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Farooq MS, Ansari ZK, Alvi A, Rustam F, Díez IDLT, Mazón JLV, Rodríguez CL, Ashraf I. Blockchain based transparent and reliable framework for wheat crop supply chain. PLoS One 2024; 19:e0295036. [PMID: 38206967 PMCID: PMC10783778 DOI: 10.1371/journal.pone.0295036] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/15/2023] [Indexed: 01/13/2024] Open
Abstract
The wheat crop that fulfills 35% of human food demand is facing several problems due to a lack of transparency, security, reliability, and traceability in the existing agriculture supply chain. Many systems have been developed for the agriculture supply chain to overcome such issues, however, monopolistic centralized control is the biggest hurdle to realizing the use of such systems. It has eventually gained consumers' trust in branded products and rejected other products due to the lack of traceable supply chain information. This study proposes a blockchain-based framework for supply chain traceability which provides trustable, transparent, secure, and reliable services for the wheat crop. A crypto token called wheat coin (WC) has been introduced to keep track of transactions among the stakeholders of the wheat supply chain. Moreover, an initial coin offering (ICO) of WC, crypto wallets, and an economic model are proposed. Furthermore, a smart contract-based transaction system has been devised for the transparency of wheat crop transactions and conversion of WC to fiat and vice versa. We have developed the interplanetary file system (IPFS) to improve data availability, security, and transparency which stores encrypted private data of farmers, businesses, and merchants. Lastly, the results of the experiments show that the proposed framework shows better performance as compared to previous crop supply chain solutions in terms of latency to add-blocks, per-minute transactions, average gas charge for the transaction, and transaction verification time. Performance analysis with Bitcoin and Ethereum shows the superior performance of the proposed system.
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Affiliation(s)
- Muhammad Shoaib Farooq
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
| | - Zain Khalid Ansari
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
| | - Atif Alvi
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
| | - Furqan Rustam
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Isabel De La Torre Díez
- Department of Signal Theory and Communications and Telematic Engineering, University of Valladolid, Valladolid, Spain
| | - Juan Luis Vidal Mazón
- Universidad Europea del Atlántico, Santander, Spain
- Universidad Internacional Iberoamericana, Arecibo, Puerto Rico, United States of America
- Universidade Internacional do Cuanza, Cuito, Bié, Angola
| | - Carmen Lili Rodríguez
- Universidad Europea del Atlántico, Santander, Spain
- Universidad Internacional Iberoamericana, Campeche, México
| | - Imran Ashraf
- Information and Communication Engineering, Yeungnam University, Gyeongsan, Korea
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Farooq MS, Abdullah M, Riaz S, Alvi A, Rustam F, Flores MAL, Galán JC, Samad MA, Ashraf I. A Survey on the Role of Industrial IoT in Manufacturing for Implementation of Smart Industry. Sensors (Basel) 2023; 23:8958. [PMID: 37960657 PMCID: PMC10650216 DOI: 10.3390/s23218958] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
The Internet of Things (IoT) is an innovative technology that presents effective and attractive solutions to revolutionize various domains. Numerous solutions based on the IoT have been designed to automate industries, manufacturing units, and production houses to mitigate human involvement in hazardous operations. Owing to the large number of publications in the IoT paradigm, in particular those focusing on industrial IoT (IIoT), a comprehensive survey is significantly important to provide insights into recent developments. This survey presents the workings of the IoT-based smart industry and its major components and proposes the state-of-the-art network infrastructure, including structured layers of IIoT architecture, IIoT network topologies, protocols, and devices. Furthermore, the relationship between IoT-based industries and key technologies is analyzed, including big data storage, cloud computing, and data analytics. A detailed discussion of IIoT-based application domains, smartphone application solutions, and sensor- and device-based IIoT applications developed for the management of the smart industry is also presented. Consequently, IIoT-based security attacks and their relevant countermeasures are highlighted. By analyzing the essential components, their security risks, and available solutions, future research directions regarding the implementation of IIoT are outlined. Finally, a comprehensive discussion of open research challenges and issues related to the smart industry is also presented.
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Affiliation(s)
- Muhammad Shoaib Farooq
- Department of Computer Science, University of Management and Technology, Lahore 54000, Pakistan; (M.S.F.); (M.A.); (S.R.); (A.A.)
| | - Muhammad Abdullah
- Department of Computer Science, University of Management and Technology, Lahore 54000, Pakistan; (M.S.F.); (M.A.); (S.R.); (A.A.)
| | - Shamyla Riaz
- Department of Computer Science, University of Management and Technology, Lahore 54000, Pakistan; (M.S.F.); (M.A.); (S.R.); (A.A.)
| | - Atif Alvi
- Department of Computer Science, University of Management and Technology, Lahore 54000, Pakistan; (M.S.F.); (M.A.); (S.R.); (A.A.)
| | - Furqan Rustam
- School of Computer Science, University College Dublin, D04 V1W8 Dublin, Ireland;
| | - Miguel Angel López Flores
- Research Group on Foods, Universidad Europea del Atlantico, Isabel Torres 21, 39011 Santander, Spain; (M.A.L.F.); (J.C.G.)
- Research Group on Foods, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Instituto Politécnico Nacional, UPIICSA, Ciudad de México 04510, Mexico
| | - Juan Castanedo Galán
- Research Group on Foods, Universidad Europea del Atlantico, Isabel Torres 21, 39011 Santander, Spain; (M.A.L.F.); (J.C.G.)
