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Mitta P, DiFatta J, Mahler C, Huang J, Oser R, Gunn AJ, Wilson H, Raja J. Management options for pediatric venous thromboembolic disease: Beyond anticoagulation with endovascular therapies. Thromb Res 2024; 239:109027. [PMID: 38735165 DOI: 10.1016/j.thromres.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
Venous thromboembolism (VTE) in pediatric patients is an uncommon but serious diagnosis that has an array of therapeutic options and challenges. An assessment of the existing literature on management of pediatric patients with VTE was conducted. The interventions reviewed include anticoagulation, thrombolysis, thrombectomy, inferior vena cava (IVC) filters, and venous stenting. For each intervention, a discussion of mechanism of action, indications, contraindications, and potential complications was performed. While anticoagulants are considered the first-line pediatric VTE treatment, many drugs remain investigational in this patient population and treatment recommendations are extrapolated from adult practice. Thrombolysis may be indicated in cases of acute thrombosis requiring more rapid clot resolution but presents a greater bleeding risk than anticoagulation. Similarly, thrombectomy also provides rapid clot resolution and offers a larger therapeutic window and usage in more mature thrombi than thrombolysis. In select patient groups, IVC filters may be indicated in the prevention of PE but present with inherent thrombogenicity and risk of migration. The data regarding pediatric VTE treatment options, monitoring, and long term outcomes is limited compared to the adult population. The relatively few clinical trials including pediatric patients have a relatively small sample size and are heterogenous with regards to predisposing factors that further exacerbate generalizability. Additional research is needed to help construct and evaluate a robust treatment algorithm for pediatric patients with VTE.
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Affiliation(s)
- Priyanka Mitta
- University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Jake DiFatta
- University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Chase Mahler
- University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Junjian Huang
- University of Alabama at Birmingham, Division of Vascular and Interventional Radiology/Department of Radiology, Birmingham, AL, USA
| | - Rachel Oser
- University of Alabama at Birmingham, Division of Vascular and Interventional Radiology/Department of Radiology, Birmingham, AL, USA
| | - Andrew John Gunn
- University of Alabama at Birmingham, Division of Vascular and Interventional Radiology/Department of Radiology, Birmingham, AL, USA
| | - Hope Wilson
- Children's of Alabama, Division of Hematology Oncology/Department of Pediatrics, Birmingham, AL, USA
| | - Junaid Raja
- University of Alabama at Birmingham, Division of Vascular and Interventional Radiology/Department of Radiology, Birmingham, AL, USA.
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Byun JH, Rennie A, Huang J, Raja J. Rotational thrombectomy versus balloon maceration in dialysis access salvage. J Vasc Access 2024:11297298241234990. [PMID: 38436294 DOI: 10.1177/11297298241234990] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Although end stage renal disease patients who undergo hemodialysis frequently experience dialysis-associated thrombotic complications, there remains a paucity of literature comparing the efficacy of different endovascular salvage techniques for grafts and fistulas. This study aims to compare primary patency in dialysis access following salvage mechanical thrombolysis/thrombectomy with a rotational thrombolysis device versus balloon maceration. METHODS Using a database of patient records at a tertiary medical center, all patients who underwent rotational thrombectomy with the Cleaner XT™ Rotational Thrombectomy System for endovascular salvage of arteriovenous fistula or arteriovenous graft from August 2016 to July 2022 were included in the population. Fourteen patients who underwent balloon maceration for endovascular salvage were matched to the patients in the rotational thrombectomy group based on date of procedure. The primary patency of the fistula or graft for the two groups was measured. RESULTS A total of 13 patients who underwent dialysis access salvage with rotational thrombectomy (10 grafts, 3 fistulas) were matched with 14 patients who underwent balloon maceration for dialysis access salvage (10 grafts, 4 fistulas). Six patients in both groups required additional graft access salvage (46% rotational thrombectomy; 43% balloon maceration). The median time to next dialysis salvage was 51 days for rotational thrombectomy and 43.5 days for balloon maceration (W + 9, critical value 1; compatible with statistically significant difference). CONCLUSION Endovascular access salvage by rotational thrombectomy may provide longer primary patency compared to salvage by balloon maceration. However, a longer follow-up prospective study of a larger study population is necessary to clarify the safety and efficacy of rotational thrombectomy using the Cleaner XT™ device.
