Mukesh Kumar

The aim of the study is to evaluate effectiveness of normal saline tract sealing in reducing pneumothorax incidence during CT-guided lung biopsy compared with no specific intervention. A prospective, randomized controlled study was conducted with 148 patients undergoing CT-guided lung biopsy, randomized into two groups: saline sealing (Group A, n = 75) and no sealing (Group B, n = 73). All procedures were performed by an experienced radiologist using standardized protocol. Normal saline (4 mL) was instilled into needle tract during withdrawal in Group A, while Group B underwent standard needle withdrawal without any intervention. The primary outcome was incidence of pneumothorax, assessed on post-procedure CT. Risk factors for pneumothorax were analyzed using univariate and multivariate logistic regression. Incidence of pneumothorax was lower in saline group (12.0%) compared with the no-saline group (24.7%), but this difference did not reach statistical significance (p = 0.075). No patients in either group required chest tube drainage. Multivariate analysis identified saline sealing as significant protective factor (OR = 0.298, 95% CI: 0.104–0.853, p = 0.024). Procedural factors, including lateral needle puncture (OR = 8.664, 95% CI: 1.469–51.098, p = 0.017) and four pleural punctures (OR = 10.785, 95% CI: 1.119–103.951, p = 0.040), were associated with increased pneumothorax risk. Normal saline tract sealing effectively reduces pneumothorax risk in CT-guided lung biopsy and is simple and cost-effective. These findings support its broader adoption, with further multicenter studies recommended to validate results and optimize technique.

To prospectively assess the incidence, types, and risk factors for complications following interventional radiology–guided peripherally inserted central catheter (PICC) placement in adult cancer patients at a lower-middle-income-country tertiary center. In this single-center prospective cohort, all cancer patients ≥14 years who received a 4 Fr single-lumen PICC under ultrasound guidance with fluoroscopic tip confirmation were followed until line removal. Weekly structured follow-up (in-person or telephonic) was conducted. Complications were recorded using predefined criteria. Associations with demographic, clinical, and procedural factors were analyzed using chi-square/Fisher's exact or t/Mann–Whitney U tests. Fifty-six PICCs were placed in 48 patients (50% female; 28 solid and 28 hematologic cancers), contributing 4,386 catheter-days (median dwell time: 54 days). Twenty-five lines (44.6%) developed complications (32 events; 7.3/1,000 catheter-days). The most frequent were occlusion (17.9%; 2.3/1,000 days), catheter-related bloodstream infection, defined clinically rather than culture-confirmed (12.5%; 1.6/1,000 days), dislodgement (10.7%), and break/leak (10.7%). No symptomatic deep vein thrombosis (DVT) occurred. Complications led to premature removal in 21 lines (37.5%), with an 87.5% device-loss rate among affected catheters. Mean dwell time was significantly longer in lines with complications (103.6 vs. 57.9 days; p = 0.021). Higher body mass index showed a trend (p = 0.053), but other factors, including age, cancer type, puncture attempts, and tip position, were not associated with complication rates. PICC complications remain common despite imaging guidance and are driven chiefly by prolonged dwell time and patient factors, not insertion technique. Mechanical problems (including occlusion, dislodgement, and breakage) and catheter-related infections were the most common complications, and no symptomatic DVT was observed, although subclinical events could not be excluded. Obtained from the Institutional Review Board. Written consent was obtained from each patient before recruitment into the study. Data generated or analyzed during the study are available from the corresponding author upon request. ^* These authors contributed equally to this work and are designated as co-first authors. Article published online: 02 March 2026 © 2026. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

Purpose This phase II trial is designed to test whether the performance status (PS) of metastatic non-small cell lung cancer (mNSCLC) patients (pts) can improve with chemotherapy if their poor PS (Eastern Cooperative Oncology Group (ECOG) PS of ≥ 2) is due to disease burden rather than comorbidities. Methods Age18–65 years, Charlson’s comorbidity index < 9, serum albumin ≥ 3.5 g/dl, adequate bone marrow and organ function, & ECOG PS ≥ 2 as judged by the worst score of three independent physicians were administered 3 doses of weekly paclitaxel at 60 mg/m²/dose. The primary endpoint was an improvement in ECOG PS by 1 point at 4 weeks; others: toxicity (CTCAE v 5.0), quality of life (QoL) assessment at baseline and 4 weeks by EORTC QLQ-C30 and EORTC QLQ-LC13. Optimal Simon’s 2-stage design was used. Results Forty-six patients were included with a median age of 56 years (interquartile range, IQR 54–59), 12 (26%) had comorbid conditions, and 87% with ECOG PS 3/4. PS improved in 11 pts at 4 weeks and in 7 beyond this time point. Grade 3/4 toxicities are seen in 20% (most common: anemia and diarrhea). At a median follow-up of 4.8 m (95% CI 3.27–14.9), the median progression-free survival and overall survival were 3.3 months (95% CI 2.36–5.6) and 6.8 months (95% CI 2.47–8.8), respectively. QoL improved for global QoL, role functioning, pain, dyspnea, insomnia, pain in the chest, pain in other parts, and worsened for alopecia and sore mouth. Conclusions Abbreviated chemotherapy is a useful, well-tolerated strategy in carefully selected poor PS mNSCLC patients that can improve PS and QoL. Clinical trial Clinical trial information: CTRI/2020/01/022617.

