Publications by authors named "Suhag Patel"

17 Publications

  • Page 1 of 1

Performance characteristics of EUS-FNA biopsy for adrenal lesions: A meta-analysis.

Endosc Ultrasound 2019 May-Jun;8(3):180-187

Indiana University School of Medicine, Indianapolis, IN, USA.

Background And Objective: The role of EUS-FNA biopsy (EUS-FNAB) for detection of metastatic lesions (mets) to adrenals has not been evaluated systematically. Our aim is to systematically evaluate the performance characteristics of EUS-FNAB in detecting metastasis to the adrenal glands.

Materials And Methods: We performed a systematic search on PubMed and OvidSP from January 1990 to July 2016 using various search terms for EUS and adrenal lesion. Only articles published in English literature were included in the study. Studies with fewer than 10 patients were excluded from the study. Publication bias was assessed using Begg-Mazumdar test and visual inspection of funnel plots.

Results: Eight studies including 360 adrenal lesions that underwent EUS-FNAB were identified. Of these, 137 FNABs were conclusive for malignancy. Sensitivity of EUS-FNAB in detecting metastasis to the adrenals was 95% (95% confidence interval [CI]: 90%-98%) and specificity was 99% (95% CI: 96%-100%). Pooled positivity of EUS-FNAB in detecting lung cancer metastasis to the adrenals was 44% (95% CI: 31.5%-57.3%). No evidence of publication bias was noted.

Conclusion: Our study demonstrates that EUS-FNAB is highly sensitive and specific in detecting metastasis to adrenals. It also shows that up to about half of the patients with lung cancer and adrenal lesions on imaging have metastasis, a finding with profound implications on lung cancer staging and treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/eus.eus_42_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589998PMC
March 2019

Synthetic mesh vs. allograft extensor mechanism reconstruction in total knee arthroplasty - A systematic review of the literature and meta-analysis.

Knee 2018 Jan 8;25(1):2-7. Epub 2018 Jan 8.

Emory University, Department of Orthopaedics, 59 Executive Park Drive South, Atlanta, GA 30329, United States. Electronic address:

Background: Extensor mechanism disruption after total knee arthroplasty (TKA) is a devastating complication. Reconstruction with allograft and synthetic mesh has been described. However, these reports have typically been small case series, and controversy exists with regard to which reconstruction technique is optimal.

Methods: The authors performed a systematic review using PUBMED, MEDLINE, EMBASE, BIOSIS, Clinicaltrials.gov, and Cochrane Database of Systematic Reviews identifying 14 articles meeting inclusion criteria and producing 204 knees for comparison. Studies with repairs performed under full knee extension were included. Case reports and non-English studies were excluded. Available demographics and clinical outcome data were collected from each study. Appropriate statistical analysis was performed to compare the variables.

Results: Baseline demographics and patient complexity were similar between the two cohorts. Reconstruction success rates (76% allograft vs. 74% mesh), average time to diagnosis/treatment, Knee Society Scores (KSS), knee range of motion/extensor lag, and complication rates yielded no statistical difference. Synthetic mesh was used more frequently with concomitant revision of components.

Discussion: This systematic review shows equivalent success of allograft and synthetic mesh with approximately 25% failure rate in both groups. Periprosthetic joint infection remains a common and significant complication and reason for failure in both groups. Overall, synthetic mesh showed equivalent extensor mechanism reconstruction success as allograft but with much lower cost, near universal availability, lack of disease transmission, and potential for diminishing graft stretch-out. Future research in larger case series or comparative study is needed to help aid in management of this largely unsolved problem in total knee reconstruction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.knee.2017.12.004DOI Listing
January 2018

In Pursuit of Fellowship: Results From a 2016 Survey of US Trainees.

Curr Probl Diagn Radiol 2019 Jan 10;48(1):22-26. Epub 2017 Nov 10.

Pennsylvania Hospital, University of Pennsylvania Healthy System, Philadelphia, PA.

Purpose: The purpose of this study was to gauge radiology trainee perceptions regarding the fellowship selection process and survey their perceived level of preparedness and desire for a fellowship-oriented lecture.

Methods: A survey, approved by Association of Program Coordinators in Radiology (APCR) was distributed via e-mail to all APCR members for distribution to their residents.

