Biomedical subjects

C S Bal

Publications and source records attributed to C S Bal.

At least 19 recordsLinked to original sources

PubMed2006

Evaluation of cerebral blood flow by single-photon emission computed tomography in young Asian Indians with hypertension.

The objective of the study was to investigate abnormalities of regional cerebral blood flow (rCBF) in young (age 33.0+/-6.3 years; range 21-45 years) non-diabetic and normolipidemic Asian Indians with hypertension. The rCBF was assessed with single-photon emission computed tomography (SPECT) in patients with hypertension (n = 33) and healthy controls (n = 20). The SPECT findings were normal in 41 subjects and showed abnormalities of cerebral perfusion in 10 subjects, all of which were hypertensive patients. These observations are extremely important for a vast number of young hypertensive patients in India. To prevent cerebrovascular accidents in future, patients with hypertension and decreased rCBF should be carefully monitored and their hypertension should be strictly controlled. These subjects may also be researched as potential candidates for preventive antiplatelet therapy.

Adult↗

PubMed2006

A prospective clinical trial to assess the efficacy of radioiodine ablation as an alternative to completion thyroidectomy in patients with differentiated thyroid cancer undergoing sub-total thyroidectomy.

We conducted a prospective clinical trial to evaluate whether radioiodine ablation can be an effective alternative to completion thyroidectomy in patients undergoing sub-total thyroidectomy and if yes, the optimum activity of 131I and frequency of ablation. A total of 85 patients (F--63; M--22) with mean age of 37.9+/-12.3 years were recruited in this study. The pre-ablation mean 24 hour radioiodine neck uptake, effective half-life, residual thyroid tissue weight and TSH values were 13.9+/-8.5%, 4.5+/-0.9 days, 9.6+/-3.6 g and 11.7+/-6.4 microIU/ml, respectively. Thyroid tissue was completely ablated in 50 patients (58.8%, 95% CI:50-68%) after mean 1st administered activity of 32.3+/-10.7 mCi of 131I and the cumulative ablation rate was 91.8% after two doses of 131I. During mean follow-up duration of 49 months no local/distant recurrence has been observed so far in this cohort. It appears that radioiodine ablation may be an attractive alternative to completion thyroidectomy and an activity as low as 35 mCi may achieve reasonable ablation.

Adult↗

PubMed2006

Diagnosis of post-traumatic complex regional pain syndrome of the hand: current role of sympathetic skin response and three-phase bone scintigraphy.

PURPOSE: To evaluate the role of sympathetic skin response (SSR) and three-phase bone scintigraphy (TPBS) in the diagnosis of complex regional pain syndrome (CRPS). METHODS: 60 patients with CRPS of the hand were recruited. TPBS was performed using a bolus injection of 20 mCi of Tc-99m methylene diphosphonate in an antecubital vein and blood flow (first phase) image, blood pool (second phase) image, and delayed (third phase) image obtained. Patients were considered to have CRPS when the blood pool and blood flow images showed diffuse asymmetric uptake, or when the delayed image indicated increased asymmetric periarticular uptake. SSR was measured simultaneously in the affected and unaffected hands. Standard surface electromyogram disc electrodes were applied to the palm and dorsum of both hands. Electrical stimuli were applied to the skin at the base of little and ring fingers of the unaffected hand. Patients were considered abnormal when response was absent or the peak-to-peak amplitude was <50% of the contralateral hand in at least 2 readings. RESULTS: The delayed phase of TPBS tested positive in all; the first and second phases tested positive in 54 (90%) and 56 (93%) of the patients, respectively. Four of the 6 patients with a negative first phase had had symptoms persisting for more than 6 months, and the other 2 for about 3 to 6 months. No patient presenting within 3 months had a negative scan. SSR was absent in 16 (27%) patients and normal in 44 (73%). 11 (79%) of 14 patients who presented more than 6 months after symptom onset displayed an abnormal SSR, while only 10% of those presenting within 3 to 6 months and 11% of those presenting within 3 months had an abnormal SSR. 12 (75%) of the 16 patients with abnormal SSR had associated decreased sweating, compared with 2 (4.5%) of the 44 patients with a normal SSR. CONCLUSION: TPBS is a very sensitive corroborative test to confirm the clinical suspicion of CRPS during the initial stages, but not in late cases. SSR can be used to document the sympathetic dysfunction in cases having an associated sweating abnormality and may have some diagnostic value in late cases of CRPS, when TPBS is less reliable.

