13 results on '"Kachala SS"'
Search Results
2. Value of routine timed barium esophagram follow-up in achalasia after myotomy.
- Author
-
Kachala SS, Rice TW, Baker ME, Rajeswaran J, Thota PN, Murthy SC, Blackstone EH, Zanoni A, and Raja S
- Subjects
- Adult, Aged, Aged, 80 and over, Esophageal Achalasia physiopathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Young Adult, Barium therapeutic use, Contrast Media therapeutic use, Esophageal Achalasia diagnostic imaging, Esophageal Achalasia surgery, Myotomy, Radiography methods
- Abstract
Objectives: The value of routine timed barium esophagram (TBE) in longitudinal follow-up of achalasia after Heller myotomy is unknown. We prospectively prescribed a yearly follow-up TBE. Purposes were to characterize esophageal emptying over time after myotomy, identify preoperative TBE measures associated with follow-up TBE, and characterize follow-up TBE over time in relationship to reintervention., Methods: From March 1995 to April 2013, 635 patients underwent Heller myotomy for achalasia; 559 had at least 1 follow-up TBE. Temporal trends of 1335 follow-up TBEs in all nonreintervention and reintervention patients were assessed. Multivariable longitudinal analysis identified preoperative TBE measures associated with follow-up TBE., Results: On average, TBE height and width at 1 and 5 minutes decreased approximately 50% and 60%, respectively, at first postoperative follow-up, and remained stable or slightly decreased for up to 5 years. Wider TBE width at 5 minutes was associated with greater follow-up TBE height and width at 1 minute. Of 118 patients undergoing reintervention, 64 (57%) had only 1 reintervention, with follow-up TBE returning to that of nonreintervention patients. Patients whose follow-up TBE remained abnormal underwent a further reintervention, some normalizing on subsequent TBE, and some not., Conclusions: Follow-up TBE is valuable postmyotomy, particularly if there is substantial esophageal dilatation preoperatively. Follow-up TBE reassures patients with stable or decreasing TBE measures, permitting decreased follow-up intensity. Reintervention should not be considered a myotomy failure, because a successful, single, nonsurgical reintervention often results in long-term successful palliation. More than 1 reintervention requires intensification of TBE follow-up, facilitating treatment planning., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
3. Surgical Management of Sternoclavicular Joint Infections.
- Author
-
Kachala SS, D'Souza DM, Teixeira-Johnson L, Murthy SC, Raja S, Blackstone EH, and Raymond DP
- Subjects
- Academic Medical Centers, Aged, Arthritis, Infectious diagnosis, Cohort Studies, Debridement methods, Female, Follow-Up Studies, Humans, Male, Middle Aged, Osteotomy methods, Pain Measurement, Retrospective Studies, Risk Assessment, Severity of Illness Index, Sternoclavicular Joint physiopathology, Streptococcal Infections diagnosis, Surgical Wound Infection diagnosis, Wound Healing physiology, Arthritis, Infectious surgery, Sternoclavicular Joint microbiology, Sternoclavicular Joint surgery, Streptococcal Infections surgery, Surgical Flaps blood supply, Surgical Wound Infection surgery
- Abstract
Background: Infections of the sternoclavicular joint (SCJ) respond poorly to nonoperative management and typically require resection. We examined presenting characteristics and outcomes after surgical management of SCJ infections, reviewing a 20-year single-institution experience., Methods: From January 1992 to December 2012, 40 patients (age, 57 ± 12 years; 70% male) underwent resection of an infected SCJ. Sternal infections after cardiac surgery were excluded. Clinical features, microbiology, recurrence, survival, and functional impairment were assessed. Infection was documented by the surgeon, and supported by tissue culture. Clinical presentation and treatment course were obtained by review of medical records. The functional assessment was determined by phone interviews using the validated QuickDASH outcome measure. Mortality data were gathered from the medical record., Results: Pain was the presenting symptom in 93% of patients. Staphylococcal species were isolated in 73% of tissue specimens. Fifteen patients (37%) underwent primary closure and 25 patients (63%) underwent closure by secondary intention with application of negative-pressure wound therapy. There were four recurrences (10%), one after primary closure and three in the secondary intention group. No deaths occurred within 30 days of operation, and 5-year survival was 67%. Functional assessment using the QuickDASH outcome measure revealed minimal loss in upper extremity function after the procedure (preoperative score, 10 ± 3; postoperative score, 19 ± 6.8; n = 11). There was no difference in functional outcome comparing primary closure versus secondary intention (19 ± 4.4 versus 20 ± 8.2; p = 0.64)., Conclusions: Septic arthritis of the SCJ is routinely managed surgically at many centers. We report that primary closure with a muscle flap can achieve similar outcomes to secondary intention in selected patients. Furthermore, patients experienced minimal functional impairment at long-term follow-up., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
