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Mumtaz ZUA, Desai SR, Padley SPG. Frequency of extracardiac findings on "negative" CT coronary angiography studies. Clin Radiol 2024; 79:e334-e343. [PMID: 38092649 DOI: 10.1016/j.crad.2023.11.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/02/2024]
Abstract
AIM To evaluate the prevalence and nature of extracardiac findings identified on computed tomography (CT) coronary angiography (CTCA) in patients with chest pain but without evidence of coronary artery disease (CAD). MATERIALS AND METHODS CTCA studies in patients referred to the hospital between January 2017 to February 2021 with chest pain and a suspected diagnosis of CAD were reviewed retrospectively for the presence of extracardiac findings. Consensus review of CTCA studies was performed by two experienced thoracic radiologists. The presence and severity of extracardiac findings, together with the likelihood that chest pain might be attributed to these, was recorded. Patient records were reviewed to ascertain the recording of extracardiac findings on initial CTCA reports and, where applicable, the nature of the follow-up. RESULTS Extracardiac findings (n=210) were present in 110/180 patients (61%) with a mean of 1.9 findings per patient. Extracardiac findings were more prevalent in patients aged ≥65 years compared to those <65 years (p<0.001). At least one extracardiac finding with the potential to cause chest pain was present in 40 patients (22%): degenerative disc disease (n=23 [13%]) and hiatus hernia (n=6 [3.3%]) were the most common extracardiac findings. Only 37.6% (79) of all retrospectively identified findings had been initially reported and, of these, 12.7% (10) required further follow-up. CONCLUSION Extracardiac findings are common in patients with no evidence of CAD on CTCA. The entire dataset should be evaluated for the presence of extracardiac findings that could explain chest pain symptoms on wide field of view reconstructions.
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Affiliation(s)
- Z-U-A Mumtaz
- Faculty of Medicine, Imperial College School of Medicine, London, UK.
| | - S R Desai
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK; Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, UK
| | - S P G Padley
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
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2
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Fathy RA, McMahon DE, Lee C, Chamberlin GC, Rosenbach M, Lipoff JB, Tyagi A, Desai SR, French LE, Lim HW, Thiers BH, Hruza GJ, Fassett M, Fox LP, Greenberg HL, Blumenthal K, Freeman EE. Varicella-zoster and herpes simplex virus reactivation post-COVID-19 vaccination: a review of 40 cases in an International Dermatology Registry. J Eur Acad Dermatol Venereol 2021; 36:e6-e9. [PMID: 34487581 PMCID: PMC8656951 DOI: 10.1111/jdv.17646] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 07/11/2021] [Accepted: 09/02/2021] [Indexed: 01/23/2023]
Affiliation(s)
- R A Fathy
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - D E McMahon
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - C Lee
- Department of Dermatology, Las Vegas School of Medicine, University of Nevada, Las Vegas, NV, USA
| | - G C Chamberlin
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - M Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - J B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - A Tyagi
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - S R Desai
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Innovative Dermatology, Plano, TX, USA
| | - L E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - B H Thiers
- Department of Dermatology and Dermatologic Surgery, Medical University of SC, Charleston, SC, USA
| | - G J Hruza
- Department of Dermatology, St. Louis University, St. Louis, MO, USA
| | - M Fassett
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - L P Fox
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | | | - K Blumenthal
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - E E Freeman
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
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3
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Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Desai SR, Fassett M, French LE, Lim HW, Hruza GJ, Fox LP. Cold and COVID: recurrent pernio during the COVID-19 pandemic. Br J Dermatol 2021; 185:214-216. [PMID: 33657646 PMCID: PMC8014788 DOI: 10.1111/bjd.19894] [Citation(s) in RCA: 9] [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: 02/10/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- E E Freeman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - D E McMahon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J B Lipoff
- University of Pennsylvania, Philadelphia, PA, USA
| | - M Rosenbach
- University of Pennsylvania, Philadelphia, PA, USA
| | - S R Desai
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Fassett
- University of California San Francisco, San Francisco, CA, USA
| | - L E French
- University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,University of Miami Miller School of Medicine, Miami, FL, USA
| | - H W Lim
- Henry Ford Health System, Detroit, MI, USA
| | - G J Hruza
- St. Louis University, St. Louis, MO, USA
| | - L P Fox
- University of California San Francisco, San Francisco, CA, USA
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Lim WY, Loh L, Desai SR, Tien SL, Goh BK, Wong P. Major liver surgery in a Jehovah’s Witness patient: challenges for safe surgery. South Afr J Anaesth Analg 2019. [DOI: 10.36303/sajaa.2019.25.3.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Jehovah’s Witnesses presenting for major surgery run the risk of major bleeding, which is complicated by the refusal to accept blood transfusion. We present a case of a 63-year-old woman, a Jehovah’s Witness, who was diagnosed with hepatocellular carcinoma and advised for curative laparoscopic liver segmentectomy. Due to the risk of significant intraoperative haemorrhage, her perioperative care was coordinated in a multidisciplinary manner. Informed consent requires the physician to advise on the material risks of undertaking major surgery without blood transfusion and the possible alternatives. Conflicting ethical issues of patient autonomy and beneficence related to refusal of blood products also arise. Perioperative strategies to minimise blood loss, maximise haematopoiesis and tolerance of anaemia to facilitate safe surgery in such patients are also presented. Written patient consent obtained.
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Affiliation(s)
- WY Lim
- Singapore General Hospital
| | - L Loh
- Singapore General Hospital
| | | | | | - BK Goh
- Singapore General Hospital
| | - P Wong
- Singapore General Hospital
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5
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Antoniou KM, Margaritopoulos GA, Goh NS, Karagiannis K, Desai SR, Nicholson AG, Siafakas NM, Coghlan JG, Denton CP, Hansell DM, Wells AU. Combined Pulmonary Fibrosis and Emphysema in Scleroderma-Related Lung Disease Has a Major Confounding Effect on Lung Physiology and Screening for Pulmonary Hypertension. Arthritis Rheumatol 2016; 68:1004-12. [DOI: 10.1002/art.39528] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 11/19/2015] [Indexed: 02/02/2023]
Affiliation(s)
- K. M. Antoniou
- Royal Brompton and Harefield NHS Foundation Trust, London, UK, and University Hospital of Heraklion; Crete Greece
| | - G. A. Margaritopoulos
- Royal Brompton and Harefield NHS Foundation Trust, London, UK, and University Hospital of Heraklion; Crete Greece
| | - N. S. Goh
- Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - K. Karagiannis
- Royal Brompton and Harefield NHS Foundation Trust; London UK
| | | | - A. G. Nicholson
- Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College; London UK
| | | | - J. G. Coghlan
- Royal Free Hospital and University College London Medical School; London UK
| | - C. P. Denton
- Royal Free Hospital and University College London Medical School; London UK
| | - D. M. Hansell
- Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - A. U. Wells
- Royal Brompton and Harefield NHS Foundation Trust; London UK
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6
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Desai SR, Hedayati V, Patel K, Hansell DM. Chronic Aspergillosis of the Lungs: Unravelling the Terminology and Radiology. Eur Radiol 2015; 25:3100-7. [PMID: 25791639 DOI: 10.1007/s00330-015-3690-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 02/17/2015] [Accepted: 02/23/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED The propensity for Aspergillus spp. to cause lung disease has long been recognised but the satisfactory classification of these disorders is challenging. The problems caused by invasive disease in severely neutropenic patients, saprophytic infection of pre-existing fibrotic cavities and allergic reactions to Aspergillus are well documented. In contrast, a more chronic form of Aspergillus-related lung disease that has the potential to cause significant morbidity and mortality is under-reported. The symptoms of this form of Aspergillus infection may be non-specific and the radiologist may be the first to suspect a diagnosis of chronic pulmonary aspergillosis. The current review considers the classification conundrums in diseases caused by Aspergillus spp. and discusses the typical clinical and radiological profile of patients with chronic pulmonary aspergillosis. KEY POINTS • The classification of Aspergillus -related lung disease is mired in confusion. • The chronic form of Aspergillus infection is associated with significant morbidity and mortality. • Progressive consolidation and cavitation with intracavitary material is the radiological hallmark.
