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Thakur S, Patnaik U, Singh SK, Sahai K, Chugh R, Gahlot G. A comparison of the efficacy of narrow band imaging and contact endoscopy in an early diagnosis of squamous malignancies of the upper aerodigestive tract. Med J Armed Forces India 2023; 79:S250-S257. [PMID: 38144649 PMCID: PMC10746843 DOI: 10.1016/j.mjafi.2023.02.004] [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] [Received: 05/19/2021] [Accepted: 02/12/2023] [Indexed: 12/26/2023] Open
Abstract
Background This study aims to compare the efficacy of narrow band imaging (NBI) endoscopy and contact endoscopy in early diagnosis of squamous malignancies of upper aerodigestive tract. Methods This study was of 18 months duration, sample size 50, and carried out at tertiary care hospital. The patients were subjected initially to NBI endoscopy followed by contact endoscopy. Thereafter, the lesion was biopsied and subjected to histopathological examination as is done routinely. The images obtained were analyzed based on criteria proposed by earlier studies and compared with histopathological examination as gold standard. Results The sensitivity, specificity, and negative predictive values of NBI in early diagnosis of squamous malignancies of upper aerodigestive tract were high and better than contact endoscopy. Conclusion Endoscopic NBI is a noninvasive and promising tool used for in vivo differentiation between malignant and nonmalignant lesions of upper aerodigestive tract by using morphology of mucosal capillaries and is more efficacious than contact endoscopy. It can be employed as part of routine ENT examination in outpatient departments; however, it has got a learning curve associated with it.
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Affiliation(s)
- Shivali Thakur
- Resident (ENT), Command Hospital (Southern Command), Pune, India
| | - Uma Patnaik
- Commanding Officer, 359 Field Hosp, C/o 99 APO, India
| | | | - Kavita Sahai
- Deputy Commandant, Command Hospital (Northern Command), Udhampur, India
| | - Rajeev Chugh
- Commanding Officer, 408 Field Hospital, C/o 56 APO, India
| | - G.P.S. Gahlot
- Classified Specialist (Pathology), Command Hospital (Western Command), Chandimandir, India
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Roy R, Banger S, Singh SK, Swami H, Gupta DK, Goyal S, Chugh R, Yadav S, Patel B, Mahesh R. Post Surgical Outcomes in Paediatric Adenotonsillar Hypertrophy with Obstructive Sleep Apnea: Subjective and Objective Evaluation. Indian J Otolaryngol Head Neck Surg 2023; 75:822-827. [PMID: 37206789 PMCID: PMC10188855 DOI: 10.1007/s12070-022-03453-y] [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] [Received: 04/12/2022] [Accepted: 12/20/2022] [Indexed: 01/02/2023] Open
Abstract
The aim of the study was to determine the post surgical outcomes in pediatric adenotonsillar hypertrophy with OSA using portable polysomnography (PSG), OSA 18 Questionnaire and Quality of life (QoL) scores. Secondly to correlate the subjective outcomes with objective scores of polysomonography. A prospective, single-arm, nonrandomized, single center study was performed at a tertiary care centre on children aged 3-12 years (n = 30) with adenoid hypertrophy/ tonsillar hypertrophy/adenotonsillar hypertrophy and symptoms suggestive of OSA. All subjects underwent appropriate surgical intervention. A portable PSG and OSA 18 questionnaire evaluation was performed pre surgery and 06 weeks post surgery to assess objective and clinical assessment for OSA. The mean age of children enrolled in the study was 8.68 ± 3 years. The mean pre treatment AHI was 12.56 ± 13.16 which improved to 1.72 ± 1.53 post surgery and was statistically significant (p < 0.05, Wilcoxon signed rank test). There was a statistically significant improvement in other PSG indices such as RDI and ODI post surgery also. The mean total symptom score (TSS) and QoL score also showed a statistically significant improvement post treatment (p < 0.05). However there was no correlation between the PSG and OSA 18 questionnaire scores pre and post surgery. Children with OSA like symptoms can undergo a portable polysomnography pre and post surgery to demonstrate severity of OSA and objectively monitor improvement in OSA post treatment. In the absence of availability of PSG, OSA 18 questionnaire is a suitable alternative to monitor disease severity and outcomes. Further studies may plan to include impact of paediatric OSA on other function such as the cardiac, dentition & malocclusion and neurocognitive function.
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Affiliation(s)
- Ravi Roy
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Sween Banger
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - S. K. Singh
- Department of ENT HNS, Military Hospital, Jhansi, India
| | - Himanshu Swami
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - D. K. Gupta
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Sunil Goyal
- Department of ENT HNS, Command Hospital (Eastern Command), Alipore Road, Kolkata, 700027 India
| | - Rajeev Chugh
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Sneha Yadav
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Bhaumik Patel
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
| | - R. Mahesh
- Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India
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Gupta DK, Singh SK, Sabarigirish K, Roy R, Chugh R, Goyal S, Parikh B, Sukumar Reddy N. Evaluation of swallowing in patients with T3/T4 oral squamous cell carcinoma. Med J Armed Forces India 2023; 79:181-188. [PMID: 36969121 PMCID: PMC10037075 DOI: 10.1016/j.mjafi.2021.10.002] [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] [Received: 12/21/2020] [Accepted: 10/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background Follow-up of patients treated for head and neck cancer is an important part of the overall treatment. Oral cancers are one of the leading causes of dysphagia. Swallowing dysfunction occurs owing to the disease itself, its predisposing factors, and the treatment. This study aims to evaluate swallowing dysfunction in patients with oral cavity cancers. Methods This prospective study was carried out in a tertiary care hospital institution. Thirty patients with T3, T4 oral cancers were evaluated using institutional dysphagia score and fiber optic endoscopic evaluation of swallowing (FEES) (Penetration-Aspiration Scale, Yale Pharyngeal Residue Scale) before treatment, after surgery, and after adjuvant therapy. Results Advanced-stage tumor, larger resections, and adjuvant therapy are risk factors for dysphagia postoperatively. Although the dysphagia score is our institutional score, the results are promising, that is, 10 % of patients having symptoms at baseline evaluation, which increased to 60% and 70% after surgery and adjuvant radiotherapy respectively. Our study findings of the Penetration Aspiration Scale are 13% aspiration rate at the baseline evaluation, which increased to 57% and 73% after surgery and after adjuvant radiotherapy, respectively, and these results are consistent with those of other report studies. The Vallecular Residual Scale showed that there was a significant association between three different timelines and demonstrated dysphagia among study subjects. Conclusion Subjective and objective assessment of swallowing dysfunction before and after the treatment of head and neck cancers is underreported and underrecognized. Most of the patients in our study had significant swallowing impairment after treatment. FEES is a very effective procedure to diagnose dysphagia and will help in incorporating better preventative and rehabilitative measures.
