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Grover H, Grover SB, Leah Forman F, Khanna G, Margolies L. Multiple bilateral breast masses due to lymphoma metastases: A report of 2 cases highlighting the mammographic and sonographic features. Radiol Case Rep 2024; 19:357-369. [PMID: 38033677 PMCID: PMC10682527 DOI: 10.1016/j.radcr.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 12/02/2023] Open
Abstract
Metastases within breast usually occur due to a primary malignancy in the contralateral breast. Breast metastases from extra mammary malignancies are known to be very rare and the primary tumors are reported to be melanoma, lung cancer, gastro-intestinal primary tumors, neuroendocrine tumors, sarcomas, ovarian tumors and lymphomas. Breast lymphomas comprise 0.04%-0.7% of all cases of breast malignancies and may manifest either as a primary or a secondary variety. A primary breast lymphoma is known to be more infrequent than a secondary breast lymphoma. In patients with breast metastases the usual clinical presentation is with multiple palpable masses and imaging evaluation is the mainstay for initial diagnosis. We report the imaging features seen in 2 almost identical cases of secondary breast lymphoma. At mammography, multiple, round to elliptical, sharply circumscribed, high-density masses were seen, in which spiculation, calcification and architectural distortion were conspicuously absent. On sonography, these round /oval masses were homogenously hypoechoic, sharply circumscribed, showed a thin echogenic rim with posterior acoustic enhancement and were moderately to profusely vascular on color Doppler examination. These imaging features should suggest the possible diagnosis of metastases from a hematogenous malignancy and an ultrasound guided biopsy should be performed. Once the etiology of lymphoma is confirmed, a rigorous multi- modality imaging work up to identify the primary site, stage the disease and document other sites of dissemination is warranted.
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Affiliation(s)
- Hemal Grover
- Department of Radiology, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Shabnam Bhandari Grover
- Department of Radiology, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi 110029, India
| | - Frimmit Leah Forman
- Department of Radiology, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Geetika Khanna
- Department of Pathology, VMMC and Safdarjung Hospital, New Delhi 110029, India
| | - Laurie Margolies
- Department of Radiology, Icahn School of Medicine Mount Sinai, New York, NY, USA
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Grover SB, Grover H, Antil N, Patra S, Sen MK, Nair D. Imaging Approach to Pulmonary Infections in the Immunocompromised Patient. Indian J Radiol Imaging 2022; 32:81-112. [PMID: 35722641 PMCID: PMC9205686 DOI: 10.1055/s-0042-1743418] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management of such patients is of pressing concern not only to the radiologist, but also for the general physicians, pulmonologists, critical care specialists, oncologists and transplant surgery teams, we believe our review is very informative to a wide spectrum reader audience.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi (Former and source of this work)
- Department of Radiology and Imaging, Sharda School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India (Current)
| | - Hemal Grover
- Department of Radiology and Imaging, Icahn School of Medicine at Mount Sinai West, New York, New York, United States
| | - Neha Antil
- Department of Radiology and Imaging, Stanford University, California, United States
| | - Sayantan Patra
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Manas Kamal Sen
- Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Deepthi Nair
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Grover SB, Malhotra S, Pandey S, Grover H, Kale R, Devra AG. Imaging diagnosis of a giant choledochal cyst in an infant. Radiol Case Rep 2021; 17:404-411. [PMID: 34925674 PMCID: PMC8649116 DOI: 10.1016/j.radcr.2021.10.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023] Open
Abstract
The usual etiologies of giant abdominal cystic masses in infants are mesenteric cyst, enteric duplication cyst, ovarian cyst in females, cystic lymphangioma, however, the presentation of a choledochal cyst in a gigantic form, is unusual. The primary modality for diagnosis of this entity is ultrasound, followed by MRI. The characteristic ultrasound features of a choledochal cyst are a well-defined cystic lesion which may be found to replace any segment of the biliary tree and is distinctly separate from the gallbladder. The associated anomalies are biliary atresia, gallbladder atresia, hepatic fibrosis and those of the pancreatico-biliary ductal system. MRI with MRCP has a conclusive role in confirming the ultrasound diagnosis. Choledochal cysts are currently classified as proposed by Todani et al, into five types. Herein, we report the case study of a 4-month-old male infant afflicted with a gigantic, Type1 Choledochal cyst, complicated by perforation, which was diagnosed by us at the first instance itself, using ultrasound examination and confirmed by MRI. The diagnosis was further confirmed at surgery and histopathology. The recommended treatment of cyst resection accompanied by a hepatico-jejunostomy bypass procedure, was successfully performed in the reported infant.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India,Corresponding author. Shabnam B. Grover.