- Universidad Internacional Iberoamericana, Arecibo, PR 00613, USA
- Department of Projects, Universidade Internacional do Cuanza, Cuito EN250, Bie, Angola
| | - Md Abdus Samad
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Imran Ashraf
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
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Manzoor MF, Abid A, Nawaz NA, Alvi A. Aspect based sentence segregated dataset of hybrid car's consumers online reviews. Data Brief 2022; 42:108293. [PMID: 35637892 PMCID: PMC9142620 DOI: 10.1016/j.dib.2022.108293] [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: 12/29/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Muhammad Faraz Manzoor
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
| | - Adnan Abid
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
- Department of Computer Science, Virtual University of Pakistan, Lahore, Pakistan
- Corresponding author at: Department of Computer Science, University of Management and Technology, Lahore, Pakistan.
| | - Naeem A. Nawaz
- Department of Computer Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Atif Alvi
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
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Minhas S, Khanum A, Alvi A, Riaz F, Khan SA, Alsolami F, A Khan M. Early MCI-to-AD Conversion Prediction Using Future Value Forecasting of Multimodal Features. Comput Intell Neurosci 2021; 2021:6628036. [PMID: 34608385 PMCID: PMC8487363 DOI: 10.1155/2021/6628036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022]
Abstract
In Alzheimer's disease (AD) progression, it is imperative to identify the subjects with mild cognitive impairment before clinical symptoms of AD appear. This work proposes a technique for decision support in identifying subjects who will show transition from mild cognitive impairment (MCI) to Alzheimer's disease (AD) in the future. We used robust predictors from multivariate MRI-derived biomarkers and neuropsychological measures and tracked their longitudinal trajectories to predict signs of AD in the MCI population. Assuming piecewise linear progression of the disease, we designed a novel weighted gradient offset-based technique to forecast the future marker value using readings from at least two previous follow-up visits. Later, the complete predictor trajectories are used as features for a standard support vector machine classifier to identify MCI-to-AD progressors amongst the MCI patients enrolled in the Alzheimer's disease neuroimaging initiative (ADNI) cohort. We explored the performance of both unimodal and multimodal models in a 5-fold cross-validation setup. The proposed technique resulted in a high classification AUC of 91.2% and 95.7% for 6-month- and 1-year-ahead AD prediction, respectively, using multimodal markers. In the end, we discuss the efficacy of MRI markers as compared to NM for MCI-to-AD conversion prediction.
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Affiliation(s)
- Sidra Minhas
- Department of Computer Science, Forman Christian College University, Lahore, Pakistan
| | - Aasia Khanum
- Department of Computer Science, Forman Christian College University, Lahore, Pakistan
| | - Atif Alvi
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
| | - Farhan Riaz
- Department of Computer Engineering, National University of Sciences & Technology, EME College, Rawalpindi, Pakistan
| | - Shoab A Khan
- Department of Computer Engineering, National University of Sciences & Technology, EME College, Rawalpindi, Pakistan
| | - Fawaz Alsolami
- Department of Computer Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muazzam A Khan
- Department of Computer Sciences, Quaid I Azam University, Islamabad, Pakistan
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Al-Anwar S, Askari A, Alvi A. Right Iliac fossa pain due to torsion and ischaemia of accessory liver lobe. J Surg Case Rep 2019; 2019:rjz101. [PMID: 31110651 PMCID: PMC6516433 DOI: 10.1093/jscr/rjz101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/02/2019] [Revised: 03/12/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022] Open
Abstract
An accessory liver lobe (ALL) is the presence of ectopic hepatic tissue which has developed as a result of excessive hepatic development. The majority of patients with ALL remain asymptomatic and their findings are incidental, either after undergoing radiological imaging or during surgery for other pathology. However, in a small number of patients who have a pedunculated ALL, torsion of the lobe on its axis can cause pain, often due to ischaemia of the lobe. We report a 26-year-old female who presented with right iliac fossa pain mimicking acute appendicitis and preceded by recent vigorous exercising activity.
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Affiliation(s)
- Shahinda Al-Anwar
- West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford WD18 0HB, UK
| | - Alan Askari
- West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford WD18 0HB, UK
| | - Atif Alvi
- West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford WD18 0HB, UK
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Minhas S, Khanum A, Riaz F, Khan SA, Alvi A. Predicting Progression From Mild Cognitive Impairment to Alzheimer's Disease Using Autoregressive Modelling of Longitudinal and Multimodal Biomarkers. IEEE J Biomed Health Inform 2018; 22:818-825. [DOI: 10.1109/jbhi.2017.2703918] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Syed AE, Syed I, Ahmed R, Parvu O, Pancione L, Alvi A, Novacic K, Akram R. P49 Does valsalva manoeuvre reduce the risk of complications in CT-guided lung biopsies? Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.192] [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: 11/04/2022]
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Minhas S, Khanum A, Riaz F, Alvi A, Khan SA. A Nonparametric Approach for Mild Cognitive Impairment to AD Conversion Prediction: Results on Longitudinal Data. IEEE J Biomed Health Inform 2016; 21:1403-1410. [PMID: 28113683 DOI: 10.1109/jbhi.2016.2608998] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The goal of this study is to introduce a nonparametric technique for predicting conversion from Mild Cognitive impairment (MCI)-to-Alzheimer's disease (AD). Progression of a slowly progressing disease such as AD benefits from the use of longitudinal data; however, research till now is limited due to the insufficient patient data and short follow-up time. A small dataset size invalidates the estimation of underlying disease progression model; hence, a supervised nonparametric method is proposed. While depicting a real-world setting, longitudinal data of three years are employed for training, whereas only the baseline visit's data is used for validation. The train set is preprocessed for extraction of two dense clusters representing the subjects who remain stable at MCI or progress to AD after three years of the baseline visit. Similarity between these clusters and the test point is calculated in Euclidean space. Multiple features from two modalities of biomarkers, i.e., neuropsychological measures (NM) and structural magnetic resonance imaging (MRI) morphometry are also analyzed. Due to the limited MCI dataset size (NM: 145, MRI: 52, NM+MRI: 29), leave-one-out cross validation setup is employed for performance evaluation. The algorithm performance is noted for both unimodal case and bimodal cases. Superior performance (accuracy: 89.66%, sensitivity: 87.50%, specificity: 92.31%, precision: 93.33%) is delivered by multivariate predictors. Three notable conclusions of this study are: 1) Longitudinal data are more powerful than the temporal data, 2) MRI is a better predictor of MCI-to-AD conversion than NM, and 3) multivariate predictors outperform single predictor models.
