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Biomedical subjects

F M Lai

Publications and source records attributed to F M Lai.

At least 73 records · Page 4Linked to original sources
PubMed1993

Plasma exchange in the treatment of early recurrent focal glomerulosclerosis after renal transplantation. Report and review.

We report a 29-year-old female with recurrent focal glomerulosclerosis (FGS) presenting as heavy proteinuria immediately following renal transplantation. From day 13 after transplantation, daily plasma exchange was performed 6 times. Proteinuria decreased from 13 to 0.2 g/day after plasma exchange and remained to be less than 0.1 g/day even 20 months thereafter. Our review of the literature on the use of plasma exchange in treating recurrent FGS suggests this procedure is not useful in patients whose allograft biopsy showed advanced glomerular sclerotic lesions. We propose early plasma exchange may be a therapeutic option in those patients who have no sclerotic lesions in their allograft biopsy.

Adult↗
PubMed1993

Non-puerperal uterine inversion--a case report.

A rare case of non-puerperal uterine inversion caused by a large fundal leiomyoma in a 36-year-virgo intacta resulting in intractable haemorrhage was reported. After a myomectomy, attempts to reduce the inversion vaginally by transecting the anterior and posterior cervix was unsuccessful and a laparotomy was performed. The inversion was successfully corrected with return of normal function of the uterus.

Adult↗
PubMed1993

Diabetic patients with IgA nephropathy and diabetic glomerulosclerosis.

Eleven diabetic patients with biopsy-proven IgA nephropathy were studied. Seven exhibited coexistence of both IgA nephropathy and diabetic glomerulosclerosis and the remaining four patients had IgA nephropathy without diabetic lesion. The clinicopathological features and follow-up of those patients with IgA nephropathy surperimposed on diabetic glomerulosclerosis were compared with a similar group of patients with diabetic glomerulosclerosis alone. Our observation suggests that the occurrence of both glomerulopathies was fortuitous with IgA nephropathy coexisting with or preceding diabetic glomerulosclerosis. There was no apparent causal relationship between the two glomerulopathies. The renal outcome is poor in both groups of patients and is possibly related to diabetic glomerulosclerosis.

Adult↗
PubMed1992

Acute renal failure in hepatitis B virus-related membranous nephropathy with mesangiocapillary transition and crescentic transformation.

We report the first case of hepatitis B virus (HBV)-related membranous nephropathy (MN) that progressed to crescentic transformation superimposed on a mixed membranous and mesangiocapillary glomerulonephritis. The patient developed acute renal failure, which partially responded to pulse methylprednisolone therapy, and subsequently recovered after plasma exchange.

Acute Kidney Injury↗
PubMed1992

Fatal adult Henoch-Schönlein purpura due to small intestinal infarction.

A 57-year-old woman presented with classical symptoms of Henoch-Schönlein purpura including arthralgia, abdominal pain, palpable purpuric rash and abnormalities of the urinary sediments. The clinical course was subsequently complicated by severe paralytic ileus leading to respiratory embarrassment. Laparotomy confirmed patchy areas of small bowel infarction due to necrotizing vasculitis. Skin biopsy revealed extensive leukocytoclastic vasculitis with granular deposits of IgA in the blood vessels. Anti-neutrophil cytoplasmic autoantibodies (ANCA) were not detectable. The patient continued to deteriorate despite bowel resection, intensive immunosuppressive therapy and plasma exchange, and eventually died. Gastrointestinal involvement in adult Henoch-Schönlein purpura has previously been reported to have a favourable clinical course. However, our case illustrates the rate but lethal complication of intestinal infarction in patients who fail to respond to conservative treatment.

Female↗
PubMed1992

Microscopic polyarteritis presenting with chest infections and acute appendicitis.