| | - Sonali Malhotra
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India
| | - Saurabh Pandey
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India
| | - Hemal Grover
- Department of Radiology & Imaging, Ichan School of Medicine at Mount Sinai West, New York, USA
| | - Ravi Kale
- Department of Pediatric Surgery, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India
| | - Anshu Gupta Devra
- Department of Pathology, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India
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Castro M, Ganti A, Grover H, Kumar A, Mohapatra S, Basu K, Sahu D, Tyagi A, Nair P, Prasad S, Kumari P, Mundkur N, Patel S, Sauban M, Behura L, Kulkarni S, Patil M, Narvekar Y, Ghosh A, Ullal Y, Amara A, Kapoor S, Velcheti V. P12.06 Computational Omics Biology Model (CBM) Identifies PD-L1 Immunotherapy Response Criteria Based on Genomic Signature of NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grover SB, Patra S, Grover H, Mittal P, Khanna G. Prospective revalidation of IOTA "two-step", "alternative two-step" and "three-step" strategies for characterization of adnexal masses - An Indian study focussing the radiology context. Indian J Radiol Imaging 2020; 30:304-318. [PMID: 33273764 PMCID: PMC7694716 DOI: 10.4103/ijri.ijri_279_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: The purpose of this study was to revalidate the diagnostic performance of IOTA “two step” (Simple Descriptors and Simple Rules), “ alternative two step” (Simple Rules Risk Calculation tool / SRrisk score), and three step (two step with subjective assessment) strategies, for characterization of adnexal masses as benign or malignant, using histopathology as gold standard. Materials and Methods: This prospective, study comprised of 100 patients with newly diagnosed adnexal masses, who underwent ultrasound evaluation first by a level I and then by a level III investigator (EFSUMB criteria). Initially, the level I investigator evaluated each adnexal mass, applying IOTA “two-step” strategy and simultaneously assigned a risk category, by applying the simple rules risk score (SRrisk score) or performing the “alternative two step” strategy. Subsequently the inconclusive masses were evaluated by the level III investigator using “real time subjective assessment”, thereby performing the third step. Following histopathology diagnosis, the performance of each strategy was evaluated using diagnostic tests. Results: The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of “two-step” strategy were 87.5%, 79.2%, 89.4%, 76%, and 84.7%, respectively; those of “alternative two-step” strategy were 91.5%, 75.6%, 84.4%, 86.1% and 88%; and those of “three-step” strategy were 98.2%, 93.3%, 94.7%, 97.7% and 96%, respectively. Conclusion: All IOTA strategies showed good diagnostic performance for characterization of adnexal masses and the “three-step” strategy performed best. We believe this is the first ever prospective re-validation and comparative evaluation of all three IOTA strategies by Indian Radiologists. Since ultrasound is the primary modality for evaluation of adnexal masses, based on the good results of our study, a recommendation for henceforth standard application, of the three-step IOTA strategy in routine Radiology practice appears justified. Although, IOTA strategies been proposed and validated mainly by Gynaecologists and Oncology surgeons, based on the results of our study, this paradigm can now be made to shift back to the arena of Radiology and Radiologists, the imaging experts.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sayantan Patra
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Hemal Grover
- Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA
| | - Pratima Mittal
- Department of Gynecology and Obstetrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Geetika Khanna
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Grover SB, Patra S, Grover H, Kumar A. Contrast-enhanced voiding urosonography (CEVUS) as a novel technique for evaluation in a case of male urethral diverticulum. Indian J Radiol Imaging 2020; 30:409-414. [PMID: 33273782 PMCID: PMC7694731 DOI: 10.4103/ijri.ijri_50_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/09/2020] [Accepted: 06/14/2020] [Indexed: 02/05/2023] Open
Abstract
Male urethral diverticulum is an uncommon entity, the abnormality being more frequently encountered in females. The pathology may be congenital or acquired and the more frequent acquired type usually occurs following trauma. Afflicted patients usually lack specific symptoms, although in a few instances, symptoms of lower urinary tract obstruction, calculi, or infection may prevail. Imaging investigations utilizing a composite Retrograde urethrography (RGU)– Voiding cystourethrography (VCUG) protocol are accepted as standard approach and ultrasound is considered a secondary supplementary investigation. However, recent literature reports the utility of contrast-enhanced ultrasound (CEUS) as a novel technique in the evaluation of urinary bladder and urethra, for vesico-ureteric reflux (VUR) in children and for urethral diverticula in women. We report a case of acquired post-traumatic urethral diverticulum in an adult male patient and document a relatively unexplored novel application of contrast enhanced voiding uro-sonography (CEVUS) for the evaluation of this malady.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New York, USA
| | - Sayantan Patra
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New York, USA
| | - Hemal Grover
- Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA
| | - Anup Kumar
- Department of Urology and Renal Transplant, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Gandhi D, Ahuja K, Grover H, Sharma P, Solanki S, Gupta N, Patel L. Review of X-ray and computed tomography scan findings with a promising role of point of care ultrasound in COVID-19 pandemic. World J Radiol 2020; 12:195-203. [PMID: 33033574 PMCID: PMC7523085 DOI: 10.4329/wjr.v12.i9.195] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/22/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
As healthcare professionals continue to combat the coronavirus disease 2019 (COVID-19) infection worldwide, there is an increasing interest in the role of imaging and the relevance of various modalities. Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management, it is critical to examine the role of different modalities currently in use, such as baseline X-rays and computed tomography scans carefully. In this article, we will draw attention to the critical findings for the radiologist. Further, we will look at point of care ultrasound, an increasingly a popular tool in diagnostic medicine, as a component of COVID-19 management.