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Affiliation(s)
- Sidra Minhas
- Computer Engineering Department, College of Electrical and Mechanical Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Aasia Khanum
- Computer Science Department, Forman Christian College, Lahore, Pakistan
| | - Farhan Riaz
- Computer Engineering Department, College of Electrical and Mechanical Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Atif Alvi
- Computer Science Department, Forman Christian College, Lahore, Pakistan
| | - Shoab Ahmed Khan
- Computer Engineering Department, College of Electrical and Mechanical Engineering, National University of Sciences and Technology, Islamabad, Pakistan
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Affiliation(s)
| | - Robert Tyler
- Department of Colorectal Surgery, Hinchingbrooke Hospital, Huntingdon, UK
| | - Atif Alvi
- Department of Colorectal Surgery, Hinchingbrooke Hospital, Huntingdon, UK
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Berlanga O, Alvi A, Carr-Smith H, Harding S. Comparison of the performance of the newly developed IgA heavy chain/light chain immunoassays with serum protein electrophoresis and nephelometric total IgA measurements for monitoring IgA multiple myeloma patients. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Hamilton S, Ranjan S, Bourne R, Alvi A, Wojcik A, Bashford S, Harris A, Martin A, Wazait H, Hasan R, Rene C, Chang L, Mitchell D, Johnson H, Hille I, Barabas T, Pradhan A, Jenabzadeh R, Mohamed A, Jamali N, Boland C, Matthews A, Pathak S, Akerele T, Morgan T, Di Franco F, Ward D, Srouji I, Hubbard C, Hoggarth C, Palmer C, Schumacher H, Shiew M, Mathews A, Felli B, Dubash S, Manzo E, Connick R, Taveres J, Walsh K, Lillicrap M. Hinchingbrooke Hospital's reply to "inadequate" rating on patient care. BMJ 2015; 350:h293. [PMID: 25647183 DOI: 10.1136/bmj.h293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Suzanne Hamilton
- Medical Advisory Committee, Hinchingbrooke Hospital, Huntingdon PE29 6NT, UK
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Alvi A, Pitt JP. A case of entero-colic fistula formation resulting from stent migration inserted for obstructing left colonic tumour. Int J Colorectal Dis 2009; 24:353. [PMID: 19084970 DOI: 10.1007/s00384-008-0627-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2008] [Indexed: 02/04/2023]
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Abstract
BACKGROUND The importance of antinucleolar antibodies seen by indirect immunofluorescence on HEp-2 cells, although associated with systemic sclerosis (SSc), in unselected patients is unknown. AIMS To determine the true clinical significance of antinucleolar antibodies in an unselected patient population. METHODS Antinucleolar antibody (ANoA) positive samples were identified in the immunology laboratory during routine autoimmune screening tests; case notes were reviewed using a standard proforma. RESULTS 104 patients with ANoA were identified and ANoA+ samples were subclassified into homogeneous, clumpy and speckled antinucleolar types. SSc was evident in only two (1.8%) patients. Other connective tissue diseases were identified in 33 patients (32%); 22 patients (21%) had evidence of various malignancies. Both disordered liver function and anaemia were seen in 22 patients and were the commonest laboratory abnormalities. CONCLUSIONS Neither the presence nor subtype of ANoA is specific for systemic sclerosis. Laboratory comments appended to results should reflect this fact.
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Affiliation(s)
- S Khan
- Path Links Immunology, Scunthorpe General Hospital, Scunthorpe, UK.
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Pearson J, Alvi A, Hashemi M. Splenic rupture as an unusual cause of massive hematemesis. J Trauma 2007; 63:E88-E89. [PMID: 18089995 DOI: 10.1097/01.ta.0000195508.27907.df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Judith Pearson
- University College London, Department of Surgery, Whittington Hospital, London, United Kingdom
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Khan S, Holding S, Alvi A, Saravana S, Sewell W. The Clinical Significance Of Isolated Antinucleolar Antibodies. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.084] [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: 11/28/2022]
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Ahmed KS, Khan AA, Ahmed I, Tiwari SK, Habeeb MA, Ali SM, Ahi JD, Abid Z, Alvi A, Hussain MA, Ahmed N, Habibullah CM. Prevalence study to elucidate the transmission pathways of Helicobacter pylori at oral and gastroduodenal sites of a South Indian population. Singapore Med J 2006; 47:291-6. [PMID: 16572240] [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] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Since the discovery of Helicobacter pylori (H. pylori), much progress has been made worldwide in the field of its epidemiology. In spite of these advancements, many aspects of epidemiology still remain unclear, particularly among populations with low socio-economic status. The present study was designed to elucidate the different routes of transmission of H. pylori in the Hyderabad (South India) population and to investigate the impact of certain factors, such as age, gender, and lifestyle. METHODS Samples used for the study included saliva and biopsy samples of 400 symptomatic subjects from Hyderabad, India. The patients were retrospectively grouped, based on histopathology of the biopsy and 16S rRNA amplification of both saliva and biopsy as H. pylori positive and negative. RESULTS This study showed that the prevalence of H. pylori in both saliva and biopsy samples increased with age. In addition, the H. pylori infection was found more commonly in the saliva and biopsy samples among males (64 percent and 60 percent, respectively) than females (53.3 percent and 64 percent, respectively). Similarly, 71.6 percent and 73.5 percent of those who consumed municipal water acquired H. pylori (which were respectively found in their saliva and biopsy samples) compared to a lesser proportion (12.6 percent and 12.6 percent, respectively) of those who consumed boiled or filtered water. The study also found that subjects who preferred home-cooked food (57.1 percent and 57.7 percent) showed a lower prevalence of H. pylori in saliva and biopsy samples, respectively, compared to those (80 percent and 88 percent) who frequently ate out. CONCLUSION The results of the present study suggest that besides the oral-oral route, the transmission of H. pylori also takes place through the consumption of food prepared under unhygienic conditions. Consumption of municipal tap water also has a high impact in the transmission of H. pylori.
