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Ali MJ. Alterations of lacrimal sac vasculature in lacrimal disorders: Chromo endoscopic assessment with changes in effective spectral response. J Fr Ophtalmol 2024; 47:104133. [PMID: 38696863 DOI: 10.1016/j.jfo.2024.104133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/29/2023] [Accepted: 10/22/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE To study the structural and dynamic alterations in the lacrimal sac vasculature of patients with congenital, primary, and secondary acquired nasolacrimal duct obstructions (CNLDO, PANDO, SANDO) and patients with acute dacryocystitis (AD) and failed dacryocystorhinostomy (DCR). METHODS A prospective study was performed on 65 consecutive lacrimal sacs following their complete exposure during endoscopic dacryocystorhinostomy. High magnification chromo endoscopy and changes in effective spectral response was achieved using the Storz professional image enhancement system (SPIES®). Structural characteristics studied include vascular arrangement, superficial and deep vessels, vessel calibers on cut section, abnormal branching, localized and generalized dilatations and pathologies like varices. Flow characteristics in different caliber vessels and their alterations were assessed in Spectra A mode of SPIES®. RESULTS Distinct vascular alterations were noted in several lacrimal disorders. Vascular dilatations differed between the fundus and the body segments of the lacrimal sac, except in cases of traumatic SANDO and prior failed DCRs. 23% (7/30) of PANDO sacs showed peri sac varices and severe tortuosity. The flow in the dilated vessels was either very slow or showed intermittent backflow. Moderate dilatation of peri sac venous plexus with distinct surface linear vessels was noted in CNLDO. The cut surface of the sac wall and luminal surface differentially demonstrated several vascular patterns like speckled, scattered, branched loops, and skip areas in various diseased states. CONCLUSION The present study found distinct alterations of lacrimal sac vasculature in several lacrimal drainage disorders and provides impetus to the vascular theory for pathogenesis of PANDO.
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Affiliation(s)
- M J Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, 500034 Hyderabad, India.
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Ali MJ, Yartsev VD. [Rare cases of lacrimal stent dislocation]. Vestn Oftalmol 2019; 135:204-208. [PMID: 31691661 DOI: 10.17116/oftalma2019135052204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intubation of lacrimal passages is a relatively frequent procedure performed as either independent intervention, or as a part of a complex surgery. Although complications after intubation of lacrimal passages occur rarely, and their detailed description is easily found in literature, cases of stent dislocation often become difficult for the surgeon. The article presents two clinical cases belonging to the type of lacrimal stent dislocation not previously described in literature. In the first case, intrapalpebral arc of the stent was in the right position, while its nasal ends could not be found in the nasal cavity. Endoscopic stent reposition was performed using an endoscope with a 30-degree viewing angle. In the second case, intrapalpebral arc of the stent could not be determined, but its heel was removed from the lover nasal passage using an endoscope. This seems to have been preceded by intraluminal disruption of stent's integrity. The authors also analyze cases of lacrimal stent dislocation described in literature and reach a conclusion that endonasal endoscopy with the application of optics with different viewing angles is suitable for efficient visualization of a dislocated lacrimal stent and its reposition.
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Affiliation(s)
- M J Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India, 500034
| | - V D Yartsev
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Abstract
Ophthalmologists and interventional radiologists are not the only professionals for whom diseases of the efferent tear duct system occupy centre stage; this applies also to ENT specialists involving endonasal conservative or surgical treatment. On the basis of current knowledge and taking account of results yielded by own research in recent years and of clinical aspects, we here give an overview of basic knowledge on the anatomy and physiology of the nasolacrimal system. In doing so functional aspects regarding tear transport as well as embryological and pathophysiological issues are integrated.
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Affiliation(s)
- F Paulsen
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland.
