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Article ; Online: Test of cure and beyond: superiority of thermal ablation over LLETZ in the treatment of high-grade CIN.

Armstrong, G M / Ragupathy, K

2022 Volume 306, Issue 5, Page(s) 1815–1820

Abstract: Purpose: Among the treatment modalities for high-grade cervical intraepithelial neoplasia (CIN), large-loop excision of the transformation zone (LLETZ) is the commonest offered in the UK, whereas thermal ablation (TA) has not been common in several ... ...

Abstract	Purpose: Among the treatment modalities for high-grade cervical intraepithelial neoplasia (CIN), large-loop excision of the transformation zone (LLETZ) is the commonest offered in the UK, whereas thermal ablation (TA) has not been common in several decades, despite several notable advantages. TA and LLETZ are both routinely undertaken in our colposcopy unit, and extensive follow-up data have been used to interrogate outcomes between the two modalities and determine whether one modality may be preferred over the other. Methods: Up to 8 years of follow-up data (cytology and histology) were collected for patients who have undergone LLETZ or TA and failed post-treatment test of cure (ToC). These data were analysed and used to plot Kaplan-Meier survival curves, in order to compare outcomes: negative cytology, dyskaryosis, low- and high-grade CIN and invasive squamous cell carcinoma. Results: i) Very few women treated with TA developed recurrent high-grade CIN in the follow-up period; (ii) LLETZ-treated women had a significantly higher rate of recurrence than those treated by TA; (iii) women who failed both virology and cytology components of post-treatment ToC had higher recurrence than those who failed only one, and the rate of recurrence was highest in those treated by LLETZ (> 65%). Conclusion: TA is an effective treatment of high-grade CIN, with a high chance of achieving double-negative ToC and low recurrence relative to LLETZ. We recommend the wider adoption of TA, so that young women of reproductive age have a choice of treatment with no reported adverse effects on pregnancy outcomes.
MeSH term(s)	Cervical Intraepithelial Neoplasia/pathology ; Colposcopy ; Cytodiagnosis ; Female ; Humans ; Pregnancy ; Trachelectomy ; Uterine Cervical Neoplasms/pathology ; Uterine Cervical Neoplasms/surgery
Language	English
Publishing date	2022-02-02
Publishing country	Germany
Document type	Journal Article
ZDB-ID	896455-5
ISSN	1432-0711 ; 0932-0067
ISSN (online)	1432-0711
ISSN	0932-0067
DOI	10.1007/s00404-022-06409-3
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Article ; Online: Role of an IUCD in managing patients with post-LLETZ cervical stenosis.

Ross, Samantha / Ragupathy, Kalpana

BMJ case reports

2022 Volume 15, Issue 3

Abstract: Large loop excision of the transformation zone (LLETZ) is one of the fertility sparing treatments for people with high-grade cervical intraepithelial neoplasia, however, this procedure is known to increase the risk of postoperative cervical stenosis by 1. ...

Abstract	Large loop excision of the transformation zone (LLETZ) is one of the fertility sparing treatments for people with high-grade cervical intraepithelial neoplasia, however, this procedure is known to increase the risk of postoperative cervical stenosis by 1.3%-5.2%. We present a case demonstrating the successful use of a copper intrauterine contraceptive device to manage a patient with cervical stenosis secondary to three LLETZ procedures for severe dyskaryosis.
MeSH term(s)	Colposcopy/methods ; Constriction, Pathologic/surgery ; Female ; Humans ; Pregnancy ; Trachelectomy ; Uterine Cervical Neoplasms/surgery ; Uterine Cervical Dysplasia/surgery
Language	English
Publishing date	2022-03-01
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-246118
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Article ; Online: Mirenas against malignancy: an alternative to operative management.

Caldwell, G / Ragupathy, K

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

2018 Volume 38, Issue 5, Page(s) 731

Abstract: Background: Complex atypical hyperplasia is a recognised precursor to endometrial cancer, the most common gynaecological cancer of the Western World, with hysterectomy being the first line of management. With the increasing elderly population size and ... ...