Adolescent↗

PubMed2006

Neuropathological spectrum of lesions associated with intractable epilepsies: a 10-year experience with a series of 153 resections.

BACKGROUND: Surgical management of intractable epilepsies is currently an established mode of therapy in various clinical settings. AIMS: To retrospectively evaluate the neuropathological findings in both temporal and extratemporal lobe resections in such patients. MATERIALS AND METHODS: The study included resected specimens from patients with intractable epilepsy managed at a tertiary care hospital of India, during a 10-year period (1995-2004). RESULTS: A total of 153 patients, with mean age of 19.4 years and male predominance (73.2%) were included in the study. Overall, there was a predilection for the temporal lobe (73.2%), while 41cases were extratemporal in location. On histopathology, mesial temporal sclerosis (MTS) (24.8%) was the commonest lesion, followed by tumors (19.6%) and isolated focal cortical dysplasia (FCD - 15.11%). Other less common findings included Rasmussen encephalitis, non-specific gliosis and vascular malformations. In addition, 20.9% (32 cases) had dual lesions, majority of which included FCD with ganglioglioma (15 cases) or with dysembryoplastic neuroepithelial tumor (12 cases). In the temporal lobe, neoplasms and dual lesions formed the majority (apart from MTS), unlike dual lesions followed by neoplasms and FCD, in the extratemporal location. CONCLUSION: This series demonstrates that most patients with chronic intractable epilepsy have significant histopathological findings and highlights the neuropathological spectrum of such lesions, in the Indian context. This was similar to that reported from the West, but different from the single Indian series available in the literature. Further, the overall profile of temporal lobe lesions was not different from the extratemporal ones.

Adolescent↗

PubMed2005

Effect of iopanoic acid on radioiodine therapy of hyperthyroidism: long-term outcome of a randomized controlled trial.

CONTEXT: Telepaque [iopanoic acid (IA)] is believed to rapidly ameliorate hyperthyroidism; however, it may preclude subsequent 131I therapy, possibly delaying it for several months. OBJECTIVE: Our objective was to see how early patients, made euthyroid with Telepaque, can be treated with 131I and to compare their short- and long-term outcome with patients treated with 131I, after making them euthyroid with carbimazole and beta-blockers. DESIGN: We conducted a randomized controlled trial. SETTING AND PATIENTS: We studied 200 hyperthyroid patients at a tertiary care teaching institute. INTERVENTIONS: The IA group received Telepaque, 500 mg/d orally, for 7 d and then no medication for 1 wk followed by 131I therapy if radioiodine neck uptake had recovered. The control group received 30-40 mg oral carbimazole daily until patients became euthyroid followed by 131I. MAIN OUTCOME: After 1 wk of Telepaque therapy and 6 wk of carbimazole, almost all patients became clinically and biochemically euthyroid, and 86 and 94% of patients were ready for 131I therapy after 1 and 2 wk off Telepaque, respectively. The cure rate, defined as euthyroid plus hypothyroid, after the first dose of 131I in controls and the IA group was 80 and 76.2%, respectively (P = 0.54). Thirty-two percent among controls and 25% in the IA group became hypothyroid within 1 yr (P = 0.33); thereafter, the annual rate of hypothyroidism was about 2% in both groups. After a mean follow-up duration of 11 yr, 58% of patients in the control group and 51% in the IA group were hypothyroid. CONCLUSIONS: Telepaque rapidly ameliorates hyperthyroidism without jeopardizing the subsequent radioiodine therapy, and the outcome of radioiodine therapy in this subset of patients is in no way different compared with those prepared by carbimazole.

Adult↗

PubMed2005

Radiation dose to family members of hyperthyroidism and thyroid cancer patients treated with 131I.

