Assessment of novel prognostic biomarkers to predict pathological complete response in patients with non-metastatic triple-negative breast cancer using a window of opportunity design.

Background: Triple-negative breast cancer (TNBC) includes approximately 20% of all breast cancer and is characterized by its aggressive nature, high recurrence rates, and visceral metastasis. Pathological complete response (pCR) is an established surrogate endpoint for survival. The window of opportunity studies provide valuable information on the disease biology prior to definitive treatment. Objectives: To study the association of dynamic change in pathological, imagining, and genomic biomarkers that can prognosticate pCR. The study aims to develop a composite prognostic score. Design: Clinical, interventional, and prognostic biomarker study using the novel window of opportunity design. Methods: The study aims to enroll 80 treatment-naïve, pathologically confirmed TNBC patients, administering a single dose of paclitaxel and carboplatin during the window period before neoadjuvant chemotherapy (NACT). Tumor tissue will be obtained through a tru-cut biopsy, and positron emission tomography and computed tomography scans will be performed for each patient at two time points aiming to evaluate biomarker alterations. This will be followed by the administration of standard dose-dense NACT containing anthracyclines and taxanes, with the study culminating in surgery to assess pCR. Results: The study would develop a composite prognostic risk score derived from the dynamic change in the Ki-67, tumor-infiltrating lymphocytes, Standardized Uptake Value (SUV max), Standardized Uptake Value for lean body mass (SUL max), and gene expression level pre- and post-intervention during the window period prior to the start of definitive treatment. This outcome will aid in categorizing the disease biology into risk categories. Trial registration: The current study is approved by the Institutional Ethics Committee [Ethics: Protocol. no. JIP/IEC/2020/019]. This study was registered with ClinicalTrials.gov [CTRI Registration: CTRI/2022/06/043109]. Conclusion: The validated biomarker score will help to personalize NACT protocols in patients in TNBC planned for definitive treatment.

Precision in action: unveiling predictive biomarkers for enhanced TNBC treatment We are investigating new ways to predict how well a particular treatment will work in patients with a specific type of breast cancer called triple-negative breast cancer. The study goal is to find biomarkers that change in response to drugs to predict the complete elimination of cancer in patients before it spreads to other parts of the body. To do this, we are using a special research approach called a 'window of opportunity design.' This information could be valuable in personalizing and improving cancer treatments.

Role of bisphosphonates in hypertrophic osteoarthropathy: a systematic review.

BACKGROUND: The role of bisphosphonates (BP) in hypertrophic osteoarthropathy (HPOA) is unclear. We presented a case of primary HPOA and performed a systematic review of literature on the effect of BP on treatment response in primary and secondary HPOA. METHODS: The study was prospectively registered in PROSPERO (CRD42022343786). We performed a PubMed literature search that restricted to the English language. We included patients diagnosed with primary or secondary HPOA who received BP. The primary endpoint assessed was the effectiveness of BP on response to pain or arthritis. Secondary outcomes included timing, degree, and duration of response, comparison to other HPOA therapies, impact of BP on radiology, bone scan, bone turnover markers, and adverse effects of BP. RESULTS: Literature search retrieved only case reports. Forty-five patients (21 primary, 24 secondary HPOA) had received BP. Majority(88.3%) experienced improvement in pain or arthritis. Response was gradual for primary HPOA and within a median of 3 to 7 days for secondary HPOA after treatment with BP. Most patients had reduced bone scan uptake after BP. When other HPOA therapies were tried, half responded to BP after not having previously responded to other therapies, while a third received the treatments concurrently, making it difficult to attribute treatment response to a drug. Reporting of other secondary outcomes was very heterogenous and qualitative to draw conclusions. No major adverse effects have been reported for BP in HPOA. CONCLUSION: Bisphosphonates provide an effective and safe treatment option for primary and secondary HPOA. However, there is a lack of randomized controlled trials.

Intermodality Variability in Gross Tumor Volume Delineation for Radiation Therapy Planning in Oropharyngeal Squamous Cell Carcinoma.