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Affiliation(s)
- S R Desai
- The Department of Radiology, King's Health Partners, King's College London, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK,
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7
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Desai SR, Shinde HH. Correlation of interdental and interradicular bone loss in patients with chronic periodontitis: a clinical and radiographic study. Niger J Clin Pract 2012; 15:125-31. [PMID: 22718157 DOI: 10.4103/1119-3077.97280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the correlation between interdental and interradicular bone loss and clinical parameters in patients with chronic periodontitis. MATERIALS AND METHODS One hundred-twenty intraoral periapical radiographs of first molars were obtained from patients with chronic periodontitis and were digitalized to record height and width of the bone defect in the interdental and interradicular region (furcation) and bone defect angle in the interdental region in vertical defects. Pocket depth (PD) and clinical attachment loss (CAL) was recorded at three sites. The data was divided into groups according to the pocket depth at each site. One-way ANOVA was used to compare three different pocket depths with respect to CAL, height and width at a particular site. This was followed by Tukeys HSD post hoc tests to know the significant difference between two groups of pocket depths. Lastly Karl Pearsson's co-efficient method was applied to find out the relationship among CAL, height and width for the particular site. RESULTS When the pocket depth groups were compared for CAL, height and width of the defect at all three maxillary and mandibular sites, the results were statistically significant. In maxillary molars, a radiographic bone defect height ranging from 3.4-7.1 mm at the mesiobuccal site and 3.6-7.2 mm at the distobuccal site was associated with 1.2-3.5 mm defect height in the interdental region. In mandibular molars, a radiographic bone defect height ranging from 2.9-7.0 mm at the mesiobuccal site and 3.2-6.8 mm at the distobuccal site was associated with 1.2-3.6 mm defect height in the interdental region. The mean bone defect angle was 36.3 ± 16.5 degrees. CONCLUSION Treatment of interdental bone loss can prevent further bone loss in the interradicular region. Radiographic measurements combined with clinical findings can be useful for periodontal risk assessment.
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Affiliation(s)
- S R Desai
- Department of Periodontics, H.K.E. Society's S. Nijalingappa Institute of Dental Sciences and Research, Gulbarga, Karnataka, India.
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Desai SR, Katti G, Desai MS, Karthikeyan I. Evaluation of design parameters of eight dental implant designs: A two-dimensional finite element analysis. Niger J Clin Pract 2012; 15:176-81. [DOI: 10.4103/1119-3077.97308] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Zappala CJ, Desai SR, Copley SJ, Spagnolo R, Cramer D, Sen D, Alam SM, du Bois RM, Hansell DM, Wells AU. Optimal scoring of serial change on chest radiography in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2011; 28:130-138. [PMID: 22117504] [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: 05/31/2023]
Abstract
BACKGROUND The optimal means of quantifying change on chest radiography in sarcoidosis is uncertain. In current guidelines, the role of serial measurement of carbon-monoxide diffusing capacity (DLco) remains undefined and the prevalence of discordance between serial chest radiographic change and pulmonary function tends is unknown. OBJECTIVE To identify and explore key uncertainties in the monitoring of sarcoidosis by serial pulmonary function tests and chest radiography. DESIGN 354 patients with sarcoidosis and concurrent tests (chest radiography and PFTs within three months at baseline, two years and/or four years) were studied. Chest radiographs were assessed by two radiologists for changes in stage and disease extent. Radiographic change and pulmonary function trends were quantified and compared. RESULTS Change in radiographic extent of lung disease was always more frequent than change in stage (p < 0.0001) and there was poor agreement between change in stage and change in radiographic extent (Kw = 0.21 at two years; Kw = 0.23 at four years). Change in disease extent on chest radiography was linked to PFT trends on analysis of variance (p < 0.0005 for FEV1, FVC, DLco), whereas change in radiographic stage was not. Changes in gas transfer were often isolated or discordant with other serial data. Discordance between pulmonary function data and chest radiographic data was observed in 50% of cases. CONCLUSIONS Change in radiographic extent is more applicable to routine monitoring in sarcoidosis than change in radiographic stage. In future guidelines, the role of serial gas transfer estimation and reconciliation of divergent chest radiographic and functional trends might usefully be addressed.
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Affiliation(s)
- C J Zappala
- Royal Brompton Hospital and National Heart and Lung Institute, London, UK
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10
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Corte TJ, Copley SJ, Desai SR, Zappala CJ, Hansell DM, Nicholson AG, Colby TV, Renzoni E, Maher TM, Wells AU. Significance of connective tissue disease features in idiopathic interstitial pneumonia. Eur Respir J 2011; 39:661-8. [PMID: 21920896 DOI: 10.1183/09031936.00174910] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In idiopathic interstitial pneumonia (IIP), the significance of connective tissue disease (CTD) features in the absence of a specific CTD diagnosis remains unclear. We studied the clinical and prognostic utility of a diagnosis of undifferentiated CTD (UCTD) in patients with biopsy-proven IIP. IIP patients undergoing surgical lung biopsy (1979-2005) were studied (nonspecific interstitial pneumonia (NSIP), n = 45; idiopathic pulmonary fibrosis, n = 56). UCTD was considered present when serum autoantibodies were present and symptoms or signs suggested CTD. The relationship between UCTD and NSIP histology was evaluated. A clinical algorithm that best predicted NSIP histology was constructed using a priori variables. The prognostic utility of UCTD, and of this algorithm, was evaluated. UCTD was present in 14 (31%) NSIP and seven (13%) IPF patients. UCTD was not associated with a survival benefit. The algorithm predictive of NSIP (OR 10.4, 95% CI 3.21-33.67; p<0.0001) consisted of the absence of typical high-resolution computed tomography (HRCT) features for IPF and 1) a compatible demographic profile (females aged <50 yrs) or 2) Raynaud's phenomenon. In patients with an HRCT scan not typical for IPF, this algorithm predicted improved survival (hazard ratio 0.35, 95% CI 0.14-0.85; p = 0.02) independent of IIP severity. UCTD is associated with NSIP histology. However, the diagnostic and prognostic significance of UCTD in IIP patients remains unclear.
