Ritambhra Nada

Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the characterization of pancreatic masses: Experience from tropics

Early detection and differentiation of malignant from benign pancreatic tumors is very essential as mass‐forming pancreatitis is a frequently encountered problem. Positron emission tomography (PET) has a role in establishing the diagnosis of pancreatic carcinoma when the conventional imaging modalities or biopsies are nondiagnostic. In this prospective study, the utility of fluorodeoxyglucose (FDG)‐PET/computed tomography (CT) in the characterization of mass‐forming lesions of the pancreas was reported.

Safety and efficacy of autologous mesenchymal stromal cells transplantation in patients undergoing living donor kidney transplantation: A pilot study

This pilot study assesses the safety and feasibility of autologous mesenchymal stromal cell (MSC) transplantation in four patients that underwent living donor renal transplantation, and the effect on the immunophenotype and functionality of peripheral T lymphocytes following transplantation.

Tacrolimus therapy in adult-onset steroid-resistant nephrotic syndrome due to a focal segmental glomerulosclerosis single-center experience

INTRODUCTION Management of adults with steroid-resistant (SR) nephrotic syndrome due to focal segmental glomerulosclerosis (FSGS) is a challenging task. Is tacrolimus (TAC) effective in this situation without serious adverse effects? This prospective study was done to answer this question. MATERIALS AND METHODS In patients with SR nephrotic syndrome due to FSGS, oral TAC (0.1 mg/kg/day) was started targeting a trough level of 5-10 ng/mL along with oral prednisolone (0.15 mg/kg/day) for 48 weeks. In patients with complete remission (CR), TAC dose was reduced to a target of 3-6 ng/mL whereas in partial responders, TAC trough levels were kept at 5-10 ng/mL. TAC was discontinued in those with no remission at 24 weeks and was deemed TAC resistant. Outcome, namely CR and partial remission (PR), was assessed at the end of 24 and 48 weeks. All patients were prospectively followed for 60 weeks. Relapses after CR or PR were recorded; adverse effects, namely nephrotoxicity (>25% rise in creatinine), cosmetic effects, infections and hyperglycemia, were recorded every month. RESULTS A total of 44 SR-FSGS [not otherwise specified 33 (75%), tip lesion 03 (6.8%) and cellular variant 8 (18.1%)] were analyzed. Mean age was 25.16 ± 8.26 (18-51) years. Of 44 patients, CR and PR were achieved in 17 (38.6%) and 06 (13.6%) patients, respectively. TAC resistance was seen in 21 (47.7%) patients. Time taken to achieve remission was 15.2 ± 6 weeks. Five (21.7%) patients with CR had relapse on tapering the dose and seven (30.4%) after stopping TAC. Reversible nephrotoxicity was seen in seven (15.9%) and irreversible in four patients (9%). TAC-related diarrhea was the problem in 10 (22.7%), and infections were seen in 19 patients (43.1%). Impaired fasting glucose and diabetes mellitus were seen in 10 patients (22.7%). CONCLUSION TAC is an effective agent in the management of SR-FSGS. However, strict renal function and blood sugar monitoring is required due to its potential nephrotoxicity and diabetogenic potential.

Tacrolimus combined with corticosteroids versus Modified Ponticelli regimen in treatment of idiopathic membranous nephropathy: Randomized control trial

There have been very few studies comparing cyclophosphamide (CTX) and calcineurin inhibitor based regimens in the management of non‐immunosuppressive symptomatic therapy (NIST) resistant idiopathic membranous nephropathy (IMN). The present study was aimed at comparing the efficacy and safety of tacrolimus (TAC)/steroids with cyclical CTX/steroids (Modified Ponticelli regimen (MPR)) in patients with IMN.

Primary focal segmental glomerulosclerosis in adults: is the Indian cohort different?

