1
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Chong CZ, Cherian R, Ng P, Yeo TC, Ling LH, Soo WM, Wong RCC, Tambyah PA, Kong WKF, Tay ELW. Clinical outcomes of severe tricuspid valve infective endocarditis related to intravenous drug abuse - a case series. Acta Cardiol 2022; 77:884-889. [PMID: 34517788 DOI: 10.1080/00015385.2021.1976448] [Citation(s) in RCA: 4] [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] [Indexed: 01/18/2023]
Abstract
BACKGROUND Right-sided infective endocarditis (IE) related to intravenous drug use (IVDU) can follow an acute fulminant course. However, there is limited information on its longer-term clinical outcomes. AIM AND METHODS We assessed a cohort of consecutive patients who presented with IVDU complicated by severe tricuspid valve regurgitation to determine their presentation, treatment, and long-term outcomes. In this study, severe tricuspid regurgitation (TR) was defined by the European Association of Cardiovascular Imaging criteria at initial presentation to the hospital. RESULTS Thirty-three patients with a mean age of 35 ± 18 years (72% males) presented with IVDU associated with severe TR. At the initial presentation, 15 patients were in septic shock and required inotropes. 26 patients had septic pulmonary emboli; 10 patients had associated metastatic systemic sites of infection of which 5 patients had central nervous system (CNS) involvement. Three patients were in disseminated intravascular coagulation (DIC) and 1 patient had multi-organ failure (MOF), but not requiring dialysis or mechanical ventilation. Most patients had large tricuspid valve vegetations of >20mm. Eleven patients underwent surgery with 18% perioperative mortality. The Median follow-up was 6.4 years (0.5-11.4). Recurrent IE occurred in one-third of patients, the overall incidence of heart failure and Atrial fibrillation (AF) on follow-up was low in all 3 groups. Five-year survival was 94%. CONCLUSION Acute severe TR following associated endocarditis IVDU results in a fulminant initial presentation, but a longer-term prognosis is good with surgical and medical treatment.
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Affiliation(s)
- Cheryl Zhiya Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Robin Cherian
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Perryn Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Tiong Cheng Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Lieng Hsi Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Wern Miin Soo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Raymond Ching Chiew Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Paul Anantharajah Tambyah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore
| | - William Kok-Fai Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Edgar Lik Wui Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
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2
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Tan SR, Low CJW, Ng WL, Ling RR, Tan CS, Lim SL, Cherian R, Lin W, Shekar K, Mitra S, MacLaren G, Ramanathan K. Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis. Life (Basel) 2022; 12:life12101629. [PMID: 36295065 PMCID: PMC9605512 DOI: 10.3390/life12101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022] Open
Abstract
Microaxial left ventricular assist devices (LVAD) are increasingly used to support patients with cardiogenic shock; however, outcome results are limited to single-center studies, registry data and select reviews. We conducted a systematic review and meta-analysis, searching three databases for relevant studies reporting on microaxial LVAD use in adults with cardiogenic shock. We conducted a random-effects meta-analysis (DerSimonian and Laird) based on short-term mortality (primary outcome), long-term mortality and device complications (secondary outcomes). We assessed the risk of bias and certainty of evidence using the Joanna Briggs Institute and the GRADE approaches, respectively. A total of 63 observational studies (3896 patients), 6 propensity-score matched (PSM) studies and 2 randomized controlled trials (RCTs) were included (384 patients). The pooled short-term mortality from observational studies was 46.5% (95%-CI: 42.7–50.3%); this was 48.9% (95%-CI: 43.8–54.1%) amongst PSM studies and RCTs. The pooled mortality at 90 days, 6 months and 1 year was 41.8%, 51.1% and 54.3%, respectively. Hemolysis and access-site bleeding were the most common complications, each with a pooled incidence of around 20%. The reported mortality rate of microaxial LVADs was not significantly lower than extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumps (IABP). Current evidence does not suggest any mortality benefit when compared to ECMO or IABP.
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Affiliation(s)
- Shien Ru Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Christopher Jer Wei Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Wei Lin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119228, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore
| | - Robin Cherian
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore
| | - Weiqin Lin
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
- Faculty of Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Saikat Mitra
- Intensive Care Unit, Dandenong and Casey Hospital, Monash Health, Melbourne, VIC 3175, Australia
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Health System, Singapore 119228, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Health System, Singapore 119228, Singapore
- Correspondence:
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3
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Ng P, Cherian R, Chan SP, Soo WM, Kong W, Poh KK, Wong R, Yeo TC, Ling LH, Tay E. Severe Functional Tricuspid Valve Regurgitation: Predictors of Mortality After Initial Diagnosis. Heart Lung Circ 2022; 31:1234-1240. [PMID: 35667972 DOI: 10.1016/j.hlc.2022.04.053] [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: 11/20/2021] [Revised: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Severe functional tricuspid regurgitation (fTR) is associated with adverse clinical outcomes and remains under-treated. There is recent interest in this disease due to emerging tricuspid valve therapies. However, the timing and selection of patients who may benefit from treatment is uncertain. Risk factors associated with mortality after diagnosis of severe fTR may help guide treatment. AIM We studied patients with severe fTR to assess predictors of mortality. METHODS We retrospectively identified consecutive patients who had severe fTR diagnosed on transthoracic echocardiography in a single academic tertiary hospital. These were categorised into atrial fibrillation (AF)- and non-AF-related groups. Patient characteristics and echocardiographic parameters were collected. We then analysed the collected parameters on their impact on occurrence of mortality and also on the time to mortality. RESULTS A total of 635 patients with severe fTR were studied (41.6 % male, mean age of 68.6±15.4 years). There were 130 (20.5%) in the AF-related group and 505 (79.5%) in the non-AF related-group. Median follow-up duration was 774 days, during which 154 (24.3%) deaths occurred within the first year. Older age on diagnosis, reduced left ventricular ejection fraction (LVEF) (<50%), high pulmonary systolic pressure (PASP) (>50 mmHg) and a prior history of heart failure admissions were associated with occurrence of mortality. Older age on diagnosis, reduced LVEF, and high PASP were also found to be associated with time to mortality. CONCLUSIONS For patients diagnosed with severe fTR, advanced age on diagnosis, prior heart failure admission, LVEF <50%, and PASP >50 mmHg are associated with mortality. These factors could form the basis of future studies that determine the timing and decision to intervene in patients with severe fTR.
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Affiliation(s)
- Perryn Ng
- National University Heart Centre, Singapore.
| | | | | | | | | | | | | | | | | | - Edgar Tay
- National University Heart Centre, Singapore
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4
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Chieng JHL, Sia TK, Teo YH, Wong JZA, Ng TJY, Teo YN, Syn NL, Cherian R, Lim YC, Chai P, Lin W, Wong RC, Sia CH. Evaluating the Initiation of Sodium/Glucose Cotransporter 2 Inhibitors within 2 Weeks of an Acute Hospital Admission: A Systematic Review and Meta-Analysis of Nine Clinical Trials. Med Princ Pract 2022; 31:215-223. [PMID: 35378527 PMCID: PMC9274826 DOI: 10.1159/000524435] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/20/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Recent studies have increasingly shown the benefits of using sodium/glucose cotransporter 2 inhibitor (SGLT2i). However, there are concerns regarding the initiation of SGLT2i during acute hospital admissions due to the potential increased risk of complications. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of SGLT2i initiation within 2 weeks of an acute hospital admission. METHODS Four electronic databases (PubMed, Embase, Cochrane, and Scopus) were searched for articles published from inception up to 27 March 2021 that evaluated the efficacy and/or safety of SGLT2i initiation within 2 weeks of an acute hospital admission. Random-effects pair-wise meta-analysis models were utilized to summarize the studies. The protocol was registered with PROSPERO (CRD42021245492). RESULTS Nine clinical trials were included with a combined cohort of 1,758 patients. Patients receiving SGLT2i had a mean increase in 24-h urine volume of +487.55 mL (95% CI 126.86-848.25; p = 0.008) compared to those not started on SGLT2i. Patients with heart failure treated with SGLT2i had a 27% relative risk reduction in rehospitalizations for heart failure, compared to controls (risk ratio 0.73; p = 0.005). There were no differences in other efficacy and safety outcomes examined. CONCLUSION There was no increased harm with initiation of SGLT2i within 2 weeks of an acute hospital admission, and its use reduced the relative risk of rehospitalizations for heart failure in patients with heart failure. It was also associated with increased urine output. However, current evidence pool is limited, especially in specific population subtypes.
