Medical Specialties Commons^™

Labrad : Vol 38, Issue 1 - July 2012, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• How to Investigate a Bleeding Disorder
• Nucleic Acid Testing at AKUH
• Lab Diagnosis of von Willebrand Disease
• Scoring Systems in Diagnosis of Disseminated Intravascular Coagulation
• Plasma and Platelet Transfusions in Liver Diseases
• Ristocetin Cofactor Activity
• All You Need to Know About Thrombophilia Screening
• Signifi cance of Antiphospholipid Antibodies
• Homocysteine as a Risk Factor of Thrombosis
• Report on 4th Biennial Course in Chemical Pathology

Interventions For Improving Research Productivity In Clinical Radiology, Waseem Akhtar, Mubashir Aslam Arain, Arif Ali, Zafar Sajjad

Section of Dental-Oral Maxillofacial Surgery

The purpose of this study was to evaluate the effects of research promotion activities on overall quality and quantity of research output in a clinical department of a teaching tertiary care hospital. Simple research enhancing strategies including regular journal club, research hour, basic research skills training, hiring of research faculty, research awards, and annual research retreat and research board to increase research production were implemented in the Department of Radiology of a teaching hospital in Pakistan. A total of 77 papers were produced by the Department of Radiology before the intervention, which increased to 92 after the introduction of research …

Diffusion Weighted Mr Imaging Of Ring Enhancing Brain Lesions, Muhammad Shahbaz Alam, Zafar Sajjad, Muhammad Azeemuddin, Zahid Anwar Khan, Fatima Mubarak, Waseem Akhtar

Department of Radiology

Objective: To evaluate the role of diffusion weighted imaging in differentiating the cause of ring enhancing brain lesions.

Study Design: Analytical, descriptive study.

Place and Duration of Study: Department of Radiology, The Aga Khan University Hospital, Karachi, from March 2007 to July 2011. Methodology: Diffusion weighted imaging (DWI) was performed on 37 patients having ring enhancing lesions on their post-contrast brain MRI scans. These lesions were characterized into neoplastic and abscess cavity on the basis of diffusion restriction. Correlation of all these findings was done with histopathology obtained in all these patients. Sensitivity, specificity, positive and negative predictive values and …

Department Of Radiology-Annual Executive Summary Report-July 1, 2011 To June 30, 2012, Vijay M. Rao, Md

Department of Radiology Administrative Documents and Reports

93 page Department of Radiology Annual Executive Summary Report, July 1, 2011 to June 30, 2012, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

Table of Contents

Chairman, Vice Chairmen 1

Divisions and Directors 1

Committees and Chairmen 1

Radiology Department Faculty Rank 2

Faculty with Secondary Appointments 3

Clinical Divisions 4

Radiology Residents and Fellows 5

Department Organizational Chart 6

Department Administration Chart 7

State of the Department 8

Appendix I: Publications

Journal Articles 23

Books and Book Chapters 31

Abstracts 35

Appendix II: Formal Scientific Presentations 50

Appendix III: Honors, Editorial Activities, Service to Regional or National Organizations …

Towards Omni-Tomography -- Grand Fusion Of Multiple Modalities For Simultaneous Interior Tomography, Ge Wang, Jie Zhang, Hao Gao, Victor Weir, Hengyong Yu, Wenxiang Cong, Xiaochen Xu, Haiou Shen, James Bennett, Mark Furth, Yue Wang, Michael Vannier

Radiology Faculty Publications

We recently elevated interior tomography from its origin in computed tomography (CT) to a general tomographic principle, and proved its validity for other tomographic modalities including SPECT, MRI, and others. Here we propose "omni-tomography", a novel concept for the grand fusion of multiple tomographic modalities for simultaneous data acquisition in a region of interest (ROI). Omni-tomography can be instrumental when physiological processes under investigation are multi-dimensional, multi-scale, multi-temporal and multi-parametric. Both preclinical and clinical studies now depend on in vivo tomography, often requiring separate evaluations by different imaging modalities. Over the past decade, two approaches have been used for multimodality …

Anatomical Relationships Of The Anterior Blood Vessels To The Lower Lumbar Intervertebral Discs: Analysis Based On Magnetic Resonance Imaging Of Patients In The Prone Position., Alexander R Vaccaro, Christopher K Kepler, Jeffrey A Rihn, Hidekazu Suzuki, John K Ratliff, James S Harrop, William B Morrison, Worawat Limthongkul, Todd J Albert

Rothman Institute Papers

BACKGROUND: Intra-abdominal vascular injuries are rare during posterior lumbar spinal surgery, but they can result in major morbidity or mortality when they do occur. We are aware of no prior studies that have used prone patient positioning during magnetic resonance imaging for the purpose of characterizing the retroperitoneal iliac vasculature with respect to the intervertebral disc. The purpose of this study was to define the vascular anatomy adjacent to the lower lumbar spine with use of supine and prone magnetic resonance imaging.