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Affiliation(s)
- K S Ahmed
- Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences and Allied Hospitals, Kanchanbagh, Hyderabad, India
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Abstract
We present an unusual case of breast ulceration secondary to heroin injection in a pregnant woman.
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Affiliation(s)
- A Alvi
- Department of Breast & Endocrine surgery, Luton & Dunstable Hospital, Luton LU4 0DZ, UK.
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Tiwari SK, Khan AA, Ahmed KS, Ahmed I, Kauser F, Hussain MA, Ali SM, Alvi A, Habeeb A, Abid Z, Ahmed N, Habibullah CM. Rapid diagnosis of Helicobacter pylori infection in dyspeptic patients using salivary secretion: a non-invasive approach. Singapore Med J 2005; 46:224-8. [PMID: 15858691] [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] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Current guidelines that recommend Helicobacter pylori eradication treatment without endoscopy in selected patients underscore the importance of non-invasive testing. The accuracy of saliva as a non-invasive specimen was compared with that of invasive tests in pretreatment diagnosis of H. pylori infection. METHODS One hundred patients undergoing gastroscopy were grouped into 80 symptomatic and 20 asymptomatic subjects and were investigated for the presence of H. pylori in saliva and stomach. Samples tested comprised saliva and gastric biopsies collected from each patient. Exclusion criteria were history of peptic ulcer, bleeding ulcer, cancer or recent use of antibiotics, proton pump inhibitors and non-steroidal anti-inflammatory drugs. Two sets of primers homologous to 534 bp fragment of H. pylori DNA, which have been shown previously to be highly specific and sensitive, were used for the polymerase chain reaction (PCR) amplification. RESULTS 72 (90 percent) of the symptomatic group and 10 asymptomatic subjects were infected with H. pylori in the stomach as determined by histology and direct PCR amplification of biopsy DNA obtained from each subject. H. pylori DNA was identified in the saliva of 70 (87.5 percent) symptomatic subjects and 12 (60 percent) asymptomatic control subjects. CONCLUSION High rates of detection using saliva as a specimen indicate that saliva of the infected person could serve as a reliable non-invasive alternative to detect the presence of H. pylori infection in comparison to the currently available standard diagnostic tests.
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Affiliation(s)
- S K Tiwari
- Centre for Liver Research and Diagnostics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad 500058, Andhra Pradesh, India
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Naik MJ, Abu-Omar Y, Alvi A, Wright N, Henderson A, Channon K, Forfar JC, Taggart DP. Total arterial revascularisation as a primary strategy for coronary artery bypass grafting. Postgrad Med J 2003; 79:43-8. [PMID: 12566552 PMCID: PMC1742583 DOI: 10.1136/pmj.79.927.43] [Citation(s) in RCA: 5] [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: 11/03/2022]
Abstract
BACKGROUND Bilateral internal thoracic arteries confer improved survival benefit after coronary artery bypass grafting (CABG). Despite increasing evidence, the use of arterial conduits has not been accepted as a primary practice in most of the centres in the UK for various reasons. A series of patients has been analysed to assess the feasibility of total arterial revascularisation as a primary strategy in patients requiring first time CABG. METHODS Altogether 245 patients undergoing first time CABG by one surgeon, from June 1999 to October 2000, were studied. Group 1 consisted of 165 patients undergoing total arterial revascularisation (using bilateral internal thoracic and radial arteries) and group 2 consisted of 80 patients undergoing conventional CABG (using one internal thoracic artery and supplemental veins). Thirty day mortality and early morbidity with particular reference to resternotomy for bleeding, cerebrovascular accidents, renal failure, and sternal dehiscence were the main outcome measures. RESULTS Patients in group 1 were younger (mean (SD) 60 (10) v 65 (9) years; p<0.001), had lower Parsonnet scores (mean (SD) 5 (5) v 11 (7); p<0.001), and better left ventricular function. Both groups received a similar number of grafts. The percentage of patients undergoing total arterial revascularisation rose from 44% in the first three months to over 75% in the three latter three month periods. Overall 30 day mortality was 1.3%, one patient (0.6%) in group 1 and two patients (2.5%) in group 2. There was a similar incidence of postoperative complications and length of median postoperative stay in both groups. CONCLUSION Total arterial revascularisation can be adopted as a primary strategy in most patients undergoing CABG with no increase in mortality or morbidity.
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Affiliation(s)
- M J Naik
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, UK
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Abstract
Serratia marcescens is an opportunistic pathogen responsible for causing nosocomial infections, corneal ulcer, necrotizing fasciitis, cellulites, and brain abscess. Alkaline phosphatase (APase) is believed to play an important role in the survival of several intracellular pathogens and their adaptation. We have studied the effect of low phosphate concentration and acid pH on the APase activities of S. marcescens. In a low phosphate medium, some strains of S. marcescens synthesize two different types of APases, a constitutive (CAPase) and an inducible (IAPase). Both the CAPase and IAPase isoenzymes completely lost their enzyme activities at pH 2.3, within 10 min of incubation at 0 degrees C. Acid-treated IAPase isoenzymes I, II, III, and IV solutions when adjusted to pH 7.8 showed recovery of 70%, 52%, 72%, and 60% of the lost activities, respectively. When the pH of the CAPase reaction mixture was raised to pH 7.8, the enzyme activity regained only 5% of its initial activity. Variations in protein concentration also affected the pH-dependent reversible changes of the IAPase activity. The higher the protein concentration, the faster the inactivation of enzyme activity observed at acidic pH at 0 degrees C. Conversely, the lower the protein concentration, the higher the rate of reactivation of enzyme activity observed for IAPase at alkaline pH. Protein interaction studies revealed a lack of similarity between CAPase and IAPase, suggesting separate genetic origin of these potentially virulent genes of S. marcescens.
