PubMed Health⌕ Search

Biomedical subjects

E K Sim

Publications and source records attributed to E K Sim.

50 records · Page 3Linked to original sources
PubMed1993

Prevalence of peripheral artery disease in patients with coronary artery disease.

The incidence of coronary artery disease in Singapore has shown a rapid rise in recent years, however, there is a subjective impression that the prevalence of atherosclerotic peripheral artery diseases, although sharing common aetiological factors with coronary artery disease, has not shown a similar rise. We set out to determine the incidence of occlusive peripheral artery diseases of the lower limb in a selected population of Asian patients using a non-invasive test and we analysed the risk factors. The overall prevalence of peripheral artery disease of the subjects as determined by an abnormal ankle brachial index less than 0.9 in at least one limb was 19.1%. Increasing age, hypercholesterolemia and smoking were risk factors. In patients with proven coronary artery disease, abnormal ankle brachial indices were present in 21.3% of patients with angiographic evidence of coronary artery disease but in only 13.0% of those without. In this study, the incidence of peripheral artery disease in this selected Asian population was high. With the increasing availability of vascular laboratories and awareness of the diseases, we can expect to see increasing numbers of patients presenting with these problems.

Adult↗
PubMed1992

Mitral valve repair in patients on chronic hemodialysis.

Two cases of successful mitral valve repair in patients on chronic hemodialysis are presented. We stress that valve repair is preferable to valve replacement whenever feasible because of improved left ventricular function, reduced complication rate, and freedom from anticoagulation. This especially applies to patients on chronic hemodialysis as they have impaired immunological function, are subjected to repeated fistula punctures with possible bacteremia, and are more susceptible to early calcification and degeneration of tissue valves.

Female↗
PubMed1992

Intravascular hemolysis after mitral valve repair: a word of caution.

The case of a young patient who presented with severe hemolysis after mitral valve repair is presented. Valve repair included chordal shortening, transposition of chordae tendinae, and annular remodelling using a Duran flexible ring. Reoperation and valve replacement were required to control hemolytic anemia. The possible mechanisms leading to such an uncommon complication after plastic repair of the mitral valve are commented on. The scanty literature concerned is reviewed.

Adult↗
PubMed1992

Coronary artery bypass surgery in young patients.

Coronary atherosclerosis is being increasingly observed in young patients. However results of surgery in such patients have so far been disappointing both in terms of operative mortality, symptomatic relief and long-term survival. Reasons given for this include the increased prevalence of risk factors in young patients and a higher incidence of graft occlusion. In the treatment of Asian patients, a further negative factor is the belief that coronary artery disease is more often diffuse and the vessels smaller. Between January 1987 and May 1991, a total of 66 patients under the age of 45 years at the time of surgery had coronary artery bypass grafting performed. The demographic, clinical, angiographic and operative data were analysed. Eighty-nine per cent of the patients were male and their racial distribution was 63% Chinese, 8% Malays, 26% Indians and 3% Others. Their mean age was 40.8 years. The presence of risk factors was high: 45.6% had hypertension; 34.8% were smokers; 21.2% had diabetes mellitus; and 12.1% had hyperlipidaemia. The main indication in these patients was either angina or a previous myocardial infarction (53%). There were no patients with perioperative infarction diagnosed by the presence of new Q wave. There was no hospital death. The stay of the patients ranged from 6 to 28 days with a mean of 10 days. Follow-up ranged from 3 to 54 months. There were no late deaths. It was concluded that there is a high incidence of risk factors among young patients with coronary artery disease, which follows the pattern of many other studies. The operative risk in these patients is low and morbidity is minimal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

The surgical treatment of multiple small bowel strictures in Crohn's disease by combined resection and stricturoplasty.

Crohn's disease is extremely rare among Asians. Resection of strictures causing obstruction has traditionally been the accepted choice in surgical therapy. This may lead to problems such as iatrogenic short bowel syndrome and its sequelae. Stricturoplasty is an acceptable and safe alternative. We report a case where combined stricturoplasty and resection was performed safely and advocate its use.

Adult↗
PubMed1992

Early experiences of intra-operative trans-oesophageal echocardiography (TEE) in mitral valve repair.

