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Biomedical subjects

C L Chua

Publications and source records attributed to C L Chua.

15 recordsLinked to original sources
PubMed1992

Relative risks of complications in giant and nongiant gastric ulcers.

There are two divergent views regarding giant gastric ulcers. Traditionally, they have been regarded as a virulent disease prone to massive hemorrhage, intractability, and perforation. Recently, an entirely opposing viewpoint has developed that considers them no different from ordinary gastric ulcers. In this study between 1984 and 1989, 62 patients with giant ulcers (greater than or equal to 3 cm) were compared with 476 benign gastric ulcer patients to evaluate their relative risks of ulcer complications. The results showed that giant ulcers are more prone to severe hemorrhage (44% versus 27%; chi 2 test: p less than 0.009) but not more prone to free perforation. Penetration into contiguous organs occurred more frequently with giant gastric ulcers (45% versus 10%; chi 2 test: p less than 0.0001). The risk of the presence of microscopic malignancy in the macroscopically benign-looking giant ulcer is significantly greater than in the nongiant type (13% versus 3%; Fisher's exact test: p = 0.0013). The data showed that patients with giant gastric ulcers are more at risk for the development of life-threatening complications and, hence, more likely to require surgery.

Humans↗
PubMed1992

Clinical and social problems in young women with breast carcinoma.

Studies have noted that Asian women tend to have invasive breast cancer at a younger age compared with their Western counterparts. This is a rising trend among women in Singapore. This study compares 46 women less than or equal to 35 years with 313 women greater than 35 years who were treated in a teaching hospital between January 1983 and December 1989. Despite better education, the younger women (less than or equal to 35 years) were no different from their older counterparts in delaying medical consultation for more than 3 months after self-detection (39 vs 38.6%) though a higher percentage of older women procrastinated for over a year (16.6 vs 6.5%). As a result, 28% of younger women and 21.6% of older women presented with late disease (TNM Stage III and IV). Primary healthcare physicians contributed towards further delay among 65% of women less than or equal to 35 years. They were more suspicious when breast lumps were detected in women greater than 35 years and only 8% had delayed referrals. Failure in advising early biopsy added further delay (greater than 3 months) in 27.6% of younger patients whereas it was seldom delayed for the other older group (0.3%). Eight patients less than or equal to 35 years were initially reluctant to undergo definitive surgery. These cumulative delays resulted in progression of disease in seven patients of the 11 patients whose therapy was delayed more than 6 months.

Adolescent↗
PubMed1992

Breast carcinoma-in-situ: an emerging problem in Singapore.

Breast carcinoma-in-situ constitutes 4.1% of 707 breast cancers diagnosed between 1988 and 1990. Among these 30 patients, intraductal carcinoma-in-situ (DCIS) outnumbers lobular carcinoma-in-situ (LCIS) by 9-fold. They are mostly symptomatic - 87% present as breast lumps and/or nipple discharge, with 52% of lumps exceeding 2cm size. Three patients were detected by screening mammography and it is expected that more breast carcinoma-in-situ will be detected through mammographic screening. Two-thirds of the patients had mastectomy while the rest had lesser procedures. The different surgical procedures and adjuvant therapy instituted for the patients are reflections of the differing opinions regarding optimum therapy for carcinoma-in-situ and the differing rationale for DCIS and LCIS lesions.

Adult↗
PubMed1992

Computed tomography for oesophageal carcinoma: its value to the surgeon.

Between January 1988 and June 1991, 75 patients with carcinoma of the oesophagus or gastro-oesophageal junction were evaluated by computed tomography (CT). Fifty of these patients underwent operation, allowing 48 cases to have a detailed surgical and pathological verification of CT features. For thoracic oesophageal tumours the accuracy of CT was 59% for fat plane status, 86% for aortic contact, 81% for tracheobronchial tree compression and 66% for direct local invasion. CT was 69% accurate for identifying lymph nodes, of which only 38% contained metastatic deposits. For gastro-oesophageal junction tumours, CT was 74% accurate for fat plane status and 90% accurate for direct local invasion. Accuracy for detecting lymph node involvement was 63%, metastatic tumour being present in 91% of these nodes. By pathological staging, only 15% of all resections could be considered potentially curative. The value of CT was found to be in predicting a palliative or curative resection, and in warning the surgeon about possible infiltration of specific mediastinal or abdominal structures that would be encountered during operative dissection.

Adult↗
PubMed1991

Thyroid papillary carcinoma with unusual breast metastasis.

Breast metastasis from thyroid carcinoma is a rare occurrence. We report a case of immunohistologically proven breast metastasis from a thyroid papillary carcinoma. The association of primary breast carcinoma and thyroid carcinoma is noted and the usefulness of immunohistological techniques emphasised especially when histological assessment is difficult.