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Affiliation(s)
- Jee Hyuk Byun
- Department of Interventional Radiology, University of Alabama Birmingham, Birmingham, AL, USA
- CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Republic of Korea
| | - Andrew Rennie
- School of Medicine, Florida State University, Tallahassee, FL, USA
| | - Junjian Huang
- Department of Interventional Radiology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Junaid Raja
- Department of Interventional Radiology, University of Alabama Birmingham, Birmingham, AL, USA
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Raja J, Pigg R, Li Y, Savage C, Caridi TM, Huang J, Gunn AJ. Percutaneous cryoablation of 100 anterior renal tumors: safety and technical success. Abdom Radiol (NY) 2024; 49:919-926. [PMID: 38150142 DOI: 10.1007/s00261-023-04134-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE To assess the safety, technical success, and clinical outcomes of percutaneous cryoablation (PCA) in patients with anterior renal tumors. METHODS A retrospective analysis of patients with anterior renal tumors, defined as tumors at or anterior to the level of the renal pelvis, treated with CT-guided PCA from 2008 to 2022. Summary statistics included demographics and baseline tumor attributes. Treatment and follow-up metrics included primary and secondary technical success, adverse events (AEs) according to the SIR classification, local recurrence, overall survival (OS), and cancer-specific survival (CSS)). 100 patients (60 males; mean age: 63, mean BMI: 33, mean Charlson comorbidity index:6) with 100 anterior renal tumors were included. RESULTS 78% of tumors were T1a and 22% T1b with mean maximal tumoral dimension of 29 mm (range: 6-62 mm) and mean distance to nearest critical structure 9 mm (range: 0-40 mm). Mean follow-up was 20.9 months (range: 3-103). 28% of PCAs required hydrodissection. Technical success was achieved in 92% of patients; with six remaining patients undergoing successful repeat PCA (secondary technical success: 98%). The remaining two patients without primary technical success were either surveilled or had a benign pathology on resulted concomitant biopsy. Four patients (4%) had major AEs (hemorrhage requiring prolonged admission, transfusion, or embolization (n = 3), perinephric abscess requiring drainage (n = 1)) and 27% had minor AEs. Eight patients (8%) had recurrence with a one-year OS of 94% and CSS of 100%. All recurrences underwent repeat ablation without additional recurrence and 3/8 (38%) were T1b and 5/8 (63%) were T1a tumors. CONCLUSION PCA of anterior renal tumors can be performed safely with high rates of technical and oncologic success.
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Affiliation(s)
- Junaid Raja
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St SNHB 623, Birmingham, AL, 35249, USA
| | - Richard Pigg
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St SNHB 623, Birmingham, AL, 35249, USA
| | - Yufeng Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cody Savage
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St SNHB 623, Birmingham, AL, 35249, USA
| | - Theresa M Caridi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St SNHB 623, Birmingham, AL, 35249, USA
| | - Junjian Huang
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St SNHB 623, Birmingham, AL, 35249, USA
| | - Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St SNHB 623, Birmingham, AL, 35249, USA.
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Huang J, Raja J, Cantor C, Marx W, Galgano S, Zarzour J, Caridi T, Gunn AJ, Morgan D, Smith A. Eye Motion Tracking for Medical Image Interpretation Training. Curr Probl Diagn Radiol 2023; 52:474-477. [PMID: 37739877 DOI: 10.1067/j.cpradiol.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/19/2023] [Accepted: 08/23/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The significance of Eye Motion Tracking in aiding learners in training search patterns, pattern recognition, and efficiently using their gaze in terms of time and scanning distribution has been highlighted in the USAF Pilot Training Next initiative. METHODS The innovation described further builds on this concept in the realm of medical imaging and the provision of real-time feedback of eye direction and gaze duration. RESULTS This real-time indicator enables the trainer to adapt verbal queueing of the trainee in a personalized manner to improve knowledge transfer, and to increase the confidence of the trainer and trainee in the competency of the trainee. The initial experiment data set included bone radiographs, digital subtraction angiograms, and computed tomography images. DISCUSSION Preliminary results and formative feedback from participants was encouraging with expert viewers able to use Eye Motion Tracking to successfully guide novice readers through search and gaze protocol patterns of the medical images.
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Affiliation(s)
- Junjian Huang
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Junaid Raja
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
| | | | - William Marx
- Intuitive Research and Technology, Huntsville, AL
| | - Sam Galgano
- Department of Radiology, University of Alabama at Birmingham; Birmingham, AL
| | - Jessica Zarzour
- Department of Radiology, University of Alabama at Birmingham; Birmingham, AL
| | - Theresa Caridi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew John Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Desiree Morgan
- Department of Radiology, University of Alabama at Birmingham; Birmingham, AL
| | - Andrew Smith
- Department of Radiology, University of Alabama at Birmingham; Birmingham, AL
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Layman D, Raja J, Parkhurst W, Huang J, Caridi T. Abstract No. 253 Assigning Objective Value to Consultative Interventional Radiology. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.317] [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: 02/26/2023] Open
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Raja J, Madoff DC. Oncopharmacology in Interventional Radiology. Semin Intervent Radiol 2022; 39:411-415. [PMID: 36406031 PMCID: PMC9671678 DOI: 10.1055/s-0042-1758076] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The broad scope of malignancies treated in interventional oncology is mirrored by the breadth of oncotherapeutics, drugs used to treat cancer. Many of these treatments are administered endovascularly, though a group of therapies can be delivered percutaneously. Perhaps the best taxonomy of oncotherapeutics is based on their biological inactivity or activity and the mechanism by which they interact with treated and targeted tissues. As the fields of interventional oncology and oncotherapeutics continue to grow and expand, this framework may provide a more organized approach in helping distinguish and select the best therapy for patients.
