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Maggiulli F, Hinton C, Simpson L, Gujral S, Hardwicke J, Slator R, Pigott R, Su T, Richard B. Lip symmetry following rotation advancement cleft lip repair in 5-year-old children treated by Ralph Millard and Ron Pigott. JPRAS Open 2022; 33:145-154. [PMID: 35928808 PMCID: PMC9343930 DOI: 10.1016/j.jpra.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the symmetry of the lip following Rotation-Advancement cleft lip repair by Millard and Pigott and to investigate the effect on the symmetry of cleft side and gender by using different surgical protocols. Symmetry following cleft surgery was compared to that of non-cleft children. Design Retrospective study of photographs of children aged 5 years. Setting Three decades of post-operative photographs of children treated by Millard and Pigott. Patients Eighty-nine children treated by Millard, 87 by Pigott and 91 non-cleft children. Interventions Photographs were assessed using the Symnose Computer program, a rapid semi-objective quantitative assessment of lip symmetry. Main Outcome Measure(s) Asymmetry score for each surgeon, and non-cleft children. Results There was no significant difference in the median lip % mismatch score of Millard, 36.65% and Pigott, 38.52%. Right-sided clefts showed better symmetry than left-sided clefts for Millard (p<.001). This was reversed for Pigott (P=.0121). There was a difference (P<.001) between the symmetry of the two cleft cohorts and the non-cleft children (asymmetry 19.9%), and between Millard's outcomes following different lip surgical protocols (P < .0001), but no difference between Pigott's outcomes using different palate surgical protocols (P = 0.59). Conclusions Cleft lip repair by Millard and Pigott resulted in similar lip asymmetry (37% and 39% symmetry mismatch, respectively). Lip surgical protocol and cleft side may affect lip asymmetry. Palate surgery did not affect lip asymmetry. Following cleft surgery, children were more asymmetric than non-cleft children.
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2
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Varghese S, Sriram H, Chatterjee G, Girase K, Rajpal S, Ghogale S, Deshpande N, Badrinath Y, Patkar N, Gujral S, Subramanian P, Tembhare P. Expression pattern of a new marker, GL7 in different stages of B-cell maturation and its utility in B-lymphoblastic leukemia/lymphoma measurable residual disease assessment. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.03.175] [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: 10/18/2022] Open
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3
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Hakim MA, Dominguez ED, Priest S, Lee KS, Mardanpour A, Tandle S, Al-Khalil M, Slade G, Gujral S. Surgical Skills Workshops Should Be a Part of the United Kingdom Undergraduate Medical Curriculum. Cureus 2019; 11:e4642. [PMID: 31312568 PMCID: PMC6624155 DOI: 10.7759/cureus.4642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Medical students across the United Kingdom (UK) report poor satisfaction with surgical teaching. The Surgical Skills Day (SSD) begins to address this by exposing medical students to surgery through an easily accessible one-day practical workshop. This study shows how the SSD encourages undergraduate engagement in surgery. Method: Feedback forms were emailed to attendees of the SSD and their anonymised responses were used to evaluate the SSD. Results: A total of 144 students attended the SSD across three years and the feedback response rate was 74% (n = 107). Key findings were that 100% of respondents (n = 107) would like the SSD to be an annual event, 79% (n = 83) were more inclined to pursue a surgical career following the event, and 97% (n = 103) would like to see practical surgical skills incorporated into the curriculum. The SSD was able to engage undergraduates with surgery through mentorship, practical skills, specialty exposure, and teaching of the General Medical Council (GMC) mandated skills. Conclusions: Undergraduate surgical teaching in the UK is insufficient. The student-led annual SSD showed improved engagement in practical surgical skills and increased enthusiasm for a surgical career. In light of this, the authors feel the SSD or similar event should be integrated into the UK medical school curriculum.
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Affiliation(s)
- Muhammad A Hakim
- Health Sciences, University of Bristol Medical School, Bristol, GBR
| | | | - Sebastian Priest
- Health Sciences, University of Bristol Medical School, Bristol, GBR
| | - Keng Siang Lee
- Health Sciences, University of Bristol Medical School, Bristol, GBR
| | - Ameen Mardanpour
- Health Sciences, University of Bristol Medical School, Bristol, GBR
| | - Sankalp Tandle
- Health Sciences, University of Bristol Medical School, Bristol, GBR
| | - Majid Al-Khalil
- Health Sciences, University of Bristol Medical School, Bristol, GBR
| | - George Slade
- Health Sciences, University of Bristol Medical School, Bristol, GBR
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4
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Gujral S, Coelho J, Chummun S, Watts A. Management of Vulval Lichen Sclerosus-The Role of the Plastic Surgeon. Eplasty 2019; 19:ic12. [PMID: 31080544 PMCID: PMC6489424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Sameer Gujral
- Department of Plastic Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom,Correspondence:
| | - James Coelho
- Department of Plastic Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Shaheel Chummun
- Department of Plastic Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Andrew Watts
- Department of Plastic Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
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5
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Mihailidis T, Izadi D, Gujral S. Cutaneous Pyoderma Gangrenosum of the Hand. Eplasty 2018; 18:ic4. [PMID: 29487673 PMCID: PMC5799722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Toni Mihailidis
- aDepartment of Medicine, University of Bristol, Bristol, UK,Correspondence:
| | - David Izadi
- bDepartment of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| | - Sameer Gujral
- cDepartment of Plastic Surgery, Southmead Hospital, Bristol, UK
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6
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Evgeniou E, Walker H, Gujral S. The Role of Simulation in Microsurgical Training. J Surg Educ 2018; 75:171-181. [PMID: 28774503 DOI: 10.1016/j.jsurg.2017.06.032] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 05/07/2017] [Revised: 06/21/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
Simulation has been established as an integral part of microsurgical training. The aim of this study was to assess and categorize the various simulation models in relation to the complexity of the microsurgical skill being taught and analyze the assessment methods commonly employed in microsurgical simulation training. Numerous courses have been established using simulation models. These models can be categorized, according to the level of complexity of the skill being taught, into basic, intermediate, and advanced. Microsurgical simulation training should be assessed using validated assessment methods. Assessment methods vary significantly from subjective expert opinions to self-assessment questionnaires and validated global rating scales. The appropriate assessment method should carefully be chosen based on the simulation modality. Simulation models should be validated, and a model with appropriate fidelity should be chosen according to the microsurgical skill being taught. Assessment should move from traditional simple subjective evaluations of trainee performance to validated tools. Future studies should assess the transferability of skills gained during simulation training to the real-life setting.