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Affiliation(s)
- A R Bhatti
- Defence Research Establishment Suffield, Box 4000, Medicine Hat, Alberta, Canada, T1A 8K6
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Alvi A, Carrau RL. The bicoronal flap approach in craniofacial trauma. J Craniomaxillofac Trauma 2002; 2:40-55. [PMID: 11951482] [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: 02/24/2023]
Abstract
The utilization of the bicoronal scalp flap in craniofacial trauma has proved indispensable in the management of severe craniofacial injuries. It provides vast exposure of such critical structures as the cranium, frontal sinus, orbit and upper midface, compared with that for previous techniques of facial fracture reduction. Although the flap has great utility, severe complications, such as facial nerve injury, diplopia, telecanthus, and scalp necrosis, can occur. This article reviews the surgical anatomy, technique, and indications for the safe utilization of the bicoronal scalp flap approach in the management of craniofacial trauma.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center/Chicago Medical School, California and 15th Streets, Chicago, IL 60608, USA
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Alvi A, Bereliani A. Trauma to the temporal bone: diagnosis and management of complications. J Craniomaxillofac Trauma 2002; 2:36-48. [PMID: 11951455] [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: 02/24/2023]
Abstract
The temporal bone contains important sensory and neural structures that may be damaged in patients who experience craniofacial trauma. The most serious complications of temporal bone trauma include facial nerve paralysis, cerebrospinal fluid leak, and hearing loss. Injury to the temporal bone often presents with subtle signs and symptoms, such as otorrhea, facial palsy, and hemotympanum. A high index of suspicion and a thorough knowledge of how to diagnose injury to the temporal bone are paramount in treating patients who present to the emergency room with craniofacial trauma. This article provides an overview of temporal bone trauma, outlines a methodical approach to the patient with temporal bone trauma, details four cases, and describes the treatment of complications.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center/Chicago Medical School, California and 15th Streets, Chicago, IL 60608, USA
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23
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Abstract
OBJECTIVES Bone-screw mandible fixation (BSMF) is evaluated as an alternative to intraoperative arch-bar maxillomandibular fixation before plating of mandibular fractures. BSMF is achieved by wire ligation of opposing bone-screws placed in the maxilla and mandible. METHODS A retrospective evaluation of 23 patients with 40 mandibular fractures who underwent mandibular fracture repairs. BSMF was used instead of arch bars to ensure proper dental occlusion. All fractures were then plated, after which BSMF was removed before termination of anesthesia. RESULTS Normal occlusion was observed in 21 patients (91.3%), Class II malocclusion was noted in 1 patient (4. 3%), and 1 patient was edentulous. No complications related to the use of BSMF were observed. CONCLUSION BSMF can serve as a viable alternative to arch-bar maxillomandibular fixation for obtaining temporary intraoperative occlusion. BSMF produces acceptable malocclusion rates and offers the advantages of decreased intraoperative time, lower risk for percutaneous and mucosal wire punctures, and ease of use.
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Affiliation(s)
- A J Vartanian
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear Infirmary, University of Illinois at Chicago, 60612-7244, USA.
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24
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Abstract
Certain strains of Serratia marcescens synthesized two different types of alkaline phosphatase (APase), constitutive (CAPase) and inducible (IAPase) APases, in low phosphate medium. Synthesis of the IAPase was repressed in the presence of high phosphate. Purification and separation of these electrophoretically distinct APases was achieved by using fractional (NH(4))(2)SO(4) precipitation, adsorption on a DEAE-cellulose column and elution of enzymes by a linear sodium chloride gradient. Starch gel electrophoresis of certain fractions revealed the separation of not only IAPase from CAPase but its separation into four distinct isozymes. CAPase gave maximum enzyme activity around pH 9.5, whereas for IAPase a broad range of enzyme activity was found between pH 8.5 and 10.5. Reversible inactivation at low pH occurred for IAPase but very little with CAPase. CAPase was more thermolabile than IAPase at 95 degrees C. The two APases were found to be distinct in their kinetic as well as immunological properties, suggesting two distinct enzyme species.
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Affiliation(s)
- A R Bhatti
- Defence Research Establishment Suffield, Box 4000, T1A 8K6, Medicine Hat, Alta., Canada.
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25
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Abstract
Head and neck manifestations of acquired immunodeficiency syndrome (AIDS) can involve the skin, ear, upper aerodigestive tract, and neck. Several head and neck manifestations of AIDS may be the only initial sign of this disease process and therefore primary-care physicians and otolaryngologists must be able to recognize and understand the management of these lesions. Cystic enlargement of the parotid gland and Kaposi's sarcoma are increasingly being encountered in the head and neck exam of HIV-infected patients. An example of each of these disease processes is presented with full discussion about the various treatment methods.
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Affiliation(s)
- M K Kim
- Department of Otorhinolaryngology and Bronchoesophagology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
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Affiliation(s)
- A J Vartanian
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, The Eye and Ear Infirmary, 60612, USA
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Abstract
OBJECTIVE Head and neck cancers present a special challenge to the patient and the physician because they affect the quintessential aspects of living such as breathing, eating, and speaking. Numerous articles have described how the physician should perform the difficult task of conveying bad news, but only a small number of articles specifically assess the patients' perceptions when being told of a serious diagnosis. The purpose of this survey was to evaluate the thoughts and concerns of patients receiving diagnoses of head and neck cancer. STUDY DESIGN Questionnaire survey. METHODS A 41-item questionnaire was sent to head and neck cancer patients who have been treated for and remain free of disease for at least 2 years. RESULTS All of the respondents felt that their diagnosis was adequately explained to them and that no further explanations were necessary. Eighty-one percent of the respondents did not wish to have anyone else present at the time of diagnosis. Additionally, 75% of the respondents did not want the physician to touch their hands or hug them when given the bad news. Only 63% of the respondents had further discussions with family, friends, or other physicians after being told of their diagnosis. CONCLUSION When patients are told of the diagnosis of head and neck cancer, they want their physician to be truthful, caring, and compassionate. The patients want their diagnosis in simple and direct terms without the incorporation of complex medical terminology. The results of this survey can provide insightful information to physicians when they are undertaking the difficult task of conveying bad news to their patients.
