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Rao SK. Marketing decision support systems for strategy building. MARKETING HEALTH SERVICES 2001; 20:14-8. [PMID: 11183424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Brand teams charged with the commercialization of pharmaceutical products in the pipeline operate in an uncertain environment. Market, customer and competitive interrelationships undergo changes, often in ways that are unpredictable with conventional research practices. This article describes a framework whereby such uncertainty can be managed more effectively in the context of ongoing business needs.
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Mariani A, Webb MJ, Rao SK, Lesnick TG, Podratz KC. Significance of pathologic patterns of pelvic lymph node metastases in endometrial cancer. Gynecol Oncol 2001; 80:113-20. [PMID: 11161847 DOI: 10.1006/gyno.2000.6050] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to correlate the pathologic characteristics of pelvic lymph node metastases with survival, recurrence, and patterns of recurrence in endometrial cancer. METHODS Sixty patients with epithelial endometrial cancer and pelvic node metastasis were managed surgically between 1984 and 1993 at the Mayo Clinic. The mean number of nodes harvested was 16.7 and the mean number of nodes positive was 3.0. Mean follow-up was 45.5 months. The pathologic patterns of lymph node metastases were characterized. RESULTS Outcome was related to pathologic patterns of pelvic node metastasis. Both diameter of lymph node metastasis (P < 0.01) and capsular integrity (P < or = 0.01) influenced 5-year disease-related survival and 5-year progression-free survival. The percentage of biopsied pelvic lymph nodes harboring metastatic disease and the proportion of the involved lymph nodes occupied by tumor significantly influenced death rates and recurrence rates (P < 0.05). The immune response and the absolute number of positive pelvic nodes did not impact recurrence or survival. The above characteristics of pelvic node metastasis correlated also with patterns of recurrence. Regression analysis indicated that capsular integrity (RR = 2.97; P = 0.005) and proportion of positive pelvic nodes biopsied (RR = 3.84; P = 0.01) were significant predictors of recurrence, whereas diameter of metastasis (RR = 3.68; P = 0.02) and proportion of positive pelvic nodes biopsied (RR = 4.04; P = 0.02) were most predictive of survival. CONCLUSIONS The pathologic patterns of pelvic node metastasis appear to be significantly related to survival, recurrence, and patterns of recurrence.
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Abstract
Stress fractures have been reported in the upper limb of sportspeople involved in upper limb dominated events. Olecranon stress fractures have been cited in baseball pitchers, javelin throwers, and gymnasts. The unusual case of a stress fracture of the olecranon in a young weight lifter is reported here. The minimally displaced stress fracture was treated with tension band and two Kirschner wires. The fracture healed in four months and the patient returned to light sports activity after six months.
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Mori M, Rao SK, Popper HH, Cagle PT, Fraire AE. Atypical adenomatous hyperplasia of the lung: a probable forerunner in the development of adenocarcinoma of the lung. Mod Pathol 2001; 14:72-84. [PMID: 11235908 DOI: 10.1038/modpathol.3880259] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An increasingly large body of work suggests that atypical adenomatous hyperplasia (AAH) of the lung may be a forerunner of pulmonary adenocarcinoma. Recognizing this fact, the World Health Organization now acknowledges the existence of AAH while noting difficulties that may be encountered in distinguishing AAH from the nonmucinous variant of bronchioloalveolar carcinoma. Regrettably, a universally acceptable definition of morphologic criteria for the diagnosis of AAH has not been achieved. This review of the literature examines the epidemiology, gross appearance, light microscopic findings, morphometry, immunohistochemistry, and molecular features of AAH and suggests a set of histopathologic features that may help the practicing pathologist identify this intriguing lesion. These features include the following: irregularly bordered focal proliferations of atypical cells spreading along the preexisting alveolar framework; prominent cuboidal to low columnar alveolar epithelial cells with variable degree of atypia but less than that seen in adenocarcinoma; increased cell size and nuclear-cytoplasmic ratio with hyperchromasia and prominent nucleoli, generally intact intercellular attachment of atypical cells with occasional empty-looking spaces between them without high cellularity and without tufting or papillary structures; and slight thickening of the alveolar walls on which the AAH cells have spread, with some fibrosis but without scar formation or significant chronic inflammation of the surrounding lung tissue. Several lines of evidence indicate that AAH is a lesion closely associated with adenocarcinoma of the lung, suggesting AAH may be involved in the early stage of a complex multistep carcinogenesis of pulmonary adenocarcinoma.