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Affiliation(s)
- T J Corte
- Dept of Respiratory Medicine, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LP, UK
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11
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Shinagare SA, Angarkar NN, Desai SR, Naniwadekar MR. An audit of fresh frozen plasma usage and effect of fresh frozen plasma on the pre-transfusion international normalized ratio. Asian J Transfus Sci 2011; 4:128-32. [PMID: 20859514 PMCID: PMC2937290 DOI: 10.4103/0973-6247.67024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To audit the usage of fresh frozen plasma (FFP) and to study the effect of FFP on the pre-transfusion international normalized ratio (INR). MATERIALS AND METHODS Medical records of 100 consecutive patients who received FFP in our institute were retrospectively studied. FFP usage was classified as appropriate or inappropriate based on the guidelines by the National Health and Medical Research Council and The Australasian Society for Blood Transfusion. Pre-and post-transfusion INR were recorded and the effect of FFP on the pre-transfusion INR was studied in patients who appropriately received FFP. Relationship between the pre-transfusion INR and improvement in the INR per unit of FFP was studied using Pearson's correlation. RESULTS Total 325 units were issued for the 100 patients (37 males and 63 females, mean age 33 years, range 1-65 years). Obstetrics and gynecology and medicine departments requested most units of FFP. Total 197 units (60.6%) in 67 patients were appropriately transfused and 128 units (39.4%) in 33 patients were inappropriately used. Mean improvement in the pre-transfusion INR per unit of FFP was 0.79 (median 0.53, range 0-3.5, SD 0.94). A significant improvement in the pre-transfusion INR per unit of FFP was seen in 64.9% patients. A linear relationship was noted between the pre-transfusion INR and improvement in INR per unit of FFP (r=0.89, degree of freedom 55). CONCLUSION Proportion of inappropriate FFP usage remains high. A significant improvement in INR is more likely with a high pre-transfusion INR. The improvement in INR per unit of FFP is also more with higher pre-transfusion INR.
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Affiliation(s)
- S A Shinagare
- Department of Pathology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
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12
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Goh NSL, Desai SR, Anagnostopoulos C, Hansell DM, Hoyles RK, Sato H, Denton CP, Black CM, du Bois RM, Wells AU. Increased epithelial permeability in pulmonary fibrosis in relation to disease progression. Eur Respir J 2011; 38:184-90. [PMID: 21030449 DOI: 10.1183/09031936.00010910] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Epithelial injury contributes to pathogenesis in idiopathic pulmonary fibrosis (IPF) but its role in the interstitial lung disease (ILD) of systemic sclerosis (SSc) is uncertain. We quantified the prognostic significance of inhaled technetium-99m ((99m)Tc)-labelled diethylene triamine pentacetate (DTPA) pulmonary clearance, a marker of the extent of epithelial injury, in both diseases. Baseline (99m)Tc-DTPA pulmonary clearance was evaluated retrospectively in patients with SSc-ILD (n = 168) and IPF (n = 97) against mortality and disease progression. In SSc-ILD, the rapidity of total clearance (hazard ratio (HR) 1.02, 95% CI 1.01-1.03; p = 0.001) and the presence of abnormally rapid clearance (HR 2.10; 95% CI 1.25-3.53; p = 0.005) predicted a shorter time to forced vital capcity (FVC) decline, independent of disease severity. These associations were robust in both mild and severe disease. By contrast, in IPF, delayed clearance of the slow component, an expected consequence of honeycomb change, was an independent predictor of a shorter time to FVC decline (HR 1.01, 95% CI 1.00-1.02; p<0.01). Epithelial injury should be incorporated in pathogenetic models in SSc-ILD. By contrast, outcome is not linked to the overall extent of epithelial injury in IPF, apart from abnormalities ascribable to honeycombing, suggesting that core pathogenetic events may be more spatially focal in that disease.
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Affiliation(s)
- N S L Goh
- Royal Brompton Hospital and National Heart and Lung Institute, London, UK
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13
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Nikumbh DB, Desai SR, Madan PS, Patil NJ, Wader JV. Bilateral giant juvenile fibroadenomas of breasts:a case report. Patholog Res Int 2011; 2011:482046. [PMID: 21660274 PMCID: PMC3108471 DOI: 10.4061/2011/482046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 11/20/2022]
Abstract
Juvenile fibroadenoma constitutes only 4% of the total fibroadenomas. The incidence of giant juvenile fibroadenomas is found to be only 0.5% of all the fibroadenomas. Bilateral giant juvenile fibroadenomas are extremely rare, and only four cases have been reported in the literature. To the best of our knowledge, we are presenting the fifth case of bilateral giant juvenile fibroadenomas in a 12-year-old prepubertal girl. The diagnosis was made on fine-needle aspiration cytology which was confirmed on histopathology. In this paper, we present this rare case to illustrate the diagnosis and management of this tumour and to emphasize that these tumours are almost always benign and should be treated with breast-conserving surgery to provide a healthy physical and social life to the patient.
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Affiliation(s)
- D B Nikumbh
- Department of Pathology, Krishna Institute of Medical Sciences, Karad, District Satara, Maharashtra 415110, India
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14
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Desai SR, Verlecar XN, Ansari ZA, Jagtap TG, Sarkar A, Vashistha D, Dalal SG. Evaluation of genotoxic responses of Chaetoceros tenuissimus and Skeletonema costatum to water accommodated fraction of petroleum hydrocarbons as biomarker of exposure. Water Res 2010; 44:2235-2244. [PMID: 20096916 DOI: 10.1016/j.watres.2009.12.048] [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] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Revised: 12/24/2009] [Accepted: 12/29/2009] [Indexed: 05/28/2023]
Abstract
Genotoxic responses towards chronic exposure of Chaetoceros tenuissimus and Skeletonema costatum to water accommodated fraction of petroleum hydrocarbons (WAF-P) were evaluated as biomarkers of petroleum hydrocarbons pollution. The DNA damage caused by water accommodated fraction of petroleum hydrocarbons was assessed in terms of the DNA integrity measured by alkaline unwinding assay. The comparative study of the growth pattern of C. tenuissimus with respect to DNA integrity and the DNA strand breaks in different concentrations of WAF-P showed sufficient tolerance. However, its toxicity increased proportionately with exposure to elevated levels of WAF-P. Although DNA damage in S. costatum was similar to C. tenuissimus, its tolerance level to WAF-P was at least 5 times lower than that of C. tenuissimus indicating its high sensitivity to petroleum hydrocarbons. Active growth was exhibited by C. tenuissimus between 10 and 20% WAF-P (ranging from 0.59 to 1.18mg/L petroleum hydrocarbons) which can be related to the polluted regions only, suggesting the tolerant nature of this organism. Considering the degree of sensitivity to petroleum products and good growth under laboratory conditions, these two diatoms could be recommended as model species for evaluating ecogenotoxic effects of wide range of petroleum hydrocarbon pollutants using alkaline unwinding assays.
