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Biomedical subjects

K Y Tan

Publications and source records attributed to K Y Tan.

At least 19 recordsLinked to original sources
PubMed2006

Finding hepatic portal venous gas in an adult patient: its significance.

Portal venous gas is a well-established radiological finding in neonates. With the advancement in diagnostic imaging, more cases are being reported in adults. We present a 55-year-old man with radiological findings of both portal venous gas and pneumatosis intestinalis secondary to ischaemic necrotising enterocolitis, with subsequent fatality. The significance of finding portal venous gas and its possible aetiology is discussed.

Embolism, Air↗
PubMed2005

A pilot project on hospital-based universal newborn hearing screening: lessons learned.

OBJECTIVE: This paper reports the performance of a newly implemented hospital-based universal newborn hearing screening programme and the challenges to the effective implementation. METHODS: Data of 4437 babies screened from April 2003 to February 2004 at Hospital Universiti Kebangsaan Malaysia was analyzed to measure the performance of the newborn hearing screening programme. Quality indicators, which include the coverage rate, initial refer rate, return for follow-up rate, ages of diagnosis and intervention were calculated. Factors contributing to poor compliance for follow-up were examined through questionnaire survey of 341 parents who did not bring their babies for the initial screening follow-up. RESULTS: The findings of this study revealed unsatisfactory performance of the hearing screening programme compared to the Joint committee of Infant Hearing recommendation [Joint Committee on Infant Hearing Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs, Pediatrics 106 (4) (2000) 798-817]. The coverage rate, initial refer rate, and return for follow-up rate were 84.64, 11.97 and 56.97%, respectively. The average age of diagnosis was 3.56 months (S.D. 1.33). Only 1 of the 16 babies identified as having hearing loss through the screening programme has been fitted with hearing aids. Delay in coming to audiological certainty was one of the reasons hampering early intervention of these children. The commonly cited reasons for not returning for screening follow-up reflect the need to create public awareness of the importance of early diagnosis and intervention of hearing loss. CONCLUSIONS: The implementation of the present screening programme needs to be reviewed. Factors contributing to its unsatisfactory performance must be identified and steps must be taken to resolve them so that early identification and intervention of permanent congenital hearing loss can become a reality.

Continuity of Patient Care↗
PubMed2005

[Problematic cases of mesothelioma reported to the Dutch Institute for Asbestos Victims: evaluation by the Mesothelioma Working Group of the Netherlands Association of Pulmonologists and Specialists in Tuberculosis].

OBJECTIVE: To analyse the assessments of problematic cases reported to the Dutch Institute for Asbestos Victims (IAS) by the Mesothelioma Working Party of the Netherlands Association of Pulmonologists and Specialists in Tuberculosis (NVALT). DESIGN: Descriptive. METHOD: The pathological confirmation of a malignant pleural mesothelioma of occupational origin is difficult in about 10% of the cases. The IAS has requested the Mesothelioma Working Party of the NVALT to review these cases. When no definitive diagnosis can be made on histological or cytological grounds, three pulmonologists reach a conclusion on the basis of correspondence, X-ray examination and other information. RESULTS: In the period January 2000--March 2004 the Working Party evaluated 132 cases, two-thirds of whom (n = 89) were assessed to be compatible with 'malignant pleural mesothelioma' and one-third of whom (n = 43) were felt to be non-compatible. In 69% of the cases (91/132) the conclusions of the three independent specialists were unanimous. The median time from request to report was 25 days (range: 1-185). CONCLUSION: This approach was effective and rapid.

Aged↗
PubMed2004

Which colorectal cancers are missed by double contrast barium enema?

