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Georgy JT, Singh A, John AO, Joel A, Andrews AG, Thumaty DB, Rebekah G, Sigamani E, Chandramohan J, Manipadam MT, Cherian AJ, Abraham DT, Paul MJ, Balakrishnan R, Backianathan S, Chacko RT. Pathological response and clinical outcomes in operable triple-negative breast cancer with cisplatin added to standard neoadjuvant chemotherapy. Klin Onkol 2021; 34:49-55. [PMID: 33657819 DOI: 10.48095/ccko202149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Response to neoadjuvant chemotherapy is associated with improved outcomes for patients with triple negative breast cancer (TNBC). Patients with residual disease are at increased risk of relapse and death from breast cancer. In this retrospective study, we aimed to evaluate the efficacy and safety of cisplatin added to standard neoadjuvant chemotherapy for locally advanced TNBC. MATERIALS AND METHODS All TNBC treated with neoadjuvant cisplatin 60mg/m2 once in 3 weeks with weekly paclitaxel for 12 weeks, following 8 weeks of dose-dense epirubicin 90mg/m2 or doxorubicin 60mg/m2 with cyclophosphamide 600mg/m2 were analyzed retrospectively. The data related to pathological complete response, adherence to planned therapy, disease-free survival and overall survival were collected. RESULTS Eighty-three patients were included, of whom 80% had stage III disease. Pathological complete response in both breast (T0/Tis) and axilla (N0) was observed in 48.1% of patients. Miller Payne grade 5 pathological response in the breast was seen in 61% of patients. Good partial responses (Miller Payne grades 3,4) were observed in 32.5% of patients. The remaining 6.5% were poor responders. Seventy-seven patients underwent surgery. The disease-free survival at 1 and 3 years for those who had a pathological complete response was 96.7% and 77.6%, respectively, and 92.3% and 62.7% for those who did not, respectively. The predominant adverse events were hematological, with anemia being the most common one. CONCLUSION The addition of cisplatin to neoadjuvant chemotherapy with anthracycline and taxane in TNBC was tolerable and produced a high rate of pathological complete response. Cisplatin added to standard chemotherapy in patients with locally advanced TNBC could improve clinical outcomes.
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Gorey A, Jacob PM, Abraham DT, John R, Manipadam MT, Ansari MS, Chen GCK, Vasudevan S. Differentiation of malignant from benign thyroid nodules using photoacoustic spectral response: a preclinical study. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab101c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hemalatha R, Pai R, Manipadam MT, Rebekah G, Cherian AJ, Abraham DT, Rajaratnam S, Thomas N, Ramakant P, Jacob PM. Presurgical Screening of Fine Needle Aspirates from Thyroid Nodules for BRAF Mutations: A Prospective Single Center Experience. Indian J Endocrinol Metab 2018; 22:785-792. [PMID: 30766819 PMCID: PMC6330867 DOI: 10.4103/ijem.ijem_126_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Analysis of BRAF V600E mutation in thyroid fine needle aspirates (FNA) is an important adjunct to cytology, particularly among FNA placed in the "indeterminate category." However, such a prospective evaluation of FNA obtained from patients with thyroid nodules has been lacking from India. MATERIAL AND METHODS FNA from 277 patients were prospectively evaluated for BRAF mutations by Sanger's sequencing. A subset of 30 samples was also analyzed by pyrosequencing using the PyroMark BRAF mutation kit. RESULTS Overall, 27.2% of FNA samples were positive for mutations including 19 (35.8%) of the 53 histologically confirmed papillary thyroid carcinoma (PTC), 2 of the 25 follicular variants of PTC, and 1 anaplastic thyroid carcinoma. Only 1 (2.7%) of the 37 samples in the atypia of undetermined significance/follicular lesion of unknown significance category was BRAF positive. The sensitivity of cytology improved marginally from 67.1% to 68.3% when evaluated with BRAF. Further, a comparison of the clinicopathological characteristics of BRAF positive and negative PTCs showed a significant association (P = 0.05) between lymph node metastasis and BRAF positivity. CONCLUSION BRAF positivity was lower than that reported from East Asia with the test being useful in confirming malignancies among the suspicious of malignancy and malignant categories.
