Medical Specialties Commons^™

Improving The Tracking And Removal Of Retrievable Inferior Vena Cava Filters., Anthony D Goei, Shellie C Josephs, Thomas B Kinney, Charles E Ray, David Sacks

Reading Hospital Interventional Radiology

Therapeutic and prophylactic inferior vena cava (IVC) filters should be placed based on currently accepted indications to prevent a fatal pulmonary embolism (PE). The protective effect of filters is offset by the potential for lower extremity deep venous thrombosis (DVT), caval thrombosis, and possible otherwise unnecessary life-long anticoagulation (AC). The duration of treatment for most DVTs or PEs is 3 to 6 months of AC/filter. Filters should be retrieved when duration of treatment for a DVT/PE has been met, the risk of a PE is no longer high, and/or there is no longer a contraindication to AC. An effective system …

The Implications Of Chronic Pain Models For Rehabilitation Of Distal Radius Fracture, Saurabh Mehta, Joy Macdermid, Mary Tremblay

Physical Therapy Faculty Research

Distal radius fracture (DRF) is the most common fracture and usually occurs as a result of a fall. Most patients recover following DRF with minimal residual pain or disability; however, a small subset of patients continue to experience pain and disability even one year after the injury. Currently, there are no practice guidelines for early identification and treatment of patients who are potentially at greater risk of developing these adverse outcomes. As a result, hand therapy management of patients following DRF does not incorporate screening of these at-risk patients. The objective of this paper is to apply constructs from learned …

Diabetic Ketoacidosis Associated With Tacrolimus In Solid Organ Transplant Recipients, Muhammad Qamar Masood, Madiha Rabbani, Wasim Jafri, Manal Habib, Taimur Saleem

Section of Diabetes, Endocrinology and Metabolism

Diabetic ketoacidosis in patients receiving tacrolimus in the post-transplant setting is rare. We describe two such cases in solid-organ transplant recipients. The first patient, a 17-year-old male, presented with severe diabetic ketoacidosis and was managed with intravenous fluids and insulin infusion. He was a known case of Laurence-Moon-Bardet-Biedl syndrome and had received a renal transplant 2 years ago and was receiving tacrolimus since then. Although diabetic ketoacidosis resolved in 24 hours, large doses of subcutaneous insulin (upto 130 units per day) were needed to keep serum glucose within the normal range. Substitution of tacrolimus with cyclosporine obviated the need for …

Spurious Hyperkalaemia: An Insight, Khawaja Salman Zaki, Uzma Majid, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Hyperkalaemia is a common electrolyte disorder with potentially lethal consequences and can lead to life-threatening cardiac dysrhythmias. Spurious hyperkalaemia, also known as pseudohyperkalaemia or factitious hyperkalaemiais, is also quite common in clinical practice and it's a source of avoidable emergency department visits or hospital admissions. We report a case in which alarming hyperkalaemia was found in a patient having Chronic Monomyelocytic Leukaemia on two different occasions, later diagnosed to be spurious.

Aneurysm Of Sinus Of Valsalva, Fateh Ali Tipoo Sultan, Nageeb Basir, Saulat H. Fatimi

Section of Cardiology

Aneurysm of sinus of Valsalva is a rare cardiac abnormality with congenital origin in most of the cases. If it is located in the right coronary sinus, it usually ruptures into a right heart chamber and frequently a ventricular septal defect (VSD) coexists with this condition. Early diagnosis and immediate surgical treatment can save the patient’s life in most cases. All the 3 cases reported in this series had aneurysm of right sinus of Valsalva with associated VSD and mild degree of aortic regurgitation (AR). Two of the cases ruptured aneurysm into the right ventricle. Trans-esophageal echocardiography was used to …

Negative Pressure Pulmonary Oedema: A Rare Complication Following General Anaesthesia, Zeeshan Waheed, Javaid Khan

