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McDonald HG, Zaki OA, Wright MJ, Jayswal R, Weiss H, Nair RT, Ganesh H, Ellis S, Kolesar JM, Moss J, Barry-Hundeyin M, Pandalai PK, Kim J, Patel RA, Cavnar MJ. Phase I Safety and Feasibility Pilot of Hepatic Artery Infusion Chemotherapy in a Rural Catchment Area Using The Codman Vascular Catheter with The Medtronic SynchroMed II Pump for Intrahepatic Cancers. Ann Surg Oncol 2024; 31:1252-1263. [PMID: 38006531 DOI: 10.1245/s10434-023-14519-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/13/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Discontinuation of the Codman 3000 pump in 2018 left no Food and Drug Administration (FDA)-approved hepatic artery infusion (HAI) device for unresectable colorectal liver metastases (uCLM) and intrahepatic cholangiocarcinoma (uIHC). Historically, HAI has been performed at academic medical centers in large metropolitan areas, which are often inaccessible to rural patients. Consequently, feasibility of dissemination of HAI to rural populations is unknown. PATIENTS AND METHODS Under an FDA investigational device exemption, we opened the only HAI program in Kentucky and enrolled patients with uCLM and uIHC in a phase I clinical trial. The trial examined the safety of the hybrid Codman catheter/Medtronic SynchroMed II pump (hCMP) combination, defined as successful completion of one cycle of HAI chemotherapy. Rural feasibility was assessed by number of missed pump fills appointments. RESULTS A total of 21 patients (n = 17 uCLM, n = 4 uIHC) underwent hCMP implantation before accrual was stopped early owing to FDA approval of the Intera 3000 pump. 20/21 (95%) patients met the primary safety endpoint. Serious adverse events (AEs) included a grade 5 coronavirus disease 2019 (COVID-19) infection (n = 1) and a grade 3 catheter erosion into the bowel (n = 1). Biliary sclerosis developed in two patients (9.5%). Median distance to infusion center was 47.6 miles (2-138 miles), and 62% were from Appalachia, yet there were no missed pump fill appointments. The 2-year overall survival was 82.4% (uCLM) and 50% (uIHC). CONCLUSIONS The hCMP device had an acceptable safety profile. Despite the complexity of starting a new HAI program, early results showed feasibility for HAI delivery in a rural catchment area and comparable outcomes to larger urban-based HAI centers.
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Affiliation(s)
- Hannah G McDonald
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Omar A Zaki
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Matt J Wright
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Rani Jayswal
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Heidi Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Rashmi T Nair
- College of Medicine Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Halemane Ganesh
- College of Medicine Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Scott Ellis
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jill M Kolesar
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jessica Moss
- College of Medicine Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Mautin Barry-Hundeyin
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Prakash K Pandalai
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Joseph Kim
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Reema A Patel
- College of Medicine Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Michael J Cavnar
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA.
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McDonald HG, Zaki OA, Wright MJ, Jayswal R, Weiss H, Nair RT, Ganesh H, Ellis S, Kolesar JM, Moss J, Barry-Hundeyin M, Pandalai PK, Kim J, Patel RA, Cavnar MJ. ASO Visual Abstract: Phase I Safety and Feasibility Pilot of Hepatic Artery Infusion Chemotherapy in a Rural Catchment Area Using the Codman Vascular Catheter with the Medtronic Synchromed II Pump for Intrahepatic Cancers. Ann Surg Oncol 2024; 31:1292-1293. [PMID: 38006533 DOI: 10.1245/s10434-023-14653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Affiliation(s)
- Hannah G McDonald
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Omar A Zaki
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Matt J Wright
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Rani Jayswal
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Heidi Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Rashmi T Nair
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Halemane Ganesh
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Scott Ellis
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jill M Kolesar
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jessica Moss
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Mautin Barry-Hundeyin
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Prakash K Pandalai
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Joseph Kim
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Reema A Patel
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Michael J Cavnar
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA.