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Affiliation(s)
- Devendra Kumar Gupta
- Classified Specialist (ENT & Head Neck Onco), Army Hospital (R&R), Delhi Cantt, India
| | | | | | - Ravi Roy
- Classified Specialist (ENT), Army Hospital (R&R), Delhi Cantt, India
| | - Rajeev Chugh
- Commanding Officer, 408 Field Hospital, C/o 56 APO, India
| | - Sunil Goyal
- Classified Specialist (ENT), Command Hospital (Eastern Command), Kolkata, India
| | - Badal Parikh
- Classified Specialist (Anaesthesia), Army Hospital (R&R), Delhi Cantt, India
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Gupta V, Dwivedi G, Chugh R, Sahu PK, Gupta DK, Basu A, Upadhyay K, Patnaik U, Bhatia R. Role of Octreotide in Conservative Management of Chyle Leak Post Neck Dissection in Cases of Head Neck Cancer: A Retrospective Analysis. Indian J Otolaryngol Head Neck Surg 2022; 74:6078-6086. [PMID: 36742480 PMCID: PMC9895617 DOI: 10.1007/s12070-021-02746-y] [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] [Received: 02/24/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
Chyle leak is a dreadful complication in patients undergoing neck dissections. Octreotide has been used in the management of chyle leak post neck dissections in head and neck cancer patients. Currently there is no consensus and practice guidelines on the same. (1) To study the role of octreotide in early cessation of post neck dissection chyle leak. (2) To study incidence of intra-operative and post-operative CL, its relation to the extent of nodal disease and neck dissection, prior radiotherapy. Retrospective analysis of 16 patients out of 529 neck dissection over a period of 03 years between Jan 2016 and Dec 2019 who developed post-operative chyle leak. All patients who had post-operative chyle leak were administered octreotide. Time taken for chyle leak to stop was primary outcome. Secondary outcomes were duration of hospitalization post-operatively, incidence of intra-operative and post-operative chyle leak, its relation to the extent of nodal disease, prior radiotherapy and type of neck dissection. 59 of 529 neck dissections (11.15%) were noted to have intra-operative chyle leak. 16 of 529 neck dissections (3.02%) developed post-operative chyle leak. On applying chi square test, prior multimodality and N plus neck were found to be significant risk factors in developing postoperative chyle leak. Considering only RT versus no RT in prior multimodality treated group, the difference was insignificant. Onset of chyle leak varied from 1 to 5 post-op day (mean 2.68 days). 15 (93.75%) patients responded to octreotide. Chyle leak resolved between 3 and 10 days (mean 5.18 days) and octreotide was given for 5-12 days (mean-7.18 days). Overall duration of hospitalization ranged from 09 to 18 days (mean 12.18 days). 01 patient (6.25%) had to be re-explored due to high volume leak despite using octreotide. Adverse effects of octreotide were minimal and tolerable. Octreotide is effective in reducing the duration of chyle leak, hospital stay and need for surgical intervention. It may be considered as suitable adjunct to conservative measures in the management for post-operative chyle leak.
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Affiliation(s)
- Vikas Gupta
- Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh India
| | - Gunjan Dwivedi
- Department of ORL-HNS, Command Hospital, Pune, Maharashtra India
| | - Rajeev Chugh
- Department of ORL-HNS, Army Hospital (Research and Referral), New Delhi, India
| | | | | | - Abhijit Basu
- Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh India
| | - Kiran Upadhyay
- Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh India
| | - Uma Patnaik
- Department of ORL-HNS, Command Hospital, Pune, Maharashtra India
| | - Ritika Bhatia
- Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh India
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Chugh R. The Role of Empirical Treatment with Proton Pump Inhibitor as a Diagnostic Tool in Laryngopharyngeal Reflux. Indian J Otolaryngol Head Neck Surg 2022; 74:1744-1751. [PMID: 36452527 PMCID: PMC9702284 DOI: 10.1007/s12070-019-01750-7] [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] [Received: 04/15/2019] [Accepted: 10/14/2019] [Indexed: 01/06/2023] Open
Abstract
The presentations of laryngopharyngeal reflux (LPR) are diverse and include chronic hoarseness, sensation of foreign body in the throat, sore throat etc. 24 h pH monitoring considered the gold standard of investigation for LPR is costly, cumbersome and not readily available at all centers. Empirical trial of Proton pump inhibitor (PPI) as a diagnostic tool after assessment by Reflux Symptom Index (RSI) and Reflux Findings Score (RFS) is a cheaper, simple and readily available alternative. The objectives of the study were to determine clinical manifestations in patients presenting with LPR and to evaluate the role of empirical treatment with PPI as a diagnostic tool in LPR. 100 patients were divided into experimental group (RSI ≥ 13 and RFS ≥ 7) and control group (RSI < 13 and RFS < 7). Omeprazole trial was given to experimental group and assessed for RSI and RFS at 04 and 08 weeks. Statistical analysis was done within the group and between the groups. (1) The response rate to Omeprazole at 04 and 08 weeks interval (RSI<13 and/or RFS<7) was 60% and 76% respectively. (2) The response to Omeprazole given to the experimental group with RSI≥13 and RFS≥7 was significant at 04 weeks and 08 weeks duration (P<0.0001). RSI and RFS are good clinical tools to assess and diagnose patients with Laryngopharyngeal reflux. Based on the clinical diagnosis an empirical trial of a proton pump inhibitor (PPI) can be given to patients for duration of 02 months resulting in a good response.
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Affiliation(s)
- Rajeev Chugh
- Department of ENT, Army Hospital Research and Referral, New Delhi, 110010 India
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6
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Chugh R, Gupta DK, Patel B, John AR, Vashisth R, Goyal S. Utilization of PET/CT Scan in Head and Neck Carcinoma: A Tertiary Care Hospital Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:2466-2471. [PMID: 36452547 PMCID: PMC9702424 DOI: 10.1007/s12070-020-02228-7] [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] [Received: 08/29/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022] Open
Abstract
Objective PET/CT scan has been increasingly used in assessment of Head and Neck cancer prior to treatment for evaluation and for surveillance. In this study we aim to assess the utilization of PET/CT scan at a tertiary care hospital. Methods Retrospectively data was reviewed of all patients of Head and Neck cancer who underwent PET/CT scan for workup or for follow-up between July 2018 and December 2019. PET/CT scan done in the pre-treatment assessment and post-treatment surveillance were analyzed for its utility. Results A total of 145 patients were included. The main indication for pre-treatment PET/CT scan was loco-regionally advanced disease (62 of 90 patients, 68.8%). No specific indication was noted in 19 patients (21%). A significant change in treatment decision was seen in pre-treatment patients based on M stage following a PET/CT scan. However, no change was noted on the basis of T or N stage. In the post-treatment surveillance there was a significant correlation of type of recurrence with clinical assessment and indication for PET/CT scan. 37 out of 87 patients (42.5%) underwent PET/CT scan for no specific reason, of which, 07 patients (18.9%) were detected to have distant metastasis. Conclusion Role of PET/CT in the pre-treatment assessment is very limited and maybe confined to advanced local or regional disease. Post-treatment surveillance with PET/CT scan has a promising role and must be done as a baseline during 1st follow up at 03 months in all patients who have advanced disease and have undergone multi-modality treatment for the same.