We describe a 38-year-old male with antineutrophil cytoplasmic auto-antibody (ANCA) positive microscopic polyarteritis who presented with recurrent chest infections, lung haemorrhage, renal insufficiency and acute appendicitis. Appendectomy was followed by resolution of abdominal symptoms and the surgical specimen revealed vasculitis of the serosal vessels. A renal biopsy was performed because of impaired renal function and this revealed focal necrotising glomerulonephritis with absence of immune deposits. Chest infections were treated with antibiotics resulting in partial clinical response, but pulmonary symptoms relapsed and a complete resolution was achieved only after plasma exchange and the administration of cyclophosphamide. Our observation emphasises the protean manifestations of microscopic polyarteritis and the relationship between ANCA and disease activity.

Adult↗
PubMed1992

Combined chemotherapy using cisplatin, ifosfamide and bleomycin (PIB) in the treatment of advanced and recurrent cervical carcinoma.

Combined cisplatin, ifosfamide and bleomycin (PIB) chemotherapy was given to 14 (11 recurrent and 3 advanced and metastatic) cervical carcinoma patients. At least 2 cycles of chemotherapy were given before assessment of tumour response. The overall response rate was 28.6%; the complete response rate was 14.3%. Sites of response included cervical lymph nodes and the lung. Toxicity was common. Alopecia was universal. Other toxicity included suppression of haematopoiesis (73%), leucopenia (71%) and nausea and vomiting. Two patients died from sepsis during the myelosuppressive phase. The role of PIB in the management of advanced and recurrent carcinoma of the cervix should be evaluated in a randomized-controlled trial.

Adenocarcinoma↗
PubMed1992

Glomerulonephritis associated with Robertsonian translocation t(13;14).

We report the first case of glomerulonephritis associated with Robertsonian translocation t(13;14) in a 18-year-old female. The renal biopsy revealed mesangial proliferative glomerulonephritis with mesangial IgG and C3 deposits. The patient also has congenital absence of ovaries and an underdeveloped uterus. Our report suggests that renal abnormalities may be found in patients with Robertsonian translocation.

Adolescent↗
PubMed1992

Crescentic glomerulonephritis related to hepatitis B virus.

Crescentic glomerulonephritis was diagnosed in two chronic hepatitis B surface antigen carriers. In all three biopsies performed, hepatitis B e antigen was found in glomerular capillary tufts. The first patient presented with nephrotic syndrome and acute renal failure. The glomerular pathology revealed crescentic glomerulonephritis with endocapillary proliferation, and she recovered spontaneously with normal renal function over the following 6 mo despite a persistent hepatitis B surface antigenemia. The other patient presented with nephrotic syndrome and normal renal function. Hepatitis B virus-related membranous nephropathy was diagnosed on the first biopsy, and he did well on symptomatic treatment for 20 mo. The nephrotic syndrome recurred and subsequently he developed acute renal failure a month following interferon treatment. The repeated biopsy revealed a crescentic glomerulonephritis that was associated with mixed membranous and membranoproliferative glomerulopathies. This patient responded to immunosuppression and plasma exchange with residual impairment of renal function. He has been stable after 18 mo follow-up.

Adult↗
PubMed1991

Membranous nephropathy related to hepatitis B virus in adults.

