Faisal Raja - Academia.edu (original) (raw)

Papers by Faisal Raja

CJEM, 2013

A 51-year-old man presented with a 5-day history of progressive facial swelling, sensation of hea... more A 51-year-old man presented with a 5-day history of progressive facial swelling, sensation of head fullness, increasing shortness of breath and paroxysmal nocturnal dyspnea. He denied chest pain, syncope or presyncope. Pastmedical history included mechanical aortic valve replacement 7 years prior and atrial fibrillation treated with warfarin. A clinical diagnosis of acute superior vena cava (SVC) syndrome was made. Portable chest radiograph showed a widened superior mediastinum. Computed tomography scan of the thorax demonstrated a large type A aortic dissection almost completely effacing the SVC. Acute type A aortic dissection (AD) is an emergency requiring prompt diagnosis and treatment. Patients typically present with acute onset of chest and/or back pain, classically described as “ripping” or “tearing.” SVC syndrome is rarely, if ever, mentioned as a presentation, as it is usually due to more chronic conditions. This case illustrates a rare incidence of type A AD actually presen...

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 19, 2002

Coronary artery disease affects a significantly larger proportion of Canadians of South Asian ori... more Coronary artery disease affects a significantly larger proportion of Canadians of South Asian origin than Canadians of other ethnic origins. We compared differences in presentation, risk factors and management of myocardial infarction (MI) between South Asian Canadians and matched control subjects. We reviewed the charts of 553 South Asian patients and 553 non-South Asian matched control subjects presenting with acute MI (International Classification of Diseases code 410) to 2 hospitals in Canada from January 1994 to April 1999. We identified South Asian subjects by their surnames and first names, and by using self-reported ethnicity and country of birth when available. Patients of Southeast Asian and Middle Eastern origin were excluded. The remaining patients were classified as non-South Asian. Subjects were matched by age within 5 years, sex, discharge date within 6 months and hospital of admission. Presentation characteristics, risk factors and major complications were compared b...

Canadian Association of Radiologists Journal, 2012

Canadian Association of Radiologists Journal, 2011

Journal of Ultrasound in Medicine, 2012

A female neonate was born at term by cesarean delivery because of shoulder dystocia. Her mother w... more A female neonate was born at term by cesarean delivery because of shoulder dystocia. Her mother was a healthy 34-year-old woman, gravida 3, para 1, aborta 1. The child was vigorous at birth, with otherwise uncomplicated perinatal circumstances. Prenatal morphologic sonography performed at 19 weeks identified a dilated right renal pelvis (Figure 1A). Subsequent antenatal sonographic examinations consistently showed an abnormal fetal right kidney, which changed in appearance through the course of the pregnancy. Prenatal sonography at 28 weeks’ gestation showed an enlarged echogenic right kidney (Figure 1B), progressing on to a 4.2-cm echogenic upper pole masslike area at term (Figure 1C). The patient went on to have an urgent computed tomographic scan soon after delivery, which identified a reniform expansion of the right kidney upper pole, with minimal and mostly peripheral enhancement and no visualized associated collecting system. The differential diagnosis considered was mesoblastic nephroma, complications from a duplex collecting system, or a Wilms tumor. The radiologic findings were varied and not typical of a purely solid renal mass or pure segmental cystic dysplasia. The morphologic characteristics of the right kidney upper pole differed considerably between prenatal and neonatal sonography and neonatal computed tomography. Because the imaging findings at times were highly suggestive of a solid renal mass, and the parents were quite concerned about that possibility, the decision for nephrectomy was made. Resection revealed a right renal specimen with a bosselated surface; two ureters were present: a superior ureter contiguous with a fibrotic and stellate superior major calyx and a middle major calyx surrounded by granular and cystic parenchyma; and an inferior ureter contiguous with a normal-appearing lower pole (Figure 1D). The diagnosis on biopsy was segmental dysplasia of the upper pole with duplicated ureters. These findings, taken in context with the dilated collecting system seen on the 19-week sonographic examination, suggested that the dysplasia was likely secondary to congenital obstruction of the upper pole moiety. The patient did well postoperatively, with no recurrence or ongoing complications. A unilateral Wilms tumor is generally treated by resection.1 Mesoblastic nephroma usually exhibits benign characteristics; however, it is also resected for risk of sarcomatous degeneration.1 With regard to segmental renal dysplasia with duplicate ureters, as in this case, the literature is scarce on detection and treatment in the prenatal and neonatal periods. If considered within the same realm as a multicystic dysplastic kidney, then conservative treatment without nephrectomy has been advocated in asymptomatic patients whose abnormal renal tissue is poorly functioning or nonfunctioning.2 Risks, such as hypertension and malignant transformation, are not substantially increased compared with the general population,3 and patients with a multicystic dysplastic kidney maintain normal growth and development.4 In a retrospective review performed by Mattioli et al,5 in which all patients had histologically confirmed segmental or complete dysplasia of the kidney, no malignancies were detected. Most cases of a multicystic dysplastic kidney that were followed only and not resected tended to show involution.2,4 There is no consensus in the literature to support routine nephrectomy in segmental renal dysplasia. Hence, in a patient whose dysplastic renal tissue is essentially nonfunctioning, conservative management with close follow-up may be a prudent course of action.

