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Arumugam P, Carey BC, Wikenheiser-Brokamp KA, Krischer J, Wessendarp M, Shima K, Chalk C, Stock J, Ma Y, Black D, Imbrogno M, Collins M, Kalenda Yombo DJ, Sakthivel H, Suzuki T, Lutzko C, Cancelas JA, Adams M, Hoskins E, Lowe-Daniels D, Reeves L, Kaiser A, Trapnell BC. A toxicology study of Csf2ra complementation and pulmonary macrophage transplantation therapy of hereditary PAP in mice. Mol Ther Methods Clin Dev 2024; 32:101213. [PMID: 38596536 PMCID: PMC11001781 DOI: 10.1016/j.omtm.2024.101213] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/13/2024] [Indexed: 04/11/2024]
Abstract
Pulmonary macrophage transplantation (PMT) is a gene and cell transplantation approach in development as therapy for hereditary pulmonary alveolar proteinosis (hPAP), a surfactant accumulation disorder caused by mutations in CSF2RA/B (and murine homologs). We conducted a toxicology study of PMT of Csf2ra gene-corrected macrophages (mGM-Rα+Mϕs) or saline-control intervention in Csf2raKO or wild-type (WT) mice including single ascending dose and repeat ascending dose studies evaluating safety, tolerability, pharmacokinetics, and pharmacodynamics. Lentiviral-mediated Csf2ra cDNA transfer restored GM-CSF signaling in mGM-Rα+Mϕs. Following PMT, mGM-Rα+Mϕs engrafted, remained within the lungs, and did not undergo uncontrolled proliferation or result in bronchospasm, pulmonary function abnormalities, pulmonary or systemic inflammation, anti-transgene product antibodies, or pulmonary fibrosis. Aggressive male fighting caused a similarly low rate of serious adverse events in saline- and PMT-treated mice. Transient, minor pulmonary neutrophilia and exacerbation of pre-existing hPAP-related lymphocytosis were observed 14 days after PMT of the safety margin dose but not the target dose (5,000,000 or 500,000 mGM-Rα+Mϕs, respectively) and only in Csf2raKO mice but not in WT mice. PMT reduced lung disease severity in Csf2raKO mice. Results indicate PMT of mGM-Rα+Mϕs was safe, well tolerated, and therapeutically efficacious in Csf2raKO mice, and established a no adverse effect level and 10-fold safety margin.
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Affiliation(s)
- Paritha Arumugam
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Brenna C. Carey
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Kathryn A. Wikenheiser-Brokamp
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
- Division of Pathology & Laboratory Medicine, CCHMC, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey Krischer
- Departments of Pediatrics and Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Matthew Wessendarp
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
| | - Kenjiro Shima
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
| | - Claudia Chalk
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
| | - Jennifer Stock
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
| | - Yan Ma
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
| | - Diane Black
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
| | - Michelle Imbrogno
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, UCMC, Cincinnati, OH, USA
| | - Margaret Collins
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, UCMC, Cincinnati, OH, USA
| | - Dan Justin Kalenda Yombo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, UCMC, Cincinnati, OH, USA
| | - Haripriya Sakthivel
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Takuji Suzuki
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
| | - Carolyn Lutzko
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Cell Manipulations Laboratory, CCHMC, Cincinnati, OH, USA
| | | | - Michelle Adams
- Office for Clinical and Translational Research, CCHMC, Cincinnati, OH, USA
| | - Elizabeth Hoskins
- Office for Clinical and Translational Research, CCHMC, Cincinnati, OH, USA
| | | | - Lilith Reeves