Section of Pulmonary & Critical Care

An important cause of pulmonary oedema is Negative Pressure Pulmonary Oedema (NPPE) which characteristically develops soon after extubation from an endo-tracheal intubation. In this case report we identified a case of previously healthy man who was intubated for General Anaesthesia for extraction of impacted molar tooth. Soon after extubation he developed severe respiratory distress. Immediate diagnosis of NPPE secondary to post extubation laryngospasm was made. He was promptly treated with 100 percent oxygen via CPAP (continuous positive airway pressure) mask and within an hour he markedly improved and subsequently became asymptomatic. NPPE is an important cause of morbidity and need …

Racial/Ethnic Disparities In Survival Among Men Diagnosed With Prostate Cancer In Texas, Arica L. White, Ann L. Coker, Xianglin L. Du, Katherine S. Eggleston, Melanie Williams

CRVAW Faculty Journal Articles

BACKGROUND:

To the authors' knowledge, few studies to date have examined racial differences in prostate cancer survival while controlling for socioeconomic status (SES). No such studies have examined this association in Texas, a large state with significant ethnic and racial diversity. The objective of this analysis was to determine whether racial disparities in survival for men diagnosed with prostate cancer in Texas from 1995 through 2002 remained after adjusting for SES, rural residence, and stage of disease.

METHODS:

A cohort of 87,449 men who were diagnosed with prostate cancer was identified from the Texas Cancer Registry. The SES measure was …

Intracerebral Migration Of Stray Bullet Leading To Sudden And Fatal Worsening, Manzar Hussain, Muhammad Ehsan Bari

Section of Neurosurgery

Gunshot wounds to the cranium are one of the leading cause of death and disability in young adults. Stray bullets are also being increasingly seen in clinical setting. We report a case of a 14-year-old boy who sustained a stray bullet to the cranium during election festivities. He arrived at the health care facility institution nearly 24 hours after the event in good neurological condition. He remained neurologically stable for about 8 hours after his presentation and later on deteriorated due to intracranial bullet migration. This required immediate bifrontal decompressive craniotomy along with right frontal lobectomy. However, the patient could …

Atrial Fibrillation, Is Warfarin The Only Option For Stroke Prevention?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Results Of Re-Excision For Inadequate Margins Following Partial Mastectomy For Carcinoma Of The Breast, Aaron D. Bleznak Md, Facs, Christine W. Du Md, Samuel Steerman Md, Elizabeth Dellers Md

Department of Surgery

No abstract provided.

Value Analysis: Perioperative Link In The Supply Chain, Gwenda L. Petrohoy Msn, Med, Rn, Cnor, Aaron D. Bleznak Md, Facs, Susan Toomey Cmrp

Department of Surgery

No abstract provided.

Dynamic Contrast Enhanced Mri Breast For Lesion Detection And Characterization With Histopathological Co Relation: Preliminary Experience At Tertiary Care Hospital, Gulnaz Shafqat, Ajmal Agha, Imrana Masror, Mahwash Rehan, Shaista Afzal

Department of Radiology

OBJECTIVE: To determine the morphological and enhancement characteristics significantly associated with malignant breast lesions on dynamic contrast enhanced MRI by considering the histopathological findings as a gold standard.

METHODS: A retrospective analysis was performed on 70 patients who underwent MRI breast during the study period because of suspicious mammographic abnormalities. MR imaging was performed on 1.5 tesla machine with dynamic contrast enhancement by using dedicated breast coil. MR Images of breast were evaluated on a workstation and reported on the basis of morphological appearance of lesion and time activity curves. Histopathological analysis of the lesion was done either after mastectomy …

Knowledge, Attitudes And Practices (Kap) Regarding Sexuality, Sexual Behaviors And Contraceptives Among College/University Students In Karachi, Pakistan, Fozia Ajmal, Ajmal Agha, Nabila Zareen, Mehtab S Karim

Department of Radiology

OBJECTIVE: To assess the knowledge, attitudes and practices regarding sexuality, high risk sexual behaviors and methods of contraception, among college/university students of Karachi, Pakistan.

STUDY DESIGN: Cross-sectional observational study.

