Biomedical subjects

F K Lim

Publications and source records attributed to F K Lim.

12 recordsLinked to original sources

PubMed2005

Growth dynamics of human leiomyoma cells and inhibitory effects of the peroxisome proliferator-activated receptor-gamma ligand, pioglitazone.

Uterine leiomyomas (fibroids) are the most frequent tumour of the female reproductive tract and are the primary cause of hysterectomies in women worldwide. Effective treatment options are few. In a search for alternative treatments, we have established primary cultures of human leiomyoma cells and adjacent myometrial tissues, and documented their growth dynamics in response to estradiol (E2) and pioglitazone (PIO), a peroxisome proliferation-activated receptor-gamma (PPARgamma) ligand, currently in clinical use for type II diabetes mellitus. Human uterine primary cell cultures display morphology and desmin content consistent with their smooth muscle origin. Surprisingly, leiomyoma cells exhibited slower proliferation patterns relative to matched myometrial cells, both in the absence and presence of E2, suggesting that tumour genesis may not be because of increased growth potential but could be related to suppression of growth-inhibiting factors in vivo. PIO significantly inhibited the cell proliferation of both myometrial and leiomyoma cells in a dose-dependent manner. Our results suggest the possibility of using PPARgamma ligands, such as PIO, as therapeutic agents for the conservative management of uterine fibroids.

Adult↗

PubMed2002

Management of premalignant lesions of the cervix.

The screening, detection and treatment of precancer lesions of the cervix have resulted in a dramatic decline in the incidence of cervical cancer in many parts of the world. The effect is most pronounced in countries with organised screening. The proper management of premalignant lesions of the cervix is an important and integral part of any screening programme. The importance of proper colposcopic technique and the adherence to well-established colposcopic guidelines cannot be overemphasized to ensure appropriate treatment. The colposcope is indispensable in treatment planning as it guides the optimal amount of cervical tissue to be ablated or excised and the type of cone biopsy to be taken. Various methods of treatment involving ablative procedures and excisional procedures have been found to be highly efficacious and safe. The choice of treatment modality is very much dependent on individual preferences. However, in those with extensive high-grade lesions, an excisional method has the added advantage of detecting unsuspected microinvasive disease which can be missed if ablative methods are used. Although treatment for squamous intraepithelial neoplasia is well established, the treatment for adenocarcinoma-in-situ is more controversial. Newer methods of treatment are currently being developed to further improve on the good results achievable with present treatment modalities.

Catheter Ablation↗

PubMed2001

Hemostatic and fibrinolytic status in patients with ovarian cancer and benign ovarian cysts: could D-dimer and antithrombin III levels be included as prognostic markers for survival outcome?

We determined the hemostatic and fibrinolytic status in 60 patients with ovarian cancer and benign ovarian cysts. Hypercoagulation, increased platelets, and enhanced fibrinolysis were seen in patients with preoperative ovarian cancer compared to patients with benign ovarian cysts. Enhanced thrombin generation, evidenced by increased F1+2 and decreased antithrombin III (ATIII) levels with further enhanced fibrinolysis by elevated D-dimer, was seen in advanced cancer. Ten ovarian cancer patients died within 13 months after diagnosis and another died at 24 months, all from advanced stage of cancer, except one from stage IC cancer who died at 11 months. The survival rates from the disease at 13 months and 24 months were 66.7% and 45%, respectively. Most of the patients had gone through the complete course of chemotherapy, and those patients still alive have been disease free between 13 and 42 months. No statistical relationships for the hemostatic parameters studied in ovarian cancer patients could be found between those who died and those still living 13 and 24 months after diagnosis, except for ATIII and D-dimer levels. Elevated D-dimer levels were associated with those who died within 13 and 24 months from the disease, and the decreased ATIII levels only reached statistical significance by 24 months. It could be suggested that these two parameters might be useful as systemic prognostic markers in survival outcome from the disease for the first 24 months in advanced ovarian cancer, in addition to the known correlation with the International Federation of Gynecology and Obstetrics stage.

Adolescent↗

PubMed1999

Small cell neuroendocrine carcinoma of the cervix with involvement of multiple pelvic nodes--A successfully treated case by multimodal approach.