4. Lung transplantation for multifocal lung adenocarcinoma (multifocal lung carcinoma).
- Author
-
Kachala SS and Murthy SC
- Subjects
- Adenocarcinoma, Bronchiolo-Alveolar diagnosis, Diagnostic Imaging, Humans, Lung Neoplasms diagnosis, Pneumonectomy methods, Adenocarcinoma, Bronchiolo-Alveolar surgery, Lung Neoplasms surgery, Lung Transplantation methods
- Abstract
Lung transplantation is an acceptable treatment option in highly selected patients with lung limited AIS or MIA. Aside from the cancer diagnosis, ideal candidates should not possess any absolute or relative contraindications to lung transplantation as described by the ISHLT. Confirmation of lung-limited disease and AIS/MIA with lepidic histology and the absence of carcinoma metastatic to mediastinal lymph nodes will optimize outcomes. Those patients with multifocal minimally invasive lung ACA and respiratory insufficiency from severe bronchorrhea may enjoy the best palliation of their disease and have high enough LAS to facilitate transplantation. The role of targeted therapies for those patients with EGFR or ALK-activating mutations and might favorably AIS/MIA has yet to be determined and impact survival and augment (or supplant) lung transplantation for these patients., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
5. Mesothelin overexpression is a marker of tumor aggressiveness and is associated with reduced recurrence-free and overall survival in early-stage lung adenocarcinoma.
- Author
-
Kachala SS, Bograd AJ, Villena-Vargas J, Suzuki K, Servais EL, Kadota K, Chou J, Sima CS, Vertes E, Rusch VW, Travis WD, Sadelain M, and Adusumilli PS
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adenocarcinoma of Lung, Aged, Animals, Biomarkers, Tumor genetics, Cell Line, Tumor, Cell Movement, Cell Proliferation, Disease-Free Survival, Female, GPI-Linked Proteins genetics, Gene Expression, Humans, Kaplan-Meier Estimate, Lung Neoplasms mortality, Lung Neoplasms pathology, Male, Mesothelin, Mice, Mice, Inbred NOD, Mice, SCID, Middle Aged, Neoplasm Invasiveness, Neoplasm Transplantation, Adenocarcinoma metabolism, Biomarkers, Tumor metabolism, GPI-Linked Proteins metabolism, Lung Neoplasms metabolism, Neoplasm Recurrence, Local metabolism
- Abstract
Purpose: In an effort to identify molecular markers of tumor aggressiveness and therapeutic targets in lung adenocarcinoma (ADC), we investigated the expression of mesothelin (MSLN) in lung ADC, as well as its biologic and clinical relevance., Experimental Design: In a training and validation set of patients with early-stage (I-III) lung ADC (n = 1,209), a tissue microarray consisting of tumors and normal lung tissue was used to examine the association between MSLN expression and recurrence-free survival (RFS) and overall survival (OS). The influence of MSLN overexpression on lung ADC was investigated in vitro and in vivo by use of clinically relevant orthotopic and metastatic xenogeneic and syngeneic mouse models., Results: MSLN was expressed in 69% of lung ADC tumors, with one in five patients strongly expressing MSLN and no expression in normal lung tissue. Increased MSLN expression was associated with reduced OS [HR = 1.78; 95% confidence interval (CI), 1.26-2.50; P < 0.01] and RFS (HR = 1.67; 95% CI, 1.21-2.27; P < 0.01) in multivariate analyses, even after adjustment for currently known markers of tumor aggressiveness in lung ADC: male sex, smoking history, increasing stage, morphologic pattern, visceral pleural invasion, lymphatic or vascular invasion, and mutation status. In vitro, lung ADC cells overexpressing MSLN demonstrated increased cell proliferation, migration, and invasion; in vivo, mice with MSLN(+) tumors demonstrated decreased survival (P = 0.001)., Conclusions: MSLN expression in patients with early-stage lung ADC is associated with increased risk of recurrence and reduced OS, indicating that MSLN expression is a molecular marker of tumor aggressiveness and a potential target for therapy., (©2013 AACR)
- Published
- 2014
- Full Text
- View/download PDF
6. A grading system combining architectural features and mitotic count predicts recurrence in stage I lung adenocarcinoma.