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Affiliation(s)
- Rajeev Chugh
- ENT Department, Army Hospital Research and Referral, New Delhi, 110010 India
| | - D. K. Gupta
- ENT Department, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Bhaumik Patel
- ENT Department, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Arun Ravi John
- Department of Nuclear Medicine, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Rekha Vashisth
- Department of Radiation Oncology, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Sunil Goyal
- ENT Department, Army Hospital Research and Referral, New Delhi, 110010 India
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Ramakrishnan N, Roy R, Singh S, Goyal S, Gupta DK, Chugh R. Approach to Management of Cerebrospinal Fluid Rhinorrhea: Institutional Based Protocol. Indian J Otolaryngol Head Neck Surg 2022; 74:737-744. [PMID: 36452775 PMCID: PMC9702286 DOI: 10.1007/s12070-019-01728-5] [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] [Received: 07/03/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022] Open
Abstract
The role of otolaryngologist in the management of CSF rhinorrhea is expanding. It is prudent to evaluate all cases of CSF leak, understand the etiological causes and formalize a working approach to management of such cases to yield better outcome. A retrospective descriptive study of 39 cases of proven CSF rhinorrhea treated at a tertiary care center between January 2014 to August 2019. The data retrieved were analyzed for age, gender, weight, etiology, recurrence of the disease, history of meningitis, nasal or neurosurgical intervention in past, imaging inform of CT and MR cisternography as and when required. This was aimed at understanding the various etiological types of CSF rhinorrhea and work out a management approach. The patients with skullbase tumors who presented with CSF Rhinorrhea were excluded from the study sample. There were 18 cases of spontaneous CSF rhinorrhea and 20 cases of traumatic CSF rhinorrhea. The mean BMI of spontaneous gp was 32.9 ± 2.46 kg/m2 while in traumatic group was 25.7 ± 2.94 kg/m2 and difference was statistically significant. None of the spontaneous CSF rhinorrhea cases showed features of raised ICP preoperatively either clinically or on imaging except empty sella in 14 of 18 cases. 6 of 18 cases of spontaneous category while 01 of 20 cases in traumatic had recurrence and the recurrence rate was significantly (p < 0.05) higher in spontaneous group. In traumatic group 7 were iatrogenic, 8 were occult traumatic and rest were acute traumatic. 4 of traumatic and 1 spontaneous group had history of meningitis and the incidence was 12.8% in our study group. Early identification and localization of CSF fistula is necessary to reduce morbidity and mortality associated with it. Risk of meningitis is high in CSF rhinorrhea especially in traumatic group. The etiology of CSF rhinorrhea has a bearing on the management and spontaneous CSF rhinorrhea has higher rate of recurrence.
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Affiliation(s)
| | - Ravi Roy
- Department of ENT, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, 110010 India
| | - Sanajeet Singh
- Department of ENT, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, 110010 India
| | - Sunil Goyal
- Department of ENT, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, 110010 India
| | - D. K. Gupta
- Department of ENT, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, 110010 India
| | - Rajeev Chugh
- Department of ENT, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, 110010 India
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Gomindes A, Welch C, Chugh R, Appleton J. 150 Muscle Quantity at C3 And/or L3 on Routine Trauma Series Computed Tomography Correlate with Brain Frailty and Clinical Frailty Scale: A Cross-Sectional Study. Br J Surg 2022. [DOI: 10.1093/bjs/znac040.014] [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: 11/14/2022]
Abstract
Abstract
Background
Sarcopenia is increasingly recognised to impact the quality of life and patient outcomes. The relationship with brain frailty is unknown.
Objectives
Assess if muscle mass at C3 correlates with muscle mass at L3 on routine trauma imaging. Assess for associations between muscle-mass, brain-frailty, and Clinical Frailty Scale (CFS) on routine trauma imaging.
Method
Routine trauma-series CT scans were retrospectively analysed for patients aged ≥16-years-old admitted to Queen-Elizabeth-Hospital in January2020. Paravertebral, sternocleidomastoid, and total muscle cross-sectional-area (CSA) at C3 (C3-SMM), and total psoas muscle CSA (TPA), total muscle CSA (L3-SMM), and total adipose CSA at L3 were calculated. Brain-frailty scores were calculated assessing for leukoaraiosis, cerebral atrophy, and old vascular lesions/infarcts. CFS was calculated retrospectively from clinical notes. We assessed for correlation against age, CFS, muscle-mass, and brain-frailty using Pearson’s correlations.
Results
We included 111 patients in this study (mean age 49, SD 25.6; 65.8% female). C3-SMM strongly correlated with L3-SMM (r=0.746, p<0.001). Paravertebral and sternocleidomastoid CSA correlated with C3-SMM (paravertebral: r=0.814, p<0.001; sternocleidomastoid: r=0.814, p<0.001). TPA strongly correlated with L3- SMM (r=0.800, p<0.001). Sternocleidomastoid CSA and TPA both negatively correlated moderately with age (sternocleidomastoid: r=−0.460, p<0.001; TPA: r=−0.468, p<0.001), CFS (sternocleidomastoid: r=−0.414, p<0.001; TPA: r=−0.431, p<0.001), and brain frailty (sternocleidomastoid: r=−0.395, p<0.001; TPA: r=−0.436, p<0.001). Adipose CSA at L3 did not correlate with age, CFS, brain-frailty, or muscle-mass.
Conclusions
Muscle-mass at C3 relates to muscle-mass at L3. Muscle-mass on routine trauma-imaging is negatively associated with age, CFS, and brain-frailty.
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Affiliation(s)
- A. Gomindes
- Queen Elizabeth Hospital, Birmingham, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - C. Welch
- Queen Elizabeth Hospital, Birmingham, United Kingdom
- Medical Research Council (MRC) - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - R. Chugh
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Appleton
- Stroke, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Kumari S, Chugh R. A novel four-step feedback procedure for rapid control of chaotic behavior of the logistic map and unstable traffic on the road. Chaos 2020; 30:123115. [PMID: 33380015 DOI: 10.1063/5.0022212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
We present a new four-step feedback procedure to study the full dynamics of a nonlinear dynamical system, namely, the logistic map. We show that by using this procedure, the chaotic behavior of the logistic map can be controlled easily and rapidly or the system can be made stable for higher values of the population growth parameter. We utilize various dynamical techniques (orbit evolution, time series analysis, bifurcation diagrams, and Lyapunov exponents) to analyze the dynamics of the logistic map. Additionally, we adopt the switching strategy to control chaos or to increase the stability performance of the logistic map. Finally, we propose a modified traffic control model to enable rapid control of unexpected traffic on the road. The results of this model are supported by a physical interpretation. The model is found to be more efficient than existing models of Lo and Cho [J. Franklin Inst. 342, 839-851 (2005)] and Ashish et al. [Nonlinear Dyn. 94, 959-975 (2018)]. This work provides a novel feedback procedure that facilitates rapid control of chaotic behavior and increases the range of stability of dynamical systems.
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Affiliation(s)
- S Kumari
- Department of Mathematics, Government College for Girls, Sector 14, Gurugram 122001, Haryana, India
| | - R Chugh
- Department of Mathematics, Maharshi Dayanand University, Rohtak 124001, Haryana, India
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Chakrabarti S, Gupta DK, Gupta M, Daga D, Mishra A, Sharma SS, Chugh R, Singh SK. Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction. Laryngoscope 2020; 130:1967-1972. [PMID: 32267549 DOI: 10.1002/lary.28662] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Reconstruction of head and neck cancer ablative defects is challenging. A modification of the nasolabial flap (islanded pedicled nasolabial flap [ipNLF]) is an easy and reliable option for reconstruction of small- to medium-sized defects of the head and neck, especially in resource-constrained and high-volume centers. STUDY DESIGN AND METHODS We present the retrospective analysis of 27 consecutive patients reconstructed with ipNLF at two high-volume cancer centers, Homi Bhabha Cancer Hospital, Varanasi, India; and Army Hospital Research and Referral, New Delhi, India. The functional outcomes measured were duration of weaning of feeding and tracheotomy tubes and speech assessment (speech intelligible rating score [SIR]) postsurgery. Complications assessed were flap loss, orocutaneous fistula, donor site wound dehiscence, oral incompetence, and angle of mouth deviation. RESULTS The most common ablative defect was of the oral cavity (22 patients), followed by the oropharynx (4 patients) and hypopharynx (1 patient). The mean operating time for flap harvesting and insetting was 57.7 minutes. The mean durations for postoperative feeding tube and tracheotomy removal were 10 and 5 days, respectively. Twenty-four subjects had SIR scores of I or II. None of the subjects had flap loss, orocutaneous fistula, or donor site wound dehiscence. Twenty-five subjects had no oral incompetence, and 26 subjects had no or minimal angle of mouth deviation. CONCLUSION This is the largest series of ipNLF to date and emphasizes the versatility, reliability, reproducibility and excellent functional and acceptable cosmetic outcomes of this flap for the reconstruction of judiciously chosen head and neck ablative defects. LEVEL OF EVIDENCE 2C Laryngoscope, 130: 1967-1972, 2020.
