Central hepatic involvement in paragonimiasis: appearance on CT and MRI.
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Female↗
Biomedical subjects
Rameez Alasadi
Publications and source records attributed to Rameez Alasadi.
Preoperative evaluation of pancreatic cystic lesions: cost-benefit analysis and proposed management algorithm.
BACKGROUND: This study was performed to develop a management algorithm that accurately predicts the necessity of operative intervention and results in significant cost savings for patients with cystic pancreatic tumors. METHODS: We reviewed 60 patients treated between 1992 and 2003. Accuracy rates of tests used to differentiate benign from premalignant and malignant cysts were calculated. A management algorithm was generated that incorporated clinical presentation, radiologic findings, and selective use of endoscopic procedures. This algorithm was tested for predictive accuracy, and savings between actual management and proposed management were compared. RESULTS: There was an average of 3 preoperative tests performed per patient. Endoscopic procedures included endoscopic retrograde cholangiopancreatography in 21 patients and endoscopic ultrasound in 25 patients. A cyst fluid carcinoembryonic antigen (CEA) level of 158 ng/mL or greater had an accuracy rate of 87.5% that was significantly higher than endoscopic retrograde cholangiopancreatography (72%), endoscopic ultrasound morphology (45%), or endoscopic ultrasound cytology (66.7%). There was no combination of tests that provided greater accuracy than cyst fluid CEA level alone (P < .05). The management algorithm had a positive predictive value of 81%. The average actual cost of radiographic and endoscopic procedures was dollar 8,080 per patient. The proposed cost based on the algorithm was dollar 6,677 with a savings of dollar 1,403 per patient (P = .009). CONCLUSIONS: In patients with clinical symptoms or radiographic findings of mucinous or malignant tumors, further testing is excessive. Of endoscopic tests available, the cystic fluid CEA level most accurately predicts the presence of a mucinous neoplasm. A management algorithm based on presenting symptoms, radiographic findings, and cyst fluid CEA level provides a guideline for the evaluation of cystic lesions in the most cost-efficient manner while ensuring proper care.
Adult↗
Endoscopic ultrasound of the pancreas: tissue acquisition and intervention.
Endoscopic ultrasound is an established modality for staging gastrointestinal and pancreatic malignancies. Since the development of the linear array echoendoscope, the field of interventional endoscopy has continued to evolve as an adjunctive method to standard endosonography. The ability to sample extraluminal lesions or lymph nodes has overcome the initial limitations of endoscopic ultrasound and provided a list of attractive endoscopic ultrasound-guided therapeutic applications.This review focuses on recent advancements in the field of interventional endosonography related to the diagnosis and therapy of pancreatic diseases. In particular, the article reviews the role of endoscopic ultrasound-guided fine-needle aspiration in diagnosing various pancreatic diseases; the role of endoscopic ultrasound-guided fine-needle injection in delivering neurolytic, chemotherapeutic, or biologic agents; and emerging procedures like endoscopic ultrasound-assisted biliary bypass in the setting of malignant biliary obstruction.
Journal Article↗
Synovial sarcoma of the heart: Report of a case with diagnosis by endoscopic ultrasound-guided fine needle aspiration biopsy.
BACKGROUND: Primary synovial sarcomas of the heart are aggressive and extremely rare tumors. At least 17 cases have been reported in the literature. In all the published cases the diagnosis was based on histologic sections. To our knowledge, this is the first case of primary synovial sarcoma of the heart diagnosed by fine needle aspiration (FNA). CASE: A 36-year-old male with an unremarkable past medical history presented with a 4.4-cm mass arising from the left ventricular wall of the heart. Endoscopic ultrasound guided fine needle aspiration biopsy of the mass revealed a high grade tumor showing an intimate admixture of spindle and epithelial cells. A diagnosis of undifferentiated sarcoma, favor synovial sarcoma, was rendered. Reverse transcription-polymerase chain reaction demonstrated the presence of a SYT-SSX fusion transcript. The patient received 6 cycles of chemotherapy followed by resection of the residual tumor. The histology of the viable tumor showed histologic findings typical of biphasic synovial sarcoma. CONCLUSION: Synovial sarcoma rarely presents as a primary tumor of the heart. Sampling by FNA allows demonstration of the cytomorphologic appearance typical of the tumor and other ancillary studies. The specific genetic abnormality of these tumors allows confirmation by cytogenetic and molecular studies.
Adult↗