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Rao SK, Cheng AC, Fan DS, Leung AT, Lam DS. Effect of preoperative keratometry on refractive outcomes after laser in situ keratomileusis. J Cataract Refract Surg 2001; 27:297-302. [PMID: 11226798 DOI: 10.1016/s0886-3350(00)00746-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effect of preoperative keratometry on the refractive outcome after laser in situ keratomileusis (LASIK) for myopia. SETTING University Eye Clinic, Prince of Wales Hospital, Hong Kong, China. METHODS In this retrospective study, the records of patients who had LASIK for myopia greater than -6.0 diopters (D) using the Chiron Automated Corneal Shaper and the Schwind Keratome-F excimer laser were reviewed. RESULTS Laser in situ keratomileusis was performed in 167 eyes of 103 patients (mean age 34.7 years +/- 7.5 [SD]). Preoperative myopic spherical equivalent (SE) refraction was -9.0 +/- 2.0 D (range -6.0 to -13.9 D). Three months after surgery, SE refraction was -0.04 +/- 1.1 D (range +2.3 to -3.3 D); uncorrected visual acuity > or = 20/40 was present in 91.8% of 110 eyes in which emmetropia was the postoperative goal. Mean preoperative keratometry was 43.9 +/- 1.5 D (range 40.3 to 48.1 D). When eyes were stratified by the degree of preoperative myopia in 1.0 D steps, a trend toward greater undercorrection was noted in eyes with preoperative keratometry < 43.5 D than in those with steeper keratometry (> 44.5 D) in all myopia groups except the -7.0 to -7.9 D group. This difference was statistically significant in eyes with a preoperative SE of -10.0 to -10.9 D and -11.0 to -11.9 D. CONCLUSIONS Preoperative keratometry appeared to influence the refractive outcome after myopic LASIK. Eyes with flatter corneas tended to have greater undercorrection than eyes with similar myopia and steeper corneas. Validation of these findings in larger data sets using the methodology described may improve the predictability of current LASIK nomograms, particularly in eyes with high myopia.
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Abstract
PURPOSE To report five cases of insect wing case foreign body. METHODS Clinical presentation, investigations, management, and outcome of these cases are discussed. RESULTS Five patients, four males and one female, in the age group from 4 to 55 years presented with an insect wing case embedded in the cornea or peripheral limbus. All patients were relatively asymptomatic, and the foreign body was associated with vascularization and infiltration. Culture of the foreign body after removal showed Staphylococcus epidermidis in two cases and Corynebacterium species and Mycobacterium fortuitum in one case each. All patients responded to removal of the wing case foreign body and treatment with topical ciprofloxacin (0.3%). CONCLUSION Insect wing case is an unusual foreign body and produces minimal symptoms and may be associated with infective agents in some patients.
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Rao SK, Ranjan Sen P, Fogla R, Gangadharan S, Padmanabhan P, Badrinath SS. Corneal endothelial cell density and morphology in normal Indian eyes. Cornea 2000; 19:820-3. [PMID: 11095057 DOI: 10.1097/00003226-200011000-00012] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe corneal endothelial cell density and morphology in the Indian population and to compare endothelial cell characteristics in the Indian population with data available in literature for American and Japanese populations. METHODS Specular microscopy and corneal pachymetry were performed in both eyes of 537 normal Indian volunteers, aged 20-87 years. Parameters studied included endothelial cell density, cell area, coefficient of variation (CV) in cell area and hexagonality. RESULTS Mean endothelial cell density in the study population was 2,525 +/- 337 cells/mm2. There was a statistically significant decrease in endothelial cell density with age (p < 0.001, correlation -0.387) and the rate of cell loss was 0.3% per year. There was also a statistically significant increase in mean cell area (p < 0.001, correlation 0.362) and CV (p = 0.02, correlation 0.096), and decrease in percentage of hexagonal cells (p = 0.01, correlation -0.127) with increasing age. There was no significant difference in these parameters between fellow eyes of subjects. In all age groups, the mean endothelial cell density was significantly lower than values reported previously in the Japanese population. The values were less than those described in the American population, but the differences were statistically significant only in the 20-30 and 41-50 year age groups. CONCLUSION Normative data for the endothelium in the Indian population are reported. Endothelial cell density in Indian eyes is less than the values described in the Japanese and American populations.
