Medicine and Health Sciences Commons^™

Current Approach To Primary Central Nervous System Lymphoma, Amar Lal, Nehal Masood

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Treatment Of Spinal Tuberculosis: Role Of Surgical Intervention, Syed Ather Enam, Ahmed Ali Shah

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Psychiatry, Syed Ahmer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Neuroradiology, Zafar Sajjad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Estimation Of Blood Loss During Caesarean Section: An Audit, Fauzia A. Khan, Mueenullah Khan, Asif Ali, Ursula Chohan

Department of Anaesthesia

Objective: To evaluate the blood ordering practice and blood transfusion for Caesarean sections at our institution and to compare the estimated blood loss between anaesthetists and obstetricians.Methods: A review of 126 patients undergoing both elective and emergency Caesarean section was undertaken in 2002. Information collected included the number of blood units cross-matched preoperatively, type of surgery (emergency or elective), type of anaesthesia, parity of the patient, estimated blood loss by both anaesthetists and obstetricians, intraoperative and postoperative transfusion within 48 hours and pre and post operative haemoglobin (Hb) and haemocrit (Hct).Results: A total of 215 units were cross-matched for 126 …

Caesarian Section Rates And Perinatal Outcome At The Aga Khan University Hospital, Nairobi, Sikolia Wanyonyi, Evan Sequeira, Timona Obura

Obstetrics and Gynaecology, East Africa

Background: There has been a persistent rise in the rate of Caesarean sections over the years.Whether this rise is the cause of the decline in infant mortality and improved neonatal outcome still remains debatable.

Objective: To compare the Caesarian section rate and the perinatal outcome at the Aga Khan University Hospital for the years 2001and 2004.

Design: Retrospective study.

Setting: The Aga Khan University Hospital, Nairobi.

Main outcome measures: The total Caesarian section rates, their indication and the perinatal outcome. Results: The overall Caesarian section rate was 20.4% in 1996,25.9% in 2001and 38.1% in 2004.The rate among patients managed by …

Oncolog Volume 51, Number 12, December 2006, Sunni Hosemann

OncoLog MD Anderson's Report to Physicians (All issues)

• Curable But Not Conquered: Hodgkin’s Lymphoma Today
• House Call: Big Benefits for Smokers Who Quit

Variability In Selecting Lateral Cephalometric Landmarks In Two Cbct Image Modes, Dana Nguyen

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to determine the variability of lateral cephalometric landmark selection in two cone beam computed tomography (CBCT) lateral cephalometric simulations: 1) a mean projection image (MPI) and 2) a serial sagittal slice image (SSSI).

Methods: A MPI is a two-dimensional (2D) image obtained from the NewTom 3G^TM CBCT that resembles the conventional lateral cephalogram. A SSSI is a 2D image also obtained from CBCT data, but is created by superimposing a series of selected thin sagittal slices containing the required cephalometric landmarks. This study compared the Ricketts and Steiner analysis of the MPI …

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

The Diagnosis Of Adrenal Insufficiency In The Critically Ill Patient: Does It Really Matter?, Paul E. Marik

Division of Pulmonary and Critical Care Medicine Faculty Papers

No abstract provided.

Proteomic Identification Of In Vivo Substrates For Matrix Metalloproteinases 2 And 9 Reveals A Mechanism For Resolution Of Inflammation, Kendra J Greenlee, David B Corry, David A Engler, Risë K Matsunami, Philippe Tessier, Richard G Cook, Zena Werb, Farrah Kheradmand

Journal Articles

Clearance of allergic inflammatory cells from the lung through matrix metalloproteinases (MMPs) is necessary to prevent lethal asphyxiation, but mechanistic insight into this essential homeostatic process is lacking. In this study, we have used a proteomics approach to determine how MMPs promote egression of lung inflammatory cells through the airway. MMP2- and MMP9-dependent cleavage of individual Th2 chemokines modulated their chemotactic activity; however, the net effect of complementing bronchoalveolar lavage fluid of allergen-challenged MMP2(-/-)/MMP9(-/-) mice with active MMP2 and MMP9 was to markedly enhance its overall chemotactic activity. In the bronchoalveolar fluid of MMP2(-/-)/MMP9(-/-) allergic mice, we identified several chemotactic …