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Affiliation(s)
- Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL 60611, United States
| | - Kriti Ahuja
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Hemal Grover
- Department of Diagnostic Radiology, Icahn School of Medicine at Mount Sinai West, New York, NY 10029, United States
| | - Pranav Sharma
- Department of Diagnostic Radiology, Vascular and Interventional Radiology, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
| | - Shantanu Solanki
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Nishant Gupta
- Department of Radiology, Bassett Healthcare, Cooperstown, NY 13326, United States
| | - Love Patel
- Division of Hospital Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
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Weinberg L, Grover H, Cowie D, Langley E, Heland M, Story DA. Attitudes of anesthetists towards an anesthesia-led nurse practitioner model for low-risk colonoscopy procedures: a cross-sectional survey. Hum Resour Health 2020; 18:20. [PMID: 32183813 PMCID: PMC7076960 DOI: 10.1186/s12960-020-0458-1] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The mounting pressure on the Australian healthcare system is driving a continual exploration of areas to improve patient care and access and to maximize utilization of our workforce. We hypothesized that there would be support by anesthetists employed at our hospital for the design, development, and potential implementation of an anesthesia-led nurse practitioner (NP) model for low-risk colonoscopy patients. METHODS We conducted a cross-sectional, mixed methods study to ascertain the attitudes and acceptability of anesthetists towards a proposed anesthesia-led NP model for low-risk colonoscopy patients. An online survey using commercial software and theoretical questions pertaining to participants' attitudes towards an anesthesia-led NP model was e-mailed to consultant anesthetists. Participants were also invited to participate in a voluntary 20-min face-to-face interview. RESULTS A total of 60 survey responses were received from a pool of 100 anesthetists (response rate = 60%, accounting for 8.04% margin of error). Despite the theoretical benefits of improved patient access to colonoscopy services, most anesthetists were not willing to participate in the supervision and training of NPs. The predominant themes underlying their lack of support for the program were a perception that patient safety would be compromised compared to the current model of anesthesia-led care, the model does not meet the Australian and New Zealand College of Anesthetists guidelines for procedural sedation and analgesia, and the program may be a public liability prone to litigation in the event of an adverse outcome. Concerns about consumer acceptance and cost-effectiveness were also raised. Finally, participants thought the model should be pilot tested to better understand consumer attitudes, logistical feasibility, patient and proceduralist attitudes, clinical governance, and, importantly, patient safety. CONCLUSIONS Most anesthetists working in a single-center university hospital did not support an anesthesia-led NP model for low-risk colonoscopy patients. Patient safety, violations of the current Australian and New Zealand College of Anesthetists guidelines on procedural sedation, and logistical feasibility were significant barriers to the acceptance of the model. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, 12619001036101.
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Affiliation(s)
- L. Weinberg
- Department of Anesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084 Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria Australia
| | - H. Grover
- Department of Anesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084 Australia
| | - D. Cowie
- Department of Anesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084 Australia
| | - E. Langley
- Department of Anesthesia Perioperative and Pain Medicine Unit, The University of Melbourne, Melbourne, Victoria Australia
| | - M. Heland
- Department of Anesthesia Perioperative and Pain Medicine Unit, The University of Melbourne, Melbourne, Victoria Australia
| | - D. A. Story
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria Australia
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Grover SB, Bhayana A, Grover H, Kapoor S, Chellani H. Imaging diagnosis of Crouzon syndrome in two cases confirmed on genetic studies - with a brief review. Indian J Radiol Imaging 2020; 29:442-447. [PMID: 31949350 PMCID: PMC6958874 DOI: 10.4103/ijri.ijri_353_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/04/2019] [Revised: 09/21/2019] [Accepted: 09/26/2019] [Indexed: 02/05/2023] Open
Abstract
Crouzon syndrome is the most common form of craniofacial dysostosis, characterised by a classical triad of abnormal skull shape, abnormal facies, and exophthalmos. The clinically overt dental abnormalities in these patients, distracts clinicians from the developmental neurological defects and therefore this entity remains relatively under - highlighted in radiology literature. We report and highlight the role of imaging in diagnosis of Crouzon syndrome in two patients, and discuss the relevant differential diagnosis. Moreover, our report is among the few Indian studies in which Crouzon syndrome was confirmed by genetic studies. The classical clinical triad of Crouzon syndrome was observed in both patients. The skull radiographs and cranial CT with 3D reconstruction VRT (Volume rendered technique), revealed characteristic radiological features. Genetic studies reconfirmed the clinical and radiological diagnosis of Crouzon syndrome, in both patients.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Aanchal Bhayana
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Hemal Grover
- Department of Radiology and Imaging, Mount Sinai West, New York, USA
| | - Seema Kapoor
- Department of Genetics, Maulana Azad Medical College, New Delhi, India
| | - Harish Chellani
- Department of Paediatric Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Aujayeb A, Taylor L, Grover H, Mitchell D, Hopkins D, Jackson K. A review of a medical thoracoscopy service. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30223-3] [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: 11/17/2022]
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Aujayeb A, Hopkins D, Taylor L, Grover H, Mitchell D. A review of an indwelling pleural catheter service. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30219-1] [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: 10/25/2022]