Purpose: Multimodality imaging can enhance the precision of tumor delineation for intensity modulated radiation therapy planning. This study aimed to analyze intermodality variation for gross tumor volume (GTV) delineation in locally advanced oropharyngeal carcinomas (LAOCs). Methods and Materials: We examined the pretreatment contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and fluoro-deoxy-glucose-based positron emission tomography (FDG-PET) image data sets of 33 adult patients with primary LAOC. Automatic segmentation method was used to derive PET-based metabolic tumor volumes (MTVs) at 30%, 40%, 50%, 60%, and 70% of the primary tumor's maximum standardized uptake value (SUVmax). The geometric conformality or spatial overlap was assessed using the Dice similarity coefficient (DSC), which ranges from 0 to 1, indicating no overlap to complete overlap. Results: The size of the tumor in the anteroposterior dimension of the GTV was found to be more on CT than MRI, with a mean difference of 0.29 cm (P value .015). Overall, PET-based MTV volumes were smaller than GTVs on CT and MR. Among various intensities on PET, MTV30 was the closest match with GTV-CT/MR. The mean difference for absolute tumor volumes (GTV-CT, GTV-MR, and MTV30) was not statistically significant; however, spatial overlap by DSC score was average, that is, <0.7. DSC was 0.65 ± 0.15 between GTV-CT and GTV-MR, 0.62 ± 0.15 between GTV-CT and MTV30, and 0.576 ± 0.16 between GTV-MR and MTV30 pairs, respectively. On qualitative analysis, overall tumor extension into adjacent muscles, parotid gland, retromolar trigone, and marrow infiltration of mandible was better appreciated on MRI. Conclusions: Given the significant spatial variation, multimodality imaging can serve as an excellent complement for target volume delineation on CT scans during intensity modulated radiation therapy planning for LAOC by harnessing the improved soft tissue definition of MRI and the ability of PET to provide metabolic activity information.

Myocardial Perfusion Scan Study before and after On-Pump Coronary Artery Bypass Grafting Surgery - A Single-Center Study.

Aim: Ischemic cardiac disease is the most common adult heart disease. The primary aim of the study was to analyze the myocardial perfusion status of the patients undergoing coronary artery bypass graft using sestamibi scan and assess the improvement in perfusion status of the myocardium after the surgery. Materials and Methods: This study was a descriptive study consisting of a single group of patients undergoing elective surgery for coronary artery disease. The patients underwent myocardial perfusion scan before surgery. Another myocardial perfusion scan was performed 3 months after the surgery. The change in myocardial perfusion status was analyzed. Results: Totally, 49 patients were initially included in this study. Seven patients lost their follow-up. Among the 17 patients who had severely reduced tracer uptake preoperatively, 3 (7.1%) had a good outcome, while 14 (33.3%) had a poor outcome, which was statistically significant (P < 0.001). Eighteen cases who belonged to the category of moderately reduced tracer uptake while analyzed, it was found that 16 (38.1%) had a good outcome while only 2 (4.8%) had a poor outcome; the difference in proportion among these two groups was statistically significant (P < 0.001). The patients who had mildly reduced tracer uptake preoperatively, all 3 (7.1%) had a good outcome, but it was not statistically significant (P = 0.23). Four patients had adequate tracer uptake preoperatively, out of which 3 (7.1%) had a good outcome, while the other 1 (2.4%) had a poor outcome and was not statistically significant (P = 0.63). Conclusion: Surgical revascularization improves perfusion in a selective group of patients.

Role of 68 Ga-FAPI PET/CT in Assessing Hepatobiliary Malignancies : A Prospective Pilot Study.

INTRODUCTION AND AIM: Preliminary studies showed good expression of fibroblast activating protein inhibitor (FAPI) in hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Our aims were to study the diagnostic performance of 68 Ga-FAPI PET/CT in diagnosing the primary hepatobiliary malignancies and to compare its performance with 18 F-FDG PET/CT. PATIENTS AND METHODS: Patients suspected to have HCC and CC were recruited prospectively. FDG and FAPI PET/CT studies were completed within 1 week. Final diagnosis of malignancy was achieved by tissue diagnosis (either histopathological examination or fine-needle aspiration cytology) and radiological correlation from conventional modalities. Results were compared with final diagnosis and expressed as sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. RESULTS: Forty-one patients were included. Thirty-one were positive for malignancy and 10 were negative. Fifteen were metastatic. Of 31, 18 were CC and 6 were HCC. For overall diagnosis of the primary disease, FAPI PET/CT performed exceptionally compared with FDG PET/CT with sensitivity, specificity, and accuracy of 96.77%, 90%, and 95.12%, respectively, versus 51.61%, 100%, and 63.41% for FDG PET/CT. FAPI PET/CT clearly outperformed FDG PET/CT for the evaluation of CC with sensitivity, specificity, and accuracy of 94.4%, 100%, and 95.24%, respectively, whereas for FDG PET/CT sensitivity, specificity, and accuracy were 50%, 100%, and 57.14%, respectively. Diagnostic accuracy of FAPI PET/CT was 61.54% for metastatic HCC compared with 84.62% for FDG PET/CT. CONCLUSIONS: Our study highlights the potential role of FAPI-PET/CT in evaluating CC. It also ascertains its usefulness in the cases of mucinous adenocarcinoma. Although it showed a higher lesion detection rate than FDG in primary HCC, its diagnostic performance in the metastatic setting is questionable.