- Author
-
Kadota K, Suzuki K, Kachala SS, Zabor EC, Sima CS, Moreira AL, Yoshizawa A, Riely GJ, Rusch VW, Adusumilli PS, and Travis WD
- Subjects
- Adenocarcinoma metabolism, Aged, Biomarkers, Tumor metabolism, Cell Nucleus metabolism, Cell Nucleus pathology, Female, Humans, Ki-67 Antigen metabolism, Lung Neoplasms metabolism, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Prognosis, Adenocarcinoma classification, Adenocarcinoma secondary, Lung Neoplasms classification, Lung Neoplasms diagnosis, Mitosis
- Abstract
The International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) has recently proposed a new lung adenocarcinoma classification. We investigated whether nuclear features can stratify prognostic subsets. Slides of 485 stage I lung adenocarcinoma patients were reviewed. We evaluated nuclear diameter, nuclear atypia, nuclear/cytoplasmic ratio, chromatin pattern, prominence of nucleoli, intranuclear inclusions, mitotic count/10 high-power fields (HPFs) or 2.4 mm(2), and atypical mitoses. Tumors were classified into histologic subtypes according to the IASLC/ATS/ERS classification and grouped by architectural grade into low (adenocarcinoma in situ, minimally invasive adenocarcinoma, or lepidic predominant), intermediate (papillary or acinar), and high (micropapillary or solid). Log-rank tests and Cox regression models evaluated the ability of clinicopathologic factors to predict recurrence-free probability. In univariate analyses, nuclear diameter (P=0.007), nuclear atypia (P=0.006), mitotic count (P<0.001), and atypical mitoses (P<0.001) were significant predictors of recurrence. The recurrence-free probability of patients with high mitotic count (≥5/10 HPF: n=175) was the lowest (5-year recurrence-free probability=73%), followed by intermediate (2-4/10 HPF: n=106, 80%), and low (0-1/10 HPF: n=204, 91%, P<0.001). Combined architectural/mitotic grading system stratified patient outcomes (P<0.001): low grade (low architectural grade with any mitotic count and intermediate architectural grade with low mitotic count: n=201, 5-year recurrence-free probability=92%), intermediate grade (intermediate architectural grade with intermediate-high mitotic counts: n=206, 78%), and high grade (high architectural grade with any mitotic count: n=78, 68%). The advantage of adding mitotic count to architectural grade is in stratifying patients with intermediate architectural grade into two prognostically distinct categories (P=0.001). After adjusting for clinicopathologic factors including sex, stage, pleural/lymphovascular invasion, and necrosis, mitotic count was not an independent predictor of recurrence (P=0.178). However, patients with the high architectural/mitotic grade remained at significantly increased risk of recurrence (high vs low: P=0.005) after adjusting for clinical factors. We proposed this combined architectural/mitotic grade for lung adenocarcinoma as a practical method that can be applied in routine practice.
- Published
- 2012
- Full Text
- View/download PDF
7. High SUVmax on FDG-PET indicates pleomorphic subtype in epithelioid malignant pleural mesothelioma: supportive evidence to reclassify pleomorphic as nonepithelioid histology.