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Affiliation(s)
- Evgenios Evgeniou
- Department of Plastic Surgery, North Bristol NHS Trust, Bristol, United Kingdom.
| | - Harriet Walker
- Department of Plastic Surgery, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Sameer Gujral
- Department of Plastic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
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7
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Khanna N, Kalyani N, Godasastry J, Menon H, Sengar M, Khattry N, Dangi U, Arora B, Shet T, Gujral S, Sridhar E, Rangarajan V, Banavali S, Laskar S. PO-0646: Nodular Lymphocyte Predominant Hodgkin’s Lymphoma (NLPHL): Early Outcomes. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31083-6] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Coelho J, Izadi D, Gujral S. Enoxaparin-Induced Skin Necrosis. Eplasty 2016; 16:ic40. [PMID: 27703596 PMCID: PMC5035328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- James Coelho
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, Devon, England,Correspondence:
| | - David Izadi
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, Devon, England
| | - Sameer Gujral
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, Devon, England
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9
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Patkar N, Joshi S, Chaudhary S, Mascerhenas R, Doshi H, Tembhare P, Gujral S, Subramanian PG. Development of a cost-effective 'duplexed' real-time PCR assay for minimal residual disease monitoring of chronic myeloid leukemia using locked nucleic acid probes. Int J Lab Hematol 2016; 38:e102-e106. [PMID: 27461906 DOI: 10.1111/ijlh.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Patkar
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - S Joshi
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - S Chaudhary
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - R Mascerhenas
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - H Doshi
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - P Tembhare
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - S Gujral
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
| | - P G Subramanian
- Hematopathology Laboratory, Tata Memorial Centre, Mumbai, India
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10
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Jain H, Sengar M, Nair R, Menon H, Laskar S, Shet T, Gujral S, Sridhar E. Treatment results in advanced stage Hodgkin's lymphoma: a retrospective study. J Postgrad Med 2016; 61:88-91. [PMID: 25766339 PMCID: PMC4943438 DOI: 10.4103/0022-3859.150446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hodgkin's lymphoma displays distinct epidemiological attributes in Asian population thus making it relevant to study whether there are any differences in treatment outcomes too when treated with current standard of care. AIM To evaluate the treatment outcomes of de-novo advanced stage HL in adults. MATERIALS AND METHODS This retrospective study included de-novo advanced stage HL patients (≥15 years) registered at our center from January 2004 to December 2007. Treatment outcomes were measured in terms of response rates, overall survival (OS) and progression-free survival (PFS). Overall and PFS were calculated with Kaplan-Meier methodology and Cox-proportional hazards model was used for multivariate analysis to identify prognostic factors. RESULTS There were 125 patients (males 77%) who received minimum one cycle of chemotherapy with median age of 32 years (Range 15-65 years). Stage IV disease was seen in (46 patients) 37%; 75% (94 patients) patients had B symptoms. International prognostic score (IPS) ≤4 was seen in 95/112 (85%) patients. ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy was given to 94%. Radiation to residual/bulky sites was given to 36% (45 patients). Response data was available for 112 patients; complete response in 76%; partial response in 10 % and progressive disease in 3 patients. Nineteen deaths (progressive disease-7, toxicity-8, unrelated cause-4) were observed. At median follow-up of 28 months, estimated 5-year OS and PFS were 60% and 58%, respectively. On multivariate analysis, IPS and response to treatment were significant factors for both OS and PFS. CONCLUSIONS The treatment outcomes in this study are comparable with the published literature with limited follow-up data.
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Affiliation(s)
- H Jain
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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11
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Warbrick-Smith J, Urriza Rodriguez D, Gujral S, Smith J. Re: Novel oral anticoagulants in plastic surgery. J Plast Reconstr Aesthet Surg 2016; 69:1151-2. [PMID: 27306951 DOI: 10.1016/j.bjps.2016.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/22/2016] [Indexed: 11/15/2022]
Affiliation(s)
- J Warbrick-Smith
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Heol Maes Eglwys, Swansea, Wales, SA6 6NL, UK.
| | - D Urriza Rodriguez
- Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - S Gujral
- Department of Plastic Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - J Smith
- Department of Plastic Surgery, Bradford Royal Infirmary, Duckworth Lane, BD9 6RJ, UK
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12
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Pattni A, Jones M, Gujral S. Volar Plate Avulsion Injury. Eplasty 2016; 16:ic22. [PMID: 27313814 PMCID: PMC4894366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ashish Pattni
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, Devon, England
| | - Matt Jones
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, Devon, England
| | - Sameer Gujral
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, Devon, England
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13
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Abstract
Unicortical fixation has some practical and theoretical advantages over bicortical fixation. Questions have been raised to its adequacy for post-operative mobilization. We hypothesized that fixation using a plate and eight unicortical screws would be as strong as using a plate and four bicortical screws. A total of 40 unicortical and 40 bicortical fixations were compared using a cadaveric metacarpal model. Unicortical fixation was performed using an eight-hole parallel plate and bicortical fixation with a four-hole straight plate. Fixations were tested to failure using four-point bending load. The mean load to failure was 414 N SD 38(SE) for the unicortical group and 296 N SD 29(SE) for the bicortical group. Significant differences between these two constructs were observed. The mean stiffness of the fixation was higher for the bicortical group than the unicortical, although this difference did not reach significance. Unicortical fixation alone is sufficient to enable early post-operative mobilization in a live model.
