Studies of baseline prognostic factors in patients with localized osteosarcoma treated without hi... more Studies of baseline prognostic factors in patients with localized osteosarcoma treated without high dose methotrexate are limited. This is single-institutional review of localized osteosarcoma patients treated without high dose methotrexate between June 2003-December 2012. A multivariate analysis of impact of baseline and treatment characteristics on outcome was performed and a prognostic model was developed based solely on baseline factors for predicting event-free survival (EFS) and overall survival (OS). Of 237 patients with median age of 17 years (range 2-66 yrs), neoadjuvant chemotherapy (NACT) was administered in 220 (92.82%) patients. Post NACT, 200/237 (84.38%) patients underwent surgery. At 30 months median follow-up, 5-year EFS and OS were 36.60 ± 0.03%, and 50.33 ± 0.04%, respectively. In multivariate analysis, baseline factors including duration of symptom >4 months (P < 0.001) and good performance status (PS) (P < 0.001) predicted better EFS whereas good PS (P ...
Sodium pyruvate, a free radical scavenger was evaluated for anti-inflammatory activity using UV r... more Sodium pyruvate, a free radical scavenger was evaluated for anti-inflammatory activity using UV radiation induced dermal erythema on guinea pig and compared with that of standard naproxen. Oral as well as topical pyruvate exhibited significant activity against UV induced dermal erythema model and the activity was comparable to that of naproxen. In the other pharmacodynamic studies, such as the studies on rat blood pressure, isolated guinea pig ileum and rat uterus, it showed no effect on any of these. In conclusion, sodium pyruvate showed a significant protection in the UV induced dermal erythema in guinea pigs. It also showed good absorption in UV-B range and this property can be utilised to develop the sodium pyruvate as a sunscreening agent.
Jansen's metaphyseal chondrodysplasia (JMC) is a rare genetic disorder that is characterized ... more Jansen's metaphyseal chondrodysplasia (JMC) is a rare genetic disorder that is characterized by short-limbed dwarfism and severe, agonist-independent hypercalcemia. An activating PTH/PTHrP receptor mutation that results in constitutive cAMP accumulation was recently identified in the genomic DNA of a patient with this disorder. These findings provide a plausible explanation for the abnormal regulation of growth-plate chondrocytes and mineral ion homeostasis in JMC, and may have significant implications for understanding the broader biological role of PTHrP and its receptor.
Management of early stages of osteonecrosis aims to prevent the collapse of the femoral head by a... more Management of early stages of osteonecrosis aims to prevent the collapse of the femoral head by attempts at restoring the vascularity of femoral head. Bone marrow-derived mononuclear cells with their angiogenic and osteogenic properties appear to have the potential to halt the disease process when injected intralesionally following core decompression. Forty patients (60 hips) with stage I, II or III (ARCO system) osteonecrosis of femoral head were treated by either core decompression and isolated mononuclear cells (group A) or core decompression and unprocessed bone marrow injection (group B). The patients were followed up clinically and radiologically for a minimum of 2 years. The functional outcome was assessed in terms of Harris hip score, and disease progression was assessed radiologically by comparing the preoperative and follow-up MRI at the end of 2 years. On 2-year follow-up, there was considerable improvement in the hip function as measured by the Harris hip score in both t...
A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma an... more A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma and aspiration cytology from the lytic lesion in the upper humerus seen on X-ray revealed a metastatic papillary carcinoma from the thyroid. Total thyroidectomy confirmed the papillary carcinoma thyroid. Post-operatively, she was given radioactive iodine (I-131) ablation therapy for 8 years and was asymptomatic during this period; however, for the last 1 year, she has been complaining of swelling in the shoulder, which did not respond to palliative radiotherapy and rapidly increased in size. Disarticulation of the shoulder joint was performed, which showed anaplastic carcinoma on histopathological examination. Anaplastic transformation of papillary carcinoma at the metastatic sites is well documented in the literature and is rare. However, the same has not been reported at the shoulder and from India before. Although soft tissue sarcomas are most common at this site, however, the possibili...
