Kadambari Dharanipragada | JIPMER - Academia.edu (original) (raw)

Uploads

Papers by Kadambari Dharanipragada

Acta Cytologica, 2010

To evaluate the efficacy of imprint cytology (IC) in detecting residual axillary metastasis follo... more To evaluate the efficacy of imprint cytology (IC) in detecting residual axillary metastasis following neoadjuvant chemotherapy (NACT) in order to check its feasibility on sentinel nodes in the posttherapy setting in patients with breast carcinoma Thirty women on NACT for locally advanced breast cancer were subjected to total mastectomy with axillary node dissection. Routinely stained imprints from 172 resected nodes were studied to detect residual metastasis and therapy-induced changes, adopting a semiquantitative grading system for assessing the cell yield. Sensitivity and specificity tests were performed. The effect of cellularity in detecting malignancy was statistically determined by the McNemar test. Of the 172 nodes, 58 (33.7%) and 64 (37.2%) were positive by IC and histopathologic examination, respectively. Sparse, moderate and high cell yield was observed in 27 (15.2%), 33 (19.4%) and 112 (66.4%) nodes, respectively. No statistically significant difference was found with respect to the cellularity of imprints. Sensitivity, specificity and diagnostic accuracy were 89.1%, 99.1% and 95.4%, respectively. The false positive and negative rates were 0.6% and 4.1%, respectively. The positive and negative predictive values were 98.3% and 93.9%, respectively. IC is a sensitive, specific and accurate method of detecting axillary metastasis in patients with down-staged tumors following chemotherapy. The fact that therapy did not affect the cell yield on IC makes the technique very applicable for assessing the sentinel nodes following NACT.

Indian Journal of Cancer, 2009

Tamoxifen is being used in patients with estrogen receptor positive breast cancer as an adjuvant ... more Tamoxifen is being used in patients with estrogen receptor positive breast cancer as an adjuvant or palliative hormonal therapy. w0 estern studies have found a 30% incidence of gallstones in patients who are taking Tamoxifen and they have proved a significant association between the two. The objective of the study was to find out the association of Tamoxifen use and gallstone formation in postmenopausal breast cancer patients in a South Indian population. Ninety patients who had undergone surgery for invasive breast cancer in our institute, and were receiving adjuvant Tamoxifen, were recruited for the study. An equal number of age-matched postmenopausal women were taken as controls. All of them underwent an abdominal ultrasound screening test for gallstones. Presence or absence of gallstones was noted down from their ultrasound scan reports. Pretreatment status of the gall bladder was assessed from the preoperative scan reports. An odds ratio of 1 was derived when the case group was compared with the control group. In our study we could not establish that an association existed between Tamoxifen use and gallstone formation in postmenopausal South Indian women.

Pediatric Surgery International, 2000

Primary pyogenic psoas abscess, although quite a common condition, particularly in the tropics, i... more Primary pyogenic psoas abscess, although quite a common condition, particularly in the tropics, is often overlooked as a clinical entity, probably because a psoas abscess has been traditionally associated with tuberculous spondylitis. The abscess is easily diagnosed by ultrasonography (US). Treatment by open drainage and antibiotics effective against Staphylococcus aureus results in complete reversal of symptoms and signs. In our series of 55 cases in the pediatric age group (0–12 years), pain and flexion at the hip were the most frequent clinical features at presentation. US was diagnostic in all cases in which it was performed. All except 1 patient showed complete resolution with extraperitoneal drainage, antibiotics, and skin traction. Although 4% of the cases were associated with suppurative external-iliac lymphadenitis, the remaining ones arose de novo in the psoas sheath, suggesting a primary pyomyositis of the psoas muscle.

Cases Journal, 2008

Enterocutaneous fistula following mesh repair of incisional hernia is usually due to mesh erosion... more Enterocutaneous fistula following mesh repair of incisional hernia is usually due to mesh erosion of the underlying viscus and presents late. We describe an early enterocutaneous fistula due to an unusual but a potential mode of bowel injury during mesh fixation. This case is reported to emphasize the need for greater attention to the technique of mesh fixation. We suggest laparoscopic guidance to prevent this serious complication in lateral Incisional hernias with ill defined edges of the defect.

