Ihab Roushdy Kamel, M.D., Ph.D.
https://www.hopkinsmedicine.org/profiles/results/directory/profile/0015667/ihab-kamel
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The soleus muscle plantarflexes the foot and is innervated by the tibial nerve (Sl-S2) heart attack prevention buy hydrochlorothiazide 25 mg. The gastrocnemius muscle plantarflexes the foot, weakly flexes the knee, and is innervated by the tibial nerve (Sl-S2). Attaches to the lateral supracondylar region of the femur and the calcaneus and is located between the gastrocnemius and soleus muscles. The plantaris muscle weakly plantarflexes the ankle and is innervated by the tibial nerve (Sl-S2). The calcaneal (Achilles) tendon is a large ropelike band of fibrous tissue in the posterior ankle that connects the calf muscles (gastrocnemius and soleus muscles) to the calcaneus bone. When the calf muscles contract, the calcaneal tendon tightens and pulls the heel, resulting in standing on tiptoe; therefore, it is important in activities such as walking and jumping. Rupture of the calcaneal tendon usually is caused by a forceful push-off during an activity such as sprinting when running or jumping in a game of basketball. Bruising usually is apparent, and a visible bulge forms in the posterior region of the leg because of calf muscle shortening. The flexor digitorum longus muscle flexes digits 2 to 5 and is innervated by the tibial nerve (S2-S3). The popliteus muscle unlocks the knee joint (it laterally rotates the femur on a fixed tibia) and is innervated by the tibial nerve (lA-S I). Attaches to the posterior surface of the fibula, interosseous membrane, and distal phalanx of the great toe. The flexor hallucis longus muscle flexes the great toe and is innervated by the tibial nerve (S2-S3). Attaches to the tibia, interosseous membrane, fibula, navicular bone, cuneiform bones, and metatarsals 2-4. The tibial nerve enters the foot through the tarsal tunnel inferior to the medial malleolus and innervates the plantar surface ofthe foot. The anterior tibial artery descends along with the deep fibular nerve, crosses the anteriorly over the ankle, and continues as the donal is pedis artery. The anterior tibial artery supplies blood to structures in the anterior compartment of the leg as well as partial blood supply to the lateral compartment. The tibial nerve innervates the muscles in the posterior compartment of the leg (gastrocnemius, plantaris, soleus, popliteus, flexor hallucis longus, flexor digitorum longus, and tibialis posterior muscles. Gives rise to the medial sural nerve, which arises in the popliteal fossa and descends superficial to the gastrocnemius muscle to join the sural communicating branch from the lateral sural nerve. Supplies the posterior compartment of the leg and continues distally through the tarsal tunnel to supply the plantar surface of the foot. Gives rise to a motor branch (innervates the short head of the biceps femoris muscle) and sensory branch (Lateral sural nerve), which provides cutaneous innervation to the lateral region of the leg. Descends along the posterior region of the leg by the fibula and supplies the posterior and lateral compartments of the leg.