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Affiliation(s)
- Ramamoorthy Hemalatha
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Marie T. Manipadam
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Anish J. Cherian
- Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Deepak T. Abraham
- Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Simon Rajaratnam
- Department of Endocrinology and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Pooja Ramakant
- Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Paul M. Jacob
- Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
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Ramakant P, Paul MJ, Paul TV, Rao SD, Abraham DT, Uttley L, Balasubramanian SP, Tharyan P. Surgery versus surveillance for asymptomatic (mild) primary hyperparathyroidism in adults 50 years or older. Hippokratia 2017. [DOI: 10.1002/14651858.cd010093.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Pooja Ramakant
- CMC Vellore; Endocrine Surgery; Ida Scudder Road Vellore Tamil Nadu India 632004
| | - M J Paul
- CMC Vellore; Endocrine Surgery; Ida Scudder Road Vellore Tamil Nadu India 632004
| | - Thomas V Paul
- CMC Vellore; Department of Endocrinology; Ida Scudder Road Vellore Tamil Nadu India 632004
| | - Sudhaker D Rao
- Henry Ford Hospital; Division of Endocrinology and Bone and Mineral Metabolism; 3031 W. Grand Blvd Suite 800 Detroit Michigan USA 48202-2689
| | - Deepak T Abraham
- CMC Vellore; Endocrine Surgery; Ida Scudder Road Vellore Tamil Nadu India 632004
| | - Lesley Uttley
- University of Sheffield; School of Health and Related Research; Sheffield UK
| | - Sabapathy P Balasubramanian
- Sheffield Teaching Hospitals; Endocrine Surgery, Department of General Surgery; Glossop Road Sheffield South Yorkshire UK S10 2JF
| | - Prathap Tharyan
- Christian Medical College; Cochrane South Asia, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
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Joseph AJ, Kapoor N, Simon EG, Chacko A, Thomas EM, Eapen A, Abraham DT, Jacob PM, Paul T, Rajaratnam S, Thomas N. Endoscopic ultrasonography--a sensitive tool in the preoperative localization of insulinoma. Endocr Pract 2014; 19:602-8. [PMID: 23425640 DOI: 10.4158/ep12122.or] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A number of imaging modalities have been used in the preoperative localization of insulinomas. Computed tomography (CT) is the most commonly employed modality. Endoscopic ultrasound (EUS) allows the transducer to be placed in close proximity to the pancreas, thereby yielding higher quality images, which facilitates accurate localization, minimally invasive surgery, and a lower occurrence of residual tumors, all of which contribute to a better clinical outcome. METHODS We analyzed the hospital records of all adult patients (age >18 years) diagnosed with insulinoma between October 2004 and September 2010. The diagnosis was based on the clinical practice guidelines of the American Endocrine Society. We compared the sensitivities of EUS and multidetector computed tomography (MDCT) in lesion. RESULTS Eighteen patients were seen over a period of 6 years, and all underwent EUS. MDCT scans were carried out in 17 patients. EUS had greater sensitivity (89%) in localizing insulinomas compared to CT (69%). In this series, the lesions that were missed on CT but picked up on EUS were smaller (<12 mm, P<.001). Lesions that were near mesenteric vessels and those located in the head of the pancreas were more likely to be missed on CT. CONCLUSIONS EUS has a greater sensitivity in identifying and localizing insulinomas. As availability increases, EUS should be part of a preoperative insulinoma workup.