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Affiliation(s)
- S R Desai
- Environmental Laboratory, National Institute of Oceanography, Dona Paula, Goa - 403004, India
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15
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Copley SJ, Bryant TH, Chambers AA, Harvey CJ, Hodson JM, Graham A, Lynch MJ, Paley MR, Partridge WJ, Rangi P, Schmitz S, Win Z, Todd JJ, Desai SR. Observer accuracy in the detection of pulmonary nodules on CT: effect of cine frame rate. Clin Radiol 2009; 65:133-6. [PMID: 20103435 DOI: 10.1016/j.crad.2009.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 05/07/2009] [Accepted: 05/07/2009] [Indexed: 10/20/2022]
Abstract
AIM To assess the effect of cine frame rate on the accuracy of the detection of pulmonary nodules at computed tomography (CT). MATERIALS AND METHODS CT images of 15 consecutive patients with (n = 13) or without (n = 2) pulmonary metastases were identified. Initial assessment by two thoracic radiologists provided the "actual" or reference reading. Subsequently, 10 radiologists [board certified radiologists (n = 4) or radiology residents (n = 6)] used different fixed cine frame rates for nodule detection. Within-subjects analysis of variance (ANOVA) was used to evaluate the data. RESULTS Eighty-nine nodules were identified by the thoracic radiologists (median 8, range 0-29 per patient; median diameter 9 mm, range 4-40 mm). There was a non-statistically significant trend to reduced accuracy at higher frame rates (p=0.113) with no statistically significant difference between experienced observers and residents (p = 0.79). CONCLUSION The accuracy of pulmonary nodule detection at higher cine frame rates is reduced, unrelated to observer experience.
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Affiliation(s)
- S J Copley
- Department of Radiology, Hammersmith Hospital, Imperial College NHS Trust, London W12 0HS, UK.
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Naniwadekar MR, Desai SR, Kshirsagar NS, Angarkar NN, Dombale VD, Jagtap SV. Pure choriocarcinoma of ovary diagnosed by fine needle aspiration cytology. INDIAN J PATHOL MICR 2009; 52:417-20. [PMID: 19679980 DOI: 10.4103/0377-4929.55013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pure ovarian choriocarcinoma is extremely rare and can develop as a germ cell tumor or as a metastasis from uterine or tubal gestational choriocarcinoma or rarely from an ovarian pregnancy. The cytomorphologic findings have been reported previously in different sites. However, this is the first case of pure ovarian choriocarcinoma diagnosed on cytology to the best of our knowledge. The distinction between a gestational and nongestational choriocarcinoma is difficult. A 19-year-old female patient presented with an irregular per-vaginal bleeding and a mass in lower abdomen. Fine needle aspiration cytology smears of the mass were hypocellular and showed large, multinucleated giant cells and malignant mononucleated cells. Background was hemorrhagic. Serum beta hCG level was 3,80,000 mIU/ml. A diagnosis of choriocarcinoma was offered which was later confirmed by histopathology. The diagnosis of choriocarcinoma on fine needle aspiration cytology is based on the presence of large, multinucleated giant cells and malignant mononucleated cells. A high index of suspicion should be maintained and estimation of serum beta hCG plays a key role in supporting the diagnosis.
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Affiliation(s)
- M R Naniwadekar
- Department of Pathology, Krishna Institute of Medical Sciences, Karad, India.
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17
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Sato H, Williams HRT, Spagnolo P, Abdallah A, Ahmad T, Orchard TR, Copley SJ, Desai SR, Wells AU, du Bois RM, Welsh KI. CARD15/NOD2 polymorphisms are associated with severe pulmonary sarcoidosis. Eur Respir J 2009; 35:324-30. [PMID: 19679608 DOI: 10.1183/09031936.00010209] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sarcoidosis and Crohn's disease are heterogeneous systemic diseases characterised by granulomatous inflammation. Caspase recruitment domain (CARD)15 is a major susceptibility gene for Crohn's disease, and specifically for ileal and fibrostenotic subtypes. The C-C chemokine receptor (CCR)5 gene has been associated with both parenchymal pulmonary sarcoidosis and perianal Crohn's disease. This study explored associations between CARD15 polymorphisms, CCR5 haplotype and distinct pulmonary sarcoidosis subtypes. 185 Caucasian sarcoidosis patients were genotyped for CARD15 and CCR5 polymorphisms. The genetic data were compared with 347 healthy controls and were examined for associations with serial pulmonary function tests and chest radiographs. CARD15 genotypes did not differ between the unselected sarcoidosis cohort and controls. However, patients carrying the functional 2104T (702W) polymorphism were more likely to have radiographic stage IV disease at 4-yr follow-up. All patients possessing both CARD15 2104T and CCR5 HHC haplotype had stage IV disease at presentation. Carriage of 2104T was associated with worse forced expiratory volume in 1 s, whereas carriage of the CARD15 1761G (587R) polymorphism was associated with better lung function. For the first time, an association between two CARD15 polymorphisms and specific sarcoidosis phenotypes has been demonstrated, as well as an additive effect of possessing CARD15 2104T and CCR5 HHC haplotype.
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Affiliation(s)
- H Sato
- Clinical Genomics Group Royal Brompton Hospital and NHLI, Imperial College, 1B Manresa Road, London SW3 6LR, UK.
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18
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Naniwadekar MR, Desai SR, Ranade RG, Kanetkar SR. Extra genital heterologous malignant mixed mullerian tumor of primary peritoneal origin. INDIAN J PATHOL MICR 2009; 52:88-90. [PMID: 19136793 DOI: 10.4103/0377-4929.44976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The case of an extragenital heterologous malignant mixed müllerian tumor (MMMT) of primary peritoneal origin occurring in a 76-year-old female is presented. A large tumor was seen between the uterus and rectosigmoid occupying the entire pelvis. The uterus, fallopian tubes and ovaries were uninvolved. The tumor was composed of carcinomatous areas showing endometrioid and serous papillary differentiation and sarcomatous areas showing cartilaginous differentiation. The extragenital primary MMMTs of the female peritoneum are thought to originate from the secondary müllerian system. This case is presented for its rarity. To the best our knowledge, this is the first case of extragenital MMMT of primary peritoneal origin in Indian literature.
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Affiliation(s)
- M R Naniwadekar
- Department of Pathology, Krishna Institute of Medical Sciences, University, Karad, India.