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Affiliation(s)
- Jenny Hui Ling Chieng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tze Kai Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joseph Zi An Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tricia Jing Ying Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas L.X. Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Robin Cherian
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Yoke-Ching Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Weiqin Lin
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Raymond C.C. Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
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5
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Ng LFP, Tay E, Chan SP, Soo WM, Kong WKF, Poh KK, Wong RCC, Yeo TC, Ling LH, Cherian R. PREDICTORS OF MORTALITY FOR SEVERE ATRIAL FIBRILLATION-RELATED FUNCTIONAL TRICUSPID REGURGITATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Djohan AH, Evangelista LKM, Sia CH, Lin W, Chan KH, Ching LY, Chan MY, Cherian R, Wong RCC, Lee RCH, Tung BWL, Ng ZY, Tan HC, Yeo TC, Chai P, Low A, Loh PH. ASSOCIATION BETWEEN CLINICAL CHARACTERISTICS AND THE DEVELOPMENT OF CARDIOGENIC SHOCK IN ASIAN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Evangelista LKM, Djohan AH, Sia CH, Tan SML, Low A, Lim YC, Chan M, Cherian R, Wong RCC, Lee CH, Ng P, Yeo TC, Chai P, Tan HC, Lin W, Loh PH. ASSOCIATION BETWEEN CLINICAL CHARACTERISTICS AND IMPROVEMENT IN LEFT VENTRICULAR EJECTION FRACTION IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01524-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Ramachandran S, Rupakheti M, Cherian R. Insights into recent aerosol trends over Asia from observations and CMIP6 simulations. Sci Total Environ 2022; 807:150756. [PMID: 34619211 DOI: 10.1016/j.scitotenv.2021.150756] [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] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
Aerosols continue to contribute the largest uncertainty in climate change. Over Asia, a global aerosol hotspot, spatial patterns of aerosol emissions are changing mainly because of changes in anthropogenic emissions, producing a dipole in atmospheric aerosol loading between East (decrease in emissions) and South Asia (increase in emissions). The resultant aerosol radiative effects are expected to be different as compared to the last decades of the 20th century because of this emerging Asian aerosol dipole. The projection and assessments of radiative and climate impacts of aerosols rely on simulating accurately the aerosol properties, thus, making it imperative that current climate models involved in climate assessments including the Intergovernmental Panel on Climate Change Assessment Reports, simulate well the magnitude and trends in changing aerosol properties. For the first time, in this study we analyze trends in aerosol properties over Asia from satellite and ground-based observations, and simulations from climate models in Coupled Model Intercomparison Project Phase 6 (CMIP6) experiment with state-of-the-art treatment of aerosol chemistry, physics and meteorology. The results reveal large inter-model differences in model estimates, and discrepancies between model simulations and observations as most models are not able to capture the recent observed magnitudes and trends in aerosol optical depth (AOD) and single scattering albedo (SSA) over Asia. The absolute and the relative (percent) trends (positive and/or negative) in AOD are significantly higher than the trends in SSA. The aerosol-induced effective radiative forcing within the atmosphere simulated with three CMIP6 models show a positive (increasing) trend over Asia. A positive trend in atmospheric heating due to aerosols in model simulations is consistent with model simulated trends in AOD (positive) and SSA (negative). These results on model-observations comparison need to be taken into account while examining the projected/expected future climate impacts due to aerosols, and potential value of various mitigation measures, in particular on regional and decadal climate change in Asia which is largely uncertain. MAIN FINDING: Our analysis of satellite and ground-based observations, and simulations from climate models in CMIP6 experiment with state-of-the-art treatment of aerosol chemistry, physics and meteorology reveal large difference in model calculations, and most models are not able to capture the recent observed trends in aerosol optical depth and single scattering albedo over Asia during 2000-2018.
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Affiliation(s)
- S Ramachandran
- Physical Research Laboratory, Ahmedabad, India; Institute for Advanced Sustainability Studies, Potsdam, Germany.
| | | | - R Cherian
- Leipzig Institute for Meteorology, University of Leipzig, Leipzig, Germany
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9
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Cherian R, Chandra B. Time to move away from an oxygen-centric model of pulmonary infarction? Lancet Respir Med 2021; 9:e91. [PMID: 34352218 PMCID: PMC9765706 DOI: 10.1016/s2213-2600(21)00325-8] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Robin Cherian
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228
| | - Bharatendu Chandra
- Division of Neurology, National University Hospital, Singapore,Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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10
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Li TYW, Ngiam JN, Chew NWS, Tham SM, Lim ZY, Cen S, Lim SL, Cherian R, Wong RCC, Chai P, Yeo TC, Tambyah PA, Santosa A, Cross GB, Sia CH. Low incidence of cardiac complications from COVID-19 and its treatment among hospitalised patients in Singapore. Ann Acad Med Singap 2021; 50:490-493. [PMID: 34195758 DOI: 10.47102/annals-acadmedsg.202122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Tony Yi Wei Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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11
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Tung ML, Tan B, Cherian R, Chandra B. Anti-phospholipid syndrome and COVID-19 thrombosis: connecting the dots. Rheumatol Adv Pract 2021; 5:rkaa081. [PMID: 33615129 PMCID: PMC7882149 DOI: 10.1093/rap/rkaa081] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
As the coronavirus disease 2019 (COVID-19) pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly worldwide, it has emerged as a leading cause of mortality, resulting in >1 million deaths over the past 10 months. The pathophysiology of COVID-19 remains unclear, posing a great challenge to the medical management of patients. Recent studies have reported an unusually high prevalence of thromboembolic events in COVID-19 patients, although the mechanism remains elusive. Several studies have reported the presence of aPLs in COVID-19 patients. We have noticed similarities between COVID-19 and APS, which is an autoimmune prothrombotic disease that is often associated with an infective aetiology. Molecular mimicry and endothelial dysfunction could plausibly explain the mechanism of thrombogenesis in acquired APS. In this review, we discuss the clinicopathological similarities between COVID-19 and APS, and the potential role of therapeutic targets based on the anti-phospholipid model for COVID-19 disease.