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Affiliation(s)
- A J Joseph
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Sabaretnam M, Ramakant P, Abraham DT, Paul MJ. Preoperative ultrasonography assessment of vocal cord movement during thyroid and parathyroid surgery. World J Surg 2014; 37:1740. [PMID: 23354924 DOI: 10.1007/s00268-013-1921-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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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Sabaretnam M, Ramakant P, Abraham DT, Paul MJ. Radioactive iodine ablation does not prevent recurrences in patients with papillary thyroid microcarcinoma. Clin Endocrinol (Oxf) 2013; 79:444-5. [PMID: 23253032 DOI: 10.1111/cen.12130] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mruthyunjaya MD, Abraham DT, Oommen R, Paul TV. Visual vignette. Ectopic parathyroid adenoma. Endocr Pract 2013; 19:383. [PMID: 23337156 DOI: 10.4158/ep12310.vv] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ramakant P, Chakravarthy S, Cherian JA, Abraham DT, Paul MJ. Challenges in management of phyllodes tumors of the breast: A retrospective analysis of 150 patients. Indian J Cancer 2013; 50:345-8. [DOI: 10.4103/0019-509x.123625] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ramakant P, Cherian AJ, Abraham DT, Paul MJ. Factors predicting local recurrence in phyllodes tumor of the breast. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e19562] [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: 11/20/2022] Open
Abstract
e19562 Background: Phyllodes tumor of the breast (PT) has local recurrences resulting in higher morbidity and disfiguring reoperations. Aim to find factors predicting local recurrences in PT. Methods: Retrospective data analyzed with SPSS v.17 (Pearson Chi square test, Logistic regression test for multivariate analysis) done on patients with PT managed during 2000-2010. Results: In total 141 patients with PT, mean age was 40.44 years (+0.98) and mean tumor size 11.07 cm (+0.57). Preoperatively cytology done in 96 % and was suggestive of PT in 59%; core biopsy done in 58 % and was suggestive of PT in 93% Imaging done in 65%. The mean duration of lump- 2.2 years (+0.23). Thirty two patients (23%) presented with recurrence post lumpectomy done elsewhere. Adjuvant radiotherapy was given in 28% patients. In multivariate analysis, high stromal cellularity ( p 0.002), surgery type (p= 0.000) and recurrent status (p=0.05) at first time presentation showed statistically significant p values for odd’s ratios. Conclusions: Tumor size, margins, surgery type, histological features of high stromal hypercellularity, necrosis with high mitotic rates predicted recurrence in PT. Core biopsy is more accurate than fine needle biopsy in diagnosis and recommended in suspected cases to permit the correct initial surgery. [Table: see text]
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Affiliation(s)
| | | | | | - MJ Paul
- Christian Medical College, Vellore, India
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Abraham DT, Low TH, Messina M, Jackson N, Gill A, Chou AS, Delbridge L, Learoyd D, Robinson BG, Sidhu S, Sywak M. Medullary thyroid carcinoma: long-term outcomes of surgical treatment. Ann Surg Oncol 2010; 18:219-25. [PMID: 20878247 DOI: 10.1245/s10434-010-1339-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Indexed: 01/30/2023]
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) accounts for 5 to 10% of all thyroid cancers but is responsible for a disproportionate number of deaths. METHODS We performed a retrospective review to describe clinical outcomes in patients with medullary thyroid carcinoma, screening a subset of patients for somatic mutations in the RET and p18 genes and performing genotype-phenotype correlation in a tertiary-care referral hospital from 1967 to 2009. RESULTS We studied a total of 94 patients identified from a prospectively maintained thyroid cancer database. Data gathered included patient demographics, serum calcitonin, clinical outcomes, histopathology, genetic analysis, and status at final follow-up. A subset cohort (n = 50) was screened for somatic mutations in the RET gene and the three exons of the p18 gene. The subset cohort was composed of hereditary medullary thyroid carcinoma (HMTC) (n = 19, index patients = 10, screen detected = 9) and sporadic medullary thyroid carcinoma (SMTC) (n = 31). There were no mutations in the p18 gene in the subset cohort. CONCLUSIONS A total of 67 SMTC and 27 (28.7%) HMTC cases identified. SMTC were older at initial presentation (52 vs. 34, P = 0.003), had higher preoperative serum calcitonin levels (7968 vs. 1346 ng/L, P = 0.008), and had lymph node recurrence (P = 0.001) compared to HMTC. The tumors were smaller in HMTC (P = 0.038). Overall 10-year survival in SMTC versus HMTC was 69 versus 93% (P = 0.12). On multivariate analysis, vascular invasion (hazard ratio 6.4, P = 0.019) was an adverse predictor for disease-free survival. HMTC in the era of RET analysis presents with a smaller primary tumor, lower preoperative serum calcitonin levels, and lower rates of lymph node metastasis. Mutations in the p18 gene were not a major factor in medullary thyroid carcinoma tumorigenesis.
