aravind kumar | Jntuh - Academia.edu (original) (raw)

Papers by aravind kumar

International journal of spine surgery, 2014

Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range fro... more Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. A number of minimally invasive procedures have also been developed in the recent past for its management. Disc-FX is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification. Literature on its role in the management of lumbar disc pathology is scarce. We included 24 consecutive patients who underwent the Disc-FX for back pain due to lumbar disc pathology non-responsive to non-operative treatment for a period of at least 6 months. Based on Magnetic Resonance Imaging (MRI) these patients fell into 2 groups - those with degenerative disc disease (DDD) (n = 12) and those with a contained lumbar disc herniation (CLDH)(n = 12). They were evaluated using the Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preoperatively and postoperatively. The mean age was 37.9 years (21-53 years). There were 17 males and 7 females. One patient in each subgroup was excluded from the final evaluation. Significant improvement was seen in all outcome measures. The overall rate of reintervention for persistent symptoms was 18.18% (4/22); in the CLDH subgroup, it was 36.36% (4/11). Early results after the Disc-FX procedure suggest that it s a reasonable treatment option for patients with back pain due to lumbar disc disease, especially for those with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement. This study presents Level IV evidence. We feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD. However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH.

Nuclear Medicine Communications, 2015

There is evidence that the status of human papilloma virus subtype 16 (HPV-p16) alters the progno... more There is evidence that the status of human papilloma virus subtype 16 (HPV-p16) alters the prognosis of patients with oropharyngeal squamous cell cancer (OSCC). We sought to establish whether there is a relationship between HPV-p16 status and 18F-FDG uptake in the prognosis of OSCC. Patients with newly diagnosed OSCC at our institution between June 2011 and June 2012 were retrospectively evaluated. All patients underwent a baseline 18F-FDG PET/computed tomographic scan and HPV-p16 testing. Tumour maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and total glycolytic activity (TGA) [defined as metabolic tumour volume (MTV) multiplied by SUVmean] were measured. All PET/computed tomographic scans were reviewed on a Siemens Syngo.via (version VA11B_HF03) workstation. A designated operator defined the region of the primary tumour with the MTV segmented by 40% of the SUVmax fixed threshold method. Seventy-nine patients aged 27-84 years met the criteria for inclusion in the study. The types of primary tumour were tonsillar squamous cell carcinoma in 48% and base of tongue squamous cell carcinoma in 29%. The mean SUVmax was 17.5 and 17.7 in HPV-p16-positive and HPV-p16-negative groups, respectively (P=0.90). The mean MTV was 8.36 and 7.07 ml in HPV-p16-positive and HPV-p16-negative patients, respectively (P=0.42). The mean TGA values were 96.3 and 82.5 g among the HPV-p16-positive and HPV-p16-negative patients (P=0.54). There was no significant difference between HPV-p16 status and tumour grading for any of the imaging markers. There were no statistically significant differences between HPV-p16-positive and HPV-p16-negative OSCC for any of the metabolic imaging markers (SUVmax, SUVmean, MTV and TGA) measured in this study.

Clinical Endoscopy, 2012

We agree with Roh et al. 1 that cancerous and pre-cancerous lesions may be harboured by the findi... more We agree with Roh et al. 1 that cancerous and pre-cancerous lesions may be harboured by the finding of incidental F-18-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan. This study-and our own data 2 -advocates for urgent investigation of such findings, especially considering the treatment implications for patients undergoing therapy for other established malignancies (which was the principal indication for PET).

Journal of medical microbiology, 2005

European Journal of Orthopaedic Surgery and Traumatology, 2006

We present a case of wooden foreign bodies in the foot with delayed diagnosis. Unreliability of p... more We present a case of wooden foreign bodies in the foot with delayed diagnosis. Unreliability of plain radiographs in these situations is emphasized. The comparative utility of computed tomography, magnetic resonance scans and ultrasonography is evaluated from a literature review. We utilized a sinogram which showed the splinters and also indicated their location and orientation in a region of complex anatomy, thus reducing surgical time and morbidity. Management of a suspected radiolucent foreign body is fraught with pitfalls and we provide a possible algorithm for management. Nous présentons un cas d’échardes en bois du pied avec diagnostic retardé. Le manque de fiabilité des radiographies standard dans ces situations est souligné. L’utilité comparative de la scanographie, de l’I.R.M. et de l’échographie est évalué à partir d’une revue de la littérature. Nous avons utilisé un sinogramme qui a montré les échardes et a également indiqué leur localisation exacte et orientation dans une région anatomique complexe, ce qui a permis de réduire la durée et la morbidité de l’acte chirurgical. La gestion d’un corps étranger radio-transparent suspecté est pleine de pièges et nous fournissons un algorithme utilisable dans ces cas.

Management of syndesmotic injuries of the ankle remains controversial. A postal questionnaire was... more Management of syndesmotic injuries of the ankle remains controversial. A postal questionnaire was administered to 310 Orthopaedic consultants in the United Kingdom to explore these issues. One hundred and ninety seven (63.55%) replies were received. A large number of surgeons use intra-operative hook test as an aid to assess syndesmotic stability (68.8%). A clear majority favoured the use of a syndesmotic screw as the preferred method of fixation (97.4%). The opinion on technique was divided over issues including number of cortices fixed, position and type of screw used. Most surgeons (88.4%) do not compress the syndesmosis while inserting the screw. Very few surgeons (8.5%) allow full weight bearing immediately after surgery. The survey establishes an overview of current practice of management of syndesmotic ankle injuries.

Journal of Gastrointestinal Surgery, 2013

Clinical Nuclear Medicine, 2007

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > January ...

