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Ghandour M, Thimmisetty RK, Sondheimer J, Imran N, Bhat ZY, Osman-Malik YM. Conversion from Intermittent Hemodialysis to Peritoneal Dialysis in Metastatic Catheter-Related Bloodstream Infection. Case Rep Nephrol Dial 2023; 13:97-103. [PMID: 37900928 PMCID: PMC10601878 DOI: 10.1159/000531094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/09/2023] [Indexed: 10/31/2023] Open
Abstract
Of all complications from central venous catheters (CVC) in end-stage renal disease (ESRD) patients, catheter-related bloodstream infection (CRBSI) is one of the most devastating consequences. The option of catheter salvage is not an effective measure with metastatic infections. However, in patients with severe vasculopathy and/or near end-stage vascular disease, preservation of the venous access should be given utmost importance as the luxury of utilizing another vascular site is markedly limited. Providing adequate renal replacement therapy in this group of patients can be remarkably challenging for nephrologists. We are presenting an ESRD patient with advanced vascular disease who developed metastatic CRBSI with worsening uremia who was successfully converted from intermittent hemodialysis (IHD) to peritoneal dialysis (PD). Our rationale was to minimize repeated intravascular procedures coupled with the presence of another intravascular device. This has led to a complete resolution of persistent bacteremia, with a steady improvement in the uremic state. Conversion from IHD to PD for persistent bacteremia with metastatic complications was seldom addressed in literature. In the absence of a significant contraindication to PD, it can be considered as a valid alternative possibility in order to interrupt this viscous cycle, especially in vasculopathic patients.
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Affiliation(s)
- Mohamedanwar Ghandour
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ravi K Thimmisetty
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - James Sondheimer
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nashat Imran
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Zeenat Y Bhat
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Yahya Mohamed Osman-Malik
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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2
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Abdulrahim A, Ghandour M, Mohamed AB, Samavati L. The Role of Using Red-Topped - Non-Additive-Containing - Collecting Tube in Diagnosing Pseudohyperkalemia in Chronic Lymphocytic Leukemia. Cureus 2021; 13:e14074. [PMID: 33903836 PMCID: PMC8063070 DOI: 10.7759/cureus.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pseudohyperkalemia in the context of chronic lymphocytic leukemia (CLL) is becoming a common clinical presentation in our daily practice, yet the recognition and the overall approach to this condition remains a challenge as clinicians ponder on whether it's a true rise of serum potassium or not, weighing the risk-benefit ratio of giving the full anti-hyperkalemia measures, dreading the potential iatrogenic hypokalemia if it proves to be a pseudohyperkalemia instead.
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Affiliation(s)
- Ahmed Abdulrahim
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Mohamedanwar Ghandour
- Internal Medicine and Nephrology, Wayne State University Detroit Medical Center, Detroit, USA
| | - Abu-Bekr Mohamed
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Lobelia Samavati
- Pulmonary and Critical Care Medicine, Wayne State University Detroit Medical Center, Detroit, USA
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3
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Ahmed AK, Elkhair AM, Adam O, Ghandour M. A Rare Case of Small Bowel Obstruction Secondary to Pelvic Inflammatory Disease. Cureus 2021; 13:e13983. [PMID: 33884236 PMCID: PMC8054941 DOI: 10.7759/cureus.13983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Small bowel obstruction (SBO) secondary to pelvic inflammatory disease (PID) is a rare complication only reported on a few occasions. We presented a 38-year-old female with an acute abdomen secondary to PID diagnosed via CT and MRI abdomen. The patient was treated in a conservative manner and recovered with no further complications. In our case, the learning point is the consideration of such an etiology in women with no previous surgical history presenting with an acute abdomen.
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Affiliation(s)
- Ahmed K Ahmed
- Radiology, Countess of Chester Hospital, Chester, GBR
| | - Ahamed M Elkhair
- Internal Medicine, University of Medical Sciences and Technology, Khartoum, SDN
| | - Omeralfaroug Adam
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Mohamedanwar Ghandour
- Internal Medicine/Nephrology, Wayne State University Detroit Medical Center, Detroit, USA
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Shereef H, Ahmed M, Ghandour M, Tapia-Zegarra G. A Rare Case Report of Ruptured Cyst Presenting With Acute Meningitis in an Untreated Neurocysticercosis. Cureus 2021; 13:e13222. [PMID: 33728172 PMCID: PMC7945967 DOI: 10.7759/cureus.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neurocysticercosis (NCC) rarely presents as acute meningitis; however, when it does, it is not distinguishable clinically from other more common infectious etiologies. Here, we report a case of NCC presenting as acute meningitis, which also highlights the importance of brain MRI imaging rather than CT where possible, the need to include MRI of the spine in patients with the subarachnoid disease, and the limitations of NCC antigen detection assay in cerebrospinal fluid when used in ventriculoperitoneal shunt specimens. A prolonged course of albendazole, praziquantel, and corticosteroids led to the resolution of our patient's NCC.
