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Guo J, Malik G, Wasilenko S, Halloran B, Montano-Loza AJ, Zepeda-Gomez S. A118 BALLOON-ASSISTED ENTEROSCOPY TIMING INCREASES DIAGNOSTIC YIELD IN PATIENTS WITH OVERT OBSCURE GASTROINTESTINAL BLEEDING: A RETROSPECTIVE STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991250 DOI: 10.1093/jcag/gwac036.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from an unknown etiology despite initial investigations with upper endoscopy and colonoscopy, of which 75-80% is attributed to a small bowel (SB) source. OGIB poses a significant diagnostic and therapeutic challenge, resulting in high morbidity and mortality with increased utilization of health care resources. Balloon-assisted enteroscopy (BAE) is a useful procedure for the evaluation and management of small bowel bleeding, with reported diagnostic and therapeutic rates up to 87% and 80%, respectively. Purpose This retrospective study aims to evaluate the diagnostic and therapeutic yields in a large cohort of adult patients presenting with different subtypes of OGIB who have undergone BAE, as well as to assess for association between various patient and disease factors, and clinical outcomes. Method We performed a retrospective review of 1057 cases of BAE at a large quaternary referral centre between 2016 to 2021 and 158 OGIB cases were identified. Sex, age, and, preprocedural variables including indication, time from video capsule endoscopy (VCE) to BAE and subclassification of SB bleed were collected. Endoscopic modality, findings, and therapeutic interventions were used to calculate diagnostic and therapeutic yields. The association between the timing of BAE relative to VCE and clinical outcomes including rebleeding rate, diagnostics and therapeutic yields were assessed. Bleeding free-survival was estimated using Kaplan-Meier function. All data analyses were performed with SPSS. Result(s) The overall diagnostic yield of BAE was 74%. Patients with active overt bleeding were found to have a statistically significant higher yield compared to those with inactive overt bleeding (94% vs 67%, P= 0.03). The therapeutic yield was 51%, with a significantly higher rate of injection therapy and hemoclip placement in those with active overt bleeding compared to those with inactive overt and occult bleeding (P< 0.001). BAE performed within 72 hours of overt GI bleeding was found to have a statistically significant higher diagnostic yield when compared to procedures performed after 72 hours (94% vs 67%, p =0.05). Univariable analysis revealed higher diagnostic yield in patients requiring transfusion within the past 12 months (P= 0.02) Finally, rebleeding-free survival in all patients at 1 year and 5 years was 98% and 68%, respectively. Image ![]()
Conclusion(s) Balloon-assisted enteroscopy continues to be an effective diagnostic and therapeutic modality for the investigation of obscure gastrointestinal bleeding. Our retrospective study shows a higher diagnostic yield in those presenting with active overt GI bleed as well as those who underwent BAE within 72 hours of overt GI bleeding. Furthermore, patients who required transfusion within the past 12 months are more likely to have a positive BAE finding. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- J Guo
- Division of Gastroenterology, Department of Medicine, The University of Alberta, Edmonton, Canada
| | - G Malik
- Division of Gastroenterology, Department of Medicine, The University of Alberta, Edmonton, Canada
| | - S Wasilenko
- Division of Gastroenterology, Department of Medicine, The University of Alberta, Edmonton, Canada
| | - B Halloran
- Division of Gastroenterology, Department of Medicine, The University of Alberta, Edmonton, Canada
| | - A J Montano-Loza
- Division of Gastroenterology, Department of Medicine, The University of Alberta, Edmonton, Canada
| | - S Zepeda-Gomez
- Division of Gastroenterology, Department of Medicine, The University of Alberta, Edmonton, Canada
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Malik G, Yang DY, Wong K. A206 GALLSTONE IMPACTION IN THE DESCENDING COLON WITH SUCCESSFUL ENDOSCOPIC REMOVAL. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859216 DOI: 10.1093/jcag/gwab049.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Gallstone impaction in the colon is a rare complication of cholelithiasis, typically because of gallstones migrating into the colon via a cholecystocolonic fistula. Gastrointestinal obstruction from gallstones only develops in 0.3–0.5% of patients with cholelithiasis and accounts for 0.095% of all mechanical bowel obstruction. Successful treatment has been described with endoscopic and surgical techniques.
Aims
This report aims to present a case of colonic obstruction from gallstone that was successfully treated endoscopically.
Methods
We conducted a retrospective chart review on one patient including assessing the history of presenting illness along with biochemical, radiographic, and endoscopic results. We then conducted a narrative literature review on this subject matter.