PLACE AND DURATION OF STUDY: Higher Education Commission-recognized government and private colleges/universities in Karachi from 2005-2006.

METHODOLOGY: Two colleges/universities were randomly selected from each category i.e. government medical, government non-medical and private medical and non-medical colleges/universities. Three stage cluster sampling was employed to draw a representative sample of students. A self administered questionnaire was used to elicit information on knowledge, attitudes and practices regarding high risk sexual behaviors, methods of contraception …

Audit Of Postoperative Nausea And Vomiting In Paediatric Day Case Surgery, Fauzia N. Minai, Faraz Shafiq, Azhar Rehman

Department of Anaesthesia

OBJECTIVE: To assess the incidence of PONV, delay in discharge or unplanned admissions in paediatric surgical cases done at the Surgical Day Care Unit at Aga Khan University between January and July 2009.

METHODS: All paediatric ASA 1-2 cases, from 6 months to 18 years of age undergoing day case surgeries at the Surgical day care unit were included in this retrospective audit. Data was collected on a designed form filled with information from preoperative, intraoperative and postoperative recovery forms. Any relevant data was also noted from nurses notes in recovery room and step down unit. Episodes of vomiting, delay …

Understanding The Context Of Balanced Scorecard Implementation: A Hospital-Based Case Study In Pakistan., F Rabbani, Sabrina Nh Lalji, Farhat Abbas, Sm Wasim Jafri, Junaid A. Razzak, Naheed Nabi, Firdous Jahan, Agha Ajmal, Max Petzold, Mats Brommels, Goran Tomson

Section of Urology

Background: As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods: Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs …

Oncolog, Volume 56, Number 03, March 2011, Bryan Tutt, Joe Munch

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

• Glioblastoma Cure Remains Elusive Despite Treatment Advances: Aggressive surgery followed by radiation therapy and chemo-therapy offers hope of long-term survival for some patients with glioblastoma, but for most glioblastoma patients, the prognosis is poor
• Assessing and Addressing the Biological Effects of Stress in Cancer Patients: Stress has long been linked to cancer progression. But the precise mechanisms by which stress exacts its pro-tumor effects are not fully understood
• MD Anderson One of Four Centers to Test Cancer Cell Detection Chip: A new test that could monitor the effectiveness of cancer treatment
• HOUSE CALL: Yoga and Tai Chi: Two distinct disciplines …

Triggers Of Blood Transfusion In Percutaneous Nephrolithotomy, Ali Akbar Zehri, Syed Raziuddin Biyabani, Khurram Muthair Siddiqui, Amanullah Memon

Section of Urology

Objective: To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL).
Study Design: Observational study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 1988 to 2007.
Methodology: The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quantity of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis.
Results: A total of 326 procedures …

The Pulmonologist's Role In Caring For Pregnant Women With Regard To The Reproductive Risks Of Diagnostic Radiological Studies Or Radiation Therapy., Robert Brent

Department of Pediatrics Faculty Papers

Radiography of the chest, head, neck, teeth, or extremity exposes the embryo or ovary to insignificant exposures of radiation except when radionuclides are utilized. In some instances, there is no exposure at all. Pulmonologists are fortunate with regard to the specific studies they request to provide clinical care because most of the diagnostic tests do not directly expose the uterus (embryo) or ovary. This article discusses radiation risks and their evaluation and pregnancy-related issues in diagnostic radiological studies.

A Warm Welcome Goes A Long Way., Jody Shigo Rn, Cmsrn, Eileen Fruchtl Msn, Rn, Ccrn, Cmsrn, Kai Bortz Bsn, Rn, Cmsrn

Patient Care Services / Nursing

No abstract provided.