Results: A total of 98.6% (n = 261) of residents plan to pursue a fellowship. The most popular fellowships are interventional radiology, body, musculoskeletal, and Neuro. For fellowship information, residents believe that fellowship directors in their field of intent were the most reliable (76%), followed by fellows (65%). Only approximately 50% of residents felt somewhat strongly that they were preparing for their fellowship application correctly. Lastly, 44% of residents (n = 94) replied extremely likely to attend a lecture series given by fellowship directors, and 36% (n = 77) said somewhat likely.

Conclusion: This survey demonstrates that most trainees plan to pursue fellowship training. Residents ranked certain resources as more important in fellowship selection, such as fellowship directors and fellows. Lastly, there is a high interest in a lecture series that would bring together fellowship directors and residents that are interested in that particular fellowship.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1067/j.cpradiol.2017.10.013DOI Listing
January 2019

Interleukin-13 conjugated quantum dots for identification of glioma initiating cells and their extracellular vesicles.

Acta Biomater 2017 08 3;58:205-213. Epub 2017 Jun 3.

Department of Neurosurgery, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States.

Cadmium selenide (CdSe) based quantum dots modified with polyethylene glycol and chemically linked to interleukin-13 (IL13) were prepared with the aim of identifying the high affinity receptor (IL13Rα2) which is expressed in glioma stem cells and exosomes secreted by these cancer stem cells. IL13 conjugated quantum dots (IL13QD) were thoroughly characterized for their physicochemical properties including particle size and surface morphology. Furthermore, the specific binding of the IL13QD to glioma cells and to glioma stem cells (GSC) was verified using a competitive binding study. The exosomes were isolated from the GSC conditioned medium and the expression of IL13Rα2 in the GSC and exosomes was verified. The binding property of IL13QD to the tumor associated exosomes was initially confirmed by transmission electron microscopy. The force of attraction between the quantum dots and U251 glioma cells and the exosomes was investigated by atomic force microscopy, which indicated a higher force of binding interaction between the IL13QD and IL13Rα2 expressing glioma cells and exosomes secreted by glioma stem cells. Flow cytometry of the IL13QD and exosomes from the culture media and cerebrospinal fluid (CSF) of patients with glioma tumors indicated a distinctly populated complex pattern different from that of non-targeted quantum dots and bovine serum albumin (BSA) conjugated quantum dots confirming specific binding potential of the IL13QD to the tumor associated exosomes. The results of this study demonstrate that IL13QD can serve as an ex vivo marker for glioma stem cells and exosomes that can inform diagnosis and prognosis of patients harboring malignant disease.

Statement Of Significance: Functionalized quantum dots are flexible semiconductor nanomaterials which have an immense application in biomedical research. In particular, when they are functionalized with biomolecules like proteins or antibodies, they have the specialized ability to detect the expression of receptors and antigens in cells and tissues. In this study we designed a cytokine (interleukin-13) functionalized quantum dot to detect a cancer associated receptor expressed in cancer stem cells and the extracellular vesicles (exosomes) secreted by the cancer cells themselves. The binding pattern of these cytokine modified quantum dots to the cancer stem cells and exosomes alters the physical properties of the complex in the fixed and suspended form. This altered binding pattern can be monitored by a variety of techniques, including transmission electron microscopy, atomic force microscopy and flow cytometry, and subsequent characterization of this quantum dot binding profile provides useful data that can be utilized as a fingerprint to detect cancer disease progression. This type of functionalized quantum dot fingerprint is especially useful for invasive cancers including brain and other metastatic cancers and may allow for earlier detection of disease progression or recurrence, thus saving the lives of patients suffering from this devastating disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.actbio.2017.06.002DOI Listing
August 2017

Brunner's gland hamartoma: a rare cause of iron deficiency anaemia and report of an adapted colonic polyp resection technique.

BMJ Case Rep 2017 Mar 8;2017. Epub 2017 Mar 8.

John D Dingell VA Medical Center, Detroit, Michigan, USA.