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Affiliation(s)
- Moon Ley Tung
- Department of Hematology and Oncology, National University Cancer Institute
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Bryce Tan
- Department of Medicine, National University Hospital
| | - Robin Cherian
- Yong Loo Lin School of Medicine, National University of Singapore
- Department of Cardiology, National University Heart Centre Singapore
| | - Bharatendu Chandra
- Yong Loo Lin School of Medicine, National University of Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
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12
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Affiliation(s)
- Robin Cherian
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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13
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Cherian R, Chandra B, Tung ML, Vuylsteke A. Positive Bubble Study in Severe COVID-19 Indicates the Development of Anatomical Intrapulmonary Shunts in Response to Microvascular Occlusion. Am J Respir Crit Care Med 2021; 203:263-265. [PMID: 32997512 PMCID: PMC7874427 DOI: 10.1164/rccm.202008-3186le] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robin Cherian
- National University Heart Centre Singapore Singapore, Singapore
| | | | - Moon Ley Tung
- National University Cancer Institute Singapore, Singapore and
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14
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Lin W, Cherian R, Kang GS, Tan HC, Low AF. Catheter-Based Left Ventricular Assist Device for the Management of Cardiogenic Shock Complicating Acute Myocardial Infarction: A First-in-Singapore Experience. Ann Acad Med Singap 2020; 49:707-711. [PMID: 33241263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Weiqin Lin
- Department of Cardiology, National University Heart Centre, Singapore
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15
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Cherian R, Chandra B, Tung ML, Vuylsteke A. COVID-19 conundrum: clinical phenotyping based on pathophysiology as a promising approach to guide therapy in a novel illness. Eur Respir J 2020; 56:13993003.02135-2020. [PMID: 32675212 PMCID: PMC7366182 DOI: 10.1183/13993003.02135-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Robin Cherian
- Dept of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Bharatendu Chandra
- Division of Neurology, National University Hospital, Singapore, Singapore
| | - Moon Ley Tung
- Dept of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Alain Vuylsteke
- Dept of Anaesthesia and Critical care, Royal Papworth Hospital NHS Trust, Cambridge, UK
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16
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Low TT, Cherian R, Lim SL, Chandra B, Tung ML, Kumar SK, Lye P, Chin Xin Yi A, Teo L, Tay ELW. Rethinking COVID-19 'pneumonia' - is this primarily a vaso-occlusive disease, and can early anticoagulation save the ventilator famine? Pulm Circ 2020; 10:2045894020931702. [PMID: 32537129 PMCID: PMC7268134 DOI: 10.1177/2045894020931702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Ting-Ting Low
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Robin Cherian
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | | | - Moon Ley Tung
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | | | - Priscillia Lye
- Department of Medicine, National University Hospital, Singapore
| | | | - Lynette Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Edgar Lik-Wui Tay
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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17
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Affiliation(s)
- Robin Cherian
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Hoy W, Zhang J, Wang Z, Healy H, Venuthurupalli S, Fassett R, Tan K, Cherian R, Cameron A, CKD.QLD Collaborative O. SAT-242 THE END OF THE CKD JOURNEY - RENAL REPLACEMENT THERAPY (RRT) OR DEATH WITHOUT RRT: THE CKD.QLD EXPERIENCE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.278] [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] Open
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19
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Ng P, Tay E, Chan SP, Ling LH, Yeo TC, Wong R, Poh KK, Kong W, Cherian R. 5321Severe functional tricuspid valve regurgitation: predictors of mortality at 1 and 2 years and heart failure admission. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Ng
- National University Heart Centre, Singapore, Singapore
| | - E Tay
- National University Heart Centre, Singapore, Singapore
| | - S P Chan
- National University Heart Centre, Singapore, Singapore
| | - L H Ling
- National University Heart Centre, Singapore, Singapore
| | - T C Yeo
- National University Heart Centre, Singapore, Singapore
| | - R Wong
- National University Heart Centre, Singapore, Singapore
| | - K K Poh
- National University Heart Centre, Singapore, Singapore
| | - W Kong
- National University Heart Centre, Singapore, Singapore
| | - R Cherian
- National University Heart Centre, Singapore, Singapore
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Antony J, Godbolt D, Burstow D, Fetherston E, Wijesekera V, Williams L, Garg R, Cherian R, Kannan R, Platts D. Papillary Fibroelastoma of Mitral Valve Chordae. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.487] [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: 11/25/2022]
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21
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Kalk NJ, Guo Q, Owen D, Cherian R, Erritzoe D, Gilmour A, Ribeiro AS, McGonigle J, Waldman A, Matthews P, Cavanagh J, McInnes I, Dar K, Gunn R, Rabiner EA, Lingford-Hughes AR. Decreased hippocampal translocator protein (18 kDa) expression in alcohol dependence: a [ 11C]PBR28 PET study. Transl Psychiatry 2017; 7:e996. [PMID: 28072413 PMCID: PMC5545729 DOI: 10.1038/tp.2016.264] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 11/02/2016] [Accepted: 11/13/2016] [Indexed: 01/05/2023] Open
Abstract
Repeated withdrawal from alcohol is clinically associated with progressive cognitive impairment. Microglial activation occurring during pre-clinical models of alcohol withdrawal is associated with learning deficits. We investigated whether there was microglial activation in recently detoxified alcohol-dependent patients (ADP), using [11C]PBR28 positron emission tomography (PET), selective for the 18kDa translocator protein (TSPO) highly expressed in activated microglia and astrocytes. We investigated the relationship between microglial activation and cognitive performance. Twenty healthy control (HC) subjects (45±13; M:F 14:6) and nine ADP (45±6, M:F 9:0) were evaluated. Dynamic PET data were acquired for 90 min following an injection of 331±15 MBq [11C]PBR28. Regional volumes of distribution (VT) for regions of interest (ROIs) identified a priori were estimated using a two-tissue compartmental model with metabolite-corrected arterial plasma input function. ADP had an ~20% lower [11C]PBR28 VT, in the hippocampus (F(1,24) 5.694; P=0.025), but no difference in VT in other ROIs. Hippocampal [11C]PBR28 VT was positively correlated with verbal memory performance in a combined group of HC and ADP (r=0.720, P<0.001), an effect seen in HC alone (r=0.738; P=0.001) but not in ADP. We did not find evidence for increased microglial activation in ADP, as seen pre-clinically. Instead, our findings suggest lower glial density or an altered activation state with lower TSPO expression. The correlation between verbal memory and [11C]PBR28 VT, raises the possibility that abnormalities of glial function may contribute to cognitive impairment in ADP.
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Affiliation(s)
- N J Kalk
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK,National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 4 Windsor Walk, London SE5 8BB, UK. E-mail:
| | - Q Guo
- Neuroimaging Department, Kings College London, London, UK,Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - D Owen
- Division of Brain Sciences, Imperial College London, London, UK
| | - R Cherian
- West London Mental Health NHS Trust, London, UK
| | - D Erritzoe
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - A Gilmour
- Centre for Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - A S Ribeiro
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - J McGonigle
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - A Waldman
- Division of Brain Sciences, Imperial College London, London, UK
| | - P Matthews
- Division of Brain Sciences, Imperial College London, London, UK
| | - J Cavanagh
- Institute of Health and Well-being, University of Glasgow, Glasgow, UK
| | - I McInnes
- Centre for Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | - K Dar
- Central and North West London NHS Trust, London, UK
| | - R Gunn
- Imanova Limited, London, UK
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Bansal A, McGregor DH, Anand O, Singh M, Rao D, Cherian R, Wani SB, Rastogi A, Singh V, House J, Jones PG, Sharma P. Presence or absence of intestinal metaplasia but not its burden is associated with prevalent high-grade dysplasia and cancer in Barrett's esophagus. Dis Esophagus 2013; 27:751-6. [PMID: 24165297 DOI: 10.1111/dote.12151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Universal agreement on the inclusion of intestinal metaplasia to diagnose Barrett's esophagus (BE) is lacking. Our aim was to determine the association of intestinal metaplasia and its density with the prevalence of dysplasia/cancer in columnar lined esophagus (CLE). Patients with CLE but no intestinal metaplasia (CLE-no IM) were identified by querying the clinical pathology database using SNOMED codes for distal esophageal biopsies. CLE-IM patients were identified from a prospectively maintained database of BE patients. Subsequently, relative risks for prevalent dysplasia and cancer were calculated. Since patients with CLE-no IM are not usually enrolled in surveillance, only prevalent dysplasia/cancer on index endoscopy was analyzed. Goblet cell density and percent intestinal metaplasia were estimated. All biopsy slides were reviewed for dysplasia by two experienced gastrointestinal pathologists. Two hundred sixty-two CLE-IM and 260 CLE-no IM patients were included (age 64±12 vs. 60±11 years, P=0.001; whites 92% vs. 82%, P=0.001; males 99.7% vs. 99.3%, P=NS; CLE length 3.4±3.2 vears 1.4±0.4 cm, P=0.001 and hiatus hernia 64% vs. 56%, P=0.013). The odds of finding low-grade dysplasia and of high-grade dysplasia (HGD)/cancer were 12.5-fold (2.9-53.8, P=0.007) and 4.2-fold (95% CI 1.4-13, P=0.01) higher, respectively, in the CLE-IM group. Reanalysis after controlling for important variables of age, race, and length did not significantly alter the overall results. In CLE-IM group, when patients with high (>50/LPF) versus low goblet cell density (<50/LPF) and <10% versus >10% intestinal metaplasia were compared, the odds of HGD/cancer, OR 1.5 (0.5-4.9, P=0.5) and 1.97 (0.54-7.22), respectively, were not significantly higher. Demonstration of intestinal metaplasia continues to be an essential element in the definition of BE, but its quantification may not be useful for risk stratification of HGD/cancer in BE.