| | - F Garreis
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland
| | - M Schicht
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland
| | - L Bräuer
- Institut für Anatomie, Lehrstuhl II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 19, 91054, Erlangen, Deutschland
| | - M J Ali
- The Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - S Sel
- Universitätsaugenklinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
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Nair AG, Kaliki S, Ali MJ, Naik MN, Vemuganti GK. Intraocular malignant melanoma of the choroid presenting as orbital cellulitis. Int Ophthalmol 2013; 34:647-50. [DOI: 10.1007/s10792-013-9836-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/22/2013] [Indexed: 11/29/2022]
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Chintagumpala MM, Langholz B, Eagle R, Albert D, Ali MJ, Khetan V, Honavar S, O'Brien J, Leahey A, Matthay KK, Meadows AT, Chevez-Barrios P. A large prospective trial of children with unilateral retinoblastoma with and without histopathologic high-risk features and the role of adjuvant chemotherapy: A Children’s Oncology Group (COG) study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9515 Background: The definition of histopathologic high-risk features (HRF) in enucleated eyes of children with unilateral retinoblastoma and their contribution to metastases is controversial. The COG completed a large, prospective international study to determine the prevalence of strictly defined histopathologic HRF that are predictors of recurrence and the role of chemotherapy to prevent recurrences. Methods: All patients who underwent enucleation for unilateral retinoblastoma were eligible for the study. Pathology slides were submitted for central review within 21 days of enucleation. Patients with evidence of one or more high-risk features (posterior uveal invasion grades IIC and D, concurrent optic nerve and choroid involvement and post-lamina optic nerve involvement) as determined by central review, received 6 cycles of chemotherapy consisting of carboplatin, vincristine and etoposide. All others were observed. All patients were followed for extraocular recurrences. Results: Patients were enrolled from February of 2005 until May 2010. As of July 2011, the median follow-up from enrollment was 1.9 years (max=5.3 years). Of 312 patients with central histopathology review, 49 patients had their risk classification changed (13% with no HRF had HRF, 24% with HRF had no HRF). Two patients developed extraocular disease and one patient died of unknown cause. The death and one of the extraocular relapses occurred among the 93 (2/93=2.2%, upper 95% CI 3.4%) patients assigned by the central review to receive chemotherapy, while one patient experienced extraocular relapse among the 209 (1/209=0.5%, upper 95% CI 0.6%) assigned to observation only. There is no evidence of a difference in the EFS and OS in these two groups. Conclusions: Preliminary results strongly suggest that a central review of pathology can spare a significant number of patients from exposure to chemotherapy. Chemotherapy may have contributed to fewer relapses in patients with high-risk features as defined in this study. The preliminary results from this study indicate an excellent outcome with this approach.
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Affiliation(s)
| | | | | | - Daniel Albert
- University of Wisconsin Eye Research Institute, Madison, WI
| | | | | | | | | | - Ann Leahey
- Children's Hospital of Philadelphia, Philadelphia, PA
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Reddy VAP, Honavar S, Fairooz PM, Ali MJ, Vemuganti GK. Demographics, treatment, and outcome of retinoblastoma: A large series with protocol-based management. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9568] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9568 Background: Retinoblastoma is the most common primary intraocular malignancy of childhood with incidence of 1 in 20,000 and the third most common pediatric cancer. In the previous decades, early diagnosis and treatment of retinoblastoma have improved survival rates in developed countries. Nevertheless, protocol based management help reduce the mortality rate associated with advanced tumors. The purpose of the study is to report demographics, management, and outcome of retinoblastoma in the Ocular oncology centre of South India. Methods: Consecutive case series of 1,543 eyes of 1,067 patients with 22 years of follow-up. Demographics, clinical features, treatment and outcome (survival, organ salvage and function salvage) were analyzed. Management comprised of focal therapy for small tumors, standard triple drug chemoreduction for larger (>4mm) tumors, high dose chemoreduction and periocular chemotherapy for vitreous seeds, and enucleation for advanced tumors. Adjuvant therapy was provided in patients with histopathologic high-risk factors for systemic metastasis. Orbital retinoblastoma was managed with a multimodal treatment protocol. Results: Sixty-six percent were <3 years of age. Forty-five percent were bilateral. Symptoms were leucocoria (33%), vision loss (10%), proptosis (6%), and squint (6%). The tumor was intraocular in 94% and orbital in 6%. Management was by protocol and included enucleation (52%), chemoreduction (26%), focal therapy (11%), and external beam radiation (5%). Fifty-five percent of enucleated patients had histopathologic risk factors for metastasis and received adjuvant chemotherapy. Chemoreduction with focal therapy resulted in eye and vision salvage in 92%. Overall, 94% survived. Conclusions: Protocol-based management of retinoblastoma provides excellent prognosis for survival, eye salvage and vision salvage.