Small cell neuroendocrine carcinoma of the cervix is very rare and is usually associated with dismal prognosis if treated by conventional surgery and radiotherapy even in early stage disease. This tumor is characterized by early lymphatic and hematogenous spread. Only one successfully treated case of small cell neuroendocrine carcinoma of the cervix with dissemination to the pelvic nodes had been reported before in the literature. We are reporting a case of small cell neuroendocrine carcinoma of the cervix with multiple pelvic nodal metastases including the common iliac nodes, which had been successfully treated with a multimodal approach including radical hysterectomy, pelvic/para-aortic lymphadenectomy, and postoperative chemotherapy using cisplatin-etoposide combinations and pelvic irradiation.

Adult↗

PubMed1999

A preliminary study of the immunohistochemical detection of a novel tumour marker, 22-1-1 antigen, in gynaecological cancer specimens.

A novel tumour associated antigen, 22-1-1, has been recently described in association with a cervical adenocarcinoma cell line. The aims of this paper were to study the tissue distribution of this antigen in sections of gynaecological cancer specimens and to compare it with negative controls. Six cases of cervical cancers, 5 cases of endometrial cancers, 4 cases of ovarian cancers and 5 cases each of normal endometrium and cervix were studied. Immunohistochemical staining using streptoavidin-biotin methodology was used for each tumour specimen. This revealed positive staining for the 22-1-1 antigen in 5 out of 6 cases of cervical cancer, 3 out of 5 cases of endometrial cancers, and all 4 cases of ovarian mucinous cystadenocarcinomas. Importantly, the antigen was expressed in the cytoplasm, cell membrane and glandular lumen of adenocarcinoma cells. The 22-1-1 antigen was not detected in normal uterine tissues except in uterine cervix, in which its expression was observed at low levels. This study shows that the 22-1-1 antigen was expressed in cancer cells derived from the uterus, cervix and the ovary and may be a potential tumour marker in the management of gynaecological cancer patients.

Adenocarcinoma↗

PubMed1998

Prophylactic oophorectomy: a continuing controversy.

Prophylactic oophorectomy remains a controversial issue among gynecological surgeons. A woman's history of hereditary ovarian cancer syndrome is currently considered the most important indication for prophylactic oophorectomy. This is because of the high risk of ovarian cancer developing in these women and the poor prognosis that is generally associated with ovarian cancer. The purpose of prophylactic oophorectomy in women with no family history of hereditary ovarian cancer syndrome who present for hysterectomy because of other gynecological indications is, however, less clear. The attitude of the patients toward removal of normal ovaries deserves special consideration when counseling for prophylactic oophorectomy in this group of women. Knowledge about the risk of ovarian cancer in the conserved ovaries, cancer phobia, possible psychological effects of prophylactic oophorectomy, and the need for long-term hormone replacement therapy if prophylactic oophorectomy is carried out, are all important considerations in the counseling process.

Female↗

PubMed1998

Malignant ovarian germ cell tumours: experience in the National University Hospital of Singapore.

Management of thirteen cases of malignant ovarian germ cell tumours was reported. Of these, 5 (38%) were immature teratoma, 3 (23%) were endodermal sinus tumour, 1 (8%) was dysgerminoma and 4 (31%) were mixed germ cell tumour. Eight (61%) had stage I, 1 (8%) had stage II and 4 (31%) had stage III diseases. Six had unilateral salpingo-oophorectomy, 6 had total abdominal hysterectomy and bilateral salpingo-oophorectomy and 1 had bilateral oophorectomy. Ten (77%) had adjuvant chemotherapy predominantly with bleomycin/etoposide/cisplatin combination. All patients with stage I and stage II tumours were alive with no evidence of disease at 1/2 year to 5 years followup. Of the 4 patients with stage IIIC diseases, 2 with optimal debulking surgery were alive and disease free at 4 and 7 years after surgery. The other 2 patients with stage IIIC tumours had multiple bulky residual tumours. One of them with a combination of endodermal sinus tumour and embryonal carcinoma died of progressive disease despite chemotherapy 6 months after surgery and the other with mixed endodermal sinus tumour and dysgerminoma was alive with disease at 6 months. Alpha-fetoprotein levels were raised in all 6 patients with endodermal sinus tumour, either pure or combined with other tumours. Regression of alpha-fetoprotein levels was of important prognostic significance in endodermal sinus tumour.

Adult↗

PubMed1997

Pre and intraoperative diagnosis of ovarian tumours: how accurate are we?

