Publications by authors named "Hira Lal"

100 Publications

Zinner syndrome: a rare diagnosis in infancy.

BMJ Case Rep 2022 May 19;15(5). Epub 2022 May 19.

Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

We present a case of Zinner syndrome (ZS), where we were fortunate to diagnose a child with this rare syndrome immediately after birth. Gross hydronephrosis was observed during the prenatal period on ultrasound, and further imaging after birth confirmed the presence of a multicystic dysplastic kidney and seminal vesicle cyst. The majority of cases of ZS is asymptomatic; however, symptoms relating to urination, ejaculation or infertility may present later on in life and so regular follow-up is required to ensure interventions can be carried out if such symptoms do occur.
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http://dx.doi.org/10.1136/bcr-2021-248558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9121408PMC
May 2022

Feminizing adrenocortical oncocytoma presenting as precocious puberty: a case report and literature review.

J Pediatr Endocrinol Metab 2022 Jun 3;35(6):827-830. Epub 2022 Mar 3.

Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Objectives: Feminizing adrenal tumors are rare in childhood. We present a case of a special category of adrenal tumor, an oncocytoma, causing isosexual peripheral precocity.

Case Presentation: A 4-year old girl presented with breast development and menstrual bleeding over a period of 3-4 months. Her SMR staging was breast stage 4, pubic hair stage 3. Her bone age was advanced (6 year 10 months), stimulated LH 0.7 IU/L, estradiol 206 pmol/L and DHEAS >27.1 micromol/L. CT scan revealed a right adrenal mass with features of atypical adrenal adenoma. Laparoscopic adrenalectomy was done and histopathology revealed oncocytoma. Lin-Weiss-Bisceglia criteria classified it as likely benign, borne out till a 2 year follow up.

Conclusions: Adrenal oncocytoma can be a cause of isosexual peripheral precocity in a young girl. Recognition and correct classification of this histological variant, which is more often benign, is important for prognostication and choice of therapy after surgery.
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http://dx.doi.org/10.1515/jpem-2021-0707DOI Listing
June 2022

Role of Computed Tomography in Estimation of Residual Renal Function at One Year after Donor Nephrectomy: Comparison with Nuclear Scintigraphy.

Saudi J Kidney Dis Transpl 2021 Jul-Aug;32(4):993-998

Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Computed tomography (CT) is routinely used for preoperative anatomical evaluation of renal donors, but recent studies show that it may be useful as a predictor of renal function too. This study aimed to compare CT volumetry-attenuation-based glomerular filtration rate (GFR) with Tc99m-diethylene-triamine-pentaacetic acid (DTPA) renal scintigraphy GFR and predict post-donor nephrectomy renal function. This is a prospective study involving 39 renal donors at a tertiary care hospital in northern India from 2014 to 2017. Renal volume and attenuation were determined by CT using a semiautomatic tool, and split renal function (SRF) was calculated for each side. CT-GFR was obtained using CT-SRF and global GFR from modification of diet in renal disease equation. At 12 months after nephrectomy, GFR was estimated from serum creatinine (eGFR). Predonation CT-GFR of preserved kidney was used to predict post-nephrectomy renal function which was compared with post-donation renal function calculated using serum creatinine as well as with DTPA-GFR. Pearson correlation coefficient and scatter diagram were used to assess and test the linear relationship between two continuous variables. The Statistical Package for the Social Sciences, version 23, was used for data analysis. There was a highly significant change in mean DTPA-GFR and mean CT-GFR compared to eGFR values (50.79-64.25, 26.50%, and 50.77-64.25, 26.55%, respectively). Similarly, there was a very good correlation between DTPA-GFR and eGFR (r = 0.968, P <0.001) as well as CT-GFR and eGFR (r = 0.968, P <0.001). CT volumetry-attenuation-based GFR accurately predicts post-donor nephrectomy renal function at 1 year similar to Tc99m-DTPA renal scintigraphy.
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http://dx.doi.org/10.4103/1319-2442.338312DOI Listing
March 2022

Endovascular Embolization in Problematic Hemodialysis Arteriovenous Fistulas: A Nonsurgical Technique.

Indian J Nephrol 2021 Nov-Dec;31(6):516-523. Epub 2020 Nov 7.

Department of Radio Diagnosis, Sanjay Gandhi Post graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Introduction: In the past, surgical techniques were considered gold standard practice for obliterating the accessory veins, reducing the flow across the high flowing arteriovenous fistulas (AVFs), or for closing the problematic hemodialysis AVFs. However, recently endovascular embolization has emerged as a safe and cost-effective alternative to these surgical techniques. In this study, technical and clinical success, and safety of endovascular embolization have been evaluated for accessory vein obliteration, flow reduction, and fistula closure in problematic AVFs using various embolizing agents.