Urological Involvement In Renal Transplantation., Daniel D Sackett, Pooja Singh, Costas D Lallas

Department of Urology Faculty Papers

Historically, urologists were the primary surgeons in renal transplantation. Specialization and increased complexity of the field of transplantation, coupled with a de-emphasis of vascular surgical training in urology, has created a situation where many renal transplants are carried out by surgeons with a general surgery background. Because of its genitourinary nature, however, urological input in renal transplantation is still vital. For living donors, a urologist should be involved to help evaluate and prepare certain patients for eventual donation. This could involve both medical and surgical intervention. Additionally, urologists who carry out living donor nephrectomy maintain a sense of ownership in …

Epidermal Growth Factor Receptor Overexpression In Resected Pancreatic Cancer, Amit Mahipal, Mary J. Mcdonald, Agnieszka Witkiewicz, Brian I. Carr

Department of Medical Oncology Faculty Papers

Conclusions:

Membrane EGFR overexpression is associated with poorer clinical outcomes in patients with pancreatic cancer receiving adjuvant therapy post resection.

Cytoplasmic EGFR overexpression is not associated with clinical outcomes.

Tuberculous Pericardial Abscess With Impending Pericardial Effusion And Cardiac Tamponade, Saulat H. Fatimi, Faheem-Ul-Haq, Fatima Jalil, Marium Muzaffar, Hashim Muhammad Hanif

Section of Cardiothoracic Surgery

The case of a 59 year male with acute tuberculous pericardial abscess who presented with cough, dyspnoea, haemoptysis, signs of Tamponade and a large Pleural Effusion is reported. Performing Pericardiocentesis did not improve his symptoms hence he was subjected to surgery. Acute tuberculous pericardial abscess was the diagnosis made after histopathology which was successfully managed with sternotomy along with drainage of pus.

The Effects Of Consumption Of California Dried Mission Figs On Serum Lipid Concentrations In Hyperlipidemic Adults, Joycelyn M. Peterson

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The National Cholesterol Education Program and American Heart Association have recommended the use of functional or cholesterol-reducing foods, some categories of which include viscous or soluble fibers, soy protein, plant sterols, and nuts, as aids to reduce serum cholesterol concentrations. Figs are a rich source of viscous fiber and antioxidants. Fig consumption has not been studied in regard to effects in reducing serum lipid concentrations. In previous pilot data, increasing fig consumption for six weeks among volunteers was found to be feasible.

Objective: To evaluate the effect of the consumption of California dried mission figs on serum lipid …

Diagnosis Of Coronary Stenosis With Ct Angiography Comparison Of Automated Computer Diagnosis With Expert Readings., Ethan J Halpern, David J Halpern

Department of Radiology Faculty Papers

RATIONALE AND OBJECTIVES: To compare computer-generated interpretation of coronary computed tomography angiography (cCTA) by commercially available COR Analyzer software with expert human interpretation.

MATERIALS AND METHODS: This retrospective Health Insurance Portability and Accountability Act‑compliant study was approved by the institutional review board. Among 225 consecutive cCTA examinations, 207 were of adequate quality for automated evaluation. COR Analyzer interpretation was compared to human expert interpretation for detection of stenosis defined as ≥50% vessel diameter reduction in the left main, left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), or a branch vessel (diagonal, ramus, obtuse marginal, or posterior descending artery). …

Ercc1 And Rrm1 As Predictors Of Survival And Response In Pancreatic Ductal Adenocarcinoma Treated With Gemcitabine-Based Chemotherapy, Thomas Holdbrook, Kathleen D. Danenberg, Suneeta Satti, Jessica Kline, Charles J. Yeo, Jonathan R. Brody, Peter Mccue, Agnieszka K. Witkiewicz

Department of Surgery Faculty Papers

Conclusion:

In this study, we used RT-PCR and IHC to analyze RRM1 and ERCC1 mRNA and protein expression in PDA specimens. PDA patients with low expression of RRM1 by IHC derived benefit from gemcitabine-based chemotherapy. Assessment of RRM1 mRNA expression was limited by the small sample size. Low ERCC1 expression by RT-PCR was associated with a 2.5 times higher risk of mortality than high expression (p=0.031). There was no association between ERCC1 expression by IHC and survival; however, agreement between mRNA and protein expression was poor for ERCC1. This study demonstrates the ERCC1 and RRM1 expression have an impact on …