METHODS: A prospective observational study included thirty patients without spinal abnormality who underwent supine and prone magnetic resonance …

Has The Significance Of Incidental Findings On Unenhanced Computed Tomography For Urolithiasis Been Overestimated? A Retrospective Review Of Over 800 Patients, Nadir Khan, M Hammad Ather, Farhan Ahmed, Abdul M. Zafar, Aamir Khan

Department of Radiology

Objectives: To evaluate the detection of clinically unsuspected pathologies using 64-slice multidetector computed tomography (CT) of the abdomen in patients with flank pain. The presence of significant incidental findings (those warranting immediate management) was also correlated with that of urolithiasis, to assess potential changes of management.PATIENTS AND Methods: The study included 899 patients undergoing CT in a 6-month period between June and December 2008. Patients who were referred from outside, with no medical record in the hospital where the study was conducted, and those who were lost to follow-up, were excluded. All of the CT examinations were reported after a …

Rare Co-Occurrence Of Dural Arteriovenous Fistula And Arteriovenous Malformation With Bilateral Subcortical And Basal Ganglia Calcification, Raza Sayani, Zahid Anwar Khan, Tanveer-Ul-Haq, Rana Shoaib Hamid, Muhammed Azeemuddin

Department of Radiology

The present study describes the imaging findings in a patient with dural arteriovenous fistula (AVR) and arteriovenous malformation (AVM) with bilateral subcortical and basal ganglia calcification. A 29 year old male patient presented with chief complaint of recent onset of generalized tonic clonic seizures and mild disorientation. The imaging studies on MCT demonstrated diffuse, symmetric calcification in the bilateral basal ganglia and subcortical white matter. MR imaging and angiography revealed AVM in parietooccipital region with supply predominantly from left posterior cerebral and middle cerebral arteries. Multiple dural feeders from meningeal branches of occipital and superficial temporal branches of bilateral external …

Threshold Primary Tumour Sizes For Nodal And Distant Metastases In Papillary And Follicular Thyroid Cancers., Maseeh Uz Zaman, Nosheen Fatima, Zafar Sajjad, Jaweed Akhter, Najmul Islam, Qamar Masood, Asma Ahmed

Department of Radiology

Abstract

BACKGROUND:

In papillary and follicular thyroid cancers (PTC, FTC), nodal and distant metastasis are generally considered important determinants of recurrence and survival, respectively. However, there is no consensus about the threshold primarytumour size (PTS) for these determinants. The aim of this study was to assess size relationships for developing nodal, pulmonary, bone and overall distant metastases.

METHODS:

This prospective study covered 139 (93 females and 46 males) consecutive biopsy proven patients with PTC (114/139, mean age 41.0 ± 15.7 years, M: F, 35%:65%) and FTC (25/139, mean age 39.2 ± 14.3 years, M: F: 24%:76%).

RESULTS:

Average primary tumor …

Radiation Oncology At Thomas Jefferson University: A Specialty Emerges As A Department Evolves, Eric Gressen Md, Ben W. Corn Md, Adam P Dicker

Department of Radiation Oncology Faculty Papers

Jefferson Radiation Oncology has maintained over fifty years of excellence led by only four chairmen. Dr Kramer after receiving his medical training inLondonled the department into the modern megavoltage era while creating the first independent academic radiation oncology department in the country. He was well-respected nationally as a leader and advocate for the specialty and he mastered the execution of progressive ideas that have raised the standard for the profession. The creation of the Radiation Therapy Oncology Group (RTOG) was critical in developing trials to expand the management and treatment of malignancy. The Patterns of Care Study (PCS) educated the …

Concurrent Intracranial And Spinal Arteriovenous Malformations: Report Of Two Pediatric Cases And Literature Review, Hussain Shallwani, Muhammad Zubair Tahir, Muhammad Ehsan Bari, Tanveer Ul Haq

Medical College Documents

Background: Concurrent intracranial and spinal arteriovenous malformations (AVMs) are very rare with only a few cases being reported in literature. Two of the rare concurrent intracranial and spinal AVM cases are presented.
Case description: Case 1 is a 12-year-old girl with headache and motor disturbances in the lower limbs. Her spinal and brain angiogram was done and she was diagnosed to have a spinal AVM at level T8-T9 and an intracranial AVM in the left mesial temporal lobe. Her spinal AVM was embolized, while no treatment was given for her intracranial AVM. Case 2 is a 10-year-old girl who presented …

Role Of Endovascular Treatment In Vascular Injuries, Muhammad Misbah Tahir, Tanveer-Ul-Haq

Department of Radiology

OBJECTIVE: To evaluate retrospectively the results, complications and follow-up of patients after endovascular treatment of vascular injuries.