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Affiliation(s)
- A Bansal
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, University of Kansas Medical Center, Kansas City, Missouri, USA; Kansas Cancer Institute, Veterans Affairs Medical Center, University of Kansas Medical Center, Kansas City, Missouri, USA
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Tofteland N, Singh M, Gaddam S, Wani SB, Gupta N, Rastogi A, Bansal A, Kanakadandi V, McGregor DH, Ulusarac O, Cherian R, Mathur SC, Sharma P. Evaluation of the updated confocal laser endomicroscopy criteria for Barrett's esophagus among gastrointestinal pathologists. Dis Esophagus 2013; 27:623-9. [PMID: 24006939 DOI: 10.1111/dote.12121] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Previously developed novel probe-based confocal laser endomicroscopy (pCLE) criteria have been found to have high accuracy and substantial interobserver agreement (IOA) for diagnosing dysplasia in Barrett's esophagus (BE) when used by endoscopists. These updated criteria are: (i) epithelial surface: saw toothed, (ii) cells: enlarged, (iii) cells: pleomorphic, (iv) glands: not equidistant, (v) glands: unequal in size and shape, and (vi) goblet cells: not easily identified. The accuracy and IOA among pathologists in the diagnosis of dysplasia using the novel pCLE criteria is not known. The primary objective of the study was to evaluate the accuracy, overall IOA and learning curve among three gastrointestinal (GI) pathologists in diagnosing dysplasia in BE using the updated pCLE criteria. The secondary aim was to compare the accuracy and IOA between GI pathologists and gastroenterology endoscopists. Ninety pCLE videos and respective histology were retrieved from a previously conducted multicenter, prospective, randomized, controlled trial evaluating the utility of pCLE in BE patients. Videos were obtained from 101 BE patients previously enrolled for surveillance or endoscopic treatment of high-grade dysplasia or early esophageal adenocarcinoma. Three GI pathologists reviewed 90 pCLE video clips for dysplasia versus no dysplasia, confidence in their diagnosis, and image quality. The overall accuracy for the diagnosis of dysplasia (low-grade dysplasia/high-grade dysplasia/esophageal adenocarcinoma) was 77.8% (95% confidence interval [CI]: 72.4-82.3). The accuracy was higher when pathologists had 'high confidence' in their assessment of the videos (93.8% vs. 69.3%, P < 0.001). There was no significant difference in accuracy between the first set of 30 and second set of 60 videos (84% vs. 74%, P = 0.065). IOA among GI pathologists was substantial, k = 0.65 (95% CI: 0.53-0.73). The sensitivity for detecting dysplasia was 85% (95% CI: 78.1-90.7) and the specificity was 70% (95% CI: 61.91-77.92). These results were comparable with the evaluation of the same set of videos by endoscopists. GI pathologists have high accuracy and substantial IOA for diagnosing BE dysplasia with pCLE. Pathologists appear to have similar accuracy and IOA as endoscopists. These results provide further support of endoscopists accurately interpreting the in vivo optical histology provided by pCLE.
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Affiliation(s)
- N Tofteland
- Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri, USA; Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Petit G, Kornreich C, Noel X, Verbanck P, Campanella S, Choi J, Park SM, Park CB, Gwak AR, Hwang JY, Lee JY, Jung HY, Maurage P, Noel X, Joassin F, Philippot P, Hanak C, Verbank P, Luminet O, de Timary P, Campanella S, Grynberg D, Maurage P, Noel X, Joassin F, Hanak C, Verbank P, Luminet O, de Timary P, Campanella S, Philippot P, Grynberg D, Nyssen L, Quertemont E, Noel X, Doallo S, Gomez-Suarez A, Malkowska A, Topolewska-Wochowska A, Bamburowicz-Klimkowska M, Matsumoto H, Szutowski M, Wojnar M, Corral M, Mateos P, Porras C, Garcia-Moreno LM, Cadaveira F, Rubio G, Libman-Sokolowska M, Matsumoto H, Sygitowicz G, Filipek A, Piwowarska J, Dziklinska A, Radziwon-Zaleska M, Ryszewska-Pokrasniewicz B, Skalski M, Naruszewicz M, Biecek P, Tyce M, Zwierzchowska K, Nasierowski T, Sitkiewicz D, Wojnar M, Kalk N, Cherian R, Naveed M, Newson M, Cavanagh J, Rabiner E, Dar K, McInnes I, Lingford-Hughes A, Neumann A, Vande Weghe N, Philippot P, Luminet O, de Timary P, Vilenne A, Kreusch F, Quertemont E, Brkic S, Soderpalm B, Soderpalm-Gordh A, Oswald L, Wand G, Kuwabara H, Wong D, Brown C, Hutchison KE, Karoly H, Bryan AD, Thayer R, Weiland B, Harlaar N, Bryan AD, Thayer R, Weiland B, Montanaro E, Hutchison K, Lason W, Walecki P, Gorzelanczyk EJ, Walecki P, Gorzelanczyk EJ, Feit J, Pasgreta K, Lason W, Ziolkowski M. PSYCHOLOGY AND MARKERS. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt117] [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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Abstract
BACKGROUND Leukaemic transformation (LT) is rare in the natural history of Philadelphia(Ph) chromosome-negative myeloproliferative disorders (MPD), and has a dismal prognosis. Little literature is available on Asian patients. AIMS The aim of this study is to report a single institution experience of Asian patients who developed acute leukaemia after being diagnosed and treated for Ph chromosome-negative MPDs, and to compare the findings of this series with similar studies from the literature. METHODS Patients were recruited from the MPD registry of Singapore General Hospital, Department of Hematology. Clinical data including treatment modalities and duration of use in myeloproliferative phase, latency to LT, characteristics of leukaemia, chemotherapy administered and survival after LT were examined. RESULTS Over a 29-year period from 1980 to 2009, there were 22 Asian patients with LT of Ph chromosome-negative MPD of which four had polycythaemia vera (PV), nine had essential thrombocythaemia (ET), seven had myelofibrosis (MF) and two had unspecified MPD at diagnosis. Primary treatment modality was Hydroxyurea (HU) during MPD phase. Median latency to LT was 14 years for PV, 10 years for ET and 1 year for MF. Median age at LT diagnosis was 67.5 years. Nine patients had complex cytogenetics, with abnormalities of chromosomes 5 and 7 being common. Overall, median survival was 2 months after LT. Eight patients who received induction chemotherapy had a median survival of 2.5 months. Survival was independent of MPD type and treatment administered. None received stem cell transplantation. CONCLUSIONS LT of Ph chromosome-negative MPD is rare and uniformly fatal. Despite chemotherapy, survival was poor, and patients succumbed to refractory disease and infections. Asian patients did not have a more favourable outcome. It remains to be investigated whether upfront stem cell transplant may be a treatment option.
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Affiliation(s)
- R Cherian
- Department of Hematology, Singapore General Hospital, Singapore.
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26
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Tadiparthi R, Ponnuru K, Cherian R, Mathur SC, Rastogi A. An uncommon presentation of a common cancer. Endoscopy 2010; 42 Suppl 2:E61-2. [PMID: 20157893 DOI: 10.1055/s-0029-1243874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- R Tadiparthi
- Division of Gastroenterology and Hepatology, Veteran's Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
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Amritanand R, Venkatesh K, Cherian R, Shah A, Sundararaj GD. Telangiectatic osteosarcoma of the spine: a case report. Eur Spine J 2008; 17 Suppl 2:S342-6. [PMID: 18421481 DOI: 10.1007/s00586-008-0672-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 03/08/2008] [Accepted: 03/30/2008] [Indexed: 10/22/2022]
Abstract
Telangiectatic osteosarcoma (TOS) of the spine is rare accounting for only 0.08% of all primary osteosarcomas. Though a well described radio-pathological entity it is not often thought of as a cause of paraplegia. We describe the clinical, radiological and pathological features and discuss the treatment options of telangiectatic osteosarcoma of the dorsal spine presenting in a young man. The diagnostic pitfalls are discussed emphasising the fact that the diagnosis of TOS of the spine requires not only a multi modal approach of appropriate radiological and pathological tests but also an awareness of this condition.
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Affiliation(s)
- R Amritanand
- Department of Orthopaedics Unit 1 and Spinal Disorder Services, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
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Ayyappan AP, Thomas R, Kurian S, Christopher DJ, Cherian R. Multiple cavitating masses in an immunocompromised host with rheumatoid arthritis-related interstitial lung disease: an unusual expression of cytomegalovirus pneumonitis. Br J Radiol 2006; 79:e174-6. [PMID: 17065281 DOI: 10.1259/bjr/17487872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cytomegalovirus is a known opportunistic infection in immunocompromised individuals. We document multiple cavitating lung masses caused by cytomegalovirus in a patient with rheumatoid arthritis-induced interstitial lung disease on immunosuppressant medication, an unusual expression of CMV pneumonitis. With increasing use of immunosuppressive therapy and increase in AIDS, pulmonary cytomegalovirus infection is expected to be a more frequently encountered disease and familiarity with its uncommon radiological manifestations will be advantageous.
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Affiliation(s)
- A P Ayyappan
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632 004 India.