Menstrual Bleeding Patterns In Adolescents Using Etonogestrel (Eng) Implant, Amit M. Deokar, Wendy Jackson, Hatim A. Omar

Pediatrics Faculty Publications

Background: Etonogestrel (ENG) implant is an effective method of contraception. The implant is designed to provide contraceptive efficacy for 3 years with a relatively quick return of fertility upon its removal. Menstrual irregularities are not uncommon on long-acting progestins and can often be the factor for discontinuation or removal. A retrospective chart analysis was done on 58 patients who chose to be on the ENG implant. Age ranged from 12 to 24 years. The cycle ranged from 1 to 17 months. The mean length of use of the implant was 10.9 months. Over the 20-month period, 13 ENG implants were …

Gastric Malt Lymphoma: A Rarity, Shahid Pervez, Naureen Ali, Hina Aaqil, Khalid Mumtaz, Syed Siddiq Ullah, Nake Akhtar

Department of Pathology and Laboratory Medicine

Association of Helicobacter pylori (H. Pylori) infection with gastric 'Mucosa Associated Lymphoid Tissue' (MALT) lymphomas (MALTomas) is well established. In this study the frequency and characteristics of gastric MALToma over a period of 18 years was evaluated. During this period 24 patients with gastric MALToma were diagnosed; out of them, 13 (54.2%) had active H. Pylori infection. The mean and median age was 49.7 and 53.5 years. The male: female ratio was 17:7. The common presenting complaints were epigastric pain (n=10) and dyspepsia (n=9). Endoscopic findings revealed mild gastric hyperemia (n=16), superficial erosions (n=4) and superficial ulcers (n=4). It was …

Regulation Of The Androgen Receptor By Set9-Mediated Methylation., Luke Gaughan, Jacqueline Stockley, Nan Wang, Stuart R C Mccracken, Achim Treumann, Kelly Armstrong, Fadhel Shaheen, Kate Watt, Iain J Mcewan, Chenguang Wang, Richard Pestell, Craig N Robson

Kimmel Cancer Center Faculty Papers

The androgen receptor (AR) is a member of the nuclear hormone receptor family of transcription factors that plays a critical role in regulating expression of genes involved in prostate development and transformation. Upon hormone binding, the AR associates with numerous co-regulator proteins that regulate the activation status of target genes via flux to the post-translational modification status of histones and the receptor. Here we show that the AR interacts with and is directly methylated by the histone methyltransferase enzyme SET9. Methylation of the AR on lysine 632 is necessary for enhancing transcriptional activity of the receptor by facilitating both inter-domain …

Pancreaticoduodenectomy: A Developing Country Perspective, Khawaja Muhammad Inam Pal, Hassaan Bari, Sana Nasim

Section of General Surgery

Objective: To review retrospectively, the resultsof Whipple's procedure from 1986 to December 2009 at the Aga Khan University Hospital.
Methods: Patient's case notes were reviewed to extract information related to demographics, clinical and laboratory data, operative procedure and post operative period. Surgical mortality was defined as death within 30 days of procedure.
Results: Hundred and twenty one patients underwent a successful pancreaticoduodenectomy during this period. There were 78 males and 43 females. Most presented with clinical features of obstructive jaundice. Perioperative evaluation in the majority included an abdominal ultrasound and contrast enhanced CT scan. A preoperative ERCP was performed in …

Expression Of Aldehyde Dehydrogenase In Dysplastic Lesions Arising From Inflammatory Bowel Disease, Adam D. Toll, Bruce M. Boman, Juan P. Palazzo

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Conclusion: Our study demonstrates ALDH1 is significantly expressed in dysplatic lesions arising from IBD. ALDH1-expression in cancer stem cells suggest an important causative role in the progression to cancer in IBD. Although we found high sensitivity for dysplasia, the specificity was poor. In addition to neoplasia, ALDH1-expressing stem cells proliferate in response to chronic inflammation, accounting for the cases of inflammatory atypia with positive ALDHI1 expression.