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Biomedical subjects

M K Ali

Publications and source records attributed to M K Ali.

At least 55 records · Page 3Linked to original sources
PubMed1990

Surgical treatment of the cancer patient: preoperative assessment and perioperative medical management.

Cancer patients undergoing surgery often present with unusual and challenging problems. Their age and the fact that they are often chronically ill place them at increased surgical risk. In many instances the need for surgical intervention is crucial to the extent that risk-assessment becomes an academic issue, especially for those patients whose only reasonable chance for either cure or palliation of unbearable disease is surgery. However, the internist's role in these situations often has preoperative, intraoperative, and postoperative ramifications. Preoperatively, the internist assesses operative risk and intervenes, when possible, to reduce the likelihood of surgical complications. Patients who clearly cannot survive surgery may be identified and channeled to other treatment modalities. Intraoperatively, the internist may be called upon to help with the management of acute organ failure, cardiac arrest, or vascular collapse. Following surgery, the internist may help by managing cardiopulmonary problems and treating infectious complications. The critical care internist is therefore an important member of the perioperative team and often provides valuable expertise, which can help to identify and treat problems expediently.

Emergencies↗
PubMed1990

Predicted pulmonary function and survival after pneumonectomy for primary lung carcinoma.

Between 1982 and 1987, 139 patients with primary carcinoma of the lung were treated with pneumonectomy. Thirty-nine patients (28%) were in clinical stage I, 10 (7%) were in clinical stage II, and 90 (65%) were in clinical stage III. Overall actuarial 3-year survival was 33%. Actuarial 3-year survival for patients in clinical stage I was 44%; for those in clinical stage II, 48%; and for those in clinical stage III, 28%. Risk factors for operative mortality examined included preoperative forced vital capacity (FVC) of 2.13 L or less and forced expiratory volume in 1 second (FEV1) of 1.65 L or less, percent predicted FVC of 64% or less and FEV1 of 65% or less, predicted postoperative FVC of 1.31 L or less and FEV1 of 0.89 L or less, and predicted postoperative percent predicted FVC of 41% or less and FEV1 of 34% or less. Operative deaths occurred only in clinical stage III patients (7/90 or 8%). Patients with compromised pulmonary function based on one or more of the examined risk factors were at increased risk for death (2/10) compared with patients with better pulmonary function (5/80 or 6.25%). Actuarial 3-year survival for high-risk clinical stage III patients ranged from 0% to 16% compared with 28% for other clinical stage III patients. Thirty-day mortality for pathological stage III patients was 6.3% (5/79), and 3-year actuarial survival was 24%. No patient in pathological stage III who was at high risk survived beyond 3.1 years. Select individuals with adequate pulmonary function and stage III disease can achieve substantial long-term survival after pneumonectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

Squamous cell carcinoma arising in a plunging ranula.

A case report of a 36-year-old man with a plunging ranula of 15 years' duration, in which squamous cell carcinoma arose from the cyst wall, is presented. Pathogenesis and treatment of ranulas is briefly discussed.

Adult↗
PubMed1989

Determinants of perioperative morbidity and mortality after pneumonectomy.

A total of 197 consecutive patients undergoing pneumonectomy at the M.D. Anderson Cancer Center from 1982 to 1987 were reviewed. Sixty-five variables were analyzed for the predictive value for perioperative risk. The operative mortality rate was 7% (14/197). Patients having a right pneumonectomy (n = 95) had a higher operative mortality rate (12%) than patients having a left pneumonectomy (1%, p less than 0.05). The extent of resection correlated with the operative mortality rate (chest wall resection or extrapleural pneumonectomy, n = 39, 15%; versus simple or intrapericardial pneumonectomy, n = 158, 5%; p less than 0.05). Patients whose predicted postoperative pulmonary function, by spirometry and xenon 133 regional pulmonary function studies, was a forced expiratory volume in 1 second greater than 1.65 L, forced expiratory volume in 1 second greater than 58% of the preoperative value, forced vital capacity greater than 2.5 L, or forced vital capacity greater than 60% of the preoperative value had a lower operative mortality rate (p less than 0.05). Atrial arrhythmia was the most common postoperative complication (23%). Xenon 133 regional pulmonary function studies are useful in predicting the risks of pneumonectomy.

Aged↗
PubMed1989

Cardiac arrhythmia in a CML patient treated with interferons.