A man aged 65 years presented with symptomatic anaemia without overt gastrointestinal bleeding. An oesophagogastroduodenoscopy (EGD) was performed and he was found to have a large ulcerated pedunculated Brunner's gland hamartoma in the duodenal bulb. The polyp was resected using snare cautery in forward and retroflexed positions. Colonoscopy was also performed and a few diminutive polyps were resected. A year later, the patient returned for a surveillance EGD, and no residual polyp was noted. Haemoglobin and iron studies normalised within a few months after polypectomy, with resolution of symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2016-218628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353376PMC
March 2017

Aortic air embolus following pulmonary tumor radiofrequency ablation.

Radiol Case Rep 2016 Dec 4;11(4):341-343. Epub 2016 Oct 4.

Department of Diagnostic Radiology, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave, Chicago, IL 60657, USA.

Aortic air embolism following a computed tomography (CT) guided percutaneous transthoracic procedure is a rare occurrence, but one that can have dire consequences. We present a case of a 48-year old female diagnosed with aortic air embolism during percutaneous radiofrequency ablation of a pulmonary mass. A large amount of intra-aortic air can be seen on the CT images just before the patient suffered acute cardiac arrest. Although this is a rare occurrence, recognition and management of this complication is important for physicians who perform any percutaneous transthoracic procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2016.05.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5128370PMC
December 2016

Sudden Cardiac Arrest From Heat Stroke: Hidden Dangers of Hot Yoga.

Am J Med 2016 Aug 21;129(8):e129-30. Epub 2016 Apr 21.

Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2016.03.030DOI Listing
August 2016

Overestimate of Fibrosis by FIBROSpect® II in African Americans Complicates the Management of their Chronic Hepatitis C.

J Clin Transl Hepatol 2016 Mar 15;4(1):12-9. Epub 2016 Mar 15.

Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA.

Background: Evaluation of advanced fibrosis in patients with hepatitis C virus (HCV) infection is used to facilitate decisions on treatment strategy and to initiate additional screening measures. Unfortunately, most studies have predominately Caucasian (Cau) patients and may not be as relevant for African Americans (AA).

Aims: This study specifically addresses the issue of defining minimal vs. significant fibrosis in African Americans (AA) with chronic hepatitis C (CHC) using noninvasive assays.

Methods: All patients (n = 319) seen between 1 January 2008 and 30 June 2013 for whom a FibroSpect II® (FSII) assay was performed and had data for calculation of aspartate aminotransferase (AST) platelet ratio index (APRI) and Fibrosis-4 (FIB-4) were identified using the medical records.

Results: When liver biopsy score and FSII assay results for the AA patients with CHC were compared, 31% of AA had advanced FSII fibrosis scores (F2-F4) despite a biopsy score of F0-F1. In contrast, 10% of Cau over-scored. The AA false positive rate was 14% for APRI and 34% for FIB-4. Combining FSII with either APRI (7% false positive) or FIB-4 (10% false positive) improved the false positive rate in AA to 7% (FSII + APRI) and 10% (FSII + FIB-4) but reduced the sensitivity for significant fibrosis.

Conclusions: The FSII assay overestimates fibrosis in AA and should be used with caution since these patients may not have significant fibrosis. If the APRI or FIB-4 assay is combined with the FSII assay, minimal fibrosis in AA can be defined without subjecting the patients to a subsequent biopsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14218/JCTH.2015.00053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807138PMC
March 2016

Insulin Resistance is Associated With Significant Liver Fibrosis in Chronic Hepatitis C Patients: A Systemic Review and Meta-Analysis.

J Clin Gastroenterol 2016 Jan;50(1):80-4

*Department of Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University †Department of Medicine, Division of Gastroenterology, Henry Ford Hospital ‡Detroit Medical Center, Detroit, MI §Department of Medicine, Indiana University Medical Center and Roudebush Veterans Administration Medical Center, Division of Gastroenterology and Hepatology, Indianapolis, IN.

Background: The role of insulin resistance (IR) on fibrosis progression in hepatitis C virus (HCV) patients has not been systematically evaluated. Therefore, this systemic review aimed to summarize the available epidemiologic evidence to evaluate the strength of association between IR and advanced liver fibrosis in these patients.

Methods: We performed a systemic literature search in PubMed, OvidSP, and MEDLINE from January 1990 to April 2015 without language restriction using the following search terms: insulin resistance, liver fibrosis, cirrhosis, diabetes mellitus, and chronic hepatitis C. Publication bias was assessed using the Begg and Egger tests and with a visual inspection of funnel plot. All analyses were performed using Comprehensive Meta-Analysis, version 2 software.