Results
An 85-year-old male with known cholelithiasis complicated by prior cholecystitis presented with a 2-day history of generalized abdominal pain. Computed tomography (CT) showed fistulisation between the gallbladder and hepatic flexure. Follow-up CT with rectal contrast showed lack of contrast beyond an impacted gallstone in the descending colon (Figure 1A, 1B). The patient was deemed a poor surgical candidate thus endoscopic gallstone extraction was attempted. With a pediatric colonoscope, the 41mm x 51mm gallstone was visualized 70cm from anal verge (1C). The stone was too large to be extracted en-block with snare or basket. Attempts to cut the stone at its surface with a polypectomy snare and other tools were unsuccessful because of the roundness and smoothness of the stone. Although we could chip away at the surface, we were unable to break the seal of the stone against the colon mucosa. We found the most effective method was tunneling through the stone’s centre using a closed rat-tooth forceps, then angling the tip of the scope and pulling the scope back to break off fragments from within. A polypectomy snare was used to further breakup larger fragments to prevent repeat impaction (1D). There was underlying diverticular disease and mild ischemic changes to the mucosa but no stricture. The patient did well post-procedure and was able to tolerate oral intake, pass flatus, and pass bowel movements. He was discharged 3 days later.
A recent systematic review found a total of 38 cases of gallstone obstruction of the colon. Majority of patients (73.6%) ultimately required surgical intervention. Overall mortality is 13.1%.
Conclusions
Gallstone impaction in the colon is uncommon with successful endoscopic treatment seldomly described. This report describes a rare complication of gallstone disease that was successfully treated with widely available endoscopic tools.
Funding Agencies
None
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Affiliation(s)
- G Malik
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - D Y Yang
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Medicine, University of Alberta, Edmonton, AB, Canada
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Malik G, Swyka RA, Tiwari VK, Fei X, Applegate GA, Berkowitz DB. A thiocyanopalladation/carbocyclization transformation identified through enzymatic screening: stereocontrolled tandem C-SCN and C-C bond formation. Chem Sci 2017; 8:8050-8060. [PMID: 29568453 PMCID: PMC5855125 DOI: 10.1039/c7sc04083k] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/29/2017] [Indexed: 12/31/2022] Open
Abstract
Herein we describe a formal thiocyanopalladation/carbocyclization transformation and its parametrization and optimization using a new elevated temperature plate-based version of our visual colorimetric enzymatic screening method for reaction discovery. The carbocyclization step leads to C-SCN bond formation in tandem with C-C bond construction and is highly stereoselective, showing nearly absolute 1,2-anti-stereoinduction (5 examples) for substrates bearing allylic substitution, and nearly absolute 1,3-syn-stereoinduction (16 examples) for substrates bearing propargylic substitution. Based upon these high levels of stereoinduction, the dependence of the 1,2-stereoinduction upon cyclization substrate geometry, and the generally high preference for the transoid vinyl thiocyanate alkene geometry, a mechanistic model is proposed, involving (i) Pd(ii)-enyne coordination, (ii) thiocyanopalladation, (iii) migratory insertion and (iv) β-elimination. Examples of transition metal-mediated C-SCN bond formation that proceed smoothly on unactivated substrates and allow for preservation of the SCN moiety are lacking. Yet, the thiocyanate functionality is of great value for biophysical chemistry (vibrational Stark effect) and medicinal chemistry (S,N-heterocycle construction). The title transformation accommodates C-, O-, N- and S-bridged substrates (6 examples), thereby providing the corresponding carbocyclic or heterocyclic scaffolds. The reaction is also shown to be compatible with a significant range of substituents, varying in steric and electronic demand, including a wide range of substituted aromatics, fused bicyclic and heterocyclic systems, and even biaryl systems. Combination of this new transformation with asymmetric allylation and Grubbs ring-closing metathesis provides for a streamlined enantio- and diastereoselective entry into the oxabicyclo[3.2.1]octyl core of the natural products massarilactone and annuionone A, as also evidenced by low temperature X-ray crystal structure determination. Utilizing this bicyclic scaffold, we demonstrate the versatility of the thiocyanate moiety for structural diversification post-cyclization. Thus, the bridging vinyl thiocyanate moiety is smoothly elaborated into a range of derivative functionalities utilizing transformations that cleave the S-CN bond, add the elements of RS-CN across a π-system and exploit the SCN moiety as a cycloaddition partner (7 diverse examples). Among the new functionalities thereby generated are thiotetrazole and sulfonyl tetrazole heterocycles that serve as carboxylate and phosphate surrogates, respectively, highlighting the potential of this approach for future applications in medicinal chemistry or chemical biology.
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Affiliation(s)
- G Malik
- Department of Chemistry , University of Nebraska , Lincoln , NE 68588 , USA .
| | - R A Swyka
- Department of Chemistry , University of Nebraska , Lincoln , NE 68588 , USA .
| | - V K Tiwari
- Department of Chemistry , University of Nebraska , Lincoln , NE 68588 , USA .
| | - X Fei
- Department of Chemistry , University of Nebraska , Lincoln , NE 68588 , USA .
| | - G A Applegate
- Department of Chemistry , University of Nebraska , Lincoln , NE 68588 , USA .
| | - D B Berkowitz
- Department of Chemistry , University of Nebraska , Lincoln , NE 68588 , USA .