- Author
-
Kadota K, Kachala SS, Nitadori J, Suzuki K, Dunphy MP, Sima CS, Travis WD, Rusch VW, and Adusumilli PS
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinosarcoma classification, Carcinosarcoma mortality, Carcinosarcoma pathology, Female, Follow-Up Studies, Humans, Male, Mesothelioma classification, Mesothelioma mortality, Mesothelioma pathology, Middle Aged, Neoplasm Staging, Neoplasms, Glandular and Epithelial classification, Neoplasms, Glandular and Epithelial mortality, Neoplasms, Glandular and Epithelial pathology, Pleural Neoplasms classification, Pleural Neoplasms mortality, Pleural Neoplasms pathology, Prognosis, Radionuclide Imaging, Retrospective Studies, Survival Rate, Carcinosarcoma diagnostic imaging, Mesothelioma diagnostic imaging, Neoplasms, Glandular and Epithelial diagnostic imaging, Pleural Neoplasms diagnostic imaging
- Abstract
Background: We have recently proposed to reclassify the pleomorphic subtype of epithelioid malignant pleural mesothelioma (MPM) as nonepithelioid (biphasic/sarcomatoid) histology because of its similarly poor prognosis. We sought to investigate whether preoperative maximum standardized uptake value (SUVmax) on F-fluorodeoxyglucose (FDG) positron emission tomography (PET) correlates with histologic subtype in MPM., Methods: Clinical data were collected for 78 patients with MPM who underwent preoperative FDG-PET. We retrospectively classified the epithelioid tumors into five subtypes: trabecular, tubulopapillary, micropapillary, solid, and pleomorphic. Tumors were categorized by SUVmax into two groups: low (<10.0) and high (≥10.0)., Results: The median overall survival of epithelioid tumors with high SUVmax (n = 12) was significantly shorter (7.1 months) than that of epithelioid tumors with low SUVmax (n = 54, 18.9 months, p < 0.001) and comparable to nonepithelioid tumors (n = 12, 7.2 months). Epithelioid tumors with pleomorphic subtype (n = 9) had marginally higher SUVmax (mean ± SD: 10.6 ± 5.9) than epithelioid nonpleomorphic subtype (n = 57, 6.5 ± 3.2, p = 0.050), and were comparable to that of nonepithelioid tumors (n = 12, 9.1 ± 4.8). Among the epithelioid tumors with high SUVmax (n = 12), 50% (n = 6) showed pleomorphic subtype. In contrast, among epithelioid tumors with low SUVmax (n = 54), 6% (n = 3) showed epithelioid pleomorphic subtypes (p = 0.001). A positive correlation between mitotic count and SUVmax was observed (r = 0.30, p = 0.010)., Conclusions: Pleomorphic subtype of epithelioid MPM showed higher SUVmax than the epithelioid nonpleomorphic subtype and was similar to nonepithelioid histology. Preoperative SUVmax on FDG-PET in epithelioid MPM can indicate patients with pleomorphic subtype with poor prognosis, supporting their reclassification as nonepithelioid.
- Published
- 2012
- Full Text
- View/download PDF
8. Pre-clinical mouse models of primary and metastatic pleural cancers of the lung and breast and the use of bioluminescent imaging to monitor pleural tumor burden.
- Author
-
Servais EL, Colovos C, Kachala SS, and Adusumilli PS
- Subjects
- Animals, Breast Neoplasms secondary, Humans, Lung Neoplasms secondary, Mesothelioma pathology, Mice, Pleural Neoplasms pathology, Antineoplastic Agents therapeutic use, Breast Neoplasms drug therapy, Lung Neoplasms drug therapy, Mesothelioma drug therapy, Molecular Imaging methods, Neoplasm Metastasis drug therapy, Pleural Neoplasms drug therapy, Tumor Burden drug effects, Xenograft Model Antitumor Assays methods
- Abstract
Malignant pleural disease (MPD) results in an estimated 150,000 cases of malignant pleural effusions (MPE) annually. The most common malignancies associated with MPD are primary malignant pleural mesothelioma (MPM) and metastatic lung cancer, breast cancer, and lymphoma. MPM is a rare, regionally aggressive malignancy whose incidence is increasing secondarily to the latency of disease progression. MPD is characteristic of advanced-stage pleural disease and portends a grave clinical prognosis with a median survival between 3 and 12 months. Preclinical investigations conducted in flank and intraperitoneal tumor models do not fully recapitulate the pleural tumor microenvironment, and the results are not directly translatable to the clinical setting. The protocol described herein provides a mouse model of MPM and MPD from nonhematogenous tumors, resulting in reproducible tumor location, tumor progression, animal survival, and histopathology. Pleural tumor growth in this model resembles the regionally aggressive clinical course and tumor microenvironment of human pleural cancers and provides an optimal animal model to investigate MPD biology and therapies.