- Translational Core Laboratory, CCHMC, Cincinnati, OH, USA
| | - Anne Kaiser
- Office of Research Compliance & Regulatory Affairs, CCHMC, Cincinnati, OH, USA
| | - Bruce C. Trapnell
- Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Division of Pulmonary Biology, Perinatal Institute, CCHMC, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, UCMC, Cincinnati, OH, USA
- Division of Pulmonary Medicine, CCHMC, Cincinnati, OH, USA
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Karthikeyan R, Sakthivel H, Rajkumar N, Srinivasan K. Interdigitating Dendritic Cell Sarcoma of the Small Intestine Presenting as Spontaneous Hemoperitoneum - A Rare Case Report. Niger J Surg 2021; 27:71-74. [PMID: 34012247 PMCID: PMC8112361 DOI: 10.4103/njs.njs_55_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/24/2020] [Accepted: 03/26/2020] [Indexed: 11/21/2022] Open
Abstract
Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare neoplasm arising from the antigen-presenting cells of the immune system. It usually involves the lymph nodes, and extranodal sites are rarely affected. Here, we report a first known case of spontaneous hemoperitoneum caused by the rupture of IDCS of the small bowel. A 61-year-old male presented with complaints of abdominal pain and fever for 3 days and breathlessness for 1 day. Ultrasound abdomen revealed a 15 cm × 7 cm heterogeneous collection with thick septations in the periumbilical region. Diagnostic peritoneal lavage revealed hemoperitoneum and gangrenous bowel. Emergency laprotomy was done and it revealed a friable mass arising from the ileum. Resection of 2 ft of the ileum and double-barrel ileostomy was done. Immunohistochemical analysis revealed a positivity of S100 and leukocyte common antigen). A diagnosis of IDCS was made. The patient had an uneventful postoperative recovery and planned for postoperative chemotherapy.
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Affiliation(s)
- Raveena Karthikeyan
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - H Sakthivel
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - N Rajkumar
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - K Srinivasan
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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3
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Seu KG, Trump LR, Emberesh S, Lorsbach RB, Johnson C, Meznarich J, Underhill HR, Chou ST, Sakthivel H, Nassar NN, Seu KJ, Blanc L, Zhang W, Lutzko CM, Kalfa TA. VPS4A Mutations in Humans Cause Syndromic Congenital Dyserythropoietic Anemia due to Cytokinesis and Trafficking Defects. Am J Hum Genet 2020; 107:1149-1156. [PMID: 33186543 DOI: 10.1016/j.ajhg.2020.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
The Congenital Dyserythropoietic Anemia (CDA) Registry was established with the goal to facilitate investigations of natural history, biology, and molecular pathogenetic mechanisms of CDA. Three unrelated individuals enrolled in the registry had a syndrome characterized by CDA and severe neurodevelopmental delay. They were found to have missense mutations in VPS4A, a gene coding for an ATPase that regulates the ESCRT-III machinery in a variety of cellular processes including cell division, endosomal vesicle trafficking, and viral budding. Bone marrow studies showed binucleated erythroblasts and erythroblasts with cytoplasmic bridges indicating abnormal cytokinesis and abscission. Circulating red blood cells were found to retain transferrin receptor (CD71) in their membrane, demonstrating that VPS4A is critical for normal reticulocyte maturation. Using proband-derived induced pluripotent stem cells (iPSCs), we have successfully modeled the hematologic aspects of this syndrome in vitro, recapitulating their dyserythropoietic phenotype. Our findings demonstrate that VPS4A mutations cause cytokinesis and trafficking defects leading to a human disease with detrimental effects to erythropoiesis and neurodevelopment.
