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Z Amin

Publications and source records attributed to Z Amin.

At least 37 records · Page 2Linked to original sources
PubMed2000

Theory and practice in continuing medical education.

INTRODUCTION: Continuing medical education (CME) represents the final and often most poorly understood stage of physician education. The understanding of contemporary theories of physician education and characteristics of effective CME interventions will help CME providers and physician learners to plan productive CME activities and improve learning. This article aims to provide readers with emerging evidences on effective CME, particularly in relation to theories of physician learning and their implications for CME planning. The article also summarises attributes of effective CME interventions. METHODS: The data and evidence were collected from contemporary medical education journals and published books on medical education. Two electronic databases, Medline and ERIC (Educational Research Information Clearinghouse) were searched for suitable articles. RESULTS: Physician learning is a distinct phenomenon with high inclination towards autonomy and self-directed learning. CME interventions are more likely to be fruitful if they are modelled with strong theoretical background, catered towards individual learning needs and preferences, and focused on the learning component of education. Many widely practised CME interventions fail to be effective as those are not based on the above principles. CONCLUSION: Evidence suggests that careful planning and evaluation of CME will improve the key measure of physician's performance and health care outcome.

Clinical Competence↗
PubMed2000

Q methodology--a journey into the subjectivity of human mind.

AIMS: This paper introduces a relatively new research methodological tool, known as Q method, useful in exploring issues related to human subjectivity. DESCRIPTION: Q methodology is unique as it combines the strengths of both qualitative and quantitative research traditions. The sequential steps involve generation of ideas about the research topics, clarification and refinement of the ideas, and rank ordering these ideas by the respondents in a quasinormal distribution. The data are extracted with by-person factor analysis and useful in exploring arrays of attitude either cross-sectionally or longitudinally over a period of time. CONCLUSION: Q methodology can be used to analyse opinions, perceptions, and attitudes in both clinical and non-clinical settings. It is a preferred method of human subjectivity study as it provides more in-depth analysis of complex subjectivity issues.

Data Interpretation, Statistical↗
PubMed1999

New device for closure of muscular ventricular septal defects in a canine model.

BACKGROUND: Repair of muscular ventricular septal defects (MVSDs) has always been challenging to the surgeon. Long-term morbidity and mortality are significantly increased if the defects are closed via left ventriculotomy or if they are associated with other complex congenital anomalies. The purpose of this study was to close MVSDs with the Amplatz ventricular septal defect device. This device is constructed from 0.004-in nitinol wire mesh filled with polyester fibers. It is retrievable, repositionable, self-centering, and of low profile. METHODS AND RESULTS: MVSDs were created with the help of a sharp punch in 10 dogs. The location of the defects was anterior muscular (n=3), midmuscular (n=3), apical (n=3), and inlet muscular (n=1). The diameter of the defects ranged from 6 to 14 mm. All defects were closed in the catheterization laboratory. The device was placed with the help of transesophageal echocardiography and fluoroscopy. A 7F sheath was used to deploy the device from the right ventricular side in 8 and the left ventricular side in 2 dogs. Placement was successful in all animals. The complete closure rate was 30% (3/10) immediately after placement and 100% at 1-week follow-up. Pathological examination of the heart revealed complete endothelialization of the device in dogs killed after 3 months. CONCLUSIONS: The Amplatz ventricular septal defect device appears highly efficacious in closing MVSDs. The advantages include a small delivery sheath, complete retrievability before release, and the fact that it is self-centering and self-expanding, thereby making it an attractive option in smaller children.

Alloys↗
PubMed1999

Perventricular [correction of Periventricular] closure of ventricular septal defects without cardiopulmonary bypass.