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Affiliation(s)
| | | | - Monika Gupta
- Department of Head and Neck Oncology, Homi Bhabha Cancer Hospital, Varanasi
| | - Dipti Daga
- Department of Head and Neck Oncology, Homi Bhabha Cancer Hospital, Varanasi
| | - Aseem Mishra
- Department of Head and Neck Oncology, Homi Bhabha Cancer Hospital, Varanasi
| | | | - Rajeev Chugh
- Dept of ENT-HNS, Army Hospital Research and Referral, New Delhi
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Gounder M, Merriam P, Ratan R, Patel S, Chugh R, Villalobos V, Thorton M, Van Tine B, Abdelhamid A, Joshi P, Whalen J, Yang J, Rajarethinam A, Duh M, Bobbili P, Cavanaugh C, Huynh L, Totev T, Demetri G. Real-world outcomes of patients with locally advanced or metastatic epithelioid sarcoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.020] [Citation(s) in RCA: 1] [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] [Indexed: 11/13/2022] Open
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Gupta DK, Chugh R, Singh SK, Pati S. Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique. BMJ Case Rep 2019; 12:12/8/e230712. [PMID: 31383687 DOI: 10.1136/bcr-2019-230712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/04/2022] Open
Abstract
Reconstruction of neopharynx after total laryngectomy is a challenging task. Various locoregional flaps like pectoralis major myocutaneos/ latismus dorsi flaps and free flaps have their own limitations and advantages. To overcome this, we used facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy (DK Gupta technique). This flap is thin, pliable, without any gravitational pull and without any risk of anastomosis failure and hence has advantage of both locoregional and free flaps and eliminates the limitations of both. It is simple, reproducible and reliable reconstructive option for neopharynx. We present a case report, review of literature and this novel technique for an excellent outcome and recommend to use it as the new workhorse of neopharyngeal reconstruction.
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Affiliation(s)
| | - Rajeev Chugh
- ENT-HNS, Army Hospital Research and Referral, New Delhi, India
| | | | - Seema Pati
- ENT-HNS, Army Hospital Research and Referral, New Delhi, India
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Chugh R, Griffith KA, Davis EJ, Thomas DG, Zavala JD, Metko G, Brockstein B, Undevia SD, Stadler WM, Schuetze SM. Correction to: Doxorubicin plus the IGF-1R antibody cixutumumab in soft tissue sarcoma: a phase I study using the TITE-CRM model. Ann Oncol 2019; 30:1405. [PMID: 30726873 PMCID: PMC7360153 DOI: 10.1093/annonc/mdy557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Park H, Ashour D, Elsharoud A, Chugh R, Al-Hendy A, El Andaloussi A. towards stem cell therapy of polycystic ovary syndrome (PCOS): therapeutic effect of human mesenchymal stem cells transplantation in pcos mouse model by regulating ovarian vascularization. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.484] [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: 10/26/2022]
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Gounder M, Schöffski P, Villalobos V, Cote G, Chugh R, Chen TW, Jahan T, Loggers E, Italiano A, Gupta A, Agulnik M, Attia S, Jones R, van Tine B, Demetri G, Roche M, Sapir I, Daigle S, Clawson A, Stacchiotti S. A phase II, multicenter study of the EZH2 inhibitor tazemetostat in adults: Epithelioid sarcoma cohort (NCT02601950). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy299.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Daigle S, Stacchiotti S, Schöffski P, Villalobos V, Cote G, Chugh R, Chen TW, Jahan T, Loggers E, Italiano A, Gupta A, Agulnik M, Attia S, Jones R, van Tine B, Demetri G, Clawson A, Roche M, Blakemore S, Gounder M. Molecular characterization of epithelioid sarcoma (ES) tumors derived from patients enrolled in a phase II study of tazemetostat (NCT02601950). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mir O, Azaro A, Merchan J, Chugh R, Trent J, Rodon J, Ohnmacht U, Smith C, Oakley III G, Le Cesne A, Soria JC, Benhadji K, Massard C. Notch pathway inhibition with LY3039478 in soft tissue sarcoma (STS) and gastrointestinal stromal tumours (GIST). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx387.009] [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: 11/14/2022] Open
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18
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Sapir E, Tao Y, Lin J, Kollar L, Schipper M, Chugh R, Schuetze S, Biermann J, Lawrence T, Feng M. Surgical Resection or Stereotactic Body Radiation Therapy for Sarcoma Patients With Pulmonary Metastases. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chugh R, Griffith KA, Davis EJ, Thomas DG, Zavala JD, Metko G, Brockstein B, Undevia SD, Stadler WM, Schuetze SM. Doxorubicin plus the IGF-1R antibody cixutumumab in soft tissue sarcoma: a phase I study using the TITE-CRM model. Ann Oncol 2015; 26:1459-64. [PMID: 25858498 DOI: 10.1093/annonc/mdv171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/27/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Insulin-like growth factor receptor (IGF-1R) has been studied as an oncologic target in soft tissue sarcoma (STS), but its role in sarcoma biology is unclear. Anti-IGF-1R antibody cixutumumab demonstrated acceptable toxicity but limited activity as a single agent in STS. We carried out a dose-escalation study of cixutumumab with doxorubicin to evaluate safety and dosing of the combination. PATIENTS AND METHODS Eligible patients with advanced STS were treated with cixutumumab intravenously on days 1/8/15 at one of three dose levels (A: 1 mg/kg, B: 3 mg/kg, C: 6 mg/kg) with doxorubicin at 75 mg/m(2) as a 48 h infusion on day 1 of a 21 day cycle. After six cycles of the combination, patients could receive cixutumumab alone. The Time-to-Event Continual Reassessment Method was used to estimate the probability of dose-limiting toxicity (DLT) and to assign patients to the dose with an estimated probability of DLT≤20%. RESULTS Between September 2008 and January 2012, 30 patients with advanced STS received a median of six cycles of therapy (range <1-22). Two DLTs were observed, grade 3 mucositis (dose level B) and grade 4 hyperglycemia (dose level C). Grade 2 and 3 reduced left ventricular ejection fraction was seen in three and two patients, respectively. Five partial responses were observed, and estimated progression-free survival was 5.3 months (95% confidence interval 3.0-6.3) in 26 response-assessable patients. Immunohistochemical staining of 11 available tumor samples for IGF-1R and phospho-IGF-1R was not significantly different among responders and non-responders, and serum analysis of select single-nucleotide polymorphisms did not predict for cardiotoxicity. CONCLUSION The maximum tolerated dose was doxorubicin 75 mg/m(2) on day 1 and cixitumumab 6 mg/kg on days 1/8/15 of a 21 day cycle. Cardiac toxicity was observed and should be monitored in subsequent studies, which should be considered in STS only if a predictive biomarker of benefit to anti-IGF-1R therapy is identified. TRIAL REGISTRATION ClinicalTrials.gov:NCT00720174.