Efficacy and safety of pomalidomide, bortezomib, and dexamethasone combination chemotherapy for newly diagnosed multiple myeloma: POMACE Phase II Study.

Bortezomib, lenalidomide, and dexamethasone induction chemotherapy (VRd), followed by autologous stem cell transplantation (ASCT), are the standard of care for patients with newly diagnosed multiple myeloma (NDMM). Pomalidomide is currently approved for relapsed-refractory multiple myeloma. This single-arm, open-label, phase 2 study was the prospective evaluation of the efficacy and safety of bortezomib, pomalidomide, and dexamethasone (VPd) induction for NDMM. We used Fleming's two-stage design for sample size calculation. We included transplant-eligible and ineligible patients aged 18-75 years in the study. The patients received four cycles of VPd induction followed by response assessment. Thirty-four patients were included in the study, of which 31 completed all four cycles of induction. The median age was 52 years (32-72). Thirty (91%) patients had multiple myeloma, and three had multiple plasmacytomas with less than 10% bone marrow involvement. Nine (27%) had ISS-I, 9 (27%) had ISS-II, and 15 (46%) had ISS-III myeloma. Three patients had high-risk cytogenetic abnormalities. After four cycles of VPd induction, ten patients (32%) achieved stringent CR, nine had CR (29%), eight (26%) had VGPR, and 4 (13%) had PR. Fifteen (48%) had a complete metabolic response (CMR) on PET-CT. Two patients developed SAEs. Anemia was the most common hematological toxicity. Peripheral neuropathy and constipation were the most common non-hematological toxicities. Patients with ≥VGPR had significantly better 12-month PFS than those with PR. Patients with ≥VGPR and CMR on PET-CT had significantly better 12-month OS. Our study showed VPd induction is safe and efficacious in NDMM. Further Phase 3 studies are necessary to establish the superiority and survival benefits.

Complete Metabolic Response in Adenocarcinoma Lung With Lymphangitic Carcinomatosis.

ABSTRACT: Pulmonary lymphangitic carcinomatosis refers to the tumor spread into the lymphatic system of the lungs and is considered a poor prognostic marker. We present an interesting case of adenocarcinoma of right lung evaluated with 18 F-FDG PET/CT for baseline staging, with extensive bilateral lung involvement and lymphangitic carcinomatosis pattern. Subsequently, the patient received 3 cycles of carboplatin- and pemetrexed-based chemotherapy regimen along with oral ceritinib. Complete metabolic response and significant reduction in size of the primary lung lesion was noted on response evaluation with 18 F-FDG PET/CT, which is a rare phenomenon.

Incidental Detection of Asymptomatic Brain Metastases Due to Carcinoma Prostate in Ga-68 PSMA HBED-CC Positron Emission Tomography-Computed Tomography: Reiterating its Superiority in Assessing Disease Status.

Brain metastasis originating in adenocarcinoma of the prostate is rare and can be expected in cases of disseminated bone and soft-tissue disease. Asymptomatic brain metastasis is rare at any point of the disease stage. Ga-68 PSMA positron emission tomography-computed tomography (PET-CT) is one of the useful investigations for assessing the disease status in adenocarcinoma of the prostate. We report a case of asymptomatic brain metastases detected in Ga-68 PSMA PET-CT scan.

Utility of Urinary Biomarkers Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 as a Marker for Diagnosing the Presence of Renal Scar in Children with Vesicoureteral Reflux (VUR): A Cross-Sectional Study.