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Affiliation(s)
- Junaid Raja
- Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David C. Madoff
- Division of Interventional Radiology, Yale New Haven Hospital, New Haven, Connecticut
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Patel P, Thomas R, Hamady M, Hague J, Raja J, Tan T, Bloom S, Richards T, Weiss C, Prechtl C, Smith C, Thiagarajah S, Fiorentino F, Markakis H, Ahmed AR. O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity? Br J Surg 2022. [DOI: 10.1093/bjs/znac242.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction
Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded randomised controlled trial comparing LGAE vs Placebo procedure to evaluate its efficacy on weight loss and obesity related comorbidities over a 12 month follow up period. Here, we perform a systematic review of the existing literature.
Methods
9 studies were reviewed. Studies which investigated weight loss as a % +- Ghrelin % change at 3,6 and 12 months were included as these pre-defined time points correlate with the EMBIO protocol. 6 studies met our inclusion criteria, 5 single arm studies and 1 single blinded RCT.
Results
N=62 patients were included in our analysis. Mean weight loss reported was 8.5%, 8.8% and 10% at 3, 6 and 12 months respectively post LGAE. Ghrelin levels reduced by 36%, 16.2% and 16.5% at 3, 6 and 12 months respectively post LGAE. To date, the only reported adverse events recorded include superficial gastric erosions healed on endoscopy by day 90 and one case of subclinical pancreatitis.
Conclusion
LGAE potentially offers a day case procedure under local anaesthesia and sedation to treat obesity and its metabolic complications. The EMBIO trial will provide level 1 evidence to confirm if LGAE is a viable intervention for obesity and evaluate its safety profile.
Take-home message
Left gastric artery embolisation could be the perfect solution to treat obesity in between existing tier-3 and tier-4 treatments.
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Affiliation(s)
| | | | | | | | - J Raja
- University College Hospital
| | | | | | - T Richards
- University of Western Australia , Perth , Australia
| | - C Weiss
- Johns Hopkins University , Baltimore, Maryland USA
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Raja J, Muthusamy S, Ng CM. AB0458 SURVIVAL OF SCLERODERMA PATIENTS WITH INTERSTITIAL LUNG DISEASE: OBSERVATION DATA FROM A MALAYSIAN TERTIARY CENTRE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Interstitial lung disease (ILD) is the leading cause of death in scleroderma (SSc) with decline in FVC as a predictor of mortality in patients with SSc-ILD, especially in the early course of the disease.Objectives:The aim of this study is to determine the survival rate of SSc-ILD in a Malaysian cohort of patients from University Malaya Medical Centre (UMMC).Methods:61 patients clinically diagnosed with SSc-ILD were identified and prospectively recruited. Baseline demographic data were collected. Kaplan-Meier analysis was used to estimate the survival.Results:Females were predominant (56, 91.8%). 39 (64%) had limited cutaneous SSc. Majority were ethnicity Chinese 30 (49.2%), followed by Malays 20 (32.8%), Indians 7 (11.4%) and others 4 (6.6%). Mean age was 56.25 (SD ± 12.5) years while mean duration of disease (non-Raynaud’s disease onset) was 10.5 years (SD ± 9.2) (range of 1 year to 44 years) years. 29 (47.5%) patients were positive for anti-ScL-70, whereas 6 (9.8%) patients were anti-centromere positive. There were 16 (26.2%) deaths. Median survival was 24 years. Patients had a sharper drop in survival probability for the first 10 years compared to the next 20 years (Figure 1). Median survival in limited subset was 24 years whereas in diffuse subset was 11 years. Patients from the limited subset appeared to have higher chance of surviving for 10 years and above, compared to those in the diffuse subset (Figure 2).Conclusion:The results demonstrate the poor survival in SSc-ILD patients. The survival rate tends to be worse in the first 10 years of SSc disease duration. Survival rate was poorer in patients with diffuse cutaneous subset.References:[1]Parelas A et al. Lancet Resp Med 2020[2]Goh NS et al. Am J Respir Crit Care Med 2008Disclosure of Interests:JASMIN RAJA Speakers bureau: For Boehringer Ingelheim for topic on Scleroderma-ILD, Grant/research support from: From Boehringer Ingelheim for scleroderma research, Shantini Muthusamy: None declared., CHOUNG MIN NG: None declared.