Results: A total of 3659 participants with HCV infection from 14 studies were included in the analysis. After adjusting for publication bias, the relative risk (RR) for significant hepatic fibrosis among HCV subjects with IR was 1.63 [95% confidence interval (CI), 1.34-2.01]. Subgroup analysis by genotypes showed RR of 2.16 (95% CI, 1.52-3.06) for genotype 1; however, the association was no longer significant when we analyzed the data for HCV genotype 3; RR=1.40 (95% CI, 0.8-2.45).

Conclusion: Our study showed significant association between IR and significant hepatic fibrosis in patients with HCV genotype 1 infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MCG.0000000000000400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674302PMC
January 2016

The association between metabolic syndrome and hepatocellular carcinoma: systemic review and meta-analysis.

J Clin Gastroenterol 2014 Feb;48(2):172-7

*Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI †Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University Medical Center ‡Roudebush Veterans Administration Medical Center, Indianapolis, IN.

Background: The metabolic syndrome (MetS) and/or its individual components have been linked to the development of cancer. Recent studies have suggested a similar link to hepatocellular carcinoma (HCC). The aim of this study was to evaluate the direction and magnitude of the association between the MetS and HCC.

Methods: Two reviewers independently conducted a systemic search to identify the available evidence from databases from January 1980 to June 2012. Search terms included "Metabolic syndrome," "insulin resistance syndrome," "metabolic abnormalities" combined with "hepatocellular carcinoma," and "liver cancer." No language restriction was applied to the search. Only studies reporting an effect measure for the association between MetS and HCC were eligible for inclusion. Publication bias was assessed using the Begg and Egger tests, with a visual inspection of funnel plot. All analyses were performed using Comprehensive Meta-analysis version 2 software.

Results: Four studies (3 cohort and 1 case control) with a total of 829,651 participants were included in the analysis. The age range of participants was between 30 and 84 years. The combined analysis showed an overall 81% increased risk of HCC in cases with MetS (relative risk, 1.81; 95% confidence interval, 1.37-2.41). After excluding the single case-control study from analysis, the overall risk ratio remained statistically significant (relative risk, 1.49; 95% confidence interval, 1.27-1.74). Funnel plot inspection, Begg and Egger tests showed no evidence of publication bias for combined analysis.

Conclusions: Though studies are scarce, currently available epidemiologic data are suggestive of significantly higher risk of HCC among patients with MetS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MCG.0b013e3182a030c4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887366PMC
February 2014

Adenocarcinoid tumor of the rectum: a rare finding in a patient with recurrent fistulizing perianal Crohn's disease.

Endoscopy 2013 13;45 Suppl 2 UCTN:E428-9. Epub 2013 Dec 13.

Division of Gastroenterology, Department of Internal Medicine, John D. Dingell VA Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0033-1358808DOI Listing
June 2014

Laparoscopic right donor nephrectomy: endo TA stapler is safe and effective.

Saudi J Kidney Dis Transpl 2010 May;21(3):421-5

Institute of Kidney Diseases and Research Centre, Ahmedabad, India.

Although laparoscopic donor nephrectomy is now a well-accepted alternative to traditional open donor nephrectomy at many transplantation centers, there are always concerns regarding quality of graft and vessels after laparoscopic harvest, especially with right donor nephrectomy. Several methods of graft retrieval have been explored to achieve acceptable graft outcome. We share our initial experience at the Institute of Kidney Diseases and Research Center, Amedabad, India of laparoscopic right donor nephrectomy performed by subcostal open, and pure laparoscopic approach with the use of Endo TA stapler. Nine laparoscopic right donor nephrectomies were performed by the trans-peritoneal approach at our centre from January 2006 to March 2007. In the first five cases, the grafts were retrieved through subcostal incision (Group A) and the last four cases were performed purely laparoscopically by using Endo TA stapler device (Group B). None of the patients needed open conversion. The mean operative time and hospital stay were comparable in each group. The warm ischemia time was longer in pure laparoscopic group (415 seconds) than the subcostal open approach group (176 seconds). The serum creatinine of the recipients on day seven was comparable in both the groups. The recipient surgery was effectively performed with graft retrieved using Endo TA stapler device (Group B) without any compromise to the renal vein length. Our study suggests that the Endo TA stapler device is safe and provides all the benefits of minimally invasive surgery to the donor.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2010

Modified laparoscopic abdominal vesico-vaginal fistula repair--"Mini-O'Conor" vesicotomy.