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Affiliation(s)
- J K Dickson
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - W Bhat
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - S Gujral
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - J Paget
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - J O'Neill
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - S J Lee
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
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14
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Jones M, Gujral S. Ring Avulsion Injuries. Eplasty 2016; 16:ic5. [PMID: 26933469 PMCID: PMC4753839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Matt Jones
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, Devon, England,Correspondence:
| | - Sameer Gujral
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, Devon, England
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15
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Amare PSK, Jain H, Kabre S, Walke D, Menon H, Sengar M, Khatri N, Bagal B, Dangi U, Jain H, Subramanian PG, Gujral S. Characterization of Genomic Events Other than Ph and Evaluation of Prognostic Influence on Imatinib in Chronic Myeloid Leukemia (CML): A Study on 1449 Patients from India. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jct.2016.74030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Amare PSK, Jain H, Kabre S, Deshpande Y, Pawar P, Banavali S, Menon H, Sengar M, Arora B, Khattry N, Narula G, Sarang D, Kaskar S, Bagal B, Jain H, Dangi U, Subramanian PG, Gujral S. Cytogenetic Profile in 7209 Indian Patients with <i>de novo</i> Acute Leukemia: A Single Centre Study from India. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jct.2016.77056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Idowu A, Lee K, Gujral S, Manushakian J. Unilateral Swollen Hand: A Rare Case of Primary Lymphedema Tarda. Eplasty 2015; 15:ic53. [PMID: 26421093 PMCID: PMC4576842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Akinyemi Idowu
- Department of Plastic Surgery, Derriford Hospital, Plymouth, United Kingdom
| | - Kingyin Lee
- Department of Plastic Surgery, Derriford Hospital, Plymouth, United Kingdom
| | - Sameer Gujral
- Department of Plastic Surgery, Derriford Hospital, Plymouth, United Kingdom,Correspondence:
| | - Jacob Manushakian
- Department of Plastic Surgery, Derriford Hospital, Plymouth, United Kingdom
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18
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Laskar S, Hotwani C, Wadasadawala T, Khanna N, Sastri J, Shet T, Sengar M, Gujral S, Menon H, Sridhar E, Tambe C, Chaudhari S. 3212 Total skin electron beam therapy for mycosis fungoides: Long-term outcomes. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Tandon N, Banavali S, Menon H, Gujral S, Kadam PA, Bakshi A. Is there a role for metronomic induction (and maintenance) therapy in elderly patients with acute myeloid leukemia? A literature review. Indian J Cancer 2015; 50:154-8. [PMID: 23979209 DOI: 10.4103/0019-509x.117033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Acute myeloid leukemia (AML) in older adults differs biologically and clinically from that in younger patients and is characterized by adverse chromosomal abnormalities, stronger intrinsic resistance, and lower tolerance to chemotherapy. In patients over age 60 with AML, cure rates are under 10% despite intensive chemotherapy, and most of them die within a year of diagnosis. Over the last decade, metronomic chemotherapy has emerged as a potential strategy to control advanced/refractory cancer. Here, we report a case of a 68-year-old gentleman having AML with high-risk cytogenetic features, who achieved complete remission on our oral metronomic PrET (PrET: Prednisolone, etoposide, thioguanine) protocol on an outpatient basis. He was later treated with standard high-dose (HD) cytosine arabinoside (Ara-C) consolidation followed by maintenance with etoposide, thioguanine, and sodium valproate. Presently, the patient is nearly 35 months since diagnosis and 21 months off treatment. This case report and review highlights that the combination of oral low-intensity metronomic therapy, followed by standard HD consolidation therapy and metronomic maintenance therapy may be well tolerated by elderly patients especially with less proliferative, high (cytogenetic)-risk AML who are otherwise deemed to be unfit for intensive intravenous induction chemotherapy regimens. References for this review were identified through searches of Pubmed for recent publications on the subject as well as searches of the files of the authors themselves. The final list was generated on the basis of originality and relevance to this review.
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Affiliation(s)
- N Tandon
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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20
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Dickson JK, Gujral S, Bhat W, Paget J, O'Neill J, Lee SJ. Unicortical fixation of metacarpal fractures–Is it strong enough? J Plast Reconstr Aesthet Surg 2014. [DOI: 10.1016/j.bjps.2014.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Gujral S, Hughes JMF, Wiberg A. Necrotizing fasciitis. Eplasty 2014; 14:ic15. [PMID: 24917900 PMCID: PMC4034121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sameer Gujral
- Department of Plastic Surgery, Derriford Hospital, Plymouth, United Kingdom,Correspondence: ;
| | | | - Akira Wiberg
- Department of Plastic Surgery, Derriford Hospital, Plymouth, United Kingdom
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22
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Amare PSK, Gadage V, Jain H, Nikalje S, Manju S, Mittal N, Gujral S, Nair R. Clinico-pathological impact of cytogenetic subgroups in B-cell chronic lymphocytic leukemia: experience from India. Indian J Cancer 2014; 50:261-7. [PMID: 24061469 DOI: 10.4103/0019-509x.118730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The present study of 238 B-cell Chronic Lymphocytic Leukemia (B-CLL) patients were undertaken to seek the prevalence and to evaluate clinico-pathological significance of recurrent genetic abnormalities such as del(13q14.3), trisomy 12, del(11q22.3) (ATM), TP53 deletion, del(6q21) and IgH translocation/deletion. MATERIALS AND METHODS We applied interphase - fluorescence in situ hybridization (FISH) on total 238 cases of B-CLL. RESULTS Our study disclosed 69% of patients with genetic aberrations such as 13q deletion (63%), trisomy 12 (28%), 11q deletion (18%), 6q21 deletion (11%) with comparatively higher frequency of TP53 deletion (22%). Deletion 13q displayed as a most frequent sole abnormality. In group with coexistence of ≥2 aberrations, 13q deletion was a major clone indicating del(13q) as a primary event followed by 11q deletion, TP53 deletion, trisomy 12, 6q deletion as secondary progressive events. In comparison with del(13q), trisomy 12, group with coexistence of ≥2 aberrations associated with poor risk factors such as hyperleukocytosis, advanced stage, and multiple nodes involvement. In a separate study of 116 patients, analysis of IgH abnormalities revealed either partial deletion (24%) or translocation (5%) and were associated with del(13q), trisomy 12, TP53 and ATM deletion. Two of 7 cases had t(14;18), one case had t(8;14), and four cases had other variant IgH translocation t(?;14). CONCLUSION Detail characterization and clinical impact are necessary to ensure that IgH translocation positive CLL is a distinct pathological entity. Our data suggests that CLL with various cytogenetic subsets, group with coexistence of ≥2 aberrations seems to be a complex cytogenetic subset, needs more attention to understand biological significance and to seek clinical impact for better management of disease.