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Affiliation(s)
- R Chugh
- Departments of Internal Medicine, University of Michigan, Ann Arbor
| | - K A Griffith
- Biostatistics, University of Michigan, Ann Arbor
| | - E J Davis
- Departments of Internal Medicine, University of Michigan, Ann Arbor
| | - D G Thomas
- Pathology, University of Michigan, Ann Arbor
| | - J D Zavala
- Cancer Clinical Trials Office, University of Chicago, Chicago
| | - G Metko
- Clinical Trials Office, University of Michigan, Ann Arbor
| | | | - S D Undevia
- Department of Medicine, University of Chicago, Chicago, USA
| | - W M Stadler
- Department of Medicine, University of Chicago, Chicago, USA
| | - S M Schuetze
- Departments of Internal Medicine, University of Michigan, Ann Arbor
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Alsaied O, Sangwan V, Banerjee S, Chugh R, Saluja A, Vickers S, Jensen E. Sorafenib and Triptolide as Combination Therapy for Hepatocellular Carcinoma. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.648] [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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Mina LA, Ramanathan RK, Wainberg ZA, Byers LA, Chugh R, Sachdev JC, Matei D, Zhang C, Henshaw JW, Dorr A, Kaye SB, de Bono JS. Abstract P2-09-02: BMN 673 is a PARP inhibitor in clinical development for the treatment of breast cancer patients with deleterious germline BRCA 1 and 2 mutations. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-09-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: BMN 673 is the most potent and specific inhibitor of poly-ADP ribose polymerase (PARP) 1 and 2 in clinical development (IC50<1nM). In BRCA-related tumors, which are genetically dependent on PARP-mediated DNA repair by base excision repair, PARP inhibition induces synthetic lethality. Initial phase 1 results have been presented (de Bono et al JCO 31:5s, 2013 suppl; abstr 2580), showing good tolerability and anti-tumor activity with an MTD on a daily, oral dosing schedule of 1000 μ/day.
Methods: In this 2-stage study, patients with solid tumors including BRCA-related cancers, were enrolled during dose-escalation followed by an expansion phase at the MTD in breast, ovarian, and pancreatic cancer patients with deleterious germline BRCA mutations and in small cell lung cancer and Ewing sarcoma patients to further characterize safety and efficacy. This abstract summarizes demographics and safety for all patients and efficacy for patients with BRCA-related cancers.
Results: As of 17May2013, a total of 1 pancreatic, 18 breast (17F/1M), and 28 ovarian cancer pts with germline BRCA mutations were enrolled at doses from 100-1100 μg/day. All breast cancer patients were treated from 900-1100 μg/day. The median (range) age for all 70 patients is 51.5 (18-81), PS 0 (0-1) and # of prior therapies 4 (1-13), with 47 patients having deleterious BRCA mutations. An MTD of 1000 μg/day was established with thrombocytopenia being dose-limiting. Related adverse events occurring in > 10% of all 70 patients included fatigue, nausea, alopecia, anemia, thrombocytopenia and neutropenia. One patient has had related grade 4 thrombocytopenia. Grade 3 related AE's included fatigue in 1 patient (1%), anemia and thrombocytopenia in 9 each (13%) and neutropenia in 4 (6%). Dose reductions occurred in 11 pts due to myelosuppression. No patients discontinued for adverse events.
Response in Germline BRCA PatientsBRCA Tumor TypeNDose Range (μ/day)ResponseBreast18900-11001CR/6PR/5SD≥12 weeksOvarian28100-11001CR/10PR/19GCIG/4SD≥24 weeksPancreas110001 SD ≥ 12weeksTwo of 2 BRCA breast responders had responded to prior platinum while 0 of 4 non-responders to prior platinum responded to BMN 673. Five of 12 breast cancer pts with no prior platinum have responded.
Conclusions: BMN 673 is well tolerated with impressive anti-tumor activity in pts with deleterious germ line BRCA mutations. Myelosuppression and fatigue are the primary side effects associated with need for dose reduction. A phase 3 trial in metastatic breast cancer patients with deleterious germ line BRCA mutations is planned with single-agent, once-daily oral dosing of 1000 μg (1 mg) per day.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-09-02.
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Affiliation(s)
- LA Mina
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - RK Ramanathan
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - ZA Wainberg
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - LA Byers
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - R Chugh
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - JC Sachdev
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - D Matei
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - C Zhang
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - JW Henshaw
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - A Dorr
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - SB Kaye
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - JS de Bono
- Indiana University, Indianapolis, IN; Virginia G. Piper Cancer Center @ Scottsdale Healthcare/TGen, Scottsdale, AZ; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Texas MD Anderson Cancer Center, Houston, TX; University of Michigan, Ann Arbor, MI; BioMarin Pharmaceutical Inc, San Rafael, CA; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
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Smith D, Chugh R, Patnaik A, Papadopoulos K, Chambers G, Thorpe V, Xu L, Kapoun A, Dupont J, Tolcher A. 28 A First-in-human Phase I Study to Evaluate the Fully Human Monoclonal Antibody OMP-59R5 (anti-Notch2/3) Administered Intravenously to Patients with Advanced Solid Tumors. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71827-0] [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: 10/27/2022]
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Tolcher A, Kapoun A, Wang M, Zhang C, Patnaik A, Papadopoulos K, Chugh R, Thorpe V, Dupont J, Smith D. 314 Biomarker Analysis in the First-in-human OMP-59R5 (anti-Notch2/3) Phase I Study Demonstrates Pharmacodynamic (PD) Modulation of the Notch Pathway in Patients with Advanced Solid Tumors. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72112-3] [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: 10/27/2022]
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Nair S, James E, Chugh R. An unusual case of recurrent post aural abscess. Indian J Otolaryngol Head Neck Surg 2012; 63:58-60. [PMID: 22754840 DOI: 10.1007/s12070-011-0194-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 03/29/2009] [Indexed: 11/28/2022] Open
Abstract
Preauricular sinus (PAS) is a common congenital anomaly which is usually asymptomatic and noted on routine otolaryngological examination which requires no treatment. Patients presenting with discharge, recurrent infections and preauricular abscess will require management with antibiotics and surgical extirpation of the sinus tract. We present a rare case of a PAS presenting as a recurrent postaural abscess.