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Kang S, Verma S, Teng G, Belke D, Svystonyuk D, Guzzardi D, Park D, Turnbull J, Malik G, Fedak P. DIRECT EFFECTS OF EMPAGLIFLOZIN ON EXTRACELLULAR MATRIX REMODELING IN HUMAN CARDIAC FIBROBLASTS: NOVEL TRANSLATIONAL CLUES TO EMPA-REG OUTCOME. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Svystonyuk D, Malik G, Mewhort H, Guzzardi D, Park D, Belke D, Teng G, Fedak P. SIS-ECM BIOMATERIAL DECREASES HUMAN CARDIAC MYOFIBROBLAST ACTIVATION AND ATTENUATES LOCAL MATRIX REMODELING. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kapoor R, Malik G, Palta J, Hagan M. SU-E-T-469: Implementation of VAs Web-Based Radiotherapy Incident Reporting and Analysis System (RIRAS). Med Phys 2015. [DOI: 10.1118/1.4924831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kapoor R, Palta J, Hagan M, Grover S, Malik G. SU-E-T-524: Web-Based Radiation Oncology Incident Reporting and Learning System (ROIRLS). Med Phys 2014. [DOI: 10.1118/1.4888857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cossburn M, Tackley G, Baker K, Ingram G, Burtonwood M, Malik G, Pickersgill T, te Water Naudé J, Robertson N. The prevalence of neuromyelitis optica in South East Wales. Eur J Neurol 2011; 19:655-9. [PMID: 21967235 DOI: 10.1111/j.1468-1331.2011.03529.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Neuromyeltis optica (NMO) is a neuroinflammatory disorder considered rare in Caucasian populations. However, accurate population-based epidemiological data for NMO and NMO spectrum disorder (NMO-SD) from Western populations employing validated diagnostic criteria remain limited. We sought therefore to estimate the prevalence and clinical features of NMO in a north European Caucasian population in South East Wales. METHODS Patients were identified by a comprehensive, multistage ascertainment strategy employing a regional neuroinflammatory disease register, hospital diagnostic databases personal physician referrals and regional requests for anti-aquaporin-4 antibodies (anti-AQP4). RESULTS Fourteen Caucasian patients (11 patients with NMO and three with NMO-SD) were identified in a population of 712,572 (19.6/million; 95% CIs: 12.2-29.7). There was an excess of females (female:male 12:2), 11/14 were anti-AQP4 positive and 5/14 had disease onset under the age of 20 years. CONCLUSION This study suggests that NMO and related spectrum disorders are at least as frequent in Northern European populations as in non-Caucasian populations and that the demographic profile of prevalent patients differs from clinic-based cohorts.
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Affiliation(s)
- M Cossburn
- The Department of Psychological Medicine and Neurology, Cardiff University, Cardiff, UK
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Abstract
INTRODUCTION Childhood asthma is a common condition and the prevalence has increased in many countries during the late 20th century. The Aberdeen schools asthma surveys reported rising lifetime prevalence of asthma between 1964 and 2004 in children aged 9-12 years, but a fall in wheeze in the last 3 years between 1999 and 2004. The present study tested the hypothesis that lifetime childhood asthma prevalence has fallen since 2004. METHODS Children aged 9-12 years who attended the same schools surveyed since 1964 were invited to participate. A lifetime history of asthma or eczema and also wheeze in the past 3 years and 12 months was ascertained from a questionnaire. Trends over 1999, 2004 and 2009 were analysed with adjustment for age, gender and an index of deprivation. RESULTS There were 2253 eligible children and 1196 (53%) questionnaires were returned. The lifetime prevalence of asthma rose from 24.3% in 1999 to 28.4% in 2004 but fell to 22.1% in 2009 (p<0.001), while wheeze in the last 3 years fell from 27.9% in 1999 to 25.2% in 2004 and fell further to 22.2% in 2009 (p<0.001). The lifetime prevalence of eczema among 9-12 year olds was 21.4% in 1999, 34.1% in 2004 and 30.7% in 2009 (p<0.001). Reductions in symptom prevalences between 2004 and 2009 were significant for girls but not boys. CONCLUSION The prevalence of lifetime asthma and wheeze appear to have fallen in school children, especially girls, although the low response rate means some caution is required when interpreting the results. Asthma prevalence remains high and the underlying mechanisms remain incompletely understood.
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Affiliation(s)
- G Malik
- Department of Child Health, University of Aberdeen, Aberdeen, UK
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Kataria RS, Sunder S, Malik G, Mukesh M, Kathiravan P, Mishra BP. Genetic diversity and bottleneck analysis of Nagpuri buffalo breed of India based on microsatellite data. RUSS J GENET+ 2009. [DOI: 10.1134/s1022795409070102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kataria RS, Sunder S, Malik G, Mukesh M, Kathiravan P, Mishra BP. Genetic diversity and bottleneck analysis of Nagpuri buffalo breed of India based on microsatellite data. Genetika 2009; 45:941-948. [PMID: 19705746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this study, 25 heterologous bovine microsatellite markers have been used for the assessment of genetic diversity in Nagpuri buffalo, an important breed of Central India. For this, 48 DNA samples of unrelated individuals of Nagpuri buffalo were PCR amplified and microsatellite alleles were resolved in 6% denaturing, silver stained Urea-PAGE gel. Genotypic status of individuals at each locus was identified manually and data analysis carried out using POPGENE software. Observed number of alleles varied from 2 (ILSTS073 locus) to 8 (HEL13 & ILSTS058 loci) with a mean of 5.24 alleles per locus. Moderate level of heterozygosity (0.45) indicated sufficient genetic diversity existing in this buffalo population. PIC values for the microsatellite loci analysed, ranged from 0.10 (ILSTS019 locus) to 0.81 (ILSTS058 locus) with a mean of 0.53. No shift in the frequency distribution of alleles and a normal L-shaped curve indicated non-existence of any bottleneck in Nagpuri. The study thus highlights the usefulness of heterologous bovine microsatellite markers to assess the genetic variability in buffalo breeds as well. Also various diversity indices suggest sufficient genetic variability within Nagpuri buffalo that can be utilized as initial guidelines for future breeding strategies and conservation.