Abstract	Background: Complex atypical hyperplasia is a recognised precursor to endometrial cancer, the most common gynaecological cancer of the Western World, with hysterectomy being the first line of management. With the increasing elderly population size and BMI, optimal surgical management can be challenging in a sub-set of patients. Levonorgestrol releasing IUS system (Mirena coil) has been identified as a treatment for those unsuitable for surgical management. Aims: To assess the efficacy of Mirena coils in the treatment of endometrial cancers and complex atypical hyperplasia in our patient population. Method: Retrospective analysis of all type 1 endometrial cancers and CAH diagnosed in Tayside from April 2011 to March 2016 (duration 5 years) managed by a Mirena coil. Primary outcome was resolution of malignancy on biopsy. Secondary outcome was continuation of treatment. Results: Two hundred nineteen out of 245 eligible endometrial cancers and 38 of 41 CAH case notes were available for assessment. A Mirena coil was the primary mode of treatment in eight endometrial cancers (3.6%) and 18 cases of CAH (47.4%). Of the eight endometrial cancers treated, five (62%) continued with the Mirena coil as the primary mode of treatment. Two patients died during their follow-up due to unrelated illnesses and one patient proceeded to hysterectomy due to the absence of progestogenic effect on repeat Pipelle biopsy at six months (12.5%). Four patients have been followed for one year and of those; two showed no evidence of malignancy, one was unable to be biopsied and the last showed persistent disease but was too frail for intervention. At two-year follow-up, two patients remain with one showing disease recurrence. Thirteen patients (87%) have continued to use the Mirena as management of CAH out of 18 treatments. Of the five patients who did not continue with the IUS; two patients had progressive disease, despite the coil (11%), two patients lost enough weight to proceed to hysterectomy and one patient died unexpectedly. Medical co-morbidities and BMI were the main cited reasons for proceeding with the IUS as the primary treatment. Average BMI of endometrial cancer cases was 43.9 and 45.1 for CAH. Conclusions: Mirena coil is effective in treating or controlling the progression of endometrial malignancy in the subgroup of patients where there is an increased risk associated with definitive surgery. The treatment failure rate appears to be consistent at about one-tenth of the cohort of women with both endometrial cancers and complex atypical hyperplasia.
Language	English
Publishing date	2018-05-28
Publishing country	England
Document type	Journal Article
ZDB-ID	604639-3
ISSN	1364-6893 ; 0144-3615
ISSN (online)	1364-6893
ISSN	0144-3615
DOI	10.1080/01443615.2018.1444395
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Article ; Online: Morbidly obese patient with endometrial cancer treated by bariatric surgery to enable cancer treatment.

Sharma, Nidhi / Ragupathy, Kalpana

BMJ case reports

2021 Volume 14, Issue 7

Abstract: The case demonstrates the use of bariatric surgery to improve a patient's candidacy for surgical treatment for endometrial cancer (EC). A 50-year-old morbidly obese woman with early-stage EC was initially treated with levonorgestrel-releasing ... ...

Abstract	The case demonstrates the use of bariatric surgery to improve a patient's candidacy for surgical treatment for endometrial cancer (EC). A 50-year-old morbidly obese woman with early-stage EC was initially treated with levonorgestrel-releasing intrauterine system (52 mg) . She had to reduce her body mass index (BMI) to become eligible for definite EC treatment. Using conservative methods, she was unable to lose weight effectively. She then underwent bariatric surgery that reduced her BMI from 71.3 to 54.3 kg/m
MeSH term(s)	Bariatric Surgery ; Endometrial Neoplasms/complications ; Endometrial Neoplasms/surgery ; Female ; Humans ; Hysterectomy ; Middle Aged ; Neoplasm Recurrence, Local ; Obesity, Morbid/complications ; Obesity, Morbid/surgery
Language	English
Publishing date	2021-07-22
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-243843
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Article ; Online: Maxillofacial fractures in Pondicherry, India: An eight-year single centre retrospective study.

Ragupathy, Karthik / Rajendran, Geetha / Pasupathy, Sanjay / Ramakrishnan, Ganesh / Shriranjani, Kiruthika

Indian journal of dental research : official publication of Indian Society for Dental Research

2023 Volume 34, Issue 1, Page(s) 54–59

Abstract: Background: The purpose of the present study was to analyze the etiology, incidence, pattern, and treatment modalities of patients with maxillofacial fractures treated at the Department of Dentistry of a medical college in Pondicherry during the period ... ...