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Balasubramanian P, Mathew J, Cherian R, Abraham OC. Bilateral massive pleural effusion--a rare presentation of sarcoidosis. J Postgrad Med 2005; 51:335-6. [PMID: 16388185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
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30
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John AJ, Cherian R, Subhash HS, Cherian AM. Evaluation of the efficacy of bitter gourd (momordica charantia) as an oral hypoglycemic agent--a randomized controlled clinical trial. Indian J Physiol Pharmacol 2003; 47:363-5. [PMID: 14723327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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31
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Sharma P, Weston AP, Topalovski M, Cherian R, Bhattacharyya A, Sampliner RE. Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett's oesophagus. Gut 2003; 52:24-7. [PMID: 12477754 PMCID: PMC1773525 DOI: 10.1136/gut.52.1.24] [Citation(s) in RCA: 245] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The presence of intestinal metaplasia (IM) in the columnar lined distal oesophagus defines Barrett's oesophagus with the risk of future malignant transformation. The distribution of both IM and dysplasia (low grade (LGD) and high grade (HGD)) within the columnar lined oesophagus is patchy and mosaic requiring random biopsies. Techniques that could help target areas of high yield within Barrett's mucosa would be helpful. AIM To study the utility of high magnification chromoendoscopy (MCE) in the detection of IM, LGD, and HGD in patients with Barrett's oesophagus. METHODS Consecutive patients detected with columnar mucosa in the distal oesophagus were studied using an Olympus magnification endoscope (GIF-Q16OZ, 115x). The distal oesophagus was sprayed with indigo carmine solution and the oesophageal columnar mucosa patterns were noted under high magnification and targeted for biopsy. All biopsies were read by pathologists blinded to the endoscopic findings. RESULTS Eighty patients with suspected Barrett's oesophagus (that is, columnar lined distal oesophagus) were studied: mean age 62.7 years (range 35-81). Mean length of columnar mucosa was 3.7 cm (range 0.5-17). Three types of mucosal patterns were noted within the columnar mucosa after spraying indigo carmine and using MCE: ridged/villous pattern, circular pattern, and irregular/distorted pattern. The yield of IM on target biopsies according to the patterns was: ridged/villous 57/62 (97%) and circular 2/12 (17%). Six patients had an irregular/distorted pattern and all had HGD on biopsy (6/6 (100%)). Eighteen patients had LGD on target biopsies; all had the ridged/villous pattern. All patients with long segment Barrett's were identified using MCE whereas 23/28 patients (82%) with short segment Barrett's had the ridged/villous pattern. CONCLUSIONS MCE helps visually identify areas with IM and HGD having specific patterns but not patients with LGD (appear similar to IM). MCE may be a useful clinical tool for the increased detection of patients with IM as well as for surveillance of patients for the detection of HGD. If these preliminary results are validated, MCE would help identify high yield areas, potentially eliminating the need for random biopsies.
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Affiliation(s)
- P Sharma
- Department of Medicine, Gastroenterology, and Pathology Section, University of Kansas School Medicine and Veterans Affairs Medical Center, Kansas City, MO, USA.
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Abstract
AIM To evaluate the hypothesis that where there is good clinical practice in an emergency department (ED), there is a low uptake of plain radiography. MATERIALS AND METHODS Emergency notes and radiography records were reviewed over one week in January 1999, to determine the rate of radiography of first time attenders at the North Staffordshire NHS Trust. The clinical appropriateness of the imaging was assessed by pairs of radiology specialist registrars and casualty physicians. They judged the appropriateness of the imaging by the 1998 Royal College of Radiologists (RCR) guidelines and/or their clinical judgement, by consensus. Where there was no consensus or the data appeared incomplete, the radiology and ED consultant reviewed the notes. RESULTS A total of 1615 notes were found out of 1643 (98%). Of these, 147 (9%) return attenders were excluded and 32 patients left without being seen. The number of first time attenders was 1436 (87%), of whom 637 (44%) were radiographed; 95% of these radiography examinations were appropriate and 5% were inappropriate. Of the first time attenders who were not radiographed the decision was appropriate in 95% of cases, and inappropriate for 5%, i.e. 5% of those who had no radiography, should have been X-rayed. There were no disagreements between RCR guidelines and the clinical judgements, but in 16% there were no suitable RCR guidelines. Junior doctors were not always able to find the relevant RCR guideline (relevant clinical guideline found in 73% of cases) in the guideline book, compared to the consultants (relevant clinical guideline found in 84% of cases). CONCLUSION The application of the RCR guidelines is taken as representing good clinical practice in determining when to refer a patient for radiography. Based on this assumption, a referral rate for radiography of 44% of first time attenders was found to be appropriate. This referral rate can be taken as a benchmark. A benchmark is necessary in order to allow departments to make a local assessment as to whether their local referral rate is likely to be too high or too low.
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Affiliation(s)
- P J Richards
- Department of Radiology, Keele University, Keele, U.K.
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Rose AR, Roy A, Cherian R, John G. Round pneumonias in adults. J Assoc Physicians India 2002; 50:285-6. [PMID: 12038669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Weston AP, Banerjee SK, Sharma P, Tran TM, Richards R, Cherian R. p53 protein overexpression in low grade dysplasia (LGD) in Barrett's esophagus: immunohistochemical marker predictive of progression. Am J Gastroenterol 2001; 96:1355-62. [PMID: 11374668 DOI: 10.1111/j.1572-0241.2001.03851.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The presence of low grade dysplasia (LGD) within Barrett's esophagus (BE) has a multitude of ramifications. Identification of markers that could risk stratify LGD would be of great clinical benefit. We aimed to prospectively evaluate the prognosis of the immunohistochemical overexpression of p53 protein in BE colocalized to LGD. METHODS Consecutive BE patients in whom LGD was found had a repeat esophagogastroduodenoscopy within 8-12 wk per an ongoing prospective study. At each esophagogastroduodenoscopy, a therapeutic scope was used in conjunction with the Seattle Biopsy Protocol. Patients were observed until development of multifocal high grade dysplasia (mHGD), presence of an HGD dysplasia-associated lesion or mass (DALM) lesion, or frank adenocarcinoma. p53 protein overexpression was determined by computerized immunoquantitation using image analysis software on step serial-sectioned specimens of BE segment(s) harboring LGD. Kaplan-Meier survival curves were made on the ability of p53 staining colocalized to areas of LGD to predict progression to mHGD, HGD DALM, or cancer during prospective follow-up. RESULTS Forty-eight BE patients with LGD were observed for a mean of 41.2+/-22.5 months. During this period, five of 48 patients progressed to mHGD with a focus in which intramucosal cancer could not be excluded (one), mHGD/DALM with one or more foci in which intramucosal cancer could not be excluded (two), cancer (one), or mHGD (one). Twelve had persistent LGD and 31 had regressed to no dysplasia. p53 staining was positive and colocalized to areas of LGD in 4/31 of patients that regressed, 3/12 that persisted, and 3/5 that progressed. Kaplan-Meier curves differed significantly between p53 positive and negative patients for outcome defined as progression of LGD. CONCLUSIONS p53 colocalization with LGD at index LGD diagnosis is a risk factor for progression of LGD. This can potentially be used to risk stratify BE LGD patients in terms of surveillance intervals or enrollment into secondary prevention studies.
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Affiliation(s)
- A P Weston
- Cancer Research Unit, Research Division, Veterans Administration Medical Center, Kansas City, Missouri 64128-2226, USA
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Danda D, Shyam Kumar NK, Cherian R, Cherian AM. Enthesopathy: clinical recognition and significance. Natl Med J India 2001; 14:90-2. [PMID: 11396326] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Enthesopathy is a common clinical finding denoting pathology at the 'entheses', i.e. attachment sites of muscles, tendons, joint capsules, ligaments and fascia to the bone. Inflammatory enthesopathy or enthesitis is a sine qua non of seronegative spondyloarthropathies (SSA). It can also be occupational, metabolic, drug induced, infective or degenerative. Bursitis closely mimics enthesitis. Ultrasound with high frequency transducers is a simple, cost-effective and feasible test to detect enthesopathy which is amenable to treatment with local steroid injections, physiotherapy and non-steroidal anti-inflammatory drugs, in addition to treatment of the primary disease. Unrecognized and untreated, it can lead to considerable morbidity.
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Affiliation(s)
- D Danda
- Department of Medicine, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India.