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Levy RM, Major E, Ali MJ, Cohen B, Groothius D. Convection-enhanced intraparenchymal delivery (CEID) of cytosine arabinoside (AraC) for the treatment of HIV-related progressive multifocal leukoencephalopathy (PML). J Neurovirol 2001; 7:382-5. [PMID: 11517421 DOI: 10.1080/13550280152537283] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [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: 10/16/2022]
Abstract
AIDS-related PML continues to be a relatively common and rapidly fatal infection in patients with AIDS, and no effective therapy has been established to alleviate the effects of this disease. Through the years, isolated reports and small case studies have shown somewhat encouraging results using cytosine arabinoside (AraC) in the treatment of PML. The optimism behind the use AraC for this disease began to fade with ACTG trial 243, which suggested that AraC had no benefit in patients with HIV-related PML. In this article, we provide evidence that suggests that the failure of AraC in the ACTG trial may have been due to insufficient delivery of the drug through traditional intravenous and intrathecal routes. Furthermore, we provide evidence that convection-enhanced intraparenchymal delivery of AraC may prove to be a safe and effective means of treating this infection, and we outline a clinical trial that we have recently undertaken to test this hypothesis.
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Affiliation(s)
- R M Levy
- Department of Neurosurgery, Northwestern University Medical School, Chicago, Illinois 60611, USA.
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Peragallo RA, Ali MJ, Omran AS, Williams WG. An unusual finding in a patient with hypertrophic cardiomyopathy. J Cardiothorac Vasc Anesth 2001; 15:396-7. [PMID: 11426379 DOI: 10.1053/jcan.2001.23336] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R A Peragallo
- Departments of Anesthesia, Medicine, and Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Ali MJ, Omran AS, Rakowski HR, William WG. Pulmonary valve injury: Swan-Ganz or surgery. Can J Cardiol 2001; 17:467-70. [PMID: 11329547] [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: 02/19/2023] Open
Abstract
Pulmonary artery catheter (PAC) is a commonly used monitor in cardiac surgery. Pulmonary valve injury from the balloon of the pulmonary artery catheter is exceedingly rare; its description by transesophageal echocardiography is nonexistent in the literature. A patient is reported who developed a flail anterior pulmonary leaflet several days after successful myectomy for hypertrophic cardiomyopathy. The temporal sequence of PAC use and four transesophageal echocardiography studies over 13 days, with the first three showing normal pulmonary valves, suggested pulmonary valve trauma, most likely from a Swan-Ganz catheter, as the etiology. Partial damage to the pulmonary valve from the original surgery may have predisposed the patient to further damage when the PAC was reintroduced in the intensive care unit.
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Affiliation(s)
- M J Ali
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
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Day FJ, Ali MJ. Embracing the heart: perioperative management of patients undergoing off-pump coronary artery bypass grafting using the octopus tissue stabilizer. J Cardiothorac Vasc Anesth 2000; 14:236; author reply 237. [PMID: 10794353 DOI: 10.1016/s1053-0770(00)90042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
PURPOSE Recently, the American College of Cardiology - American Heart Association (ACC-AHA) published guidelines and an associated algorithm for preoperative cardiovascular evaluation of patients undergoing non-cardiac surgery. Our purpose was to (i) test guideline's ability to predict adverse cardiac events within seven days after surgery, (ii) determine whether medical clinical predictors or surgical risks was a better predictor of cardiac events. METHODS Retrospective review of 119 cardiology and anesthesia consultations over 15 mo, ending March 31, 1998. Patients were classified into their respective medical clinical predictor and surgical risk groups, as outlined in ACC-AHA guidelines. Associations between the medical predictor and surgical risk scores and adverse cardiac outcomes were quantified via multiple logistic regression analysis. Two outcomes were employed. Outcome I, included: myocardial infarction/ischemia; angina; congestive heart failure, arrhythmia or death. Outcome 2 expanded the definition to include "cancellation of surgery due to cardiac risk" as a negative cardiac outcome. RESULTS Diabetes, Canadian Cardiovascular Class (CCS) III or IV angina, and MI within six months before surgery were strongly associated with the two cardiac outcomes. For outcome 1 and 2, medical predictors and surgical risks, considered simultaneously, performed with a sensitivity of 93% and specificity of 46-51%. When considered separately, major clinical medical predictors had a sensitivity of 87-89%, while surgical risks showed a specificity of 89% in predicting the two outcomes. CONCLUSION Medical predictors in ACC-AHA classification scheme were highly sensitive whereas surgical risks were more specific in predicting adverse post-operative cardiac events. Prospective study is needed to confirm these observations.