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Pak D, Vineberg K, Griffith K, Sabolch A, Chugh R, Biermann J, Ben-Josef E, Feng M. Dosimetric Predictors for Femoral Fractures following Limb-sparing Surgery and Radiotherapy for Soft-tissue Sarcoma of the Proximal Lower Extremity. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.945] [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: 11/16/2022]
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Schuetze S, Zhao L, Chugh R, Zalupski M, Thomas D, Lucas DR, Baker LH. Results of a phase II trial of sirolimus (S) and cyclophosphamide (C) in advanced sarcoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Trent JC, Wathen K, von Mehren M, Samuels BL, Staddon AP, Choy E, Butrynski JE, Chugh R, Chow WA, Rushing DA, Forscher CA, Baker LH, Schuetze S. A phase II study of dasatinib for patients with imatinib-resistant gastrointestinal stromal tumor (GIST). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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29
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Smith DC, Britten C, Garon EB, Vlahovic G, Chugh R, Lee MA, Cancilla B, Clary DO, Robertson SC, Hurwitz H. A phase I study of XL228, a multitargeted protein kinase inhibitor, in patients (pts) with solid tumors or multiple myeloma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3105] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
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Dudeja V, Chugh R, Bezek H, Skube S, Mujumdar N, Yokoyama Y, Borja-Cacho D, Rajinder D, Vickers S, Saluja A. SIRT1 Gene Silencing: A Potential Therapeutic Strategy for Pancreatic Cancer. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.461] [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: 12/01/2022]
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Saraiya B, Karantza-Wadsworth V, Stein MN, Chugh R, Mehnert J, Moss R, Lin Y, Poplin E. Phase I study of gemcitabine, docetaxel, and imatinib in refractory and relapsed solid tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e13538] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13538 Background: The combination of the tyrosine kinase inhibitor imatinib with cytotoxic chemotherapy targets multiple pathways of tumor progression. In a previous phase I study, the combination of gemcitabine and imatinib was tolerable and had broad activity. The maximally tolerated dose (MTD) was gemcitabine 1500 mg/m2/150 minute and imatinib 400 mg days 1–5, 8–12, and 15–19. Given the activity seen when combining gemcitabine and docetaxel in some solid tumors, this phase I trial studied the addition of docetaxel to gemcitabine/imatinib. Methods: Twenty patients with relapsed/refractory solid tumors were enrolled in this IRB-approved study at the Cancer Institute of New Jersey and University of Michigan. The mean age was 64, mean ECOG PS 1. Five patients had lung cancer; 5, sarcoma; 3 ampullary-biliary tumors; 2 mesothelioma and bladder, 3, other. Imatinib was administered at 400 mg daily on days 1–5, 8–12 and 15–19. Gemcitabine was started at 600 mg/m2 at the fixed dose infusion of 10 mg/min on days 3 and 10 and docetaxel at 30 mg/m2 on day 10. Results: Because of unexpectedly severe hematological toxicities seen with escalating either gemcitabine or docetaxel, the protocol was amended to eliminate days 15–19 of imatinib. The MTD is gemcitabine 600 mg/m2, on days 3 and 10, docetaxel 30 mg/m2 on day 10, and imatinib 400 mg PO given on days 1–5 and 8–12. The dose limiting toxicities were neutropenic fever, pleural and pericardial effusion after cycle 1 of chemotherapy. The best response achieved was stable disease at 6 cycles in one patient each with mesothelioma and non small cell lung cancer (NSCLC) at the MTD. Two other patients with NSCLC had stable disease at 4 cycles. Discussion: An unexpectedly low MTD for this triplet was identified, an outcome different from prior experience with the doublets gemcitabine/imatinib or gemcitabine/docetaxel where much higher dosages are tolerated. Our results suggest possible drug-drug interactions that amplify toxicities with little initial evidence of improved tumor control. Given the unexpectedly high toxicity of the combination of gemcitabine, docetaxel and imatinib at low dosages, further development of this regimen is not indicated. [Table: see text]
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Affiliation(s)
- B. Saraiya
- The Cancer Institute of New Jersey, New Brunswick, NJ; University of Michigan Hospitals, Ann Arbor, MI
| | - V. Karantza-Wadsworth
- The Cancer Institute of New Jersey, New Brunswick, NJ; University of Michigan Hospitals, Ann Arbor, MI
| | - M. N. Stein
- The Cancer Institute of New Jersey, New Brunswick, NJ; University of Michigan Hospitals, Ann Arbor, MI
| | - R. Chugh
- The Cancer Institute of New Jersey, New Brunswick, NJ; University of Michigan Hospitals, Ann Arbor, MI
| | - J. Mehnert
- The Cancer Institute of New Jersey, New Brunswick, NJ; University of Michigan Hospitals, Ann Arbor, MI
| | - R. Moss
- The Cancer Institute of New Jersey, New Brunswick, NJ; University of Michigan Hospitals, Ann Arbor, MI
| | - Y. Lin
- The Cancer Institute of New Jersey, New Brunswick, NJ; University of Michigan Hospitals, Ann Arbor, MI
| | - E. Poplin
- The Cancer Institute of New Jersey, New Brunswick, NJ; University of Michigan Hospitals, Ann Arbor, MI
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Mita AC, Sankhala K, Sarantopoulos J, Carmona J, Okuno S, Goel S, Chugh R, Coffey MC, Mettinger K, Mita MM. A phase II study of intravenous (IV) wild-type reovirus (Reolysin) in the treatment of patients with bone and soft tissue sarcomas metastatic to the lung. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10524] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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
10524 Background: Reolysin is a Dearing strain, naturally occurring, ubiquitous human reovirus. The PKR (double stranded RNA-activated protein kinase) is inhibited and therefore the virus replicates specifically in transformed cells possessing an activated Ras pathway producing lysis. In vitro and in vivo studies with Reolysin in sarcoma cell lines revealed significant antitumor activity. Methods: This phase II open-label, single agent study was designed to characterize the efficacy and safety of Reolysin given IV every 28 days in patients (pts) with bone or soft tissue sarcoma with lung metastasis using a Simon two-stage design. 38 pts were accrued to the first stage. If 1 or more pts experience clinical benefit (prolonged SD > 6 months, partial or complete response) up to 52 pts could be accrued. The agent will be considered active if 3 or more responses or prolonged SD are observed. Results: Since July 2007, 43 pts age 19–76 (median 49) were enrolled (20 female) and received a total of 141 cycles (range 1–18). All pts had performance status 1 (29 pts) or 0 (14 pts). 38 pts received prior chemotherapy, radiotherapy, biological agents or combinations for their metastatic disease, 15 pts received more than 3 chemotherapy regimens. The sarcoma subtypes included: synovial sarcoma (13 pts), osteosarcoma (7 pts), leiomyosarcoma (7 pts), MFH (5 pts), Ewing/PNET (1 pt), chordoma (1 pt), others (9 pts). Side effects were mild to moderate (grade 1–2) and included constitutional symptoms fever, chills, fatigue. Two pts experienced respiratory side effects (cough and dyspnea) and 2 pts had diarrhea. Hematological side effects included grade 2–3 neutropenia (6 pts) and grade 2 thrombocytopenia (2 pts). One patient experienced grade 2 AST elevation. 33 pts are evaluable for response to date: 14 pts (42%) had SD for 2+ months including 5 pts having SD for more than 6 months. Conclusions: Utilization of single agent reovirus for treatment of sarcoma is a novel and unique therapeutic approach to date. Reolysin is well tolerated and shows promise for the treatment of metastatic sarcoma. Primary efficacy goals have been met. Accrual is ongoing to a total of 52 pts. [Table: see text]
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Affiliation(s)
- A. C. Mita
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - K. Sankhala
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - J. Sarantopoulos
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - J. Carmona
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - S. Okuno
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - S. Goel
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - R. Chugh
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - M. C. Coffey
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - K. Mettinger
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - M. M. Mita
- Institute for Drug Development, CTRC, UTHSCSA, San Antonio, TX; Mayo Clinic, Rochester, MN; Montefiore Einstein Cancer Center, New York, NY; University of Michigan Health System, Ann Arbor, MI; Oncolytics Biotech Inc., Calgary, AB, Canada
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Antonoff M, Borja-Cacho D, Chugh R, Sorenson B, Saltzman D, Saluja A, Vickers S. 73. Triptolide Therapy for Neuroblastoma Decreases Cell Viability in Vitro and Inhibits Tumor Growth in Vivo. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dudeja V, Skube S, Chugh R, Yokoyama Y, Daniel B, Antonoff M, Dawra R, Vickers S, Saluja A. 172. Silencing of Heat Shock Factor-1 (HSF1): A Novel Therapeutic Modality for Pancreatobiliary Tumors. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.209] [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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Wagner AJ, Morgan JA, Chugh R, Rosen LS, George S, Gordon MS, Devine CM, Van den Abbeele AD, Grayzel D, Demetri GD. Inhibition of heat shock protein 90 (Hsp90) with the novel agent IPI-504 in metastatic GIST following failure of tyrosine kinase inhibitors (TKIs) or other sarcomas: Clinical results from phase I trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10503] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ha HT, Chugh R, Griffith KA, Thomas DG, Schuetze SM, Lucas DR, Biermann JS, Zalupski MM. Phase II trial of cetuximab in patients (pts) with metastatic and/or locally advanced soft tissue and bone sarcomas. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chugh R, Benjamin R, Chawla S, Heaton J, Schwartz B. 7524 POSTER ZIO-201, isophosphoramide mustard in advanced sarcoma. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71501-x] [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: 10/22/2022] Open