BACKGROUND: The natural course of adult hepatitis B virus (HBV)-related membranous nephropathy in areas where HBV infection is endemic (characterized by vertical and horizontal transmission of HBV in early childhood) has not been fully defined. METHODS: We evaluated the clinical features, pathological findings, serologic profiles, therapeutic responses, and prognoses of 21 patients with adult-onset HBV-related membranous nephropathy. The patients were followed for a mean of 60 months (range, 12 to 108). Only patients with evidence of glomerular capillary deposition of hepatitis B e antigen (HBeAg) in a renal-biopsy specimen were included. RESULTS: The clinical features and serologic studies suggested that the patients had acquired chronic HBV infection in early childhood; moreover, other causes of membranous nephropathy had been excluded. All were seropositive for hepatitis B surface antigen and had high titers of antibody to hepatitis B core antigen at first clinical presentation. HBeAg was detected in the serum of 17 patients (81 percent), yet only 3 had even slightly increased plasma alanine aminotransferase levels. The clinical response to therapy with interferon alfa was disappointing; only one of the five patients treated had a complete remission with seroconversion to antibody to HBeAg. Contrary to reports of studies in children, spontaneous remission of the nephrotic syndrome or proteinuria was uncommon in the adults with HBV-related membranous nephropathy whom we studied. Proteinuria and HBV antigenemia persisted in untreated patients. During the follow-up period, 29 percent of the patients had progressive renal failure and 10 percent required maintenance dialysis therapy. CONCLUSIONS: The course of HBV-related membranous nephropathy in adults in areas where HBV is endemic is not benign. Regardless of treatment, the disease has a slowly but relentlessly progressive clinical course in approximately one third of patients.

Adolescent↗
PubMed1991

Effect of cyclosporine A on circulating immune complexes in IgA nephropathy.

This work was undertaken to examine the effect of cyclosporine A (CyA) on the serum concentration of circulating immune complexes in 22 patients with IgA nephropathy during an infection-free period. They were randomly divided into 2 groups: 11 patients received oral cyclosporine A (5 mg/kg/day) for 12 weeks and 11 patients received placebo (0.05 ml/kg/day). A significant reduction of proteinuria was observed in patients on CyA therapy but not in those receiving placebo. IgG-circulating immune complexes (CIC) were determined by solid phase Clq enzyme immunoassay (Clq EIA) and radial immunodiffusion (RID) and IgA-CIC were determined by solid phase anti-C3 enzyme immunoassay (anti-C3 EIA) and radial immunodiffusion. There was no change in IgA-CIC measured by RID and anti-C3 EIA after 12 weeks of CyA therapy. Similarly, changes in IgG-CIC were not demonstrated with CyA therapy. No apparent decrease in IgG-CIC or IgA-CIC was observed with placebo treatment. Our study suggests that immunomodulation by CyA therapy does not affect the IgA-CIC and IgG-CIC levels in patients with IgA nephropathy.

Adult↗
PubMed1991

Locally metastasizing vascular tumor. Spindle cell, epithelioid, or unclassified hemangioendothelioma?

The authors report the case of a 2-year-old boy with a recurrent and locally metastasizing, spindle cell, vascular tumor with histiocytoid cells involving the skin, subcutaneous tissue, and muscle of the right forearm, the right distal radius and ulna, and multiple lymph nodes of the right axilla. Diagnoses of hemangioma, hemangiopericytoma, angiomatosis, spindle cell hemangioendothelioma, and malignant hemangioendothelioma were made on successive excision specimens. The soft tissue of the right arm became diffusely enlarged, and a severe syndrome developed that was similar to that described by Kasabach and Merritt. The limb was amputated above the elbow, the axillary lymph nodes were cleared, and a total dose of 6,000 centigrays axillary radiation was given. After operation, the Kasabach-Merritt syndrome resolved. Despite the lymph node metastases and multiple tissues involved, the patient has remained well 6 years after surgery. Although the tumor exhibited some of the histologic features of a spindle cell hemangioendothelioma, the low-grade aggressive behavior resembled that of an epithelioid hemangioendothelioma. The reported case cannot be classified into any of the recognized categories or subdivisions of vascular tumors.

Bone Neoplasms↗
PubMed1991

Giant cell arteritis in two Chinese patients.

Giant cell arteritis is virtually unknown in Orientals. We report two cases of histologically proven giant cell arteritis in two elderly Chinese men, one of whom presented with typical symptoms and the other with occult features of the disease.

Aged↗
PubMed1991

Soluble interleukin 2 receptor release, interleukin 2 production, and interleukin 2 receptor expression in activated T-lymphocytes in vitro.