BACKGROUND: Minimally invasive techniques are currently in use to close atrial and ventricular septal defects (VSD). Cardiopulmonary bypass (CPB) is instituted via the femoral vessels, which may cause injury to these vessels, especially in younger patients. The objectives of this study were to demonstrate the feasibility of perventricular [corrected] closure of muscular VSD (MVSD) and paramembranous VSD (PVSD) without CPB, using the Amplatz VSD device. METHODS: Five Yucatan pigs with naturally occurring PVSD (3- to 7-mm diameter) and 5 dogs with surgically created MVSD (6- to 14-mm diameter) were subjects of this study. The VSDs were closed intraoperatively with a 7-French delivery sheath inserted through the free wall of the right (n = 5) or left ventricle (n = 5), under epicardial echocardiogram guidance. The animals were followed for 3 months. RESULTS: There was no operative mortality. All MVSD closed after placement of the device. Closure rate of PVSD was 4 of 5 after placement and 3 of 5 after 3 months. One pig developed aortic incompetence at the last follow-up. CONCLUSIONS: Perventricular closure of MVSD and PVSD is feasible. Avoidance of CPB can decrease recovery time, its complications, and trauma to the femoral vessels.

Animals↗
PubMed1998

Aggressive approach in the treatment of acute lead encephalopathy with an extraordinarily high concentration of lead.

OBJECTIVE: To report a case of a 3-year-old child with an extraordinarily massive lead concentration, 26.4 micromol/L (550 microg/dL), following environmental exposure to lead paint in the home. LITERATURE REVIEW: The relevant literature concerning the treatment of lead encephalopathy was reviewed during the treatment of this child and preparation of the manuscript. To our knowledge, the landmark article written by Julian Chisolm in 1968 is the only recent article that reported similarly high levels of lead concentration. This case, however, is the first in which 3 chelating agents were used for the treatment of lead encephalopathy. We also reviewed the literature on the use of whole bowel irrigation in heavy metal intoxications. CONCLUSIONS: In this case, aggressive gut decontamination with whole bowel irrigation and triple chelation therapy with British anti-Lewisite, EDTA, and oral succimer was well tolerated and seemed effective for rapidly deleading the child. The extent to which her lead concentration increased while being treated with oral succimer alone necessitated further chelation with EDTA. Further evaluation is necessary to determine if triple chelation therapy is an appropriate method for severe lead intoxication, and if the use of whole bowel irrigation should be considered in heavy metal intoxication.

Brain Diseases↗
PubMed1998

Does banding the pulmonary artery affect pulmonary valve function after the Damus-Kaye-Stansel operation?

BACKGROUND: The Damus-Kaye-Stansel (DKS) operation can be an effective palliation in patients who have single-ventricle physiology and systemic outflow obstruction. Pulmonary artery banding (PAB) may be used as a preliminary procedure in these patients to limit overperfusion of the pulmonary circulation. In some series, the DKS operation has been associated with pulmonary insufficiency (PI). We retrospectively analyzed medical records of our patients who had PAB and later DKS to determine the incidence of PI in these patients. METHODS: Between 1982 and 1996, 15 patients underwent PAB before DKS. Median age at PAB placement was 7 days and median duration of PAB was 7 months. Echocardiograms obtained before PAB, before DKS, and at the most recent post-DKS follow-up were reviewed. RESULTS: Follow-up ranged from 1 to 15 years (mean follow-up, 7.5 years). One patient had trivial PI before PAB, which progressed to moderate PI at the last follow-up. Only 1 other patient had mild PI, but only at the last follow-up after DKS. CONCLUSIONS: These findings suggest that prior PAB does not appear to cause significant PI in patients slated for DKS, and the incidence of significant PI after the DKS operation is relatively low.

Cardiac Surgical Procedures↗
PubMed1998

Repair of coarctation with resection and extended end-to-end anastomosis.