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Abstract
OBJECTIVE The management of Barrett's high-grade dysplasia (HGD) remains controversial. The aims of this study were to evaluate prospectively the outcome of unifocal HGD (uHGD) in patients with Barrett's esophagus, and to determine demographic and endoscopic features predictive of progression to multifocal HGD (mHGD) and/or adenocarcinoma. METHODS Consecutive Barrett's patients in whom uHGD was found at initial endoscopy or during surveillance underwent intensification of medical treatment and repeat endoscopy. The study endpoint was progression to mHGD or adenocarcinoma or HGD in conjunction with a dysplasia-associated lesion or mass (DALM). HGD diagnosis was confirmed by a second, blinded pathologist. RESULTS A total of 15 Barrett's patients with uHGD met inclusion criteria and have been prospectively followed for a mean +/- SD of 36.8 +/- 23.2 months. All were white and male, with a mean age +/- SD of 61.4 +/- 14.9 yr. Barrett's length varied from 1 to 13 cm (mean, +/- SD, 6.8 +/- 4 cm). Overall, eight (53.3%) uHGD progressed: four of 15 (26.7%) to frank cancer between 17 and 35 months of follow-up, two of 15 (13.3%) to mHGD with DALM in conjunction with one or more foci of possible intramucosal cancer after 12-91 months of follow-up, one of 15 (6.7%) to mHGD with a focus of possible intramucosal cancer after 14 months, and one of 15 (6.7%) to mHGD after 29 months. Seven of 15 (46.7%) uHGD have regressed, five to no dysplasia and two to LGD, over the course of follow-up ranging from 24 to 73 months (mean +/- SD, 43.3 +/- 19.9). All three patients with short-segment Barrett's esophagus with uHGD regressed. Fisher's exact test revealed that Barrett's length > or =3 cm and presence of hiatal hernia approached significance (p < 0.08) in predicting uHGD progression to mHGD/DALM/cancer. However, use of the log-rank test to account for differences in length of follow-up show no significance for hiatal hernia or Barrett's length. CONCLUSIONS Barrett's uHGD has a high risk for progressing to mHGD or cancer. Justification of an observational approach to uHGD should be discouraged. Markers of uHGD progression, as well as regression, are needed.
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Affiliation(s)
- A P Weston
- Veterans Administration Medical Center, Kansas City, Missouri 64128, USA
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Abstract
Chronic pancreatitis (CP) is one condition in which epidemiologic studies have demonstrated a definite association with pancreatic adenocarcinoma (PAC). The pathophysiologic and molecular events that either predispose to the development of, or potentiate the growth of, PAC are unknown. Mutation of the codon 12 K-ras gene is one genetic aberration commonly associated with development of PAC. Tumor angiogenesis, or microvascular proliferation of new capillaries, is another pathophysiologic alteration associated with PAC. Although activated ras oncogenes modulate tumor angiogenesis/neovascularization in some tumors, the importance of tumor angiogenesis and the role of K-ras mutation in regulating angiogenesis in CP and PAC are unknown. The aim of this study was to elucidate the relationship between angiogenesis and K-ras mutations in CP and PAC. Tumor angiogenesis and K-ras mutations were evaluated in resected specimens from 25 CP (23 CP plus two CP with PAC) and 16 PAC patients. Tumor angiogenesis was determined using immunohistochemistry of factor VIII-related antigen (FVIIIRAg) and ras mutations were identified by enriched-nested polymerase chain reaction. The mean number of FVIIIRAg-positive blood vessels was significantly (p < 0.005) higher in PAC (23.0 +/- 7.5), CP with a mutant K-ras genome (17.7 +/- 2.8) and CP with a normal K-ras genome (6.5 +/- 3.8), compared to unaffected areas. Codon 12 K-ras mutations were detected in three of 25 CP specimens (12%) and in 15 of 16 PAC specimens (94%). In CP patients with mutant K-ras in their genome, microvessel density was significantly (p < 0.01) elevated, compared to patients with a normal K-ras genome. Statistical analyses (Spearman rank-difference correlation coefficient, Student t test, and chi2 analysis) indicated a significant association between codon 12 K-ras mutations and tumor angiogenesis in both CP and PAC. This study demonstrates a significant association between angiogenesis and K-ras mutation in both PAC and CP. At a minimum, K-ras mutation is associated with the events that increase angiogenesis and it may potentiate or promote tumor angiogenesis.
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Affiliation(s)
- S K Banerjee
- Research Division, VA Medical Center, Kansas City, Missouri, USA
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Weston AP, Badr AS, Topalovski M, Cherian R, Dixon A, Hassanein RS. Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett's esophagus, Barrett's dysplasia, and Barrett's adenocarcinoma. Am J Gastroenterol 2000; 95:387-94. [PMID: 10685740 DOI: 10.1111/j.1572-0241.2000.01758.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was undertaken to prospectively determine the prevalence of gastric H. pylori infection in Barrett's esophagus and Barrett's complicated by dysplasia or adenocarcinoma. METHODS The prevalence of H. pylori was determined in Barrett's esophagus patients compared to a control population of patients with gastroesophageal reflux disease (GERD) only. All patients had a minimum of 10 gastric surveillance biopsies obtained. H. pylori colonization was determined upon the basis of hematoxylin and eosin and use of a modified Giemsa and or Steiner's silver stain of all gastric biopsy specimens. RESULTS Two hundred and eighty-nine Barrett's patients and 217 GERD control patients were included in the study. H. pylori was found in 95/289 (32.9%) of the Barrett's patients, compared with 96/217 (44.2%) of the GERD controls (NS). Forty-seven of the Barrett's patients had low-grade dysplasia/indefinite dysplasia, 14 high-grade dysplasia, and 20 Barrett's adenocarcinoma. When Barrett's was subgrouped according to absence of dysplasia, and presence of low-grade dysplasia, high-grade dysplasia, or adenocarcinoma, H. pylori prevalence was found to be significantly less for patients with Barrett's high-grade dysplasia (14.3%) and adenocarcinoma (15.0%) versus patients with GERD alone (44.2%), Barrett's alone (35.1%), or Barrett's with low-grade dysplasia (36.2%) (p = 0.016). This difference could not be explained by differences between Barrett's esophagus patients infected with H. pylori and those who were not with respect to gender, smoking history, alcohol consumption, use of proton pump inhibitor, or length of Barrett's mucosa. CONCLUSIONS Barrett's high-grade dysplasia and adenocarcinoma are significantly more prevalent in patients who are not infected with H. pylori. H. pylori appears to have a protective effect against the development of Barrett's adenocarcinoma.
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Affiliation(s)
- A P Weston
- Veterans Administration Medical Center, Kansas City, Missouri, 64128, USA
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Govil S, Justus A, Korah I, Cherian R, Chacko A. Efficacy of non-breath-hold magnetic resonance cholangiography at midfield strength. Indian J Med Res 1999; 110:194-9. [PMID: 10701299] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The efficacy of non-breath-hold magnetic resonance (MR) cholangiography at mid-field strength (0.5 Tesla) was evaluated for delineating biliary anatomy and the cause and extent of biliary obstruction. We performed 65 MR cholangiograms on a mid-field 0.5 Tesla MR unit and correlated them with contrast cholangiography and/or surgery. MR cholangiography was found to be both sensitive and specific in the detection of biliary obstruction and in the definition of its cause (sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 85.7%, accuracy 98%). MR cholangiography accurately predicted the level of obstruction in 94 per cent of strictures. Normal caliber intra-hepatic biliary radicles were visualised in only 6 per cent of the MR cholangiograms. In contrast, 94 per cent of dilated intrahepatic biliary radicles were demonstrated. The confluence, and right and left hepatic ducts were visualized in 98 per cent; the gall bladder in 65 per cent; the cystic duct in 45 per cent and the cystic duct insertion in 25 per cent. The extrahepatic bile duct was seen in 82.7 per cent. A normal caliber pancreatic duct was seen in 18 per cent while a dilated pancreatic duct was seen in 86 per cent. The pancreatico-biliary junction was visualised in 7 per cent. Non-breath-hold MR cholangiography at midfield strength is a highly accurate method of evaluating the cause and level of biliary obstruction, comparable to high-field MR cholangiography. The spatial resolution however is inadequate for the detection of variations in biliary or pancreatic ductal anatomy when the ducts are of normal caliber.