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Slovak R, Lu DS, Raja J, Arellano RS, Kim HS. In Regard to Jackson et al. Int J Radiat Oncol Biol Phys 2019; 104:695-696. [PMID: 31162060 DOI: 10.1016/j.ijrobp.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 02/12/2019] [Accepted: 03/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ryan Slovak
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; University of Connecticut School of Medicine, Farmington, Connecticut
| | - David S Lu
- Department of Radiological Sciences, University of California at Los Angeles, School of Medicine, Los Angeles, California
| | - Junaid Raja
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hyun S Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Division of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
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Adam LC, Raja J, Ludwig JM, Adeniran A, Gettinger SN, Kim HS. Cryotherapy for nodal metastasis in NSCLC with acquired resistance to immunotherapy. J Immunother Cancer 2018; 6:147. [PMID: 30541627 PMCID: PMC6292083 DOI: 10.1186/s40425-018-0468-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022] Open
Abstract
Novel approaches with checkpoint inhibitors in immunotherapy continue to be essential in the treatment of non-small cell lung cancer (NSCLC). However, the low rate of primary response and the development of acquired resistance during the immunotherapy limit their long-term effectiveness. The underlying cause of acquired resistance is poorly understood; potential management strategies for patients with acquired resistance are even less clear. Here, we report the case of a 75-year-old female smoker with cough, fatigue, and weight loss that was found to have an 8.6 cm right upper lobe lung lesion with local invasion, adenopathy, and a malignant pericardial effusion. This lesion was biopsied and identified to be cT3N3M1b squamous cell cancer of the lung without any recognizable PD-L1 expression on tumor cells. For her metastatic NSCLC, the patient underwent two lines of conventional chemotherapy before initiation of combination immunotherapy with an anti-PD-L1 and anti-CTLA-4 antibody. Though she initially achieved a response, she thereafter progressed and developed immunotherapy resistant lymph nodal metastasis. While cervical lymph nodes could be surgically removed, another metastasis in an aortocaval area required a more sensitive therapy like thermal ablation. The aortocaval node was partially treated with a single treatment of cryotherapy and demonstrated durable complete response. Cryotherapy for checkpoint immunotherapy resistant metastasis appears to be a safe and feasible treatment for treating metastatic disease in non-small cell lung cancer. The prospect of cryotherapy adjuvancy may enable local control of metastatic disease after initial response to immune checkpoint immunotherapy and may impact on overall outcomes.
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Affiliation(s)
- Lucas C Adam
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA
| | - Junaid Raja
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA
| | - Johannes M Ludwig
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA.,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Adebowale Adeniran
- Department of Pathology, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA.,Division of Medical Oncology, Department of Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA
| | - Scott N Gettinger
- Division of Medical Oncology, Department of Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA.,Yale Cancer Center, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA
| | - Hyun S Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA. .,Division of Medical Oncology, Department of Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA. .,Yale Cancer Center, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA.
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Abstract
BACKGROUND Immunotherapy is at the forefront of modern oncologic care. Various novel therapies have targeted all three layers of tumor biology: tumor, niche, and immune system with a range of promising results. One emerging class in both primary and salvage therapy is oncolytic viruses. This therapy offers a multimodal approach to specifically and effectively target and destroy malignant cells, though a barrier oncoviral therapies have faced is a limited therapeutic response to currently delivery techniques. MAIN BODY The ability to deliver therapy tailored to specific cellular targets at the precise locus in which it would have its greatest impact is a profound development in anti-cancer treatment. Although immune checkpoint inhibitors have an improved tolerability profile relative to cytotoxic chemotherapy and whole beam radiation, severe immune-related adverse events have emerged as a potential limitation. These include pneumonitis, pancreatitis, and colitis, which are relatively infrequent but can limit therapeutic options for some patients. Intratumor injection of oncolytic viruses, in contrast, has a markedly lower rate of serious adverse effects and perhaps greater specificity to target tumor cells. Early stage clinical trials using oncolytic viruses show induction of effector anti-tumor immune responses and suggest that such therapies could also morph and redefine both the local target cells' niche as well as impart distant effects on remote cells with a similar molecular profile. CONCLUSION It is imperative for the modern immuno-oncologist to understand the biological processes underlying the immune dysregulation in cancer as well as the effects, uses, and limitations of oncolytic viruses. It will be with this foundational understanding that the future of oncolytic viral therapies and their delivery can be refined to forge future horizons in the direct modulation of the tumor bed.
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Affiliation(s)
- Junaid Raja
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA
| | - Johannes M Ludwig
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Scott N Gettinger
- Division of Medical Oncology, Department of Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA
- Yale Cancer Center, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA
| | - Kurt A Schalper
- Department of Pathology, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA
| | - Hyun S Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA.
- Division of Medical Oncology, Department of Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA.
- Yale Cancer Center, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA.