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A presumptive diagnosis of pheochromocytoma is based on the combination of an adrenal mass blood pressure by age group buy cheap hydrochlorothiazide 12.5 mg, hypertension, and elevated blood and urinary levels of catecholamines and their metabolites, such as vanillylmandelic acid. Although 97% arise in the adrenal gland, a small percentage occur elsewhere, such as in the organs of Zuckerkandl; extraadrenal pheochromocytomas are called paragangliomas. With alcohol-fixed, Papanicolaou-stained preparations, the cytoplasm has a characteristic, deep red-to-purple, granular appearance. A rare and unusual lymphoma, the intravascular large B-cell lymphoma, has a predilection for involving the adrenal glands at presentation. Morphologically, the malignant cells are indistinguishable from a diffuse large B-cell lymphoma. The bubbly background and the absence of mitoses, necrosis, and elongated cells confirm that the lesion is a benign adrenal cortical nodule/adenoma and not metastatic small cell carcinoma. Metastatic adenocarcinomas from the lung, kidney, breast, and other sites can look like an adrenal cortical carcinoma. Active surveillance for localized renal masses: tumor growth, delayed intervention rates, and >5-yr clinical outcomes. Active surveillance of small renal masses: a safe management strategy for select patients. Diagnostic accuracy and clinical impact of imaging-guided needle biopsy of renal masses. Individualized renal mass biopsy strategy for Chinese patients with different subtypes and necrosis area. Retroperitoneal recurrence of a stage 1 renal cell carcinoma four years following core biopsy and fine needle aspiration: possible needle tract seeding. Utility of fine-needle aspiration and core biopsy with touch preparation in the diagnosis of renal lesions. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Combination of core biopsy and fine-needle aspiration increases diagnostic rate for small solid renal tumors. What is the added value of combined core biopsy and fine needle aspiration in the diagnostic process of renal tumours Diagnostic value of processing cytologic aspirates of renal tumors in agar cell (tissue) blocks. Benefits of a combined approach to sampling of renal neoplasms as demonstrated in a series of 351 cases. Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses. The value of preoperative needle core biopsy for diagnosing benign lesions among small, incidentally detected renal masses. Core needle biopsy and fine needle aspiration alone or in combination: diagnostic accuracy and impact on management of renal masses.
Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and and the American Society of Transplantation heart attack quotes discount 25 mg hydrochlorothiazide overnight delivery. Osteoporosis Pretransplant bone disease resulting from impaired vitamin D absorption in cholestatic liver disease, low calcium intake and activity, use of diuretics for ascites, and prednisone for autoimmune hepatitis is common. Inactivity after the transplant procedure and the use of high doses of steroids further accelerate bone loss. Consequently, post-transplant osteoporosis is a major cause of morbidity in patients undergoing transplantation. All patients should receive calcium and vitamin D supplementation after transplantation. Bone densitometrytesting is recommended and bisphosphonates prescribed if osteoporosis is noted. Hypertension Hypertension is a common occurrence after transplantation likely to the result of age and the use of calcineurin inhibitors. Standard antihypertensive regimens are efficacious in patients post-transplantation. Comparison between nifedipine and carvedilol in the treatment of de novo arterial hypertension after liver transplantation: preliminary results of a controlled clinical trial. Pregnancy Pregnancy has occurred as soon as a few weeks after liver transplantation. Because transplantation is associated with an increased incidence of premature and low-birth-weight infants, pregnant patients should be managed by an obstetrician who specializes in high-risk pregnancy. To minimize the risk of rejection and graft failure, immunosuppression is continued. Hyperlipidemia Hyperlipidemia is a common occurrence after liver transplantation, with an incidence of up to 50%. For patients with hypertriglyceridemia, fish oil and fibric acid derivatives should be considered. Neurologic Conditions Chronic headaches are noted with calcineurin inhibitors and may require modification in dosing. Early identification and treatment may prevent substance abuse relapse post-transplantation. Various antidepressants have been shown to be effective in post-transplant patients.