Conclusion INH-vitamin B6 combinations should therefore be banned, and manufacturers should be r... more Conclusion INH-vitamin B6 combinations should therefore be banned, and manufacturers should be requested to withdraw such products from the market. Physicians are also requested not to prescribe drugs containing INH with B6.
Pigmented villonodular synovitis is a common disease entity particularly in the knee joint but it... more Pigmented villonodular synovitis is a common disease entity particularly in the knee joint but its incidence in the foot is quite rare. A case of first metatarsophalangeal (MTP) joint pigmented villonodular synovitis (PVNS), presented to us with recurrence of symptoms after surgical excision done outside our institute. After histological confirmation of recurrence of the disease, repeat open surgical excision was performed. After being asymptomatic for two months she presented to us with recurrence of symptoms for which hyperkeratotic plaque at the ventral aspect of the first MTP joint was found to be responsible on physical examination. It was treated surgically by pairing it and now patient is symptom free for last 1 year. It signifies the importance of the histopathology in the diagnosis and recurrence of the PVNS and thorough physical examination in the management of the foot pathologies.
To evaluate the role of (99m)Tc-DMSA (V) and [(18)F]FDG PET-CT in management of patients with ost... more To evaluate the role of (99m)Tc-DMSA (V) and [(18)F]FDG PET-CT in management of patients with osteosarcoma, 22 patients were included in our study. All patients underwent both (99m)Tc-DMSA (V) and whole-body [(18)F]FDG PET-CT scans within an interval of 1 week. 555-740 MBq of (99m)Tc-DMSA (V) was injected i.v. the whole-body planar, SPECT images of primary site and chest were performed after 3-4 hours. [(18)F]FDG PET-CT images were obtained 60 minutes after i.v. injection of 370 MBq of F-18 FDG. Both FDG PET-CT (mean SUV(max) = 7.1) and DMSA (V) scans showed abnormal uptake at primary site in all the 22 patients (100% sensitivity for both). Whole-body PET-CT detected metastasis in 11 pts (lung mets in 10 and lung + bone mets in 1 patient). Whole-body planar DMSA (V) and SPECT detected bone metastasis in one patient, lung mets in 7 patients and LN in 1 patient. HRCT of chest confirmed lung mets in 10 patients and inflammatory lesion in one patient. 7 patients positive for mets on DMS...
A prospective study was undertaken to evaluate the diagnostic and prognostic significance of seru... more A prospective study was undertaken to evaluate the diagnostic and prognostic significance of serum levels of vascular endothelial growth factor (VEGF) in patients with primary localised osteosarcoma. Serum VEGF levels were measured by an enzyme-linked immunosorbent assay (ELISA) in blood samples collected prechemotherapy, postchemotherapy, and postsurgery in 40 patients with histologically proven primary osteosarcoma. Comparison was made between serum VEGF level of healthy controls (n = 10) and prechemotherapy patient sera to evaluate its diagnostic potential. Serum VEGF levels of patients with and without metastasis were compared. Immunohistochemical staining was done to establish the correlation between serum and tissue VEGF expression. The Kaplan-Meier curve was used for survival analysis No significant relationship was observed between serum VEGF levels and age, gender, tumour size, local recurrence or histopathological subtypes of osteosarcoma. We observed significantly raised mean serum VEGF in patient sera compared with healthy controls (p = 0.001). Significant fall in mean serum VEGF level was observed following chemotherapy (p = 0.001). Patients who developed metastases had significantly higher serum VEGF levels compared with the nonmetastatic group (P = 0.001). Serum VEGF levels correlated well with VEGF expression in tissues. Serum VEGF levels might prove to be of diagnostic, predictive and prognostic value in patients with primary osteosarcoma, although further studies with larger sample size and longer follow-up is needed to support the hypothesis.
Results of treatment in 78 patients with volar Barton&#39;s fractures have been analysed. On ... more Results of treatment in 78 patients with volar Barton&#39;s fractures have been analysed. On radiological assessment these fractures were divided into three distinct categories and this classification is related to the results of closed manipulation. Results are best when this fracture is treated with open reduction and internal fixation. In non-operatively treated cases results are much better if the articular step is less than 2 mm.