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Chugh R, Maki RG, Thomas DG, Reinke D, Wathen JK, Patel S, Priebat DA, Meyers PA, Benjamin RS, Baker LH. A SARC phase II multicenter trial of imatinib mesylate (IM) in patients with aggressive fibromatosis. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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
9515 Background: Aggressive fibromatosis (desmoid tumors, AF) are uncommon, locally aggressive, connective tissue neoplasms. Existing literature on systemic treatment of AF is sparse and consists mostly of case reports and small case-series. Based on previous observation of regression of AF treated with IM and tumoral expression of IM targets, SARC (Sarcoma Alliance for Research through Collaboration) included the treatment of AF onto a multi-institution phase II trial of IM in sarcoma. Here we report early clinical and laboratory results of the AF group. Methods: Eligible patients had histologically proven AF, unresectable or difficult to resect without considerable functional impairment. Patients were treated with IM 300 mg po BID (BSA≥1.5m2). The primary endpoint was complete (CR) or partial response(PR) at two months or stable disease (SD) or better at four months. Tumor DNA was extracted from available formalin fixed paraffin embedded tissue specimens and analyzed via allelic PCR and genomic DNA sequence analysis for specific point mutations in PDGFRα exons 12/14/18, PDGFRβ exons 12/18, KIT exons 9/11/13/17, and bRAF. Results: 51 patients were enrolled from 10/02 to 12/05 at 5 institutions, with 45 patients currently evaluable. The median age is 37 (range 14–67), and median number of prior therapies is 1 (range 0–3). 36 patients (80%) reached the primary endpoint of CR/PR at 2 months or SD or better at 4 months. The median time to treatment failure is 6.8 months (95% C.I. 5.8–17.1). Thus far, the maximum change in the largest dimension of the tumor ranged from a 21% increase to a 45% decrease. In 22 available tumor specimens, deletions within PDGFRαE12 and E18 were noted in 1 and 3 patients, respectively, while a wildtype genotype was found in other regions. Conclusions: IM has activity in AF, the mechanism of which remains unclear. While this is the largest reported phase II trial of AF, further improvement in evaluating clinical efficacy in this disease is clearly necessary. We plan an analysis of the maximum change in largest tumor dimension for each patient, which will be particularly beneficial in AF as responses often occur late. We have not as yet identified a laboratory predictor of clinical benefit. Further investigation of other potential targets in fresh tissue is warranted. [Table: see text]
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Affiliation(s)
- R. Chugh
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - R. G. Maki
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - D. G. Thomas
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - D. Reinke
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - J. K. Wathen
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - S. Patel
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - D. A. Priebat
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - P. A. Meyers
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - R. S. Benjamin
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
| | - L. H. Baker
- University of Michigan, Ann Arbor, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; Washington Hospital Center, Washington, DC
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Chugh R, Thomas DG, Wagner T, Griffith K, Taylor J, Worden F, Schuetze S, Zalupski MM, Baker LH. Pharmacokinetics of ifosfamide and cytochrome P450 3A in a phase II trial of doxorubicin and ifosfamide in sarcoma patients. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Chugh
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
| | - D. G. Thomas
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
| | - T. Wagner
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
| | - K. Griffith
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
| | - J. Taylor
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
| | - F. Worden
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
| | - S. Schuetze
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
| | - M. M. Zalupski
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
| | - L. H. Baker
- Univ of Michigan Comprehensive Cancer Ctr, Ann Arbor, MI; Univ of Michigan, Ann Arbor, MI; Univ Hosp Luebeck, Luebeck, Germany
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Baker LH, Wathen K, Chugh R, Thomas D, Thall PF, Maki RG, Samuels BL, Meyers PA, Priebat DA, Benjamin RS. Activity of imatinib mesylate in desmoid tumors: Interim analysis of a Sarcoma Alliance for Research thru Collaboration (SARC) phase II trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9013] [Citation(s) in RCA: 4] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- L. H. Baker
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - K. Wathen
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - R. Chugh
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - D. Thomas
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - P. F. Thall
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - R. G. Maki
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - B. L. Samuels
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - P. A. Meyers
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - D. A. Priebat
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
| | - R. S. Benjamin
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Washington Hospital Center, Washington, DC
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Chugh R, Thomas D, Wathen K, Thall PF, Benjamin RS, Maki RS, Samuels BL, Keohan ML, Priebat DA, Baker LH. Imatinib mesylate in soft tissue and bone sarcomas: Interim results of a Sarcoma Alliance for Research thru Collaboration (SARC) phase II trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9001] [Citation(s) in RCA: 3] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Chugh
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - D. Thomas
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - K. Wathen
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - P. F. Thall
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - R. S. Benjamin
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - R. S. Maki
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - B. L. Samuels
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - M. L. Keohan
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - D. A. Priebat
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
| | - L. H. Baker
- University of Michigan, Ann Arbor, MI; M.D. Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; University of Illinois at Chicago, Chicago, IL; Columbia University, New York, NY; Washington Hospital Center, Washington, DC
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Kaushal SK, Chugh R, Dagar KS, Vyas R, Radhakrishnan S, Shrivastva S, Iyer KS. Types of AR with VSD: Which one is malignant? Indian J Thorac Cardiovasc Surg 2004. [DOI: 10.1007/s12055-004-0383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Despite a dramatic increase in research on eating-related pathologies, gaps remain in our understanding of the factors responsible for the development and maintenance of dysfunctional attitudes and behaviour related to weight and eating among adolescents. A study was therefore conducted to compare eating and weight concerns among underweight, normal-weight and obese affluent adolescent girls in New Delhi. The sample comprised fifty underweight, fifty normal-weight and thirty obese girls, 16-18 years of age. Information was collected about their body image perception, weight concerns and eating attitudes by a well-structured questionnaire. Dietary intake was determined by 24 h recall and a food-frequency questionnaire. Body size was adjudged by measurements of weight, height, waist, hip and mid upper arm circumferences, and the BMI and waist : hip ratio were determined. Of the subjects, 99.2 % had a gynoid pattern of fat distribution. Concerns about excess weight were prevalent among the adolescent girls, even among those who were normal-weight and underweight. The level of satisfaction with body size decreased with increase in weight. Dieting behaviour was reported in a higher number of obese (76.6 %) compared with normal-weight (38 %) and underweight (14 %) girls. Of the obese girls, 43.3 % were found to be at a significantly (P=0.00109) greater risk of developing anorexia in the future. Characteristic dietary features of adolescence, such as missing meals, snacking and eating out, were observed. While the diets of most of the subjects were adequate in Ca, thiamin, riboflavin and vitamin C, they were found to be deficient in energy, protein, Fe, niacin, vitamin A and fibre. Thus, it is important to recognize that weight concerns and dissatisfaction with body size may pose a threat to a healthy nutritional state, and may develop into precursors of a later eating disturbance.