Mucinous tubular and spindle cell carcinoma of the kidney: Diagnosis by fine needle aspiration and review of the literature heart attack under 30 25 mg hydrochlorothiazide buy with amex. Cytologic aspect of mucinous tubular and spindle-cell renal carcinoma in fineneedle aspirates. Cercariform cells for helping distinguish transitional cell carcinoma from non-small cell lung carcinoma in fine needle aspirates. Importance of flow cytometry in the cytopathologic evaluation of lymphoid lesions involving the kidney. Lymphoproliferative disorders of the kidney on fine-needle aspiration: cytomorphology and radiographic correlates in 33 cases. Utilization of fine-needle aspiration in the diagnosis of metastatic tumors to the kidney. Metastases to the kidney: eleven cases diagnosed by aspiration biopsy with histologic correlation. Basaloid squamous carcinoma metastatic to renal-cell carcinoma: fine needle aspiration cytology of tumor-to- tumor metastasis. Distinguishing primary and metastatic conventional renal cell carcinoma from other malignant neoplasls in fine-needle aspiration biopsy specimens. Metastases to the kidney: a comprehensive analysis of 151 patients from a tertiary referral centre. Fine-needle aspiration cytology of clear-cell sarcinoma of the kidney: study of eight cases. The cytomorphologic spectrum of Wilms tumour on fine needle aspiration: a single institutional experience of 110 cases. Critical role of fine needle aspiration cytology and immunocytochemistry in preoperative diagnosis of pediatric renal tumors. Cellular mesoblastic nephroma in an infant: report of the cytologic diagnosis of a rare paediatric renal tumor. Clear cell sarcoma, cellular mesoblastic nephroma and metanephric adenoma: cytological features and differential diagnosis with wilms tumour. Fine-needle aspiration of renal and extrarenal rhabdoid tumors: the experience of the Institut Curie regarding 20 tumors in 13 patients. Fine needle aspiration cytology of fetal rhabdomyomatous and teratoid Wilms tumor. Intrarenal neuroblastoma diagnosed by fine-needle aspiration a report of two cases. Cytological diagnosis of mesoblastic nephroma: a report of three cases with summary of prior published cases.
The pathologic classification of neuroendocrine tumors: a review of nomenclature arteria anonima trusted hydrochlorothiazide 12.5 mg, grading, and staging systems. Pancreatic neuroendocrine tumour grading on endoscopic ultrasound-guided fine needle aspiration: high reproducibility and inter-observer agreement of the Ki-67 labelling index. Accuracy of pancreatic neuroendocrine tumour grading by endoscopic ultrasound-guided fine needle aspiration: analysis of a large cohort and perspectives for improvement. Islet 1 (Isl1) expression is a reliable marker for pancreatic endocrine tumors and their metastases. Fine needle aspiration cytology of acinar cell carcinoma of the pancreas: a report of two cases. Comparative cytologic features of pancreatic acinar cell carcinoma and islet cell tumor. Clinicopathologic study of 62 acinar cell carcinomas of the pancreas: insights into the morphology and immunophenotype and search for prognostic markers. Solid-pseudopapillary tumors of the pancreas are genetically distinct from pancreatic ductal adenocarcinomas and almost always harbor beta-catenin mutations. Significance of aberrant (cytoplasmic/nuclear) expression of beta-catenin in pancreatoblastoma. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Asymptomatic pancreatic cysts: a decision analysis approach to observation versus resection. Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy. Fine-needle aspiration of pancreatic serous cystadenoma: cytologic features and diagnostic pitfalls. Lymphoepithelial cysts of the pancreas: a report of 12 cases and a review of the literature. Giant epidermoid cyst within an intrapancreatic accessory spleen mimicking a cystic neoplasm of the pancreas: case report and review of the literature. Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms.