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Affiliation(s)
- Katie G Seu
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Lisa R Trump
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Sana Emberesh
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Robert B Lorsbach
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Clarissa Johnson
- Pediatric Hematology-Oncology Cook Children's Medical Center, Fort Worth, TX 76104, USA
| | - Jessica Meznarich
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT 84132, USA; Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT 84113, USA
| | - Hunter R Underhill
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA; Department of Radiology, University of Utah, Salt Lake City, UT 84108, USA
| | - Stella T Chou
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Haripriya Sakthivel
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nicolas N Nassar
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Kalani J Seu
- Department of Chemistry, Earlham College, Richmond, IN 47374, USA
| | - Lionel Blanc
- Laboratory of Developmental Erythropoiesis, Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; Les Nelkin Memorial Pediatric Oncology Laboratory, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; Department of Molecular Medicine and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Wenying Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Laboratory of Genetics and Genomics, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Carolyn M Lutzko
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Theodosia A Kalfa
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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Chonat S, Risinger M, Sakthivel H, Niss O, Rothman JA, Hsieh L, Chou ST, Kwiatkowski JL, Khandros E, Gorman MF, Wells DT, Maghathe T, Dagaonkar N, Seu KG, Zhang K, Zhang W, Kalfa TA. Corrigendum: The Spectrum of SPTA1-Associated Hereditary Spherocytosis. Front Physiol 2019; 10:1331. [PMID: 31736770 PMCID: PMC6843059 DOI: 10.3389/fphys.2019.01331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/04/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Mary Risinger
- College of Nursing, University of Cincinnati, Cincinnati, OH, United States
| | - Haripriya Sakthivel
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Omar Niss
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | | | - Loan Hsieh
- Division of Hematology, CHOC Children's Hospital and UC Irvine Medical Center, Orange, CA, United States
| | - Stella T Chou
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Janet L Kwiatkowski
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Eugene Khandros
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Matthew F Gorman
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, United States
| | - Donald T Wells
- Dell Children's Medical Center, Austin, TX, United States
| | - Tamara Maghathe
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Neha Dagaonkar
- Genomics Analysis Facility, Institute for Genomic Medicine, Columbia University, New York, NY, United States
| | - Katie G Seu
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kejian Zhang
- Coyote Bioscience Co., Ltd., San Jose, CA, United States
| | - Wenying Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Laboratory of Genetics and Genomics, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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5
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Chonat S, Risinger M, Sakthivel H, Niss O, Rothman JA, Hsieh L, Chou ST, Kwiatkowski JL, Khandros E, Gorman MF, Wells DT, Maghathe T, Dagaonkar N, Seu KG, Zhang K, Zhang W, Kalfa TA. The Spectrum of SPTA1-Associated Hereditary Spherocytosis. Front Physiol 2019; 10:815. [PMID: 31333484 PMCID: PMC6617536 DOI: 10.3389/fphys.2019.00815] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 02/01/2019] [Accepted: 06/11/2019] [Indexed: 12/05/2022] Open
Abstract
Hereditary spherocytosis (HS) is the most common red blood cell (RBC) membrane disorder causing hereditary hemolytic anemia. Patients with HS have defects in the genes coding for ankyrin (ANK1), band 3 (SLC4A1), protein 4.2 (EPB42), and α (SPTA1) or β-spectrin (SPTB). Severe recessive HS is most commonly due to biallelic SPTA1 mutations. α-spectrin is produced in excess in normal erythroid cells, therefore SPTA1-associated HS ensues with mutations causing significant decrease of normal protein expression from both alleles. In this study, we systematically compared genetic, rheological, and protein expression data to the varying clinical presentation in eleven patients with SPTA1-associated HS. The phenotype of HS in this group of patients ranged from moderately severe to severe transfusion-dependent anemia and up to hydrops fetalis which is typically fatal if transfusions are not initiated before term delivery. The pathogenicity of the mutations could be corroborated by reduced SPTA1 mRNA expression in the patients’ reticulocytes. The disease severity correlated to the level of α-spectrin protein in their RBC cytoskeleton but was also affected by other factors. Patients carrying the low expression αLEPRA allele in trans to a null SPTA1 mutation were not all transfusion dependent and their anemia improved or resolved with partial or total splenectomy, respectively. In contrast, patients with near-complete or complete α-spectrin deficiency have a history of having been salvaged from fatal hydrops fetalis, either because they were born prematurely and started transfusions early or because they had intrauterine transfusions. They have suboptimal reticulocytosis or reticulocytopenia and remain transfusion dependent even after splenectomy; these patients require either lifetime transfusions and iron chelation or stem cell transplant. Comprehensive genetic and phenotypic evaluation is critical to provide accurate diagnosis in patients with SPTA1-associated HS and guide toward appropriate management.