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Affiliation(s)
- P S Kadam Amare
- Cancer Cytogenetics Laboratory, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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23
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Khanna N, Kalyani N, Goda J, Menon H, Sengar M, Arora B, Shet T, Gujral S, Epari S, Laskar S. PO-0651: Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL): Early outcomes. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30769-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
The role of patient-reported outcomes (PROs) in surgery evaluation is increasing. PROs include measures of health-related quality of life (HRQL), patient satisfaction and utility. It is hypothesized that they add to traditional end points by providing detailed assessment of the impact of surgery on patient well-being as well as assessing patient preferences. In addition, qualitative observations from in-depth or semistructured interviews, or focus groups provide data about patient experiences and views of surgery that may supplement standard outcomes and quantitative PROs. This type of detail may contribute to clinical decision-making and informed consent. It is essential, however, that PROs are valid and reliable, and that robust methodology is used in trials and other research settings to incorporate PROs in a clinical context. Future work focusing upon the role of PROs in surgical decision-making is needed, and there is a need to develop methods for communicating PROs to patients. In addition, evaluating surgery with qualitative approaches will add useful insights into how patients experience surgery. This review article focuses on evaluating surgery with measures of HRQL and the qualitative methods that may supplement quantitative outcomes.
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Affiliation(s)
- Kerry Nl Avery
- Department of Social Medicine, University of Bristol, BS8 2PR, UK
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Sengar M, Akhade A, Nair R, Menon H, Shet T, Gujral S, Sridhar E, Laskar S, Muckaden M. A retrospective audit of clinicopathological attributes and treatment outcomes of adolescent and young adult non-Hodgkin lymphomas from a tertiary care center. Indian J Med Paediatr Oncol 2012; 32:197-203. [PMID: 22563152 PMCID: PMC3343245 DOI: 10.4103/0971-5851.95140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 11/08/2022] Open
Abstract
Background: The uniqueness of adolescent and young adult (AYA) non-Hodgkin lymphomas (NHL) with respect to biology and treatment have largely remained unanswered due to marked heterogeneity in treatment, paucity of prospective, or retrospective studies and poor representation of AYA in clinical trials. This audit attempts to put forward the clinicopathological attributes and treatment outcomes of AYA NHL treated with both pediatric and adult protocols from a single centre in a developing country. Patients and Methods: Hospital records of all consecutive NHL patients registered in lymphoma clinic from January 2007 to May 2010 were reviewed for information on demography, clinical features, histology subtype, staging, treatment regimen, response rates, toxicities, and follow up. Two-year progression-free (PFS) and overall survival (OS) were calculated with Kaplan-Meier method. Results: AYA NHL constituted 4% of all lymphomas. Diffuse large B-cell (DLBL) was the most frequent subtype. Following were the 2-year PFS and OS - DLBL 64%, 76.9%, Burkitt's lymphoma: 56%, 56%, lymphoblastic lymphoma: 33.2%, 44%. Our results did not show any improvement in outcome of DLBL with the use of Burkitt's lymphoma like regimen. Conclusions: This study highlights some of the key features of AYA NHL occurring in developing world.
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Affiliation(s)
- Manju Sengar
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, Maharashtra, India
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Roy P, Sengar M, Menon H, Bagal B, Khattry N, Shridhar E, Gujral S, Laskar S, Rangarajan, V, Nair R. A Retrospective Single Centre Analysis of Safety, Toxicity and Efficacy of Rituximab (ORIGINAL) and Its Biosimilar in Diffuse Large B-Cell Lymphoma Patients Treated with Chemo-Immunotherapy. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33629-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kumar D, Laskar S, Muckaden M, Nair R, Menon H, Sengar M, Arora B, Gujral S, Shet T, Banavali S. PO-0642 TREATMENT OUTCOMES AND PATTERNS OF FAILURE IN EARLY STAGE UNFAVOURABLE HODGKINÍS LYMPHOMA. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gujral S. Facial plastic surgery course. Assoc Med J 2011. [DOI: 10.1136/bmj.d1613] [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: 11/03/2022]
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Gujral S, Gandhi JS, Valsangkar S, Shet TM, Epari S, Subramanian PG. Study of the morphological patterns and association of Epstein-Barr virus and human herpes virus 8 in acquired immunodeficiency deficiency syndrome-related reactive lymphadenopathy. INDIAN J PATHOL MICR 2011; 53:723-8. [PMID: 21045401 DOI: 10.4103/0377-4929.72055] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS Study of the morphological patterns of acquired immunodeficiency syndrome (AIDS)-related lymphadenopathy. SETTINGS AND DESIGN We retrospectively selected cases of AIDS-related benign lymphadenopathy. Cases with lymphomas, frank granulomas and necrosis were excluded. We analyzed different morphological patterns and correlated these with immunophenotypic markers along with viral markers human herpesvirus 8-latency-associated nuclear antigen (HHV8-LANA), and Epstein-Barr virus-encoded ribonucleic acid (EBER) studies via in situ hybridization (EBER-ISH). MATERIALS AND METHODS We present the morphological patterns of 13 cases of human immunodeficiency virus (HIV)-reactive lymph nodes and their clinical, hematological, biochemical and radiological parameters with special emphasis on the presence or absence of viral markers, including HHV8 and EBV. RESULTS Common patterns included follicular hyperplasia only (five cases), mixed pattern of follicular hyperplasia with burnt-out germinal centres (four cases), completely atretic follicle (two cases), folliculolysis (11 cases), dumbbell-shaped follicles (three each), progressive transformation of germinal centers (four cases), T-zone expansion (two cases), Reed Sternberg (RS) cells like immunoblasts (two cases), Castleman's-like features with lollipop-like follicles (three cases) and a spindle cell prominence (one case). CD8+ T-cells were predominant in 12 cases. CD8+ T-cells were prominent in germinal centers (eight cases). Plasmablasts were seen in four cases within the perigerminal center area. Immunohistochemistry for HHV8, i.e. HHV8-LANA were negative in all cases while EBER was detected in 11 cases in the centrocyte-like B cells. Two cases of multicentric Castleman's disease expressed EBER; however, they did not express HHV8. CONCLUSION The wide spectrum of histological changes in HIV-associated lymphadenopathy requires recognition. The histological changes can mimic those of other infective lymphadenitis, follicular lymphoma, Castleman's disease, progressive transformation of germinal center, Hodgkin's disease and spindle cell neoplasms. Presence of EBV is common while HHV8 was not seen.