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Affiliation(s)
- R S Kataria
- DNA Fingerprinting Unit, National Bureau of Animal Genetic Resources, P.B. 129, GT Road By-Pass, Karnal- 132 001, Haryana, India.
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Gupta N, Choudhary S, Malik G, Pandey A, Gupta SC. Single nucleotide polymorphism (SNP) in prion protein gene (PRNP) exon-3 in Gaddi sheep. Dev Biol (Basel) 2008; 132:261-266. [PMID: 18817311 DOI: 10.1159/000317169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Nine PCR-SSCP conformations in PRNPthe exon-3 genomic DNA segment covering codons 136, 154 and 171 were observed. DNA sequences revealed 9 unique variants (DQ885789-DQ885796). At codon 171 of exon-3, two alleles, Q and R, had a frequency of 0.336 and 0.664, respectively. Genotypes QQ, QR and RR were observed in 25.86, 15.51 and 58.62% of animals, respectively, showing deviation from Hardy-Weinberg equilibrium. At codon 154, all genotypes were RR. At codon 136 AA, AV and W genotypes were 86.21, 10.34 and 3.44%, respectively, and frequencies of the alanine (A) and valine (V) alleles were 0.914 and 0.086, respectively, where the W genotype had lower frequency than expected. Polymorphisms were also observed at codons 137, 143 and 173 of exon-3.
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Kumar D, Sharma R, Pandey AK, Gour DS, Malik G, Ahlawat SPS, Jain A. Genetic diversity and bottleneck analysis of Indian bellary sheep by microsatellite markers. RUSS J GENET+ 2007. [DOI: 10.1134/s1022795407090050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kumar D, Sharma R, Pandey AK, Gour DS, Malik G, Ahlawat SPS, Jain A. Genetic diversity and bottleneck analysis of Indian bellary sheep by microsatellite markers. Genetika 2007; 43:1198-1208. [PMID: 17990518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Bellary sheep population variability and structure was investigated genetically utilizing FAO recommended microsatellite markers. Genetic variation at 20 microsatellite loci, population structure, and genetic bottleneck hypothesis were examined. Estimates of genetic variability such as effective number of alleles and gene diversities revealed substantial genetic variation frequently displayed by microsatellite markers. A total of 133 alleles were detected. Average polymorphism across the studied loci and expected gene diversity in the population were 1.419 +/- 0.405 and 0.684 +/- 0.140, respectively. No significant genotypic linkage disequilibrium was detected across population, suggesting no evidence of linkage between loci. The population was observed to be significantly differentiated into different groups, showed fairly high level of inbreeding (f = 0.253 +/- 0.050) and global heterozygote deficit. Population structure analysis indicated the intermixing/introduction of unique/rare alleles in these migrating flocks. A normal L-shaped distribution of mode-shift test, non-significant heterozygosity excess on the basis of different models, as revealed from Sign, Standardized differences and Wilcoxon sign rank tests suggested that there was no recent bottleneck. The study revealed that even breed with increasing population trend needs genetic management for the conservation and improvement.
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Affiliation(s)
- D Kumar
- Small Ruminant Molecular Genetics Laboratory, DNA Fingerprinting Unit, National Bureau of Animal Genetic Resources, Karnal-132 001, Haryana, India
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Gurusamy N, Malik G, Gorbunov N, Das D. Redox activation of Ref-1 potentiates cell survival following myocardial ischemia reperfusion injury. J Mol Cell Cardiol 2007. [DOI: 10.1016/j.yjmcc.2007.03.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Malik G, Turner SW. Is the "instant flow" option on the NIOX analyser needed? Med Eng Phys 2006; 29:72-5. [PMID: 16531093 DOI: 10.1016/j.medengphy.2006.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2005] [Revised: 01/25/2006] [Accepted: 02/01/2006] [Indexed: 11/29/2022]
Abstract
Asthmatics have increased gaseous nitric oxide in their exhaled breath. Measurements of the fraction of nitric oxide in exhaled breath (FE(NO)) are used for the diagnosis and management of asthma. One analyser (the NIOX chemiluminescence analyser) has a feature (restriction of instant flow, IF) which we suspected was responsible for reducing the success rate for obtaining FE(NO) measurements whilst not affecting the measurement itself. In a study involving 38 children, median age 10 years, we observed that FE(NO) values taken in the same individual with and without IF restriction did not differ. We also observed that the success in obtaining a FE(NO) measurement was higher (57%) when IF was not restricted and was lower (41%) when IF was restricted, p=0.002. Our findings do not support the use of restriction of IF on the NIOX analyser.