CJEM, 2013

A 51-year-old man presented with a 5-day history of progressive facial swelling, sensation of hea... more A 51-year-old man presented with a 5-day history of progressive facial swelling, sensation of head fullness, increasing shortness of breath and paroxysmal nocturnal dyspnea. He denied chest pain, syncope or presyncope. Pastmedical history included mechanical aortic valve replacement 7 years prior and atrial fibrillation treated with warfarin. A clinical diagnosis of acute superior vena cava (SVC) syndrome was made. Portable chest radiograph showed a widened superior mediastinum. Computed tomography scan of the thorax demonstrated a large type A aortic dissection almost completely effacing the SVC. Acute type A aortic dissection (AD) is an emergency requiring prompt diagnosis and treatment. Patients typically present with acute onset of chest and/or back pain, classically described as “ripping” or “tearing.” SVC syndrome is rarely, if ever, mentioned as a presentation, as it is usually due to more chronic conditions. This case illustrates a rare incidence of type A AD actually presen...

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 19, 2002

Coronary artery disease affects a significantly larger proportion of Canadians of South Asian ori... more Coronary artery disease affects a significantly larger proportion of Canadians of South Asian origin than Canadians of other ethnic origins. We compared differences in presentation, risk factors and management of myocardial infarction (MI) between South Asian Canadians and matched control subjects. We reviewed the charts of 553 South Asian patients and 553 non-South Asian matched control subjects presenting with acute MI (International Classification of Diseases code 410) to 2 hospitals in Canada from January 1994 to April 1999. We identified South Asian subjects by their surnames and first names, and by using self-reported ethnicity and country of birth when available. Patients of Southeast Asian and Middle Eastern origin were excluded. The remaining patients were classified as non-South Asian. Subjects were matched by age within 5 years, sex, discharge date within 6 months and hospital of admission. Presentation characteristics, risk factors and major complications were compared b...

Canadian Association of Radiologists Journal, 2012

Canadian Association of Radiologists Journal, 2011

Journal of Ultrasound in Medicine, 2012

A female neonate was born at term by cesarean delivery because of shoulder dystocia. Her mother w... more A female neonate was born at term by cesarean delivery because of shoulder dystocia. Her mother was a healthy 34-year-old woman, gravida 3, para 1, aborta 1. The child was vigorous at birth, with otherwise uncomplicated perinatal circumstances. Prenatal morphologic sonography performed at 19 weeks identified a dilated right renal pelvis (Figure 1A). Subsequent antenatal sonographic examinations consistently showed an abnormal fetal right kidney, which changed in appearance through the course of the pregnancy. Prenatal sonography at 28 weeks’ gestation showed an enlarged echogenic right kidney (Figure 1B), progressing on to a 4.2-cm echogenic upper pole masslike area at term (Figure 1C). The patient went on to have an urgent computed tomographic scan soon after delivery, which identified a reniform expansion of the right kidney upper pole, with minimal and mostly peripheral enhancement and no visualized associated collecting system. The differential diagnosis considered was mesoblastic nephroma, complications from a duplex collecting system, or a Wilms tumor. The radiologic findings were varied and not typical of a purely solid renal mass or pure segmental cystic dysplasia. The morphologic characteristics of the right kidney upper pole differed considerably between prenatal and neonatal sonography and neonatal computed tomography. Because the imaging findings at times were highly suggestive of a solid renal mass, and the parents were quite concerned about that possibility, the decision for nephrectomy was made. Resection revealed a right renal specimen with a bosselated surface; two ureters were present: a superior ureter contiguous with a fibrotic and stellate superior major calyx and a middle major calyx surrounded by granular and cystic parenchyma; and an inferior ureter contiguous with a normal-appearing lower pole (Figure 1D). The diagnosis on biopsy was segmental dysplasia of the upper pole with duplicated ureters. These findings, taken in context with the dilated collecting system seen on the 19-week sonographic examination, suggested that the dysplasia was likely secondary to congenital obstruction of the upper pole moiety. The patient did well postoperatively, with no recurrence or ongoing complications. A unilateral Wilms tumor is generally treated by resection.1 Mesoblastic nephroma usually exhibits benign characteristics; however, it is also resected for risk of sarcomatous degeneration.1 With regard to segmental renal dysplasia with duplicate ureters, as in this case, the literature is scarce on detection and treatment in the prenatal and neonatal periods. If considered within the same realm as a multicystic dysplastic kidney, then conservative treatment without nephrectomy has been advocated in asymptomatic patients whose abnormal renal tissue is poorly functioning or nonfunctioning.2 Risks, such as hypertension and malignant transformation, are not substantially increased compared with the general population,3 and patients with a multicystic dysplastic kidney maintain normal growth and development.4 In a retrospective review performed by Mattioli et al,5 in which all patients had histologically confirmed segmental or complete dysplasia of the kidney, no malignancies were detected. Most cases of a multicystic dysplastic kidney that were followed only and not resected tended to show involution.2,4 There is no consensus in the literature to support routine nephrectomy in segmental renal dysplasia. Hence, in a patient whose dysplastic renal tissue is essentially nonfunctioning, conservative management with close follow-up may be a prudent course of action.