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Affiliation(s)
- M K Kim
- Department of Otorhinolaryngology and Bronchoesophagology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
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Affiliation(s)
- A Alvi
- Department of Otorhinolaryngology and Bronchoesophagology, Temple University School of Medicine, Philadelphia, PA 19140, USA
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29
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Abstract
Temporal bone trauma can be disastrous for the individual and his or her family. With the increase in violent crime throughout our society, the number of intracranial complications associated with temporal bone injury has increased significantly. Although multiple reports concerning the diagnosis and management of temporal bone trauma have been published, few studies on its intracranial complications have been addressed. In this study, we assessed the cases of 43 patients treated for temporal bone fractures between January 1992 and December 1994. The number of temporal bone fractures increased from 6 in 1992 to 21 in 1994. Twenty-one patients (49%) presented with decreased mental status. Significant alcohol and drug use was documented in 28% and 58% of patients, respectively. The most common radiologic finding was skull and intracranial injury. Thirty-six patients (84%) had at least one abnormal intracranial finding; of these patients, 14 (39%) had more than one abnormal finding on computed tomography. Cerebral midline shift, subarachnoid hemorrhage, subdural hemorrhage, and cerebral edema were the most common radiologic findings. Nineteen patients (44%) required an open neurosurgical procedure, and almost all patients with more than one abnormal radiologic finding underwent neurosurgery (86%). Seven patients required further institutional care after discharge. Four patients died (9% mortality); all the deaths were neurologically related. Mean hospital charges increased from $30,900 in 1992 to $63,000 in 1994.
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Affiliation(s)
- A Alvi
- Department of Otorhinolaryngology and Bronchoesophagology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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30
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Abstract
The pain of trigeminal neuralgia can be excruciating and debilitating. Fortunately, effective medical and surgical therapies for the disorder exist. Successful treatment hinges on thorough history taking and accurate diagnosis. Diagnostic evaluation of patients with orofacial pain should include complete head and neck, dental, and neurologic examinations combined with radiologic imaging of the head and appropriate laboratory tests.
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Affiliation(s)
- G K Kumar
- Department of Medicine, Mount Sinai Hospital Medical Center, Finch University Health Sciences/Chicago Medical School, USA
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31
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Abstract
Controversy continues to exist regarding the routine histologic examining of tonsillectomy specimens. Proponents suggest that among other reasons, missing an important diagnosis such as occult malignancy or granulomatous disease and possible medicolegal consequences argue in favor of routine histologic examination. Others state that we should consider the very low yield of significant histologic findings in routine tonsillectomy specimens and its added cost. We performed a retrospective evaluation of all cases of patients who underwent tonsillectomy with or without adenoidectomy between January 1992 and July 1996. Two hundred eighty-eight charts were evaluable. Group 1 consisted of all tonsillectomy specimens that were subjected to gross examination only. Group 2 consisted of all tonsillectomy specimens that were subjected to gross examination as well as microscopic examination. In group 1, no abnormal gross findings were noted. Group 2 consisted of specimens from an older population with a mean age of 21.6 years. There were 43 patients older than 20 years old in group 2, and in all cases except four the preoperative clinical impression correlated with the microscopic findings. Occult malignancy was found in only one of these four patients. No cases of granulomatous disease were discovered. Overall, no patients except one had any change in postoperative treatment on the basis of the results of microscopic examination. We believe that routine microscopic examination of tonsillectomy specimens results in unnecessary cost and consumption of resources and time. Microscopic examination should be done in only selected cases such as in patients with grossly asymmetric tonsils or in patients with a history of malignancy.
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Affiliation(s)
- A Alvi
- Mount Sinai Hospital Medical Center/Chicago Medical School, Division of Otolaryngology, Illinois, USA
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Alvi A, Weissman J, Myssiorek D, Narula S, Myers EN. Computed tomographic and magnetic resonance imaging characteristics of laryngocele and its variants. Am J Otolaryngol 1998; 19:251-6. [PMID: 9692634 DOI: 10.1016/s0196-0709(98)90127-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Alvi
- Department of Otorhinolaryngology and Bronchoesophagology, Temple University School of Medicine, Philadelphia, PA 19140, USA
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Affiliation(s)
- A Alvi
- Department of Otorhinolaryngology and Bronchoesophagology, Temple University School of Medicine, Philadelphia, Pennsylvannia 19140, USA
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34
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Moazzez AH, Alvi A. Head and neck manifestations of AIDS in adults. Am Fam Physician 1998; 57:1813-22. [PMID: 9575321] [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] [Indexed: 02/07/2023]
Abstract
Head and neck manifestations of acquired immunodeficiency syndrome (AIDS) are among the most common complications of this disease. Some of these manifestations are the initial signs of human immunodeficiency virus (HIV) infection, and others are associated with full-blown AIDS. Otologic manifestations include otitis externa, otitis media, Kaposi's sarcoma and sensorineural hearing loss. Nasal and oral manifestations of AIDS are more common than otologic manifestations and range from infections, caused by both opportunistic and nonopportunistic organisms, to malignancies. We address common manifestations and current treatment recommendations.