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19
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Naniwadekar MR, Desai SR, Dombale VD, Kulkarni SR. Diagnosis of metastatic carcinoid in mesenteric lymph node by fine needle aspiration cytology. INDIAN J PATHOL MICR 2008; 51:424-6. [PMID: 18723980 DOI: 10.4103/0377-4929.42550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although carcinoid tumor is a relatively common neoplasm in surgical pathology, fine needle aspiration cytology (FNAC) as a method of primary diagnosis has only been reported a few times. We report the case of a 55-year-old male patient who presented with colicky pain in the abdomen and a vague mass in the right lumbar region. Ultrasonographic study showed an enlarged mesenteric lymph node. Ultrasonography-guided FNAC revealed cellular smears with neuroendocrine cellular arrangement and morphology. The cytomorphologic characteristics of carcinoid tumors are distinctive enough for diagnosis. A diagnosis of metastatic carcinoid was given. 5-hydroxyindolacetic acid in 24-hour urine turned out to be high. Histopathology and immunohistochemistry studies also confirmed the diagnosis. Thus, FNAC can be a useful and safe tool in the diagnosis of carcinoid tumors.
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20
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Desai SR, Ranade SR. Congenital amegakaryocytic thrombocytopenia (CAMT): a case report with review of literature. INDIAN J PATHOL MICR 2007; 50:659-60. [PMID: 17883175] [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: 05/17/2023] Open
Abstract
Congenital amegakaryocytic thrombocytopenia (CAMT) is an uncommon cause of thrombocytopenia in children. Mutations in the thrombopoietin (Tpo) receptor gene C-mpl were found to be the likely cause of thrombocytopenia and complete marrow failure. Two types are identified: CAMT with or without congenital anomalies. We report a case of the latter type for its extreme rarity.
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Affiliation(s)
- S R Desai
- Department of Pathology, K.I.M.S., Karad, Maharashtra.
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21
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Desai SR, Jagtap SV, Shinagare S. Cerebellar medulloblastoma in a 19 weeks fetus. INDIAN J PATHOL MICR 2007; 50:609-10. [PMID: 17883159] [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: 05/17/2023] Open
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22
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Desai SR, Angarkar NN, Patil NJ, Dombale VD, Kulkarni SR. Primary malignant melanoma of left buccal mucosa with metastasis in thyroid: a case report. INDIAN J PATHOL MICR 2007; 50:385-7. [PMID: 17883084] [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: 05/17/2023] Open
Abstract
Primary oral malignant melanomas are rare with an incidence of .2 to 8% of all melanomas. Less than 1% of them arise on buccal mucosa. Grossly they arise as a black macule with irregular borders & are commonly of mucosal lentiginous type. They appear at a higher stage and are aggressive with a 5 yr survival rate of 10-25%. 39% of metastasis in thyroid occur from skin (melanomas) and melanomas produce a thyroid mass while the original source remains occult. We report a case of oral malignant melanoma of left buccal mucosa for its rarity and its spread to cervical lymph nodes and thyroid.
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Affiliation(s)
- S R Desai
- Department of Pathology, K.I.M.S., Karad, Maharashtra.
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23
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Ingram W, Desai SR, Gibbs JSR, Mufti G. Reduced-intensity conditioned allogeneic haematopoietic transplantation in an adult with Langerhans' cell histiocytosis and thrombocytopenia with absent radii. Bone Marrow Transplant 2006; 37:713-5. [PMID: 16489360 DOI: 10.1038/sj.bmt.1705300] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sylvester KP, Desai SR, Wells AU, Hansell DM, Awogbade M, Thein SL, Greenough A. Computed tomography and pulmonary function abnormalities in sickle cell disease. Eur Respir J 2006; 28:832-8. [PMID: 16737989 DOI: 10.1183/09031936.06.00007006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to determine whether patients with sickle cell disease (SCD) in steady state had pulmonary abnormalities seen on high-resolution computed tomography (HRCT) and whether any abnormalities correlated with contemporaneously diagnosed lung function abnormalities. A subsidiary question was whether the results of a noninvasive measure of haemolysis (end-tidal carbon monoxide (ETCO) levels) correlated with pulmonary function abnormalities. Thirty three patients with SCD, median (range) age 36 yrs (17-67 yrs) were examined. The degree of lobar volume loss and ground-glass opacification and prominence of central vessels on HRCT were quantitatively assessed. Pulmonary function was assessed by measurements of lung volumes, spirometry, gas transfer and oxygen saturation. ETCO levels were measured using an end-tidal CO monitor. Forced expiratory volume in one second (FEV1), forced vital capacity and total lung capacity significantly correlated with HRCT findings, particularly lobar volume loss. ETCO levels significantly negatively correlated with FEV1, vital capacity measured using a plethysmograph, specific airway conductance and arterial oxygen saturation measured by pulse oxymetry. In conclusion, the present results suggest that high-resolution computed tomography noninvasive assessment of haemolysis might be useful to identify sickle cell disease patients with respiratory function impairment.
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Affiliation(s)
- K P Sylvester
- Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine at Guy's, King's College & St Thomas' Hospitals, London, UK
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25
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Desai SR, Dombale VD, Janugade HB. Infantile fibromatosis (desmoid type)--a case report. INDIAN J PATHOL MICR 2005; 48:379-80. [PMID: 16761760] [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: 05/10/2023] Open
Abstract
Infantile fibromatosis represents the childhood counter part of musculoaponeurotic fibromatosis & arises as a solitary mass in skeletal muscle, adjacent fascia, aponeurosis or periosteum. The lesion is extremely rare. Microscopically it exists in two forms diffuse (mesenchymal) & desmoid. The less common desmoid form rarely occurs in infancy. Immunophenotype shows vimentin positivity with variable positivity with muscle markers. The differential diagnosis of this type is infantile fibrosarcoma. The tumor may locally recur if inadequately excised. We report a case of infantile fibromatosis of desmoid type occurring in 10 months male child for its extreme rarity.
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Affiliation(s)
- S R Desai
- Department of Pathology, KIMS, Karad, Maharashtra.
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26
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Desai SR, Wader JV. Meckel Gruber Syndrome--a case report. INDIAN J PATHOL MICR 2004; 47:430-2. [PMID: 16295449] [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: 05/05/2023] Open
Abstract
Meckel Gruber Syndrome is a rare syndrome inherited as Mendelian autosomal recessive condition. The affected infant usually has a large occipital encephalocoele associated with renal cysts and sometimes polydactyly. The prognosis is poor. The affected child is still born or dies early in infancy. If diagnosis is done by prenatal ultrasound examination termination of pregnancy can be done.
