68Ga-PSMA-11 uptake in tracheal mucus plug – a potential pitfall

Kunal Ramesh Chandekar,Apurva Sood,Kumar Rajender,Singh Harmandeep,Shrawan Kumar Singh 대한핵의학회 2022 핵의학 분자영상 Vol.56 No.1

Prostate-specific membrane antigen (PSMA) PET/CT is a well-acclaimed imaging modality for prostate cancer (PCa). However, many reports have highlighted PSMA radioligand uptake in a variety of benign tumors and lesions. We report a case of PCa in which 68 Ga-PSMA-11 uptake was noted in the tracheal lumen. However, 18F-PSMA-1007 PET/CT was done on a subsequent day, which demonstrated no abnormal radiotracer uptake or morphological lesion within the tracheal lumen. This case highlights an uncommon finding of PSMA ligand uptake in a tracheal mucus plug (non-prostatic benign uptake), which may be misinterpreted as a false-positive finding.

Clinical outcomes and technical description of unstented end to side pancreaticogastrostomy by small posterior gastrotomy

Sandeep Kumar Bhoriwal,Sunil Kumar,SVS Deo,Jyoti Sharma,Ashutosh Mishra,Naveen Kumar,Jyoutishman Saikia,Kunal Dhall 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2

Backgrounds/Aims: Morbidity following Whipple’s surgery largely depends upon the pancreatic stump anastomosis leak. Pancreaticogastrostomy is one of the techniques of pancreatic stump reconstruction and is described variously in the literature. Duct to mucosa pancreaticogastrostomy is described either by a large 3-4 cm posterior gastrotomy or by small gastrotomy of 2-3 mm with the use of internal stents along with. We describe clinical outcomes and technique of 2 layer end to side pancreatico-gastrostomy by a small posterior gastrotomy without the use of internal stents. Methods: Hospital records of 35 patients where the technique of, small posterior gastrotomy end to side duct to mucosa pancreatico-gastrostomy without internal stents, was used for pancreatic stump reconstruction were studied retrospectively. The data were analyzed for demographic details, stage of the disease, and short term outcomes related to surgical procedure. Results: The mean duration of surgery was 7.4 hours. Grade A, B, and C POPF were observed in 10 (28.5%), 3 (8.5%), and 1 (2.8%) of patients respectively. The mean time to remove pancreatic drain was 9 days, and the mean time to start oral feeds was 8.9 days. The mean hospital stay was 12.9 days (07-26). Thirty days mortality was 2.8%. Conclusions: Unstented duct to mucosa end to side pancreatico-gastrostomy technique is comparable with other pancreatico-gastrostomy techniques in outcomes in terms of POPF, morbidity, mortality, and hospital stay. However, to establish the superiority or inferiority of this technique, a larger study is recommended.

Theoretical and Experimental Study of UV Detection Characteristics of Pd/ZnO Nanorod Schottky Diodes

Shaivalini Singh,Pramod Kumar Tiwari,Hemant Kumar,Yogesh Kumar,Gopal Rawat,Sanjay Kumar,Kunal Singh,Ekta Goel,S. Jit,박시현 성균관대학교(자연과학캠퍼스) 성균나노과학기술원 2017 NANO Vol.12 No.11

In this work, we report theoretical and experimental study of Pd/ZnO nanorod (NR) Schottky diodes-based ultraviolet photodetector (UV-PD). The ZnO-NRs are deposited on indium tin oxide (ITO) coated glass substrates by using a low-temperature hydrothermal method. The surface morphology of the ZnO-NRs film is characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM). The SEM image shows vertically grown NRs with uniformity, and XRD shows the preferred (002) orientation of ZnO-NR films. The current–voltage characteristics of Pd/ZnO-NR Schottky diodes are studied under dark and UV light. A voltage bias from -1V to +1V is applied and the ratio of photocurrent to dark current was ( ~0.17 x 10 2 at V = 0.5V) calculated from the I–V curve. The value of responsivity was found to be 0.111A/W at λ = 365 nm and at bias = 0.50 V. An approximated UV-PD structure has also been numerically simulated using three-dimensional (3D) device simulator from Visual TCAD of Cogenda International. The simulated I–V characteristics have also been plotted under both dark and light conditions. The simulated results are found to be following the nature of experimental results.

Interaction of Short Pulse Radiation with Scattering Media : Issues and Transient Radiative Transfer Formulation

Kunal Mitra,Sunil Kumar 대한기계학회 1998 Heat transter conference Vol.7 No.1

Impact of diabetes mellitus on morbidity and survival after pancreaticoduodenectomy for malignancy

Kunal Bikram Deo,Aditya Atul Kulkarni,Praveen Kumar-M,Gautham Krishnamurthy,Sunil Shenvi,Surinder Singh Rana,Rakesh Kapoor,Rajesh Gupta 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2