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Grover SB, Antil N, Katyan A, Rajani H, Grover H, Mittal P, Prasad S. Niche role of MRI in the evaluation of female infertility. Indian J Radiol Imaging 2020; 30:32-45. [PMID: 32476748 PMCID: PMC7240899 DOI: 10.4103/ijri.ijri_377_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: 09/13/2019] [Revised: 01/16/2020] [Accepted: 02/11/2020] [Indexed: 02/05/2023] Open
Abstract
Infertility is a major social and clinical problem affecting 13-15% of couples worldwide. The pelvic causes of female infertility are categorized as ovarian disorders, tubal, peritubal disorders, and uterine disorders. Appropriate selection of an imaging modality is essential to accurately diagnose the aetiology of infertlity, since the imaging diagnosis directs the appropriate treatment to be instituted. Imaging evaluation begins with hystero- salpingography (HSG), to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at HSG but usually require further characterization with pelvic ultrasound (US), sono-hysterography (syn: hystero-sonography/saline infusion sonography) or pelvic magnetic resonance imaging (MRI), when US remains inconclusive. The major limitation of hysterographic US, is its inability to visualize extraluminal pathologies, which are better evaluated by pelvic US and MRI. Although pelvic US is a valuable modality in diagnosing entities comprising the garden variety, however, extensive pelvic inflammatory disease, complex tubo-ovarian pathologies, deep-seated endometriosis deposits with its related complications, Mulllerian duct anomalies, uterine synechiae and adenomyosis, often remain unresolved by both transabdominal and transvaginal US. Thus, MRI comes to the rescue and has a niche role in resolving complex adnexal masses, endometriosis, and Mullerian duct anomalies with greater ease. This is a review, based on the authors' experience at tertiary care teaching hospitals and aims to provide an imaging approach towards the abnormalities which are not definitively diagnosed by ultrasound alone.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neha Antil
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amit Katyan
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Heena Rajani
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Hemal Grover
- Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA
| | - Pratima Mittal
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sudha Prasad
- Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
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Grover SB, Antil N, Rajani H, Grover H, Kumar R, Mandal AK, Bagga D, Katyan A. Approach to pediatric renal tumors: an imaging review. Abdom Radiol (NY) 2019; 44:619-641. [PMID: 30311048 DOI: 10.1007/s00261-018-1773-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Renal tumors comprise 7% of all childhood cancers. A wide variety of renal tumors can affect the pediatric kidneys, which can be broadly classified as primary benign tumors, primary malignant tumors, and metastatic lesions. This article aims to enumerate usual benign and malignant renal tumors that can occur in childhood and emphasizes the characteristic imaging appearances which aid in their differential diagnosis. Additionally, the leading role of the Radiologist in primary diagnosis of renal infiltration by hematological malignancies and contiguous invasion by neuroblastoma is also introduced and unraveled. Imaging protocol comprises initial Ultrasound evaluation with subsequent computed tomography (CT) and/or Magnetic resonance imaging (MRI), all of which are invaluable in confirming the diagnosis, documenting the organ of origin, describing extent of local and distant spread. The complimentary role of nuclear medicine studies in delineating differential renal function, post-operative complications, and metastasis is also highlighted.
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Grover H, Qian Y, Boada FE, Lakshmanan K, Flanagan S, Lui YW. MRI Evidence of Altered Callosal Sodium in Mild Traumatic Brain Injury. AJNR Am J Neuroradiol 2018; 39:2200-2204. [PMID: 30498019 DOI: 10.3174/ajnr.a5903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 09/27/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Mild traumatic brain injury is a leading cause of death and disability worldwide with 42 million cases reported annually, increasing the need to understand the underlying pathophysiology because this could help guide the development of targeted therapy. White matter, particularly the corpus callosum, is susceptible to injury. Animal models suggest stretch-induced mechanoporation of the axonal membrane resulting in ionic shifts and altered sodium ion distribution. The purpose of this study was to compare the distribution of total sodium concentration in the corpus callosum between patients with mild traumatic brain injury and controls using sodium (23Na) MR imaging. MATERIALS AND METHODS Eleven patients with a history of mild traumatic brain injury and 10 age- and sex-matched controls underwent sodium (23Na) MR imaging using a 3T scanner. Total sodium concentration was measured in the genu, body, and splenium of the corpus callosum with 5-mm ROIs; total sodium concentration of the genu-to-splenium ratio was calculated and compared between patients and controls. RESULTS Higher total sodium concentration in the genu (49.28 versus 43.29 mmol/L, P = .01) and lower total sodium concentration in the splenium (which was not statistically significant; 38.35 versus 44.06 mmol/L, P = .08) was seen in patients with mild traumatic brain injury compared with controls. The ratio of genu total sodium concentration to splenium total sodium concentration was also higher in patients with mild traumatic brain injury (1.3 versus 1.01, P = .001). CONCLUSIONS Complex differences are seen in callosal total sodium concentration in symptomatic patients with mild traumatic brain injury, supporting the notion of ionic dysfunction in the pathogenesis of mild traumatic brain injury. The total sodium concentration appears to be altered beyond the immediate postinjury phase, and further work is needed to understand the relationship to persistent symptoms and outcome.
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Affiliation(s)
- H Grover
- From the New York University Langone Medical Center, New York, New York
| | - Y Qian
- From the New York University Langone Medical Center, New York, New York
| | - F E Boada
- From the New York University Langone Medical Center, New York, New York
| | - K Lakshmanan
- From the New York University Langone Medical Center, New York, New York
| | - S Flanagan
- From the New York University Langone Medical Center, New York, New York
| | - Y W Lui
- From the New York University Langone Medical Center, New York, New York.