Methods: This is a retrospective study of patients with problematic hemodialysis AVFs, who underwent endovascular embolization for accessory vein obliteration, flow reduction, and AVF closure at our center from February 2017 to January 2019 with various embolic agents like vascular plugs (VP), thrombin, coils, and glue. Follow-up was done at 1 week, 3 months, 6 months, and annually thereafter.

Results: In this study 30 patients with problematic hemodialysis AVFs [Left brachiocephalic fistula (BCF) ( = 22), right BCF ( = 4), and left radiocephalic fistula (RCF) ( = 4)], underwent endovascular embolization for accessory vein obliteration ( = 6), flow reduction ( = 3), and AVF closure ( = 21). Of the 6 patients undergoing embolization for obliteration of accessory collateral, 4 patients had nonmaturing AVFs and 2 patients had symptoms of venous hypertension (VH). Post embolization, all 4 AVFs matured over a month and symptoms of VH completely resolved within a week. Three patients who underwent embolization for flow reduction had patent AVF (on doppler) post procedure and they achieved adequate flow during dialysis with complete resolution of symptoms of VH. Out of 21 patients, who underwent endovascular closure, complete AVF thrombosis was seen in 18 patients only with the use of VP, while 4 patients required additional procedure to achieve complete thrombosis of AVF.

Conclusion: Endovascular embolization in problematic hemodialysis AVF is a safe and cost-effective alternative to open surgical methods and vascular plug could be embolic agent of choice for AVF closure.
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http://dx.doi.org/10.4103/ijn.IJN_84_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8722546PMC
November 2020

Role of blood oxygen level-dependent magnetic resonance imaging in studying renal oxygenation changes in renal artery stenosis.

Abdom Radiol (NY) 2022 03 20;47(3):1112-1123. Epub 2022 Jan 20.

Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, U.P., 226014, India.

Aim: Primary objective of this study was to compare R2* value of the post-stenotic kidney with contralateral kidney, kidneys of essential hypertensive patients, and healthy subjects using blood oxygen level-dependent magnetic resonance imaging (BOLD MRI) technique. The secondary objective was to study the effect of severity of stenosis and viability of kidneys on R2* value.

Methods: We compared 4 groups of kidneys including 92 with renal artery stenosis, 37 normal contralateral kidneys of unilateral renal artery stenosis patients, 62 kidneys of essential hypertensive patients, and 40 kidneys of healthy controls using BOLD MRI. Deoxyhemoglobin level represented by R2* was calculated before and after giving furosemide and was compared among different groups.

Results: Baseline means cortical R2* value did not differ between groups. Response to furosemide was reduced in stenotic kidneys as compared to essential hypertensive and healthy control groups (p < 0.001). The mean R2* value of the contralateral normal kidney group was not significantly different from the stenotic group. Baseline R2* value and delta R2* values did not differ between different degrees of stenosis. Higher mean cortical R2* was seen in stenotic kidneys which were small (< 7 cm) in size (24.27 ± 5.65 vs 21.7 ± 3.88; p value 0.02) or with poor corticomedullary differentiation (24.64 ± 5.8 vs 20.74 ± 3.34; p value 0.006) as compared to other stenotic kidneys. Similarly, the delta R2* value was also blunted in these small shrunken kidneys (p value < 0.001).

Conclusion: R2* values on BOLD MRI are significantly different between kidneys with and without renal artery stenosis and can potentially also predict the utility of revascularization.
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http://dx.doi.org/10.1007/s00261-022-03408-5DOI Listing
March 2022

Exploring the binding mode of ester-based cationic gemini surfactants with calf thymus DNA: A detailed physicochemical, spectroscopic and theoretical study.

Bioorg Chem 2022 02 11;119:105555. Epub 2021 Dec 11.

Department of Chemistry, College of Natural and Computational Sciences, Arba Minch University, Arba Minch, Ethiopia.