The thermoluminescence dosemeter (TLD) was used for measuring radiation dose to family members of thyrotoxicosis and thyroid cancer patients treated with (131)I using CaSO(4):Dy discs. There were 45 family members of thyrotoxicosis patients, who were divided into two groups with 22 in the first and 23 in the second group. Radiation safety instructions were the same for both the groups except in the second group where the patients were advised to use a separate bed at home for the first 3 d of dose administration. An activity ranging from 185 to 500 MBq was administered to these patients. The whole-body dose to family members ranged from 0.4 to 2.4 mSv (mean 1.1 mSv) in the first group and 0-1.9 mSv (mean 0.6 mSv) in the second group. A total of 297 family members of thyroid cancer patients were studied for whole-body dose estimation. An activity ranging from 0.925 to 7.4 GBq was administered to the thyroid cancer patients. The family members were divided into three groups depending upon the mode of transport and facilities available at home to avoid close proximity with the patient. Group A with 25 family members received a dose ranging from 0 to 0.9 mSv (mean 0.4 mSv), group B with 96 family members received a dose ranging from 0 to 8.5 mSv (mean 0.8 mSv) and group C with 176 family members received a dose ranging from 0 to 5.0 mSv (mean 0.8 mSv). The thyroid monitoring was also done in 103 family members who attended the patients in isolation wards for >2 d. Thyroid dose in them ranged from 0 to 2.5 mGy (mean 0.1 mGy).

Environmental Exposure↗

PubMed2005

Posterior urethral valves: preliminary observations on the significance of plasma Renin activity as a prognostic marker.

PURPOSE: A significant number of children with posterior urethral valves (PUVs) have chronic renal failure due to tubulointerstitial damage. Activation of the renin-angiotensin system is known to inflict this injury. We investigated the role of plasma renin activity (PRA) in patients with PUVs and sought to establish a relationship between renal damage and PRA. MATERIALS AND METHODS: The records of patients with PUVs were reviewed regarding the time of valve ablation, serum creatinine, scars, grade of reflux and glomerular filtration rate (GFR). PRA was measured before and after valve ablation. RESULTS: A total of 25 patients had PUVs (mean age 3.2 +/- 2.4 years, mean period of observation 4.5 +/- 1.2 years). Mean PRA was increased before valve ablation in all patients irrespective of age, and decreased after ablation. Of 25 patients 14 (56%) had renal damage, with a mean PRA of 36 +/- 4.5 ng/ml per hour compared to 26 +/- 8.2 ng/ml per hour in patients with normal renal function (chi-square 4.2 p = 0.01). Of the 14 patients with renal damage 9 (64%) had normal GFR at age 1 year but increased PRA. Of these 14 patients the accepted criteria for renal damage of increased serum creatinine, high grade reflux, scars and decreasing GFR were present in only 6 (43%), 3 (21%), 2 (14%) and 4 (29%), respectively. PRA was increased in all 14 cases. CONCLUSIONS: PRA was increased before valve ablation and decreased after ablation. It is increased in patients with early renal damage. Our preliminary observations indicate that PRA may be helpful in identifying patients with early renal damage.

Biomarkers↗

PubMed2005

Unidirectional whole body turning: a new lateralising sign in complex partial seizures.

BACKGROUND: The lateralising significance of unidirectional whole body turning in patients with complex partial seizures (CPS) arising from the temporal lobe was evaluated. METHODS: A total of 330 patients undergoing long term video-EEG study were included. "Unidirectional whole body turning" was defined as rotation of the trunk, head, and limbs by >90 degrees and lasting >10 s. EEG correlates, MRI, and SPECT findings were compared and outcome after surgery was noted for patients with follow up data for >1 year. RESULTS: Unidirectional whole body turning was observed in 13 patients with a mean age of 18+/-8 years. Concordance of the side of whole body turning with the EEG focus and MRI findings was observed in 11 of the 13 patients (84.7%) and in 26 of 28 seizures (92.8%). The six patients who underwent temporal lobectomy or resection of lesion, opposite to the direction of body turning, had good seizure outcome. CONCLUSION: Unidirectional whole body turning is a new lateralising sign in temporal lobe CPS with good predictive value for epileptogenic focus contralateral to the direction of turning.

Adolescent↗

PubMed2005

Adrenal and renal metastases from follicular thyroid cancer.