- Published
- 2011
- Full Text
- View/download PDF
9. Prognostic immune markers in non-small cell lung cancer.
- Author
-
Suzuki K, Kachala SS, Kadota K, Shen R, Mo Q, Beer DG, Rusch VW, Travis WD, and Adusumilli PS
- Subjects
- Biomarkers, Tumor immunology, Carcinoma, Non-Small-Cell Lung diagnosis, Carcinoma, Non-Small-Cell Lung immunology, Gene Expression Regulation, Neoplastic, Gene Regulatory Networks, Humans, Lung Neoplasms diagnosis, Lung Neoplasms immunology, Models, Genetic, Models, Immunological, Prognosis, Tumor Microenvironment immunology, Biomarkers, Tumor genetics, Carcinoma, Non-Small-Cell Lung genetics, Lung Neoplasms genetics, Tumor Microenvironment genetics
- Abstract
Tumor-associated immune responses have polarized effects in regulating tumor growth. Although a clear association has been shown between the tumor immune response and clinical outcome in colorectal and ovarian cancers, the role of immune markers for stratifying prognosis in non-small cell lung cancer (NSCLC) is less defined. Herein, we review the prognostic significance of published immune markers in the tumor microenvironment and peripheral blood of NSCLC patients. To identify prognostic immune genes, we reviewed all published gene-profiling studies in NSCLC and delineated the significance of immune genes by doing subanalysis on the microarray database of the NIH Director's Challenge study. This first comprehensive review of prognostic immune markers provides a foundation for further investigating immune responses in NSCLC., (©2011 AACR.)
- Published
- 2011
- Full Text
- View/download PDF
10. The ageing physician.
- Author
-
Morales EA, Kachala SS, Bograd AJ, and Adusumilli PS
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Certification, Humans, Middle Aged, United States, Clinical Competence, Patient Preference, Physicians
- Published
- 2011
11. Doctor, did you wash your hands?
- Author
-
Rodriguez LA, Kachala SS, and Adusumilli PS
- Subjects
- Humans, Cross Infection prevention & control, Hand Disinfection, Physicians
- Published
- 2010
12. Therapeutic sentinel lymph node imaging.
- Author
-
Kachala SS, Servais EL, Park BJ, Rusch VW, and Adusumilli PS
- Subjects
- Animals, Carcinoma, Non-Small-Cell Lung secondary, Humans, Lung Neoplasms secondary, Lymphatic Metastasis, Neoplasm Staging, Patient Selection, Predictive Value of Tests, Treatment Outcome, Carcinoma, Non-Small-Cell Lung diagnosis, Carcinoma, Non-Small-Cell Lung therapy, Diagnostic Imaging methods, Lung Neoplasms diagnosis, Lung Neoplasms therapy, Lymph Nodes pathology
- Abstract
Improving existing means of sentinel lymph node identification in non-small cell lung cancer will allow for molecular detection of occult micrometastases that may cause recurrence in early stage non-small cell lung cancer. Furthermore, targeted application of chemical and biological cytotoxic agents can potentially improve outcomes in patients with lymph node (LN) metastases. "Therapeutic Sentinel Lymph Node Imaging" incorporates these modalities into a single agent thereby identifying which LNs harbor tumor cells and simultaneously eradicating metastatic disease. In this review, we summarize the novel preclinical agents for identification and treatment of tumor bearing LNs and discuss their potential for clinical translation., (Copyright 2009 Elsevier Inc. All rights reserved.)
- Published
- 2009
- Full Text
- View/download PDF
13. Health insurance reform.
- Author
-
Servais EL, Kachala SS, and Adusumilli PS
- Subjects
- Humans, India, Politics, United States, Health Care Reform legislation & jurisprudence, Insurance, Health legislation & jurisprudence
- Published
- 2009
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.