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Affiliation(s)
- S Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.
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Bandyopadhyay A, Laskar S, Nair R, Gujral S, Shet T, Sengar M, Menon H, Muckaden M, Bahl G. Primary Diffuse Large B-cell Lymphoma of the Stomach: Prognostic factors and Outcomes in 160 Indian patients. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gujral S, Polampalli S, Badrinath Y, Kumar A, Subramanian PG, Nair R, Sengar M, Nair C. Immunophenotyping of mature T/NK cell neoplasm presenting as leukemia. Indian J Cancer 2010; 47:189-93. [DOI: 10.4103/0019-509x.63020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gujral S, Agnihotri M, Khatib Y. Myeloid proliferation in a newborn with down syndrome. Indian J Cancer 2010; 47:470-1. [DOI: 10.4103/0019-509x.73552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sable MN, Sehgal K, Gadage VS, Subramanian PG, Gujral S. Megakaryocytic emperipolesis: a histological finding in myelodysplastic syndrome. INDIAN J PATHOL MICR 2009; 52:599-600. [PMID: 19805998 DOI: 10.4103/0377-4929.56153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gota VS, Purandare NC, Gujral S, Shah S, Nair R, Rangarajan V. Positron emission tomography / computerized tomography evaluation of primary Hodgkin's disease of liver. Indian J Cancer 2009; 46:237-9. [PMID: 19574678 DOI: 10.4103/0019-509x.52960] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Occurrence of primary Hodgkin's lymphoma (PHL) of the liver is extremely rare. We report on a case of a 60-year-old male who presented with liver mass and B-symptomatology. Hepatoma or hepatic metastasis from a gastrointestinal primary was initially suspected. Tumor markers like AFP, CEA, Total PSA, and CA-19.9 were within normal limits. Positron Emission Tomography / Computerized Tomography (PET/CT) revealed a large hepatic lesion and a nodal mass in the porta hepatis. A liver biopsy was consistent with Hodgkin's lymphoma. There was complete regression of the hepatic lesion and evidence of shrinkage of the nodal mass following four cycles of chemotherapy. 18F Fluro -de-oxy Glucose (FDG) PET / CT in this case helped in establishing a primary hepatic lymphoma by demonstrating the absence of pathologically hypermetabolic foci in any other nodes or organs. PET / CT scan is a useful adjunct to conventional imaging and histopathology, not only to establish the initial diagnosis, but also to monitor treatment response in PHL.
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Affiliation(s)
- V S Gota
- Departments of Medical Oncology and Bioimaging, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai - 400 012, India
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Gujral S, Badrinath Y, Kumar A, Subramanian PG, Raje G, Jain H, Pais A, Amre Kadam PS, Banavali SD, Arora B, Kumar P, Hari Menon VG, Kurkure PA, Parikh PM, Mahadik S, Chogule AB, Shinde SC, Nair CN. Immunophenotypic profile of acute leukemia: critical analysis and insights gained at a tertiary care center in India. Cytometry B Clin Cytom 2009; 76:199-205. [PMID: 18803279 DOI: 10.1002/cyto.b.20451] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To analyze the spectrum of various types and subtypes of acute leukemia. METHODS Two thousand five hundred and eleven consecutive new referral cases of acute leukemia (AL) were evaluated based on WHO classification. RESULTS It included 1,471 cases (58%) of acute lymphoblastic leukemia (ALL), 964 cases (38%) of acute myeloid leukemia (AML), 45 cases (1.8%) of chronic myelogenous leukemia in blast crisis (CMLBC), 37 cases (1.5%) of biphenotypic acute leukemia (BAL), 1 case of Triphenotypic AL, and 2 cases of acute undifferentiated leukemia (AUL). Common subtypes of ALL were B-cell ALL (76%), which comprised of intermediate stage/CALLA positive (73%), early precursor/proBALL (3%). T-cell ALL constituted 24% (351 cases) of ALL. Common subtypes of AML included AMLM2 (27%), AMLM5 (15%), AMLM0 (12%), AMLM1 (12%), APML (11%), and AML t(8;21) (9%). CMLBC was commonly of myeloid blast crisis subtype (40 cases). CONCLUSION B-cell ALL was the commonest subtype in children and AML in adults. Overall incidence of AML in adults was low (53% only). CD13 was most sensitive and CD117 most specific for determining myeloid lineage. A minimal primary panel of nine antibodies consisting of three myeloid markers (CD13, CD33, and CD117), B-cell lymphoid marker (CD19), T-cell marker (CD7), with CD45, CD10, CD34, and HLADR could assign lineage to 92% of AL. Cytogenetics findings lead to a change in the diagnostic subtype of myeloid malignancy in 38 (1.5%) cases.
