Browsing by Author "Saroj Chooramani Gopal"

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Co-infusion of donor adipose tissue-derived mesenchymal and hematopoietic stem cells helps safe minimization of immunosuppression in renal transplantation - Single center experience
(Informa Healthcare, 2014) Aruna V. Vanikar; Hargovind L. Trivedi; Ashutosh Kumar; Saroj Chooramani Gopal; Himanshu V. Patel; Manoj R. Gumber; Vivek B. Kute; Pankaj R. Shah; Shruti D. Dave
Background: Stem cell therapy (SCT) is used for immunosuppression minimization in renal transplantation (RT). We carried out a prospective study to evaluate the benefits of co-infusion of donor adipose-derived mesenchymal stem cells (AD-MSC) + hematopoietic stem cells (HSC) in living donor RT (LDRT) under non-myeloablative conditioning.; Methods: In a demographically balanced three-armed LDRT trial with 95 patients in each arm, group-1 received portal co-infusion of AD-MSC + HSC, group-2 received HSC and group-3 received no SCT. Lymphoid irradiation and anti-thyroglobulin were used for conditioning.; Results: SCT was safe. At 1 and 5 years post-transplant, patient survival was 100% and 94.7% in group-1, 100% and 95.7% in group-2, and 94.7% and 84% in group-3, death-censored graft survival was 100% and 94.6% in group-1, 100% and 91.3% in group-2, and 98.9% and 94.4% in group-3 with mean serum creatinine (mg/dL) of 1.38 and 1.39 in group-1, 1.48 and 1.51 in group-2, and 1.29 and 1.42 and in group-3. Rejection episodes and immunosuppression requirement were lesser in SCT groups versus controls with best results noted in group-1.; Conclusion: Coinfusion of donor AD-MSC +HSC in portal circulation pre-transplant under non-myeloablative conditioning is safe and effective for immunosuppression minimization in LDRT. © 2014 Informa Healthcare USA, Inc. All rights reserved.
Conservative management of ulcerated haemangioma - Twenty years experience
(2009) Anand Pandey; Ajay Narayan Gangopadhyay; Shiv Prasad Sharma; Vijayendra Kumar; Saroj Chooramani Gopal; Dinesh Kumar Gupta
Ulceration is the most common complication of haemangioma and occurs in 5-15% of cases. The present study was carried out to evaluate the clinical features of ulcerated haemangioma and efficacy of the management protocol adopted by us over a period of 20 years. All patients with ulcerated haemangioma were evaluated on the basis of age at presentation, sex, rural or urban distribution and site of haemangioma. Treatment included application of topical antibiotic and systemic antibiotic and analgesic for pain. The total number of patients was 608. The male to female ratio was 1: 2·28. The rural:urban distribution was 2·43:1. The most common site of involvement was head and neck. Mean age of patients was 5·60 ± 2·44 months. Mean size of haemangioma and ulceration was 47·30 ± 20·67 cm2 and 7·49 ± 4·52 cm2, respectively. The mean time for ulcer healing was 40·06 ± 19·41 days. Ulcer size of more than 10 cm2 took more time to heal. Response to treatment was satisfactory. Ulcerated haemangioma usually occurs before completion of 1 year of age; hence, every patient with haemangioma needs careful attention. Adequate treatment and regular follow up brings satisfactory response in the patients. © 2009 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
Covered exstrophy: A rare variant of classical bladder exstrophy
(Informa Healthcare, 1997) Sakti Prasad Sahoo; Ajay Narayan Gangopadhyay; Chandrasen Kumar Sinha; Dinesh Kumar Gupta; Saroj Chooramani Gopal
Covered exstrophy is an extremely rare variant of exstrophy-epispadias complex. It is less distressing and easier to manage than classical exstrophy of the bladder. We report three cases of this entity, two associated with anorectal malformation and one with unilateral renal agenesis, along with a review of the literature.