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Abstract
Background Primary tumors in the presacral (retrorectal) space are extremely rare in adults, with an estimated incidence of 0.0025 to 0.014 in large referral centers. Congenital varieties are most common and comprise two thirds of these tumors. Primary retroperitoneal sarcomas in the pelvic region are extremely rare. We report the ultrasound and the corresponding Computed Tomography (CT) features of a rare presacral fibrosarcoma in an adult woman, in whom the diagnosis was confirmed by a CT-guided biopsy. Case Report A 54-year-old woman presented with a history of lumbar and perineal pain and painful defecation. Rectal examination revealed a hard mass in the retrorectal space. The patient was referred for imaging and a laboratory evaluation with a clinical diagnosis of a presacral mass. An abdominal ultrasound was followed by laboratory evaluation of routine hematological and hepato-renal parameters, abdomino-pelvic CT and a CT-guided biopsy. The imaging studies showed a presacral solid mass with nodular calcifications. There was conspicuous absence of cystic or adipose contents and of sacral erosion/destruction. However, hepatic metastasis was present. All imaging features suggested a retroperitoneal sarcoma in the pelvic region with metastases to the liver. The diagnosis was confirmed by CT-guided biopsy. Conclusions We are reporting a new case of a very rare entity, a presacral fibrosarcoma. The imaging approach and the analysis leading to an appropriate differential diagnosis and final diagnosis is highlighted in our case report.
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Affiliation(s)
- Hemal Grover
- At the time of study: Postgraduate Resident, Department of Radiology & Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India; Currently, Department of Neuro-Radiology, New York Medical University, New York, NY, U.S.A
| | - Amrit Pal Ahluwalia
- Department of Radiology and Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Sanjay Sethi
- Department of Radiology and Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
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Grover H, Sethi S, Garg J, Ahluwalia AP. Pseudo Prune Belly Syndrome: Diagnosis Revealed by Imaging - A Case Report and Brief Review. Pol J Radiol 2017; 82:252-257. [PMID: 28580040 PMCID: PMC5436412 DOI: 10.12659/pjr.899743] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/13/2016] [Indexed: 11/14/2022] Open
Abstract
Background Prune Belly Syndrome (PBS) is a rare entity, usually found in male neonates. It comprises complex urinary tract anomalies, bilateral undescended testis and absence of anterior abdominal wall muscles. Patients with unilateral abdominal wall deficiency, unilateral undescended testis and female neonates with abdominal wall laxity are classified as Pseudo Prune Belly syndrome (PPBS). Reports on PPBS do not highlight the radiological and imaging characteristics of this syndrome and the current literature on the role of newer imaging modalities, such as Magnetic Resonance Imaging (MRI), remains relatively sparse. We describe a new case of PPBS and emphasize the role of imaging, especially ultrasound and MRI in the process of diagnosis and briefly review the subject. Case Report A male infant of four months of age was referred for evaluation of left-sided cryptorchidism. Clinical examination revealed laxity of the left abdominal wall. Ultrasound examination of the abdomen, pelvis and scrotum was performed together with routine laboratory tests. Ultrasound examination was followed by intravenous urography, voiding cysto-urethrography and MRI of the abdomen. On ultrasound, the left testis was located in the inguinal canal, the right kidney was slightly enlarged and the left kidney could not be localized. Ultrasound appearances suggested chronic obstruction in the urinary bladder. Intravenous urography, voiding cysto-urethrography and MRI confirmed the ultrasound diagnosis and also revealed a left dysplastic kidney with a dilated, tortuous ureter. Clinical and imaging features were consistent with pseudo prune belly syndrome (PPBS). Conclusions We report a new occurrence of PPBS, a rare entity. The imaging approach for a comprehensive evaluation of the renal system in PPBS, especially with MRI, is emphasized.
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Affiliation(s)
- Hemal Grover
- At the time of study: Postgraduate Resident, Department of Radiology and Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India; Currently, Department of Neuro-Radiology, New York Medical University, New York, NY, U.S.A
| | - Sanjay Sethi
- Department of Radiology and Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Jatin Garg
- Dexa Scan Centre, Patiala, Punjab, India
| | - Amrit Pal Ahluwalia
- Department of Radiology and Imaging, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
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17
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Grover SB, Arora S, Kumar A, Grover H, Katyan A, Nair DM. "Caught by the Eye of Sound" - Epigastric Swelling due to Xiphisternal Tuberculosis. Pol J Radiol 2017; 82:41-45. [PMID: 28217237 PMCID: PMC5292989 DOI: 10.12659/pjr.899329] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Common causes of an epigastric mass include hepatomegaly, pancreatic pseudocyst and epigastric hernia, less common causes being carcinoma of the stomach or pancreas, whereas diseases of the sternum presenting as an epigastric swelling is extremely uncommon. We report a case of tubercular infection of the sternum located in the xiphoid process resulting in its presentation as an epigastric swelling. CASE REPORT A 30-year-old immunocompetent woman with complaints of an epigastric swelling and undocumented pyrexia for four months was referred for sonographic evaluation with a clinical suspicion of an incompletely treated liver abscess. The patient was examined with ultrasound, sternal radiographs, CT and MRI. Ultrasound revealed a heterogeneous epigastric collection with linear echogenic components suggestive of bone fragments. These appearances suggested chronic infective osteomyelitis of the xiphoid process of the sternum. Lateral chest radiograph demonstrated lytic destruction of the xiphisternum. Tubercular etiology was considered and further evaluation with Multidetector Computed tomography (MDCT) and Magnetic Resonance Imaging (MRI) demonstrated erosive osteomyelitis of the xiphoid process with enhancing inflammation and collection in the adjoining soft tissue. Ultrasound-guided aspiration, PCR and Amplified Mycobacterium tuberculosis DNA test confirmed tubercular infection. CONCLUSIONS We report a new case of osteo-articular tuberculosis localized to the xiphisternum, a rare clinical entity with an extremely unusual clinical presentation as an epigastric mass. The role of ultrasound in primary diagnosis and as an interventional diagnostic modality for guided aspiration is highlighted.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sumit Arora