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Tadisetty S, Nair RT, Heba ER, Dawkins A. I saw the "kissing ovaries" sign: Too close for comfort. Clin Imaging 2023; 100:7-9. [PMID: 37120923 DOI: 10.1016/j.clinimag.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
The Kissing ovaries sign is a radiological sign seen in women with deep pelvic endometriosis. It refers to abutment of the ovaries within the cul-de-sac. The term kissing ovaries was first described by Ghezzi et al. (2005) and has been since used widely. When seen on imaging it indicates moderate to severe endometriosis with the ovaries tethered within abnormal pelvic soft tissue, which may warrant surgical management.
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Affiliation(s)
- Sindhura Tadisetty
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States of America.
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States of America.
| | - Elhamy R Heba
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States of America.
| | - Adrian Dawkins
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States of America.
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Khot R, Morgan MA, Nair RT, Ludwig DR, Arif-Tiwari H, Bhati CS, Itani M. Radiologic findings of biliary complications post liver transplantation. Abdom Radiol (NY) 2023; 48:166-185. [PMID: 36289069 DOI: 10.1007/s00261-022-03714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
Liver transplantation is a potentially curative treatment for patients with acute liver failure, end-stage liver disease, and primary hepatic malignancy. Despite tremendous advancements in surgical techniques and immunosuppressive management, there remains a high rate of post-transplant complications, with one of the main complications being biliary complications. In addition to anastomotic leak and stricture, numerous additional biliary complications are encountered, including ischemic cholangiopathy due to the sole arterial supply of the bile ducts, recurrence of primary biliary disease, infections, biliary obstruction from stones, cast, or hemobilia, and less commonly cystic duct remnant mucocele, vanishing duct syndrome, duct discrepancy and kinking, post-transplant lymphoproliferative disorder, retained stent, and ampullary dysfunction. This article presents an overview of biliary anatomy and surgical techniques in liver transplantation, followed by a detailed review of post-transplant biliary complications with their corresponding imaging findings on multiple modalities with emphasis on magnetic resonance imaging and MR cholangiopancreatography.
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Affiliation(s)
- Rachita Khot
- Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Chandra S Bhati
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
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Morgan MA, Khot R, Sundaram KM, Ludwig DR, Nair RT, Mittal PK, Ganeshan DM, Venkatesh SK. Primary sclerosing cholangitis: review for radiologists. Abdom Radiol (NY) 2023; 48:136-150. [PMID: 36063181 PMCID: PMC9852001 DOI: 10.1007/s00261-022-03655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 01/22/2023]
Abstract
Primary sclerosing cholangitis is a rare chronic inflammatory disease affecting the bile ducts, which can eventually result in bile duct strictures, cholestasis and cirrhosis. Patients are often asymptomatic but may present with clinical features of cholestasis. Imaging plays an important role in the diagnosis and management. This review covers the pathophysiology, clinical features, imaging findings as well as methods of surveillance and post-transplant appearance.
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Affiliation(s)
- Matthew A. Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Rachita Khot
- Radiology and Medical Imaging, University of Virginia Health, 1215 Lee Street, Charlottesville, VA, USA
| | - Karthik M. Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Daniel R. Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO, USA
| | - Rashmi T. Nair
- Department of Radiology, University of Kentucky, 800 Rose Street, Room HX 313B, Lexington, KY 40536-0293, USA
| | - Pardeep K. Mittal
- Medical College of Georgia at Augusta University, 1120 15th street BA −1411, Augusta, GA 30912, USA
| | - Dhakshina M. Ganeshan
- The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1473, Houston, TX 77030, USA
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Zhang Y, Hammonds A, Tran-Harding K, Schaberg KB, Nair RT, Wang C, Wu Y, Pandalai PK, Kolesar J, Kim J, Cavnar MJ. Targetable IDH1 mutation identified in a rare case of pancreatic serous cystadenocarcinoma but not a series of serous cystadenomas. J Surg Case Rep 2022; 2022:rjac096. [PMID: 35350224 PMCID: PMC8944732 DOI: 10.1093/jscr/rjac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022] Open
Abstract
Serous cystadenocarcinoma (SCAC) of the pancreas is rare, with only 35 cases reported in the literature. We present a case of SCAC, comparing the clinical presentation, management and molecular features of this case to a series of serous cystadenoma (SCA), which may be a precursor. Compared with SCAs (n = 5), SCAC was larger (11.5 vs median 3.6 cm). The case of SCAC invaded the spleen and exhibited distant metastasis, a requirement for diagnosis since pathologic features are otherwise indistinguishable from SCA. VHL mutations have been reported in about half of SCA in the literature. Accordingly, we identified either somatic or germline VHL mutations in 3 of 5 SCAs (60%), yet no pathogenic mutation was identified in the SCAC. A somatic mutation in IDH1 was found in SCAC only. This has been associated with multiple malignancies, is targetable with the drug ivosidenib and should be studied as a progression factor in SCAC.