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Affiliation(s)
- S R Desai
- Department of Pathology, K.I.M.S., Karad
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27
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Aziz ZA, Wells AU, Hansell DM, Bain GA, Copley SJ, Desai SR, Ellis SM, Gleeson FV, Grubnic S, Nicholson AG, Padley SPG, Pointon KS, Reynolds JH, Robertson RJH, Rubens MB. HRCT diagnosis of diffuse parenchymal lung disease: inter-observer variation. Thorax 2004; 59:506-11. [PMID: 15170034 PMCID: PMC1747041 DOI: 10.1136/thx.2003.020396] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study was designed to measure inter-observer variation between thoracic radiologists in the diagnosis of diffuse parenchymal lung disease (DPLD) using high resolution computed tomography (HRCT) and to identify areas of difficulty where expertise, in the form of national panels, would be of particular value. METHODS HRCT images of 131 patients with DPLD (from a tertiary referral hospital (n = 66) and regional teaching centres (n = 65)) were reviewed by 11 thoracic radiologists. Inter-observer variation for the first choice diagnosis was quantified using the unadjusted kappa coefficient of agreement. Observers stated differential diagnoses and assigned a percentage likelihood to each. A weighted kappa was calculated for the likelihood of each of the six most frequently diagnosed disease entities. RESULTS Observer agreement on the first choice diagnosis was moderate for the entire cohort (kappa = 0.48) and was higher for cases from regional centres (kappa = 0.60) than for cases from the tertiary referral centre (kappa = 0.34). 62% of cases from regional teaching centres were diagnosed with high confidence and good observer agreement (kappa = 0.77). Non-specific interstitial pneumonia (NSIP) was in the differential diagnosis in most disagreements (55%). Weighted kappa values quantifying the likelihood of specific diseases were moderate to good (mean 0.57, range 0.49-0.70). CONCLUSION There is good agreement between thoracic radiologists for the HRCT diagnosis of DPLD encountered in regional teaching centres. However, cases diagnosed with low confidence, particularly where NSIP is considered as a differential diagnosis, may benefit from the expertise of a reference panel.
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Affiliation(s)
- Z A Aziz
- Department of Radiology, Royal Brompton Hospital, London, UK
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Desai SR, Angarkar NN, Kulkarni AG. Primary plasma cell leukemia. J Assoc Physicians India 2004; 52:510-1. [PMID: 15645969] [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: 05/01/2023]
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Kshirsagar AY, Desai SR, Pareek V. Primary adenocarcinoma of the vermiform appendix: a case report. J Indian Med Assoc 2004; 102:262-3. [PMID: 15636030] [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: 05/01/2023]
Abstract
Primary adenocarcinoma of the appendix is rare, and since Berger first recognised the neoplasm in 1882, fewer than 250 cases have been recorded. Adenocarcinoma of the appendix is never suspected pre-operatively, being usually first discovered by histological examination. Ileocaecal resection during the first operation and right hemicolectomy for a carcinoma diagnosed after appendicectomy remain the main stay of treatment.
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Affiliation(s)
- A Y Kshirsagar
- Department of Surgery, Krishna Institute of Medical Sciences, Karad 415110
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30
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Desai SR, Kalamdani AA, Kulkarni AG. Hypoplasia of the abdominal aorta--a case report. INDIAN J PATHOL MICR 2004; 47:274-7. [PMID: 16295499] [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: 05/05/2023] Open
Abstract
Infrarenal aortic coarctation is a very uncommon vascular disease. It has been named as hypoplasia of abdominal aorta, mid aortic dysplasia, mid aortic syndrome, atrophy of aorta, atresia of the terminal aorta & atypical coarctation. The pathogenesis is still controversial. Hypertension is an almost universal feature of this disorder. We present a case report with postmortem findings of a young female patient having hypoplasia of abdominal aorta for its rarity.
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Affiliation(s)
- S R Desai
- Department of Pathology, KIMS, Karad, Maharashtra.
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Desai SR, Wader JV, Kulkami SR. Nodular and diffuse fibrous proliferation of tunica vaginalis--a case report. INDIAN J PATHOL MICR 2003; 46:468-70. [PMID: 15025310] [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: 04/29/2023] Open
Abstract
A case of nodular and diffuse fibrous proliferation (NDFP) of the tunica vaginalis testis occurring in a 40 year male is described. Immunohistochemistry confirmed fibroblastic origin. Histogenesis & differential diagnosis of this lesion is considered. Simple excision of this lesion is curative. The lesion is very rare but it is important that both surgeons & pathologists become aware of this entity to avoid radical orchiectomy in young patients.
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Affiliation(s)
- S R Desai
- Department of Pathology, K.I.M.S., Karad
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Abstract
The present review focuses on the interstitial lung diseases related to smoking. Thus, the pathology and radiology of Langerhans cell histiocytosis, desquamative interstitial pneumonia, respiratory bronchiolitis and respiratory bronchiolitis-associated-interstitial lung disease are considered. The more tenuous association between pulmonary fibrosis and smoking is also discussed.
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Affiliation(s)
- S R Desai
- Department of Radiology, King's College Hospital, London, UK.
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Desai SR, Angarkar NN. Leiomyosarcoma of the scrotum. INDIAN J PATHOL MICR 2003; 46:212-3. [PMID: 15022912] [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: 04/29/2023] Open
Abstract
A case of leiomyosarcoma of the scrotum is reported for its rarity. The tumor measured 6.2 x 4 x 4 cm and presented as a gradually increasing painless mass of 1 month duration. Light microscopy showed the typical interlacing fascicles of neoplastic cells with mitotic count of 1-2 / 10 HPF in different areas. Immunoperoxidase stains of vimentin & desmin and electron microscopy confirmed its muscle origin.
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Affiliation(s)
- S R Desai
- Department of Pathology, K.I.M.S., Karad
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Mangoni AA, Desai SR, Shaikh H, Barker RD, Mufti GJ, Jackson SHD. An unusual case of pneumonia. Int J Clin Pract 2003; 57:153-4. [PMID: 12661804] [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: 03/01/2023] Open
Abstract
A previously healthy 37-year-old man was admitted with a two-month history of increasing shortness of breath and high temperature. A chest X-ray demonstrated bibasal shadowing and small bilateral pleural effusions; arterial blood gases demonstrated low pO2. Despite intravenous antibiotics no significant improvement was observed. A high-resolution chest computed tomography showed diffuse ground-glass opacification with segmental and subsegmental airways opacification, indicating fine fibrosis. Subsequently, open lung biopsy showed diffuse alveolar damage and a histopathological diagnosis of acute interstitial pneumonia (Hamman-Rich syndrome) was made. Antibiotics were stopped and high intravenous doses of steroids were given with a dramatic improvement in the patient's breathing and radiographic findings. The pathophysiological mechanisms of acute interstitial pneumonia and current therapeutic options are discussed.
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Affiliation(s)
- A A Mangoni
- Department of Health Care of the Elderly, King's College Hospital, London, UK
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Sheehan RE, Wells AU, Copley SJ, Desai SR, Howling SJ, Cole PJ, Wilson R, Hansell DM. A comparison of serial computed tomography and functional change in bronchiectasis. Eur Respir J 2002; 20:581-7. [PMID: 12358332 DOI: 10.1183/09031936.02.00284602] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [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]
Abstract
In bronchiectasis the morphological determinants of (marginal) fluctuations in pulmonary function tests are uncertain. The aim of the present study was to evaluate serial computed tomography (CT) changes in relation to pulmonary function trends in patients with bronchiectasis. The relationships between pulmonary function indices and CT scans in 48 adult patients with bronchiectasis were evaluated at baseline and at follow-up, at a median interval of 28 months (range 6-74 months). Two independent observers semiquantitatively scored CT features of bronchial and small airways disease. At initial assessment, the severity of airflow obstruction was linked primarily to the extent of mosaic attenuation. However, serial changes in pulmonary function indices were only associated with serial changes in mucous plugging scores. Alterations in mucous plugging on serial CT were associated with changes in the severity of bronchiectasis and bronchial wall thickness. Greater severity of all three morphological abnormalities at baseline CT were predictive of significant declines in forced expiratory volume in one second, with severe bronchial wall thickness being the most adverse prognostic determinant. Variations in mucous plugging on computed tomography correlate with minor fluctuations in pulmonary function tests in bronchiectasis. However, the severity of bronchial wall thickness is the primary determinant of subsequent major functional decline.