Gene therapy is a transfectant method for the treatment of hereditary disease, which transfers the gene mutation into the cells. In the view of the high prospects of utilization of cationic gemini surfactants as a non-viral vector for the gene transfection, we have made a comprehensive study on the interactions between a recently synthesized series of ester-functionalized cationic C-E2O-C gemini surfactants (m = 12, 14 and 16) with calf thymus deoxyribonucleic acid (ctDNA) utilizing various techniques. The micellization behavior of gemini surfactants has been altered in the presence of ctDNA. A series of measurements (fluorescence, UV-vis and time-resolved fluorescence) show that the quenching of ctDNA proceeds by a static mechanism. The competitive displacement studies (EB, AO and HO), KI quenching analysis, CD studies and viscosity measurements suggested intercalative binding mode in a stoichiometry ratio of 1:1 with the K (binding constant) order being: C-E2O-C > C-E2O-C > C-E2O-C. The thermodynamic parameters show that the geminis interacted with ctDNA spontaneously through ionic/electrostatic interactions. Furthermore, the theoretical approaches offer accurate insights about the binding of gemini surfactants with DNA, and are in consistence with the experimental results.
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http://dx.doi.org/10.1016/j.bioorg.2021.105555DOI Listing
February 2022

Noninvasive urine metabolomics of prostate cancer and its therapeutic approaches: a current scenario and future perspective.

Expert Rev Proteomics 2021 11 6;18(11):995-1008. Epub 2021 Dec 6.

Centre of Biomedical Research, SGPGIMS Campus, Lucknow, India.

Introduction: The sensitive, specific, fast, robust and noninvasive biomarkers for the evaluation of prostate cancer (PC) remain elusive in medical research. However, efforts are in full sway to investigate and resolve these puzzles for clinical practice. Advances in modern analytical techniques, sample processing, and the emergence of multiple omics approaches have created a great hope for the development of better detection modalities for PC. The objective of the present review is to provide a concise overview of the PC metabolomics-based potential discriminating molecules in urine samples using nuclear magnetic resonance spectroscopy and mass spectrometry.

Area Covered: A literature search was executed to find the studies reporting the noninvasive urine-based biomarkers for the diagnosis and prognosis of underlying disease. Most studies have extensivelyreported PC discriminating molecules with their respective controls. Additionally, pathophysiology and the treatment paradigm of PC are summarized and related to the insights underpinning the therapeutic intervention of PC.

Expert Opinion: With multi-centric, global, comprehensive omics approaches via either a non- or least-invasive bio-matrix may open new avenues of research for PC biomarker discovery, backed by a molecular mechanistic outline.
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http://dx.doi.org/10.1080/14789450.2021.2011225DOI Listing
November 2021

Metabolomics of prostate cancer: Knock-in versus knock-out prostate.

J Pharm Biomed Anal 2021 Oct 25;205:114333. Epub 2021 Aug 25.

Department of Urology, King George's Medical University, Lucknow, India. Electronic address:

Several metabolomics-derived biomarkers of prostate cancer (PC) have been reported with pre-radical prostatectomy (RP) (knock-in PC) conditions; however, uncontested PC biomarkers panel appraisal and investigation of correlative evidence of these measures is lacking through post-RP (knock-out PC). We sought to explore patients' filtered serum-based metabolomics derived signature measures in knock-in PC (n = 90) using nuclear magnetic resonance spectroscopy and multiple rigorous statistical analyses, and to develop the correlative evidence of these measures through knock-out PC (n = 90) follow-up on the 15th and 30th days. The glutamate, citrate and glycine were observed as hallmarks of PC. Observed trends revealed; augmented glutamate level in knock-in PC following a sudden drop and subsequently upside of glutamate at 15th and 30th days of knock-out PC, reduction of citrate in knock-in PC subsequently gradual increase of citrate in knock-out PC, and glycine lessening in knock-in PC following augmentation on 30th day of knock-out PC. This study-based evidence clears the doubts regarding the discovery of metabolomics-derived PC biomarkers.
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http://dx.doi.org/10.1016/j.jpba.2021.114333DOI Listing
October 2021

The obstructive index in antenatal unilateral pelviureteric junction obstruction: A novel predictor of the failure of conservative management.

Pediatr Int 2021 Aug 30;64(1):e14977. Epub 2021 Aug 30.

Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Background: To find the impact of the obstructive index (OI) as a predictor of management in antenatal pelviureteric junction obstruction.

Methods: Records of 135 cases of antenatally detected unilateral pelviureteric junction obstruction, selected for initial observation were retrospectively analyzed. All patients who underwent pyeloplasty on follow up were assigned to Group A. Those patients who were still on conservative management were assigned to Group B. The pelvic anteroposterior diameters of the affected (PAPD[A]) and normal kidney (PAPD[N]) of the same patient, along with the cortical thickness of the affected kidneys (CT[A]) and normal kidneys (CT[N]) on postnatal ultrasound scan, the T1/2 of the affected (T1/2 [A]) and normal kidneys (T1/2 [N]), the differential renal function (DRF), and the shape of the curve on a diuretic renogram were noted for each patient at 6 weeks. The OI was defined as (PAPD[A] × T1/2 [A]) / (PAPD[N] × T1/2 [N]).

