Biomedical subjects
Publications and source records attributed to D R Koh.
With the use of homologous recombination in embryonic stem cells, two new strains of mice lacking surface CD4 or CD8 expression have been generated. It is hoped that they will be useful mouse strains for the study of autoimmune diseases, tissue transplantation rejections and tumour rejections.
With the use of homologous recombination in embryonic stem cells, two new strains of mice lacking surface CD4 or CD8 expression have been generated. It is hoped that they will be useful mouse strains for the study of autoimmune diseases, tissue transplantation rejections and tumour rejections.
Radiographs of the hand and wrists in 33 patients with a diagnosis of classic or definite rheumatoid arthritis were reviewed. The mean duration of disease was about five years. A scoring system for quantitative analysis was used to assess the presence and severity of erosions, joint space narrowing and deviation of joint alignment. No radiological abnormality was seen in 30% of patients while in another 30%, only minor radiological changes were seen. Moderate to severe radiological abnormality was seen in only 40% and in this group of patients all showed more severe disease in the wrists than in the finger joints. Erosions in the fingers were only seen in 21% of patients and erosions in the wrists were present in 57%. Previous reports have indicated that disease in the wrists can be more severe than the hands in up to 60% while the incidence of erosions can be expected to range from 40% at 3 months to 95% at 10 years. Although the sample size in this study is small, the findings suggest that the radiological pattern of rheumatoid in the hands in Singapore is quite different from that classically described in temperate countries as the incidence of erosions appears lower while disease in the wrists can be expected to be more severe than in the fingers in almost all cases. The usual radiological criteria used to aid diagnosis of the disease may not be applicable.
The management of patients with Factor VIIIC inhibitor is frequently a therapeutic challenge. Treatment is often individualized. We describe 3 patients, nonhaemophilic adults, with bleeding diatheses caused by a circulating inhibitor to Factor VIIIC. One patient had long standing rheumatoid arthritis. The other two did not have any apparent underlying disease, although one of them had an antecedent antecedent phenylbutazone injection for arthralgias. Prednisolone was prescribed for two patients which resulted in rapid clinical improvement and the eventual normalization of Factor VIIIC activity. The role and rationale of immunosuppressive therapy in Factor VIIIC inhibitor is reviewed.
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Adult respiratory distress syndrome (ARDS) or high permeability pulmonary oedema (HPPE) is an uncommon presentation of a viral pneumonia and usually occurs in the setting of a fulminant or severe viral pneumonia. High permeability pulmonary oedema (HPPE) can be loosely defined as those forms of pulmonary oedema with normal cardiac function associated with the accumulation of protein-rich fluid in the interstitial or intraalveolar spaces. Through the years, a number of phrases have been used to describe this entity: white lung, shock lung, wet lung, adult hyaline membrane disease, ARDS and others. The aetiology is varied but the clinical, radiologic and pathologic pictures are similar. In fact the pathologic picture is so consistent from patient to patient regardless of aetiology that it has been suggested that the term HPPE be used in place of the other commonly used ones. A case of HPPE of possible viral aetiology who responded to prompt intervention with a successful outcome, is described here.