METHODS: Fifty transcatheter embolisation procedures (TCE) were performed in 46 patients between 1999 and 2008 at the Aga Khan University Hospital, Karachi. Injuries in 14 (30.4%) patients were due to road traffic accident; iatrogenic in 13 (28%); accidental in 6 (13%). Firearms, bomb blasts and earthquake contributed to injuries in 8(17%), 4(8.8%) and 1(2.2%) patients respectively. All patients underwent angiography and had evidence of either active haemorrhage, pseudo-aneurysm, abnormal vascularity or arteriovenous fistula. Followup ranged from 1 day to 6 years with mean …

Predictive Prognosis Value Of Baseline Volumetric Mri, Song Lai, John Lackey

Department of Radiology Faculty Papers

Atrophic changes have been proposed as biomarkers for differential diagnosis of Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI), and different atrophic rates have been observed in AD, MCI-tp-AD converters (cMRI), stable MCI (sMCI), and normal healthy controls[1]. Measurement of atrophic changes, however, requires longitudinal MRI studies. The purpose of this study was to investigate the following questions: 1. Is it possible to use baseline volumetric MRI to predict MCI conversion to AD, i.e., to tell if a MCI patient is a cMCI or a sMCI? 2. What are the predictive values of APOE genotype, and clinical cognitive …

Structural Changes In Glaucoma: A Volumetric Mri Study, John Lackey, Alice L. Williams, Srinivas Gatla, Sheryl S. Wizov, Thomas Chia, George Spaeth, Song Lai

Department of Radiology Faculty Papers

Purpose: To investigate brain structural changes in patients with glaucoma.

Methods: High resolution 3D T1-weighted MP-RAGE MRI images were collected in 11 glaucoma patients (5 female, 6 male, 65+/-11 yrs), and 11 age- and gender-matched controls (64+/-12 yrs). The images were first analyzed using an automatic voxel-based morphometry technique which combines a fully automated spatial normalization approach, dubbed HAMMER [1], in conjunction with a tissue mass preserving framework called RAVENS [2]. Four consecutive steps were carried out: removal of non-brain voxels, tissue segmentation, spatial normalization to a standardized template, and generation of a mass-preserving tissue density map (i.e. RAVENS map) …

Infiltrating Ductal Carcinoma Of Breast Presenting As Areolar Dermal Lesion, Gulnaz Shafqat, Shaista Khan, Khurram Minhas, Shaista Afzal

Department of Radiology

Infiltrating ductal carcinoma is the most common form of invasive breast cancer. It accounts for 80% of all types of breast cancer. We report an unusual presentation of histologically proven case of infiltrating ductal carcinoma of breast presented clinically as a small palpable areolar dermal lesion. Well defined hypoechoic cystic lesion in areolar dermis was present on ultrasound with a negative mammogram.

Avoiding Unnecessary Fine-Needle Aspiration Cytology By Accuractely Predicting The Benign Nature Of Thyroid Nodules Using Ultrasound, Sudhir Vinayak, Joyce Sande

Imaging & Diagnostic Radiology, East Africa

Objective: The objective of this study was to describe a reliable ultrasound based index scoring system based on ultraound characteristics to identify benign thyroid nodules and avoid unnecessary fine needle aspiration cytology.

Materials and Methods: Patients undergoing ultrasound-guided fine-needle aspiration cytology (FNAC) for thyroid nodules were evaluated prospectively. A total of 284 patients were evaluated from November 2005 to November 2011. There were 284 nodules. Any solid or partly solid focal nodule in the thyroid gland was included in the study. Cysts with no solid component were excluded. We used LOGIQ 9 (GE Healthcare) scanner equipped with a 10--14 MHz …

Giant Cystic Parathyroid Adenoma With Thrombosis Of Internal Jugular Vein Seen On Ct And Tc-99m Methoxy Isobutyl Isonitrile Parathyroid Scan, Maseeh Uz Zaman, Nosheen Fatima, Zafar Sajjad

Department of Radiology

Primary hyper-parathyroidism is attributed by a solitary parathyroid adenoma in 80-85% cases and mostly are non-palpable and needs imaging for localization. Cystic degeneration of parathyroid adenoma is rarely seen in primary hyperparathyroidism. We are presenting a case of giant cystic functioning parathyroid adenoma with associated localized co-morbids.