Results: The median duration of follow up was 55 months (36-110). Median age at surgery was 12 months (4-80). Group A had 30 patients with 105 in Group B. On multivariate analysis, OI and shape of curve predicted need for surgery with statistical significance. Median OI in Group A was 18.9 compared to 4.82 in Group B (P < 0.001, Mann-Whitney). Using receiver operating characteristic analysis, the area under curve for the OI was 0.95. A level of 12.2 could predict failure of conservative management with a sensitivity of 93.3% and a specificity of 92.4%.

Conclusions: The OI can reliably predict the need for surgery at a very early stage, thus avoiding repeated tests and saving time.
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http://dx.doi.org/10.1111/ped.14977DOI Listing
August 2021

Renal graft malakoplakia masquerading post-transplant lymphoproliferative disorder.

BMJ Case Rep 2021 Aug 16;14(8). Epub 2021 Aug 16.

Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

A 45-year-old woman presented to us in March 2019 with complaints of fever and right lower quadrant abdominal pain for 1 month. She had undergone renal transplantation in 2017 for end-stage renal disease and developed four episodes of urinary tract infection in the next 16 months post transplantation, which were treated based on culture reports. She was subsequently kept on long-term prophylaxis with trimethoprim and sulfamethoxazole. Her present laboratory parameters showed a normal blood picture and elevated creatinine. Urine culture grew Non-contrast CT of the abdomen-pelvis revealed an endo-exophytic hyperdense mass in the graft kidney showing local infiltration and associated few regional lymph nodes. PET-CT revealed the soft-tissue mass and regional lymph nodes to be hypermetabolic, raising the possibility of lymphoma. However, biopsy showed features of malakoplakia. She was subsequently initiated on long-term antibiotic therapy and her immunosuppression decreased.
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http://dx.doi.org/10.1136/bcr-2021-244228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370553PMC
August 2021

A Computed Tomography Angiography (CTA): Based score (SGPGI score) to predict level of difficulty, operative, and postoperative outcomes for right-sided radical nephrectomy.

Urologia 2022 Aug 27;89(3):347-353. Epub 2021 Jul 27.

Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Objective: With the advent of laparoscopic approach for the large (T1b-T3a ± N1) right renal masses, higher rates of complications and conversion to open surgery are being reported. The role of preoperative angioembolization (PAE), which has increased cost and inherent morbidity but may help in select circumstances has also not been clearly defined in the literature. We therefore devised a scoring system (SGPGI score) based on pre-operative Computed Tomography Angiography (CTA) to predict the level of difficulty of radical nephrectomy and enhance its safety and efficacy which could also be used for the judicious use of PAE in selected cases.

Methods: In a prospective observational study on 52 patients with right renal masses from January 2014 to July 2018, we calculated a score based on CTA parameters. The patients were stratified for type and duration of surgery, blood loss, postoperative stay, and Clavien-Dindo grade of postoperative complications.

Results: Patients were classified into three groups based on our scoring system. Progressively groups with higher score had higher blood loss, operating time, complications and hospital stay, and were more likely to have undergone conversion to open surgery (Area under curve 0.8625 for a cut off score of 10). Intraclass Correlation Coefficient (ICC) was 0.678-1 for the different components of our score.

Conclusion: The pre-operative CTA based SGPGI score evaluates right renal masses and is able to predict intra-operative difficulties effectively, leading to enhancement of surgery safety and efficacy. It also helps judiciously use PAE.
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http://dx.doi.org/10.1177/03915603211015541DOI Listing
August 2022

Daughter cyst sign in the congenital ovarian cyst.

BMJ Case Rep 2021 Jun 2;14(6). Epub 2021 Jun 2.

Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

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http://dx.doi.org/10.1136/bcr-2021-243963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174496PMC
June 2021

Duplicated internal auditory canal with dysplastic ossicles and microtia: role of high-resolution CT and MRI.

BMJ Case Rep 2021 May 12;14(5). Epub 2021 May 12.

Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

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http://dx.doi.org/10.1136/bcr-2021-243825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117983PMC
May 2021

Effect of local anesthetic drug procaine hydrochloride on the conformational stability of bovine hemoglobin: Multi-spectroscopic and computational approaches.

J Biomol Struct Dyn 2021 May 10:1-11. Epub 2021 May 10.