The Sub-Axial Cervical Spine Injury Classification System (Slic): A Novel Approach To Recognize The Importance Of Morphology, Neurology And Integrity Of The Disco-Ligamentous Complex, Alexander R. Vaccaro, R. John Hulbert, Charles Fisher, Marcel Dvorak, Alpesh A. Patel, Ronald A. Lehman Jr., Paul Anderson, James Harrop, F. C. Oner, Paul Arnold, Michael Fehlings, Rune Hedlund, Ignacio Madrazo, Glenn Rechtine, Bizhan Aarabi, Mike Shainline, Spine Trauma Study Group

Department of Orthopaedic Surgery Faculty Papers

Abstract Background Context Despite technological advances in spine surgery, classification of sub-axial cervical spine injuries remains largely descriptive, lacking standardization and any relationship to prognosis or clinical decision making. Purpose The primary purpose of this paper is to define a classification system for sub-axial cervical spine trauma that conveys information about injury pattern and severity as well as treatment considerations and prognosis. The proposed system is designed to be both comprehensive and easy to use. The secondary objective is to evaluate the classification system in the basic principles of classification construction, namely reliability and validity. Study Design/Setting Derivation of the …

Cdx4 Dysregulates Hox Gene Expression And Generates Acute Myeloid Leukemia Alone And In Cooperation With Meis1a In A Murine Model, Dimple Bansal, Claudia Scholl, Stefan Frohling, Elizabeth Mcdowell, Benjamin H. Lee, Konstanze Döhner, Patricia Ernst

Dartmouth Scholarship

HOX genes have emerged as critical effectors of leukemogenesis, but the mechanisms that regulate their expression in leukemia are not well understood. Recent data suggest that the caudal homeobox transcription factors CDX1, CDX2, and CDX4, developmental regulators of HOX gene expression, may contribute to HOX gene dysregulation in leukemia. We report here that CDX4 is expressed normally in early hematopoietic progenitors and is expressed aberrantly in approximately 25% of acute myeloid leukemia (AML) patient samples. Cdx4 regulates Hox gene expression in the adult murine hematopoietic system and dysregulates Hox genes that are implicated in leukemogenesis. Furthermore, bone marrow progenitors that …

Altered Placental And Fetal Expression Of Igfs And Igf-Binding Proteins Associated With Intrauterine Growth Restriction In Fetal Sheep During Early And Mid-Pregnancy., Barbra De Vrijer, Meredith L Davidsen, Randall B Wilkening, Russell V Anthony, Timothy Regnault

Paediatrics Publications

The insulin-like growth factors (IGFs) are postulated to be altered in association with the development of intrauterine growth restriction (IUGR). The present studies examined placental and fetal hepatic mRNA concentration of components of the IGF system at two time points (55 and 90 d gestational age, dGA; Term 147 dGA) in a hyperthermia (HT)-induced sheep model of placental insufficiency-IUGR. Maternal plasma insulin and IGF-I were constant at 55 and 90 dGA and were unaffected by treatment. Umbilical vein insulin concentrations tended to be reduced at 90 dGA following HT exposure. Caruncle IGF-I mRNA was increased at 90 dGA in HT …

The Role Of Allograft Inflammatory Factor 1 In Systemic Sclerosis, Francesco Del Galdo, Carol M. Artlett, Sergio A. Jimenez

Selected Works of Sergio Jiménez, MD, MACR

ABSTRACT

Purpose: To review studies which support the hypothesis that allograft inflammatory factor-1 (AIF-1), a protein initially identified in chronically rejected cardiac allografts, may be involved in the pathogenesis of the progressive fibroproliferative vasculopathy which is a hallmark of systemic sclerosis (SSc).

Recent findings: Recent findings demonstrated elevated AIF-1 expression both in SSc affected tissues and peripheral blood mononuclear cells. A detailed immunohistopathologic study examined the tissue and cellular localization of the protein in affected SSc tissues and demonstrated its expression in the endothelium of dermal and pulmonary vessels, in the pulmonary parenchyma, and in relevant inflammatory cells including T …

Incidence And Epidemiology Of Cerebral Venous Thrombosis., Fazeel Mukhtar Siddiqui, Ayeesha Kamran Kamal

Department of Medicine

Cerebral venous sinus thrombosis is a disorder whose epidemiology has changed over the past few decades. It is no longer regarded as a uniformly fatal disease. CVST is not a rare disorder. It may have a differential geographic distribution with a higher incidence in the Asian world. It is a disease of neonates, younger women and men, often a hypercoagulable state, either acquired (e.g., cancer) or a genetic prothrombotic condition may be present. Outcome is not uniformly dismal and prognostic criteria that detect patients with a poor outcome have become available from prospective studies. There is a paucity of well …