Human papillomavirus can infect the urinary tract blood pressure 700 buy generic hydrochlorothiazide 25 mg online,96 but when cytopathic changes characteristic of this virus are seen in a voided urine specimen from a woman, the cells most likely have originated from the vulva or vagina. Noninfectious Findings and Conditions Crystals Crystals are a common finding in urine specimens. Most have no clinical significance, and their existence depends on the concentration of their constituents and on the pH and temperature of the specimen. Crystals are reported and classified as a part of routine urinalysis, which is carried out on wet preparations rather than on cytologic ones. Still, many crystals retain their characteristic shapes on alcohol-fixed, Papanicolaou-stained preparations. Other less-common crystals include those composed of bilirubin (brown granules and needles), cholesterol, cystine (hexagonal plates), leucine (spheres with radiating striations), and tyrosine (slender needles). As with crystals, most urologists do not expect an interpretation of casts on a cytologic specimen, but it is appropriate to comment on them if numerous. Hyaline casts and granular casts are physiologic and can be present in normal urine in large numbers, especially after physical stress. Hyaline casts have a homogeneous, glassy texture; granular casts are composed of finely or coarsely granular debris. White blood cell casts are seen in tubulointerstitial diseases and in association with transplant rejection. Epithelial casts, composed of degenerated renal tubular cells, can be seen in any disease, including acute tubular necrosis. Fatty casts contain lipid vacuoles and are seen in patients with the nephrotic syndrome. Nonspecific reactive urothelial cell changes Inflammation and injury to the urothelium result in reactive urothelial cell changes. Coarsely vacuolated (as opposed to granular or finely vacuolated) cytoplasm is another characteristic of benign urothelial cells. Although adenocarcinomas can have vacuolated cytoplasm, their nuclei are so atypical that they are rarely confused with reactive urothelial cells. The nuclear chromatin can be smudged and featureless, but the nuclear membrane remains smooth, without the irregularity typical of malignant cells. Radiation effect can persist for weeks, months, or years after completion of treatment. Affected cells have enlarged cytoplasm and nuclei, but the normal nuclear-to-cytoplasmic ratio is preserved. These changes are observed in patients as early as 1 month after treatment with thiotepa. In recurrent cancer, the nucleus is dark, and the nuclear-to-cytoplasmic ratio is increased. Urothelial atypia associated with urinary calculi Urinary tract calculi typically present with hematuria and severe pain. Cytologic specimens may have a background of blood and inflammatory cells, including neutrophils and lymphocytes.
Syndromes
The luminal diameter of the uterine tubes is very narrow (as wide as a human hair) heart attack 23 years old purchase hydrochlorothiazide 12.5 mg online. In contrast to the male reproductive system, where the tubules are continuous with the testes, the uterine tubes are separate from the ovaries. Conveys the fertilized or unfertilized oocytes to the uterus by ciliary action and muscular contraction. Conveys spermatozoa from the uterine cavity to fertilize the oocyte in the infundibulum or ampulla. The beating movement of the fimbriae may create currents in the peritoneal fluid to carry oocytes into the uterine tube lumen. A fibrous cord that courses from the uterus through the deep inguinal ring and inguinal canal, exits the superficial inguinal ring, and attaches to the labia Ampulla. The constricted region of the uterine tube where each tube attaches to the superolateral wall of the uterus. Serves as the birth canal, the passageway for the sloughed endometrium from menstruation and is the receptacle for the penis during sexual intercourse. Primarily supplied by internal pudendal artery branches (internal iliac artery origin) and some from external pudendal arterial branches (femoral artery origin). Lymphatics from the lower region of the vagina drain into the superficial inguinal nodes. Arise from the ischiopubic rami and surround the crura ofthe clitoris and corpora cavernosa. Arises from the perineal body and bulb of the clitoris and inserts into the corpus spongiosum; compresses the erectile tissue of the vestibular bulbs. Arises from the ischial tuberosities and attaches to and supports the perineal body. Located within the deep perineal space and encircles the membranous urethra to inhibit or enhance the voiding of the bladder during urination. Paired longitudinal ridges of skin that are inferior and posterior to the mons pubis. The space between the labia minora containing the external urethral orifice, vagina, and ducts from the greater vestibular glands. Serves as an attachment site for the superficial perineal, deep perineal, levator ani, and external anal sphincter muscles.