Department of Chemistry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

The interaction between bovine hemoglobin (BHb) and local anesthetic drug procaine hydrochloride (PCH) was examined by spectroscopic and computational studies. Intrinsic fluorescence analysis explored the ground-state complex formation in the binding of PCH with BHb through static quenching mechanism. The binding constants () are 29.38 × 10, 22.54 × 10 and 17.99 × 10 at 288, 298 and 308 K, respectively, and the ratio of BHb:PCH was 1:1 in the interaction mechanism of PCH and BHb. The acquired thermodynamic parameters ( and ) demonstrated that interaction mechanism is spontaneous and enthalpy driven. The van der Waals forces and hydrogen bonding have been played a predominant role in the binding mechanism. The UV-vis spectroscopy validates the ground-state complexation between PCH and BHb and the binding constant () has been evaluated utilizing Benesi-Hildebrand equation. Fluorescence resonance energy transfer (FRET) results have demonstrated that the distance between donor (BHb) and acceptor (PCH) is very short (2.34 nm) suggesting a significant probability to energy transfer from BHb to PCH. Synchronous fluorescence results revealed that the alteration in the micro-environment of Tyrosine (Tyr) is more than tryptophan (Trp) residues suggesting that PCH molecule is close to Tyr residue. The secondary structure alterations were confirmed by CD, 3-D fluorescence and FT-IR spectroscopic measurements. Moreover, computational analyses further corroborated that PCH molecules are closer to Tyr residues as compared to Trp residues of BHb during the interaction process. The BHb-PCH complexes may contribute to a deeper understanding of the metabolism of drug, blood circulation process and may help to illustrate the relationship between functions and structure of BHb.Communicated by Ramaswamy H. Sarma.
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http://dx.doi.org/10.1080/07391102.2021.1920465DOI Listing
May 2021

Caput medusa: a sign of portal hypertension in case of chronic Budd-Chiari syndrome.

BMJ Case Rep 2021 Apr 26;14(4). Epub 2021 Apr 26.

Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

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http://dx.doi.org/10.1136/bcr-2021-242076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076947PMC
April 2021

Congenital renal arteriovenous malformation: a rare cause of visible haematuria.

BMJ Case Rep 2021 Apr 23;14(4). Epub 2021 Apr 23.

Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

We report a case of renal arteriovenous malformation (AVM) and describe its angioarchitecture and endovascular management. A 28-year-old male patient presented with visible painless haematuria. CT of the abdomen showed a right renal AVM. Digital subtraction angiography of the right renal vessels showed an AVM of middle and lower pole segmental arteries with communication to a large saccular aneurysm, which was arising from the right main renal vein. Complete occlusion of the AVM was done by using glue (a mixture of n-butyl-cyanoacrylate and lipiodol), resulting in nonvisualisation of the aneurysm on angiography. His vital signs were stable during the procedure. Follow-up CT after 12 months showed no residual flow in the aneurysm, normal upper pole renal parenchyma and nonvisualisation of AVM. Early diagnosis of this clinical entity is of paramount importance for proper management as it can cause massive blood loss and rapid clinical deterioration.
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http://dx.doi.org/10.1136/bcr-2021-242347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074538PMC
April 2021

Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study.

Pediatr Gastroenterol Hepatol Nutr 2021 Mar 8;24(2):154-163. Epub 2021 Mar 8.

Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Purpose: In children overlap of autoimmune hepatitis (AIH) and primary sclerosing cholangitis is labelled as autoimmune sclerosing cholangitis (ASC). The only prospective pediatric study showed a high prevalence of ASC by using endoscopic retrograde cholangiopancreatography. Aims of our study were to find the prevalence of ASC by using magnetic resonance cholangiography (MRC) in AIH and in non-AIH cirrhosis and to compare clinical presentation and outcome of AIH and ASC.

Methods: Prospectively we did MRC in 38 children with AIH (cases) and 19 disease controls (Wilson disease). Multiple biliary strictures with proximal dilatation on MRC were taken as definitive changes of ASC. Detail clinical, laboratory parameters, liver histopathology and treatment outcome were recorded.

Results: The median age of cases was 11.5 (3-18) years, 22 (57.9%) were girls and 28 (73.7%) were diagnosed as type 1 AIH. MRC was done in 11 children (28.9%) at the time of diagnosis and in 27 (71.1%) after a median follow-up of 2.5 (0.3-10) years. Abnormal MRC changes were seen in 14/38 (36.8%) of AIH and 8/19 (42.1%) of controls. However, definite changes of ASC were present in four (10.5%) children in AIH and none in controls. None of the clinical, laboratory, histological parameters and treatment response were significantly different between ASC and AIH groups.

Conclusion: The prevalence of ASC in children with AIH was just 10.5%. We suggest MRC in select group with cholestatic features, inflammatory bowel disease and in those who showed poor response to immunosuppression instead of all children with AIH.
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http://dx.doi.org/10.5223/pghn.2021.24.2.154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007839PMC
March 2021

Crossed unfused renal ectopia with pelviureteric junction obstruction associated with nephrolithiasis: a rare troublesome triad managed by robotic surgery.