Aim: To explore the possibility of using urinary biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) to assess the presence of renal scars in children with Vesicoureteric Reflux (VUR). Materials and Methods: This cross-sectional study was conducted in 94 children aged 0-16 years diagnosed with VUR in the Department of Pediatric Surgery, JIPMER. Urinary biomarkers were measured using the enzyme-linked immunosorbent assay kits, normalized with urinary creatinine (Cr) and compared with severity of VUR (low grade [I and II] and high grade [III, IV, and V]), presence or absence of renal scar in VUR patients and severity of renal scar. Independent Student's t-test, Mann-Whitney U-test, and analysis of variance Kruskal-Wallis test were used for comparison, and receiver operating characteristic (ROC) curve analysis for predicting the accuracy of biomarkers in detecting the presence of renal scars. Results: The median urinary NGAL (uNGAL) value was higher in children with renal scar (1.49 ng/mL) than those without renal scar (0.58 ng/mL) and was statistically significant (<0.001). Whereas median uNGAL/Cr was higher in children with renal scar (0.07) than those without renal scar (0.03) but was not statistically significant (P = 0.06). Urinary KIM-1 and urinary KIM-1/urinary Cr (uKIM-1/Cr) was not found to be a significant predictor of renal scar. The difference of uNGAL/Cr was comparable between the grades of renal scar but was not statistically significant. On ROC curve analysis, uNGAL had area under the ROC curve (AUC) of 0.769 with 71% of both specificity and sensitivity, whereas uNGAL/Cr was found to be a poor predictor of renal scar with AUC of 0.611, 60% sensitivity, and 61.2% specificity. Conclusion: uNGAL can serve as a noninvasive marker for diagnosing the presence of renal scar in children with VUR and a multicentric more extensive cohort study may be needed to strengthen or negate its role.

Brief Report: A Novel Sodium/Iodide Symporter Mutation, S356F, Causing Congenital Hypothyroidism.

The sodium-iodide symporter (NIS, SLC5A5) is expressed at the basolateral membrane of the thyroid follicular cell, and facilitates the thyroidal iodide uptake required for thyroid hormone biosynthesis. Biallelic loss-of-function mutations in NIS are a rare cause of dyshormonogenic congenital hypothyroidism. Affected individuals typically exhibit a normally sited, often goitrous thyroid gland, with absent uptake of radioiodine in the thyroid and other NIS-expressing tissues. We report a novel homozygous NIS mutation (c.1067 C>T, p.S356F) in four siblings from a consanguineous Indian kindred, presenting with significant hypothyroidism. Functional characterization of the mutant protein demonstrated impaired plasma membrane localization and cellular iodide transport.

Tuberculosis in Posttransplant Recipients: Challenges in Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Reporting in Countries with a High Prevalence of Tuberculosis.

Tuberculosis (TB) is a common bacterial infection in developing countries. Solid-organ and hematopoietic stem cell transplant recipients are more prone to this infection. Reactivation from previously acquired infection is the most common mode. It has to be ruled out in cases of pyrexia of unknown origin (PUO) before ruling out the other possibilities. We present two cases of incidentally detected TB in the posttransplant patients referred for the evaluation of PUO.

Comparison of Epicardial Fat Volume between Patients with Normal Perfusion and Reversible Perfusion Abnormalities on Myocardial Perfusion Imaging.

PURPOSE OF THE STUDY: Our study purpose was to compare the epicardial fat volume (EFV) in myocardial perfusion imaging single photon emission computed tomography/computed tomography (MPI SPECT/CT) with normal and abnormal perfusion in patients with known or suspected coronary artery disease (CAD). MATERIALS AND METHODS: one hundred and seventy-six patients (88 records with normal and 88 with reversible perfusion defects) underwent physical or adenosine stress with Tc-99m MIBI followed by SPECT and low-dose CT for attenuation correction. Rest MPI was done in patients showing perfusion defects on stress imaging. Software-based quantification of EFV was done by manually delineating pericardial contours with epicardial fat threshold set between -30 HU and -190 HU. RESULTS: Median EFV in scans with normal perfusion was found to be 74.46 ml (32.92-211.51), and with reversible ischemia was 92.94 ml (43.70-207.53) with a median-summed difference score (SDS) of 5.00 (1.0-27). In 15 scans with reversible perfusion defects associated with infarcts in other segments, median EFV was 101.71 ml (63.03-156.46) with mean - SDS of 7.50 (standard deviation = 6.20). Scans with reversible perfusion defects demonstrated an increased EFV (median - 92.94 ml) when compared to scans with a normal perfusion (median = 74.64 ml) (P < 0.001). CONCLUSION: Our results demonstrated an increased EFV in scans with presence of active reversible ischemia compared to that of normal perfusion on MPI (P < 0.001) suggesting potential role of cardiac SPECT/CT to evaluate EFV for risk stratification of suspected CAD.