BACKGROUND: The relative merits of either barium enema or colonoscopy for investigating lower gastrointestinal tract symptoms is still unclear. We studied the value of double contrast barium enema (DCBE) as the initial evaluation modality. We reviewed our 10-year experience of double contrast enemas as read by consultant radiologists. The study also aimed to identify which lesions are usually missed. PATIENTS AND METHODS: We reviewed clinical data for all patients who underwent DCBE within the 6 months prior to surgical resection of colorectal cancer between April 1989 and April 1999. Patient demographics and tumour characteristics were analysed for their effects on the likelihood of the lesions being missed at DCBE. RESULTS: There were 706 patients included in the study, 54.2% were male and the mean age was 63.7 years (SEM=0.5 years). The site along the colon and rectum of tumours missed by DCBE corresponded with the frequency of tumour occurrence at each site. The overall rate of missed lesions was 4.1% (29 of 706 patients); these patients were found on subsequent endoscopy to harbour cancer. Tumours less than 3 cm in length and with lesser extent of circumferential involvement were more likely missed at DCBE (p=0.05 and p=0.01, respectively). Age, sex, and tumour grade and stage were not significant predictors of the likelihood of missed lesions. Of the 29 patients with missed lesions, 77.2% had a serum concentration of carcinoembryonic antigen (CEA) above the normal range (3.5 microg/l). The mean follow-up was 65.3 months (SEM=1.8 months). The overall survival for this series was 60.1%. The inaccuracy of the initial DCBE was not found to cause statistically significant differences in the stage of the tumour at diagnosis nor the overall survival of the patients in our series. CONCLUSIONS: Smaller cancers without circumferential involvement may be missed when DCBE is performed to evaluate lower gastrointestinal symptoms. Further evaluation by colonoscopy must be recommended when symptoms persist, especially in the context of a raised CEA level.

Adult↗
PubMed2003

[Severe respiratory symptoms following the use of waterproofing sprays].

Five patients became short of breath following the use of a waterproofing spray in an unventilated room: one 40-year-old woman and 4 men aged 40, 18, 21 and 39 years, respectively. After treatment the complaints diminished within the course of a few weeks. Waterproofing sprays are commonly used to make clothing and shoes water-repellent. Several hours after inhalation of such sprays symptoms of dyspnoea can occur. Without therapy this can lead to pulmonary fibrosis. Corticosteroid therapy seems to shorten the duration of complaints in the acute phase and preclude fibrosis. It is therefore advisable to present patients with respiratory complaints following inhalation of waterproofing sprays at an emergency department. A chest X-ray and blood gas analysis should be performed. In case of abnormalities, patients should be hospitalised.

Acute Disease↗
PubMed2003

Open reduction and internal fixation of fractures of the acetabulum--local experience.

INTRODUCTION: It is now widely accepted that open reduction and internal fixation of displaced acetabular fractures should be the standard of care. This paper reports a case series of acetabular fracture fixation performed at the Changi General Hospital by a single trauma surgeon. PATIENTS AND METHODS: A retrospective study was conducted of 15 consecutive cases of displaced acetabular fracture fixation between February 1996 and September 1999. Outcome was assessed radiologically and functionally with the use of a hip scoring system used by Matta. RESULTS: The patients' age had a mean of 34.9 years. All fractures were a result of high energy trauma. The median duration to operation upon admission was eight days. The mean hospital stay was 24.9 days and the mean medical hospitalisation leave was 159 days. Bony union was achieved in all patients. Two patients (13.3%) had a residual displacement of 1 mm. Four patients (26.6%) had a residual displacement of 2 mm. Of these four patients with 2 mm displacement, two eventually developed osteoarthritis. Subsequently, one of the two with OA required revision to a total hip arthroplasty two years post fracture. Other complications include 1 (6%) wound infection and 2 (13%) deep vein thrombosis. There were no complications of heterotopic ossification or sciatic nerve injury. Functional scores with a minimum follow up of one year and a mean of 22.6 months follow-up were excellent in 13.3%, good in 66.7%, fair in 13.3% and poor in 6.7%. CONCLUSION: The number of cases in this paper is insufficient to produce any statisticallly significant outcome predictors but accuracy of reduction is an important factor. A good to excellent result was attained in 80% of the patients which confirms that open reduction and internal fixation is the treatment of choice for displaced and acetabular fractures.

Acetabulum↗
PubMed2002

Toxicity assays to determine the start-up strategy for an anaerobic sequencing batch reactor (anSBR).

Addition of glucose as the co-substrate and the use of a water-based polymer to enhance granulation were studied with the aim of shortening the start-up period of an anSBR (anerobic sequencing batch reactor) for high-strength industrial wastewater treatment. An initial start-up feed composition consisting of 70% sucrose and 30% industrial wastewater was favorable to reduce the start-up time. Increase in the average particle size and reduction in settled supernatant turbidity was observed with increased water-based polymer addition up to a concentration of 0.1 m/L. Polymer dosages above 0.1 ml/L were undesirable as big and "flaky" flocs were formed which prevented the flocs from settling quickly. Addition of 0.005 ml/L to 0.1 ml/L polymer to the mixed liquor had no observable adverse effects on the anaerobic biomass metabolism. Instead, the addition of the polymer appeared to improve biogas production and had an overall positive effect on anSBR performance treating the industrial wastewater.