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Affiliation(s)
- S Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.
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Gujral S, Agarwal A, Gota V, Nair R, Gupta S, Pai SK, Sanger M, Shet T, Subramanian PG, Muckaden M, Laskar S. A clinicopathologic study of mantle cell lymphoma in a single center study in India. INDIAN J PATHOL MICR 2009; 51:315-22. [PMID: 18723950 DOI: 10.4103/0377-4929.42503] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present clinical features, histopathology and results of treatment in cases of mantle cell lymphoma (MCL) at our hospital. We had 93 cases (2.1%) of MCL out of total 4301 cases of non-Hodgkin's lymphoma (NHL) in a 4-year period. It included 68 cases (1.7%) of MCL from 3987 cases of NHL diagnosed on histopathology. Remaining 25 cases (7.9%) diagnosed solely on peripheral blood examination were excluded. Thirty-six (85%) patients had advanced-stage disease. Sixty-three were nodal and five were extranodal (all gastrointestinal tract). Common patterns were diffuse (64%), nodular (25%) and mantle zone type (11%). Sixty-two cases had lymphocytic while six had blastic morphology (all nodal). Tumor cells expressed CD20 (100%), CD43 (94%), CD5 (89%) and cyclin D1 (85%). Bone marrow was involved in 25 (59%) cases. Thirty-two patients could be treated. Median recurrence-free survival was 22.23 months. Diffuse pattern of nodal involvement had a lower overall survival.
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Affiliation(s)
- S Gujral
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.
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Qureshi S, Mistry R, Natrajan G, Gujral S, Laskar S, Banavali S. Leiomyosarcoma of the maxilla as second malignancy in retinoblastoma. Indian J Cancer 2009; 45:123-5. [PMID: 19018117 DOI: 10.4103/0019-509x.44069] [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] [Indexed: 11/04/2022]
Abstract
Patients with hereditary retinoblastoma are at increased risk of second primary tumor, the commonest tumor being osteosarcoma. Leiomyosarcoma developing as second primary neoplasm in retinoblastoma patients is unusual and most have occurred in the field of previous radiotherapy. Although with aggressive therapy better survival can be achieved, the overall prognosis of patients developing these second neoplasms is poor. In this report we present a case of leiomyosarcoma of the maxilla as a second neoplasm in a patient with bilateral retinoblastoma which has developed outside the radiation field.
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Affiliation(s)
- Ss Qureshi
- Department of Surgical Oncology, Tata Memorial Hospital, Ernest Borges Road, Parel, Bombay, India.
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Azzopardi EA, Gujral S, Mandal A, Kulkarni M. Rapidly expanding thenar eminence ganglion: a case report. Cases J 2009; 2:129. [PMID: 19200372 PMCID: PMC2649054 DOI: 10.1186/1757-1626-2-129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 02/06/2009] [Indexed: 11/25/2022]
Abstract
Introduction This study documents the first reported case of a rapidly growing (volar) thenar eminence ganglion arising form the first carpometacarpal joint, masquerading as a sarcoma. The discussion informs the hand surgeon on the evidence regarding the unusual presenting features. Case presentation An 85 year old left hand dominant female presented with a six week history of rapidly growing lump on the thenar eminence. Clinical examination revealed a non-tender large lobulated mobile swelling measuring 5 × 4 cm and involving the whole thenar eminence. Conclusion Ganglia may present from the thenar eminence and are a source of diagnostic confusion.
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Affiliation(s)
- E A Azzopardi
- Department of Plastic Reconstructive and Aesthetic Surgery, Wexham Park Hospital, Slough, UK.
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Choughule A, Polampalli S, Amre P, Shinde S, Banavali S, Prabhash K, Nair R, Subramanian P, Gujral S, Parikh P. Identification of PML/RARα fusion gene transcripts that showed no t(15;17) with conventional karyotyping and fluorescent in situ hybridization. Genet Mol Res 2009; 8:1-7. [DOI: 10.4238/vol8-1gmr488] [Citation(s) in RCA: 13] [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: 11/03/2022]
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Gujral S, Polampalli S, Badrinath Y, Kumar A, Subramanian PG, Raje G, Amare P, Arora B, Banavali SD, Nair CN. Clinico-hematological profile in biphenotypic acute leukemia. Indian J Cancer 2009; 46:160-8. [DOI: 10.4103/0019-509x.49156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Polampalli S, Choughule A, Negi N, Shinde S, Baisane C, Amre P, Subramanian PG, Gujral S, Prabhash K, Parikh P. Analysis and comparison of clinicohematological parameters and molecular and cytogenetic response of two Bcr/Abl fusion transcripts. Genet Mol Res 2008; 7:1138-49. [PMID: 19048492 DOI: 10.4238/vol7-4gmr485] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Different forms of p210 are produced by alternative splicing, namely b2a2 and b3a2. There have been many contrasting data establishing a relationship between the two Bcr/Abl transcripts and platelet counts and also response to treatment. However, the data published to date have been on a small group of patients. The aim of the present study was to determine whether there was any difference between clinical and hematological parameters at diagnosis between the two Bcr/Abl fusion transcripts in our population, and whether the two transcripts responded differently or similarly to imatinib treatment. RT-PCR was performed in 202 cases for detection of Bcr/Abl transcripts in newly diagnosed chronic myelogenous leukemia cases in one year. The two transcripts were compared and correlated with clinical, hematological and FISH data and with response to treatment. A total of 138 cases were of b3a2 and 64 were of b2a2 transcript. There was no correlation between the hematological parameters and the type of transcript. There was a significant association of blast crisis with b2a2, especially with myeloid blast crisis. When compared to FISH results, 10% of b3a2 were found to have a significant association with 5'Abl deletion as compared to 3% of b2a2. On analyzing the therapeutic response, we did not find any difference between the two transcripts. In conclusion, our findings confirm that the b3a2 type transcript is not significantly associated with thrombocytosis, that the short transcript, b2a2, occurs with acute phase, i.e., blast crisis, and that there is no difference in treatment response between the two transcripts. However, further studies are required to understand the molecular pathways involved in the Bcr/Abl mechanism.