Complications Associated With Cerebral Venous Thrombosis., Fazeel Mukhtar Siddiqui,, Ayeesha Kamran Kamal

Department of Medicine

Although CVT is associated with a good outcome in the majority of cases, it may be complicated by numerous unique and sometimes rare complications. The purpose of this review is to discuss the acute and chronic complications of CVT in greater detail. Awareness may lead to a more aggressive approach in those in which these complications are anticipated and perhaps avoided.
The complications of CVT may be temporally divided into those unique to the acute stage and those that are associated with the chronic stage of CVT. They are venous infarction and haemorrhage, subarachnoid haemorrhage, a rapid progression and pulmonary …

Heparin In The Treatment Of Cerebral Venous Thrombosis., Saad Shafqat, Ayeesha Kamran Kamal, Mohammad Wasay

Department of Medicine

Cerebral venous thrombosis (CVT) is a potentially life-threatening condition requiring rapid diagnosis and urgent treatment. Heparin anticoagulation is the time-honoured treatment, and is advocated in all cases of CVT, irrespective of etiology or presence of haemorrhage. The supportive evidence is largely observational; data from randomized placebo-controlled trials shows a nonsignificant trend favouring heparin. Current practice is to begin heparin (unfractionated or low-molecular weight) immediately on confirmation of the diagnosis. Newer antithrombotic agents such as ximelagatran may offer advantages over heparin and need to be investigated in the treatment of CVT.

Pathophysiology Of Cerebral Venous Thrombosis--An Overview., Ahmed Itrat, Sana Shoukat, Ayeesha Kamran Kamal

Department of Medicine

Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described. A Medline search of all articles detailing pathophysiology of CVST was done, using keywords: cerebral venous thrombosis and pathophysiology. In addition, major texts were reviewed for additional references. The pathophysiology of CVST depends on two interconnected events, local signs due to venous infarct, e.g., hemiparesis and global signs due to raised ICP from an obstructed venous system--papilloedema and isolated intracranial hypertension being one of them. Pathophysiology of CVST is diverse and makes it easier to understand the diversity of clinical presentations.

Local Thrombolytic Treatment Of Cerebral Venous Thrombosis In Three Paediatric Patients, Mohammad Wasay, Rohit Bakshi, Alper Dai, Steve Roach

Section of Neurology

There is increasing evidence that local thrombolysis can be used with relative safety and efficacy in adults with superior sagittal sinus thrombosis (SSST). However, little data is available on the use of local thrombolysis in children with SSST. We report three patients who received local thrombolysis for dural sinus thrombosis. Two patients received urokinase and one patient received urokinase followed by local TPA infusion. Recanalization was achieved in two patients.

Cerebral Venous Thrombosis: Recent Advances And Need For An Asian Registry, Mohammad Wasay, Ayeesha K. Kamal

Department of Medicine

No abstract provided.

Isolated Deep Venous Thrombosis--Case Series, Literature Review And Long Term Follow Up., Ayeesha Kamran Kamal, Ahmed Itrat, Sana Shoukat, Asumal Khealani, Kamran Kamal

Department of Medicine

Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported. We conducted a retrospective review of all patients admitted to a major tertiary care center, with the diagnosis of isolated deep venous thrombosis. Two patients were identified with isolated involvement of the deep venous system, they are reviewed in detail with long term follow up. Two young South Asian women in their thirties with rapid onset of neurologic signs and symptoms are …

Thrombolytic Therapy In Cerebral Venous Sinus Thrombosis., Ayeesha Kamran Kamal

Department of Medicine

The use of thrombolytic agents to rapidly lyse the clot has emerged as a therapeutic modality, in concert with interventional neuroradiologic approaches to deliver the agent locally at the site of thrombosis. There are no randomized, double blind, placebo, controlled trials to support thrombolysis as a first line therapy in patients with cerebral venous sinus thrombosis compared to standard therapy using anticoagulation with weight based dose adjusted unfractionated Heparin. Numerous case reports and a single non randomized trial have shown that it is comparatively safe and may rescue patients who are deteriorating despite anticoagulation with unfractionated Heparin. Consideration must be …

Mechanism Of Neuronal Injury In Cerebral Venous Thrombosis, Uzma Usman, Mohammad Wasay

Department of Medicine

The impact of CVT on the brain is wide spectrum, ranging from completely normal parenchyma to brain oedema and/or haemorrhage. Multiple factors relate to neuronal injury in CVT including; dural sinus pressure, increased venous flow velocities, collateralization of venous channels, rate of occlusion, development of cytotoxic and vasogenic oedema, recanalization and accelerated myelination. It is suggested that recanalization of occluded vein, as well as, the presence or absence and the efficiency of intracranial venous collaterals, may have an impact on the extent of brain tissue damage and hence the prognosis of acute CVT.

