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   2011| October-December  | Volume 1 | Issue 2  
    Online since December 20, 2011

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Solitary pulmonary nodule: A diagnostic algorithm in the light of current imaging technique
Ali Nawaz Khan, Hamdan H Al-Jahdali, Klaus L Irion, Mohammad Arabi, Shyam Sunder Koteyar
October-December 2011, 1(2):39-51
DOI:10.4103/2231-0770.90915  PMID:23210008
The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT). The finding of a SPN usually provokes a flurry of clinical and imaging activity as an SPN in at-risk population is an alert signal of possible lung cancer. The frequency of malignant nodules in a given population is variable and depends on the endemicity of granulomatous disease. The percentage of malignant nodules also rises when dealing with at-risk population. The problem is compounded by the fact that with the present generation of CT scanners, 1-2 mm nodules are discovered in approximately half of the smokers aged 50 years or older scanned. A variety of management approaches are applied in the work-up of SPN often requiring evaluation over a long period of time to establish a benign or malignant diagnosis. Comparison with previous imaging studies and morphologic evaluation of the size, margins, and internal characteristics are usually the first step in the evaluation of these nodules. It is often necessary to use additional imaging techniques and occasionally invasive procedures such a percutaneous needle lung or a surgical biopsy. Until recently, the guidelines for follow-up of indeterminate noncalcified nodules detected on nonscreening CT was a minimum of 2 years. However, during the past few years due to further refinements in CT technology and better understanding of tumor behavior, it has prompted a revision of the guidelines of the follow-up of small indeterminate nodules. These guidelines have been endorsed by the Fleischner Society.
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Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review
Belal M Firwana, Rim Hasan, Mazen Ferwana, Joseph Varon, Aaron Stern, Umesh Gidwani
October-December 2011, 1(2):29-34
DOI:10.4103/2231-0770.90913  PMID:23210006
Background and Objectives: Hemodialysis catheters are commonly used when renal replacement therapy is initiated. These catheters have significant complications. Among "locking" solutions used in an attempt to decrease these complications is recombinant tissue plasminogen activator (rt-PA). This systematic review is to determine the efficacy of rt-PA versus heparin, the standard of care. Materials and Methods: A systematic review of randomized controlled trials studying rt-PA alone or rt-PA plus heparin versus heparin alone as locking agents for hemodialysis catheters, which included patients needed a temporary hemodialysis catheter for hemodialysis. We identified relevant trials through electronic databases and correspondence with experts. Two investigators independently reviewed potentially eligible trials and extracted data. Results: Three trials met the inclusion criteria. One trial reported an improved catheter malfunctioning in patients using rt-PA plus heparin to lock catheters (20.0%) versus heparin alone (34.8%). Another trial reported higher blood flow rate in hemodialysis catheters in patients who received rt-PA (231.6 ± 12.4 mL/min) compared with those who received heparin (206.9 mL/min). The third trial reported formation and weight of clots which were decreased by half in rt-PA group versus heparin group. Conclusions: In the few randomized trials that met our inclusion criteria, the use of rt-PA as a locking solution for hemodialysis catheters seems to be associated with fewer adverse events and catheter malfunctioning as compared with heparin. Our systematic review is limited by the few randomized trials addressing our question and the wide variety of outcome measures. Further prospective randomized trials are needed to confirm this conclusion.
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Alteration in pulmonary perfusion due to iatrogenic pulmonary vein stenosis: A mimicker of pulmonary embolism
Wesam Ostwani, Mohammad Arabi
October-December 2011, 1(2):58-60
DOI:10.4103/2231-0770.90918  PMID:23210011
Iatrogenic pulmonary vein stenosis (PVS) is a known, yet rare, complication of atrial radiofrequency ablation. Alterations in pulmonary perfusion may mimic massive pulmonary embolism on a ventilation/perfusion (V/Q) scintigraphy. This is particularly important due to the overlap in presenting clinical symptoms. The present case illustrates the functional significance of PVS and the changes in perfusion in response to angioplasty.