Patients with differentiated thyroid cancer may have asymptomatic involvement of renal and/or adrenal gland, particularly if they are elderly and have associated metastases to other organs, which may remain undetected if these patients are not subjected to radioiodine treatment. Our experience also emphasises the role of routine post-radioiodine therapy whole body scan with high degree of clinical suspicion, which may reveal lesions otherwise not discernable in low dose whole body scan. All suspicious lesions should be subjected to structural imaging like ultrasound, CT or MRI for confirmation. In this setting, the role of radioiodine therapy is primarily aimed at palliation that might prolong their survival, probably reduce further spread and thus overall improve the quality of life.

Adenocarcinoma, Follicular↗

PubMed2005

Hypocholesterolemic activity of some novel azetidin-2-ones in diet and diabetes induced hypercholesterolemia in rats.

Some novel substituted azetidin-2-ones (5-8) were synthesized via [2 + 2] cycloaddition reactions of imines and ketenes and evaluated for their ability to prevent diet and diabetes induced hypercholesterolemia. The test compounds 5a and 7a significantly (p < 0.01) inhibited the rise in serum total cholesterol induced by peanut oil (5.5%), cholesterol (1.5%) and cholic acid (0.5%) diet in both acute and chronic models in a dose dependent manner. Compound 5a also raised the high density lipoprotein-cholesterol levels in chronic diet models by peanut oil (5.5%), cholesterol (1.5%) and cholic acid (0.5%). In a diabetes induced model of hypercholesterolemia, the test compounds were evaluated for preventing diabetes-induced hypercholesterolemia (protocol 1) as well as for lowering post diabetic hypercholesterolemia (protocol 2). Test compounds 5a-g and 7a-d significantly (p < 0.05) reduced serum total cholesterol with a greater reduction in protocol 1 as compared with protocol 2. Based on SAR studies, the substituents that favor hypocholesterolemic activity around the azetidin-2-one nucleus are discussed and a possible mechanism of action is proposed on the basis of their differential effects in two protocols of diabetes-induced hypercholesterolemia.

Animals↗

PubMed2004

Is chest x-ray or high-resolution computed tomography scan of the chest sufficient investigation to detect pulmonary metastasis in pediatric differentiated thyroid cancer?

We reviewed the clinical characteristics, pattern of disease at presentation, histopathologic subtype, treatment, course, and outcome of differentiated thyroid cancer (DTT) in children and adolescents presenting with pulmonary metastasis and tried to assess the effectiveness of routine chest x-ray and high-resolution computed tomography (CT) scan of the chest vis-à-vis 131I whole-body scan (WBS) in revealing pulmonary metastasis. In our series of 1754 patients, 122 (7%) were 20 years of age or younger, of whom 28 (23%) had pulmonary metastasis. Mean age was 13.9 +/- 4.4 years (F:M ratio = 12:16). All but 2 patients had undergone near-total thyroidectomy with some form of neck dissection. Histopathologic examination was papillary in 89% and follicular in 11% cases, with confirmed nodal metastasis in all. Twenty-one (75%) patients had normal chest x-ray. However, WBS revealed pulmonary metastasis in all cases. In 15 (54%) children pulmonary metastasis was detected by first postsurgery 2-3 mCi 131I WBS and in 4 (14%) patients by postablation 131I WBS. Seven cases (25%) and 2 cases were detected by first and second posttherapy 131I WBS, respectively. No statistically significant difference was observed in any of the demographic or clinical parameters in patients in whom pulmonary metastasis was detected by first postsurgical low-dose WBS versus those in whom metastasis was discovered at a later stage. When chest x-ray-positive children were compared to x-ray-negative children, a statistically significant difference was observed only for mean first dose, cumulative dose, and total number of doses of 131I, which were significantly higher in x-ray-positive children. Eighteen of 21 children who had normal chest x-ray also underwent CT scan of the chest. CT could detect micronodular pulmonary shadows in 5 (28%) children only. Complete radioiodine treatment and outcome information was available in 20 patients. Mean first dose and cumulative doses of administered 131I were 75.4 +/- 39.5 mCi and 352 +/- 263 mCi, respectively. After an average number of 3.3 doses of (131)I and mean duration of 33.2 +/- 28.5 months, pulmonary lesions disappeared in 14 (70%) patients and thyroglobulin (Tg) becoming undetectable. In 4 children, however, there was no radiologic or scintigraphical evidence of pulmonary metastasis, Tg was high and in 2 patients, disease was persisting clinically. To conclude, a large majority of pediatric patients with DTC have x-ray- and even high-resolution-negative pulmonary metastasis. However, these metastases are 131I avid, and thus are amenable to detection and treatment with radioiodine. Therefore, postsurgical evaluation with 131I is recommended in all children and adolescents.