We report eight cases of oropharyngeal carcinoma in which ultrasound-guided percutaneous distal glossopharyngeal nerve (GPN) block was performed for pain relief. Mean age of the patients was 52 ± 11.5 [SD] years and median baseline pain score was 7 (IQR, 5–8). Under ultrasound guidance, mixture of ropivacaine and dexamethasone was injected into parapharyngeal space. Pain reduced after four weeks in all patients (median [IQR], 4 [2.5–5]). Median quality of life score improved as compared with baseline in physical health (63 [44–69] vs 50 [44–63]) and psychological domains (56 [56–63] vs 50 [50–63]), reduced in social relationships domain (31 [19–44] vs 44 [31–44]), remained same in environment domain (56 [44–69] vs 56 [56–56]). Seven patients showed improvement on Patients' Global Impression of Change scale, while six showed improvement on Clinical Global Impressions scale. These early results show that ultrasound guided distal GPN block can reduce pain intensity in oropharyngeal carcinoma patients.

We recently read a manuscript, “Percutaneous gastrostomy placement by interventional radiology…” authored by Karthikumar et al[1] in your esteemed journal. Authors have succinctly re-emphasized the safety and efficacy of this procedure in selected patients. Our experience with push type percutaneous radiologic gastrostomy (PRG) has also been highly rewarding and humbling. We identified a dire need for PRG in patients being denied an endoscopic gastrostomy owing to advanced cancer/stricture and embarked on a research project to kickstart these services in our tertiary care cancer hospital. During the course of this institutionally funded research, we provided free interventions to 35 such patients. The challenges we faced during this endeavor compelled us to think deeply about this facet of interventional radiology practice. We realized that most of the eligible patients are never given an option of gastrostomy. A few logistic or quasi-scientific reasons were identified as follows: Owing to the above reasons, PRG is grossly underutilized in India. There is Level 1 evidence in literature that this intervention leads to significant improvement in quality of life and nutritional rehabilitation, essential for optimal treatment response.[2] Furthermore, PRG has been found as safe as percutaneous endoscopic gastrostomy in these patients.[3] Interacting with the patients during follow-up appointments gave us some perspectives. Presence of a NG tube hanging out from the nose leads to social isolation in a patient already dealing with physical stress and mental trauma of cancer. They can feel the NG tube every second for the rest of their life, affecting their voice, confidence, sleep and above all, acting as a continuous reminder of their cancer status. Let us cite an example of one of our patients who was a teacher by profession. For approximately 3 months after gastrostomy tube placement, he was able to give up to 4 hours of tuition classes daily, with the G tube well concealed under the clothing till it got somehow dislodged. Due to COVID-19 situation, he was unable to get his G-tube replaced and instead, got an NG tube as a rescue measure which led to self-isolation and depression leading to a rather early death. This sobbing statement from her daughter in law “Sir Agar unko wo pet wali tube dubara lag jati to wo nahi marte, wo cancer se lad lete” (sir, if he could get the G tube again, he would not have died; he would have fought the cancer) during follow-up telephonic conversation rightly emphasizes the enormous impact on the quality of life of such a patient. As interventional radiologists, we need to find solutions to increase the utilization of this valuable intervention. Our suggestions are: In developed countries, it is a standard of care to insert a G tube to supplement feeding for these patients and this is one of the most common IR procedure in oncology set-up. Although we face our unique challenges as a developing nation, this intervention has impact far and beyond nutritional supplementation and should be seen as a valuable addition in the IR practice. Instead of pointing fingers toward administration for poor resource allocation and trying to avail imported gastrostomy kits, we should take it as a collective responsibility and help in designing safe and effective indigenous kits. In our experience, the influence of PRG on the trajectory of these patient’s treatment course or nutritional rehabilitation has been immense and even in worst case scenarios, the value added to their quality of life in their last days has been very humbling. Publication Date: 27 July 2021 (online) © 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Thieme Medical and Scientific Publishers Private Ltd. A-12, Second Floor, Sector -2, NOIDA -201301, India