J Laparoendosc Adv Surg Tech A 2010 Feb;20(1):13-5

Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Center, Ahmedabad, India.

Aim: The aim of this work was to report on our experience with the laparoscopic repair of vesicovaginal fistulae and describe a modification in technique.

Patients And Methods: Between 2004 and 2008, 8 patients underwent laparoscopic repair of vesicovaginal fistula. All patients had fistulae secondary to gynecologic surgery. Two patients had undergone previous failed attempts at repair. The mean interval prior to repair was 3.5 months. Patient underwent repair by using a limited cystotomy.

Results: The operation was successfully completed in all cases. Mean operative time was 145 minutes, and mean estimated blood loss 60 mL. There were no complications. Catheter removal was done at 14 days. All patients were continent after catheter removal and remained continent at a mean follow-up of 29 months.

Conclusion: Laparoscopic repair of vesicovaginal fistula is safe and effective. Bivalving of the bladder may be avoided by use of a small cystotomy, with the potential benefits of shorter operative time and reduced bladder spasms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/lap.2009.0176DOI Listing
February 2010

Retroperitoneoscopic nephrectomy for crossed-fused ectopic kidney.

Indian J Urol 2009 Jul;25(3):401-3

Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India.

A 25-year-old female presented with a history of recurrent urinary tract infection and end stage renal failure. Voiding cystourethrography revealed bilateral Grade IV vesicoureteral reflux with left to right crossed ectopia. A computed tomography scan showed fusion of both kidneys with the left kidney situated at the lower and anterior part of the right orthotopic moiety. A retroperitoneoscopic nephrectomy with a right side ureterectomy was carried out.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0970-1591.56182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779970PMC
July 2009

Retroperitoneoscopic right-sided donor nephrectomy with pre- and postcaval renal arteries.

Urology 2008 Sep 11;72(3):672-4. Epub 2008 Jul 11.

Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, Gujarat, India.

A 56-year-old male donor was evaluated for a kidney donation. Computed tomography angiography revealed 2 right renal arteries, 1 coursing in front and 1 behind the inferior vena cava. The renal scan showed a lower glomerular filtration rate on the right side. We present a technique of retroperitoneoscopic right-sided donor nephrectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2008.06.006DOI Listing
September 2008

Xanthogranulomatous cystitis.

Int Urol Nephrol 2007 17;39(2):477-8. Epub 2007 Feb 17.

Department of Urology, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, 380016, Ahmedabad, Gujarat, India.

Xanthogranulomatous cystitis (XC) is a rare benign chronic inflammatory disease of unknown etiology. We report a patient of XC managed with long-term antibiotics and augmentation cystoplasty. A 50-year-old man presented with urgency, frequency, hematuria and lower abdominal pain. Investigations revealed small capacity bladder with diverticula and cystoscopy showed inflamed bladder with multiple small polypoidal growth that had histological findings suggestive of XC on biopsy. Patient was treated with augmentation cystoplasty and prolonged administration of broad-spectrum antibiotics. Postoperative course was uneventful and patient remains asymptomatic at 1-year follow-up. XC is rare entity of unknown etiology. Patients may be given a trial of long-term broad-spectrum antibiotics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11255-006-9059-8DOI Listing
September 2007

Case report: retroperitoneoscopic nephrectomy in pyonephrotic nonfunctioning moiety of horseshoe kidney.

J Endourol 2006 May;20(5):330-1

Department of Urology, Institute of Kidney Disease and Research Centre, Ahmedabad, India.

Laparoscopic removal of the pyonephrotic moiety of a horseshoe kidney is challenging because of inflammation, aberrant vasculature, abnormal kidney location, and the renal isthmus. We herein report retroperitoneoscopic nephrectomy of the nonfunctioning pyonephrotic right moiety of a horseshoe kidney.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/end.2006.20.330DOI Listing
May 2006
-->