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Affiliation(s)
- R E Sheehan
- Dept of Radiology, Royal Brompton Hospital, London, UK
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Chambers RJ, Tibballs J, Shaw AS, Ryan SM, Sidhu PS, Baxter GM, Moss JG, Edwards RD, Yu DFQC, Desai SR. Picture quiz. Imaging 2002. [DOI: 10.1259/img.14.4.140348] [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: 11/05/2022] Open
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MacDonald SL, Rubens MB, Hansell DM, Copley SJ, Desai SR, du Bois RM, Nicholson AG, Colby TV, Wells AU. Nonspecific interstitial pneumonia and usual interstitial pneumonia: comparative appearances at and diagnostic accuracy of thin-section CT. Radiology 2001; 221:600-5. [PMID: 11719652 DOI: 10.1148/radiol.2213010158] [Citation(s) in RCA: 202] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis. MATERIALS AND METHODS Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques. RESULTS The use of thin-section CT proved to have moderate sensitivity (70%), specificity (63%), and accuracy (66%) in the diagnosis of NSIP. An increased proportion of ground-glass attenuation was the cardinal feature of NSIP at CT (odds ratio: 1.04 for each 1% increase in the proportion of ground-glass attenuation). A histologic diagnosis of NSIP was most frequent (in 24 of 35 observations [69%]) when ground-glass attenuation predominated, and was more frequent with mixed (35 of 79 observations [44%]) than with predominantly reticular disease (25 of 98 [26%] observations, P < .005). Logistic regression analysis of the data indicated that misdiagnosis of UIP in patients with NSIP was associated with less ground-glass attenuation (P < .005) at CT and a subpleural disease distribution (P = .02), with the converse being true for UIP cases misdiagnosed as NSIP. CONCLUSION In patients with a clinical presentation of idiopathic pulmonary fibrosis, the accuracy of thin-section CT in identifying NSIP is considerably higher than previously reported. At CT, NSIP is characterized by more ground-glass attenuation and a finer reticular pattern than is UIP. Nevertheless, considerable overlap in thin-section CT patterns exists between NSIP and UIP.
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Affiliation(s)
- S L MacDonald
- Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England
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Desai SR, Wells AU, Suntharalingam G, Rubens MB, Evans TW, Hansell DM. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary injury: a comparative CT study. Radiology 2001; 218:689-93. [PMID: 11230641 DOI: 10.1148/radiology.218.3.r01mr31689] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [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: 12/23/2022]
Abstract
PURPOSE To determine computed tomographic (CT) differences between acute respiratory distress syndrome (ARDS) due to pulmonary injury (ARDS(p)) and extrapulmonary injury (ARDS(ex)). MATERIALS AND METHODS CT appearances in 41 patients (27 male, 14 female; mean age, 47.1 years +/- 17.1 [SD]; age range, 17-79 years; those with ARDS(p), n = 16; those with ARDS(ex), n = 25) were categorized as typical or atypical of ARDS by two observers. The extent of individual CT patterns was also quantified. RESULTS Typical CT appearances were more frequent in ARDS(ex) than ARDS(p) (18 [72%] of 25 vs five [31%] of 16 patients, respectively; P <.01). Sensitivity, specificity, and accuracy of a typical CT pattern for the diagnosis of ARDS(ex) were 72%, 69%, and 71%, respectively. Atypical appearances were characterized by more extensive nondependent intense parenchymal opacification (IPO) (P =.03) and cysts (P =.05), whereas typical CT appearances had more extensive dependent IPO (P =.01). Typical appearances at CT were independently related to the cause of ARDS (odds ratio, 8.9; 95% CI: 1.8, 44.2; P <.01) but were independent of the time from intubation. Foci of nondependent IPO were more extensive in ARDS(p) (P =.05) than ARDS(ex), but this finding was ascribable to differences in time to CT (after intubation) between ARDS(p) and ARDS(ex). CONCLUSION The differentiation between ARDS(p) and ARDS(ex) can, with some caveats, be based on whether the CT appearances are typical or atypical of ARDS but not on any individual CT pattern in isolation.
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Affiliation(s)
- S R Desai
- Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England
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Sanderson E, Desai SR. Non‐vascular thoracic intervention. Imaging 2000. [DOI: 10.1259/img.12.3.120178] [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: 11/05/2022] Open
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Chabat F, Desai SR, Hansell DM, Yang GZ. Gradient correction and classification of CT lung images for the automated quantification of mosaic attenuation pattern. J Comput Assist Tomogr 2000; 24:437-47. [PMID: 10864083 DOI: 10.1097/00004728-200005000-00016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/26/2022]
Abstract
PURPOSE The detection of density differences, or "mosaic attenuation pattern," on CT images may be difficult when the regional inhomogeneity of the density of the lung parenchyma is subtle. The purpose of this work was to develop a fully automated method for the reproducible quantification of the underattenuated areas of the lung parenchyma. This technique may be useful in increasing the precision of investigation of structure/function relationships. METHOD Anatomical segmentation was achieved by a structure-filtering operator based on mathematical morphology. To compensate for the density gradient visible on lung CT scans, a model-based iterative deconvolution filter and an adaptive clustering algorithm were developed. Validation was performed with CT images from a lung phantom, 15 patients with constrictive obliterative bronchiolitis, and 8 normal subjects. RESULTS The accuracy of the estimate of the density gradient on phantom studies was 93.3%. The automated quantification of the areas of decreased attenuation on scans of constrictive obliterative bronchiolitis was within 8.2% from the average scoring of two experienced observers. CONCLUSION The proposed technique is fully automated and can accurately correct for density gradient and classify areas of decreased attenuation on lung CT images.
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Affiliation(s)
- F Chabat
- Royal Brompton Hospital, Imperial College of Science, Technology, and Medicine, London, UK.