Esophageal balloon cytology and subsequent risk of esophageal and gastric-cardia cancer in a high-risk Chinese population heart attack 80 blockage 25 mg hydrochlorothiazide amex. Endoscopic brush cytology and biopsy in the diagnosis of cancer of the upper gastrointestinal tract. Opportunistic disorders of the gastrointestinal tract in the age of highly active antiretroviral therapy. Intestinal metaplasia is the probable common precursor of adenocarcinoma in Barrett esophagus and adenocarcinoma of the gastric cardia. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Cytologic features of premalignant glandular lesions in the upper gastrointestinal tract. Loss of heterozygosities in Barrett esophagus, dysplasia, and adenocarcinoma detected by esophageal brushing cytology and gastroesophageal biopsy. Efficient automated assessment of genetic abnormalities detected by fluorescence in situ hybridization on brush cytology in a Barrett esophagus surveillance population. Adenocarcinomas of the distal esophagus and "gastric cardia" are predominantly esophageal carcinomas. Dramatic decline in prevalence of Helicobacter pylori and peptic ulcer disease in an endoscopy-referral population. Evaluation of brushing cytology in the diagnosis of Helicobacter pylori gastritis. Cytologic brushing as a simple and rapid method in the diagnosis of Helicobacter pylori infection. A triple stain for the detection of Helicobacter pylori in gastric brushing cytology. Mycobacteria can be seen as "negative images" in cytology smears from patients with acquired immunodeficiency syndrome. Carcinoid and pancreatic endocrine tumors: recent advances in molecular pathogenesis, localization, and treatment. Nomenclature and classification of neuroendocrine neoplasms of the digestive system. Validation of a cytotechnologist manual counting service for the Ki-67 index in neuroendocrine tumors of the pancreas and gastrointestinal tract. A threedecade analysis of 3,911 small intestinal neuroendocrine tumors: the rapid pace of no progress.
Invasive ductal carcinoma is almost invariably solid and can be detected by palpation or mammography arrhythmia and stroke hydrochlorothiazide 12.5 mg purchase with mastercard. Many invasive ductal carcinomas have a characteristically gritty consistency, appreciable during aspiration. Although most are pure ductal carcinomas, limited foci of tubular, papillary, mucinous, or medullary differentiation can be present. Many of the isolated cells of ductal cancers are comet-shaped, with a nucleus that protrudes from the cytoplasm. Note the pronounced nuclear pleomorphism and atypia, apparent with boththeRomanowsky(A)andPapanicolaou(B)stains. The differential diagnosis includes ductal carcinoma in situ, the presumed precursor of invasive ductal carcinoma. Not surprisingly, invasive ductal carcinoma and ductal carcinoma in situ appear identical on cytologic examination. The cohesiveness of some invasive tumor cells, and the lack of tubular structures, can suggest in situ carcinoma. As with invasive carcinoma, ductal carcinoma in situ can present as a palpable mass or a nonpalpable mammographic abnormality. Because of these inherent difficulties, it has been suggested that cell blocks can aid in the diagnosis of invasion. The distension of cytoplasm with mucus gives some tumor cells a signet-ring shape. Isolated cells with nuclear atypia, however, are highly characteristic of malignancy. Nuclear hyperchromasia suggests ductal carcinoma; nuclei with a single, small, uniform nucleolus are more typical of fibroadenoma. The double stain for cytokeratin and smooth muscle actin or p63 to detect myoepithelial cells is useful. Pregnancy and lactational changes mimic carcinoma because of the presence of numerous isolated cells with prominent nucleoli. The absence of nuclear hyperchromasia, nuclear size variation, and coarse chromatin favors a benign diagnosis. Focal nuclear atypia is seen in fat necrosis, radiation change, mastitis, and subareolar abscess, but the atypia is usually mild, and other background features provide clues to the diagnosis. Nevertheless, some well-differentiated invasive ductal carcinomas are impossible to distinguish from invasive lobular carcinomas. Compared with conventional lobular carcinoma, pleomorphic lobular carcinoma yields more cells.