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Affiliation(s)
| | - Mahad Ahmed
- Internal Medicine, Beaumont Health, Dearborn, USA
| | - Mohamedanwar Ghandour
- Internal Medicine/Nephrology, Wayne State University Detroit Medical Center, Detroit, USA
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Ghandour M, Shereef H, Adam O, Osman-Malik Y, Bhat Z. Discontinuation of Intermittent Hemodialysis in HIV-Associated Nephropathy Following Initiation of Antiretroviral Therapy. Cureus 2021; 13:e13181. [PMID: 33717725 PMCID: PMC7939417 DOI: 10.7759/cureus.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection occurs due to the HIV virus. It results in an immunodeficient state and multi-organ system infections and malignancy known as AIDS. HIV-associated nephropathy (HIVAN) is the most common HIV kidney involvement and may present as acute kidney injury (AKI), as well as chronic kidney disease (CKD). HIVAN is a collapsing form of focal segmental glomerulosclerosis (FSGS). HIVAN treatment options include antiretroviral therapy (ART), steroids, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and hemodialysis (HD). We herein describe the case of a 40-year-old patient with an established diagnosis of HIVAN who has had partial recovery of end-stage renal failure following the initiation of ART.
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Affiliation(s)
- Mohamedanwar Ghandour
- Internal Medicine/Nephrology, Detroit Medical Center, Wayne State University, Detroit, USA
| | | | - Omeralfaroug Adam
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Yahya Osman-Malik
- Nephrology, Detroit Medical Center, Wayne State University, Detroit, USA
| | - Zeenat Bhat
- Internal Medicine/Nephrology, Detroit Medical Center, Wayne State University, Detroit, USA
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Ghandour M, Bhat ZY, Rossi NF, Ciccotelli G, Osman-Malik Y. Wayne State University Nephrology service experience in the constraint of COVID-19. Ther Apher Dial 2021; 25:1012-1013. [PMID: 33528080 PMCID: PMC8014492 DOI: 10.1111/1744-9987.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Zeenat Y Bhat
- Wayne State University, Nephrology Division, Detroit, Michigan, USA
| | - Noreen F Rossi
- Wayne State University, Nephrology Division, Detroit, Michigan, USA
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Ghandour M, Shereef H, Homida H, Revankar S, Zachariah MS. Disseminated Nocardiosis in a Renal Transplant Recipient. Cureus 2021; 13:e12497. [PMID: 33564506 PMCID: PMC7861065 DOI: 10.7759/cureus.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nocardiosis is an uncommon opportunistic Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia can cause localized or systemic suppurative diseases involving eyes, kidneys, skin, lungs, bone, and central nervous system. Disseminated nocardiosis is a rare condition, seen among immunocompromised patients. We report the case of a 55-year-old African American, kidney transplant male recipient on maintenance immunosuppression, who was diagnosed with cutaneous and pulmonary nocardiosis. Presenting symptoms were shortness of breath, and bilateral lower extremities pain and swelling. Tissue culture grew Gram-positive bacilli specified as Nocardia farcinica from thigh and gluteal abscesses. CT thorax showed bilateral reticulonodular opacities. The patient was managed with immunosuppression reduction and specific treatment with high-dose trimethoprim-sulfamethoxazole (TMP-SMX) in conjunction with linezolid. Combination antibiotics were continued for four weeks, and thereafter, TMP-SMX alone was continued for 12 months, at which point all lesions had healed. Nocardiosis with systemic involvement carries a poor prognosis. However, early diagnosis and appropriate antibiotic coverage had a favorable outcome in a renal transplant recipient. Recommended treatment duration is 6 to 12 months.