- At the time of study: Department of Orthopaedic Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India; Presently, Department of Orthopaedic Surgery, Maulana Azad Medical College, New Delhi, India
| | - Amit Kumar
- At the time of study: Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India; Presently: MR Centre, Green Park, New Delhi, India
| | - Hemal Grover
- At time of study: Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Deputed from Institute of Nuclear Medicine and Allied Sciences, Delhi, India; Currently, Department of Neuro Radiology, New York Medical University, New York, NY, U.S.A
| | - Amit Katyan
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Deepthi Mohan Nair
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Gupta N, Grover H, Bansal I, Hooda K, Sapire JM, Anand R, Kumar Y. Neonatal cranial sonography: ultrasound findings in neonatal meningitis-a pictorial review. Quant Imaging Med Surg 2017; 7:123-131. [PMID: 28275563 DOI: 10.21037/qims.2017.02.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neonatal bacterial meningitis is a common manifestation of late onset neonatal sepsis. Cranial sonography (CRS) has a crucial role in assessment of infants with clinical suspicion of bacterial meningitis as well as follows up of its complications. CRS is performed with high frequency transducer through anterior fontanelle in both coronal and sagittal planes. Various sonographic findings range from echogenic and widened sulci, ventriculomegaly, ventriculitis, hydrocephalus, extra-axial fluid collections, cerebritis and brain abscess. Sonography is extremely beneficial in evaluating intraventricular contents, especially debris and intraventricular septations. Linear high frequency probe along with color Doppler interrogation are of utmost importance in evaluating extra-axial fluid collection and helps differentiating it from benign subarachnoid space enlargement. Due to low cost, easy portability, speed of imaging, no need for sedation and above all lack of ionizing radiation make it superior to other cross sectional imaging, like CT and MRI, in evaluation of these sick neonates. Apart from textbooks, there is paucity of recently available literature on cranial sonographic findings in neonatal meningitis. This article is written with an educational intent to review the spectrum of findings in neonatal meningitis, with stress on findings that will be beneficial in the clinical practice.
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Affiliation(s)
- Nishant Gupta
- Department of Radiology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Hemal Grover
- Department of Neuroradiology, NYU Lagone Medical Center, New York, NY, USA
| | - Itisha Bansal
- Department of Anesthesiology, New York Methodist Hospital, Brooklyn, New York, USA
| | - Kusum Hooda
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| | - Joshua M Sapire
- Department of Neuroradiology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Rama Anand
- Department of Pediatric Radiology, Kalawati Saran Children Hospital, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Yogesh Kumar
- Department of Neuroradiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
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19
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Grover SB, Kumar N, Grover H, Taneja DK, Katyan A. Sonographic Diagnosis in a Rare Aetiology of Neonatal Scrotal Swellings: A Case Report of Congenital Nephrotic Syndrome. Pol J Radiol 2016; 81:465-468. [PMID: 27757175 PMCID: PMC5045919 DOI: 10.12659/pjr.898088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/13/2016] [Indexed: 02/05/2023] Open
Abstract
Background Common etiologies of scrotal swelling in neonates include hydrocoele, inguinal hernia and testicular torsion; less common is epididymo-orchitis. Congenital nephrotic syndrome (CNS), a rare entity, is known to present as progressive renal failure and its leading presentation with scrotal involvement has not been reported. Material/Methods We report a rare case of CNS with primary clinical presentation as scrotal cellulitis and epididymo-orchitis. In this neonate, scrotal and abdominal ultrasound examination was performed and the laboratory data were obtained. Results Sonography revealed bilaterally enlarged echogenic kidneys, testis and epididymis with echogenic peritoneal fluid tracking into both scrotal sacs. Laboratory data revealed proteinuria and severe depletion of serum IgG. Culture of the peritoneal fluid showed gram-negative organisms. A final diagnosis of CNS, complicated with peritonitis tracking into the scrotal sacs was arrived at. Conclusions CNS may have a rare presentation with distracting symptoms of scrotal cellulitis and epididymo-orchitis, as seen in our patient. However, diligent use of abdomino-scrotal sonography, supported by relevant laboratory data can clinch the accurate diagnosis.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nishith Kumar
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Hemal Grover
- At time of study: Radiology Resident Deputed to Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, from Institute of Nuclear Medicine and Allied Sciences, Delhi, India, currently, Research Associate Department of Neuro Radiology, New York Medical University, New York, NY, U.S.A
| | - Dinesh Kumar Taneja
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amit Katyan
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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20