Clinical Nuclear Medicine, 2004

Crystal arthropathies such as gout often present as an acute inflammatory monoarthritis. There co... more Crystal arthropathies such as gout often present as an acute inflammatory monoarthritis. There could be a low-grade fever but patients are not usually systemically unwell. Septic arthritis is included in the differential diagnosis of both typical and atypical presentations of gout and ...

Nuclear Medicine Communications, 2009

Unexpected focal colorectal fluorodeoxyglucose (FDG) uptake is becoming a common clinical dilemma... more Unexpected focal colorectal fluorodeoxyglucose (FDG) uptake is becoming a common clinical dilemma with the increasing utilization of positron emission tomography (PET). These findings may subsequently reveal malignant or premalignant pathology. In addition to reporting the prevalence of clinically significant colonic pathology associated with unexpected focal FDG uptake, this study analysed the correlation between pathological colonic segments with those reported on the FDG-PET scan. The reports of 2071 consecutive PET-computed tomography (PET-CT) scans performed in a calendar year were reviewed. Information regarding subsequent patient investigation and management was collected from medical records. The segments harbouring foci of unexpected bowel FDG uptake were compared against the eventual outcome(s) of the endoscopic and pathological investigations. Among the 62 individual patients represented, 37 (60%) were investigated further. Clinically unsuspected neoplasms were found in 68% of those investigated, including 10 diagnosed with carcinoma. In addition, an unknown bowel lymphoma and 19 colonic adenomas were discovered. The positive predictive value for pathology was higher in the proximal colon than the distal colon. The segments in which the pathological findings were identified correlated well with those reported as abnormal on PET-CT. Unexpected bowel FDG uptake on PET-CT is associated with a high incidence of neoplastic pathology. In particular, focal FDG uptake in the proximal colon is associated with a high positive predictive value for neoplasm. The location of pathology is strongly concordant with endoscopic findings.

Spine, 2005

A 2-dimensional axisymmetric finite element model of an intervertebral segment was used to invest... more A 2-dimensional axisymmetric finite element model of an intervertebral segment was used to investigate the stress patterns in the adjacent vertebrae of fused spinal segment incorporating 4 common cage designs. The same was used to study the effect of maturation of bone graft on stress distribution pattern. To study and compare the stress distribution patterns in a normal spinal segment and in the adjacent vertebrae of a fused spinal segment. The effect of bone graft incorporation around the mesh cage was also investigated. Lumbar fusion surgery is thought to relieve discogenic low back pain by eliminating the abnormal intersegmental movement at the level of disc degeneration. Successful spinal fusion does not guarantee symptomatic pain relief. Discogenic pain is also known to be associated with an abnormal load transmission pattern across the degenerate disc. We hypothesized that the lumbar interbody fusion results in relief of discogenic pain by normalizing the load distribution pattern. We used a 2-dimensional axisymmetric finite element model of an intervertebral segment to investigate the stress patterns in the vertebrae adjacent to a fused spinal segment incorporating 4 common cage designs: (1) anterior lumbar interbody fusion, (2) posterior lumbar interbody fusion rectangular, (3) posterior lumbar interbody fusion threaded, and (4) mesh cage. High stress concentrations and abnormal overall stress patterns were noted for all the cage designs studied. The anterior lumbar interbody fusion cage with its larger contact area showed the least abnormal stress magnitude in comparison with the other cages. Incorporation of bone in and around the mesh cage increased the area of contact and decreased the abnormal high stresses. The spine fusion model representing final bony healing showed restoration of near physiologic stress pattern. Interbody fusion cages with larger area of contact between cage and vertebral endplate produces a lower stress distribution pattern. A successful bony fusion restores near physiologic stress distribution pattern. Restoration of near normal load distribution pattern may become an important aim of surgery for discogenic low back pain.

Clinical Nuclear Medicine, 2010

Clinical Nuclear Medicine, 2011

A 29-year-old woman presented with a new right supraclavicular mass on a background of resection ... more A 29-year-old woman presented with a new right supraclavicular mass on a background of resection of a malignant melanoma from her right shoulder before 4 years. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging revealed uptake in a right supraclavicular node and the inferior pole of the left lobe of the thyroid gland. Subsequent resection and histology of the right supraclavicular node and the left lobe of the thyroid gland demonstrated metastatic melanoma and palpation thyroiditis, respectively. A number of malignant and benign pathologies of the thyroid demonstrate FDG uptake, with 75% being benign. To our knowledge, the findings of palpation thyroiditis on FDG PET/CT have never been previously described.

Clinical Nuclear Medicine, 2012

A 56-year-old patient was referred for FDG PET/CT with a right preauricular lymph node fine-needl... more A 56-year-old patient was referred for FDG PET/CT with a right preauricular lymph node fine-needle biopsy, suggesting poorly differentiated carcinoma and no obvious primary lesion. There was intense FDG uptake in the right preauricular nodule. The node was excised, and formal histology demonstrated a benign pilomatricoma rather than malignancy. Pilomatricoma is uncommon in adults and an unusual cause for marked FDG uptake, likely due to foreign body inflammation. Pilomatricoma can be either benign or malignant. The marked FDG uptake demonstrated in our patient with benign pilomatricoma also suggests that FDG PET cannot reliably grade this rare condition.

Clinical Nuclear Medicine, 2013

Rib and sternal fractures are relatively common following conventional cardiopulmonary resuscitat... more Rib and sternal fractures are relatively common following conventional cardiopulmonary resuscitation (CPR). This case demonstrates the 18F-FDG PET/CT appearances of typical CPR-related multiple rib and sternal fractures in a 55-year-old man with suspected cardiac sarcoidosis. The PET/CT scan was performed to assess disease activity of cardiac sarcoidosis, and no active cardiac inflammation was detected. The patient initially presented with an out-of-hospital cardiac arrest and successfully received bystander CPR.