Backgrounds/Aims: Diabetes mellitus (DM) is a known risk factor for morbidity, length of hospital stay, or mortality after surgery, however, its impact on postoperative course and long-term survival after pancreaticoduodenectomy (PD) is not clear. Methods: This is a retrospective analysis of prospectively maintained database of 141 patients with periampullary and pancreatic head adenocarcinoma operated between January 2001 and March 2019. Clinico-pathological records and follow-up data were retrieved and analyzed. Cumulative hazard was computed for comparing the survival between DM and non-DM. Results: DM was present in 31/141 (21.9%) patients, while 16/31 (51.6%). were new-onset DM (NODM). Tumor size, lymphovascular & perineural invasion, type of surgery, lymph node positivity and R0 resection rate were comparable between diabetic and non-diabetic. There was no significant difference in postoperative pancreatic fistula, delayed gastric emptying, infectious complication, hospital stay and mortality between DM and non-diabetics. Patients with DM had worse survival at 3 years (OS: HR, 3.11 [1.43-6.76] p=0.004, DFS: HR, 2.61 [1.23-5.53] p=0.01) and 5 years (OS: HR, 3.32 [1.46-7.53] p=0.004, DFS: HR, 2.87 [1.29-6.41] p=0.009). On multivariate analysis, DM (3 year OS: HR, 2.61 [1.14-5.98] p=0.022, DFS: HR, 2.19; p=0.058) (5 year OS: HR, 2.55; p=0.04, DFS: HR, 2.25; p=0.068) and pylorus resecting surgery were significantly associated with worse survival at 3 and 5 years. Conclusions: Preoperative DM has no significant effect on postoperative course but has negative impact on 3-year and 5-year OS and DFS after PD for pancreatic and periampullary adenocarcinoma.

Retroperitoneal fibrosis-clinical presentation and outcome analysis from urological perspective

Kunal Kishor Jadhav,Vikash Kumar,Chirag B. Punatar,Vinod S. Joshi,Sharad N. Sagade 대한비뇨의학회 2017 Investigative and Clinical Urology Vol.58 No.5

Purpose: To study clinical presentation, laboratory results, imaging findings and treatment options and outcomes of retroperitoneal fibrosis (RPF). To determine whether it follows the same natural course and response to treatment in the Asian population as in the Western world. Materials and Methods: Medical records of patients diagnosed with RPF on imaging and histopathology between February 2010 and April 2016 were reviewed. Results: Of the 21 patients analyzed, mean age at presentation was 50.81 years. The male to female ratio was 0.9:1. Pain was most common presenting complaint (95.23% cases), almost 85% cases were idiopathic and rests were postradiation induced. The median creatinine level was 1.8 mg/dL. The mean erythrocyte sedimentation rate (ESR) was 53.2 mm/h. Hydronephrosis was present in all patients and 47.6% had atrophic kidneys. Diffuse retroperitoneal mass was present in 61.1%. Ureterolysis with lateralization, omental wrapping or gonadal pedicle wrap was done in 17 cases. Two patients underwent uretero-ureterostomy. One patient underwent ileal replacement of ureter, and one ileal conduit. Eighteen patients received concurrent medical treatment, 11 were given tamoxifen, 2 steroids (Prednisolone), and five were given both. Of the 20 patients with follow-up, 70% had complete symptomatic relief; ESR improvement was seen in 77.8%. Follow-up ultrasound showed resolved and decreased hydronephrosis in 20% and 55% respectively. One patient had treatment failure and 17.65% had disease recurrence. Conclusions: RPF is a rare disease with varied presentation and outcomes. The male to female ratio may be equal in Asians and smoking could be lesser contributing factor. More Asian cohort studies are required to support same.

The Versatile Approach: A Novel Single Incision Combined with Anterior and Posterior Approaches for Decompression and Instrumented Fusion to Treat Tuberculosis of the Thoracic Spine

Sudhir Kumar Srivastava,Rishi Anil Aggarwal,Sunil Krishna Bhosale,Kunal Roy,Pradip Sharad Nemade 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.2

Study Design: Retrospective case series. Purpose: To describe a novel single incision that combines anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine and study the neurological and radiological outcomes. Overview of Literature: Tuberculosis of the spine remains a major health issue in many developing countries. The options for treating tuberculosis of the thoracic spine include the anterior, posterior, and combined approaches, each with its advantages and disadvantages. Methods: Totally, 143 patients with tuberculosis of the thoracic spine were surgically treated using the “Versatile approach”. Posterior fixation was performed using sublaminar wires and a Hartshill rectangle in all patients. Anterior reconstruction was accomplished using bone graft harvested from autologous rib, iliac crest, or fibula. Results: The study included 45 males and 98 females, with a mean age of 33.18±18.65 years (range, 3–82 years) and a mean followup of 60.23±24.56 months (range, 18–156 months). Kyphosis improved from a mean value of 24.02 preoperatively to 10.25 postoperatively. A preoperative neurological deficit was observed in 131 patients, with 130 patients regaining ambulatory power. No patient had deterioration of neurological status following surgery. Fusion was achieved in all cases. The visual analogscale score improved from an average score of 7.02 preoperatively to 1.51 at final follow-up. Eight patients had superficial macerations, which healed spontaneously. One patient had buckling of the anterior graft, and one patient had implant breakage following road traffic accident. Conclusions: The “Versatile approach” is an effective, single-stage, single-incision method that combines anterior and posterior approaches for the surgically treating tuberculosis of the thoracic spine. It offers the advantage of direct visualization for decompression and reconstruction of the anterior and posterior vertebral columns, thus providing an excellent, long-lasting clinical outcome.