BMJ Case Rep 2021 Apr 8;14(4). Epub 2021 Apr 8.

Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

We report a rare case of non-fused renal ectopia with pelviureteric junction obstruction and multiple pelvic and renal calculi thereby discussing vascular anatomy of the non-fused ectopic kidney along with robot assisted surgical management of this rare clinical entity which amounts for good preoperative workup for best surgical and clinical outcome.
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http://dx.doi.org/10.1136/bcr-2020-237794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039243PMC
April 2021

Determination of split renal function in voluntary renal donors by multidetector computed tomography and nuclear renography: How well do they correlate?

SA J Radiol 2021 5;25(1):2009. Epub 2021 Mar 5.

Department of Radiology, Faculty of Health Sciences, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

Background: The use of computed tomography (CT) for estimation of split renal function (SRF) has been reported previously. However, most of these studies have small samples, and many do not account for the renal attenuation at CT.

Objective: The aim of this study was to compare multidetector computed tomography (MDCT) volumetry-attenuation-based SRF with that obtained via Tc99m-diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy in voluntary renal donors.

Methods: Between January 2017 and January 2020, 526 voluntary renal donors were enrolled prospectively. All donors underwent contrast CT and DTPA scan before surgery. The semiautomatic region of interest (ROI) tool was applied slice by slice on axial CT images acquired in the arterial phase. The renal contour was drawn semiautomatically with mouse clicks around the renal parenchyma, and the renal volume was ascertained. Using renal volume and attenuation, SRF was determined and compared with results obtained at DTPA imaging.

Results: The mean age was 44.91 ± 10.97 years (mean ± s.d.). There was no significant difference in SRF based on DTPA and MDCT volumetry for the left kidney (49.18% ± 3.40% vs. 49.15% ± 3.38%, = 0.540) and for the right kidney (50.82% ± 3.40% vs. 50.86% ± 3.39%, = 0.358). A very good correlation was observed between the two methods for the left kidney ( = 0.953, = 0.000) and the right kidney ( = 0.955, = 0.000). On simple linear regression analysis, 90.8% of DTPA SRF values for the left kidney and 91.3% of DTPA SRF values for the right kidney could be predicted correctly using the corresponding MDCT SRF values.

Conclusion: MDCT volumetry-attenuation-derived estimation of SRF for living renal donors could be an alternative to renal scintigraphy-based SRF estimation.
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http://dx.doi.org/10.4102/sajr.v25i1.2009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008088PMC
March 2021

'Frosted liver' appearance in serohepatic variant of hepatic tuberculosis.

BMJ Case Rep 2021 Mar 16;14(3). Epub 2021 Mar 16.

Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

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http://dx.doi.org/10.1136/bcr-2021-241643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970214PMC
March 2021

Mycotic Aneurysm of Brachial Artery in Case of Aplastic Anemia.

J Assoc Physicians India 2021 Feb;69(2):73-74

Professor, Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh.

Pseudo-aneurysm of the brachial artery is relatively rare condition affecting the arterial vessels of the limbs. It can be due to trauma, infections or systemic vasculitis. We report a patient with aplastic anemia who developed pseudoaneurysm of the brachial artery following an episode of bacterial sepsis. Methicillin resistant Staphylococcus aureus (MRSA) was isolated on blood culture. Patient was treated with systemic antibiotics and underwent embolization of the pseudo-aneurysm. He later developed vascular insufficiency of the forearm and a stent had to be placed in the brachial artery at the site of calcified thrombus inside the pseudo-aneurysm to produce the patency of the artery and ensure adequate blood flow to forearm and hand.
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February 2021

A Universal Craniometric Index for Establishing the Diagnosis of Basilar Invagination.

Neurospine 2021 Mar 25;18(1):206-216. Epub 2021 Jan 25.

Department of Neurosurgery, Sanjay Gandi Post Graduate Institute of Medical Science, Lucknow, India.

Objective: The conventional criteria for defining the basilar invagination (BI) focus on the relationship of odontoid tip to basion and opisthion, landmarks that are intrinsically variable especially in presence of occipitalised atlas. A universal single reference line is proposed that helps in unequivocally establishing the diagnosis of BI, may be relevant in establishing both Goel types A and B BI, as well as in differentiating a 'very high' from 'regular' BI.

Methods: Study design - case-control study. In 268 patients (group I with BI [n = 89] including Goel type A BI [n = 66], Goel type B BI [n = 23], and group II controls [n = 179]), the perpendicular distance between odontoid tip and line subtended between posterior tip of hard palate-internal occipital protuberance (P-IOP line) was measured. Logistic regression analysis determined factors influencing the proposed parameter (p < 0.05).