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Erlotinib eradicates brain metastases from epidermal growth factor receptor mutant non-small cell lung cancer
Siavash Jabbari, Michael Pins, Kimberly Kruczek, Chadi Nabhan
October-December 2011, 1(2):52-54
DOI:10.4103/2231-0770.90916  PMID:23210009
Erlotinib is active in patients with lung cancer; especially those who demonstrate a mutation in exons 18-21 in the epidermal growth factor receptor (EGFR) gene. Patients with lung cancer and brain metastases have poor prognosis as systemic chemotherapy is ineffective in treating the central nervous system (CNS) metastases due to its inability to cross the blood brain barrier. Herein, we report a case of a 61 year old female who presented with stage IV adenocarcinoma of the lung with bilateral cerebral and cerebellar CNS involvement. The patient's tumor harbored a mutation in exon 19 in the EGFR gene. Treatment with erlotinib was started as soon as the molecular studies were available with remarkable and complete radiographic response in the CNS disease, and complete resolution of the previously detected metastases. The patient did not receive any other CNS intervention and radiation was not given due to the lack of CNS symptoms.
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Assessment of noise levels in 200 Mosques in Riyadh, Saudi Arabia
SA Al Shimemeri, Chirag B Patel, Al Fayez Abdulrahman
October-December 2011, 1(2):35-38
DOI:10.4103/2231-0770.90914  PMID:23210007
Introduction : Noise-induced hearing loss (NIHL) is a recognized concern within the context of occupational and general health. However, noise levels are seldom studied at nonworkplace and nonabode sites that are visited regularly, e.g., places of worship. The purpose of this study was to assess the noise levels inside and outside of mosque prayer rooms and to compare the levels with established noise tolerance limits. Materials and Methods : A portable digital sound level meter was used to determine the noise level (measured in dB) inside and outside of mosque prayer rooms. The highest (peak) and lowest noise levels from each recording were tabulated. Statistical analysis was performed using a two-tailed Student's t-test(alpha = 0.05). Results : Noise levels were measured at 200 mosque prayer rooms from all 15 municipal districts of Riyadh, Saudi Arabia. Of these, 151 prayer rooms (75.5%) had both inside and outside noise measurements and the remaining 49 prayer rooms (24.5%) had only inside noise measurements. There was significantly greater noise outside compared to inside the prayer rooms, for both the highest noise level (outside: 87.8 ± 4.8 dB compared to inside: 85.8 ± 5.4 dB, P < 0.0001) and lowest noise level (outside: 58.4 ± 3.8 dB compared to inside: 56.6 ± 3.6 dB, P < 0.00001). In all, 112 of the inside highest level measurements (56%) and 113 of the outside highest level measurements (74.8%) were greater than 85 dB, the sound level at which NIHL has been shown to occur in occupational settings. Conclusion : A large proportion (56%) of mosque prayer rooms with inside peak noise measurements were above acceptable levels (85 dB), however, prayers certainly do not last for 8 continuous hours. Therefore, the level of noise at mosques is acceptable and in compliance with international norms of hearing safety; moreover, it does not present any risk to hearing in the long run.
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Intravascular papillary endothelial hyperplasia of the bladder: Case report and review of the literature
Tarek Jazaerly, Hayan Jaratli, Wael Sakr, Nour Almardini, Muaz Urabi, Nivedita Dhar, Tamar Giorgadze
October-December 2011, 1(2):55-57
DOI:10.4103/2231-0770.90917  PMID:23210010
Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign unusual vascular lesion thought to arise from an organizing thrombus. Histologically, IPEH is characterized by papillary fronds lined by proliferating endothelium that may mimic angiosarcoma, and therefore the correct diagnosis may prevent unnecessary radical procedures. Involvement of the bladder is extremely rare, with only three cases reported in the literature. We report a case of IPEH arising in the bladder of a patient with history of prostate cancer treated with radiotherapy.
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