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Affiliation(s)
- S Govil
- Department of Radiology, Christian Medical College & Hospital, Vellore
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Weston AP, Banerjee SK, Horvat RT, Zoubine MN, Campbell DR, Cherian R. Prospective long-term endoscopic and histologic follow-up of gastric lymphoproliferative disease of early stage IE low-grade B-cell mucosa-associated lymphoid tissue type following Helicobacter pylori eradication treatment. Int J Oncol 1999; 15:899-907. [PMID: 10536171 DOI: 10.3892/ijo.15.5.899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Long-term endoscopic and histologic follow-up of Stage IE gastric lymphoproliferative disease of the low-grade B-cell mucosa-associated lymphoid tissue (MALT) type following cure of H. pylori was undertaken. Clinical and endoscopic features (age, race, endoscopic appearance, cure of H. pylori and duration of follow-up) were also evaluated as potential prognostic indicators for complete or near-complete regression of low-grade MALT lymphoma. Sixty-eight MALT lymphoma patients prospectively underwent H. pylori eradication. follow-up at periodic intervals with endoscopy and extensive mucosal biopsy protocol on 65 patients ranging from 12 weeks up to 73 months (mean +/- SD of 22.5+/-15.8 months) has been completed. H. pylori was eradicated in 89.2% of MALT lymphoma patients with complete histologic regression noted in 58.5%, near-complete regression in 18.5%, partial in 4.6%, and no change in 18.5%. Univariate analysis revealed two factors predictive of complete and/or near complete MALT lymphoma regression, H. pylori cure (p=0. 001) and duration of follow-up (p=0.001). Stepwise logistic regression also demonstrated that both H. pylori cure (p<0.0001) and duration of follow-up (p<0.02) were independently associated with complete and near complete MALT lymphoma regression. Age, race, and endoscopic appearance were not predictive of regression. We conclude that this lymphoproliferative disease predictably undergoes complete to near-complete histologic regression at variable rates following cure of H. pylori in a majority of patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Analysis of Variance
- Biopsy
- Endoscopy, Digestive System
- Female
- Follow-Up Studies
- Gastric Mucosa/pathology
- Helicobacter Infections/complications
- Helicobacter Infections/therapy
- Helicobacter pylori
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Polymerase Chain Reaction
- Predictive Value of Tests
- Prospective Studies
- Time Factors
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Affiliation(s)
- A P Weston
- Molecular Gastroenterology and Pancreatic Cancer Research Unit, Research Division 151, VA Medical Center, Kansas City, MO 64128, USA
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McGregor DH, Cherian R, Weston AP, Lawson L, McAnaw MP. Adenocarcinoid of ileum and appendix, incidentally discovered during exploratory laparotomy for gastric MALT lymphoma, with subsequent diffuse prostatic metastases: report of a case with light, immunohistochemical, and electron microscopic studies. Dig Dis Sci 1999; 44:87-95. [PMID: 9952228 DOI: 10.1023/a:1026654200916] [Citation(s) in RCA: 36] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The diagnosis of adenocarcinoid (mucinous/goblet cell carcinoid) is usually unexpected by both clinicians and pathologists. We report here the case of a 74-year-old man with gastric lymphoma (B-cell MALToma) diagnosed by endoscopy, who was found on exploratory laparotomy also to have extensive intraabdominal involvement by adenocarcinoid, arising from the ileum and/or appendix. The patient died two years after diagnosis with bladder outlet and small bowel obstruction due to diffuse metastases. In addition to mucin positivity, immunohistochemical stains demonstrated the tumor to be positive for chromogranin, synaptophysin, serotonin, gastrin, and glucagon. Of histogenetic interest, some individual neoplastic cells appeared to be positive for both mucin and chromogranin, and this was confirmed by the electron microscopic finding of microvilli, intracytoplasmic mucin droplets, and neurosecretory granules involving the same neoplastic cells. This also appears to be the first reported case of adenocarcinoid associated with lymphoma and demonstration of histochemical/immunohistochemical and ultrastructural evidence of cellular components with dual mucinous adenocarcinoma and neuroendocrine features, and the second reported case to have prostatic metastases.
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Affiliation(s)
- D H McGregor
- Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Kansas City, Missouri 64128, USA
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42
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Abstract
Limited information is currently available on chromosomal abnormalities in esophageal adenocarcinoma and associated premalignant lesions. In this study, numeric changes affecting chromosomes 4, 6, 7, 8, 9, 10, 11, 12, 17, 18, X, and Y were analyzed by using fluorescence in situ hybridization (FISH) with chromosome-specific centromere DNA probes in 12 esophageal adenocarcinomas. In addition, TP53 overexpression, measured by immunohistochemistry, and amplification of HER-2/neu and C-MYC, detected by FISH, were analyzed within the same tumors. The most common numeric abnormalities detected were gains of chromosomes 12 (8 cases), 6 (7 cases), 7 (7 cases), and 11 (6 cases). The total number of abnormal chromosomes varied from 0 to 10, with an average of 4.6 per case. Overexpression of TP53 was present in 9 of 12 cases. No correlation was noted between the degree of aneusomy and TP53 overexpression. In contrast, HER-2/neu amplification was present in two cases, both with large numbers of aneusomic chromosomes. Amplification of C-MYC was detected in only one case that had a moderate number of numeric abnormalities. In a subset of cases in which premalignant lesions were examined, aneusomy was found to be an early change, frequently present in both Barrett's esophagus and dysplastic regions. In contrast, gene amplification and TP53 overexpression were restricted to more advanced areas of dysplasia and malignancy. Screening larger cohorts of patients with Barrett's esophagus or dysplasia for numeric abnormalities of chromosomes 6, 7, 11, and 12 may determine whether any of these abnormalities are predictive markers of progression to malignancy.
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Affiliation(s)
- D L Persons
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City 66160-7232, USA
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Weston AP, Banerjee SK, Horvat RT, Cherian R, Campbell DR, Zoubine MN. Specificity of polymerase chain reaction monoclonality for diagnosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma: direct comparison to Southern blot gene rearrangement. Dig Dis Sci 1998; 43:290-9. [PMID: 9512120 DOI: 10.1023/a:1018842002926] [Citation(s) in RCA: 9] [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: 02/06/2023]
Abstract
The specificity of polymerase chain reaction monoclonality in the diagnosis of gastric lymphoma was prospectively evaluated. Gastric mucosal tissue from normal gastric mucosa (N = 13), benign gastric ulcers (N = 3), chronic Helicobacter pylori gastritis (N = 3), gastric mucosa-associated lymphoid tissue (N = 16), and gastric lymphoma (N = 15) was obtained. Polymerase chain reaction amplification of the heavy-chain framework 2A gene was performed. The sensitivity and specificity of heavy-chain clonality, in the detection of gastric lymphoma, were 73.3% and 45.7%, respectively. Determination of monoclonality by polymerase chain reaction methodology is not an acceptable technique for confirming the diagnosis of gastric lymphoma as it is too sensitive, detecting minute populations of clonal lymphocytes that occur in benign diseases as well as larger populations of clonal lymphocytes associated with malignant gastric lymphoproliferative diseases. Southern blot gene rearrangement testing should be utilized to determine clonality in the evaluation of gastric lymphocytic infiltrates.
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Affiliation(s)
- A P Weston
- Molecular Gastroenterology and Pancreatic Cancer Research Unit, Veterans Administration Medical Center, Kansas City, Missouri 64128-2226, USA
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Weston AP, Campbell DR, Hassanein RS, Cherian R, Dixon A, McGregor DH. Prospective, multivariate evaluation of CLOtest performance. Am J Gastroenterol 1997; 92:1310-5. [PMID: 9260796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine prospectively the effect of aspirin, nonsteroidal anti-inflammatory drugs, H2-receptor antagonists, proton pump inhibitors, alcohol intake, race, age, history of Helicobacter pylori eradication attempts, and gastric biopsy location on CLOtest performance. METHODS Biopsy specimens were obtained from the antrum, greater curve, and proximal stomach. One biopsy specimen from each site (except for the proximal stomach) was used for the CLOtest and two or more specimens were used for histopathology. Giemsa staining was used for the definitive determination of H. pylori status. RESULTS One hundred seventeen patients were included in the study, and 50 of these were infected with H. pylori. The sensitivity and specificity of an antral CLOtest, based on the results of Giemsa-stained sections from the antrum alone, were 72.7 and 98.6%, respectively, whereas they were 66.0 and 100% when based on the results of Giemsa-stained sections from all three gastric biopsy sites. The sensitivity and specificity of a body CLOtest, based on the results of Giemsa-stained sections from the body alone, were 80.5% and 93.4%, whereas they were 76.0% and 100% when based on the results of Giemsa-stained sections from all three gastric biopsy sites. Combining CLOtest results from the antrum and body increased CLOtest sensitivity to 82.0%. Univariate analysis revealed only one factor significantly associated with CLOtest concordance: absence of alcohol consumption (p < 0.02). Stepwise logistic regression demonstrated that absence of alcohol use again was independently associated with the concordance between overall CLOtest and all Giemsa-stained biopsy specimen results (p < 0.03) as well as between body CLOtest and body Giemsa-stained biopsy specimen results (p < 0.03). Additional independent and significant associations were noted between antral CLOtest-antral Giemsa-stained biopsy specimen results and no history of H. pylori eradication attempts (p = 0.04) and between body CLOtest-body Giemsa-stained biopsy specimen results and race (African-American) (p < 0.03). CONCLUSIONS Obtaining a gastric biopsy specimen from the antrum as well as from the body increased CLOtest detection of H. pylori. CLOtest performance was shown to be affected by several demographic and clinical factors.