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Affiliation(s)
- A H Moazzez
- Mount Sinai Hospital Medical Center, Chicago, Illinois, USA
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35
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Alvi A, Garner C, Thomas W. Angiolipoma of the head and neck. J Otolaryngol 1998; 27:100-3. [PMID: 9572463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A Alvi
- Department of Otorhinolaryngology & Bronchoesophagology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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36
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Vartanian AJ, Alvi A. Lingual nerve palsy following tonsillectomy. J Otolaryngol 1997; 26:389-91. [PMID: 9438939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
BACKGROUND The recognition of risk factors for the development of distant metastasis is necessary for identifying high-risk patients who may benefit from systemic therapy. Previous investigations studying possible risk factors have been heterogeneous, with patients having varied forms of therapy. This study is designed to evaluate the clinical and histologic risk factors for the development of distant metastasis (DM) in patients with only advanced-stage head and neck squamous cell carcinoma after surgery and radiotherapy. METHODS Retrospective analysis of a cohort of potentials with-surgically treated stage III and IV squamous cell carcinoma of the hypopharynx, tongue, and supraglottic larynx between 1988-1992. The cohort consisted of 130 patients of which 30 patients developed DM as the initial site of failure. All patients underwent surgical resection of the primary. Neck dissection was performed in 26 of 30 (87%0 patients who developed distant metastasis. Almost all patients received radiation therapy. Patients who initially developed DM (DM group) were compared with patients who did not initially develop DM (no DM group) with respect to certain clinical and histo-pathological factors. RESULTS The majority of patients in the DM group had advanced T stage and clinically palpable cervical lymph nodes (73% and 93% respectively). In the no DM group, most patients had advanced T stage (85%) but 42% of the patients had stage NO necks (p < .05). Eighty-eight percent of patients in the DM group and 60% of patients in the no DM group had histological evidence of extracapsular spread of tumor from cervical lymph nodes (p < .05). Three or more positive lymph nodes were found in 69% of patients who developed DM and in only 35% of patients in the no DM group (p < .05). Age, gender, primary site, history of radiation therapy, perineural invasion and tumor grade were not associated with a higher risk for DM (p > .05). CONCLUSION Patients wit clinically palpable neck disease (N1-3), histological evidence of metastatic nodal disease, extracapsular spread, and three or more positive lymph nodes are at greater risk of developing failure at distant sites. This subset of patients should have an extensive evaluation for distant metastatic disease and should be considered for systemic therapy.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center/Chicago Medical School, Illinois 60608, USA
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38
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center/The Chicago Medical School, Illinois 60608, USA
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39
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Abstract
Macroglossia is a potentially life-threatening problem. The multiple aetiologies responsible for this condition include cysts, tumours, amyloidosis, angioedema, and infections. Although injuries to the oral cavity are common, self-inflicted traumatic macroglossia is not common. We report a case of a comatose patient with limb contractures and severe trismus who developed entrapment of the tongue with progressive macroglossia and near auto-amputation of the tongue. The importance of early recognition and treatment of tongue entrapment in comatose patients is emphasised since this is a potentially reversible condition.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center, Chicago Medical School, Illinois, USA
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40
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Alvi A. How I do it: cervical visor flap approach to bilateral mandible fractures. J Otolaryngol 1996; 25:421-2. [PMID: 8972438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center/Chicago Medical School, Illinois 60608, USA
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41
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Abstract
BACKGROUND Reconstruction of the composite resection defect should provide for adequate speech and swallowing functions. Poorly designed reconstructive efforts can result in significant oral dysfunction. The composite resection defect can be reconstructed by a variety of methods. The split-thickness skin-graft method provides excellent speech and swallowing functions with minimal morbidity. METHODS Forty-three patients who underwent composite resections and were reconstructed by split-thickness skin graft (STSG) were analyzed. The patients' charts were reviewed for oncologic outcome, speech and swallowing functions, and length of hospital stay. RESULTS Speech and swallowing functions were excellent. At last follow-up, more than 90% of the patients tolerated either a soft or regular diet. The length of hospital stay was only 13 and 18 days for patients who underwent marginal and lateral segmental mandibulectomy, respectively. There were few complications. Radiation therapy had no adverse effects on the grafts. CONCLUSION The STSG method is our preferred method for reconstruction of marginal or lateral segmental mandibulectomy defects that do not require tissue bulk.
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Affiliation(s)
- A Alvi
- University of Pittsburgh Medical Center, Department of Otolaryngology, Pennsylvania, USA
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42
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Alvi A, Myssiorek D, Fuchs A. Extranasopharyngeal angiofibroma. J Otolaryngol 1996; 25:346-8. [PMID: 8902697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center/Chicago Medical School, Illinois, USA
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43
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Abstract
Hemorrhage is the most frequent complication of tonsillectomy and is responsible for the majority of post-tonsillectomy fatalities. The incidence of this hemorrhage has been reported to be as high as 20% [6]. Despite continued efforts to reduce this problem, it remains a persistent risk. The charts of 1138 patients who underwent tonsillectomy with or without adenoidectomy from 7-1-89 to 6-30-93 were reviewed. Post-tonsillectomy hemorrhage occurred in 36 patients (3%). Preoperative, intraoperative and postoperative risk factors were assessed. Postoperative bleeding occurred more often in older patients (69% over age 11 years). Seventy-five per cent of these patients were operated on for chronic tonsillitis as compared to 11% operated on for upper airway obstruction. The majority of these patients presented after postoperative day 1 (83%). Four patients required blood transfusions. Postoperative hemorrhage occurred in 14% of patients with elevated postoperative mean arterial pressures. Intraoperative blood loss that exceeded 50 cm3 was also a significant risk factor for post-tonsillectomy hemorrhage. It is concluded that older age, a history of chronic tonsillitis, excessive intraoperative blood loss and elevated postoperative mean arterial pressure are significant risk factors for post-tonsillectomy hemorrhage. An awareness of these risk factors can help identify patients with potential to bleed postoperatively.