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Affiliation(s)
- Yuxi Zhang
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Autumn Hammonds
- Department of Pathology, University of Kentucky, Lexington, KY, USA
| | | | - Kurt B Schaberg
- Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Chi Wang
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Yuanyuan Wu
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | | | - Jill Kolesar
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Joseph Kim
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Michael J Cavnar
- Department of Surgery, University of Kentucky, Lexington, KY, USA
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Nair RT, Dawkins AA, Ganesh HS. Editorial for "Diagnostic Performance of Prostate MRI Radiomics, Four Kallikrein Panel and Radiologist in the Detection of Prostate Cancer: A Retrospective External Validation Multi-center Study of Men With a Clinical Suspicion of Prostate Cancer". J Magn Reson Imaging 2021; 55:478-479. [PMID: 34448318 DOI: 10.1002/jmri.27898] [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: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rashmi T Nair
- Division of Abdominal Radiology, Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Adrian A Dawkins
- Division of Abdominal Radiology, Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Halemane S Ganesh
- Division of Abdominal Radiology, Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
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8
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Kapoor H, Issa M, Winkler MA, Nair RT, Wesam F, Ganesh H. The augmented role of pancreatic imaging in the era of endoscopic necrosectomy: an illustrative and pictorial review. Abdom Radiol (NY) 2020; 45:1534-1549. [PMID: 31197462 DOI: 10.1007/s00261-019-02093-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endoscopic cystogastrostomy for mature pancreatic collections has long been recognized. However, FDA approval of newer lumen-apposing metallic stents in 2014 has now brought pancreatic necrosectomy to the endoscopic realm. Endoscopic drainage of Walled-off necrosis and direct endoscopic necrosectomy are technically challenging procedures with higher rates of complications. Collaborative clinical decision making both pre- and post-procedurally between the radiologist, endoscopist, and the surgeon can greatly improve outcomes in necrotizing pancreatitis. Herein, we review the basic pathophysiology that underlies progressive radiographic findings in NP, value of preprocedural imaging, current management algorithms, newer tools, and techniques as well as potential post-procedure complications on imaging follow-up after endoscopic interventions in necrotizing pancreatitis.