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Affiliation(s)
- G Malik
- Department of Child Health, Royal Aberdeen Children's Hospital, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZG, United Kingdom
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Abstract
Brucella melitensis Rev 1 organisms were salt-extracted and the cell surface proteins (BCSPs) were found to be mainly 39-42 kDa (group 2 porin proteins) in addition to 31.6, 32.5, 58.5 and 14.7 kDa proteins. DEAE-Sephadex anion-exchange column chromatography of BCSPs yielded fraction 1, which contained one major protein (39.8-42.0 kDa) and a minor protein (31.6 kDa). All these proteins were found to be immunogenic by Western blotting. Fraction 1 along with monophosphoryl lipid A and trehalose dicorynomycolate adjuvants as well as BCSPs alone induced significant (p < or = 0.05) protection in BALB/c mice. Both these immunizing agents produced almost equivalent protection to live B. melitensis Rev 1 vaccine at 15 and 30 days post challenge. Lymphocyte stimulation test as well as delayed-type hypersensitivity reaction revealed that both these preparations induced cell-mediated immune response. These preparations also induced humoral immune response as indicated by indirect ELISA. Neither of the immune responses was significantly less (p < or = 0.05) than that with live B. melitensis Rev 1 vaccine, except that their duration was short.
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Affiliation(s)
- N K Mahajan
- Department of Veterinary Epidemiology and Preventive Medicine, CCS Haryana Agricultural University, Hisar-125 004, India.
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Abstract
Interferon-alpha (IFN-alpha) is a naturally occurring cytokine. It was the first cytokine used with clinical benefit in the treatment of viral hepatitis and malignancies. Patients with viral hepatitis B or C may have complications with glomerulonephritis (GN). Improvement in proteinuria with or without clearing of viral markers after IFN-alpha therapy has been reported. This encouraged us to offer IFN-alpha therapy to four patients with GN. These patients refused treatment with steroids and/or cyclophosphamide because of concerns about side effects. One patient with membranous GN and two patients with mesangial GN (MesGN) had a remission of nephrotic syndrome. In one patient with type II diabetes and MesGN, renal insufficiency and proteinuria did not subside; however, renal function remained stable. The mechanism of action of IFN-alpha is discussed, with its possible role in the treatment of primary GN.
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Affiliation(s)
- J Al-Wakeel
- Division of Nephrology, King Khalid University Hospital, Riyadh, Saudi Arabia.
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Malik G, Abdulrauf S, Yang XY, Gutierrez JA, Rempel SA. Expression of transforming growth factor-beta complex in arteriovenous malformations. Neurol Med Chir (Tokyo) 1999; 38 Suppl:161-4. [PMID: 10235000 DOI: 10.2176/nmc.38.suppl_161] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The factors responsible for the development of cerebral arteriovenous malformations (AVMs) are not well known. Patients with hereditary hemorrhagic telangiectasia (HHT) have cutaneous vascular dysplasia and a high propensity to develop systemic and cerebral AVMs. Transforming growth factor-beta (TGF-beta) complex has been implicated in HHT. The aim of this study was to evaluate the expression of TGF-beta 1, TGF-beta 2, TGF-beta 3, and their two receptors (R1 and R2) in AVMs and in normal brain vessels. Formalin-fixed, paraffin-embedded tissues from 20 patients with cerebral AVMs (including two patients with HHT) were sequentially sectioned into 6 microns sections. Similar sections from normal brain tissue were obtained from five patients without AVMs and no intracranial pathology, who had died from unrelated causes. The normal tissue sections included large intracranial arteries, small arteries, venous sinuses, cortical veins, and brain tissue containing arterioles, capillaries, and venules. All specimens underwent immunohistochemical analyses with polyclonal antibodies to the following antigens: TGF-beta 1, TGF-beta 2, TGF-beta 3, and R1 and R2. The immunoreactivity, when present, was consistently noted in endothelial cells and in the medial smooth muscle. The intensity of vessel wall immunostaining was graded on a scale from 0 to 3. The mean staining grades of normal vessels for TGF-beta 1, TGF-beta 2, TGF-beta 3, R1, and R2 were 0.6 (range 0-1), 3, 2.8 (range 2-3), 1.6 (range 0-2), and 3, respectively, whereas the mean staining grades of AVM vessels were 0.3 (range 0-1), 0.8 (range 0-1), 0.6 (range 0-1), 1.4 (range 0-2), and 0.9 (range 0-1), respectively. The study thus demonstrated that normal brain vessels (arteries, veins, small vessels) have strong (range 2.8-3) immunostaining for TGF-beta 2, TGF-beta 3, and R2, and that the AVM nidus vessels have a paucity (range 0.8-0.9) of staining for these factors. In AVM vessels that had zero immunoreactivity to the above three factors, the vessel wall was fibrocollagenous rather than muscular. Further studies to examine the TGF-beta complex behavior in AVMs are needed.