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D'souza MM, Trivedi R, Singh K, Grover H, Choudhury A, Kaur P, Kumar P, Tripathi RP. Traumatic brain injury and the post-concussion syndrome: A diffusion tensor tractography study. Indian J Radiol Imaging 2016; 25:404-14. [PMID: 26751097 PMCID: PMC4693390 DOI: 10.4103/0971-3026.169445] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of the present study is to evaluate diffusion tensor tractography (DTT) as a tool for detecting diffuse axonal injury in patients of acute, mild, and moderate traumatic brain injury (TBI), using two diffusion variables: Fractional anisotropy (FA) and mean diffusivity (MD). The correlation of these indices with the severity of post-concussive symptoms was also assessed. Materials and Methods: Nineteen patients with acute, mild, or moderate TBI and twelve age- and sex-matched healthy controls were recruited. Following Magnetic Resonance Imaging (MRI) on a 3.0-T scanner, DTT was performed using the ‘fiber assignment by continuous tracking’ (FACT) algorithm for fiber reconstruction. Appropriate statistical tools were used to see the difference in FA and MD values between the control and patient groups. In the latter group, the severity of post-concussive symptoms was assessed six months following trauma, using the Rivermead Postconcussion Symptoms Questionnaire (RPSQ). Results: The patients displayed significant reduction in FA compared to the controls (P < 0.05) in several tracts, notably the corpus callosum, fornix, bilateral uncinate fasciculus, and bilateral superior thalamic radiations. Changes in MD were statistically significant in the left uncinate, inferior longitudinal fasciculus, and left posterior thalamic radiation. A strong correlation between these indices and the RPSQ scores was observed in several white matter tracts. Conclusion: Diffusion tensor imaging (DTI)-based quantitative analysis in acute, mild, and moderate TBI can identify axonal injury neuropathology, over and above that visualized on conventional MRI scans. Furthermore, the significant correlation observed between FA and MD indices and the severity of post-concussive symptoms could make it a useful predictor of the long-term outcome.
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Affiliation(s)
- Maria M D'souza
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Richa Trivedi
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Kavita Singh
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Hemal Grover
- Department of Radiodiagnosis, Government Medical College, Patiala, Punjab, India
| | - Ajay Choudhury
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Ram Manohar Lohia Hospital, New Delhi, India
| | - Prabhjot Kaur
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Pawan Kumar
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Rajendra Prashad Tripathi
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
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Andrade W, Grover H, Lipa J, Bang C, Gilbert R, Neligan P. Reconstructive Options and Outcomes in Primary vs. Secondary Mandibular Reconstruction. J Reconstr Microsurg 2007. [DOI: 10.1055/s-2006-958656] [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: 10/19/2022]
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Kumar KS, Nair S, Hertan HI, Grover H. Isolated intrahepatic biliary dilatation in a patient with acquired immune deficiency syndrome (AIDS): AIDS cholangiopathy versus incidental unilobar Caroli's disease. J Clin Gastroenterol 2001; 32:79-81. [PMID: 11154178 DOI: 10.1097/00004836-200101000-00018] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
We describe a case of possible monolobar Caroli's disease in a patient with acquired immune deficiency syndrome (AIDS) who presented with features of cholangitis. Diagnostic workup, which included endoscopic retrograde cholangiography, revealed focal intrahepatic biliary dilatation confined to the right lobe. The patient subsequently underwent right hepatic lobectomy. Pathology revealed multiple cysts filled with calculi and inflammation in the cyst walls. Special stain results for fungi and acid-fast organisms were negative. The presence of advanced AIDS in this patient raised the possibility of this being a possible manifestation of AIDS cholangiopathy.
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Affiliation(s)
- K S Kumar
- Department of Medicine, Our Lady of Mercy Medical Center, Bronx, New York 10466, USA.
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Marra M, Kucaba T, Sekhon M, Hillier L, Martienssen R, Chinwalla A, Crockett J, Fedele J, Grover H, Gund C, McCombie WR, McDonald K, McPherson J, Mudd N, Parnell L, Schein J, Seim R, Shelby P, Waterston R, Wilson R. zA map for sequence analysis of the Arabidopsis thaliana genome. Nat Genet 1999; 22:265-70. [PMID: 10391214 DOI: 10.1038/10327] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Arabidopsis thaliana has emerged as a model system for studies of plant genetics and development, and its genome has been targeted for sequencing by an international consortium (the Arabidopsis Genome Initiative; http://genome-www. stanford.edu/Arabidopsis/agi.html). To support the genome-sequencing effort, we fingerprinted more than 20,000 BACs (ref. 2) from two high-quality publicly available libraries, generating an estimated 17-fold redundant coverage of the genome, and used the fingerprints to nucleate assembly of the data by computer. Subsequent manual revision of the assemblies resulted in the incorporation of 19,661 fingerprinted BACs into 169 ordered sets of overlapping clones ('contigs'), each containing at least 3 clones. These contigs are ideal for parallel selection of BACs for large-scale sequencing and have supported the generation of more than 5.8 Mb of finished genome sequence submitted to GenBank; analysis of the sequence has confirmed the integrity of contigs constructed using this fingerprint data. Placement of contigs onto chromosomes can now be performed, and is being pursued by groups involved in both sequencing and positional cloning studies. To our knowledge, these data provide the first example of whole-genome random BAC fingerprint analysis of a eucaryote, and have provided a model essential to efforts aimed at generating similar databases of fingerprint contigs to support sequencing of other complex genomes, including that of human.
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Affiliation(s)
- M Marra
- Washington University Genome Sequencing Center, St Louis, Missouri 63108, USA.