Results: In patients with a 'very high' BI (n = 5), the odontoid tip intersected/or was above the P-IOP line. In patients with a 'regular' BI (n = 84), the odontoid tip was 6.56 ± 3.9mm below the P-IOP line; while in controls, this distance was 12.53 ± 4.28 mm (p < 0.01). In Goel type A BI, the distance was 7.01 ± 3.78 mm and in type B BI, it was 5.07 ± 4.19 mm (p = 0.004). Receiver-operating characteristic curve analysis identified 9.0 mm (8.92-9.15 mm) as the cut-point for diagnosing BI using the odontoid tip-P-IOP line distance as reference.

Conclusion: The odontoid tip either intersecting the P-IOP line (very high BI) or being < 9 mm below the P-IOP line (Goel types A and B BI) is recommended as highly applicable criteria to establish the diagnosis of BI. This parameter may be useful in establishing the diagnosis in all varieties of BI.
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http://dx.doi.org/10.14245/ns.2040608.304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021813PMC
March 2021

Adrenal extramedullary haematopoiesis: an unusual incidentaloma.

BMJ Case Rep 2021 Jan 11;14(1). Epub 2021 Jan 11.

Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

We report a case of adrenal extramedullary haematopoiesis in a 24-year-old women who presented with pallor and weakness. Ultrasonography of the abdomen detected moderate hepatosplenomegaly with multiple lesions in the spleen and an incidental right adrenal mass. There was no ascites or lymphadenopathy. CT scan revealed a heterogeneous right adrenal mass with multiple non-enhancing lesions in the spleen. Ultrasound guided trucut biopsy was performed after excluding a functioning tumour, which confirmed the diagnosis. Later, she was diagnosed to have haemoglobin E/beta thalassaemia and was put on hydroxyurea trial.
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http://dx.doi.org/10.1136/bcr-2020-238572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802720PMC
January 2021

Plexiform neurofibromatosis of penis: a rare presentation of type 1 neurofibromatosis.

BMJ Case Rep 2020 Nov 17;13(11). Epub 2020 Nov 17.

Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India

Although more than 100 cases of genitourinary neurofibromas have been reported, only 16 cases of solitary neurofibroma arising in the penis have been reported in English literature. There can be diffuse or localised pelvic involvement in cases of neurofibromatosis and sometimes these masses can extend into and disfigure the external genitalia. We report an unusual case of plexiform neurofibroma arising from penis and review the literature on penile neurofibromas.
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http://dx.doi.org/10.1136/bcr-2020-236542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674082PMC
November 2020

Non-contrast MR angiography versus contrast enhanced MR angiography for detection of renal artery stenosis: a comparative analysis in 400 renal arteries.

Abdom Radiol (NY) 2021 05 2;46(5):2064-2071. Epub 2020 Nov 2.

Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226014, India.

Purpose: In this study, we compared non-contrast MR angiography (NC-MRA) with conventional 3D contrast-enhanced MRA (CE-MRA) in patients suspected to have renal artery stenosis (RAS).

Methods: From March 2014 to March 2020, patients who were evaluated for RAS and had a glomerular filtration rate > 30 ml/min/1.73 m underwent MR imaging on a 3T MR Scanner (Signa Hdxt General Electrics, Milwaukee, USA) using a Torso PA coil. The NC-MRA sequence was performed using a 3D fat-suppressed inflow inversion recovery balanced steady state free precession (SSFP) sequence (Inhance 3D Inflow IR, GE Medical) whereas the CE-MRA sequence was a 3D fast spoiled gradient echo (FSPGR). Overall quality of images was rated 1 to 4. Stenosis was reported as grade 1 (Normal), 2 (< 50% narrowing), 3 (> 50% narrowing) and 4 (Total occlusion). Grade 3 and 4 were considered haemodynamically significant.

Results: During the study period, 201 patients were enrolled (400 renal arteries). For hemodynamically significant (grade 3/4) stenosis, NC-MRA correctly diagnosed 72 patients (95 arteries) while in 2 patients (2 arteries), NC-MRA underdiagnosed the stenosis as grade 2 (these were found to have grade 3 stenosis on CE-MRA). The kappa value of agreement between NC-MRA and CE-MRA for detection of RAS showing excellent agreement (p < 0.001).

Conclusion: In one of the largest series of patients so far, we found that NC-MRA is a viable alternative to CE-MRA for detection of RAS, highly correlating with CE-MRA for grade of stenosis and with additional advantage of lack of gadolinium based contrast agents toxicity.
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http://dx.doi.org/10.1007/s00261-020-02836-5DOI Listing
May 2021

Selective renal segmental artery embolization for hydronephrotic upper renal moiety: simple alternative to standard surgical resection.