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Rao SK, Fogla R, Sitalakshmi G, Padmanabhan P. Corneal autografting: a systematic approach. OPHTHALMIC SURGERY AND LASERS 2000; 31:457-61. [PMID: 11095121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To describe a systematic approach to corneal autografting. PATIENTS AND METHODS Retrospective review of case records of 3 patients who underwent this procedure. RESULTS All patients achieved satisfactory visual recovery. Oversized grafts of 0.5 mm had less post-operative complications in the recipient eye. A phakic blind eye that received a 0.5 mm undersized graft had a temporary ocular hypertensive phase. CONCLUSIONS Corneal autografting is a safe and effective technique in selected patients. The preferred surgical technique consists of surgery first on the blind eye, excision of a 0.5 mm oversized donor graft, cataract extraction if the eye is phakic, and use of an appropriate temporary keratoprosthesis to maintain donor eye integrity until autografting is completed in the eye with visual potential.
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Brahmachari NS, Anantharaman DS, Rao BR, Gupte MD, Rao SK, Mahalingam VN. Underutilization of the available services by the needy disabled leprosy patients in Government Leprosy Control Unit Puttoor, Chittoor district, Andhra Pradesh, South India. INDIAN JOURNAL OF LEPROSY 2000; 70 Suppl:47S-61S. [PMID: 10992867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This study was undertaken to find out the deformity profile, utilization of disability care services, factors associated with underutilization and the impact of educating leprosy patients with visible disabilities in self-care practices in the area covered by the LCU Chittoor. The disability prevalence rate in the area was 15 per 10,000 population. Training of the staff and teaching leprosy patients in self-care practices has shown a remarkable improvement in skin texture and ulcer situation of disabled leprosy patients.
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Rao SK, Padmanabhan P, Sitalakshmi G, Rajagopal R. Partial flap during laser in-situ keratomileusis: pathogenesis and timing of retreatment. Indian J Ophthalmol 2000; 48:209-12. [PMID: 11217252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
PURPOSE To report the timing of retreatment and clinical outcomes in patients with a partial corneal flap during laser in-situ keratomileusis (LASIK), and to describe the causes of this complication. METHODS Retrospective review of case records of four patients (4 eyes) who had a partial corneal flap during LASIK. RESULTS The mean age of the four patients was 23 +/- 4.7 years, and mean preoperative spherical equivalent (SE) refraction was -9.1 +/- 3.1 D (range, -5.5 to -13 D). A 160 microns corneal flap was attempted during the initial treatment. Retreatment with a 180 microns corneal flap was performed at a mean of 5.1 +/- 1.6 weeks (range, 4 to 7.5 weeks) after the initial procedure. There were no intraoperative complications during retreatment. Post-LASIK mean SE refraction was -1.0 +/- 1.1 D (range, +0.38 to -2.0 D), after a mean follow up of 19 +/- 15.7 weeks (range, 7 to 42 weeks). Best spectacle-corrected visual acuity decreased in one eye from 6/5 to 6/6 and was maintained in the others. CONCLUSION LASIK retreatment can be performed as early as one month after a partial flap, if the refraction is stable and a thicker corneal flap is created.