Serial Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scan Distinguishing Infected Seroma from Recurrence in a Necrotic Lymph Node in a Case of Squamous Cell Carcinoma of the Right Kidney.

Seroma can occur as a complication following nephroureterectomy. We report a case of squamous cell carcinoma of the kidney, postnephroureterectomy where serial fluorodeoxyglucose positron emission tomography-computed tomography images helped in distinguishing the diagnostic dilemma between lymph node recurrence and infected seroma.

Size specific dose estimate (SSDE) for estimating patient dose from CT used in myocardial perfusion SPECT/CT.

OBJECTIVES: Size specific dose estimate (SSDE) is a new parameter that includes patient size factor in its calculation. Recent studies have produced mixed results on the utility of SSDE, especially when automatic exposure control (AEC) was used. The objective of the study was to find out if there is a relationship between patient size and each of the parameters, SSDE and CTDIvol, when AEC is used. METHODS: CT data of consecutively selected 111 patients were included for analysis. CTDIvol values of the CT scans were extracted for each patient. Effective diameter of each patient was calculated as geometric mean of anteroposterior and lateral diameters measured on axial CT images. Corresponding conversion factors for effective diameters were obtained from American Association of Physicists in Medicine (AAPM) report 204. SSDE was obtained as the product of CTDIvol and conversion factor values. Linear regression model was used to evaluate the relationship between patient size and the parameters SSDE and CTDIvol. RESULTS: Mean weight was 62 (11.5) and range was 34 - 103 kg. Median CTDIvol (mGy) on AEC mode was 7.27(IQ range 7.27, 7.65) and mean effective diameter was 26.2 cm (2.4). Mean SSDE (mGy) was 10.6 (0.84). Good positive correlation was obtained between CTDIvol and effective diameter (r=0.536; p<0.0005). Strong inverse correlation was noted between SSDE and effective diameter (r=-0.777; p<0.0005). Linear regression model for establishing relationship between CTDIvol and effective diameter showed slope of 0.314mGy/cm (R=0.561; R2=0.314; P<0.0005) whereas between effective diameter and SSDE slope was -0.23mGy/cm (R=0.676; R2=0.457; P< 0.0005). CONCLUSION: The study shows that CTDIvol and SSDE vary but divergently, with patient size. SSDE is a better estimate of patient radiation dose from CT of MPI SPECT/CT than CTDIvol in systems that use automated exposure control.

Late Effects of Breast Cancer Treatment and Outcome after Corrective Interventions.

Purpose: To study the late toxicities of treatment and its impact on Breast cancer survivors among Indian patients. Materials and Methods: Our study recruited 152 curatively treated non metastatic carcinoma breast patients. The baseline demographic details, disease related and treatment related information were collected. The late effects included breast cancer related lymphedema, shoulder dysfunction, treatment induced bone loss, hypothyroidism, cardiac dysfunction, and chemotherapy induced cognitive dysfunction and Quality of life. Results: The median age was 47 years (range 27 -72 years). The cumulative frequency of BCRL and shoulder dysfunction was 31.57% and 34.86% respectively. The improvement in BCRL with corrective intervention was not statistically significant. The BCRL was significantly associated with shoulder dysfunction. The frequency of loss of bone mineral density was 38.15%. There was statistically significant improvement in bone mineral density with interventions. The cumulative rate of hypothyroidism and cardiac dysfunction was 14.47 % and 2.17% respectively which improved after corrective therapy. We did not find any delayed cognitive dysfunction. There was improvement in global health, physical function, role function, fatigue, Nausea, vomiting, pain scores, insomnia, Loss of appetite, diarrhea and arm symptoms over time with intervention. Conclusion: Our study has shown that nearly half of the survivors were suffering from at least one of the late effects. The intervention helped in improving the loss of bone mineral density, hypothyroidism, cardiac dysfunction and quality of life in Breast cancer survivors.

Response to Zoledronic Acid in Patients with Active Paget's Disease of Bone: A Retrospective Study.