Introduction: Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases include lung, liver and bones. Bone involvement in cases of carcinoma of cervix is low and the estimates range from 0.8-16 % according to various series.Several patterns of bone involvement are observed in cases of carcinoma of cervix including, (1) direct extension into bone, either from the parametrial extensions of the primary or recurrent pelvic tumor, (2) direct extension into adjacent bone from the pelvic or distant lymph node metastasis (3) regional or systemic haematogenous metastasis to bones. Aims: To evaluate the pattern of metastases in patients of carcinoma of uterine cervix, with particular emphasis on the pattern of bone involvement on contrast enhanced CT. Settings and Design: Retrospective study. Materials and Methods: This was a retrospective study, where we reviewed the hospital records and data of patients of cervical cancer who underwent contrast enhanced CT (CECT) of the chest and abdomen over a period of one year between January and December 2016. A total of 100 patients of carcinoma cervix were included. CT images were reviewed by two experienced radiologists. The bony erosion due to pelvic mass or lymphadenopathy was classified as subtle or gross. Results: Bone involvement was seen in 11 out of 100 cases (11% cases). Among 13 cases direct bone involvement by the pelvic mass/recurrence and metastatic lymph nodes (8/11; 72.7%) was slightly more common than thehematogenous bone metastasis (5/11; 45.4% cases). Among the direct bone involvement direct erosion of the underlying bone by the nodal metastasis (6/8; 75%) was twice more common than the direct bone involvement by the pelvic mass/recurrence(2/8; 25%). Conclusions: Direct bone involvement by erosion of adjacent bone by nodal metastasis is the most common mechanism of bone involvement in cases of carcinoma of cervix signifying the high propensity of lymph nodal deposits to erode the underlying bone. This finding of direct bone erosion is not seen in any other gynaecological malignancy and should be promptly looked for in all cases of carcinoma of cervix.

Celiac plexus/ganglion block is used for palliation of severe upper abdominal pain caused by chronic pancreatitis or tumors of the pancreas. Celiac ganglia are located at T12–L1 level in relation to the celiac axis and superior mesenteric artery (SMA). It is predominantly composed of sympathetic and parasympathetic efferent fibers and visceral sensory afferent fibers. The preganglionic sympathetic efferent supply stems from greater splanchnic (T5–T9), lesser splanchnic (T10–T11), and least splanchnic (T12) nerves. This supply is derived from posterior cord of the vagus nerve ([Fig. 1]). Visceral afferent nociceptive fibers are received from the liver, pancreas, gallbladder, spleen, adrenals, kidneys, and bowel (distal esophagus till transverse colon).[1] Topographically, the innervation of the uncinate process of the pancreas originates from the superior mesenteric plexus (SMPlx) along the inferior pancreaticoduodenal artery (IPDA), whereas most nerve fibers going to body and tail of the pancreas originate from the celiac plexus.[2] Chemical neurolysis of the celiac plexus is an effective method of controlling pain that originates from these organs.[3] It has also been reported to be beneficial in managing severe nausea and vomiting in patients with pancreatic cancer. This has been attributed to sympathetic blockade causing parasympathetic predominance causing increased gastric motility and peristalsis.[4] Some authors have also reported that celiac plexus neurolysis improves survival in patients with cancer by reducing opiate requirements, diminishing drug-induced sedation, and enhancing the ability of patients to perform day-to-day activities that are necessary to extend life, such as feeding and ambulation.[5] The block can be guided by anatomical bony landmarks, fluoroscopy, sonography, or computed tomography (CT). Cross-sectional imaging such as CT and magnetic resonance imaging (MRI) can reveal soft tissue, especially the celiac plexus.[6] CT is the preferred route due to its wide availability, high contrast, and spatial resolution. It clearly depicts retroperitoneal structures, and celiac plexus may sometimes be directly identified. It depicts the exact needle tract and shows diffusion of contrast mixed neurolytic agents. CT fluoroscopy allows real-time monitoring of the procedure.[7]

Insulin resistance and insulin deficiency are the cardinal defects in the pathogenesis of type 2 diabetes mellitus (T2DM). Despite the plethora of anti-diabetic medications, drugs specifically targeting the β-cells are still desired. Stem cell therapy has emerged as a novel therapeutics strategy to target β-cells; however, their mechanism of action has not been well defined. This study aims to examine the efficacy and safety of autologous bone marrow-derived mononuclear cells (ABM-MNCs) transplantation in T2DM, and explores the mechanistic insights into stem cells action through metabolic studies. Seven T2DM patients with the duration of disease ≥5 years, receiving triple oral anti-diabetic drugs along with insulin (≥0.4 IU per kg per day) and HbA1c ≤ 7.5% (≤58.0 mmol/mol) were enrolled for ABM-MNCs administration through a targeted approach. The primary end-point was a reduction in insulin requirement by ≥50% from baseline, while maintaining HbA1c < 7.0% (<53.0 mmol/mol) with improvement in insulin secretion, and/or insulin sensitivity after ABM-MNCs transplantation. Six out of 7 (90%) patients achieved the primary end-point. At 6 months, there was a significant reduction in insulin requirement by 51% as compared to baseline (p < 0.003). This was accompanied by a significant increase in the 2nd phase C-peptide response during hyperglycemic clamp (p = 0.018), whereas there were no significant alterations in insulin sensitivity and glucose disposal rate during hyperinsulinemic–euglycemic clamp relative to the baseline. Other measures of β-cell indices like HOMA-β, and stimulated C-peptide response to glucagon and mixed meal tolerance test were non-contributory. ABM-MNCs transplantation results in significant reduction in insulin doses and improvement in C-peptide response in patients with T2DM. Metabolic studies may be more useful than conventional indices to predict β-cell function in patients with advanced duration of T2DM. Trial registration -Clinicaltrials.gov NCT01759823