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Affiliation(s)
- A P Weston
- Department of Veterans Affairs Medical Center, Kansas City, Missouri 64128-2226, USA
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Weston AP, Cherian R, Horvat RT, Lawrinenko V, Dixon A, McGregor D. Mucosa-associated lymphoid tissue (MALT) in Barrett's esophagus: prospective evaluation and association with gastric MALT, MALT lymphoma, and Helicobacter pylori. Am J Gastroenterol 1997; 92:800-4. [PMID: 9149188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Prospective evaluation of the prevalence of mucosa-associated lymphoid tissue (MALT) within Barrett's esophagus and its association with gastric MALT, gastric MALT lymphoma, and H. pylori infection. METHODS From Barrett's esophagus patients, a minimum of six gastric biopsies were obtained, in addition to Barrett's surveillance biopsies. Additional gastric biopsies were taken from any ulcer(s), nodule(s), polyp(s), or other lesions. Patients with gastroesophageal reflux symptoms without Barrett's esophagus served as controls. RESULTS One hundred and thirty-nine Barrett's patients were included in the study. One hundred and twenty-two of these patients had gastric biopsies for gastric MALT and H. pylori determination. H. pylori was noted in the stomach of 48 patients and within Barrett's mucosa in 14. Barrett's MALT was noted in seven cases, gastric MALT in 16, and gastric MALT lymphoma in two. None of the 101 control patients had esophageal MALT. Two of the seven patients with Barrett's MALT had gastric MALT. Barrett's MALT was associated with esophageal H. pylori in 57.1% cases and gastric H. pylori in 71.4%. The prevalence of gastric and esophageal H. pylori in patients with Barrett's MALT was significantly higher compared to patients with Barrett's without MALT (p < 0.0001 and p < 0.007, respectively). Barrett's MALT was very focal and its esophageal location variable. CONCLUSIONS Barrett's MALT was associated with both esophageal and gastric H. pylori colonization. Esophageal MALT was associated with Barrett's esophagus. Gastric biopsy sampling is warranted in any patient with Barrett's MALT to detect gastric MALT and H. pylori, which, if found, should be eradicated.
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Affiliation(s)
- A P Weston
- Veterans Administration Medical Center, Kansas City, Missouri 64128, USA
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Weston AP, Krmpotich PT, Cherian R, Dixon A, Topalovski M. Prospective evaluation of intestinal metaplasia and dysplasia within the cardia of patients with Barrett's esophagus. Dig Dis Sci 1997; 42:597-602. [PMID: 9073145 DOI: 10.1023/a:1018811512939] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [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: 02/04/2023]
Abstract
The prevalence of cardia versus noncardia gastric intestinal metaplasia in patients with Barrett's esophagus was assessed prospectively. Four-quadrant biopsies were obtained from the cardia from 119 consecutive patients with Barrett's esophagus and 64 control patients. Gastric surveillance biopsies were obtained in 108 of the Barrett's patients and 58 control patients. There was a significantly greater prevalence of cardia intestinal metaplasia in short-segment Barrett's (10.2%), but not traditional Barrett's (3.3%), compared to control patients (0%) (P = 0.009). Dysplastic changes were significantly more frequent in the metaplastic epithelium within the esophagus than in the cardia (P < 0.0001). A significantly greater prevalence of noncardia intestinal metaplasia compared to cardia intestinal metaplasia was found in each of the three groups of patients; however, the prevalence of noncardia intestinal metaplasia between short-segment, traditional, and control patients was not significantly different. Cardia intestinal metaplasia was an infrequent finding in patients with Barrett's esophagus and appears to develop independently from that in the remainder of the stomach.
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Affiliation(s)
- A P Weston
- Veterans Administration Medical Center, Kansas City, Missouri 64128, USA
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47
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Weston AP, Krmpotich PT, Cherian R, Dixon A, Topalosvki M. Prospective long-term endoscopic and histological follow-up of short segment Barrett's esophagus: comparison with traditional long segment Barrett's esophagus. Am J Gastroenterol 1997; 92:407-13. [PMID: 9068459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Barrett's esophagus is associated with adenocarcinoma of the cardia and esophagus, regardless of its extent. The aim of this study was to compare the prevalence and incidence of dysplasia and adenocarcinoma in short segment and traditional long segment Barrett's esophagus. METHODS Seventy-four patients with short segment Barrett's and 78 with traditional Barrett's entered the study. RESULTS There were no significant differences in age or gender between the two groups of patients with Barrett's esophagus. A greater percentage of patients with short segment barrett's were black (p = 0.04). The prevalence of dysplasia at diagnosis in patients with short segment Barrett's was 8.1% versus 24.4% in patients with traditional Barrett's (p < 0.007). Adenocarcinoma was noted at diagnosis only in patients with traditional Barrett's (p < 0.0005). Twenty-six patients with short segment Barrett's and 29 with traditional Barrett's were followed prospectively for 12-40 months. Dysplasia developed during follow-up in two patients with short segment Barrett's and in six patients with traditional Barrett's (p < 0.05). Neither high grade dysplasia nor cancer developed in any patients with short segment Barrett's. High grade dysplasia did develop in two patients with traditional Barrett's esophagus, and mucosal adenocarcinoma developed in one. The frequency of dysplasia on the latest surveillance examination continued to be significantly higher for patients with traditional Barrett's (p = 0.03). Follow-up surveillance biopsy specimens of Barrett's mucosa frequently demonstrated an absence of goblet cells in patients with short segment Barrett's compared with patients with traditional Barrett's (p < 0.0001). CONCLUSIONS The prevalence of dysplasia or adenocarcinoma and the incidence of dysplasia in patients with traditional Barrett's esophagus are significantly higher than in patients with short segment Barrett's esophagus. Further prospective surveillance is required to determine whether the incidence of adenocarcinoma in patients with short segment Barrett's esophagus is significantly lower.
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Affiliation(s)
- A P Weston
- Veterans Administration Medical Center, Kansas City, Missouri, USA
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Crimmins DL, Cherian R. Increasing the sensitivity of 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate amino acid analysis: a simple solution. Anal Biochem 1997; 244:407-10. [PMID: 9025960 DOI: 10.1006/abio.1996.9930] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D L Crimmins
- Department of Molecular Biology and Pharmacology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. crimmins@labmed
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Abstract
The prostate gland is the most common site of cancer in men in the United States. The biologic behavior of an individual tumor, however, varies widely, with some cancers taking a relatively indolent course and other progressing rapidly to disseminated disease. Prognostic factors that might help predict a tumor's aggressiveness and invasiveness are limited. The expression of urokinase plasminogen activator was evaluated in 36 human prostate cancer specimens. Using an immunohistochemical method with monoclonal antibody #394, 70.6% (12 of 17) of cancer specimens with extracapsular extension showed increased expression of urokinase plasminogen activator, compared with 26.6% (4 of 15) of specimens without capsular invasion. Increased expression was localized to the glandular cytoplasm, with tumor stroma yielding predominantly negative results. These findings provide additional evidence of the role of urokinase in determining the biologic behavior and metastatic potential of prostate cancer.
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Affiliation(s)
- P J Van Veldhuizen
- Division of Oncology, Veterans Affairs Medical Center, Kansas City, Missouri 64128, USA
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Affiliation(s)
- M E Hagan
- Department of Medicine, Veterans Affairs Medical Center, Kansas City, Missouri 64128, USA
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