BACKGROUND: Traditionally, bisphosphonates are used to treat active Paget's disease of bone (PDB). Intravenous zoledronic acid (ZA) is the most effective treatment option leading to sustained remission. OBJECTIVE: The primary objective of this study was to analyze the effect of intravenous ZA in patients with active PDB in a tertiary care center of India. MATERIALS AND METHODS: Retrospective data of 13 patients with active PDB who received a single dose of 4 mg intravenous ZA at our institute from January 2011 to June 2017 were reviewed. Response to therapy was monitored clinically, biochemically by serum alkaline phosphatase (ALP), and scintigraphically by 99m-Technetium methylene diphosphonate bone scan. RESULTS: All of our patients reported relief of bone pain. The mean duration of follow-up in our study was 35.2 ± 16.8 months. Serum ALP levels reduced significantly from 1190.9 ± 666.1 IU/L (n = 13) at baseline to 200.5 ± 68.4 IU/L (n = 13) at 6 months (P < 0.001). ALP level at 1 year was 174 ± 33.6 IU/L (n = 12), which remained stable till 36 months at 176.5 ± 50 IU/L (n = 8). This indicates that remission achieved by 6 months post ZA is sustained for at least 3 years. Scintigraphic ratio reduced from 9.6 [interquartile range (IQR) 5.25-18.2] at baseline to 2.7 (IQR 1.20-4.05) at follow-up (P < 0.001). Similarly, scintigraphic index of involvement reduced from 9.9 (IQR 5.6-28.5) at baseline to 3 (IQR 2-4) at follow-up (P = 0.018). CONCLUSION: A 4 mg single dose of intravenous ZA results in clinical, biochemical, and scintigraphic response that is sustained for at least 3 years.

Multiple Cutaneous Metastases on 99mTC-HYNIC-TOC Scan in a Rare Case of Malignant Laryngeal Paraganglioma.

Laryngeal paraganglioma is a rare neuroendocrine tumor arising from neural crest cells of larynx, contributing to 0.6% of the laryngeal tumors. Patients usually present with compressive symptoms such as hoarseness of voice. These tumors express somatostatin receptors, which can be imaged with radioligands such as 99mTc labeled hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC). The percentage of malignant transformation in laryngeal paraganglioma is 2%, and they usually metastasize to lymph nodes, bone, and liver. Here, we report a 99mTc HYNIC-TOC scan of a 55-year-old male patient with recurrent laryngeal paraganglioma, who presented with painful multiple metastatic cutaneous nodules.

Short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 radiosynoviorthesis.

PURPOSE: Various modes of therapy have been directed at breaking the vicious cycle at early stage of synovitis in haemophilia patients. This study was planned to assess the short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 (P-32) radiosynoviorthesis. METHODS: P-32 samarium radiocolloid was injected into the knee and patients were followed up at 1 and 3 months, respectively. Clinical outcomes was assessed using Tegner Lysholm scores (TLSs), Modified Knee Society Clinical Rating System (MKSS) score and circumference of the knee joint. The radiological outcomes were assessed using X-ray, ultrasonography and bone scan. RESULTS: Among the fifteen haemophilia A patients studied, there was statistically significant difference in TLS ( χ2(2) = 27.887 and p value < 0.001), MKSS scores ( χ2(2) = 27.745 and p < 0.001) and circumference of the knee joint ( χ2(2) = 21.333 and p < 0.001) at preoperatively, 1- and 3-month follow-up. There were no changes noted in follow-up X-rays compared with the preoperative X-ray. Ultrasonography showed that clinical improvement was more in suprapatellar and medial parapatellar regions in the last 2 months compared to the first month of follow-up. Post P-32 bone scan showed marked decrease in uptake in the affected knee joint suggestive of radio ablation of synovial tissue. CONCLUSION: P-32 radiosynoviorthesis done for chronic synovitis among haemophilia A patients showed significant improvement in both clinical and radiological parameters. Ultrasonography can be utilized as non-invasive radiological modality for follow-up of P32 response for knee joint.

A rare pediatric case of grossly dilated ureter presenting as abdominal mass.

Renal masses account for 55% of cases presenting as palpable abdominal mass in children.[1] An eight year male presented with palpable abdominal mass and pain. The patient underwent renal dynamic scan, which raised possibility of left duplex kidney with non-functioning moiety, as the size of left kidney was smaller than seen on Ultrasonography (USG). Magnetic resonance (MR)urography confirmed the findings with patient undergoing left hemi-nephrectomy and is doing well. In case of discrepancy in size of kidney on USG and renal scan, duplex kidney should be considered as differential, other causes being, renal cyst, benign/malignant mass and renal calculi. Gross hydro-ureter presenting as palpable abdominal mass is very rare with few reported cases.[234].