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Affiliation(s)
- S Polampalli
- Department of Medical Oncology, Molecular Biology Laboratory, Tata Memorial Hospital, Mumbai, India.
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Abstract
We have had a recent spurt in cases of AIDS-related lymphoma (ARL) at our centre. Most of these cases are aggressive mature B cell lymphomas, mainly plasmablastic lymphoma (PBL) and diffuse large B-cell lymphoma (DLBCL). Most of the PBL are extranodal in location and are mucosa-based. We reviewed the morphological features of 34 cases of PBL. Diagnosis was based on morphology, immunohistochemistry, proliferation index, HIV positive status and its preference to extranodal sites (mostly mucosa based). We classified PBL into three morphological subtypes (immunoblastic - 25, Burkitt's - 7, plasmacytic - 2). Tumor cells expressed as leucocyte common antigen (LCA) in 60%, CD138 in 100%, EMA in 45% and light chain restriction in 86% cases. CD20 was negative in all cases. Pathologists need to be aware of PBL and its various morphological subtypes as the identification of this entity from its close differentials carries major therapeutic implications.
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Affiliation(s)
- S Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.
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Prabhash K, Vikram GS, Nair R, Sengar M, Gujral S, Bakshi A, Gupta S, Parikh PM. Fludarabine in lymphoproliferative malignancies: a single-centre experience. Natl Med J India 2008; 21:171-174. [PMID: 19267037] [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: 05/27/2023]
Abstract
BACKGROUND Fludarabine has been reported to be an effective drug for the treatment of chronic lymphocytic leukaemia (CLL) and indolent lymphomas. However, its safety and efficacy in Indian patients has not been studied. We retrospectively analysed our experience with fludarabine in low grade lymphomas and CLL. METHODS The records of all patients with low grade lymphoma or CLL who received fludarabine between April 1999 and November 2006 were analysed. Response evaluation was done as per the National Cancer Institute-Working Group guidelines for CLL and International Workshop criteria for non-Hodgkin lymphomas, respectively, in those patients who received at least 3 cycles of fludarabine. Toxicity was graded as per the common terminology criteria for adverse events, version 3.0. Median event-free survival was obtained using Kaplan-Meier survival analysis. RESULTS Forty-seven patients were included in the study and 189 cycles were administered (median: 4 cycles per patient). Sixteen patients had a treatment delay, 14 due to myelosuppression. Twenty-five patients had low grade lymphoma and 22 had CLL. The response was evaluable in 22 patients with low grade lymphoma and 20 with CLL. The overall response rate for CLL was 100% in those treated upfront (n=9) and 55% in those with relapsed disease (n=11). The overall response rate for low grade lymphoma was 88% (63% complete remission) in untreated patients and 79% (43% complete remission) in those with relapsed disease. Common adverse events were myelosuppression and infection. Two patients died of sepsis and 4 due to disease progression on treatment. Median event-free survival for patients treated upfront with fludarabine was 31.4 months. CONCLUSION In our patient population, response to fludarabine is similar to that in the published literature. Our patients had a higher frequency of haematological toxicity.
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Affiliation(s)
- K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai 400012, Maharashtra, India
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Gujral S, Amre P, Nair CN, Joshi S, Sunita P, Deshmukh C. Bone marrow morphological changes in patients of chronic myeloid leukemia treated with imatinib mesylate. Indian J Cancer 2008; 45:45-9. [DOI: 10.4103/0019-509x.41769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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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Gujral S, Avery KNL, Blazeby JM. Quality of life after surgery for colorectal cancer: clinical implications of results from randomised trials. Support Care Cancer 2007; 16:127-32. [DOI: 10.1007/s00520-007-0356-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 10/18/2007] [Indexed: 01/01/2023]
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Bahl G, Laskar S, Muckaden MA, Nair R, Gupta S, Bakshi A, Gujral S, Parikh PM, Shrivastava SK, Dinshaw KA. Non-Hodgkin lymphoma of the Waldeyer's ring: Is a higher radiotherapy dose required? J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8067 Background: To evaluate the prognostic factors and treatment outcome of Indian patients with primary Non-Hodgkins Lymphoma (NHL) of the Waldeyer's Ring (WR) region treated at a single institute. Methods: 269 patients with NHL of the WR treated at Tata Memorial Hospital, Mumbai from January 1990 to December 2002 were included. The median age was 45 years and majority of the patients (67%) were males. Systemic symptoms were present in only 16% of patients, primary site was the tonsil in 58%, nasopharynx in 42% and base tongue in 5% of patients. Majority had Diffuse Large B-Cell Lymphoma (85%); 26% patients presented with stage I disease and 66% had stage II disease. Treatment comprised of a combination of chemotherapy (CTh) and radiotherapy (RT) in majority of the patients (71%). Among these patients, 63% received an RT dose of =45Gy. Results: The complete response rate was 68%. After a median follow-up of 57 months, the 5 year DFS & OS for the whole group were 62.2% and 70.1% respectively. Multivariate analysis showed that; age >30 years (HR=4.05, 95%CI=1.53–10.7, p=0.005), WHO performance score =2 (HR=2.36, 95%CI=1.12–4.95, p=0.023), T-cell lymphomas (HR=5.55, 95%CI=2.43–12.7, p<0.001), bulky tumors (HR=2.08, 95%CI=1.02–4.257, p=0.045), and nasopharyngeal primary (HR=3.26, 95%CI=1.51–7.02, p=0.003), had a negative influence on survival. Patients treated with a combination of CTh & RT had a significantly better outcome than those treated with CTh alone (OS: 78.9% vs. 48.1%, p<0.00001). The hazard ratio for death (HR) in the chemotherapy alone group was 3.50 (95% CI=2.17–5.65). The CR (p=0.01), DFS (p<0.0001) and OS (p=0.002) rates were significantly better for patients receiving a RT dose of =45Gy. The HR in the subgroup that received a RT dose of < 45Gy was 5.09 (95% CI=2.39–10.86). Conclusions: Age at diagnosis, WHO performance score, T-cell histological type, size and site of the tumor significantly influence outcome in patients with primary NHL of the Waldeyer's Ring. Combined modality treatment, comprising of CTh & RT (with an RT dose of =45Gy), results in satisfactory outcome in patients with this rare neoplasm. No significant financial relationships to disclose.