Clinical Breast Cancer, 2009

The concept of management of the locally advanced breast carcinoma has considerably evolved from ... more The concept of management of the locally advanced breast carcinoma has considerably evolved from "maximum tolerated treatment" to the "minimum effective treatment." This has led to a shift from radical mastectomy alone to a multidisciplinary approach involving surgery, radiation therapy, and systemic chemotherapy.

Purpose Tamoxifen is used in the treatment of breast cancer to prevent recurrences. It is convert... more Purpose Tamoxifen is used in the treatment of breast cancer to prevent recurrences. It is converted to its active metabolite endoxifen by CYP2D6 enzyme. This study was conducted to evaluate the influence of CYP2D6 genetic polymorphisms on the recurrence of breast cancer in patients receiving treatment with tamoxifen as an adjuvant hormonal therapy. Methods Breast cancer patients (n = 141) on adjuvant tamoxifen and not on any concomitant CYP2D6 inhibitors were recruited for the study. Patient characteristics and treatment history were obtained. Five milliliters of venous blood was collected for genotyping CYP2D6 alleles *1, *2, *4, *5 and *10. CYP2D6 activity score was calculated to determine the phenotype based on genotype. The activity scores were compared between patients with recurrence and patients with no recurrence of breast cancer. Results Of the 141 patients recruited for the study, genotyping was done for 132 of them. CYP2D6 activity score B0.5 is associated with a statistically significant increased risk of recurrence (OR-12.37; 95 % CI-3.23, 47.33; p \ 0.001) and shorter recurrence free survival (52.68 ± 10.58 months (mean ± SEM); p \ 0.001) as was shown in Kaplan-Meir survival estimates, when compared to activity score C1. The hazard ratio for activity score B0.5 is 7.29 (p \ 0.001) when compared to activity score C1. Analysis of known estrogen receptor positive patients also showed statistically significant increased risk of recurrence and shorter recurrence free survival in patients with CYP2D6 activity score B0.5. The Cox proportional hazard ratio was found to be 7.15 (p = 0.006) for activity score B0.5. Conclusion Reduced CYP2D6 activity is associated with poor treatment outcomes, in terms of increased risk of recurrence and shorter recurrence free survival, in breast cancer patients on adjuvant tamoxifen therapy.

Acta Cytologica, 2010

To evaluate the efficacy of imprint cytology (IC) in detecting residual axillary metastasis follo... more To evaluate the efficacy of imprint cytology (IC) in detecting residual axillary metastasis following neoadjuvant chemotherapy (NACT) in order to check its feasibility on sentinel nodes in the posttherapy setting in patients with breast carcinoma Thirty women on NACT for locally advanced breast cancer were subjected to total mastectomy with axillary node dissection. Routinely stained imprints from 172 resected nodes were studied to detect residual metastasis and therapy-induced changes, adopting a semiquantitative grading system for assessing the cell yield. Sensitivity and specificity tests were performed. The effect of cellularity in detecting malignancy was statistically determined by the McNemar test. Of the 172 nodes, 58 (33.7%) and 64 (37.2%) were positive by IC and histopathologic examination, respectively. Sparse, moderate and high cell yield was observed in 27 (15.2%), 33 (19.4%) and 112 (66.4%) nodes, respectively. No statistically significant difference was found with respect to the cellularity of imprints. Sensitivity, specificity and diagnostic accuracy were 89.1%, 99.1% and 95.4%, respectively. The false positive and negative rates were 0.6% and 4.1%, respectively. The positive and negative predictive values were 98.3% and 93.9%, respectively. IC is a sensitive, specific and accurate method of detecting axillary metastasis in patients with down-staged tumors following chemotherapy. The fact that therapy did not affect the cell yield on IC makes the technique very applicable for assessing the sentinel nodes following NACT.

Indian Journal of Cancer, 2009

Tamoxifen is being used in patients with estrogen receptor positive breast cancer as an adjuvant ... more Tamoxifen is being used in patients with estrogen receptor positive breast cancer as an adjuvant or palliative hormonal therapy. w0 estern studies have found a 30% incidence of gallstones in patients who are taking Tamoxifen and they have proved a significant association between the two. The objective of the study was to find out the association of Tamoxifen use and gallstone formation in postmenopausal breast cancer patients in a South Indian population. Ninety patients who had undergone surgery for invasive breast cancer in our institute, and were receiving adjuvant Tamoxifen, were recruited for the study. An equal number of age-matched postmenopausal women were taken as controls. All of them underwent an abdominal ultrasound screening test for gallstones. Presence or absence of gallstones was noted down from their ultrasound scan reports. Pretreatment status of the gall bladder was assessed from the preoperative scan reports. An odds ratio of 1 was derived when the case group was compared with the control group. In our study we could not establish that an association existed between Tamoxifen use and gallstone formation in postmenopausal South Indian women.