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Affiliation(s)
- R Chugh
- Department of Foods and Nutrition, Institute of Home Economics, Delhi University, NDSE-I, New Delhi-110049, India.
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Thanigaraj S, Chugh R, Schechtman KB, Lee LV, Wade RL, Pérez JE. Defining left ventricular segmental and global function by echocardiographic intraventricular contrast flow patterns. Am J Cardiol 2000; 85:65-8. [PMID: 11078239 DOI: 10.1016/s0002-9149(99)00608-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
Contrast echocardiography improves left ventricular (LV) endocardial border delineation by enhancement of the blood-tissue interface. In particular, the contrast appearing within the LV chamber exhibits characteristic flow patterns over the cardiac cycle, which may be related to the surrounding myocardial wall motion. To determine the relation between the LV intracavitary contrast flow pattern and surrounding wall motion, we reviewed the contrast-enhanced images of 348 consecutive patients studied at rest. We defined 2 different patterns of intracavitary contrast flow as visualized from apical views: a swift, vertical, and homogeneous flow towards the apex (pattern A), and a distinctly protracted, swirling, and heterogeneous flow (pattern B). Images recorded on videotapes were reviewed and the type of pattern (A or B) was determined within the initial 30 to 45 seconds of contrast appearance in the left ventricle. Contrast flow patterns interpreted by independent reviewer were then compared with the interpretation of the LV segmental and global function in each patient. Results demonstrate that 224 of 245 (91%) patients exhibiting pattern A had normal LV segmental function. Furthermore, all but 1 patient (102 of 103) with pattern B had > or =1 wall motion abnormality (p <0.0001). Contrast flow pattern B was observed irrespective of the location of LV wall motion abnormality. Global LV function was normal in 93% of patients exhibiting pattern A, whereas varying degrees of LV dysfunction were noted in 83% of patients with pattern B (p <0.0001). The presence of mitral regurgitation (p = 0.46), aortic insufficiency (p = 0.066), or mitral inflow Doppler abnormality (p = 0.102) was not significantly associated with either pattern. Thus, during contrast echocardiography, the LV intracavitary contrast flow pattern complements the assessment of global and segmental LV function.
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Affiliation(s)
- S Thanigaraj
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA.
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Aharon AS, Laks H, Drinkwater DC, Chugh R, Gates RN, Grant PW, Permut LC, Ardehali A, Rudis E. Early and late results of mitral valve repair in children. J Thorac Cardiovasc Surg 1994; 107:1262-70; discussion 1270-1. [PMID: 8176970] [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: 01/29/2023]
Abstract
Mitral valve repair in children has the advantage of avoiding mitral valve replacement with its attendant need for anticoagulation and reoperation. Seventy-nine children between the ages of 2 months and 17 years (mean 4.9 years) underwent mitral valve repair between May 1982 and April 1993. There were five patients with mitral stenosis and 74 patients with mitral regurgitation, and 19 children were less than 2 years of age. Patients were divided into anatomic subgroups on the basis of the primary cardiac pathologic condition. Forty-three had severe mitral regurgitation, 21 had moderate mitral regurgitation, and 12 patients with primum atrial-septal defect and 2 patients with univentricular hearts had minimal to moderate mitral regurgitation. Associated cardiac anomalies were present in 68 patients and 85% of the patients required concomitant intracardiac procedures. The methods of mitral valve repair included annuloplasty in 68 (86%), repair of cleft leaflet in 41 (52%), chordal shortening in 9 (11%), triangular leaflet resection in 8 (10%), splitting of papillary muscles with resection of subvalvular apparatus in 7 (9%), and chordal substitution in 1 (1%). The technique of annuloplasty was modified to allow for annular growth. Follow-up was available from 1 to 10 years (mean 4 +/- 2.5 years). There were three early deaths (4%), all occurring as a result of low output cardiac failure in patients with minimal postoperative mitral regurgitation. Three late deaths (4%) occurred in patients with persistent moderate to severe mitral regurgitation and progressive cardiac failure and eight patients (10%) required either rerepair or replacement of the mitral valve. Actuarial survival was 94% at 1 year, 84% at 2 years, and 82% at 5 years, and actuarial freedom from reoperation was 89% at 8 years. All patients received postoperative echocardiography with 82% having minimal to no mitral regurgitation and 98% of long-term surviving patients being free of symptoms. We conclude that mitral valve repair can be done with low early and late mortality. The need for reoperation is relatively low and valve growth has occurred with the use of a modified annuloplasty.
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Affiliation(s)
- A S Aharon
- Division of Cardiothoracic Surgery, University of California, Los Angeles School of Medicine
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Ihnken K, Morita K, Buckberg GD, Aharon A, Laks H, Panos AL, Drinkwater DC, Chugh R, Del Rizzo D, Salerno TA. The safety of simultaneous arterial and coronary sinus perfusion: experimental background and initial clinical results. J Card Surg 1994; 9:15-25. [PMID: 8148541 DOI: 10.1111/j.1540-8191.1994.tb00819.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [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: 01/29/2023]
Abstract
UNLABELLED Concern over myocardial damage from simultaneous arterial (antegrade) and coronary sinus (retrograde) perfusion has led to alternating between these delivery routes to maximize their individual benefits. Based upon predominant retrograde drainage via Thebesian veins, this study: (1) confirms experimentally the safety of simultaneous arterial and coronary sinus perfusion; and (2) reports initial clinical application of this combined strategy in 155 consecutive patients. EXPERIMENTAL Five mini-pigs (25 to 30 kg) underwent 1 hour of aortic clamping with simultaneous aortic and coronary sinus perfusion at 200 mL/min with normal blood (37 degrees C) before and after 30 minutes of perfusion with either warm (37 degrees C) or cold (4 degrees C) blood cardioplegia. Coronary sinus pressure was always less than 30 mmHg. There was no right or left ventricular edema, lactate production, or lipid peroxidation as transmyocardial and myocardial conjugated dienes were unaltered, and postbypass recovered left ventricular end-systolic elastance (conductance catheter) and preload recruitable stroke work index 101% +/- 3% and 109% +/- 90%, respectively. CLINICAL: Simultaneous arterial/coronary sinus perfusion was used in 155 consecutive high risk patients (New York Heart Association Class III to IV) undergoing isolated coronary artery bypass grafting (CABG) (n = 109) and CABG+valve replacement/repair or aneurysm (n = 46). Included were 16 patients in cardiogenic shock and 24 undergoing reoperation. Mean aortic clamping time averaged 90 +/- 4 minutes (range 30 to 207), with 3.5 +/- 0.1 grafts per patient; all anastomoses were performed with the aorta clamped. Cold intermittent blood cardioplegia was used for distal anastomoses and valve implantation/repair in 123 patients, and warm continuous blood cardioplegia was used in 32 patients. Following a warm cardioplegic reperfusate, all patients received warm noncardioplegic blood perfusion simultaneously via grafts and coronary sinus. Coronary sinus pressure was always less than 40 mmHg. Of 18 patients requiring postoperative mechanical circulatory support (IABP), 16 had IABP placed preoperatively for cardiogenic shock. There were three postoperative myocardial infarctions (2%), and six patients died (3.9% mortality). CONCLUSION These experimental and clinical findings overcome perceived concerns about myocardial damage from simultaneous arterial and coronary sinus perfusion, and suggest this approach may add to the armamentarium of cardioprotective strategies.
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Affiliation(s)
- K Ihnken
- Division of Cardiothoracic Surgery, UCLA School of Medicine 90024-1741
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