic lesions. One of the most important and constant signs that can occur is diffuse abdominal tension, without tenderness. The imagistic procedure that sets the diagnosis is retrograde cystography showing intraperitoneal urine effusion. Vesical rupture is a surgical emergency. The uroperitoneum is a particular type of peritonitis that has hidden and misleading symptoms which can delay the diagnosis long enough to endanger the patient's life.
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Abstract
Ciclosporin and tacrolimus are calcineurin inhibiting immunosuppressant agents useful in the treatment of immune-mediated inflammatory dermatoses. Available data and clinical experience demonstrate ciclosporin's efficacy in treating psoriasis, atopic dermatitis, pyoderma gangrenosum, lichen planus, autoimmune bullous disease (in combination with corticosteroids), recalcitrant chronic idiopathic urticaria, and chronic dermatitis of the hands and feet. Although the role of topical tacrolimus in atopic dermatitis is well established, such experience with the oral formulation of tacrolimus has been limited. However, there are several case studies and anecdotal reports of the successful use of oral tacrolimus in various dermatoses. In this article we discuss the utility of systemic ciclosporin and tacrolimus in dermatology.
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Affiliation(s)
- V Madan
- The Dermatology Center, University of Manchester, Hope Hospital, Salford, Manchester, UK
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Cox NH, Madan V, Popple AW, Angus B. CD30-postive lymphoproliferative disorder with lesions at depot injection sites, associated with mycosis fungoides and prostatic carcinoma. Clin Exp Dermatol 2007; 33:101-2. [PMID: 17725656 DOI: 10.1111/j.1365-2230.2007.02536.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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