BACKGROUND Primary focal segmental glomerulosclerosis (FSGS) has been redefined into five morphological categories that have different pathogenetic etiologies and are expected to have diverse clinical behaviour in terms of presentation, remission of proteinuria, progression of the disease and therapeutic response. The relative frequency of the variants of FSGS differs in different populations. METHODS A total of 210 cases of adult primary FSGS diagnosed during 4 years (May 2002 to June 2006) were categorized into the variants and their presentation and morphological details were compared. Renal biopsies were studied by light microscopy, immunofluorescence/immunohistochemistry and electron microscopy. RESULTS In the present study, the frequency of various morphological variants was collapsing 2%, tip 13.5%, cellular variant 8%, perihilar 4% and FSGS-NOS 72.5%. The variants had a significant difference in the duration of onset of illness at the time of biopsy. The cellular variants were biopsied the earliest (4.38 +/- 5.57 months) followed by collapsing (10.75 +/- 16.88 months) and perihilar variant at a later stages (65.33 +/- 99.30 months). The difference in the degree of proteinuria was statistically significant (P = 0.017) amongst various variants, being highest in collapsing variant (6.17 +/- 4.67 g/day) and lowest in perihilar variant (1.94 +/- 0.94 g/day). CONCLUSION The present study highlights that there is difference in the prevalence and some of the clinical parameters at the time of presentation in Indian patients. There was lower prevalence of perihilar variant and a higher prevalence of tip and cellular variants taken together when compared with the western literature, and this was similar to observations of another Asian cohort (China). Collapsing variant was infrequent when compared to the west.

Localized primary amyloidosis of the prostate, bladder and ureters.

Primary amyloidosis of lower urinary tract is a rare entity and is usually localized to a single site. Its clinical features, and cystoscopic and radiological findings are indistinguishable from neoplastic or inflammatory lesions. We report an unusual case of amyloidosis involving multiple sites (prostatic stroma, trigone and lower ureters) in the lower urinary tract. MRI findings of bladder amyloid, which could be used to suspect this condition, are also described.

Eosinophilic Cholangiopathy—A Case Report

Eosinophilic cholangiopathy is a rare benign disorder of the biliary tract occurring in a setting of peripheral or tissue eosinophilia. It is a broader term and comprises eosinophilic cholecystitis when it involves only the gallbladder (GB) and eosinophilic cholangitis when it involves the bile ducts (1, 2). There are only a few case reports in the literature and most often they describe the combination of GB and bile duct involvement (Table 1). Isolated involvement of bile ducts without involvement of GB is very rare. Eosinophilic cholangiopathy occurs most often in patients with idiopathic hypereosinophilic syndrome, and to our knowledge, there are only two previous reports of bile duct involvement (eosinophilic cholangitis) in patients with eosinophilic gastroenteritis (3, 4). We report a patient who had eosinophilic gastroenteritis with eosinophilic cholangitis.

Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis

Abdominal tuberculosis (TB) is the sixth most common extrapulmonary site of involvement. The sites of involvement in abdominal tuberculosis, in descending order of frequency, are lymph nodes, genitourinary tract, peritoneal cavity, and gastrointestinal tract. The radiological armamentarium for evaluating tuberculosis of the small bowel (SBTB) includes barium studies (small bowel follow-through, SBFT), CT (multidetector CT, CT enterography, and CT enteroclysis), ultrasound (sonoenteroclysis), and magnetic resonance imaging (MRI; enterography and enteroclysis). In this review, we illustrate the abnormalities at MDCT enterography in 20 consecutive patients with SB TB and also describe extraluminal findings in these patients. MDCT enterography allows non-invasive good-quality assessment of well-distended bowel loops and the adjacent soft tissues. It displays the thickness and enhancement of the entire bowel wall in all three planes and allows examination of all bowel loops, especially the ileal loops, which are mostly superimposed. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement in intestinal TB. The most common abnormality is short-segment strictures with symmetrical concentric mural thickening and homogeneous mural enhancement. Other findings include lymphadenopathy, ascites, enteroliths, peritoneal thickening, and enhancement. In conclusion, MDCT enterography is a comprehensive technique for the evaluation of SB TB.

Is there ileopathy in portal hypertension

Background and Aims:  Portal hypertensive gastropathy and colopathy are well described endoscopic abnormalities in patients with portal hypertension. Endoscopic abnormalities in the ileum in patients with portal hypertension have not been well described. The aim of the present study was to evaluate endoscopic abnormalities in the ileum of patients with portal hypertension.

Fatal renal failure as the first manifestation of sarcoidosis diagnosed on necropsy in a young man: a case report

Renal involvement as the first manifestation of sarcoidosis is rare and has never been reported in India. This report describes a 35 year old man who was admitted to the emergency department with a clinical diagnosis of acute on chronic renal failure, secondary to obstructive uropathy. Postmortem examination unexpectedly revealed disseminated sarcoidosis.