Aged↗
PubMed1991

Diaphragmatic injuries: why are they overlooked?

Twenty-one cases of diaphragmatic tears (11 blunt and ten penetrating injuries) were reviewed retrospectively. Left-sided diaphragmatic ruptures predominated except for two patients with penetrating injuries and one patient with bilateral tears following blunt trauma. Significant associated injuries (injury severity score greater than 16) were present in 76% of cases: the most common being intra-abdominal visceral injuries of the stomach, spleen and liver. Initial hypotension (systolic pressure less than 100 mmHg) was present in seven patients and respiratory distress (rate greater than 30 per min and/or Pa,O2 less than 70 mmHg) was seen in eight cases. Correct preoperative diagnosis was made in six cases while 12 were only detected during operation. The other three cases were diagnosed late. A variety of reasons accounts for the tendency to overlook diaphragmatic injuries in trauma victims. First, it is an uncommon condition presenting to an unsuspecting clinician. Second, the paucity of pathognomonic clinical signs makes for a difficult diagnosis. Third, the diverting attention of life-threatening visceral injuries accounts for failure to identify patients with the few available clinical and radiological features.

Adolescent↗
PubMed1990

Gastric polyps: the case for polypectomy and endoscopic surveillance.

Thirty-two patients with gastric polyps and a mean follow-up period of 18 months were analysed. The principal presentation was epigastric pain accompanied at times by haematemesis or melaena. As in other series, the hyperplastic polyps (21 cases) predominated, followed by the adenomatous type (six patients). Endoscopy was an effective first-line investigative method for 21 patients and for a further five who had initial false negative barium studies. Gastric polypectomy was performed for 60% of patients without any complications. There was discrepancy between the biopsy material and polypectomy specimen in five of seven patients who were recalled for snaring. Although no polyp in this series turned malignant, one diffuse polyposis patient developed linitis plastica after 4.5 years of follow-up. Hence, for reasons of recurrence, new polypoid growths and development of gastric cancer, long-term surveillance is indicated.

Adult↗
PubMed1989

Cystosarcoma phyllodes: a review of surgical options.

The unpredictable behavior of histologic types and the disputable results of particular surgical procedures have contributed to the controversies surrounding phyllode tumors. The therapeutic issue is further compounded by an imprecise preoperative diagnosis. This is illustrated in our series of 106 patients, in whom 71.7% were mistakenly operated on for fibroadenoma. Since only 15.8% of this group developed local recurrence, it may be acceptable to adopt a watchful policy, unless detailed microscopic assessment of tumor margins provides evidence of inadvertent transection. Reoperation would then be logical advice, as with one of our patients. In patients clinically suspected of having phyllode tumors, tissue diagnosis is preferable to investigative procedures, which are seldom definitive. Our experience has been with frozen-section diagnosis, although trucut core biopsy is certainly an attractive procedure. In 18 patients only 50% were positively identified as having phyllode tumors. The logistic and therapeutic issues related to use of frozen-section diagnosis are discussed. Wide excision has been recommended by many investigators as an appropriate measure, as long as it is technically possible to remove the lesion with an adequate rim of normal breast tissue. This applies especially to young female patients (less than 20 years), in whom conservation of the breast is particularly desirable and whose tumors behave in a more benign manner. On the other hand, mastectomy is necessary if the phyllode tumor is large compared with breast morphologic size,when histologic transformation has taken place, or when clinical behavior takes a more aggressive course. In this retrospective study, conservative surgery is generally practiced for both primary and recurrent tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Cystosarcoma phyllodes tumors.

Of 106 females treated surgically for cystosarcoma phyllodes, 20 had one or more local recurrences, while seven other patients had "pseudorecurrences" in that the histologic findings showed benign disease of the breast. Histologic transformation into a histologically more aggressive lesion was noted in three patients. There was a higher incidence of recurrence among the younger patients (those less than 20 years of age) and in those with the larger tumors (greater than 5 centimeters diameter). The reasons for these findings are discussed. The phenomenon of recurrence was reviewed with regard to age of the patient, size of the lesion, histologic features of the tumor and extent of the operation.

Adult↗
PubMed1988

Cystosarcoma phyllodes--Asian variations.