Targeting Apoptosis For Optical Imaging Of Infection, Mathew L Thakur, Kaijun Zhang, Bishnuhari Paudyal, Devadhas Devakumar, Maria Y Covarrubias, Changpo Cheng, Brian D Gray, Eric Wickstrom, Koon Y Pak

Department of Radiology Faculty Papers

PURPOSE: Infection is ubiquitous and a major cause of morbidity and mortality. The most reliable method for localizing infection requires radiolabeling autologous white blood cells ex vivo. A compound that can be injected directly into a patient and can selectively image infectious foci will eliminate the drawbacks. The resolution of infection is associated with neutrophil apoptosis and necrosis presenting phosphatidylserine (PS) on the neutrophil outer leaflet. Targeting PS with intravenous administration of a PS-specific, near-infrared (NIR) fluorophore will permit localization of infectious foci by optical imaging.

METHODS: Bacterial infection and sterile inflammation were induced in separate groups (n = 5) …

Inverse Relationship Between Psa And Il-8 In Prostate Cancer: An Insight Into A Nf-Κb-Mediated Mechanism, Yong Xu, Daret K. St. Clair, Fang Fang, William H. St. Clair

Toxicology and Cancer Biology Faculty Publications

Background: Prostate specific antigen (PSA) is traditionally used as an indicator for the presence of prostate cancer (PCa) and radiotherapy is generally used to treat inoperable and locally advanced PCa. However, how cellular PSA level is associated with sensitivity of PCa to radiotherapy is unknown. The previous finding that the RelB-based NF-κB alternative pathway differentially regulates PSA and interleukin-8 (IL-8) in aggressive PCa has directed our attention to the role of RelB in the response of PCa to radiotherapy.

Methodology/Principal Findings: RelB and its targets PSA and IL-8 in PCa cells were manipulated by ectopic expression in PCa …

Establishing A Center Of Excellence For Security Science And Engineering, Ke-Xun Sun

NSTec UNLV Symposium

Outline

• Introduction
• Progress report
• NNSA proposal to establishCenter of Excellence for Security Science and Engineering
• Perspective on UNLV-NSTec collaboration

Radiography And Image Processing, Stephen E. Mitchell

NSTec UNLV Symposium

Outline

• Introduction
• What? Why? Etc.
• Pulsed Power
• Diode Physics
• Radiography ABC’s
• Challenges

Portal Biliopathy, Muhammad Shahbaz Alam, Qazi Saad Bin Khalid, Muhammad Zeeshan, Zishan Haider

Department of Radiology

Portal biliopathy (PB) is a rare disorder, which mostly presents as sub-clinically. It occurs most commonly due to idiopathic extrahepatic portal vein obstruction. We present three cases having features of portal biliopathy secondary to portal hypertension. Our first case did not have a prior history of chronic liver disease while next two patients had previous history of chronic liver disease resulting in portal hypertension. Cavernous transformation of the portal vein due to extrahepatic portal vein obstruction is not infrequent but biliary obstruction in association with this disorder is distinctly uncommon. Proper case management is very important as prolonged biliary duct …

Hepatic Fibrosis Imaging: Trends And Feasibility, Saba Sohail

Department of Radiology

No abstract provided.

Dramatically Increased Musculoskeletal Ultrasound Utilization From 2000 To 2009, Especially By Podiatrists In Private Offices, Richard E. Sharpe, Levon N. Nazarian, Laurence Parker, Vijay Rao, David C. Levin

Department of Radiology Faculty Papers

PURPOSE: Over the past two decades, musculoskeletal (MSK) ultrasound has emerged as an effective means of diagnosing MSK pathologies. However, some insurance providers have expressed concern about increased MSK ultrasound utilization, possibly facilitated by the low cost and ready availability of ultrasound technology. The purpose of this study was to document trends in MSK ultrasound utilization from 2000 to 2009 within the Medicare population.

METHODS: Source data were obtained from the CMS Physician/Supplier Procedure Summary Master Files from 2000 to 2009, and records were extracted for procedures for extremity nonvascular ultrasound. We analyzed annual volume by provider type using specialties, …

An Institutional Review Of Transarterial Embolization In Haemorrhagic Urological Emergencies, Raza Sayani, Muhammad Azeemuddin, Tanveer Ul Haq, Rana Shoaib Hamid, Basit Salam

Department of Radiology

OBJECTIVE: To review the effectiveness of therapeutic transarterial embolization in controlling phagic urological emergencies irrespective of the cause of emergencies.

