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Biomedical subjects

A H Tan

Publications and source records attributed to A H Tan.

7 recordsLinked to original sources
PubMed2004

Results of shockwave lithotripsy for pediatric urolithiasis.

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) is widely practiced in the management of pediatric urolithiasis. However, the efficacy, need for ancillary procedures, and treatment-related complications are not as clearly defined as in the adult population. We reviewed the outcomes of SWL in the pediatric population at our lithotripsy unit. PATIENTS AND METHODS: A retrospective review of all patients </=16 years of age treated with SWL between January 1991 and June 2002 was undertaken. One hundred patients with 115 stones underwent 131 SWL procedures (115 first treatments, 16 retreatments). The mean age was 10.7 years (range 10 months-16 years). Stone locations were as follows: caliceal 42.6%, renal pelvic 27%, and ureteral (30.4%). The mean stone size was 7.8 mm (range 2-23 mm). Risk factors for stone formation, the need for secondary therapies, and treatment-related complications were noted. The stone-free rate for a single-session SWL procedure, defined as complete absence of stone fragments on plain film, intravenous urography, or renal ultrasonography, was calculated based on 3-month follow-up. The efficiency quotient (EQ) was also calculated. RESULTS: Risk factors were identified in 31 children (27.0%), including metabolic and anatomic abnormalities. Patients with a risk factor were less likely to be stone free after one SWL session than those without risk factors (31.7% v 64.7%; P < 0.001). General (74.8%), neurolept (24.4%), and epidural (0.8%) anesthesia were utilized. Ureteral stents were placed in 25% of treatments. There were no intraoperative complications. Minor complications were seen in 4.6% of patients. Ancillary procedures were required in 10 patients. Following initial SWL treatment, 60.2% of patients were stone free. The retreatment rate was 13.9%. Following a second treatment, the stone-free rate increased to 68%. The EQ was 54.3. CONCLUSION: Employing a strict definition of treatment success, single-session SWL in our series offers moderate efficacy in the pediatric population. Patients who have a large stone or risk factor such as an anatomic abnormality are less likely to become stone free and might better undergo an endourologic procedure.

Adolescent↗
PubMed2000

Radiological classification of meniscocapsular tears of the anterolateral portion of the lateral meniscus of the knee.

In an arthroscopic-MRI correlation study of acute injuries to the knee it was found that anterolateral meniscocapsular separations of the lateral aspect of the knee were missed on MRI reporting. Eighty sports-related injuries of the knee were seen by experienced orthopaedic surgeons at the University of Malaya Medical Centre and at the National Sports Centre, Malaysia from January 1996 to July 1997. Fifty of the patients were suspected to have meniscal tears that were either lateral or medial on clinical examination and they were sent for MRI. Many of these patients were tertiary referrals. Magnetic resonance imaging examinations in 27 of the 50 patients were reported as not showing any intrasubstance or obvious meniscocapsular tears, but arthroscopy performed on them revealed anterolateral meniscocapsular tears of the lateral meniscus of varying degrees in nine of these patients. In retrospect the tears could be seen on MRI, and a pattern to the tears was noted and classified as follows. Type 0, normal; type 1, torn inferior or superior meniscocapsular attachment; type 2, both meniscofemoral and meniscotibial ligaments torn but with minimal separation of meniscus and capsule by fluid or synovitis; and type 3, marked separation of meniscus and capsule by fluid (> 3 mm). Ten patients who did not undergo arthroscopy for various personal and financial reasons underwent MRI which showed type 1 and type 2 tears, and were treated conservatively. These patients were all asymptomatic after 4-6 weeks with regard to clinical signs, suggesting a lateral meniscal tear. Magnetic resonance imaging therefore does reveal minor degrees of meniscocapsular tears anterolaterally when one understands the normal anatomy in this region.

Arthroscopy↗
PubMed1998

Failed magnetic resonance imaging examinations due to claustrophobia.