Role Of Surgery In Cerebral Venous Sinus Thrombosis, S. Ather Enam

Department of Surgery

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity.

Liver Transplant Recipient With Calcineurin-Inhibitor Induced Pain Syndrome: A Case Report, Nethra S. Ankam, Md, Stanley R. Jacobs, Md

Department of Rehabilitation Medicine Faculty Papers

Setting: University Hospital

Patient: 65-year-old female status-post liver transplant secondary to cirrhosis.

Case Description: Prior to the rehabilitation consult on post-operative day 42, she had an episode of acute rejection requiring rapid escalation of cyclosporine dosage, later changed to high dose tacrolimus for immunosuppression, resulting in high blood levels of both calcineurin inhibitors. She then complained of paroxysms of 10/10 pain over her entire body not relieved by opioids despite escalation in medication by the acute pain service. She was not participating in a rehabilitation program because of pain. Examination revealed an anxious woman for whom any tactile stimulation …

Rehabilitation Of A Patient With Diabetic Myonecrosis: A Case Report, Nethra S. Ankam, Md, Vishal Kancherla, Do, Stanley R. Jacobs, Md

Department of Rehabilitation Medicine Faculty Papers

Setting: Inpatient rehabilitation unit at a university hospital

Patient: 37-year-old male with diabetic myonecrosis.

Case Description: The patient had a long-standing history of uncontrolled diabetes mellitus with multiple comorbidities, including end-stage renal disease on dialysis and diabetic myonecrosis of the left biceps femoris diagnosed by biopsy and magnetic resonance imaging (MRI.) On this admission, he presented with right leg pain and swelling, found to be a reoccurrence of diabetic myonecrosis in the vastus lateralis, medialis, and intermedius, diagnosed by MRI only. Prior to admission, he lived alone in a wheelchair inaccessible duplex and required minimal assistance with housekeeping.

Assessment/Results: …

Bibliography Of Secondary Sources On The History Of Dermatology Iii. Books, Monographs, And Chapters In English Supplemented Through 2005., Lawrence Charles Parish, John Thorne Crissey, Jennifer L Parish, Daniel H Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

Providing supplements to the history of dermatology bibliographic record has been a continuous project for the past four decades. When the endeavor was initiated, the original authors decided that only contributions in English and those directly related to dermatology, excluding sexually transmitted diseases as such, would be indexed.

There is the perennial question of whether such a manually created bibiliographic project has a need. The obvious answer remains yes. While Index Medicus has expanded the number of journals that are indexed, the number of dermatology publications currently included by Index Medicus is just over fifty. Granted, most of the papers …

Dermatology Is A Specialty; Dermatology Is Not A Subspecialty., Lawrence Parish, Larry E Millikan

Department of Dermatology and Cutaneous Biology Faculty Papers

Specialization began in American medicine about the time of the War Between the States. Several factors spurred the direction of practitioners away from being the so-called “complete physicians. Most important were the advances in instrumentation made by the 1860’s, which allowed ophthalmology and otolaryngology to develop into distinct divisions of allopathic medicine; sometimes, they even joined together, viz eye, ear, nose, and throat specialist. Dermatology, too, became one of the early specialties for a myriad of reasons ranging from the obvious – visual inspection - to the mundane, viz. default – syphilis was too ugly and complicated for every physician …

Oncolog Volume 51, Number 11, November 2006, Sunni Hosemann, Reginald F. Munden Md

OncoLog MD Anderson's Report to Physicians (All issues)

• Treating Skull Base Tumors
• Targeting Inflammatory Breast Cancer
• House Call: On the Job with Cancer
• DiaLog: Helical CT Screening: Does It Affect Lung Cancer Outcome? by Reginald F. Munden, MD, Professor, Department of Diagnostic Radiology