Adolescent↗

PubMed2004

Unusual widespread metastatic presentation of mixed medullary-follicular thyroid carcinoma.

Mixed medullary-follicular thyroid carcinoma (MMFTC) is a rare tumor with a metastatic behavior that has not been fully appreciated. Scintigraphy and radioiodine entrapment propensity of its metastases remains largely undescribed. The authors present a case of MMFTC with widespread bone and soft-tissue metastases, where every known site of metastases concentrated radioiodine intensely. The patient responded well to radioiodine therapy. The report suggests that the tumor may have a propensity to metastasize to the skeleton, and the metastases retain the ability to accumulate radioiodine.

Adenocarcinoma, Follicular↗

PubMed2004

Comparative evaluation of Tc-99m-heat-denatured RBC and Tc-99m-anti-D IgG opsonized RBC spleen planar and SPECT scintigraphy in the detection of accessory spleen in postsplenectomy patients with chronic idiopathic thrombocytopenic purpura.

OBJECTIVE: Radionuclide imaging specific for functioning splenic tissue is considered the method of choice to detect an accessory spleen in patients of chronic idiopathic thrombocytopenia purpura (ITP), who present with relapse after splenectomy. Radioimmunospleen scintigraphy with Tc-99m-labeled autologous RBC opsonized with anti-D IgG (RIS) is claimed to be more sensitive and specific than Tc-99m heat-denatured RBC spleen scintigraphy (HDRS) in the detection of an accessory spleen. We compared the efficacy of RIS with HDRBC for the detection of accessory spleens METHODS: A total of 45 patients (male:female = 17:28, age range: 6-58 years) who presented with relapse of ITP after splenectomy underwent scintigraphy with both methods. An average of 3 years had passed since surgery. All patients were imaged by a dual-head gamma camera with high-resolution collimators; planar static images and SPECT of abdomen were acquired. RESULTS: Accessory spleens were detected in 31% (14 of 45) of patients, 6 had 1 each and 8 had more than 1 (including 1 patient who had 13 accessory spleens). Both methods were concordant in all the patients. There was no difference in the scintigraphic picture (planar and SPECT) or in the size and number of accessory spleens detected. CONCLUSION: Tc-99m-labeled anti-D IgG opsonized autologous RBC spleen scintigraphy provides no additional diagnostic information over heat-denatured RBC spleen scintigraphy. Heat-denatured RBC scintigraphy thus remains the procedure of choice in the detection of accessory spleens.

Adolescent↗

PubMed2004

Proton magnetic resonance spectroscopy and single photon emission computed tomography study of the brain in asymptomatic young hyperlipidaemic Asian Indians in North India show early abnormalities.

OBJECTIVE: To evaluate brain metabolism and cerebral blood flow in young patients with hyperlipidaemia. PATIENTS AND METHODS: Proton magnetic resonance spectroscopy ((1)H MRS) and single photon emission computed tomography (SPECT) of the brain was carried out in 19 asymptomatic young patients with hyperlipidaemia (mean age 32.6 +/- 6.0 years, range 22-45 years) and 21 age-matched healthy controls divided into the following three groups; (i) hyperlipidaemics on pharmacological treatment (group 1, n = 13), (ii) hyperlipidaemics not on pharmacological treatment (group 2, n = 6) and (iii) control group of healthy subjects (group 3, n = 21). RESULTS: No statistical difference was observed in the brain metabolite ratios between controls and hyperlipidaemic patients (both treatment naive and treated) in the (1)H NMR study. Two hyperlipidaemic patients showed a lactate peak and one had a lipid peak. The SPECT study was abnormal in seven hyperlipidaemic patients. In the pooled data, 50% subjects with high serum triglyceride (TG) levels as opposed to 14% subjects with normal serum TG levels showed cerebral hypoperfusion. The choline/creatine (Cho/Cr) ratio of the occipital region of the brain showed correlation with the excess percentage of body fat (%BF) and low levels of high density lipoprotein cholesterol (HDL-C) compared to those with normal %BF and normal HDL-C levels, respectively, in pooled data of all subjects. The N-acetyl aspartate (NAA)/Cho ratio also showed correlation with hypercholesterolaemia. Serum TG levels were positively correlated with the NAA/Cr ratio (r = 0.62, P < 0.05) and the Cho/Cr ratio (r = 0.63, P < 0.05) in the parieto-temporal area in group 1 patients. CONCLUSION: The study revealed no difference in the brain metabolite ratios between controls and hyperlipidaemic patients, while some hyperlipidaemic patients showed abnormalities of cerebral blood flow. Brain metabolite ratios were also influenced by certain parameters of body composition and lipids. As abnormal body composition, hypertriglyceridaemia and low levels of HDL-C are prevalent in Asian Indians, such data are important and indicate a need for further study.