Turk J Urol 2019 Dec 19;45(Supp. 1):S162-S165. Epub 2018 Dec 19.

Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

Duplex kidney with an ectopic upper moiety ureter usually presents with urinary incontinence in young females. If the ectopic ureter belongs to a non-functioning moiety, it is treated with surgical resection of the moiety. Renal artery embolization has been used in patients with a poorly functioning kidney for various indications. In the present report, a 30-year old lady presented with continuous urinary incontinence with normal voids in between. On evaluation, she was found to have duplex left kidney with poorly functioning upper moiety associated with an ectopic ureter opening into the vagina. She underwent successful upper segmental renal artery embolization with no postoperative complications and uneventful recovery. Hence, renal artery embolization is a minimally invasive and well tolerated alternative to surgical partial or heminephrectomy for a non-functioning duplex renal moiety.
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http://dx.doi.org/10.5152/tud.2018.37973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595010PMC
December 2019

Inter-observer variability amongst surgeons and radiologists in assessment of Guy's Stone Score and S.T.O.N.E. nephrolithometry score: A prospective evaluation.

Arab J Urol 2019 Dec 18;18(2):118-123. Epub 2019 Dec 18.

Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Objective: (a) To assess the inter-observer variability amongst surgeons performing percutaneous nephrolithotomy (PCNL) and radiologists for the Guy's Stone Score (GSS) and S.T.O.N.E. (stone size [S], tract length [T], obstruction [O], number of involved calyces [N], and essence or stone density [E]) nephrolithometry score; (b) To determine which scoring system of the two is better for predicting the stone-free rate (SFR) after PCNL.

Patients Subjects And Methods: Patients undergoing PCNL between February 2016 and September 2016 were prospectively enrolled. Preoperative computed tomography was done in all patients. The GSS and S.T.O.N.E. nephrolithometry score were independently calculated by eight surgeons and four radiologists. The patients were operated on by one of the surgeons (all were consultants). The Fleiss' κ coefficient was used to assess agreement independently between the surgeons and radiologists. Receiver operating characteristic (ROC) curves were constructed for predicting the SFR using the average of the scores of the surgeons and radiologists separately.

Results: A total of 157 patients underwent PCNL. The SFR was 71.3% (112/157 patients). The Fleiss' κ scores ranged from 0.51 to 0.88 (overall 0.79) for the S.T.O.N.E. score and 0.53-0.91 for the GSS, suggesting moderate to very good agreement. The ROC curve for the S.T.O.N.E. nephrolithometry scores of surgeons (area under the curve [AUC] = 0.806) as well as the radiologists (AUC = 0.810) had a higher predictive value for the SFR than the GSS of the surgeons (AUC = 0.738) and the radiologists (AUC = 0.747).

Conclusion: There is overall good agreement between surgeons and radiologists for both the GSS and S.T.O.N.E. nephrolithometry score. The S.T.O.N.E. score had a higher predictive value for the SFR than the GSS.

Abbreviations: AUC: area under the curve; GSS: Guy's Stone Score; KUB: kidneys, ureters and bladder; NCCT: non-contrast CT; PCNL: Percutaneous nephrolithotomy; ROC: receiver operating characteristic; SFR: stone-free rate; S.T.O.N.E.: stone size [S], tract length [T], obstruction [O], number of involved calyces [N], and essence or stone density [E].
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http://dx.doi.org/10.1080/2090598X.2019.1703278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473116PMC
December 2019

Primitive neuroectodermal tumour (PNET) of the renal capsule mimicking solid adrenal tumour.

BMJ Case Rep 2020 Oct 4;13(10). Epub 2020 Oct 4.

Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Primitive neuroectodermal tumour (PNET) of renal capsule is a rare entity. We report a case of a 17-year-old girl, who presented with symptoms of epigastric and right hypochondrium pain since 1 year. She was afebrile and physical examination revealed a soft, non-tender, firm, bimanually palpable and ballotable mass along right flank. Ultrasound abdomen showed a large heteroechoic mass in right suprarenal region with indistinct planes with upper pole of right kidney. On CT, a large right suprarenal mass was noted with origin likely from right adrenal gland. Surgery was done and intraoperatively, the large mass in right suprarenal region showed involvement of the upper pole of the right kidney. The right adrenal gland was small in size, compressed and displaced by the lesion. Histopathology revealed the mass to be PNET of kidney. We report the relevant imaging findings of the case with review of literature of this entity.
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http://dx.doi.org/10.1136/bcr-2020-235484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536778PMC
October 2020
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