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Affiliation(s)
- S R Desai
- Department of Surgery, Auburn District Hospital, Sydney, Australia
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Cleverley JR, Desai SR, Wells AU, Koyama H, Eastick S, Schmidt MA, Charrier CL, Gatehouse PD, Goldstraw P, Pepper JR, Geddes DM, Hansell DM. Evaluation of patients undergoing lung volume reduction surgery: ancillary information available from computed tomography. Clin Radiol 2000; 55:45-50. [PMID: 10650110 DOI: 10.1053/crad.1999.0326] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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: 11/11/2022]
Abstract
AIM A number of imaging techniques have been used for the pre-operative assessment of patients for lung volume reduction surgery (LVRS). We evaluated whether data currently acquired from perfusion scintigrams and cine MR of the diaphragm are obtainable from high resolution CT (HRCT) of the thorax. MATERIALS AND METHODS Thirty patients taking part in a randomized controlled trial of LVRS against maximal medical therapy were evaluated. HRCT examinations (n= 30) were scored for (i) the extent and distribution of emphysema; (ii) the extent of normal pulmonary vasculature; and (iii) diaphragmatic contour, apparent defects and herniation. On scintigraphy, (n= 28), perfusion of the lower thirds of both lungs, as a proportion of total lung perfusion (LZ/T(PERF)), was expressed as a percentage of predicted values (derived from 10 normal control subjects). On cine MR (n= 25) hemidiaphragmatic excursion and coordination were recorded. RESULTS Extensive emphysema was present on HRCT (60% +/- 13.2%). There was strong correlation between the extent of normal pulmonary vasculature on HRCT and on perfusion scanning (r(s)= 0.85, P< 0.00005). Hemidiaphragmatic incoordination on MR was weakly associated with hemidiaphragmatic eventration on HRCT (P= 0.04). CONCLUSION The strong correlation between lung perfusion assessed by HRCT and lung perfusion on scintigraphy suggests that perfusion scintigraphy is superfluous in the pre-operative evaluation of patients with emphysema for LVRS.
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Affiliation(s)
- J R Cleverley
- Department of Radiology, The Royal Brompton Hospital, London, UK
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Abstract
Rhabdoid tumour of the kidney is not common. Presentation of such a lethal tumour along with blunt abdominal trauma is even rarer. We report such a case of Rhabdoid tumour of kidney which presented as renal trauma, and discuss the diagnostic difficulties and rapidly fatal outcome.
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Affiliation(s)
- S R Desai
- Department of Paediatric Surgery, Starship Children's Hospital, Grafton, Auckland, New Zealand
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Ng CS, Desai SR, Rubens MB, Padley SP, Wells AU, Hansell DM. Visual quantitation and observer variation of signs of small airways disease at inspiratory and expiratory CT. J Thorac Imaging 1999; 14:279-85. [PMID: 10524809 DOI: 10.1097/00005382-199910000-00008] [Citation(s) in RCA: 43] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Areas of decreased pulmonary attenuation representing small airways disease can be identified on computed tomography (CT). The objective was to quantify differences between inspiratory and expiratory CT for the detection of signs of small airways disease by four observers. Observer variation and the superiority of a fine versus a coarse grading system were also evaluated. Inspiratory and expiratory CT scans of 106 patients with conditions characterized by small airways disease and 19 healthy individuals were assessed by four observers. The extent of decreased attenuation was scored on a fine scale to the nearest 5% and also semiquantitatively on a coarser 5-point scale. Decreased attenuation was more extensive on expiratory CT (median. 6.7%; 0-76.7%) than on inspiratory CT (median, 3.8%; 0-81.7%). The fine scoring system had unacceptable interobserver variation (coefficient of variation, 80% for inspiratory CT, 70% for expiratory CT). The semiquantitative system had acceptable interobserver agreement (inspiratory CT k(w) = 0.64; expiratory CT, k(w) = 0.69) and good intra-observer agreement (inspiratory CT, k(w) = 0.80; expiratory CT, k(w) = 0.64). The major CT sign of small airways disease is more confidently quantified on expiratory CT. A fine scoring system is associated with unacceptable observer variation, and a coarse semiquantitative system is more suitable for quantitative studies of small airways disease.
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Affiliation(s)
- C S Ng
- Department of Radiology, Royal Brompton Hospital, Chelsea, London, United Kingdom
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Fotheringham T, Chabat F, Hansell DM, Wells AU, Desai SR, Gückel C, Padley SP, Gibson M, Yang GZ. A comparison of methods for enhancing the detection of areas of decreased attenuation on CT caused by airways disease. J Comput Assist Tomogr 1999; 23:385-9. [PMID: 10348444 DOI: 10.1097/00004728-199905000-00012] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this work was to investigate thin section CT image enhancement of subtle areas of decreased attenuation of the lung parenchyma in suspected airways disease. METHOD Forty-seven consecutive patients with chronic sputum production underwent pulmonary function tests and high resolution CT (HRCT). Single section inspiratory (INSP), expiratory (EXP), and minimum intensity projection (MINIP) images through the lower lobes were acquired. A histogram stretch was applied to the INSP and MINIP images, generating two further image formats. The five image types were compared for the extent of decreased attenuation, observer confidence, and correlations with pulmonary function tests. RESULTS Interobserver variation was lowest with MINIP images (mean weighted K: MINIP 0.70, INSP sections 0.65, other image formats < or =0.48). Observers were most confident with EXP and MINIP images. EXP sections identified more disease than MINIP images (p<0.001). Correlations with pulmonary function tests were similar for each image format. CONCLUSION The HRCT changes of small airways disease are enhanced with image postprocessing. MINIP images are associated with increased observer confidence and agreement as compared with HRCT alone.
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Affiliation(s)
- T Fotheringham
- Department of Radiology, Royal Brompton Hospital, London, England, UK
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Desai SR, Gishen P. Picture quiz. Imaging 1999. [DOI: 10.1259/img.11.1.110039] [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: 11/05/2022] Open
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Desai SR. Mini‐symposium: Cryptogenic fibrosing alveolitis. Imaging 1999. [DOI: 10.1259/img.11.1.1100iv] [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: 11/05/2022] Open
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Abstract
PURPOSE To document abnormalities at computed tomography (CT) in adult survivors of acute respiratory distress syndrome (ARDS), to determine the relationships between CT patients during the acute phase and at follow-up, and to assess the effects of mechanical ventilation on the development of CT abnormalities. MATERIALS AND METHODS Thin-section CT scans were obtained during the acute illness and at follow-up in 27 patients with ARDS. The extent and distribution of individual CT patterns were independently analyzed. RESULTS At follow-up CT, a reticular pattern was the most prevalent (23 patients [85%]) and extensive CT abnormality, with a striking anterior distribution (more anterior distribution than posterior distribution, P < .001). A reticular pattern at follow-up was inversely correlated with the extent of intense parenchymal opacification on scans obtained during the acute illness (Spearman r = -0.26; P < .001). The extent of a reticular pattern at follow-up CT was independently related to the total duration of mechanical ventilation (P = .02) but was most strongly related to the duration of pressure-controlled inverse-ratio ventilation (P < .001). CONCLUSION A reticular pattern, with a striking anterior distribution, is a frequent finding of follow-up CT in ARDS survivors and is most strongly related to the duration of pressure-controlled inverse-ratio ventilation.
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Affiliation(s)
- S R Desai
- Department of Radiology, Royal Brompton Hospital, Sydney, London
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