Adult↗

PubMed2004

Radioiodine dose for remnant ablation in differentiated thyroid carcinoma: a randomized clinical trial in 509 patients.

Remnant ablation can be achieved by either administering an empiric fixed dose or using dosimetry-guided techniques. Because of the technical and logistic difficulties, most centers have adapted the fixed-dose or standard-dose technique for remnant ablation using (131)I. In the late 1970s, low-dose (131)I remnant ablation was introduced, and subsequently many centers confirmed the effectiveness of such therapy. However, the optimal dose (administered activity) of (131)I for remnant ablation is not yet settled. In a randomized clinical trial to find out the smallest possible effective dose for remnant ablation in cases of differentiated thyroid carcinoma, between July 1995 and January 2002, 565 patients were randomized into eight groups according to (131)I administered activity, starting at 15 mCi and increasing activity in increments of 5 mCi until 50 mCi. In the postrandomization phase, 56 patients were excluded from the study for various reasons, and final analysis was done with 509 patients. The mean age of the patients was 37.5 +/- 12.7 yr with a female to male ratio of 2.6. The surgical procedure was total/near-total thyroidectomy in 72% and subtotal or hemithyroidectomy in the rest. Histology was papillary thyroid carcinoma in 80.6% of patients and follicular thyroid carcinoma in the rest. With one dose of (131)I, remnant ablation was achieved in 59.6, 63.6, 81.4, 83.6, 79.4, 78.3, 84.4, and 81.8% of patients in the 15- to 50-mCi groups, respectively (overall ablation rate, 77.6%). The successful ablation rate was statistically different in patients receiving less than 25 mCi of (131)I compared with those receiving at least 25 mCi [63 of 102 (61.8%) vs. 332 of 407 (81.6%); P = 0.006]. However, there was no significant intergroup difference in outcome among patients receiving 25-50 mCi of (131)I. Patients with small tumor size (</=5 cm), adequate surgery (total/near-total thyroidectomy), and radioiodine neck uptake of less than or equal to 10% had odds ratios of 2.4 [confidence interval (CI), 1.3-3.98], 2.6 (CI, 1.6-4.2), and 2.2 (CI, 1.4-3.5), respectively, for successful remnant ablation. Patients receiving at least 25 mCi of (131)I had a three times better chance of getting remnant ablation than patients receiving lesser activity of (131)I. Any activity of (131)I between 25 and 50 mCi appears to be adequate for remnant ablation.

Adenocarcinoma, Follicular↗

PubMed2003

Neonatal gastric pull up: reality or myth?

Between 1991 and 1998, 28 out of 356 neonates with esophageal atresia and tracheoesophageal fistula (EATEF) required esophageal substitution. As only 8 returned (28%) for the esophageal replacement after initial esophagostomy and gastrostomy at our center, we were prompted to offer single-stage esophageal replacement when the primary repair had either failed or was not found feasible. Twelve full-term neonates (mean birth weight 2.32 kg) with EATEF who underwent esophageal replacement by gastric pull-up between 1998 and 2000 were reviewed. The indications were: major leak after primary repair (n=9); pure EA (n=2); and EATEF with a very wide gap (n=1). The average ages at presentation and gastric pull-up were 6.0 and 8.5 days, respectively. The patients were evaluated for gastric transit by a colloid radiopharmaceutical, for duodenogastric reflux (DGR) by hepatic immunodiacetic acid (HIDA) scan, and for gastric clearance and transit by contrast studies. Three patients had minimal leaks from the neck site, all of which healed well. Follow-up with nuclear scans and contrast studies to evaluate gastric emptying revealed obstruction in 1 case and DGR in 25% of cases. There were 2 deaths (16%), 1 due to complex congenital cardiac disease and the other due to septicemia. In view of the acceptable morbidity, mortality, and functional outcome following gastric pull-up, we recommend this procedure if it becomes inevitable in the neonatal period.