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Affiliation(s)
- G Malik
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Abu-Eshy S, Malik G. Reply: Schistomiasis and appendicitis. Ann Saudi Med 1996; 16:477. [PMID: 17372524 DOI: 10.5144/0256-4947.1996.477a] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Landi J, Silbergleit R, Mehta B, Khanna R, Malik G. Intact circle of Willis: Protection against SAH-induced vasospasm. Acad Radiol 1995. [DOI: 10.1016/s1076-6332(05)80635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gallen CC, Schwartz BJ, Bucholz RD, Malik G, Barkley GL, Smith J, Tung H, Copeland B, Bruno L, Assam S. Presurgical localization of functional cortex using magnetic source imaging. J Neurosurg 1995; 82:988-94. [PMID: 7760203 DOI: 10.3171/jns.1995.82.6.0988] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The boundaries of somatosensory cortex were localized noninvasively by means of a large-array biomagnetometer in six patients with mass lesions in or near eloquent cortex. The results were used by neurosurgeons and neurologists in preoperative planning and for reference in the operating room. The magnetic source imaging (MSI) localizations from somatosensory evoked potentials were used to predict the pattern of phase reversals measurable intraoperatively on the cortical surface, providing a quantitative comparison between the two measures. The magnetic localizations were found to be predictive in all six cases, with the two sets of localizations falling within an 8-mm distance on average. Somatosensory localizations using MSI offer accuracy in localizing somatosensory cortex stereotactically and in depicting its relationship to lesions. Such data are valuable preoperatively in assessing the risks associated with a proposed surgical procedure and for optimizing subsequent minimum-risk surgical strategy.
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Affiliation(s)
- C C Gallen
- Scripps Research Institute, La Jolla, California, USA
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24
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Zamorano L, Chavantes C, Dujovny M, Malik G, Ausman J. Stereotactic endoscopic interventions in cystic and intraventricular brain lesions. Acta Neurochir Suppl (Wien) 1992; 54:69-76. [PMID: 1595412 DOI: 10.1007/978-3-7091-6687-1_10] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Image guided stereotaxis is an accurate and safe method of directing therapy to target volumes defined in two-dimensional (2D) multiplanes or three-dimensional (3D) perspectives using computer reconstruction of image data. The major limitations of stereotactic techniques are related to a lack of intraoperative visualization and direct monitoring of the procedures and to changes of intracranial coordinates after decompression of cystic lesions or aspiration of cerebrospinal fluid in the management of intraventricular lesions. Endoscopic laser stereotaxis (ELS) involves integration of rigid-flexible endoscopy and Nd-YAG laser to 3D-2D multiplanar image-guided stereotactic procedures. The major advantages of ELS include: direct intraoperative visualization, hemostasis, evacuation or resection assessment, and wide exploration of intracranial cavities or ventricles. The technique allows safe aspiration, biopsy, and resection or internal decompression of deep and subcortical intracranial lesions. ELS has proved to be safe and effective in the management of 76 clinical cases and appears to be a promising technique in the management of cystic and intraventricular lesions.
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Affiliation(s)
- L Zamorano
- Henry Ford Neurosurgical Institute, Department of Neurological Surgery, Detroit, MI
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25
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Elzouki AY, al-Nassar K, al-Ali M, Malik G, Elsharie F, Jaiswal OP. Sister chromatid exchange analysis in monitoring chlorambucil therapy in primary nephrotic syndrome of childhood. Pediatr Nephrol 1991; 5:59-61. [PMID: 2025541 DOI: 10.1007/bf00852847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sister chromatid exchange (SCE) analysis is the most sensitive method for assessing chromosome damage induced by chemical mutagens. We report the SCE of peripheral blood lymphocytes in children with primary nephrotic syndrome (NS) treated with chlorambucil. Group I consisted of 20 normal children, group 2 of 14 children with primary NS who had never received a cytotoxic drug and group III of 7 children with primary NS who had received chlorambucil, which was discontinued 6-36 months prior to the study. Group IV consisted of 4 nephrotic children who were receiving chlorambucil therapy during the study. There was no significant increase in SCE in group III compared with group I or group II (P much greater than 0.05). A significant rise in SCE (P less than 0.05) was seen in all patients in group IV.
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Affiliation(s)
- A Y Elzouki
- Department of Paediatrics, Faculty of Medicine, Kuwait University
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26
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Zamorano L, Bauer-Kirpes B, Dujovny M, Malik G, Ausman J. Application of multimodality imaging stereotactic localization in the surgical management of vascular lesions. Acta Neurochir Suppl (Wien) 1991; 52:67-8. [PMID: 1792971 DOI: 10.1007/978-3-7091-9160-6_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Multidimensional image preplanning and accurate pre and intraoperative localization for intracranial vascular lesions have been implemented. Methodology include carbon fiber base ring, localizer plates, any X-ray tubes, PC compatible software and intraoperative localizing unit. Surgical management of deep arteriovenous malformations is especially suitable for this technique, including the use of intraoperative digital angiography.