Mesenchymal stem cells and transplant tolerance
(Blackwell Publishing, 2014) Aruna V. Vanikar; Hargovind L. Trivedi; Ashutosh Kumar; Saroj Chooramani Gopal; Vivek B. Kute
Different strategies are being tried to induce transplant tolerance in clinical settings; however, none of them are both safe and effective. Mesenchymal stem cells have been found to be potent immunomodulators and immunosuppressants. We discuss in this review different sources of mesenchymal stem cells and the potent role of adipose tissue-derived mesenchymal stem cells in induction of transplant tolerance including when to use them and how to use them for achieving the Utopian dream of transplant tolerance. Summary at a Glance Transplantation tolerance which means stable graft function with absence of rejection episodes in spite of no immunosuppression requirement while maintaining third party immune response intact" is still not achieved in clinic. Tolerance has been tried to be induced by hematopoietic stem cells with the belief that chimerism resulting from stem cell transplantation will induce tolerance. Other workers believe that deletion of antibodies will lead to tolerance. This review describes mesenchymal stem cells and how they help in inducing tolerance. © 2014 Asian Pacific Society of Nephrology.
Pre-transplant co-infusion of donor-adipose tissue derived mesenchymal stem cells and hematopoietic stem cells may help in achieving tolerance in living donor renal transplantation
(Informa Healthcare, 2014) Aruna V. Vanikar; Hargovind L. Trivedi; Saroj Chooramani Gopal; Ashutosh Kumar; Shruti D. Dave
Transplantation tolerance is still a Utopian dream for many transplanters. Mesenchymal stem cells (MSC) have shown immuno-modulatory and tolerogenic effects in experimental models. We present a 29-year-old male with end stage renal disease (ESRD) who was transplanted with HLA 4/6 matched kidney from 51-year-old father in June 2010 preceded by co-infusion of donor-adipose tissue derived mesenchymal stem cells (AD-MSC) and bone marrow derived hematopoietic stem cells (BM-HSC) under non-myeloablative conditioning for deleting rejecting T and B-cells. He has maintained fairly stable graft function with serum creatinine (SCr) between 1.5 and 1.8 mg/dL at 3 years post-transplant with absence of donor specific antibodies (DSA), normal protocol graft biopsy, and peripheral T-regulatory cell levels (pTregs) (CD127low/-CD25 highCD4+) of 4.57% on zero immunosuppression since 6 months. © 2014 Informa Healthcare USA, Inc.
Twenty years' experience of steroids in infantile hemangioma-a developing country's perspective
(2009) Anand Pandey; Ajay Narayan Gangopadhyay; Saroj Chooramani Gopal; Vijayendra Kumar; Shiv Prasad Sharma; Dinesh Kumar Gupta; Chandrasen Kumar Sinha
Background: Hemangioma is a common vascular tumor. Though it involutes spontaneously, results are unpredictable. Steroid therapy is an effective mode of its regression. We present our experience of largest series and possible recommendations for treatment. Materials and methods: A total of 2398 patients were treated during the study period of 20 years. They were given oral prednisolone, intralesional triamcinolone, or combination of both as per the protocol and followed for the response. Response to the treatment was graded as excellent, good, poor, or no response. Results: The male-to-female ratio was 1:2.3. In 81% of patients, hemangioma was noticed within first month of life. The commonest site of involvement was head and neck (57%). The commonest clinical presentation was discoloration and swelling. Mean age and size were 8.43 ± 7.04 months and 23.64 ± 20.13 cm2. Response rate was highest for superficial type using any modality of treatment. Patients younger than 1 year showed better response (90.3%) in comparison with children older than 1 year (80.8%). The specific complications occurring were infections in 249 (12.4%), cushingoid facies and growth delay in 62 (3.1%), and hypertension in 51 (2.5%) patients. Conclusion: Steroid therapy either oral or intralesional as per the requirement is an easy and safe modality. Results are good to satisfactory in most patients. The complications are minimal. If treatment is needed, it should be used as a first-line therapy, especially when cost is an important concern. © 2009 Elsevier Inc. All rights reserved.