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Abstract
OBJECTIVE It is unclear why some alcohol abusers develop alcoholic cirrhosis whereas others contract chronic pancreatitis. The aim of this study was to examine the importance of race as a risk factor for the development of chronic pancreatitis. METHODS We compared the racial status of 1883 patients discharged with a first-listed diagnosis of two diseases strongly related to alcohol abuse: 433 patients with chronic pancreatitis (ICD 5771) and 1450 patients with alcoholic cirrhosis (ICD 5712). Information came from discharge statistics maintained by two acute care hospitals in New York City and one acute care hospital in Lisbon, Portugal. The study period included the years 1989-1996 in the US and 1989-1994 in Portugal. RESULTS A total of 215 (50%) of the 433 chronic pancreatitis patients were black compared with 333 (23%) of the 1450 patients with alcoholic cirrhosis. When adjusted for sex and hospital site, patients with pancreatitis were significantly more likely to be black than patients with cirrhosis (odds ratio 2.5, 95% confidence interval 1.9-3.2, p < 0.001). CONCLUSIONS In comparison with white patients, black patients are two to three times more likely to be hospitalized for chronic pancreatitis than alcoholic cirrhosis. This highly significant (p < 0.001) difference was observed in both men and women: in three different hospitals, and in two different countries. The explanation is unknown, but could be related to racial differences in diet, type or quantity of alcohol consumption, smoking, or ability to detoxify substances harmful to the liver or pancreas.
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Affiliation(s)
- A B Lowenfels
- Department of Surgery, New York Medical College, Valhalla 10595, USA
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25
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Abstract
A case of giant true diverticulum of the sigmoid colon, manifesting as pain and abdominal mass is presented. The patient is asymptomatic after resection of the diverticulum and end-to-end anastomosis of the colon.
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Affiliation(s)
- H Grover
- Division of Gastroenterology, Our Lady of Mercy University Medical Center, Bronx, New York, USA
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Nair S, Grover H, Pitchumoni CS. Retrograde esophageal contraction? A late sequela to sclerotherapy. Am J Gastroenterol 1998; 93:1600-1. [PMID: 9732967 DOI: 10.1111/j.1572-0241.1998.01600.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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ramaswamy R, Grover H, Corpuz M, Daniels P, Pitchumoni CS. Prognostic criteria in Clostridium difficile colitis. Am J Gastroenterol 1996; 91:460-4. [PMID: 8633491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the prognostic factors in Clostridium difficile (CD) colitis. METHODS We conducted a retrospective study of proven cases of CD colitis in l8 months. Seventy six patients (from a 605-bed community hospital in the Bronx, NY) with proven CD colitis were studied. Mortality in patients with CD colitis was also examined. RESULTS Seventy six patients with proven CD colitis were admitted between January 1993 and June 1994. Eighteen patients died during the same admission. Upon admission, serum albumin was less than 25 g/L in 12 (20.6%) of the survivors and in eight (44%) of the deceased patients (p <0.05). A fall in serum albumin levels was noted with the onset of symptoms of CD colitis in those who survived as well as in those who died, with a greater fall of 11.2 g/L (range 10-20 g/L) in patients who died compared with a fall of 6 g/L (range 5-10 g/L)in those who survived (p <0.05). Use of more than three antibiotics was noted in 13 (72%) of those who died and in 18 (31%) of those who survived (p <0.05). Persistence of CD cytotoxin 7 or more days after initiation of treatment was present in 14 (77%) of those who died and in eight (13%) of the survivors (p <0.01). Duration of hospitalization correlated with the development of CD colitis (35.89 vs 11.7 days) with no significant difference between survivors and deceased patients with CD colitis. Factors such as age, sex, residence, past medical history score, mean score of presenting complaints of CD colitis, history of prior episodes CD colitis, and mean number of recurrent episodes showed no difference in mortality. CONCLUSION Factors predictive of an increased mortality in patients with CD colitis include a serum albumin of less than 25 g/L on admission, a fall in serum albumin level of greater than 11 g/L at the onset of symptoms of CD colitis, use of three or more antibiotics, and persistence of positive CD cytotoxin in the stool after completion of 7 or more days of treatment.
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Affiliation(s)
- R Ramaswamy
- Department of Medicine, Our Lady of Mercy Medical Center, bronx, New York USA
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Grover H. Propoxyphene. J Indian Med Assoc 1988; 86:21-3. [PMID: 3288700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Grover H, Phillips MA, Lillicrap DP, Giles AR, Garvey MB, Teitel J, Rivard G, Blanchette V, White BN, Holden JJ. Carrier detection of haemophilia A using DNA markers in families with an isolated affected male. Clin Genet 1987; 32:10-9. [PMID: 2887317 DOI: 10.1111/j.1399-0004.1987.tb03316.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The carrier status of women in five families with an isolated haemophilia male was assessed by pedigree analysis, coagulation factor assays and DNA markers. In three families, ten women could be given very low risks of being carriers based on DNA analysis. In two of the families the DNA markers identified the mutation as originating in either the maternal or maternal grandfather's germ cell. Combined DNA and coagulation data suggested that the affected male in a third family was a de novo mutation. DNA analysis of the affected male in another family identified a large deletion of the F8 gene which was present in his mother and three sisters, suggesting that the grandmother was a carrier. A combination of coagulation factor data and DNA marker assessment can determine the carrier status of the majority of females in families with isolated affected haemophilia A males.
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