Esophageal Atresia↗

PubMed2003

Differentiated thyroid cancer.

OBJECTIVE: The retrospective analysis of the case files of children with differentiated thyroid carcinoma (DTC) was performed to define the disease by its presentation, clinical course and outcome of radioiodine therapy. METHODS: Between 1967 to October 2002, 1754 patients with thyroid cancer were treated in the Dept of Neuclear Medicine, AIIMS, out of which 122 (7%) were < or = 20 years of age (71 girls and 51 boys). The mean age was 15.8 +/- 3.6 years and the mean duration of follow-up was 90 +/- 59.3 months. Mean tumor size was 4.4 cm. Histologically, 85% of the patients had papillary and rest follicular carcinoma. Cervical lymph node involvement was seen in 64%, and distant metastases, mainly pulmonary, in 23% of the patients. The presentation of the disease was very aggressive in the first decade of life with male preponderance. All but one patient in this age group had nodal and/or distant metastases; in 83.3% the disease had spread to the lymph nodes and 67% had metastases to the lungs. The post-surgery 48-hour mean radioiodine neck uptake was 10.5 +/- 7.6%. RESULTS: 94% of the residual thyroid, 88% of nodal metastases and 71% of pulmonary metastases were ablated requiring mean cumulative doses of 2.8 +/- 2.7 GBq, 4.5 +/- 2.7 GBq and 10.4 +/- 7.9 GBq of 131I, respectively. Average number of doses required for remnant, nodal and pulmonary metastases ablation were 1.3, 2.2 and 3.3, respectively. 80% of the patients with only remnant thyroid tissue and 50% with cervical lymph node metastases got ablated with a single dose of 131I. Overall, 87% patients were currently free of disease. While, nine patients had nodal recurrence between surgery and radioiodine treatment, no recurrence was observed thereafter and 3 disease related deaths producing overall mortality of 2.5% (all in children < or =10 years of age) were seen in the mean follow-up of 7.5 years. CONCLUSION: Differentiated thyroid cancer in children and adolescents is rare but aggressive. The biological behavior differs from that in adults and is related to the age. Younger the age (< or =10 years), more aggressive and widespread is the disease with male preponderance and high mortality. The post-surgical radioiodine ablation/therapy is an important and effective adjuvant in the management of DTC in children and adolescents and even though they present with advance disease, long-term survival and overall prognosis is good.

Adolescent↗

PubMed2003

In vivo proton magnetic resonance spectroscopy (MRS) and single photon emission computerized tomography (SPECT) in systemic lupus erythematosus (SLE).

Neuropsychiatric involvement in SLE (NP-SLE) may not be picked up by routine neuroimaging procedures like computerized tomography (CT) or magnetic resonance imaging (MRI). We prospectively studied the role of single photon emission computerized tomography (SPECT) and magnetic resonance spectroscopy (MRS) in detection of NP-SLE in 20 patients with lupus (10 with clinical NP involvement and 10 without) and 9 healthy controls. MRI abnormalities were seen in 5/10 patients with NP-SLE while the MRI was normal in all the lupus patients without clinical NP involvement. Perfusion defects on SPECT were seen in as many as 8/10 patients with NP-SLE while only 1/10 lupus patients without clinical NP involvement and none of the healthy controls demonstrated perfusion defects. MRS revealed abnormal metabolite ratios in all patients with NP-SLE and as many as 8 lupus patients without clinical NP features. Normal metabolite ratios were observed in healthy controls. SPECT and MRS can help detect changes not evident on MRI and may serve as useful supplements to existing neuroimaging techniques in the diagnosis of NP-SLE. The precise significance of alterations in regional cerebral blood flow on SPECT and neurometabolite ratios on MRS needs larger, longitudinal studies.

Adult↗