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Moonan A, Raja J, Issa R, Campbell A. Race associated disparities in men after radical prostatectomy. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.593] [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: 10/28/2022]
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Raja J, Ghodadra A, Gettinger S, Kluger H, Sznol M, Kim H. 3:30 PM Abstract No. 345 Safety and feasibility of immuno-cryotherapy. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.383] [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: 11/28/2022] Open
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Raja J, Ghodadra A, Gettinger SN, Kluger HM, Sznol M, Schalper KA, "Kevin" Kim HS. Safety and feasibility of immuno-cryotherapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.5_suppl.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
34 Background: To investigate the safety and feasibility of image guided immuno-cryotherapy in patients with immune checkpoint inhibitor failure. Methods: Consecutive patients with primary or acquired failure to immune checkpoint inhibitor therapy were studied following treatment with concomitant image-guided cryotherapy and immune checkpoint inhibition. In addition to demographic features, type of malignancy, size of targeted metastatic lesion, number of cycles of cryotherapy, systemic immunotherapy, and adverse events in a 90 day post procedural window were extracted. The primary end point was safety and adverse events stratified by the common terminology for adverse events (CTCAE) criteria. As a secondary endpoint, efficacy of the cryotherapy was assessed by iRECIST. Results: Ten patients underwent combined image-guided cryotherapy and checkpoint immunotherapy between 2015 and 2017. Five patients received CTLA 4 blockade with cryotherapy, and 8 patients received PD1 axis blockade and cryotherapy. Six patients had metastatic non-small cell lung cancer and 4 had metastatic melanoma. Immunoprofiling demonstrated one patient each with a mutation in NRAS (G12C), NRAS (Q61R), KRAS (G12C), and ALK; and 2 with aBRAF V600E mutation. Cryotherapy was performed in immunotherapy failure sites, including liver (5) and adrenal glands (3), lymph node and muscle. The median size of targeted lesions was 4.5 cm (standard deviation 3.7cm). There were no grade 3 or higher adverse event, though 6 patients had grade 1 and 2 adverse effects in the periprocedural period which included fatigue, local pain, and poor appetite, isolated cases of diarrhea, colitis, pneumothorax, and procedural site hematoma. Regarding therapeutic response: 5 patients demonstrated partial response, 1 stable response, and 1 progression of disease. Two patients died in the followup period from non-treatment induced causes and 1 is awaiting follow-up. Disease control rate was 85.7%. Conclusions: Immuno-cryotherapy with immune checkpoint therapy in patients with immune checkpoint inhibitor resistance is safe and feasible in metastatic NSCLC and melanoma. There were no grade 3 or above adverse events.
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Affiliation(s)
| | | | | | | | - Mario Sznol
- Yale School of Medicine and Yale Cancer Center, New Haven, CT
| | | | - Hyun S. "Kevin" Kim
- Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, and Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA
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Abstract
Melanoma is among the most prevalent neoplasms diagnosed annually with the vast majority arising from a cutaneous origin. Though there are described metastases to the gastrointestinal tract, there are only rare descriptions of primary gastrointestinal melanoma. Both diagnosis and management of this unique population can be challenging given the infrequency with which it occurs. To follow is the third reported case of transverse colon primary melanoma with a description of multimodality treatment with surgery, chemotherapy, and immunotherapy.
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Affiliation(s)
- Junaid Raja
- Internal Medicine and Radiology, Yale University School of Medicine
| | - Rakesh Hegde
- General and Colorectal Surgery, Waterbury Hospital
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16
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Raja J, Mohareb AM, Bilori B. Recurrent urinary tract infections in an adult with a duplicated renal collecting system. Radiol Case Rep 2016; 11:328-331. [PMID: 27920854 PMCID: PMC5128389 DOI: 10.1016/j.radcr.2016.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 02/06/2016] [Revised: 07/29/2016] [Accepted: 08/19/2016] [Indexed: 11/16/2022] Open
Abstract
Because of advancements in fetal imaging, anatomic variants of the genitourinary tract are most often discovered in the antenatal period. As such, general internists are less likely to encounter adult patients with previously undiagnosed anatomic abnormalities of the renal collecting system, such as duplicated kidneys. These abnormalities put patients at risk for urinary obstruction and recurrent infections of the urinary tract. We report the case of a 40-year-old diabetic patient with a previously undiagnosed duplex kidney who had recurrent episodes of diabetic ketoacidosis triggered by urinary tract infections. She was ultimately found to have abscess formation in the duplicated renal moiety. We reviewed the epidemiology, diagnosis, and management of duplex kidneys. We also reviewed the indications for renal imaging in adult patients with similar clinical presentations.