The prognostic significance of peritoneal cytology for stage I endometrial cancer arteria tibial posterior purchase 12.5 mg hydrochlorothiazide with visa. Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph-node sampling: report of a prospective trial. Absence of prognostic significance, peritoneal dissemination and treatment advantage in endometrial cancer patients with positive peritoneal cytology. Peritoneal cytology: impact on disease-free survival in clinical stage I endometrioid adenocarcinoma of the uterus. Effect of hysteroscopy on the peritoneal dissemination of endometrial cancer cells: a meta-analysis. Incidence of peritoneal cytology from patients with early stage endometrial carcinoma following dilatation and curettage (D & C) versus hysteroscopy and D & C. Does diagnostic hysteroscopy in patients with stage I endometrial carcinoma cause positive peritoneal washings High incidence of positive peritoneal cytology in low-risk endometrial cancer treated by laparoscopically assisted vaginal hysterectomy. Laparoscopic surgery does not increase the positive peritoneal cytology among women with endometrial carcinoma. Prospective self-controlled study on prevention of hysteroscopic dissemination in endometrial carcinoma. Clinical significance of positive pelvic washings in uterine papillary serous carcinoma confined to an endometrial polyp. Positive peritoneal cytology is an adverse factor in endometrial carcinoma only if there is other evidence of extrauterine disease. The risk of lymph node metastasis with positive peritoneal cytology in endometrial cancer. Positive peritoneal cytology is an independent risk-factor in early stage endometrial cancer. The relationship between positive peritoneal cytology and the prognosis of patients with uterine cervical cancer. Localized pancreatic cancer with positive peritoneal cytology as a sole manifestation of metastatic disease: a single-institution experience. Clinical importance of intraoperative peritoneal cytology in patients with pancreatic cancer. Reappraisal of peritoneal washing cytology in 984 patients with pancreatic ductal adenocarcinoma who underwent margin-negative resection. Prognostic significance of intraoperative peritoneal washing cytology for patients with potentially resectable pancreatic ductal adenocarcinoma. Clinical implications of peritoneal cytology in potentially resectable pancreatic cancer: positive peritoneal cytology may not confer an adverse prognosis. The critical role of peritoneal cytology in the staging of gastric cancer: an evidence-based review.
Volkar, 61 years: The inferior alveolar nerve enters the mandibular foramen and provides general sensory innervation to the mandibular teeth. Subdural hematoma because of a torn bridging vein between the brain and superior sagittal sinus 2. Utilization of fine-needle aspiration in the diagnosis of metastatic tumors to the kidney.
Rufus, 27 years: Because the C282Y homozygous state does not necessarily translate into clinical disease, the diagnosis of hereditary hemochromatosis is determined by a combination of genetic, serologic, and clinical features. Greater wing and body of the sphenoid bone, with the infraorbital fissure transmitting the infraorbital nerve and the vessels in the orbit. The risk of statin-induced acute liver failure is less than 1 in 1 million patients, and cases of statininduced significant liver injury are rare in large series of patients with acute liver failure.
Josh, 57 years: Respiratory cytology-current trends including endobronchial ultrasound-guided biopsy and electromagnetic navigational bronchoscopy: analysis of data from a 2013 supplemental survey of participants in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. It is important to exclude perforation in all patients with abdominal imaging prior to considering endoscopy. Light touch of the medial region of the thigh elicits a motor reflex, causing contraction of the cremaster muscle to pull the testis on the same side of the body closer to the body.
Javier, 21 years: Metaplastic breast carcinoma with chondrosarcomatous differentiation: fine-needle aspiration cytology findings. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension.
Berek, 62 years: Autoimmune pancreatitis is important to recognize because it responds to corticosteroid therapy and does not require surgery. The differential diagnosis includes other benign effusions of nontuberculous origin, as in patients after coronary artery bypass surgery. The differential diagnosis includes follicular carcinoma, papillary carcinoma, and anaplastic carcinoma88,89-important considerations given that external radiation has been associated with an increased risk of thyroid cancer.
Barrack, 48 years: Smears show numerous naked nuclei and a finely granular background derived from the abundant, fragile cytoplasm of the tumor cells. The risk of malignancy is low and does not justify the morbidity of a Whipple resection, especially in a high-risk surgical candidate. A runny nose results from an overproduction of mucus due to conditions such as the common cold, sinusitis, and allergies.
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