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Affiliation(s)
- Mohamedanwar Ghandour
- Internal Medicine/Nephrology, Wayne State University Detroit Medical Center, Detroit, USA
| | | | - Hassan Homida
- Internal Medicine, Advocate Aurora Health Care, Detroit, USA
| | - Sanjay Revankar
- Infectious Diseases, Wayne State University Detroit Medical Center, Detroit, USA
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Ghandour M, Shereef H, Khalid M, Adam O, Hashim A, Yeddi A, Osman-Malik Y. Prevalence, Length of Stay, and Hospitalization of Acute Kidney Injury in Patients With and Without Sjogren's Syndrome. Can J Kidney Health Dis 2020; 7:2054358120970092. [PMID: 33240517 PMCID: PMC7672769 DOI: 10.1177/2054358120970092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Literature on the outcome of acute kidney injury (AKI) in Sjogren’s syndrome (SJS) is quite scanty. Acute kidney injury has emerged as a significant cause of morbidity and mortality in patients with autoimmune diseases such as systemic lupus erythematosus. Objective: To examine the outcome of AKI with and without SJS. To achieve this, we examined the prevalence, mortality, outcomes, length of stay (LOS), and hospital charges in patients with AKI with SJS compared with patients without SJS from a National Inpatient Sample (NIS) database in the period 2010 to 2013. Design: A retrospective cohort study using NIS. Setting: United States. Sample: Cohort of 97 055 weighted patient discharges with AKI from the NIS. Measurements: Not applicable. Methods: Data were retrieved from the NIS for adult patients admitted with a principal diagnosis of AKI between 2010 and 2013, using the respective International Classification of Diseases, Ninth Revision (ICD-9) codes. The study population divided into 2 groups, with and without Sjogren’s disease. Multivariate and linear regression analysis conducted to adjust for covariates. We omitted patients with systemic sclerosis and rheumatoid arthritis from the analysis to avoid any discrepancy as they were not meant to be a primary outcome in our study. Results: The study population represented 97 055 weighted patient discharges with AKI. Analysis revealed AKI patients with Sjogren’s compared with patients without Sjogren’s had statistically significant lower hyperkalemia rates (adjusted odds ratio: 0.65, confidence interval: 0.46-0.92; P = .017. There was no statistically significant difference in mortality, LOS, hospital charges, and other outcomes. Limitations: Study is not up to date as data are from ICD-9 which are testing data from 2010 to 2013, and data were obtained through SJS codes, which have their limitations. Also, limitations included lack of data on metabolic acidosis, hypokalemia, and not including all causes of AKI. Conclusions: At present, our study is unique as it has examined prevalence, mortality, and outcomes of Sjogren’s in patients with AKI. Patients with Sjogren’s had significantly lower hyperkalemia during the hospitalization. Further research is needed to identify the underlying protective mechanisms associated with Sjogren’s that resulted in lower hyperkalemia. Trial registration: Not applicable.
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Affiliation(s)
- Mohamedanwar Ghandour
- Nephrology Division, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
- Mohamedanwar Ghandour, Nephrology Division, Department of Internal Medicine, Detroit Medical Center, Wayne State University, 4160 John R, Suite 908, Detroit, MI 48201, USA.
| | - Hammam Shereef
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Mowyad Khalid
- Department of Internal Medicine, Beaumont Hospital, Detroit, MI, USA
| | - Omeralfaroug Adam
- Department of Internal Medicine, Beaumont Hospital, Detroit, MI, USA
| | - Ahmed Hashim
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Ahmed Yeddi
- Department of Internal Medicine, Beaumont Hospital, Detroit, MI, USA
| | - Yahya Osman-Malik
- Nephrology Division, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Hines SL, Agarwal A, Ghandour M, Aslam N, Mohammad AN, Atwal PS. Novel variants in COL4A4 and COL4A5 are rare causes of FSGS in two unrelated families. Hum Genome Var 2018; 5:15. [PMID: 30002862 PMCID: PMC6039481 DOI: 10.1038/s41439-018-0016-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 01/05/2023] Open
Abstract
We report two female patients with focal segmental glomerulosclerosis and chronic kidney disease. The first patient was found to have a heterozygous, de novo, pathogenic variant in COL4A5 (c.141+1G>A, IVS2+1G>A), which is associated with Alport syndrome. The second patient was found to have a heterozygous, likely pathogenic variant in COL4A4 (c.2842G>T). Both these variants in COL4A5 and COL4A4 are novel, and they were detected using whole exome sequencing and gene panel testing, respectively. Additionally, we discuss the complexities of diagnosis in such cases and the benefits of using the abovementioned diagnostic approaches.
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Affiliation(s)
- Stephanie L Hines
- 1Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Anjali Agarwal
- 2Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL 32224 USA
| | | | - Nabeel Aslam
- 1Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Ahmed N Mohammad
- 2Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL 32224 USA.,3Department of Nephrology, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Paldeep S Atwal
- 2Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL 32224 USA
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Burger CD, Ghandour M, Padmanabhan Menon D, Helmi H, Benza RL. Early intervention in the management of pulmonary arterial hypertension: clinical and economic outcomes. Clinicoecon Outcomes Res 2017; 9:731-739. [PMID: 29200882 PMCID: PMC5703162 DOI: 10.2147/ceor.s119117] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) has a high morbidity rate and is fatal if left untreated. Increasing evidence supports early intervention, possibly with initial combination therapy. PAH-specific pharmaceuticals, however, are expensive and may have serious adverse effects, particularly when used in combination. The currently dynamic health care economy reinforces the need for a review of early intervention from both outcomes and economic perspectives. We aimed to review the clinical and economic impact of PAH therapy, particularly examining drug cost, hospitalization burden, and health care economics impact, and the effect of early intervention on clinical outcomes. We searched PubMed, Scopus, Ovid, and MEDLINE databases from 2005 to 2017 for studies comparing drug cost, clinical outcomes, and hospitalization burden associated with therapy for PAH. Emerging data indicate that early therapy is effective, but drug therapy is expensive, particularly with combination therapy. Efficacy studies also generally show benefit of combination therapy for patients in World Health Organization functional class II, with a consistent decrease in hospitalization. Pharmacoeconomic studies are limited but indicate that increased pharmacy costs are at least partially offset by decreased health care utilization, particularly inpatient care. Modeling also shows a cost benefit with combination therapy at 2 years. Nonetheless, more rigorously collected health care economic data should be incorporated into future drug efficacy trials to provide a clearer understanding of the impact and the associated cost benefit of early PAH therapy. Increasing evidence in support of early intervention and combination therapy for PAH is associated with rising medication costs that are largely offset by reduced hospitalization, on the basis of the currently available literature. Nonetheless, the studies performed to date have methodologic limitations that highlight the need for prospective studies using more robust economic modeling.