Whenever possible Mitral valve repair should be performed instead of Mitral valve replacement. It is important to assess the adequacy of the repair during the operation so that any corrective steps may be taken immediately. We present three cases of Mitral valve repair in which the intraoperative TEE was used to assess the adequacy of the repair. There was good correlation of the immediate post bypass TEE findings and early post operative transthoracic echocardiographic findings. Intraoperative TEE is a useful tool in the early assessment of Mitral Valve Repair.

Adult↗
PubMed1992

Ectopic thymoma: a case for median sternotomy for complete thymectomy.

Thymomas are normally found in the superior mediastinum or the upper part of the anterior mediastinum. We report a case of thymoma arising in the inferior aspect of the anterior mediastinum. This case illustrates that thymic tissue may be found low in the anterior mediastinum and supports the practice of a median sternotomy approach for thorough mediastinal exploration in all cases of thymectomy.

Aged↗
PubMed1991

Safe and rapid palliation of dysphagia for carcinoma of the esophagus.

Patients with carcinoma of the esophagus continue to present late when their tumors are inoperable. This makes palliation of their dysphagia the main therapeutic aim. The Nd-YAG laser has been used in our department to treat dysphagia resulting from cancer of the esophagus since 1986. Our rapid, one-stage cannulation technique using the Nd-YAG laser in both contact and noncontact modes was applied to 35 cases of carcinoma of the esophagus with the aim of achieving rapid and safe palliation of dysphagia. During the treatment we aimed not to coagulate the tumor and await sloughing, but to vaporize the tumor and ablate as much as possible in a single session. In this way there was less need for repeat sessions to create an adequate lumen. In a small number of patients (9) who had tight strictures with no visible lumen, a pre-laser dilation was required to allow visualization of the lumen and tumor vaporization. For nondilated patients (26) we achieved a 15-mm lumen in an average of 1.6 sessions, and in the dilated patients (9) this was achieved in one session in all patients. Functional improvement occurred in 28 patients (80%). There were four minor complications and no mortality associated with the procedure.

Aged↗
PubMed1990

Percutaneous endoscopic gastrostomy in the adult patient--a local case report.

Patients who require a gastrostomy tube placement have traditionally been subjected to various open surgical methods requiring laparotomy. Since it was first described Percutaneous Endoscopic Gastrostomy (PEG) has rapidly become the preferred method for gastrostomy tube placement. We present a case report to illustrate the simplicity and elegance of the technique in a patient with bulbar palsy.

Adult↗
PubMedDate not supplied

Computational modelling of blood flow through curved stenosed arteries.

A computational model of three-dimensional blood flow in curved arteries with elliptic stenosis was developed. Two groups of models, (a) different angles of curvature and (b) degrees of stenosis, have been studied under typical conditions for stenosed coronary artery. Useful information on the haemodynamics has been obtained. Results of pressure drop show that the presence of the curvature augments the increased flow resistance due to stenotic lesions. The study also demonstrates the significant presence of secondary flow in a curved artery. In addition, the results have shown that the secondary flow in a curved artery brings about elevated shear stress on the vessel wall. These results indicated that both curvature and stenosis should be considered together by cardiologists to assess or quantify the severity of the stenosis. This study employed a powerful computer-aided design (CAD) package to construct the model and a commercial computational fluid dynamics (CFD) code for the analysis of blood flow in stenosed arteries. The long-term application of this form of research promises to be an effective tool for gaining insights into the pathology of arterial diseases.

Arteries↗
PubMedDate not supplied

Coronary artery bypass grafting in patients with left main coronary artery stenosis. Improved survival in a predominantly Oriental population.

Over the last 10 years, there has been a reduction of surgical mortality in coronary bypass grafting for left main coronary artery disease. Most of the available literature reports are of Caucasian populations. We report our experience of the surgical treatment of this disease in a predominantly Oriental population. From 1 January 1987 to 30 June 1991, 86 consecutive patients had coronary artery bypass surgery for left main stenosis. There were 65 men and 21 women with an age range of 34 to 80 years (mean age: 58 years SD +/- 8.63). There were no operative deaths and 1 hospital death (1.2%) from a non-cardiac cause. The perioperative myocardial infarction rate was 3.5% (3/86). These results are better than some earlier series in which hospital mortality was reported as high as 12.6% and the preoperative myocardial infarction rate 11.8%. In this series where the patients are predominantly Oriental, the results are comparable if not better than in series reported in centres where the population is predominantly Caucasian.

Age Factors↗