Studies of baseline prognostic factors in patients with localized osteosarcoma treated without hi... more Studies of baseline prognostic factors in patients with localized osteosarcoma treated without high dose methotrexate are limited. This is single-institutional review of localized osteosarcoma patients treated without high dose methotrexate between June 2003-December 2012. A multivariate analysis of impact of baseline and treatment characteristics on outcome was performed and a prognostic model was developed based solely on baseline factors for predicting event-free survival (EFS) and overall survival (OS). Of 237 patients with median age of 17 years (range 2-66 yrs), neoadjuvant chemotherapy (NACT) was administered in 220 (92.82%) patients. Post NACT, 200/237 (84.38%) patients underwent surgery. At 30 months median follow-up, 5-year EFS and OS were 36.60 ± 0.03%, and 50.33 ± 0.04%, respectively. In multivariate analysis, baseline factors including duration of symptom >4 months (P < 0.001) and good performance status (PS) (P < 0.001) predicted better EFS whereas good PS (P ...
Sodium pyruvate, a free radical scavenger was evaluated for anti-inflammatory activity using UV r... more Sodium pyruvate, a free radical scavenger was evaluated for anti-inflammatory activity using UV radiation induced dermal erythema on guinea pig and compared with that of standard naproxen. Oral as well as topical pyruvate exhibited significant activity against UV induced dermal erythema model and the activity was comparable to that of naproxen. In the other pharmacodynamic studies, such as the studies on rat blood pressure, isolated guinea pig ileum and rat uterus, it showed no effect on any of these. In conclusion, sodium pyruvate showed a significant protection in the UV induced dermal erythema in guinea pigs. It also showed good absorption in UV-B range and this property can be utilised to develop the sodium pyruvate as a sunscreening agent.
Jansen's metaphyseal chondrodysplasia (JMC) is a rare genetic disorder that is characterized ... more Jansen's metaphyseal chondrodysplasia (JMC) is a rare genetic disorder that is characterized by short-limbed dwarfism and severe, agonist-independent hypercalcemia. An activating PTH/PTHrP receptor mutation that results in constitutive cAMP accumulation was recently identified in the genomic DNA of a patient with this disorder. These findings provide a plausible explanation for the abnormal regulation of growth-plate chondrocytes and mineral ion homeostasis in JMC, and may have significant implications for understanding the broader biological role of PTHrP and its receptor.
Management of early stages of osteonecrosis aims to prevent the collapse of the femoral head by a... more Management of early stages of osteonecrosis aims to prevent the collapse of the femoral head by attempts at restoring the vascularity of femoral head. Bone marrow-derived mononuclear cells with their angiogenic and osteogenic properties appear to have the potential to halt the disease process when injected intralesionally following core decompression. Forty patients (60 hips) with stage I, II or III (ARCO system) osteonecrosis of femoral head were treated by either core decompression and isolated mononuclear cells (group A) or core decompression and unprocessed bone marrow injection (group B). The patients were followed up clinically and radiologically for a minimum of 2 years. The functional outcome was assessed in terms of Harris hip score, and disease progression was assessed radiologically by comparing the preoperative and follow-up MRI at the end of 2 years. On 2-year follow-up, there was considerable improvement in the hip function as measured by the Harris hip score in both t...
A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma an... more A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma and aspiration cytology from the lytic lesion in the upper humerus seen on X-ray revealed a metastatic papillary carcinoma from the thyroid. Total thyroidectomy confirmed the papillary carcinoma thyroid. Post-operatively, she was given radioactive iodine (I-131) ablation therapy for 8 years and was asymptomatic during this period; however, for the last 1 year, she has been complaining of swelling in the shoulder, which did not respond to palliative radiotherapy and rapidly increased in size. Disarticulation of the shoulder joint was performed, which showed anaplastic carcinoma on histopathological examination. Anaplastic transformation of papillary carcinoma at the metastatic sites is well documented in the literature and is rare. However, the same has not been reported at the shoulder and from India before. Although soft tissue sarcomas are most common at this site, however, the possibili...