BACKGROUND: Our surgical strategy for infant coarctation changed from subclavian flap aortoplasty to resection with extended end-to-end anastomosis in 1991. The purpose of this review was to evaluate the results of that strategy. METHODS: From 1991 through 1997, 55 infants underwent repair of coarctation of the aorta using resection with extended end-to-end anastomosis. Isolated coarctation of the aorta was present in 26 patients, 20 patients had a ventricular septal defect, and 9 patients had other associated intracardiac lesions. Mean age at surgery was 0.20+/-0.24 years (median, 21 days). In 34 patients (62%), arch reconstruction was performed through a left thoracotomy. Twenty patients (36%) had median sternotomy with simultaneous repair of coarctation of the aorta and intracardiac repair of associated lesions. One patient had recoarctation repair through a median sternotomy. All coarctation and ductal tissue was resected and the anastomosis was constructed starting opposite the left carotid artery with running polypropylene suture. RESULTS: There was one early death 26 days after coarctation of the aorta and ventricular septal defect repair in a child on extracorporeal membrane oxygenation for meconium aspiration and 2 late deaths owing to pneumonia and pulmonary hypertension (1) and interventricular hemorrhage (1). There were no instances of paraplegia. Follow-up in survivors ranges from 10 to 76 months (mean, 39.8+/-17.2 months). Recoarctation has developed in 2 patients, who have had successful balloon dilation 6 and 14 months after the operation. This yields a low recoarctation rate of 3.6%. CONCLUSIONS: Resection with extended end-to-end anastomosis yields a low mortality and particularly a low recoarctation rate and is our procedure of choice for infants with coarctation of the aorta.

Anastomosis, Surgical↗
PubMed1998

Helical CT pneumocolon to assess colonic tumors: radiologic-pathologic correlation.

OBJECTIVE: The objective of this study was to determine the accuracy of helical CT pneumocolon in the staging of colonic carcinomas. SUBJECTS AND METHODS: Fifty-two patients (27 men, 25 women; age range, 40-88 years old; mean age, 67 years old) with known or strongly suspected colonic disorders underwent CT pneumocolon. After bowel cleansing, administration of smooth muscle relaxant, and rectal air insufflation, CT pneumocolon was performed with 5-mm collimation, 2.5-mm reconstruction interval, and a pitch of 1.5. Two contrast administration protocols were used. Twelve patients received 100 ml of i.v. contrast material that was injected at 3 ml/sec; scan delay was 45 sec. The other 40 patients received 150 ml of contrast material at 5 ml/sec; scan delay was 25 sec. Images were prospectively evaluated. All patients had pathologic confirmation: 46 patients had resections and six patients had endoscopic biopsies. RESULTS: Diagnostic images were obtained in 47 of 52 patients. In the 47 patients, there were 38 colonic carcinomas (one synchronous), nine diverticular strictures, eight polyps, one ischemic stricture, and one normal study. Thirty of 38 carcinomas were correctly staged by CT. Sensitivity and specificity for serosal infiltration were 100% (35/35 carcinomas) and 33% (one of three carcinomas), respectively; sensitivity and specificity for lymph node involvement were 56% (nine of 16 carcinomas) and 95% (21/22 carcinomas), respectively. Four polyps that were smaller than 5 mm in diameter were not revealed by CT. Twelve of 14 benign lesions were correctly diagnosed and two were believed to be malignant. No malignant lesion was misdiagnosed. CONCLUSION: CT pneumocolon gave an overall staging accuracy of 79% in 38 carcinomas.

Adult↗
PubMed1997

Lobar or segmental consolidation on chest radiographs of patients with HIV infection.

PURPOSE: To correlate chest radiographic abnormalities with diagnoses in HIV infected patients presenting with acute respiratory symptoms and lobar or segmental consolidation. MATERIALS AND METHODS: Retrospective review of chest radiographs of 53 HIV infected patients with lobar or segmental consolidation, and their microbiological and cytological diagnoses. RESULTS: A specific diagnosis was made in 35 patients of which 12 had Pneumocystis carinii pneumonia (including four co-infections) and 23 had bacterial pneumonias (10 of these were due to Streptococcus pneumoniae and four to Mycobacterium tuberculosis). Microbiological and cytological tests were negative in 18 patients. Non-specific radiographic features included bronchial wall thickening (79%), reticulonodular or reticular change (55%), effusions (38%) and lymphadenopathy (25%); effusions favoured a bacterial aetiology. Ten of the 12 cases with P. carinii pneumonia had upper lobe consolidation (three of these had received inhaled pentamadine). Of 13 other cases of upper lobe consolidation, eight were due to pyogenic infection and only one to M. tuberculosis alone. CONCLUSION: A wide variety of causative agents may produce lobar or segmental consolidation in HIV infected individuals, and the most common cause is bacterial infection. Where there is upper lobe consolidation P. carinii pneumonia should be considered in the differential diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Technical report: spiral CT pneumocolon for suspected colonic neoplasms.