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Affiliation(s)
- G. Bahl
- Tata Memorial Hospital, Mumbai, India
| | - S. Laskar
- Tata Memorial Hospital, Mumbai, India
| | | | - R. Nair
- Tata Memorial Hospital, Mumbai, India
| | - S. Gupta
- Tata Memorial Hospital, Mumbai, India
| | - A. Bakshi
- Tata Memorial Hospital, Mumbai, India
| | - S. Gujral
- Tata Memorial Hospital, Mumbai, India
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Gujral S, Conroy T, Fleissner C, Sezer O, King PM, Avery KNL, Sylvester P, Koller M, Sprangers MAG, Blazeby JM. Assessing quality of life in patients with colorectal cancer: an update of the EORTC quality of life questionnaire. Eur J Cancer 2007; 43:1564-73. [PMID: 17521904 DOI: 10.1016/j.ejca.2007.04.005] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 04/05/2007] [Indexed: 12/16/2022]
Abstract
The European Organisation for Research and Treatment of Cancer (EORTC) has a portfolio of questionnaire modules to supplement the QLQ-C30 to assess patient reported outcomes in cancer clinical trials. This study updated the module for colorectal cancer. A review of the literature identified 20 articles that used the EORTC colorectal module. Eight papers did not report data from scales addressing sexual function and 8 added additional scales to assess ano-rectal function. Interviews with patients (n=79) and professionals (n=11) informed item selection, reduction and modification. A new 29 item module was devised and further patient interviews (n=120) examined its format and content validity. Patients found the new module acceptable with relevant content. The new module, the EORTC QLQ-CR29, is hypothesised as containing 6 scales and 11 single items. An international study examining its clinical and psychometric validity will be performed.
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Affiliation(s)
- S Gujral
- United Bristol Healthcare Trust, Clinical Sciences, South Bristol, Level 7, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
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Nair R, Prabhash K, Sengar M, Bakshi A, Gujral S, Gupta S, Parikh P. The effect of short-term intensive chemotherapy on reactivation of tuberculosis. Ann Oncol 2007; 18:1243-5. [PMID: 17434895 DOI: 10.1093/annonc/mdm107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Various malignancies and cytotoxic chemotherapy have been proposed to increase the risk of reactivation of tuberculosis. Available literature to support this observation is still conflicting. There is scarcity of data from countries with rampant tubercular infection, such as India, in this regard. DESIGN AND METHODS In the present retrospective analysis, patients with high-grade non-Hodgkin's lymphoma with past history of tuberculosis and have had adequate antitubercular therapy were identified from a Lymphoma Group study. These patients were followed up during cytotoxic chemotherapy and later to assess the risk of reactivation. RESULTS A cohort of eight patients with past history of tuberculosis was selected from 141 patients of high-grade non-Hodgkin's lymphoma. The median age was 33.5 years (range, 24-53 years). Median duration between completion of antitubercular treatment and diagnosis of lymphoma was 5 years (range, 1.5-10 years). All patients received cyclical cytotoxic chemotherapy. The median duration of follow up after completion of chemotherapy was 5 years (range, 10 months to 5 years). None of these patients developed reactivation of tuberculosis. CONCLUSION Cyclical chemotherapy for non-Hodgkin's lymphoma does not lead to reactivation of tuberculosis.
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Affiliation(s)
- R Nair
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
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Pant V, Jambhekar NA, Madur B, Shet TM, Agarwal M, Puri A, Gujral S, Banavali M, Arora B. Anaplastic large cell lymphoma (ALCL) presenting as primary bone and soft tissue sarcoma--a study of 12 cases. INDIAN J PATHOL MICR 2007; 50:303-7. [PMID: 17883051] [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
This study highlights the rare presentation of anaplastic large cell lymphoma as primary bone and soft tissue tumour. Twelve cases were studied. Clinical impression was non Hodgkin's lymphoma in 4 cases, sarcoma in 6 (osteosarcoma-2, Ewing's/primitive neuroectodermal tumour-1, and sarcoma NOS-3), and tuberculosis of thoracic spine in 1 and the last case involving the rib had a differential diagnosis of tuberculosis and NHL. Histology revealed round cells with eosinophilic cytoplasm and pleomorphic nuclei. Immunohistochemically all tumours were CD30 positive and 8 of 9 cases (88.9%) showed ALK-1 positivity. The pleomorphic cytomorphology ofALCL leads to confusion with the more frequent bone and soft tissue sarcomas affecting the musculoskeletal system. A high index of suspicion is necessary to initiate the correct panel of immunohistochemical markers to first confirm the lymphomatous nature of this tumour and to subsequently subclassify. This alone will lead to an accurate recognition of ALCL and the appropriate chemotherapy.
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Affiliation(s)
- Vinita Pant
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai
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