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Affiliation(s)
- Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Mary Risinger
- College of Nursing, University of Cincinnati, Cincinnati, OH, United States
| | - Haripriya Sakthivel
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Omar Niss
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | | | - Loan Hsieh
- Division of Hematology, CHOC Children's Hospital and UC Irvine Medical Center, Orange, CA, United States
| | - Stella T Chou
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Janet L Kwiatkowski
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Eugene Khandros
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Matthew F Gorman
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, United States
| | - Donald T Wells
- Dell Children's Medical Center, Austin, TX, United States
| | - Tamara Maghathe
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Neha Dagaonkar
- Genomics Analysis Facility, Institute for Genomic Medicine, Columbia University, New York, NY, United States
| | - Katie G Seu
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kejian Zhang
- Coyote Bioscience Co., Ltd., San Jose, CA, United States
| | - Wenying Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Laboratory of Genetics and Genomics, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Sakthivel H, Sahoo AK, Chinnakkulam Kandhasamy S, Amaranathan A, Goneppanavar M, Nelamangala Ramakrishnaiah VP. Comparison of Endoscopic Variceal Ligation with Endoscopic Sclerotherapy for Secondary Prophylaxis of Variceal Hemorrhage: A Randomized Trial. Cureus 2018; 10:e2977. [PMID: 30237938 PMCID: PMC6141059 DOI: 10.7759/cureus.2977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Though endoscopic variceal ligation (EVL) is commonly being used and has overcome the disadvantages of sclerotherapy (ST), still sclerotherapy is used as a therapeutic procedure for bleeding esophageal varices in the present institute. Hence, the study was done to see the advantages of EVL over ST. Methods Patients with portal hypertension and bleeding esophageal varices underwent banding if found to have grade 3 or 4 varices. They were randomized to EVL group, where they were reviewed after two weeks for any residual varices for which repeat banding was done and endoscopic sclerotherapy (EST) group, where ST was done until the varices were obliterated or reduced to grade 1. The efficacy, complications, recurrent bleeding rate and recurrence of varices were compared. Results A total of 60 patients were included, 30 in each group. In EVL group, four sessions were needed to eradicate the varices in 73% of patients while it was five sessions in EST group (46% patients) (p-value = 0.0001). The mean number of sessions needed in EVL and EST group was 3.73 and 5.36, respectively. The average time taken for eradication of varices was 78.6 and 134.6 days in EVL and EST group, respectively (p-value = 0.004). Complications were higher in EST group (p-value < 0.05). Conclusion EVL alone was effective than ST in terms of the number of sessions needed for eradication of varices and total duration required to completely obliterate them. The complications were less in EVL group with no significant difference in recurrent bleeding rate and recurrence of varices between the groups.
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Affiliation(s)
- H Sakthivel
- Senior Resident, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Ashok Kumar Sahoo
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | | | - Anandhi Amaranathan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Mangala Goneppanavar
- Pathology, Mahatma Gandhi Medical College and Research Institute, Puducherry, IND
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Abstract
Intussusception is a common cause of intestinal obstruction in the pediatric population. Usually, it is primary and benign and can be managed by nonoperative interventions in 80% of the cases. Adult intussusception accounts for only 5% of all cases of intussusception and 1%–5% of all cases of intestinal obstruction. Unlike in the pediatric population, intussusception in adults is usually caused by a pathologic lead point. The initial investigation to diagnose it is an ultrasound abdomen followed by contrast-enhanced computed tomography (CECT) of the abdomen. The placement of an intestinal tube for feeding purposes has been rarely reported as a cause of intussusception. Here, we present a case series of four patients who had jejunojejunal intussusception following the placement of feeding tubes into the jejunum. Three patients were operatively managed and one was managed conservatively.
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Affiliation(s)
- H Sakthivel
- MBBS, Ms Senior Resident, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ashok Kumar Sahoo
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anandhi Amaranathan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nagarajan Raj Kumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nanda K Maroju
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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