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Affiliation(s)
- D Myssiorek
- Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, New Hyde Park, New York 11040, NY, USA
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44
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Heartfield W, Alvi A, Myssiorek D. Pathologic quiz case 2. Vagal paraganglioma. Arch Otolaryngol Head Neck Surg 1996; 122:1013, 1015. [PMID: 8797570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Alvi A, Stegnjajic A. Electrodissection tracheotomy. J Laryngol Otol 1996; 110:765-6. [PMID: 8869612 DOI: 10.1017/s0022215100134905] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The acquired immune deficiency syndrome (AIDS) epidemic and other potentially fatal blood-borne infectious diseases have produced a heightened awareness for preventing accidental inoculation of surgeons and operating theatre staff. It is incumbent upon the head and neck surgeon to use safe and effective surgical technique in these patients to prevent such an event. We are seeing an increasing number of patients with AIDS and hepatitis undergoing tracheotomy. We present a sharps-free technique for tracheotomy which is safe for the hospital staff and the patient.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center, Chicago Medical School, Illinois 60608, USA
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46
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Abstract
BACKGROUND Parathyroid (PTH) cyst is a rare lesion. Only about 200 cases have been reported to date. The diagnosis of a PTH cyst is difficult, particularly in its differentiation from thyroid cyst. It has clinical significance because PTH cysts can mimic a thyroid mass and can be associated with hyperparathyroidism. METHODS This presentation illustrates an additional case of a PTH cyst. The importance of fine-needle aspiration (FNA) in the diagnosis of PTH cyst and its management are discussed. RESULTS Fine-needle aspiration of clear fluid containing an elevated PTH hormone level proved to be diagnostic in the patient. Recurrence of the cyst after FNA required surgical resection. The current concepts of etiology and treatment are summarized. CONCLUSIONS PTH cyst should be in the differential diagnosis in any patient initially seen with an anterior cystic neck mass. Radiologic imaging and FNA can accurately diagnose PTH cysts. Surgical excision may be needed for recurrent cysts after aspiration.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Medical Center, Chicago, Illinois 60608, USA
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47
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Abstract
The treatment of cancer of the supraglottic larynx has undergone an evolution. Better understanding of the anatomy and biology of cancer in this anatomic site has enabled surgeons to devise effective oncologic strategies while making every effort to preserve the function of the larynx. Certain recent concepts and changing trends have emerged in the treatment of cancer of the supraglottic larynx, including the treatment of the neck, significance of extracapsular spread of tumor in cervical lymph nodes, and conservation laser surgery. In 1985, Snyderman et al. reported the prognostic significance of extracapsular spread in patients with cancer of the supraglottic larynx. In 1990, Lutz et al. reported the results of our experience with the treatment of 202 patients. The review verified the significant risk of bilateral neck disease in these patients, even with adjuvant radiation therapy. Accordingly, since 1990 all patients having cancer of the supraglottic larynx have been treated in the Department of Otolaryngology at the University of Pittsburgh with bilateral neck dissections. The use of adjuvant radiation therapy has been based on the presence of extracapsular spread. This study documents the oncologic effectiveness of this treatment and confirms the efficacy of bilateral neck dissections in an attempt to control neck disease and the prognostic significance of extracapsular spread. We review the evolution of the treatment of cancer of the supraglottic larynx, present our results, and consider innovative surgical approaches.
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Affiliation(s)
- E N Myers
- Department of Otolaryngology, University of Pittsburgh School of Medicine, PA 15213, USA
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48
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Alvi A, Joyner-Triplett N. Acute epistaxis. How to spot the source and stop the flow. Postgrad Med 1996; 99:83-90, 94-6. [PMID: 8650098] [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] [Indexed: 02/01/2023]
Abstract
The goals of epistaxis treatment are control of hemorrhage, prevention of cardiovascular and airway compromise, and determination of the cause and the source of bleeding. Distinguishing anterior from posterior epistaxis is important because therapeutic approaches differ. Epistaxis can usually be managed nonsurgically, but a surgical procedure is sometimes necessary. Cauterization, nasal packing, and use of an intranasal tampon or balloon catheter are effective nonsurgical interventions, but they may cause sinusitis, middle ear effusion, patient discomfort, and hypoxia. Surgical interventions include arterial ligation, endoscopic cauterization, and angiographic embolization. These highly effective methods incur the risks of general anesthesia and require technical expertise. A thorough and methodical approach to epistaxis is necessary, with otolaryngologic consultation when appropriate.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center, University of Health Sciences/Chicago Medical School, IL 60608, USA
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49
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Alvi A. Oral cancer: how to recognize the danger signs. Postgrad Med 1996; 99:149-52, 155-6. [PMID: 8604403] [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] [Indexed: 01/31/2023]
Abstract
Oral cancer remains a challenge to clinicians. Early treatment results in excellent cure rates and minimal functional disability. However, patients with advanced-stage disease often require extensive surgical procedures and adjuvant therapy. Despite radical treatment, survival rates are low and morbidity is high. Detection of oral cancer at an early stage, when it is most amenable to treatment, is an important goal. Only with continued education of the public and of healthcare providers, including primary care physicians and dentists, can this goal be achieved.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center, Chicago, IL 60608, USA
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50
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Abstract
Cervical metastasis is the most important prognostic factor in head and neck cancer patients. The prognostic significance of extracapsular spread of tumor in metastatic lymph nodes has also been documented. The presence of extracapsular spread further reduces the survival by 50% in those patients with cervical metastatic disease. Most patients with clinically negative necks (stage N0) have a good prognosis. However, some of these patients will have neck disease and distant metastasis and will eventually die. Because the presence of extracapsular spread is a predictor of poor outcome, we hypothesized that extracapsular spread may be a factor in the subset of patients with clinically negative necks who have poor outcomes. One hundred nine patients with clinically negative necks who had undergone neck dissection were identified. Occult metastasis was observed in 34% of patients. In this group, extracapsular spread was present in 18 (49%) patients. Overall, 103 patients were evaluable, of whom 70 (68%) remain free of disease 2 or more years after treatment. A subgroup of 68 patients had histologically negative nodes, of whom 56 (82%) are free of disease. Of patients with extracapsular spread, only 5 (31%) of 16 are free of disease. This is in contrast to patients with metastasis confined to the lymph node, of whom 9 (47%) of 19 are free of disease. Statistical analysis of these data shows that for this sample size this difference is significant. The addition of radiation therapy did not improve outcome in these patients. Extracapsular spread predicts a worse outcome in patients with subclinical cervical metastasis. Alternative modes of adjuvant therapy are suggested because of the poor results of postoperative radiation therapy in patients with extracapsular spread.
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Affiliation(s)
- A Alvi
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, USA
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