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Affiliation(s)
- Junaid Raja
- Department of Internal Medicine, Yale Waterbury Internal Medicine Residency program, 64 Robbins St, Waterbury, CT 06708, USA
| | - Amir M Mohareb
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Bilori Bilori
- Department of Internal Medicine, Yale Waterbury Internal Medicine Residency program, 64 Robbins St, Waterbury, CT 06708, USA
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17
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Sachithanandham J, Ramalingam VV, Raja J, Abraham OC, Pulimood SA, Kannangai R. Expression of cytokine-mRNA in peripheral blood mononuclear cell of human immunodeficiency virus-1 subtype C infected individuals with opportunistic viral infections from India (South). Indian J Med Microbiol 2016; 34:76-81. [PMID: 26776123 DOI: 10.4103/0255-0857.174118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Human immunodeficiency virus (HIV) disease progression is associated with a marked change in the level of plasma cytokines. The study reported here investigated the level of mRNA expression of different cytokines: Tumour necrosis factor-alpha (TNF-α), interferon (INF)-gamma, interleukin-10 (IL-10) and IL-21 in the peripheral blood mononuclear cell among the antiretroviral therapy naive subtype C HIV-1 infected individuals and normal healthy controls by real time polymerase chain reaction. The mRNA expressions of all the 4 cytokines in HIV-1 infected individuals were significantly higher compared to healthy controls (P value range 0.0004-0.01). The mean level of IL-10, INF-gamma and TNF-α were higher in HIV infected individuals with low CD4 counts (<300 cells/μl). The IL-10 expression showed a significant negative correlation with CD4 counts (r=-0.25, P=0.04) while IL-21 showed a positive correlation with CD4 counts (r=0.26, P=0.03). There was a significant negative correlation between the cytomegalovirus (CMV) viral load and IL-21 expression. Cytokine levels by mRNA detection avoids the inherent problem of measuring plasma level and this study also provide information on the cytokine levels and CD4+ T cell level among HIV-1 subtype C infected individuals with opportunistic viral infections like CMV.
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Affiliation(s)
| | | | | | | | | | - R Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
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18
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Bruni C, Raja J, Denton CP, Matucci-Cerinic M. The clinical relevance of sexual dysfunction in systemic sclerosis. Autoimmun Rev 2015; 14:1111-5. [PMID: 26235995 DOI: 10.1016/j.autrev.2015.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 12/18/2022]
Abstract
Systemic sclerosis is a chronic multi-organ autoimmune disease, leading to important clinical and psychological implications. Among organ complications, sexual dysfunction is a major issue for both male and female gender, with high prevalence and great impact on quality of life, although frequently not addressed by both clinicians and patients. While erectile dysfunction is the most common cause of sexual problems in males, genital tract and general physical changes are major contributors to sexual impairment in females. This review presents current state of the art on this topic, discussing published data on presentation, evaluation and therapeutic options.
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Affiliation(s)
- C Bruni
- Dept Clinical and Experimental Medicine, Div Rheumatology, AOU Careggi, Firenze, Italy.
| | - J Raja
- Division of Rheumatology, Department and Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Campus, London, United Kingdom
| | - C P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Campus, London, United Kingdom
| | - M Matucci-Cerinic
- Dept Clinical and Experimental Medicine, Div Rheumatology, AOU Careggi, Firenze, Italy
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19
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Raja J, Nihtyanova S, Ong V, Denton C. FRI0470 An Observational Study of Intravenous Immunoglobulin therapy in the Treatment of Gastrointestinal Involvement in Systemic Sclerosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5204] [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: 11/04/2022]
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20
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Raja J, de Quesada G. Heterophile antibody positive, acute cytomegaloviral infection in an immunocompetent pre-teen: An atypical presentation of an atypical infection. J Infect Public Health 2015; 8:101-3. [DOI: 10.1016/j.jiph.2014.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/25/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022] Open
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21
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Raja J, Clyne S, Levine J, Tebbit C, Mair E. Otorhinolaryngology management of seven patients with iatrogenic penetrating injuries from GlideScope®: Our experience. Clin Otolaryngol 2014; 39:251-4. [DOI: 10.1111/coa.12266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J. Raja
- Ross University School of Medicine; Miramar FL USA
| | - S. Clyne
- Charlotte Eye Ear Nose & Throat Associates; Charlotte NC USA
| | - J. Levine
- Charlotte Eye Ear Nose & Throat Associates; Charlotte NC USA
| | - C. Tebbit
- Charlotte Eye Ear Nose & Throat Associates; Charlotte NC USA
| | - E. Mair
- Charlotte Eye Ear Nose & Throat Associates; Charlotte NC USA
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22