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Affiliation(s)
- L Zamorano
- Henry Ford Neurosurgical Institute, Detroit, MI
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27
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Zamorano L, Dujovny M, Chavantes C, Malik G, Ausman J. Image-guided stereotactic centered craniotomy and laser resection of solid intracranial lesions. Stereotact Funct Neurosurg 1990; 54-55:398-403. [PMID: 2080356 DOI: 10.1159/000100242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A technique in which solid intracranial lesions are removed using computerized image processing under stereotactic conditions is described. A specially developed carbon fiber ring holder compatible with most image studies is used as a reference system. Intraoperatively it affords freedom of patient positioning and unobstructed access to any site of the head. Four position alternatives of the aiming device allow the removal of lesions from any location. For superficial lesions located near eloquent areas, a 'centered' craniotomy is performed, usually under local anesthesia, and removal is performed using loupe magnification, bipolar coagulation ultrasonic aspiration of the Nd:YAG laser fiber in the contact or noncontact technique. In deep-seated lesions, a surgical 'corridor' is established and kept by means of retractors adapted for use with the stereotactic apparatus. Microsurgical techniques and the CO2 laser are used in solid lesions; in vascular lesions, bipolar coagulation or the ND:YAG laser can be used. Centered craniotomy allows the precise localization, enhancement, three-dimensional orientation and removal of lesions with minimal trauma to the surrounding brain. The technique has been applied in 78 cases where the extreme accuracy of the technique, benign postoperative course and short hospitalization have been impressive.
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Affiliation(s)
- L Zamorano
- Henry Ford Neurosurgical Institute, Detroit, Mich
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Zamorano L, Katanick D, Dujovny M, Yakar D, Malik G, Ausman JI. Tumour recurrence vs radionecrosis: an indication for multitrajectory serial stereotactic biopsies. Acta Neurochir Suppl (Wien) 1989; 46:90-3. [PMID: 2549769 DOI: 10.1007/978-3-7091-9029-6_22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
External RT has been proved to be an important adjuvant to surgery in the treatment of malignant glioma. It has also been demonstrated, that its effect on survival is dose-dependent, although accompanied by a higher morbidity. Intents to localize the field of high dose RT to the tumour area have been performed with the aim to spare damage of the normal brain tissue. Between August 1983 to December 1987, 40 patients with malignant astrocytoma (16 GM, 24 AA) underwent high dose localized hyperfractionated external RT after surgical resection. Patients received 57.6 Gy to the tumour and oedema area associated with a boost localized to the tumour of 7.4, 14.4 or 24 Gy. In the follow-up, 16 patients died with evidence of increase in size of lesion diagnosed by CT/MRI. Since July 1987, 12 patients with recurrence or increase on size of CT/MRI lesion have undergone multitrajectory serial stereotactic biopsies. From the biopsies 8 patients were histologically diagnosed was compatible with radionecrosis. From the 4 recurrences, 2 patients were treated with 125I implants and 1 with new resection. Patients with radionecrosis were treated with corticoides and diuretics, obtaining partial or complete remission of symptoms and decrease in size of CT lesion. Undoubtly, Multiplanar/3D multitrajectory serial stereotactic biopsies play a major role in the follow-up of these patients, and accurate diagnosis need to be established for further treatment therapy. The question remains if these localized boost should be replaced by 3D Multiplanar stereotactic interstitial radiotherapy boost after surgery and conventional radiotherapy.
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Affiliation(s)
- L Zamorano
- Department of Neurological Surgery, Henry Ford Hospital Division, Detroit, MI
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Abstract
The "elderly," aged 65 and over, represent a rapidly growing proportion of the American population. Their percentage among the neurosurgical admissions at Henry Ford Hospital increased from 14.4% in 1978 to 22.4% in 1984. Occlusive cerebrovascular disease was the most frequent pathology seen, representing 40% of the population studied. Spinal degenerative myeloradiculopathy represented 14%, tumors 7%, trauma 5.4%, and intracranial hematomas represented 4% of the population. Vascular anomalies represented 3.3% of the patient group, with almost the same number of patients presenting with intracranial hemorrhage. The percentage of patients who were surgically treated was 58%. Mortality was 6.5%, with only 2.5% of the patients requiring special-care-facility placement following release from the hospital. An older group, aged 85 and over, represented 4% of our geriatric population. In the age 85+ group, occlusive cerebrovascular disease was the leading pathology (18% of the population), followed by subdural hematomas (15%), spinal degenerative myeloradiculopathy (11.6%), trigeminal neuralgias (7%), hydrocephalus (4%), vascular anomalies (4%), and tumors (4%). Patients in the age 85+ group were surgically treated in 41% of the cases, with a mortality of less than 10%. In the past, older age (greater than 65 years) was believed to be a contraindication to surgery, however, the increased life expectancy, number, and health of this population made reconsideration of this arbitrary age limit essential. We feel that age alone is not a barrier to proper neurosurgical treatment when other risk factors are adequately managed.