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Chauhan A, Arnold SM, Wu J, Nair RT, Slone SA, Dressler EVM, Flynn H, Adams VR, Weiss H, Evers M, Anthony LB. Clinical efficacy and toxicity data on phase I study of fosbretabulin in combination with everolimus in neuroendocrine tumors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4114] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4114 Background: Fosbretabulin, a synthetic, water-soluble, phosphorylated prodrug of the natural product combretastatin A4 (CA4P), initially isolated from the bark of the South African bush willow, Combretum caffrum, is the lead compound in a class of agents termed vascular disrupting agents (VDAs). Everolimus, an mTOR inhibitor, is FDA approved for the management of well-differentiated NETs. A Phase I trial combining fosbretabulin and everolimus to determine the recommended Phase II trial dose (RP2D), safety data and early clinical efficacy in metastatic GEPNET patients was conducted. Methods: An investigator-initiated, single center, open-label, phase I study involving GEPNETs incorporated partial order continual reassessment method (PO-CRM) to define the dose escalation. The primary objective was to establish the maximum tolerated dose (MTD) of the combination of everolimus and fosbretabulin in NETs that have progressed after at least one prior regimen for metastatic disease. Secondary objective included identifying the safety profile of the combination using NCI CTCAE4 reporting criteria. Patients received daily oral everolimus (2.5 mg, 5 mg, 7.5 mg, and 10 mg). Fosbretabulin was administered IV 60 mg/m2 either q3 weekly or q weekly based on PO-CRM. Patients were treated for 12 weeks with all combinations. RECIST 1.1 was used to evaluate radiological responses at 3 month. Results: Of the 17 patients enrolled, 16 completed the 12-week trial. One patient was not evaluable due to noncompliance. No DLTs were observed at day 21. The highest dose of 10 mg daily oral everolimus in combination with weekly 60mg/m2 IV fosbretabulin is the RP2D. No grade 4 or 5 toxicities were noted. Grade 3 toxicities were seen in 5 patients; abdominal pain and hyperglycemia (not related to study drug), fatigue (possibly related), decreased lymphocyte count and anemia (related). Several patients had delay in treatment due to grade 2 AE’s (GI symptoms, rash, thrombocytopenia) and one patient was unable to complete treatment due to pneumonitis. All evaluable patients except one had stable disease at 3 months. One patient showed SD but non target lesion demonstrated PD. One patient had > 30% decrease in tumor size but overall sum of lesions showed SD. A detailed table with all grade toxicities and waterfall plot of RR will be presented at the meeting. Conclusions: Ten mg PO daily everolimus plus 60 mg/m2 fosbretabulin IV weekly is the RP2D. Early clinical data suggests clinical activity and stable disease in all but one patient at 3 months. Clinical trial information: NCT0301429.
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Affiliation(s)
- Aman Chauhan
- University of Kentucky, Division of Medical Oncology, Lexington, KY
| | | | | | | | | | | | | | | | - Heidi Weiss
- University of Kentucky and Markey Cancer Center, Lexington, KY
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Tran-Harding K, Nair RT, Dawkins A, Ayoob A, Owen J, Deraney S, Lee JT, Stevens S, Ganesh H. Endometriosis revisited: an imaging review of the usual and unusual manifestations with pathological correlation. Clin Imaging 2018; 52:163-171. [DOI: 10.1016/j.clinimag.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 01/06/2023]
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Clark AI, Dawkins AA, Nair RT. "Inverted Figure 3" sign of periampullary carcinoma. Abdom Radiol (NY) 2018; 43:2542-2543. [PMID: 29492601 DOI: 10.1007/s00261-018-1507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A I Clark
- Department of Radiology, University of Kentucky, Lexington, KY, USA.
| | - A A Dawkins
- Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - R T Nair
- Department of Radiology, University of Kentucky, Lexington, KY, USA
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Tran-Harding K, Nair RT, Ganesh H. Renal Granulomatosis Post Intravesical Bacillus Calmette-Guerin Therapy for Non-muscle-invasive Bladder Cancer. J Clin Imaging Sci 2018; 8:18. [PMID: 29770266 PMCID: PMC5939034 DOI: 10.4103/jcis.jcis_83_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/20/2018] [Indexed: 11/30/2022] Open
Abstract
Intravesical Bacillus Calmette–Guerin (BCG) immunotherapy is a proven, effective treatment for intermediate- and high-risk non-muscle-invasive bladder cancer. Minor side effects are common and expected but systemic effects can occur in <5% of treated patients. We present a rare case of a 49-year-old male that presented with fever and chills after 3 weeks of intravesical BCG therapy post transurethral resection of bladder tumor. New renal lesions were present on contrast-enhanced computed tomography scan which was histologically proven to be necrotizing renal granulomatosis.
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Affiliation(s)
- Karen Tran-Harding
- Department of Diagnostic Radiology, University of Kentucky Chandler Medical Center, Lexington, KY, USA
| | - Rashmi T Nair
- Department of Diagnostic Radiology, University of Kentucky Chandler Medical Center, Lexington, KY, USA
| | - Halemane Ganesh
- Department of Diagnostic Radiology, University of Kentucky Chandler Medical Center, Lexington, KY, USA
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Affiliation(s)
- Qiong Han
- Department of Radiology, University of Kentucky, Lexington, USA.
