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Biomedical subjects

M Alikhan

Publications and source records attributed to M Alikhan.

10 recordsLinked to original sources
PubMed2000

Successful thrombolytic therapy for massive pulmonary embolism.

The use and scope of thrombolytic therapy in the management of pulmonary embolism (PE) continues to evolve. The results of small studies suggest that thrombolytic therapy might have an impact on survival in massive PE with cardiogenic shock; however, no large studies to further this notion exist. Furthermore, the expanded application of thrombolytic therapy to patients with PE and right ventricular dysfunction (RVD) but without overt hemodynamic collapse remains controversial. We report successful use of the thrombolytic agent tissue plasminogen activator (tPA) in the management of life-threatening PE with RVD without overt cardiovascular collapse. We present evidence for the meritorious use of thrombolytic therapy in this category of PE patients. We believe that a broadened application of thrombolytic therapy to patients with PE and RVD but without cardiogenic shock, especially in younger patients, is beneficial and worth the risk.

Adult↗
PubMed1999

Accuracy of pathologic interpretation of colorectal polyps by general pathologists in community practice.

BACKGROUND: The histologic features of colorectal polyps often guide colonoscopic surveillance and the need for surgical intervention. Our objective was to evaluate the pathologic interpretation of colorectal polyps by general pathologists in community practice. METHODS: Twenty histologic slides of colorectal polyps were reviewed by 20 randomly selected general pathologists in community practice. There were 5 malignant polyps, 9 adenomas, and 6 miscellaneous polyps. RESULTS: Cancer was correctly identified in 91% of readings and adenoma in 94%. The grade of differentiation of cancer was provided in 55% of readings, and comment regarding whether the resection margin was free of cancer was made by 50% of pathologists. Tubular adenoma was called tubulovillous or villous in 35% of readings, but tubulovillous or villous adenoma was seldom (2%) called tubular. High-grade dysplasia was correctly identified in 47% of 60 readings, was called invasive cancer in 22%, and was missed in 31%. Among miscellaneous polyps, hyperplastic polyp was correctly recognized in 75% of cases, and inflammatory polyp and juvenile polyp each were recognized by 16 of 20 pathologists (80%). Peutz-Jeghers hamartoma was identified by 4 of 20 pathologists (20%), and the polypoid phase of solitary rectal ulcer syndrome was recognized by 2 pathologists (10%). CONCLUSION: Areas of strength with regard to interpretation of colon polyps by general pathologists in community practice included identification of cancer, adenoma, and certain non-neoplastic polyps (e.g., inflammatory and juvenile polyps). Areas of weakness included lack of comment on cancer differentiation and proximity to the resection line, erroneous identification of high-grade dysplasia, and identification of rare lesions. The results of this study suggest areas on which to focus continuing education and continuous quality improvement efforts with regard to polyp interpretation.

Adenocarcinoma↗
PubMed1999

Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice.

BACKGROUND: Pathologic interpretation of biopsy specimens of columnar lined esophagus guides subsequent endoscopic surveillance and/or surgical intervention. The aim of this study was to evaluate pathologic interpretation of columnar lined esophagus by general pathologists in community practice. METHODS: Five histologic slides representing different types of columnar lined esophagus were submitted for review by 20 randomly selected general pathologists in community practice. There were three cases with intestinal metaplasia (one with no dysplasia, one with low-grade dysplasia, and one with high-grade dysplasia) and two cases of gastric metaplasia (one fundic-type and one cardia-type). RESULTS: High-grade dysplasia was identified as such by 30% of pathologists and was called invasive adenocarcinoma by 20%, low-grade dysplasia by 30%, and moderate dysplasia by the remaining 20%. Low-grade dysplasia was identified as such by 35% of pathologists and was called high-grade dysplasia by 20%, moderate dysplasia by 20%, and no dysplasia by 25%. Specialized columnar epithelium with no dysplasia was identified as such by 35%, called low-grade dysplasia by 35%, moderate dysplasia by 15%, indeterminate for dysplasia by 10%, and invasive adenocarcinoma by 5%. Gastric metaplasia without specialized columnar epithelium was identified as Barrett's esophagus in 38% of cases. CONCLUSIONS: Pathologic interpretation of columnar lined esophagus by community pathologists may be subject to marked interobserver variation. The term Barrett's esophagus is often used to describe columnar lined esophagus without goblet cells. Because this finding is not clearly associated with an increased risk of cancer, these data support recent suggestions that the term Barrett's esophagus be abandoned. Interpretations of both high-grade and low-grade dysplasia should be considered for review by experts in esophageal pathology.

Barrett Esophagus↗
PubMed1998

Electrocardiographic changes with right-sided pneumothorax.

Pneumothorax is a well-known complication of central line placement in the intensive care unit. Other causes include spontaneous pneumothorax, trauma, and infection. Most frequently, dyspnea or respiratory decompensation raises suspicion for pneumothorax, especially after central line placement. The diagnosis is confirmed by physical examination and chest radiography. We present five cases of right-sided pneumothorax in which electrocardiographic findings resolved with reexpansion of the lung. A new finding is reported in two cases.

Adult↗
PubMed1998

Over-the-counter sympathomimetics: a risk factor for cardiac arrhythmias in pregnancy.

More than 170 over-the-counter (OTC) preparations contain a sympathomimetic agent as the active ingredient. Nonprescription medicines are consumed commonly in our society. Phenylpropanolamine, an alpha-adrenergic agonist as well as a popular decongestant, is consumed at a massive volume of 5 billion doses annually. Over-the-counter sympathomimetics have been reported to cause hypertension and arrhythmias. Despite the ability to cause these potentially serious adverse effects and the high-volume consumption of these agents, the medical literature until recently has been scant in reporting adverse events. We report symptomatic ventricular arrhythmia and presyncope in a 36-year-old pregnant woman who consumed relatively high doses of two OTC cold remedies simultaneously. Increased physician awareness of the potential side effects associated with OTC sympathomimetics as well as improved level of patient education are needed. Finally, we support the calls for more prominent warning labels on some selected OTC preparations, including OTC sympathomimetics.

Adrenergic alpha-Agonists↗
PubMed1997

Subtotal colectomy in a patient with collagenous colitis associated with colonic carcinoma and systemic lupus erythematosus.

A case of colonic carcinoma is described in a 60-yr-old woman with the typical clinical and histopathologic features of collagenous colitis and systemic lupus erythematosus, who is doing well 24 months after undergoing a subtotal colectomy with Brooke ileostomy. Collagenous colitis has only rarely been previously reported in association with colonic carcinoma (n = 1 case) or systemic lupus erythematosus (n = 1 case). In addition, this case is the second report of symptomatic collagenous colitis refractory to medical therapy, treated successfully with surgery.

Adenocarcinoma↗
PubMedDate not supplied

The challenges of cardiac pacing: an illustrative case.

The history of transvenous pacing encompasses the past five decades. Multiple lead complications have been described, including problems related to central venous access, venous thrombosis, extravascular bleeding, lead and pacemaker pocket infections, lead fractures, lead dislodgment, lead perforation, diaphragmatic pacing, and chronic lead threshold changes. Potential solutions to these problems have included: improvements in lead composition and tip technology, multiple pacemaker lead and generator insertions, alternative lead sites, pacemaker lead extenders, extraction of infected leads, multiprogrammable pacemaker generators, high output generators, antibiotics and anticoagulants, and venous reconstruction. This case illustrates complications and solutions over a 20-year period. The indications for temporary transfemoral and permanent iliac vein transvenous pacing are reviewed, including a new indication for the iliac venous approach.

Aged↗