We report a case of a 33-year-old woman who developed episodes of palpitation while receiving weekly alternating doses of daily intramuscular recombinant interferon alpha-2a (rIFN alpha-2a) and recombinant interferon gamma (rIFN gamma) for Philadelphia chromosome-positive chronic myelogenous leukemia. The electrocardiogram (ECG) and ambulatory Holter monitoring showed first-degree atrioventricular (A-V) block and episodes of junctional tachycardia. The ECG abnormality and palpitation disappeared after discontinuation of therapy. On rechallenge with recombinant interferon alpha-2b (rIFN alpha-2b) alone, there was recurrent palpitation and first-degree A-V block. Subsequent treatment with various doses of rIFN alpha-2b established a dose-response relationship between rIFN alpha-2b and palpitation in our patient. In view of increasing use of rIFNs in the clinical setting, this potential, albeit uncommon, toxicity requires attention and further investigation.

Adult↗
PubMed1988

Critical cardiologic considerations in the cancer patient.

Aggressive treatment modalities for patients with cancer are often associated with complications or side effects, frequently involving the cardiovascular system. Longer survival of cancer patients can lead to the development of related or unrelated cardiac problems. This article reviews the major cardiac entities necessitating transfer of cancer patients to intensive care facilities and addresses specific management strategies.

Antineoplastic Agents↗
PubMed1987

Coronary artery embolism following cancer chemotherapy.

A 16-year-old patient underwent partial gastrectomy for leiomyosarcoma of the stomach. Following resection, he received combination chemotherapy that included Adriamycin and dimethyltriazenoimidazole carboxamide (DTIC), with the cumulative Adriamycin dose being 405 mg/m2. The patient was subsequently treated with vincristine, actinomycin D, and cyclophosphamide. Six hours after receiving his fourth dose of cyclophosphamide, the patient developed signs and symptoms of acute anterior wall myocardial infarction. Although he recovered from this initial cardiac event, he subsequently experienced several additional episodes of vascular occlusion involving the cerebral, femoral, coronary, and pulmonary arteries. Cardiac catheterization demonstrated all coronary arteries to be normal. Both ventricles were hypokinetic, and bilateral mural thrombi were demonstrated; these were the presumed source of the embolic phenomena. To our knowledge, this is the first description of repeated coronary artery embolization following cancer chemotherapy in a patient without evidence of preexisting cardiac abnormalities.

Adolescent↗
PubMed1986

Outcome of lung cancer patients requiring mechanical ventilation for pulmonary failure.

The prognosis of lung cancer patients who are not candidates for surgery is usually poor. The unfavorable natural history of respiratory failure in this group of patients has been suggested as a causative factor. We analyzed the outcome of 46 consecutive patients with primary lung cancer on whom mechanical ventilators were utilized. Although seven patients were ultimately weaned and survived for at least 24 hours, three of them subsequently died prior to discharge from the hospital. The remaining 39 patients died while using the ventilator. Patient age, tumor cell type, and the etiology of respiratory failure were not significantly different between the weaned and unweaned populations. A difference was noted in the duration of mechanical ventilation: none of the patients who could be weaned required mechanical ventilation for more than six days (range, two to six days). Respiratory failure in the nonsurgical lung cancer patient carries a poor prognosis, and selection of patients for mechanical ventilation should be conservative.

Female↗
PubMed1984

A comparison of cardiac biopsy grades and ejection fraction estimations in patients receiving Adriamycin.

One hundred fifty-eight patients receiving Adriamycin underwent 226 transjugular biopsy procedures. The specimens were evaluated by electron microscopy for evidence of drug-related cardiotoxicity. Ejection fraction determinations using echocardiographic or nuclear techniques at rest were available for 69% and 81% of the patients, respectively. Analysis of the data revealed a correlation between cumulative Adriamycin dose and biopsy grade (p less than 0.02). No similar relationship existed between cumulative Adriamycin dose and ejection fractions obtained at rest or between biopsy grades and ejection fractions. In patients who underwent serial endomyocardial biopsies and serial ejection fraction determinations, the correlation between changes in biopsy grade and ejection fraction was poor. A change in resting ejection fraction detected by either method did not reliably predict a change in biopsy grade. The poor correlation between ejection fractions and biopsy grades could be due in part to the sensitivity and specificity of the Adriamycin-related structural changes in contrast to the wider range of disease processes that can affect myocardial function, and to the fact that structural changes often precede the ejection fraction abnormalities. The greater sensitivity and specificity of the biopsy grade should prove useful in reducing the risks associated with evaluating new anthracyclines and potential myocardial protectors of Adriamycin toxicity.

Biopsy↗
PubMed1984

Small cell bronchogenic carcinoma: factors associated with pneumonia during chemotherapy.