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky, Lexington, USA
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Nair RT, vanSonnenberg E, Shankar S, Morrison PR, Gill RR, Tuncali K, Silverman SG. Visceral and Soft-Tissue Tumors: Radiofrequency and Alcohol Ablation for Pain Relief—Initial Experience. Radiology 2008; 248:1067-76. [DOI: 10.1148/radiol.2483061883] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Nair RT, Silverman SG, Tuncali K, Obuchowski NA, vanSonnenberg E, Shankar S. Biochemical and Hematologic Alterations Following Percutaneous Cryoablation of Liver Tumors: Experience in 48 Procedures. Radiology 2008; 248:303-11. [DOI: 10.1148/radiol.2481061874] [Citation(s) in RCA: 28] [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: 11/11/2022]
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VanSonnenberg E, Shankar S, Morrison PR, Nair RT, Silverman SG, Jaklitsch MT, Liu F, Cheung L, Tuncali K, Skarin AT, Sugarbaker DJ. Radiofrequency Ablation of Thoracic Lesions: Part 2, Initial Clinical Experience—Technical and Multidisciplinary Considerations in 30 Patients. AJR Am J Roentgenol 2005; 184:381-90. [PMID: 15671350 DOI: 10.2214/ajr.184.2.01840381] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [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: 12/16/2022]
Abstract
OBJECTIVE The purpose of our study was to report our initial experience with patients who underwent percutaneous imaging-guided radiofrequency ablation of thoracic lesions, and to emphasize technical and multidisciplinary issues and adjunctive procedures specific to thoracic tumor ablation. MATERIALS AND METHODS Our cohort consisted of 30 patients with a spectrum of primary (n=18) and secondary (n=11) lung tumors, mesothelioma (n=1), and five secondarily eroded, painful ribs who underwent ablation of 36 total lesions (one patient had two ablations). Patients either were nonsurgical candidates because of medical comorbidities or extent of disease, or had exhausted chemotherapy and radiation therapy options, or had refused surgery or undergone unsuccessful surgery. Patients were treated with radiofrequency ablation after agreement among oncologists, thoracic surgeons, and interventional radiologists. An array-style electrode under impedance control was used to treat 29 thoracic tumors and the adjacent rib metastases (n=5). A cool-tip radiofrequency probe was used for two patients. CT guidance and general anesthetic were used for all but one patient. Sonographic guidance and IV conscious sedation were used in one patient. Pain (n=11) and tumor cure or control (n=19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency ablations included the creation of saline or water windows (n=3); establishment of transosseous and transchondral routes (n=4); use of intercostal and paravertebral nerve blocks (n=15); and use of an intraprocedural catheter (n=1), needle (n=1), or sheath (n=3) for treatment of pneumothoraces. Follow-up was from 2 to 26 months. RESULTS All ablations were technically successful. No periprocedural mortality occurred. Necrosis of tumor was greater than 90% in 26 of 30 lesions based on short-term follow-up imaging (CT, PET, MRI). In the 11 patients who underwent ablation for pain, relief was complete in four and partial in the other seven. One patient developed a local skin burn, four patients had self-limited hemoptysis up to 4 days after ablation, one had transient atrial fibrillation, one developed hoarseness, and two patients were transiently reintubated after extubation. Eight pneumothoraces developed; one patient underwent placement of a chest tube. Four patients died within 1 year of ablation from extrathoracic spread of tumor. CONCLUSION Radiofrequency ablation for a variety of thoracic tumors can be performed safely and with a high degree of efficacy for pain control and tumor killing. The effect of ablation can be assessed with CT, MRI, or PET. Various technical issues differentiate thoracic tumor ablation from standard abdominal ablations. Numerous other thoracic interventional radiology procedures are beneficial to assist the radiofrequency ablation. A multidisciplinary approach offers valuable expertise for patient care.
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Affiliation(s)
- Eric VanSonnenberg
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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