In the assessment of malignant potential of ovarian tumours, frozen section has been found to be accurate in 97.1% (168 of 173) of cases. The positive predictive value of frozen section in the diagnosis of a malignant lesion was 100% (34 of 34). Errors were mainly made in the diagnosis of borderline tumours with a predictive value of 87.5% (7 of 8). The negative predictive value was 98.4% (127 of 129). Frozen section however, was less accurate in the diagnosis of specific histological type with an accuracy rate of 91.9% (159 of 173). Macroscopic features were found to be useful in the intraoperative prediction of malignant potential. Completely cystic tumours were benign in 96.4% (108 of 167) of cases. Solid/cystic tumors were malignant in 69% (27 of 38) of cases. Completely solid tumours were malignant in 56% (9 of 16) of cases. Frozen section in completely cystic tumours only marginally improved the clinical macroscopic diagnosis of malignancy. The sensitivity and specificity of ultrasound scan in the diagnosis of malignant/borderline tumours were 82% and 86% respectively. The false negative rate of 7% makes laparoscopic excision of unsuspected malignant ovarian cyst a significant possibility. The predictive value of ultrasound scan in the diagnosis of malignant ovarian tumour was 62% (26 of 42). In the preoperative assessment of malignant potential of ovarian tumours, this study shows that ultrasound scan has a high false positive and a significant false negative rate. Careful intraoperative assessment of gross features and the use of frozen section especially in those with solid/cystic and solid tumours will help achieve a high accuracy rate in the assessment of ovarian tumours.

Female↗

PubMed1996

Mild cervical atypia: a management dilemma.

This study examined 117 patients with mild cervical atypia or atypical squamous cells of uncertain significance; it was found that 25% had histologically proven CIN lesions by colposcopically-directed punch biopsy or cone biopsy. 18% were found to have at least CIN 2 lesions and there was 1 case of invasive cancer. These data strongly support the recommendation of early colposcopic referral in patients with mild cervical atypia.

Adolescent↗

PubMed1995

Papillary serous carcinoma of the peritoneum.

OBJECTIVE: To describe the clinical features of papillary serous carcinoma of the peritoneum followed by a short review of the literature. METHODS: From January 1986 to May 1994, six patients with papillary serous carcinoma of the peritoneum were treated at our institution. Their presenting features, sites of disease at the time of staging laparotomy, subsequent treatment and follow-up were reviewed. RESULTS: The mean age was 53.3 years (range 46-59). The most common presenting features were abdominal pain, distention and the presence of ascites. Common sites of disease at the time of laparotomy were the peritoneal and subdiaphragmatic surfaces, omentum, serosa of bowel and superficial involvement of the ovaries. Patients were treated with cytoreductive surgery and platinum-based chemotherapy. CONCLUSION: Although experience is scant and more data is needed, for the time being, management for primary peritoneal carcinoma is as for ovarian cancer.

Cystadenocarcinoma, Papillary↗

PubMed1995

Current approach to the management of urinary stress incontinence.

The plethora of treatment modalities available for the treatment of female urinary stress incontinence reflects the uncertainty in the pathophysiology of this condition and the mechanism of cure. No single treatment method is suitable for all patients. For best results, many factors must be considered before choosing the treatment method most suited to the particular patient. This review examines the various treatment options available and attempts to set out criteria for choice of treatment. The role of conservative treatment has been deliberately highlighted especially for young and well motivated women with mild to moderate urinary stress incontinence before surgical treatment is used. The role and limitations of well established surgical procedures like Burch colposuspension and urethroplasty and the more recently introduced procedures like collagen implants, laparoscopic colposuspension and the role of artificial urinary sphincter are also examined.

Female↗

PubMedDate not supplied

Diagnosis of gonorrhea by gram-stained smears and cultures in men and women: role of the urethral smear.

A retrospective study of the diagnosis of gonorrhea by gram-stained smear and culture was made. Of 1,681 men with gonococcal urethritis, 1,437 (85.5%) were positive by both smear and culture; 151 (9%), by smear alone; and 93 (5.5%), by culture alone. Of 1,148 women with gonorrhea, 742 (64.6%) had infection in both the cervix and urethra; 307 (26.7%), in the cervix alone; and 99 (8.6%), in the urethra alone. Of 1,049 cases of cervical gonorrhea, 461 (43.9%) were positive by both smear and culture; 67 (6.4%), by smear alone; and 521 (49.7%), by culture alone. Of 841 cases of urethral gonorrhea, 394 (46.8%) were positive by both smear and culture; 43 (5.1%), by smear alone; and 404 (48%), by culture alone. Cervical and urethral smears together gave a presumptive diagnosis in 709 (61.8%) cases, thus enabling early treatment to be instituted; 181 cases (15.8%) of gonorrhea in women were diagnosed solely by urethral smears.

Cervix Uteri↗