Routine double-J stenting for live related donor kidney transplant recipients: It doesn't serve the purpose, but does it serve a better purpose?

Vikash Kumar,Chirag B Punatar,Kunal K Jadhav,Jatin Kothari,Vinod S Joshi,Sharad N Sagade,Madhav H Kamat 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.6

Purpose: Despite meticulous techniques, surgical complications continue to be problematic in kidney transplant recipients. Role of routine stenting to reduce complications is controversial. In this study, we compare incidence of early urological complications, lymphoceles, urinary tract infections (UTI) and graft function; with or without double-J stenting. Materials and Methods: All patients who underwent live related donor renal transplantation from February 2014 to February 2016 were included. Transplants prior to February 2015 were without routine stenting; subsequent transplants were with routine stenting. Patients with neurogenic bladder, previously operated bladder and delayed or low urinary output were excluded. Follow-up was for at least three months. Descriptive statistics was performed for all parameters. Chi square test and Fisher's Exact test were used for qualitative variables. For quantitative variables, Mann-Whitney test was used to test median difference and independent samples t-test for mean difference. The p-value ≤0.05 was considered significant. Results: We analysed 74 patients (34 stented and 40 non-stented). There was no difference in the incidence of urinary leak, anastomotic obstruction, lymphoceles or UTI (p>0.4 for all comparisons). However, mean estimated glomerular filtration rate at sixth day, 14th day, one month and two months were 76.1 vs. 61.5 (p=0.025), 72.1 vs. 56.6 (p=0.005), 79.4 vs. 63.1 (p=0.002) and 82.0 vs. 63.3 (p=0.001) in the stented versus non-stented groups. Conclusions: Placement of ureteral stent in renal transplant does not significantly affect the incidence of early urinary complications or UTI. However, graft function is significantly better in stented recipients, at least in the short term.

Apical Vertebral Column Resection with Sagittal Rotation and Controlled Anterior Opening and Posterior Closing Maneuver for the Treatment of Severe Post-Tubercular Kyphosis: Case Series and Literature Review

Sudhir Kumar Srivastava,Rishi Anil Aggarwal,Sunil Krishna Bhosale,Kunal Roy,Pradip Sharad Nemade,Shaligram Purohit 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: Retrospective case series. Purpose: Describe the technique and evaluate the outcome of apical vertebral column resection (VCR) with sagittal rotation and anterior opening and posterior closing (AOPC) maneuver for correction of severe post-tubercular kyphosis (PTK). Overview of Literature: The surgical procedures described for the correction of PTK are VCR, pedicle subtraction osteotomy, transpedicular decancellation osteotomy, and closing-opening osteotomy. Methods: We retrospectively evaluated 21 patients who had been operated on with single stage apical VCR with AOPC maneuver. Radiographs were obtained before surgery and at regular follow-up intervals. These were used to calculate the angle of kyphosis. Back pain was rated using the Visual Analog Scale (VAS) and neurological status was graded using Frankel grading. Radiological outcome was assessed by the improvement in the angle of kyphosis and fusion following surgery. Neurological status was assessed using Frankel grading. Results: The study included eight males and 13 females with a mean age of 21.9 and average follow-up time of 30.4 months. The average number of vertebral bodies destroyed was 2.57. Kyphosis was improved from a mean of 68.42°±13.23° preoperative to 8.71°±4.58° postoperative. The average correction achieved was 87.10%. Preoperative VAS score improved from a mean of 6.38±0.92 preoperative to 1.38±0.49 postoperative. No patients had any sign of neurological deterioration. Seven out of eight patients with a preoperative neurological deficit improved following surgery. Two patients developed superficial wound maceration, one had persistent postoperative hypotension, and the other developed hemothorax. All patients recovered fully without a need for additional surgery. Conclusions: Single stage simultaneous anterior column lengthening and posterior column shortening is an effective method for surgical correction of severe PTK.

Incidental Muscle Uptake of 177 Lu-DOTATATE in Peripheral Vascular Disease

Piyush Aggarwal,Kunal Ramesh Chandekar,Ashwani Sood,Shakti Zerial,Rajender Kumar,Anindita Sinha 대한핵의학회 2021 핵의학 분자영상 Vol.55 No.6

Somatostatin receptor (SSTR)-based imaging and therapy has emerged as well-established modality in neuroendocrinetumors. However, its role in inflammation imaging is still evolving. We present a 48-year-old male with metastatic neuroendocrinetumor who underwent lutetium-177-based somatostatin receptor-based therapy. The post-therapy scan showed afocal tracer uptake in the left calf muscle in addition to the expected tracer uptake at the primary and metastatic sites. Further,cross-sectional imaging and biochemical investigations revealed peripheral vascular disease (PVD). The incidental traceruptake in the calf on post-therapy scan potentiates the role of somatostatin receptor scintigraphy in identifying macrophagespecificinflammatory reactions.