Sixty-five patients with small cell bronchogenic carcinoma were treated with intensive induction chemotherapy and supportive treatment. The clinical course of 43 patients who had pretreatment spirometry and arterial blood gases was studied. Thirteen patients developed pneumonia. Moderate hypoxemia, advanced age, and a low forced expiratory flow 25%-75% were associated with the development of pneumonia. Endobronchial obstruction and neutropenia, other factors associated with infection in cancer patients, appeared to be less important in this patient population.

Adult↗
PubMed1984

Increased therapeutic index of weekly doxorubicin in the therapy of non-small cell lung cancer: a prospective, randomized study.

One hundred patients with non-small cell lung cancer were entered into a randomized evaluation of two schedules of doxorubicin combined with ftorafur, cyclophosphamide, and cisplatin (FACP). Doxorubicin was given either weekly at 20 mg/m2, or every three weeks (standard) at 60 mg/m2. Fifty-two patients were randomized to the FACP/weekly doxorubicin arm and 48 patients to the FACP/standard doxorubicin arm. The FACP/weekly doxorubicin regimen was associated with higher complete and partial remission rates (31% versus 19%), longer response duration (median, 33 versus 21 weeks), and longer survival duration for responders (median, 58 versus 50 weeks). These differences were not significant. Less neutropenia (p = 0.01) and less infectious morbidity (p = 0.05) were observed in the FACP/weekly doxorubicin arm. Twenty-eight patients underwent 35 endomyocardial biopsies to assess doxorubicin-induced cardiotoxicity. Sixteen biopsies were performed in 12 patients receiving cumulative doxorubicin doses ranging from 250 to 1,190 mg/m2 within the FACP/weekly doxorubicin arm. Nineteen biopsies were performed in 16 patients receiving cumulative doxorubicin doses ranging from 250 to 540 mg/m2 within the FACP/standard doxorubicin regimen. The FACP/weekly doxorubicin regimen was associated with significantly lower cardiotoxicity scores (p = 0.01). This study indicates that weekly administered doxorubicin is as effective and less cardiotoxic than the standard schedule.

Adenocarcinoma↗
PubMed1983

Noninvasive cardiac evaluation of patients receiving adriamycin-containing adjuvant chemotherapy (FAC) for stage II or III breast cancer.

Cardiac function was evaluated by noninvasive methods in 55 patients with stage II or III breast cancer treated with adjuvant Adriamycin containing combination chemotherapy (FAC). None of the 44 patients who remained free of disease for a median follow-up period of 36 months, or those who were retreated with Adriamycin up to a median cumulative total dose of 450 mg/m2 (nine patients), developed clinical evidence of cardiac decompensation. The median electrocardiographic QRS voltage and ejection fraction decreased by 11% and 5%, respectively, in the former and by 21% and 10% in the latter group at the conclusion of chemotherapy. These parameters tended to return to the baseline at the time of the last visit. The decreases in QRS voltage and ejection fraction were greater in patients who received radiotherapy and had prior cardiovascular disease than in those without such risks. The remaining two patients were retreated with higher total doses of Adriamycin. Both showed clinical evidence of cardiac decompensation and gradual deterioration of the noninvasively measured parameters of cardiac function. One patient was alive six months after the discontinuation of Adriamycin at a total dose of 842 mg/m2, and the other died of pulmonary embolism two months after receiving a total of 892 mg/m2. Our study shows that Adriamycin can be included in adjuvant therapy without inducing clinically significant alterations in cardiac function; however, patients who have additional risk factors should be monitored closely with noninvasive studies while they receive this drug.

Adult↗
PubMed1983

Immunologic studies of human schistosomiasis. II. Interrelationship of serum and ascitic fluid histamine, IgE and total eosinophils in acute and chronic human schistosomiasis.

Sera and ascitic fluid of 26 patients with acute and chronic schistosomiasis were studied for the determination of histamine levels, IgE and total eosinophil counts and their correlation with the clinical manifestations of the disease. Serum histamine levels were significantly increased in acute and chronically infected patients. Serum IgE levels were markedly increased in all patients with S. mansoni infection and S. haematobium infection and moderately elevated in chronic patients. Eosinophilia was found in 60% of patients with S. mansoni infection and in 83% with S. haematobium infection. Ascitic fluid analysis revealed the presence of IgE and high concentrations of histamine. There was also a significant positive correlation (p less than 0.01) between serum and ascitic fluid histamine levels, as well as to IgE levels. These results support the contention that histamine and other immune system components may play a role in the pathophysiology of different stages of schistosomiasis.

Acute Disease↗