A recognized cause of incomplete or cancelled MRI examinations is anxiety and claustrophobic symptoms in patients undergoing MR scanning. This appears to be a problem in many MRI centres in Western Europe and North America, where it is said to be costly in terms of loss of valuable scan time, and has led to researchers suggesting several anxiety-reducing approaches for MRI. To determine the incidence of failed MRI examination among our patients and if there are any associations with a patient's sex, age and education level, we studied claustrophobia that led to premature termination of the MRI examination in the University Malaya Medical Centre (UMMC) in 3324 patients over 28 months. The incidence of failed MRI examinations due to claustrophobia in the UMMC was found to be only 0.54%. There are associations between claustrophobia in MRI with the patients' sex, age and level of education. The majority of those affected were male patients and young patients in the 25-45-years age group. The patients' education level appears to be the strongest association with failed MRI examinations due to claustrophobia, where the majority of the affected were highly educated individuals. Claustrophobia in MRI is more of a problem among the educated individuals or patients from a higher socio-economic group, which may explain the higher incidence in Western European and North American patients.

Adult↗
PubMed1996

Concept hierarchy memory model: a neural architecture for conceptual knowledge representation, learning, and commonsense reasoning.

This article introduces a neural network based cognitive architecture termed Concept Hierarchy Memory Model (CHMM) for conceptual knowledge representation and commonsense reasoning. CHMM is composed of two subnetworks: a Concept Formation Network (CFN), that acquires concepts based on their sensory representations; and a Concept Hierarchy Network (CHN), that encodes hierarchical relationships between concepts. Based on Adaptive Resonance Associative Map (ARAM), a supervised Adaptive Resonance Theory (ART) model, CHMM provides a systematic treatment for concept formation and organization of a concept hierarchy. Specifically, a concept can be learned by sampling activities across multiple sensory fields. By chunking relations between concepts as cognitive codes, a concept hierarchy can be learned/modified through experience. Also, fuzzy relations between concepts can now be represented in terms of the weights on the links connecting them. Using a unified inferencing mechanism based on code firing, CHMM performs an important class of commonsense reasoning, including concept recognition and property inheritance.

Algorithms↗
PubMed1984

Percutaneous transluminal angioplasty. An ineffective approach to the failing vascular access.

A prosthetic arteriovenous (AV) fistula is often necessary in patients with chronic renal failure who lack suitable venous anatomy for the construction of an autogenous AV access. Not infrequently, these conduits fail as a result of neointimal hyperplasia obstructing the outflow tract at the venous anastomosis. Six patients underwent one or more attempts at balloon dilation of an anastomotic stenosis. Grafts had either thrombosed, exhibited poor arterial inflow, or developed high venous pressures. Eight of ten dilations were outright failures, while two dilations each provided an additional three months of graft function before surgical revision became necessary. We conclude that percutaneous transluminal angioplasty is of very limited value as a salvage procedure in the failing synthetic vascular access, and should be attempted only as a possible temporizing measure in those individuals in whom definitive surgical correction must be delayed.

Aged↗
PubMed1980

Characterization of the glycogen synthase D found in liver of the adrenalectomized fasted rats.

We have previously shown that the synthase D (UDPglucose:glycogen 4-alpha-D-glucosyltransferase, EC 1.4.1.11) present in the liver of the adrenalectomized fasted rat was not converted to synthase I by synthase phosphatase from normal animals, suggesting the presence of a non-substrate form of synthase D (Tan, A.W.H. and Nuttall, F.Q. (1976) Biochim. Biophys. Acta 445, 118--130). The enzymatic properties of this synthase D have now been examined. Using optimal assay conditions, the total amount of synthase D activity in the adrenalectomized fasted rats was similar to that of normal fed rats when 1% glycogen was included in the homogenizing buffer. However, the two enzymes appeared to have different affinities for the substrate, UDPglucose and the modifier, glucose-6-P. The changes in kinetic properties were not due to differences in glycogen or to a dialyzable modifier in the extracts. Synthase D from adrenalectomized fasted and from normal fed rats was partially purified. After DEAE-cellulose chromatography, modification appeared to have occurred such that the enzyme from the adrenalectomized fasted rat had properties similar to that of the normal fed rat. The enzymes were cold-labile, had different properties from enzymes in the crude extract and they were both converted to synthase I by synthase phosphatase. We conclude from these studies that the phosphorylation site in the synthase is in a flexible region of the protein. Changes in the ability of the synthase D to interact and be dephosphorylated by synthase phosphatase can occur readily in vivo and in vitro. The molecular basis for the modification remains unknown.

Adrenalectomy↗