METHODS: Thirty-seven vascular angiographies were performed in 32 patients (19 males and 13 females, age range 19-70 years) who were referred with haemorrhagic urological emergencies to Aga Khan University Hospital's angiography suite from July 2005 to June 2010. Embolization was performed with coils, polyvinyl alcohol particles, N-Butyl cyanoacrylate glue and gel foam according to the clinical indication. Data on clinical indication, technique, site and type of bleeding lesions were obtained from a retrospective review of medical records. Success rate, clinical …

Dentigerous Cyst, Aditya Tadinada

SoDM Presentations

Dentigerous Cyst

Dental School Radiology Presentation : Dentigerous Cyst

Author : Tadinada, Aditya

Medical Subject : Dentigerous Cyst, Odontogenic Cysts

Clinical Presentation Description : Radiolucency arising from the CEJ of an unerupted tooth

Location of Abnormality : Posterior Mandible

Radiological Features : Radiolucency arising from the CEJ of an unerupted tooth

DDx Description : Dentigerous cyst, odontogenic keratocyst, ameloblastoma

Type of Image : Panoramic Radiograph

Digital Publisher : UCONN Health Center : Kilham, Jessica

Format : jpg

Date : 2012

In Ovo Serial Skeletal Muscle Diffusion Tractography Of The Developing Chick Embryo Using Dti: Feasibility And Correlation With Histology, Zien Zhou, Zachary Delproposto, Lianming Wu, Jianrong Xu, Jia Hua, Yan Zhou, Yongquan Ye, Zishu Zhang, Jiani Hu, E Mark Haacke

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Magnetic resonance imaging is a noninvasive method of evaluating embryonic development. Diffusion tensor imaging (DTI), based on the directional diffusivity of water molecules, is an established method of evaluating tissue structure. Yet embryonic motion degrades the in vivo acquisition of long-duration DTI. We used a dual-cooling technique to avoid motion artifact and aimed to investigate whether DTI can be used to monitor chick embryonic skeletal muscle development in ovo, and to investigate the correlation between quantitative DTI parameters fractional anisotropy (FA) and fiber length and quantitative histologic parameters fiber area percentage (FiberArea%) and limb length.

Results

From 84 …

Neuroimaging Of Tumefactive Multiple Sclerosis With Atypical Features, Rohit Koppula, Andrew J. Degnan, Mark Ghassibi, Peter Duggan, Robert Jones, Lucien M. Levy

Radiology Faculty Publications

Tumefactive demyelinating lesions or tumefactive multiple sclerosis constitute a unique presentation of demyelinating disease which frequently mimics intracranial neoplasm, infection or other, non-demyelinating intracranial pathology. Consequently, these lesions, which are larger than typical multiple sclerosis plaques and generally characterized by certain magnetic resonance imaging features including edema and incomplete ring enhancement, pose a serious diagnostic challenge that frequently prompts biopsy in initial evaluation. Biopsy can be averted when imaging features for tumefactive multiple sclerosis are seen on MRI. Herein, we present a biopsy-proven case of tumefactive multiple sclerosis with atypical imaging features, evaluated using magnetic resonance and diffusion tensor imaging.

Acr Appropriateness Criteria®  Resectable Rectal Cancer, William E. Jones Iii, Charles R. Thomas Jr, Joseph M. Herman, May Abdel-Wahab, Nilofer Azad, William Blackstock, Prajnan Das, Karyn A. Goodman, Theodore S. Hong, Salma K. Jabbour, Andre A. Konski, Albert C. Koong, Miguel Rodriguez-Bigas, William Small Jr, Jennifer Zook, W Suh

Wayne State University Associated BioMed Central Scholarship

Abstract

The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+) benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The …

Managing Soft Tissue Sarcomas In A Developing Country: Are Prognostic Factors Similar To Those Of Developed World?, Irfan Qadir, Masood Umer, Hafiz Muhammad Umer, Nasir Uddin, Farrok Karson, Muhammad Sharoz Rabbani

Section of Orthopaedic Surgery

Background: Managing soft tissue sarcomas (STS) in a developing country with limited financial resources and a poor health referral system is a challenge. Presenting late, these extremity STS are prone to recurrence despite apparently complete resection. This study aimed to explore and compare the impact of clinico-pathological factors on recurrence and survival in Pakistan with the corresponding figures quoted from the developed world.
Methods: An institutional review was performed on all patients with primary STS of the extremities operated on between 1994 and 2008. The prognostic influence of clinical, pathologic, and treatment variables on local recurrence free survival (LRFS), metastasis …