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Affiliation(s)
- Deepak T Abraham
- Department of Surgery, University Clinic, Royal North Shore Hospital, University of Sydney Endocrine Surgical Unit, St Leonards, Sydney, NSW, Australia
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Mathew AJ, Wann VC, Abraham DT, Jacob PM, Selvan BS, Ramakrishna BS, Nair AN. The effect of butyrate on the healing of colonic anastomoses in rats. J INVEST SURG 2010; 23:101-4. [PMID: 20497012 DOI: 10.3109/08941930903469367] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Butyrate, a short-chain fatty acid (SCFA) formed by the fermentation of complex carbohydrates by the bacteria in the colon, is the main source of nutrition for colonocytes. The aim of this experiment was to investigate the effect of butyrate on the healing of colonic anastomosis in a rat model. MATERIALS AND METHODS Forty male Wistar rats were fed a fibre-free diet for 2 days. They then underwent laparotomy, transection, and anastomosis of both left and right colon, with a defunctioning caecostomy. The animals were then randomly assigned to receive butyrate or saline enemas from the third postoperative day and underwent another laparotomy on the seventh postoperative day when the bursting pressures of both anastomoses were measured. RESULTS Out of the 40 rats, 23 were available for the final data analysis. The mechanical strength of the anastomosis was measured by the bursting wall tension (BWT), which was calculated from the bursting pressure and the anastomotic circumference. The anastomoses in the butyrate arm showed a significantly higher BWT for both the right (48.9 s 64.71 dyne10(-3)/cm, p value .04) and the left (51.44 vs 72.38 dyne 10(-3)/cm, p value .01). CONCLUSION This experiment suggests that butyrate has a significant role in increasing the mechanical strength of colonic anastomoses in rats.
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Affiliation(s)
- A J Mathew
- Department of General Surgery Unit VI, CMC Hospital, Vellore, Tamil Nadu, India.
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Rajinikanth J, Paul MJ, Abraham DT, Ben Selvan CK, Nair A. Surgical audit of inadvertent parathyroidectomy during total thyroidectomy: incidence, risk factors, and outcome. Medscape J Med 2009; 11:29. [PMID: 19295950 PMCID: PMC2654678] [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: 05/27/2023]
Affiliation(s)
- J Rajinikanth
- Department of General Surgery and Endocrine Surgery, Christian Medical College and Hospital, Tamilnadu, India.
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Lee AD, Kota GK, Shyamkumar N, Abraham DT, Agarwal S. Endovascular management of an unusual cause of pancoast syndrome. Eur J Vasc Endovasc Surg 2005; 30:621-3. [PMID: 16098771 DOI: 10.1016/j.ejvs.2005.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2005] [Accepted: 06/10/2005] [Indexed: 11/17/2022]
Abstract
Vascular conditions presenting with Pancoast syndrome are rare. A case of vertebral artery pseudoaneurysm presenting with Pancoast syndrome is reported. The aneurysm was successfully treated by proximal coil embolization.
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Affiliation(s)
- A D Lee
- Department of Surgery, Christian Medical College and Hospital, Vellore, India.
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