Abstract	Background: The purpose of the present study was to analyze the etiology, incidence, pattern, and treatment modalities of patients with maxillofacial fractures treated at the Department of Dentistry of a medical college in Pondicherry during the period between June 2011 and June 2019. Materials and methods: A retrospective epidemiological study of 277 patients treated for maxillofacial fractures between June 2011 and June 2019 was performed. Data regarding age, gender, etiology, site of the fracture, time of injury, presence of associated injuries, treatment modalities, and complications were recorded. Results: A total of 491 maxillofacial fractures were seen in 277 patients. These were 261 males (94.2%) and 16 females (5.8%) with a male to female ratio of 16.3:1. Most of the patients 79.8% were in the age group of 11 to 40 years. Most common cause of injury was Road Traffic Collisions (RTCs; 62.1%), followed by fall (20.2%), assault (14.4%) and others (3.3%). Fractures of the mandible (52.3%) and zygomatic complex (18.9%) were the most common maxillofacial fractures reported in our study. 196 patients sustained associated injuries with a prevalence of soft tissue injury (61.2%). Majority of fractures were treated with open reduction and internal fixation (ORIF; 71.9%) of patients followed by closed reduction (17.7%) and observation only (10.4%). Postoperative complications were presented in 16.8% of the patients in the study. Conclusion: RTC is the commonest cause of maxillofacial injury with a male predominance in our study. Mandibular and zygomatic complex fractures were the most common. ORIF remains the preferred method of treatment.s.
MeSH term(s)	Humans ; Male ; Female ; Child ; Adolescent ; Young Adult ; Adult ; Retrospective Studies ; Mandibular Fractures/epidemiology ; Mandibular Fractures/surgery ; Zygomatic Fractures/epidemiology ; Zygomatic Fractures/complications ; Maxillofacial Injuries/epidemiology ; Maxillofacial Injuries/therapy ; India/epidemiology ; Accidents, Traffic
Language	English
Publishing date	2023-07-07
Publishing country	India
Document type	Journal Article
ZDB-ID	1354886-4
ISSN	1998-3603 ; 0970-9290
ISSN (online)	1998-3603
ISSN	0970-9290
DOI	10.4103/ijdr.IJDR_884_20
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Article ; Online: Thermal Ablation of High-Grade Premalignant Disease of the Cervix-Standing the Test of Time: A Retrospective Study.

Ragupathy, Kalpana / Jayasinghe, Thummini / McMullen, Wendy

Journal of lower genital tract disease

2022 Volume 26, Issue 1, Page(s) 27–31

Abstract: Objective: Analyze long-term (20 years) cytology and histology outcomes after treatment of high-grade cervical intraepithelial neoplasia (HGCIN) with thermal ablation (TA).: Methods: All women having TA for HGCIN between January 1996 and December ... ...

Abstract	Objective: Analyze long-term (20 years) cytology and histology outcomes after treatment of high-grade cervical intraepithelial neoplasia (HGCIN) with thermal ablation (TA). Methods: All women having TA for HGCIN between January 1996 and December 1998 (36 months; N = 885) were identified; data were collected on age of patients, symptoms, colposcopy findings, and biopsy reports. Local and national (cytology and colposcopy) databases and colposcopy records were used to collect long-term follow-up data. Probability of CIN recurrence was assessed using Kaplan-Meier "survival" curve. Results: Follow-up data (available for 796) was collected in 2018 capturing 20 years of follow-up data. Two hundred eighty-one women were treated for CIN 2 and 515 women for CIN 3. Seven hundred ninety-one of 796 (>99%) were treated at first visit. Two hundred sixty two of 796 (33%) had evidence of crypt involvement on pretreatment biopsy. Probability of having consistently normal cytological follow-up was 92%, 89%, 86%, and 83% at 5, 10, 15, and 20 years, respectively. Cumulative probability of having recurrent HGCIN was 0.5% at 5 years, 1% at 10 years, 1.9% at 15 years, and 3% at 18 years. There was 1 invasive squamous cell cancer at 11 years after treatment. Conclusions: Thermal ablation is a safe and effective treatment for HGCIN, which is now shown to have stood the test of time. We advise more widespread adoption in the United Kingdom and globally so long as agreed criteria are met.
MeSH term(s)	Carcinoma, Squamous Cell ; Cervix Uteri/surgery ; Female ; Humans ; Retrospective Studies ; Uterine Cervical Neoplasms/surgery ; Uterine Cervical Dysplasia/diagnosis ; Uterine Cervical Dysplasia/surgery
Language	English
Publishing date	2022-09-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2041332-4
ISSN	1526-0976 ; 1089-2591
ISSN (online)	1526-0976
ISSN	1089-2591
DOI	10.1097/LGT.0000000000000638
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Article ; Online: Commentary: intra-partum foetal surveillance in high-risk pregnancies.