Abdominal spiral computed tomography (CT) pneumocolon is performed after cleansing the colon, using a smooth muscle relaxant and rectal air insufflation. Rapid dynamic scanning is undertaken with intravenous contrast to give optimal hepatic and vascular enhancement, and 5-10 mm contiguous slices. The area of interest in the colon is reconstructed every 2.5 mm. This technique was performed in four patients with colorectal cancer and the CT findings were compared with the barium enema and pathology following surgical resection. Spiral CT pneumocolon clearly showed the primary tumour in all cases as an enhancing soft tissue mass, and was able to detect local extension and lymphadenopathy as well as assess the liver, peritoneum and remaining abdomen. CT depicted the morphology of the primary tumour more clearly than barium enema, and in one case also detected a 1 cm polyp which was not seen on the barium study because the patient was incontinent of barium and views were limited. There was good correlation between the CT and pathological findings. Compared to a barium enema, spiral CT pneumocolon is quick, with minimal patient discomfort, no risk of barium incontinence, and there is good assessment of the local and distant abdominal disease. Multiplanar formatting is possible and 3-D reconstruction gives intra- and extra-luminal views.

Aged↗
PubMed1996

Laser therapy for breast cancer: MR imaging and histopathologic correlation.

PURPOSE: To investigate magnetic resonance (MR) imaging guidance of interstitial laser photocoagulation to treat primary breast cancer. MATERIALS AND METHODS: Twenty female patients with symptomatic breast cancers diagnosed at cytologic examination underwent interstitial laser photocoagulation by means of a single fiber prior to surgical excision. Gadolinium-enhanced T1-weighted three-dimensional fast low-angle shot (FLASH) MR imaging was performed before and after laser therapy (median, 48 hours; range, 24-96 hours). Following resection, tumors were mapped in detail histopathologically. The extent of disease, size of laser burn, and extent of residual tumor were correlated with MR findings. RESULTS: Twenty-seven tumors were detected at histopathologic examination in the 20 patients. Five patients had more than one invasive mass. Twenty-five of the 27 tumors were identified as discrete enhancing masses at MR. The two missed invasive foci were obscured on MR images by diffuse patchy enhancement that correlated with the presence of an associated extensive intraductal component. Early (4-hour) follow-up images failed to depict the laser effect. Later (24-96 hours) follow-up images depicted the laser-induced necrosis as a zone of nonenhancement within the residual enhancing tumor. The correlation coefficients (MR vs histopathologic analysis) for the laser-burn diameter and residual tumor were 0.80 and 0.86, respectively. CONCLUSION: Delayed gadolinium-enhanced MR images can help define the extent of laser-induced necrosis and residual tumor after interstitial laser photocoagulation therapy in breast cancer.

Adult↗
PubMed1996

Retinoic acid syndrome: pulmonary computed tomography (CT) findings.

We report the pulmonary computed tomography (CT) findings in three patients with acute promyelocytic leukaemia who developed the retinoic acid syndrome following all-trans retinoic acid (ATRA) therapy. The most consistent CT findings were small, irregular peripheral nodules in the lung fields and pleural effusions. Two of the patients also showed evidence of reticular and ground glass shadowing as well as abnormal anterior mediastinal soft tissue. We report for the first time an association between ATRA and pneumothorax. We conclude that routine CT scanning may provide a sensitive means of early detection or monitoring of the syndrome and thereby may facilitate its management.

Adult↗