Conclusion INH-vitamin B6 combinations should therefore be banned, and manufacturers should be r... more Conclusion INH-vitamin B6 combinations should therefore be banned, and manufacturers should be requested to withdraw such products from the market. Physicians are also requested not to prescribe drugs containing INH with B6.
Pigmented villonodular synovitis is a common disease entity particularly in the knee joint but it... more Pigmented villonodular synovitis is a common disease entity particularly in the knee joint but its incidence in the foot is quite rare. A case of first metatarsophalangeal (MTP) joint pigmented villonodular synovitis (PVNS), presented to us with recurrence of symptoms after surgical excision done outside our institute. After histological confirmation of recurrence of the disease, repeat open surgical excision was performed. After being asymptomatic for two months she presented to us with recurrence of symptoms for which hyperkeratotic plaque at the ventral aspect of the first MTP joint was found to be responsible on physical examination. It was treated surgically by pairing it and now patient is symptom free for last 1 year. It signifies the importance of the histopathology in the diagnosis and recurrence of the PVNS and thorough physical examination in the management of the foot pathologies.
To evaluate the role of (99m)Tc-DMSA (V) and [(18)F]FDG PET-CT in management of patients with ost... more To evaluate the role of (99m)Tc-DMSA (V) and [(18)F]FDG PET-CT in management of patients with osteosarcoma, 22 patients were included in our study. All patients underwent both (99m)Tc-DMSA (V) and whole-body [(18)F]FDG PET-CT scans within an interval of 1 week. 555-740 MBq of (99m)Tc-DMSA (V) was injected i.v. the whole-body planar, SPECT images of primary site and chest were performed after 3-4 hours. [(18)F]FDG PET-CT images were obtained 60 minutes after i.v. injection of 370 MBq of F-18 FDG. Both FDG PET-CT (mean SUV(max) = 7.1) and DMSA (V) scans showed abnormal uptake at primary site in all the 22 patients (100% sensitivity for both). Whole-body PET-CT detected metastasis in 11 pts (lung mets in 10 and lung + bone mets in 1 patient). Whole-body planar DMSA (V) and SPECT detected bone metastasis in one patient, lung mets in 7 patients and LN in 1 patient. HRCT of chest confirmed lung mets in 10 patients and inflammatory lesion in one patient. 7 patients positive for mets on DMS...
A prospective study was undertaken to evaluate the diagnostic and prognostic significance of seru... more A prospective study was undertaken to evaluate the diagnostic and prognostic significance of serum levels of vascular endothelial growth factor (VEGF) in patients with primary localised osteosarcoma. Serum VEGF levels were measured by an enzyme-linked immunosorbent assay (ELISA) in blood samples collected prechemotherapy, postchemotherapy, and postsurgery in 40 patients with histologically proven primary osteosarcoma. Comparison was made between serum VEGF level of healthy controls (n = 10) and prechemotherapy patient sera to evaluate its diagnostic potential. Serum VEGF levels of patients with and without metastasis were compared. Immunohistochemical staining was done to establish the correlation between serum and tissue VEGF expression. The Kaplan-Meier curve was used for survival analysis No significant relationship was observed between serum VEGF levels and age, gender, tumour size, local recurrence or histopathological subtypes of osteosarcoma. We observed significantly raised mean serum VEGF in patient sera compared with healthy controls (p = 0.001). Significant fall in mean serum VEGF level was observed following chemotherapy (p = 0.001). Patients who developed metastases had significantly higher serum VEGF levels compared with the nonmetastatic group (P = 0.001). Serum VEGF levels correlated well with VEGF expression in tissues. Serum VEGF levels might prove to be of diagnostic, predictive and prognostic value in patients with primary osteosarcoma, although further studies with larger sample size and longer follow-up is needed to support the hypothesis.
Results of treatment in 78 patients with volar Barton&#39;s fractures have been analysed. On ... more Results of treatment in 78 patients with volar Barton&#39;s fractures have been analysed. On radiological assessment these fractures were divided into three distinct categories and this classification is related to the results of closed manipulation. Results are best when this fracture is treated with open reduction and internal fixation. In non-operatively treated cases results are much better if the articular step is less than 2 mm.
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