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Affiliation(s)
| | | | | | - Haytham Helmi
- Division of Transplant Medicine and Research Administration, Mayo Clinic, Jacksonville, FL, USA
| | - Raymond L Benza
- Advanced Heart Failure, Transplant, Mechanical Circulatory Support and Pulmonary Hypertension, Allegheny Health Network, Pittsburg, PA, USA
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Ghandour M, al Halees Z, Duran C. A simple method for intraoperative visualization of the repaired aortic valve. J Thorac Cardiovasc Surg 1994; 107:632-4. [PMID: 8302093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
This study investigated the effect of television-mediated aggression and real-life aggression on the behavior of Lebanese children. The sample consisted of 48 boys and 48 girls of Lebanese origin who were students in an elementary school in Beirut, Lebanon. After controlling for pre-experimental aggression, the subjects were randomly assigned to one of the following treatment conditions: human-film aggression, cartoon-film aggression, neutral film, or real-life (act of war) aggression. The results indicated that boys as a group were more aggressive than girls and exhibited more imitative aggression after viewing both violent film and real-life violence. Girls were not more violent after viewing filmed aggression but were affected by the real-life violence. Comparisons of Bandura's work within the Lebanese culture are made.
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Mardini MK, Gergen P, Akhtar M, Ghandour M. Niemann-Pick disease: report of a case with skin involvement. Am J Dis Child 1982; 136:650-1. [PMID: 7091102 DOI: 10.1001/archpedi.1982.03970430082029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Fifteen children with inoperable abdominal malignancies underwent percutaneous biopsy. Both fine needle aspiration (FNA) and core biopsies using a cutting needle were obtained. In 5 of the 15 specimens obtained by FNA, the material obtained showed malignant cells but did not allow a precise diagnosis to be made. In a sixth case, the diagnosis made on a FNA specimen proved to be incorrect. In contrast, all 15 specimens obtained with a cutting needle were diagnostic. No complications were observed following these procedures. Core biopsies appear to be a safe and reliable means of obtaining tissue for diagnosis in children with inoperable solid abdominal masses.
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Abstract
An infant with aplastic alae nasi, imperforate anus, focal aplasia cutis over the fontanels, microcephaly, and mental retardation is presented as an example of the Johanson-Blizzard syndrome. The infant failed to thrive and had evidence of malabsorption. He died at 4 months of age. The occurrence of extensive consanguinity in his family and the occurrence of two other members of the kindred with a similar syndrome indicate that this disorder is transmitted by an autosomal recessive gene.
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Stephan F, Ghandour M, Réville P, de Laharpe F, Thierry R. [Variation in serum nonesterified fatty acids during glucose tolerance test in undernourished patients with anorexia nervosa and in obese patients]. Sem Hop 1977; 53:661-6. [PMID: 194319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intravenous glucose tolerance tests (0,33 g glucose per kg body weight) are performed in 11 self starved women suffering from anorexia nervosa, 10 obese and 8 normal women. They have no genetic or chemical diabetes and belong to the same age group. Plasma concentrations of immuno-reactive insuline (IRI) and non esterified fatty acids (NEFA) are determined during these tests. The basal concentrations of NEFA are very high in the obese patients. In the starved women the elevation of the basal plasma NEFA concentration is less striking and statistically not significant. The plasma level of NEFA is reduced in all subjects by hyperinsulinism secondary to hyperglycemia. This drop in NEFA concentration is significantly reduced in the obese patients and markedly inhibited in the starved women. This observation points toward an increased resistance to the antilipolytic action of insulin in anorexia nervosa because, in these patients, the glucose load determines a normal increase in plasma IRI but the fall in plasma NEFA concentration is severely impaired.
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Mishalany HG, Der Kaloustian VM, Ghandour M. Familial congenital duodenal atresia. Pediatrics 1970; 46:629-32. [PMID: 5503698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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