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Raja J, Sabu N. Two-Dimensional Approximation of Piezoelectric Shallow Shells with Variable Thickness. Proc Natl Acad Sci , India, Sect A Phys Sci 2014. [DOI: 10.1007/s40010-013-0108-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Sabu N, Raja J. Erratum to: Justification of Koiter’s Shell Model Using Gamma Convergence. Proc Natl Acad Sci , India, Sect A Phys Sci 2014. [DOI: 10.1007/s40010-013-0104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Raja J, Arif AA, Warren-Findlow J, Racine EF. Analysis of the Efficacy of the U.S. Charity Care System. World Medical & Health Policy 2013. [DOI: 10.1002/wmh3.58] [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: 11/07/2022]
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25
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Ambler G, Boyle J, Cousins C, Hayes P, Metha T, See T, Varty K, Winterbottom A, Adam D, Bradbury A, Clarke M, Jackson R, Rose J, Sharif A, Wealleans V, Williams R, Wilson L, Wyatt M, Ahmed I, Bell R, Carrell T, Gkoutzios P, Sabharwal T, Salter R, Waltham M, Bicknell C, Bourke P, Cheshire N, Franklin I, James A, Jenkins M, Tyrrell M, Wilkins C, Bown M, Choke E, McCarthy M, Sayers R, Tamberaja A, Farquharson F, Serracino-Inglott F, Davis M, Hamilton G, Brennan J, Canavati R, Fisher R, McWilliams R, Naik J, Vallabhaneni S, Hardman J, Black S, Hinchliffe R, Holt P, Loftus I, Loosemore T, Morgan R, Thompson M, Agu O, Bishop C, Boardley D, Cross J, Hague J, Harris P, Ivancev K, Raja J, Richards T, Simring D, Fisher A, Smith D, Copeland G. Early Results of Fenestrated Endovascular Repair of Juxtarenal Aortic Aneurysms in the United Kingdom. Circulation 2012; 125:2707-15. [PMID: 22665884 DOI: 10.1161/circulationaha.111.070334] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - T. Metha
- Addenbrooke's Hospital, Cambridge
| | - T.C. See
- Addenbrooke's Hospital, Cambridge
| | - K. Varty
- Addenbrooke's Hospital, Cambridge
| | | | - D.J. Adam
- Birmingham Heartlands Hospital, Birmingham
| | | | | | | | - J.D. Rose
- Freeman Hospital, Newcastle upon Tyne
| | - A. Sharif
- Freeman Hospital, Newcastle upon Tyne
| | | | | | - L. Wilson
- Freeman Hospital, Newcastle upon Tyne
| | | | - I. Ahmed
- Guy's & St. Thomas' Hospital, London
| | - R.E. Bell
- Guy's & St. Thomas' Hospital, London
| | | | | | | | - R. Salter
- Guy's & St. Thomas' Hospital, London
| | | | | | | | | | | | - A. James
- Imperial College Hospitals, London
| | | | | | | | - M. Bown
- Leicester Royal Infirmary, Leicester
| | - E. Choke
- Leicester Royal Infirmary, Leicester
| | | | - R. Sayers
- Leicester Royal Infirmary, Leicester
| | | | | | | | | | | | | | - R. Canavati
- Royal Liverpool University Hospital, Liverpool
| | - R.K. Fisher
- Royal Liverpool University Hospital, Liverpool
| | | | - J.B. Naik
- Royal Liverpool University Hospital, Liverpool
| | | | | | | | | | - P. Holt
- St. George's Hospital, London
| | | | | | | | | | - O. Agu
- University College London Hospital, London
| | - C. Bishop
- University College London Hospital, London
| | | | - J. Cross
- University College London Hospital, London
| | - J. Hague
- University College London Hospital, London
| | | | - K. Ivancev
- University College London Hospital, London
| | - J. Raja
- University College London Hospital, London
| | | | - D. Simring
- University College London Hospital, London
| | - A.C. Fisher
- Globalstar on-line database IT support, University of Liverpool, Liverpool
| | - D. Smith
- Globalstar on-line database IT support, University of Liverpool, Liverpool
| | - G.P. Copeland
- POSSUM advice, Warrington General Hospital, Warrington
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26
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Morgan-Rowe L, Simring D, Raja J, Agu O, Richards T, Ivancev K. The Use of an Endovascular Stent Graft with ‘Home-made’ Fenestrations to Treat an Infected Aortic Endograft in an Emergency Setting: A Short Report. Eur J Vasc Endovasc Surg 2011. [DOI: 10.1016/j.ejvs.2011.07.001] [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: 11/26/2022]
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27
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Stepien KE, Eaton AM, Jaffe GJ, Davis JL, Raja J, Feuer W. Increased incidence of sterile endophthalmitis after intravitreal triamcinolone acetonide in spring 2006. Retina 2009; 29:207-13. [PMID: 19050670 DOI: 10.1097/iae.0b013e31818eccb3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the incidence of sterile endophthalmitis after intravitreal triamcinolone acetonide injections during a 6 month period in 2006 to the same period in 2005 and determine the incidence after switching to intravitreal preservative-free triamcinolone acetonide. METHODS Retrospective multicenter interventional case series in which patients receiving intravitreal triamcinolone acetonide at three institutions from March 2005 to August 2005 and from March 2006 to August 2006 and intravitreal preservative-free triamcinolone acetonide from late summer 2006 through February 2007 were reviewed for the development of sterile endophthalmitis. RESULTS From March 2005 to August 2005, the rate of sterile endophthalmitis was 0% at all institutions. From March 2006 to August 2006, a statistically significant increase in sterile endophthalmitis was seen at all institutions with frequencies of 3.5% to 6.3% (P < 0.001). With transition to preservative-free triamcinolone acetonide, sterile endophthalmitis over the next 6 months decreased to 0% at two sites and to 2.5% (from 5.5%) at the third institution (P < 0.009). CONCLUSIONS A statistically significant increase in the rate of sterile endophthalmitis after intravitreal triamcinolone acetonide was seen in a 6 month period in 2006 when compared with the same period in 2005. Transition to preservative-free triamcinolone acetonide produced a frequency of sterile endophthalmitis similar to 2005.