Ragupathy, Kalpana

Archives of gynecology and obstetrics

2015 Volume 291, Issue 1, Page(s) 9–10

MeSH term(s)	Female ; Fetal Monitoring/methods ; Humans ; Parturition ; Pregnancy ; Pregnancy Complications ; Pregnancy, High-Risk
Language	English
Publishing date	2015-01
Publishing country	Germany
Document type	News
ZDB-ID	896455-5
ISSN	1432-0711 ; 0932-0067
ISSN (online)	1432-0711
ISSN	0932-0067
DOI	10.1007/s00404-014-3430-2
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Article ; Online: Laparoscopic hysterectomy for endometrial cancer: impact of age on clinical outcomes.

Ee, W W / Nellore, V / McMullen, W / Ragupathy, K

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

2018 Volume 38, Issue 5, Page(s) 734

Abstract: Introduction: Improvement in preoperative care for the ageing population has resulted in an increasing number of elderly patients to be considered for surgery. With an increased incidence of endometrial cancer, it is inevitable that a significant number ...

Abstract	Introduction: Improvement in preoperative care for the ageing population has resulted in an increasing number of elderly patients to be considered for surgery. With an increased incidence of endometrial cancer, it is inevitable that a significant number of elderly patients are referred for surgery, despite the concerns over co-morbid conditions and diminished cardiopulmonary reserves. Aim: To evaluate the clinical outcomes of laparoscopic hysterectomy for elderly women operated on for endometrial cancer with comparison to younger patients. Methods: A retrospective study of women who had undergone total laparoscopic hysterectomy for endometrial cancer at Ninewells Hospital between January 2015 and January 2017 was conducted. Patients were identified from the gynaecology oncology multidisciplinary team e-case database and were categorised into younger and older group according to their age. Both groups were compared and analysed for demographics details, pre-existing comorbidity, METS score, perioperative and postoperative data. Results: There were 100 women meeting the study criteria. Of these, 79 patients were aged ≤75 (Group A) and 21 patients were aged >75 (Group B). The mean age was 62.9 (age range 37-75) and 80.6 (age range 76-90) in Group A and Group B, respectively. Group A presented with higher mean BMI (̄ = 33.8) compared to Group B (̄ = 28.8). With the increase in patient's age, reduced METS score was observed. No difference was found between the groups in the incidence of estimated blood loss and postoperative hospital stay. Fisher's exact test was used to evaluate the postoperative complication in both groups. The two-tailed p value (p = .1108) had illustrated that the observation was statistically insignificant between both groups. One patient in Group A (n = 79) was found to have pelvic haematoma after the procedure; while two patients in Group B (n = 21) developed port site haematoma. Otherwise, no other patients from both groups developed postoperative complication regardless of their pre-existing medical conditions. Only one patient in Group A (n = 79) required conversion to open surgery due to difficult access and large uterine fibroid. Conclusions: Total laparoscopic hysterectomy appears to be feasible and safe in elderly women with no significant difference between groups. Minimally invasive surgery has shown to extend considerable benefits to patient safety regardless of their age.
Language	English
Publishing date	2018-04-06
Publishing country	England
Document type	Journal Article
ZDB-ID	604639-3
ISSN	1364-6893 ; 0144-3615
ISSN (online)	1364-6893
ISSN	0144-3615
DOI	10.1080/01443615.2018.1444398
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Article ; Online: Pattern and chemosensitivity of ovarian cancer in patients with BRCA1/2 mutations.

Ragupathy, K / Ferguson, M

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

2011 Volume 31, Issue 2, Page(s) 178–179

Abstract: Our study adds to the BRCAness theory that hereditary ovarian cancers with BRCA 1 or 2 mutations show better chemosensitivity when compared with sporadic ovarian cancers. ...