Cystosarcoma phyllodes afflicting 106 female patients in a multiracial Asian society is reviewed and some interesting variations are noted when compared with Western patients. The incidence of phyllodes tumour is 3.83% of surgically removed breast tumours compared with 0.5-2.5% in Western series. This lends weight to the belief that non-Caucasians are more prone to this enigmatic breast disease than the Caucasian population. The profile of the Asian phyllodes patient is that of a young female, aged 25-30 years, whereas her Western counterpart is in her 40s. As a result, she is liable to be mistaken clinically as having fibro-adenoma. The disease is notably rare among the females below 20 years of age but in the Asian context, as much as one-quarter-one-third may be in the adolescent group. There were only three malignant and six borderline phyllodes tumours out of 106 cases, and this incidence is far below that of many other studies in which the malignant cases are believed to constitute 23-27%. However, this may not be a racial variation but explicable by the fact that the present study is an unselected cohort from a general surgical unit. The presence of associated benign breast disease in 25.5% cases helps to reinforce the widely held belief that fibro-adenoma and phyllodes tumour are related to some degree.

Adult↗
PubMed1988

Empyema of the gallbladder.

There is fairly widespread belief that suppuration superimposed upon acute cholecystitis is a rather uncommon condition. Scanty information on this subject is found in the published literature. No doubt, the scarcity of data further reinforces this clinical impression. Yet, from the few studies available, a surprisingly high incidence (7-11%) is documented. We reviewed 518 patients who underwent emergency cholecystectomy and found 139 cases to have frank pus present within the gallbladder. The clinical presentation is often difficult to distinguish from that of acute cholecystitis but diagnosis is crucial to identify this potentially fatal surgical emergency. There are encouraging reports of specific ultrasonic features which can demonstrate the increased viscosity produced by the purulent and fibrinous content within the gallbladder.

Adult↗
PubMed1986

The value of cervical lymph node biopsy--a surgical audit.

Cervical lymph node biopsy is a fairly common surgical procedure. The diagnostic yield, however, varies in different centres and in different series depending on the vigour of the screening procedure, the surgical policy adopted and the surgical techniques employed. A surgical audit of the diagnostic yield of 203 lymph node biopsies was made and the results are discussed especially in relation to asymptomatic lymphadenopathy, infective lymphadenitis and metastatic nodes. Comments are also made as to how a better diagnostic yield could be obtained through more meticulous handling of the tissue.

Adolescent↗
PubMed1985

Axonal degeneration distal to the site of accumulation of vesicular profiles in the myelinated fiber axon in experimental isoniazid neuropathy.

Morphometric sequential studies of pathologic changes were carried out on myelinated fibers in the lumbar ventral root of Sprague-Dawley rats administered with isoniazid, 1,500 mg/kg body weight, in a single dose. Accumulation of axoplasmic organelles with secondary paranodal retraction of myelin sheath occurred in the middle part of the ventral root as early as day 2 after the administration. On day 3, axonal degeneration started to occur, distal to the middle part, where the accumulation of axoplasmic organelles is prominent. Such accumulation with the possible blockade of the fast axoplasmic transport in the proximal axon may be directly responsible for the distal axonal degeneration. Alternatively such accumulation may be secondary to the distal axonal degeneration. The morphological sequential findings described clearly reflects the pathological events in isoniazid neuropathy.

Animals↗
PubMed1983

Morphometric evaluation of degenerative and regenerative changes in isoniazid-induced neuropathy.

Morphometric studies of the pathologic changes were carried out on the peripheral nerves, spinal roots, and different levels of the Goll's tract in rats given isoniazid and killed 1, 2, 3, 4, 5, 6, 7, 14, and 30 days after intoxication. In teased fiber preparations, axonal degeneration was the main change present, and this was seen as early as day 2 in the peroneal and distal sural nerves. The frequency of myelinated fibers showing axonal degeneration was higher in the distal than the proximal sural nerve, and in the ventral than the dorsal root. In the group of rats killed on 5, 6, 7, and 14 days, a significant decrease of the myelinated fiber density was observed in the distal and proximal sural nerves, ventral root, and at the third cervical level of the Goll's tract. The degree of fiber degeneration was more severe in the distal than in the proximal sural nerve and in the third cervical than the fifth thoracic level of the Goll's tract. Preferential decrease of large myelinated fibers was noted in all the affected nerves. No definite abnormalities, however, were seen in nerve cells of the 6th lumbar spinal ganglia and anterior horn cells of the lumbar spinal cord on light microscopy. On 30 days, regeneration at varying degrees was discerned in all the affected nerves with significant increase of small myelinated fibers, particularly in the ventral root. The findings indicate that both centrally and peripherally directed myelinated axons are more affected in the distal than in the proximal segments while the neuronal cell bodies are spared. The spatio-temporal evolution of this pattern of change is compatible with the concept of the "dying back" process or central-peripheral distal axonopathy.

Animals↗