Following activation in vitro, peripheral blood mononuclear cells (PBMC) express cell-associated interleukin-2 receptors (IL2R). The present study was undertaken to define the proportion of T lymphocyte subsets that express the IL2R (CD25 antigen) upon different mitogenic stimulation. Double immunofluorescence staining with different fluorochromes, fluorescein isothiocyanate and phycoethyrin, was applied for identification of IL2R positive cells and individual lymphocyte subset. The exact percentage of individual activated lymphocyte subset bearing IL2R was enumerated by photographic counting. There was paucity of IL2R in freshly isolated, unstimulated peripheral blood, PBMC cultured without mitogen, and cultured B lymphocytes. Following pokeweed mitogen stimulation in vitro, 19% of CD4 (T-helper/inducer) lymphocytes and 14% of CD8 (T-suppressor/cytotoxic) lymphocytes expressed IL2R. Similarly, 25% of CD4 lymphocytes and 19% of CD8 lymphocytes expressed IL2R following phytohemagglutinin stimulation in vitro. Contrary to the reported data of Tac-positive cells in human lymphoid tissues, our study revealed that, upon lectin mitogen stimulation, approximately 55% of IL2R positive PBMC were CD4 lymphocytes, and 45% of them were CD8 lymphocytes. These observations imply the plausible notion that interleukin-2 mediated immune activation of T lymphocytes in PBMC is different from that in local lymphoid organs. It was also demonstrated that the release of soluble IL2R (sIL2R) and IL2 production in supernatant from cultured PBMC varied with different lectin stimulation. A significant correlation was demonstrated between the cellular and soluble IL2R but the production of IL2 from activated mononuclear cells bore no good correlation with either the cellular IL2R expression or the release of sIL2R.

Adult↗
PubMed1991

Membranous nephropathy associated with spinal schwannoma.

Clinical cure was effected in a patient with biopsy-proven membranous nephropathy associated with spinal schwannoma. The renal manifestation of nephrotic syndrome antedated the clinical presentation of the spinal tumor. The proteinuria and edema subsided 4 mths after the complete resection of the intradural component and partial removal of the extradural component of the schwannoma. Careful workup in patients with membranous nephropathy should include not only malignant but also benign tumors.

Aged↗
PubMed1991

Local norms of maternal serum alpha-fetoprotein values in early second trimester: a prelude to a Down's syndrome screening programme incorporating maternal serum alpha-fetoprotein values.

Maternal alpha-fetoprotein in (MSAFP) has recently been proposed for screening of Down's syndrome. This is based on the association of a lowered MSAFP level at a given gestational age in Down's syndrome (DS) pregnancies. Most conventional 'screening' programmes in DS are based on the maternal age alone, selecting older mothers, who are at greater risk of having a DS infant born, for antenatal karyotyping. However, as 75% of DS infants are born to mothers less than 35 years old, a combination of blood tests including MSAFP and maternal age as independent risk factors would screen the younger mothers as a good cost-benefit ratio in selecting the 'at-risk' mothers for karyotyping. In this study, the gestational age was calculated from the first day of the last menstrual period (LMP) as well as from ultrasound cephalometry. The local MSAFP levels follow the same trend at a slightly higher level as those based on clinical evaluation of the Abbot AFP-EIA Monoclonal kits.

Down Syndrome↗
PubMed1991

Diffuse uterine leiomyomatosis with hemorrhage.

A 28-year-old woman with primary infertility and severe menorrhagia underwent a hysterectomy after failed hormonal therapy for multiple leiomyomas. The postoperative pathologic findings established the diagnosis of diffuse uterine leiomyomatosis, which demonstrated histologic, immunohistochemical, and ultrastructural similarity to leiomyomas of the uterus. The rapid growth of the tumor coincided with the administration of clomiphene citrate, an estrogenic agonist. As with the common leiomyoma, intralesional hemorrhage in this case of diffuse leiomyomatosis was associated with norethindrone acetate treatment given after the cessation of clomiphene therapy.

Adult↗