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Rao SK, Madhavan HN, Sitalakshmi G, Padmanabhan P. Nocardia Asteroides keratitis: report of seven patients and literature review. Indian J Ophthalmol 2000; 48:217-21. [PMID: 11217254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
PURPOSE To describe clinical features and treatment outcomes in patients with advanced Nocardia asteroides keratitis. METHODS Retrospective review of case records of 7 patients with culture-proven Nocardia keratitis. RESULTS Corneal infection occurred after corneal trauma in two patients, cataract surgery in three patients, penetrating keratoplasty in one patient and was associated with a silicone buckle element infection in one patient. Mean duration of infection at presentation was 33.4 days (7-75 days), and five patients had received prior treatment with corticosteroids. Six of seven patients had deep corneal suppuration at the time of presentation, clinically suggestive of mycotic keratitis. In two patients who had received prolonged corticosteroid therapy (> or = 45 days), the eyes could not be salvaged. Complete resolution of infection was achieved in all 4 eyes treated with topical fortified cefazolin eye drops (50 mg/ml).
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Young AL, Cheng LL, Rao SK, Lam DS. Corneal laceration with total but isolated aniridia caused by a pecking injury. J Cataract Refract Surg 2000; 26:1419-21. [PMID: 11020631 DOI: 10.1016/s0886-3350(00)00365-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 38-year-old man sustained a left eye injury after being attacked by a mynah bird. Ocular examination revealed a beak-shaped, full-thickness corneal laceration with total aniridia in the left eye. No other ocular injury was observed, and the lens and posterior segment remained normal over the subsequent 3 months. A penetrating keratoplasty was planned for visual restoration.
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Fogla RF, Rao SK. Pupillometry using videokeratography in eyes with dark brown irides. J Cataract Refract Surg 2000; 26:1266-7. [PMID: 11183847 DOI: 10.1016/s0886-3350(00)00653-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lam DS, Lyon D, Poon AS, Rao SK, Fan DS. Polyhexamethylene biguanide (0.02%) alone is not adequate for treating chronic Acanthameoba keratitis. Eye (Lond) 2000; 14 ( Pt 4):678-9. [PMID: 11040931 DOI: 10.1038/eye.2000.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
The past decade has witnessed several major advances in the field of ocular surface reconstruction. It is now established that the limbal and corneal epithelia belong to the same clonogenic lineage and that conjunctival transdifferentiation does not occur. These facts have engendered the increasing use of limbal transplantation in several ocular conditions involving limbal compromise. Many reports on this procedure have been published in the past year. They add to the growing body of evidence that limbal transplantation is efficacious in replenishing the stem cell pool, promoting improved vision and enhancing ocular comfort. Recent clinical studies on limbal autograft transplantation also underscore the importance of preoperative impression cytology in donor eyes, highlight the fact that transplantation in inflamed eyes is to be avoided, and indicate that the procedure is likely to provide better outcomes if performed several months after ocular surface burns. The appreciation of the utility of amniotic membrane transplantation in ocular surface reconstruction has provided a surgical tool to use in tandem with limbal transplantation. Questions such as why limbal autografts fail, the long-term results of LAT, and whether limbal inclusion is mandatory during conjunctival transplantation after pterygium excision have not been answered fully. Studies on long-term outcomes with limbal allograft transplantation and those reporting on experience with newer techniques such as epithelial transplantation using tissue culture-cultivated epithelium are likely to provide better perspectives on the best way to reconstruct the ocular surface in stem cell-deficient eyes.
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Abstract
With the increase in corneal laser refractive surgery, there is a greater need for precise evaluation of the corneal surface. Articles published in the past year have reported possible use of confocal scanning laser technology-based devices to image the cornea. Other studies have compared existing instruments and software in an effort to determine if data from different instruments are comparable. Topographic evaluation also has served to highlight long-term complications of procedures like radial keratotomy and the promise of newer surgical procedures like the intrastromal corneal ring segments. Studies of the corneal surface have helped refine surgical procedures like photorefractive keratectomy, laser in situ keratomileusis, penetrating keratoplasty, and cataract surgery. Topographic measures that serve as direct correlates of ocular visual performance, however, still remain elusive. Studies in the past year have confirmed that corneal topographic evaluation may be a powerful tool in the search for a genetic basis of keratoconus. Important areas for future research include precise determination of the power of the postrefractive surgery cornea to allow precise estimation of intraocular lens power in these eyes. Detecting the presence of past corneal refractive surgery in donor eyes also is likely to be a challenge. Despite the numerous advances in the field of corneal topography in the past year, there is still a need to present the data in a standardized format that is universal to all instruments and technologies.