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Zamorano L, Dujovny M, Malik G, Mehta B, Yakar D. Factors affecting measurements in computed-tomography-guided stereotactic procedures. Appl Neurophysiol 1987; 50:53-6. [PMID: 3329883 DOI: 10.1159/000100684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- L Zamorano
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Mich
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31
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Magilligan DJ, Duvernoy C, Malik G, Lewis JW, Knighton R, Ausman JI. Surgical approach to lung cancer with solitary cerebral metastasis: twenty-five years' experience. Ann Thorac Surg 1986; 42:360-4. [PMID: 3767508 DOI: 10.1016/s0003-4975(10)60536-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
From 1960 to 1985, 41 patients underwent resection of a lung cancer and one or more brain metastases. There were 24 men and 17 women ranging in age from 40 to 71 years (average, 56 years). Cell type was adenocarcinoma in 19 patients, squamous in 16, small cell in 4, and large cell in 2. Wedge resection was performed in 4 patients, lobectomy in 20, pneumonectomy in 14, and bilobectomy in 3. Brain irradiation was used for 25 patients (61%). To date, the longest survival is 18.3 years after craniotomy; mean survival is 2.3 years +/- 3.8 (+/- standard deviation). Survival was 55 +/- 7.9% (+/- standard error) at 1 year, 31 +/- 7.4% at 2 years, 21 +/- 6.5% at 5 years, and 15 +/- 6.0% at 10 years. Using multivariate analysis, we evaluated possible significant predictors of improved survival. Only wedge resection was a significant predictor (p less than .01), which suggests better results with a small peripheral lung tumor. Results of our 25 years' experience using an aggressive approach to lung cancer with solitary cerebral metastasis indicate significantly improved patient survival that justifies its widespread use.
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Gabal MA, Awad YL, Morcos MB, Barakat AM, Malik G. Fusariotoxicoses of farm animals and mycotoxic leucoencephalomalacia of the equine associated with the finding of trichothecenes in feedstuffs. Vet Hum Toxicol 1986; 28:207-12. [PMID: 3727349] [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: 01/07/2023]
Abstract
Mycotoxicoses involving horses, rabbits and cattle have been studied. Fusarium tricinctum and T-2 toxin were isolated from all incriminated feedstuffs. Other isolated trichothecenes from the feed included HT-2, verrucarins and roridin. The toxins were separated, identified and quantitated using thin-layer chromatography, gas-liquid chromatography and mass spectrometry. T-2 toxin was detected in amounts varying from 0.5-204 ppm. The contaminated feedstuffs in connection with the affected horses and rabbits, included cereal grains (corn, cornstalks, bran and barley), whereas fescue hay was associated with the mucocutaneous findings in the bovine episode. The effects of the toxin(s) seemed to be host specific and varied according to the different animal species. Horses and rabbits developed primarily central nervous disorders with conspicuous pathological findings in the brain. Hepatitis and nephritis were also seen in naturally intoxicated horses and experimentally fed rats. Affected cattle developed mucocutaneous eruptions around the mouth and nostrils. In addition, dermonecrotic findings were observed involving the extremities, ear and tail. Fusariotoxicoses are toxic conditions of farm animals and man caused by the ingestion of cereal grains and forages contaminated by different fungal species of the genus Fusarium. A variety of clinical and pathological findings have been reported (5,6,10,13,15,17,31). This study concerns neuropathic findings in horses and rabbits and mucocutaneous lesions in cattle in association with T-2 toxin contamination.
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Mikhail GR, Boulos RS, Knighton RS, Rogers JS, Malik G, Ditmars DM, Nichols RD. Cranial invasion by basal cell carcinoma. J Dermatol Surg Oncol 1986; 12:459-64. [PMID: 3700825 DOI: 10.1111/j.1524-4725.1986.tb01935.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The direct spread of basal cell carcinoma (BCC) into the bones of the cranium takes a long period. In its early stages, it may not be detectable by radiography or computerized tomography, but can be visible as pitting during surgery. Invasion through the thickness of the calvarium due to extension of a BCC of the scalp, or involvement of the cribriform plate by spread from an intranasal lesion, is serious. Examples of cranial invasion by BCC are presented. The methods used in diagnosis and treatment are outlined.
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Wu KK, Malik G, Guise ER. Atlantoaxial arthrodesis: a clinical analysis of 22 cases treated at Henry ford hospital. Orthopedics 1982; 5:865-71. [PMID: 24833323 DOI: 10.3928/0147-7447-19820701-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The indications for our 22 cases of atlantoaxial arthrodesis include rupture of transverse ligament, fracture of odontoid process, and absence of odontoid process. The surgical techniques of H-shaped unicortical and bicortical iliac grafts have been described. All our patients experienced satisfactory relief of their symptoms and reversal of their neurological deficits. In spite of the relatively minor postoperative complications, we feel that atlantoaxial fusion is a safe and effective method in treating various diseases of the atlantoaxial region.
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Abstract
Aspergillus fumigatus proved to be the causative organism of dermatitis in chickens. This has been assessed mycologically as well as histopathologically. The histopathological lesions caused by the fungi are fully described. The different factors which might help the establishment of the mycotic infection are discussed.
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