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Affiliation(s)
- M J Ali
- Department of Anaesthesia, Queens University, Toronto, Ontario, Canada.
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Ali MJ, Hutfluss R. Epidural fentanyl-bupivacaine infusion for management of pain in the Guillain-Barré syndrome. Reg Anesth 1992; 17:171-4. [PMID: 1606101] [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: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Epidural morphine with fentanyl has been used with some success to treat the pain associated with Guillain-Barré syndrome. This report describes a female with Guillain-Barré syndrome in which lower extremity and generalized positional pain failed to respond to conventional pain therapy. An epidural infusion of bupivacaine and fentanyl was used to treat her pain. METHODS A case report. RESULTS An epidural infusion of 15 mg/hour bupivacaine and 75 micrograms/hour fentanyl produced good pain relief (visual analog scale decreased from 9 to 2) and allowed increased mobility. Over 24 days of treatment, the infusion requirements gradually increased, suggestive of tachyphylaxis. CONCLUSIONS These patients sometimes fail to respond to conventional pain therapy and may require the expertise of an anesthesiologist to deliver epidural analgesics.
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Affiliation(s)
- M J Ali
- Department of Anaesthesia and Critical Care Medicine, University Hospital, London, Ontario, Canada
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Abstract
This case report describes the use of octreotide, a long-acting somatostatin analogue, in the management of a patient with an ovarian carcinoid tumour and severe cardiac valvular disease. This patient underwent laparotomy and tumour resection without complication. Anaesthesia was induced with midazolam, fentanyl, and vecuronium, and maintained with isoflurane as well as additional fentanyl and vecuronium. However, we feel that it was the use of octreotide that prevented a life-threatening crisis intraoperatively, and recommend its use in patients with carcinoid syndrome undergoing anaesthesia and surgery.
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Affiliation(s)
- J T Watson
- Department of Anaesthesia, University Hospital, University of Western Ontario, London
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Potter CW, Jennings R, Ali MJ, Wood JM, Dunleavy U, Tyrrell DA. Sequential infection or immunization of ferrets with a series of influenza A (H3N2) strains (report to the Medical Research Council's Sub-Committee on influenza Vaccines (CDVIP/IV)). Epidemiol Infect 1987; 99:501-15. [PMID: 3315713 PMCID: PMC2249279 DOI: 10.1017/s095026880006800x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 01/05/2023] Open
Abstract
Previous studies of boys at Christ's Hospital school have indicated that annual immunization with influenza virus vaccines did not significantly reduce the total incidence of influenza infection compared to unimmunized subjects. In view of the implications of this result, a similar study was conducted in ferrets to clarify these findings. Groups of ferrets were immunized or infected with a series of influenza A (H3N2) viruses over an 18-month period, and the immunity to subsequent live virus challenge was measured after each virus or vaccine exposure. The results indicated that live virus infection gave a more solid immunity than immunization with inactivated vaccine; and the serum haemagglutination-inhibiting antibody response was greater following immunization than following infection. In addition, differences in immunity could not be explained by measurements of cross-reacting and specific antibody, since the incidence of these antibodies was similar in both infected and immunized animals. The results do not suggest an explanation for the different levels of immunity induced following infection or immunization or the results obtained from the Christ's Hospital study. However, the relative contribution of various immune responses to virus or virus antigen is discussed, and it is suggested that the difference in immunity may lie in the ability of live virus infection to stimulate local antibody.
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Abstract
The growth characteristics of a series of influenza A viruses in the turbinates and lungs of hamsters was measured: in addition, the susceptibility of hamsters to infection by these viruses was also determined. These two criteria were used to give estimates of the growth potential of influenza viruses in hamsters, and the results were related to the incidence of transmission of virus from inoculated hamsters to cage-contacts. The results showed that strains of influenza virus reported as virulent for man tended to grow to higher titres in hamster nasal washings and lungs; were more infective for hamsters when inoculated by the intranasal route; and showed a high incidence of spread to cage-contacts. The methods could provide valuable measurements of virus attenuation and transmissibility for man, and the further exploitation of these techniques could facilitate the production and licensing of live, attenuated influenza virus vaccines.
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