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Baragi VM, Shaw BJ, Renkiewicz RR, Kuipers PJ, Welgus HG, Mathrubutham M, Cohen JR, Rao SK. A versatile assay for gelatinases using succinylated gelatin. Matrix Biol 2000; 19:267-73. [PMID: 10936451 DOI: 10.1016/s0945-053x(00)00086-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A spectrophotometric assay using succinylated gelatin as substrate is described for measuring the catalytic activity of gelatinases. The assay is based on measurement of primary amines exposed as a result of hydrolysis of the substrate by gelatinases. Comparison of hydrolysis by matrix metalloproteinase (MMP) 1, 2, 3, 7, 9 indicated that succinylated gelatin was primarily digested by MMP-2 and -9. The assay is rapid (<60 min), specific, suitable for measuring gelatinolytic activity of enzymes and high volume screening of MMP-2 and -9 inhibitors. Sensitivity of the assay is comparable to that of gelatin zymography, under similar experimental conditions. Thus, the assay combines ease and rapidity of assays based on synthetic peptide substrates with specificity of the gelatin zymography technique.
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Rao SK, Mukesh BN, Saraniya AS, Sitalakshmi G, Padmanabhan P. Fellow eye treatment in excimer photo refractive keratectomy. Indian J Ophthalmol 2000; 48:113-8. [PMID: 11116506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
PURPOSE To describe symmetry of response in fellow eyes of patients undergoing photorefractive keratectomy (PRK) for myopia, analyse the risk factors leading to asymmetry in response and to determine if delayed treatment of the second eye increases safety and predictability of PRK. METHODS Retrospective review of case records of 133 patients who underwent bilateral myopic PRK and had a minimum follow up of 6 months in both eyes. RESULTS Postoperative uncorrected visual acuity, spherical equivalent (SE) refraction within +/- 1 D of emmetropia, best-corrected visual acuity (BCVA) and corneal haze were not significantly different in fellow eyes of patients undergoing PRK for myopia. Of 87 eyes in group 1 (myopia < 6 D), 96.6% had uncorrected visual acuity > or = 6/12, 89.7% were within +/- 1 D of emmetropia, none lost > or = 1 line BCVA, and none had haze > or = grade 3. Similar results for 98 eyes in group II (myopia 6 to 9.9 D) were 75.6%, 55.1%, 2.0% and 2.0% respectively. For 81 eyes in group III (myopia > or = 10 D) the results were 42.7%, 33.3%, 8.6%, and 4.9% respectively. Among 84 patients with similar preoperative myopia in both eyes, 54 (64.3%) patients had a postoperative SE difference < or = 1 D in fellow eyes. Risk factors for asymmetric response among fellow eyes included increasing preoperative myopia (p < 0.001) and dissimilar treatment technique in the two eyes (p = 0.03). Corneal haze did not increase significantly after the third postoperative month. CONCLUSION This study demonstrates that considerable symmetry of response exists in fellow eyes of patients undergoing myopic PRK. Early PRK in the fellow eye of patients with < 6 D myopia is safe and allows quick visual rehabilitation of the patient. In patients with myopia > or = 6 D, a 3-month interval before treating the second eye may improve the safety of the procedure.
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Lam DS, Chua JK, Leung AT, Fan DS, Ng JS, Rao SK. Sutureless pars plana anterior vitrectomy through self-sealing sclerotomies in children. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2000; 118:850-1. [PMID: 10865328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Therese LK, Priya K, Rao SK, Biswas J, Madhavan HN. Herpes simplex virus DNA in the lens one year after an episode of retinitis. Indian J Ophthalmol 2000; 48:140-1. [PMID: 11116512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The present report describes a case where HSV was detected by polymerase chain reaction (PCR) in the lens cortical material removed during cataract surgery one year after resolution of retinal inflammation in a patient with ARN.
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Rao SK, Kumar SK, Biswas J, Fogla R, Gopal L, Padmanabhan P. Self-induced corneal crystals: a case report. Cornea 2000; 19:410-1. [PMID: 10832712 DOI: 10.1097/00003226-200005000-00033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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