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Affiliation(s)
- Kimberly E Stepien
- Bascom Palmer Eye Institute, University of Miami School of Medicine, USA
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28
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Laverick S, Kazmi S, Ahktar S, Raja J, Perera S, Bokhari A, Meraj S, Ayub K, da Silva A, Pye M, Anser M, Pye J. Asian earthquake: report from the first volunteer British hospital team in Pakistan. Emerg Med J 2007; 24:543-6. [PMID: 17652673 PMCID: PMC2660074 DOI: 10.1136/emj.2006.037333] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 11/04/2022]
Abstract
At 8:52 am on 8 October 2005 a massive earthquake wracked northern Pakistan and Kashmir. Various teams were sent to Islamabad and the disaster region from the UK. We discuss the types of injury patterns seen and recommend that a central register of volunteers should be created to deal with similar situations in the future.
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Affiliation(s)
- S Laverick
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK.
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29
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Skippage P, Raja J, McFarland R, Belli AM. Endovascular repair of iliac artery injury complicating lumbar disc surgery. Eur Spine J 2007; 17 Suppl 2:S228-31. [PMID: 17712578 PMCID: PMC2525903 DOI: 10.1007/s00586-007-0470-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 07/11/2007] [Accepted: 07/27/2007] [Indexed: 10/22/2022]
Abstract
Vascular injury as a complication of disc surgery was first reported in 1945 by Linton and White. It is a rare but potentially fatal complication. The high mortality rate (40-100%) is attributed to a combination of rapid blood loss and the failure to recognise the cause of the deteriorating patient. Early diagnosis and treatment is essential. Treatment has traditionally been by open vascular surgical repair, however with modern imaging and endovascular techniques, minimally invasive treatment should be considered first line in patients who are stable. We present the case of a 51-year-old woman who sustained common iliac artery injury during lumbar spinal surgery that was treated successfully using a covered stent.
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Affiliation(s)
- P Skippage
- Department of Interventional Radiology, St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK.
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30
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Raja J, Ramachandran N, Munneke G, Patel U. Current status of transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer. Clin Radiol 2006; 61:142-53. [PMID: 16439219 DOI: 10.1016/j.crad.2005.10.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 09/11/2005] [Accepted: 10/07/2005] [Indexed: 11/18/2022]
Abstract
In contemporary practice, most prostate cancers are either invisible on ultrasound or indistinguishable from concurrent benign prostatic hyperplasia. Diagnosis therefore rests on prostate biopsy. Biopsies are not simply directed at ultrasonically visible lesions, as these would miss many cancers; rather the whole gland is sampled. The sampling itself is systematic, using patterns based on prostate zonal anatomy and the geographical distribution and frequency of cancer. This review explains the evolution of the prostate biopsy technique, from the classical sextant biopsy method to the more recent extended biopsy protocols (8, 10, 12, >12 and saturation biopsy protocols). Extended protocols are increasingly being used to improve diagnostic accuracy, especially in those patients who require repeat biopsy. This trend has been facilitated by the ongoing improvement in safety and acceptability of the procedure, particularly with the use of antibiotic prophylaxis and local anaesthesia. The technical details of these extended protocols are discussed, as are the current data regarding procedure-related morbidity and how this may be minimized.
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Affiliation(s)
- J Raja
- Department of Radiology, St George's Hospital, Tooting, London, UK.
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31
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33
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Abstract
Establishing the diagnosis of a groin lump may be difficult, largely due to the large number of potential differential diagnoses. Indeed, this case was originally referred as a strangulated hernia. Despite the final diagnosis being infection of an undescended testicle, the patient did not report that he only ever had one scrotal testicle despite his 78 years of age.
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Affiliation(s)
- S Overstall
- Department of Surgery, St George's Hospital, Tooting, London, UK
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34
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35
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