Pediatric Surgery International, 2000

Primary pyogenic psoas abscess, although quite a common condition, particularly in the tropics, i... more Primary pyogenic psoas abscess, although quite a common condition, particularly in the tropics, is often overlooked as a clinical entity, probably because a psoas abscess has been traditionally associated with tuberculous spondylitis. The abscess is easily diagnosed by ultrasonography (US). Treatment by open drainage and antibiotics effective against Staphylococcus aureus results in complete reversal of symptoms and signs. In our series of 55 cases in the pediatric age group (0–12 years), pain and flexion at the hip were the most frequent clinical features at presentation. US was diagnostic in all cases in which it was performed. All except 1 patient showed complete resolution with extraperitoneal drainage, antibiotics, and skin traction. Although 4% of the cases were associated with suppurative external-iliac lymphadenitis, the remaining ones arose de novo in the psoas sheath, suggesting a primary pyomyositis of the psoas muscle.

Cases Journal, 2008

Enterocutaneous fistula following mesh repair of incisional hernia is usually due to mesh erosion... more Enterocutaneous fistula following mesh repair of incisional hernia is usually due to mesh erosion of the underlying viscus and presents late. We describe an early enterocutaneous fistula due to an unusual but a potential mode of bowel injury during mesh fixation. This case is reported to emphasize the need for greater attention to the technique of mesh fixation. We suggest laparoscopic guidance to prevent this serious complication in lateral Incisional hernias with ill defined edges of the defect.

Clinical Breast Cancer, 2009

The concept of management of the locally advanced breast carcinoma has considerably evolved from ... more The concept of management of the locally advanced breast carcinoma has considerably evolved from "maximum tolerated treatment" to the "minimum effective treatment." This has led to a shift from radical mastectomy alone to a multidisciplinary approach involving surgery, radiation therapy, and systemic chemotherapy.

Purpose Tamoxifen is used in the treatment of breast cancer to prevent recurrences. It is convert... more Purpose Tamoxifen is used in the treatment of breast cancer to prevent recurrences. It is converted to its active metabolite endoxifen by CYP2D6 enzyme. This study was conducted to evaluate the influence of CYP2D6 genetic polymorphisms on the recurrence of breast cancer in patients receiving treatment with tamoxifen as an adjuvant hormonal therapy. Methods Breast cancer patients (n = 141) on adjuvant tamoxifen and not on any concomitant CYP2D6 inhibitors were recruited for the study. Patient characteristics and treatment history were obtained. Five milliliters of venous blood was collected for genotyping CYP2D6 alleles *1, *2, *4, *5 and *10. CYP2D6 activity score was calculated to determine the phenotype based on genotype. The activity scores were compared between patients with recurrence and patients with no recurrence of breast cancer. Results Of the 141 patients recruited for the study, genotyping was done for 132 of them. CYP2D6 activity score B0.5 is associated with a statistically significant increased risk of recurrence (OR-12.37; 95 % CI-3.23, 47.33; p \ 0.001) and shorter recurrence free survival (52.68 ± 10.58 months (mean ± SEM); p \ 0.001) as was shown in Kaplan-Meir survival estimates, when compared to activity score C1. The hazard ratio for activity score B0.5 is 7.29 (p \ 0.001) when compared to activity score C1. Analysis of known estrogen receptor positive patients also showed statistically significant increased risk of recurrence and shorter recurrence free survival in patients with CYP2D6 activity score B0.5. The Cox proportional hazard ratio was found to be 7.15 (p = 0.006) for activity score B0.5. Conclusion Reduced CYP2D6 activity is associated with poor treatment outcomes, in terms of increased risk of recurrence and shorter recurrence free survival, in breast cancer patients on adjuvant tamoxifen therapy.