Abstract	Our study adds to the BRCAness theory that hereditary ovarian cancers with BRCA 1 or 2 mutations show better chemosensitivity when compared with sporadic ovarian cancers.
MeSH term(s)	Antineoplastic Agents/therapeutic use ; Doxorubicin/therapeutic use ; Female ; Genes, BRCA1 ; Genes, BRCA2 ; Humans ; Ifosfamide/therapeutic use ; Middle Aged ; Mutation ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/genetics ; Ovarian Neoplasms/mortality ; Platinum Compounds/therapeutic use ; Survival Rate
Chemical Substances	Antineoplastic Agents ; Platinum Compounds ; Doxorubicin (80168379AG) ; Ifosfamide (UM20QQM95Y)
Language	English
Publishing date	2011
Publishing country	England
Document type	Journal Article
ZDB-ID	604639-3
ISSN	1364-6893 ; 0144-3615
ISSN (online)	1364-6893
ISSN	0144-3615
DOI	10.3109/01443615.2010.539719
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Article ; Online: Novel use of laparoscopic-guided TAP block in total laparoscopic hysterectomy.

Yap, Jia Yie / Bhat, Mamta / McMullen, Wendy / Ragupathy, Kalpana

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

2018 Volume 38, Issue 5, Page(s) 736

Abstract: Background: Transverse abdominis plane (TAP) block is a peripheral nerve block designed to anaesthetise the nerves supplying the anterolateral abdominal wall (T6 to L1). We introduced laparoscopic TAP block at Ninewells Hospital in 2014 and present a ... ...

Abstract	Background: Transverse abdominis plane (TAP) block is a peripheral nerve block designed to anaesthetise the nerves supplying the anterolateral abdominal wall (T6 to L1). We introduced laparoscopic TAP block at Ninewells Hospital in 2014 and present a retrospective study assessing its efficacy. To our knowledge, there is limited study done on laparoscopic-guided TAP block whilst there are abundant literatures available on ultrasound-guided TAP block. Aims: To evaluate the efficacy of laparoscopic-guided TAP block as postoperative analgesia following total laparoscopic hysterectomy (TLH). Methodology: A retrospective study was done between November 2014 to October 2016 (24 months) comparing patients who had TLH with TAP block (Group 1; n = 45) and patients who had TLH without TAP block (Group 2; n = 31) in our gynaecology unit. Patients were identified from theatre database. Data was collected from clinical portal and medical notes. The data included demographic information, BMI, METS score, intra-operative opiates use, post-operative pain scores, opiate requirements and use of patient-controlled analgesia (PCA), total dose of opiates used and day of discharge. The outcomes were analysed using means, odds ratios (OR), Mann-Whitney U-test and Fisher's exact or Chi-square test with 95% confidence interval (CI). Results: Patients in Group 1 were older (mean age of 64.4, range 38-87) when compared to Group 2 (mean age of 49.3, range 37-81). Group 1 and 2 had comparable mean BMI (30.34 vs. 30.02) and METS score (6.77 vs. 7.76). Mean post-operative pain scores were lower in Group 1 within 4 hours, in periods of 4-12 hours, 12-24 hours and 24-48 hours post-op. Smaller proportion of patients in Group 1 required opiates post-operatively in all periods as compared to Group 2. This was statistically significant in the periods of 12-24 hours post-op (OR 0.31, 95% CI 0.11-0.82; p = .01). PCA use was significantly lower in Group 1 (OR 0.02, 95% CI 0.0014-0.46; p = .01). Group 1 had lower mean total dose of opiates used (27.182 mg, range 0-102 mg) than Group 2 (59.452 mg, range 0-240 mg), which was statistically significant (p < .0001). Average post-op hospital stay was 1.3 and 1.8 days in Group 1 and 2, respectively. Conclusion: Laparoscopic-guided TAP block delivered as post-operative analgesia following TLH results in reduced opiate requirement at post-operative period 12-24 hours, reduced PCA use and lower total dose of opiates used.
Language	English
Publishing date	2018-03-24
Publishing country	England
Document type	Journal Article
ZDB-ID	604639-3
ISSN	1364-6893 ; 0144-3615
ISSN (online)	1364-6893
ISSN	0144-3615
DOI	10.1080/01443615.2018.1444402
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