Bacteria, Anaerobic↗
PubMed2000

Clinics in diagnostic imaging (50). Leiomyosarcoma of bladder.

A 39-year-old man presented with intermittent painless macroscopic haematuria. He was subsequently diagnosed to have a high grade leiomyosarcoma of the bladder. He underwent total cystoprostatectomy and radiotherapy but died of metastatic disease five months after the initial diagnosis. Aspects of the imaging and diagnostic pathway of painless haematuria are discussed. The management of leiomyosarcomas in the urinary system is highlighted.

Adult↗
PubMed1999

[Pleural amyloidosis as a cause of excessive pleural effusions].

A 83-year-old woman known with a stable disease multiple myeloma was hospitalized frequently with dyspnoea caused by copious bilateral pleural effusions. Thoracentesis was performed repeatedly but pleural effusions returned. Extensive laboratory and radiological examinations failed to reveal the cause of the pleural effusions. Finally, after pleural biopsy the diagnosis of amyloidosis of the pleura could be made. The patient died in hospital from a stroke. Pleural amyloidosis is rarely reported and is accompanied by large uni- or bilateral pleural effusions even without amyloidosis of the heart.

Aged↗
PubMed1999

Normal human immunoglobulin G4 is bispecific: it has two different antigen-combining sites.

Unlike other immunoglobulin G (IgG) subclasses, IgG4 antibodies in plasma have been reported to be functionally monovalent. In this paper we show that the apparent monovalency of circulating IgG4 is caused by asymmetry of plasma IgG4. A large fraction of plasma IgG4 molecules have two different antigen-binding sites, resulting in bispecificity. Sera from patients with IgG4 antibodies to both house dust mite and grass pollen induced cross-linking of Sepharose-bound grass pollen antigen to radiolabelled house dust mite allergen Der p I. This bispecific binding activity was not observed in sera with IgG4 antibodies to either grass pollen or house dust mite exclusively. Depletion of IgG4 antibodies resulted in disappearance of the bispecific activity. By size exclusion chromatography we excluded the possibility that bispecific activity was caused by aggregation of IgG4 antibodies. These results indicate that circulating (polyclonal) IgG4 antibodies have two different antigen-binding sites and therefore are functionally monovalent antibodies.

Allergens↗
PubMed1998

[Chickenpox: varicella pneumonia in adults].

Two patients, a man aged 33 years and a woman aged 30, suffered from a varicella zoster induced pneumonia. In adults a varicella zoster infection may be accompanied by a very severe pneumonia. In one patient mechanical ventilation was necessary. A chest X-ray and blood gas analysis must be made in adults suffering from a varicella zoster virus infection who have pulmonary complaints. In case of abnormalities in one of these two examinations the patient must be observed in a clinical setting. The pneumonia can be treated with aciclovir.

Acyclovir↗
PubMed1997

Measurement of IgE antibodies against purified grass pollen allergens (Lol p 1, 2, 3 and 5) during immunotherapy.

BACKGROUND: IgE titres tend to rise early after the start of immunotherapy, followed by a decline to pre-immunotherapy levels or lower. OBJECTIVES: We were interested to know whether the early increase in IgE antibodies includes new specificities of IgE, and whether these responses persist. METHODS: Sera of 64 patients undergoing grass pollen immunotherapy were tested for IgE against four purified grass pollen allergens: Lol p 1, 2, 3, and 5. At least two serum samples were taken, one before the start of therapy and one between 5 and 18 months after the first immunization (mean: 10 months). RESULTS: The mean IgE responses to Lol p 1, 2 and 3 showed a moderate but not significant increase. In contrast, the mean IgE response to Lol p 5 showed a significant decrease of > 30%. IgE against total Lohum perenne pollen extract moderately increased (> 20%), showing that a RAST for total pollen is not always indicative for the development of IgE against its major allergens. For > 40% of the patients it was found that IgE against one or more of the four allergens increased, while IgE against the remaining allergen(s) decreased. For 10 sera the ratio of IgE titres against at least two allergens changed by at least a factor of 5. The changes in specific IgE also included conversions from negative (< 0.1 RU) to positive (0.6 to 5.0 RU) for five patients. For two patients, the induction of these 'new' IgE antibodies against major allergens was shown to result in a response that was persistent over several years. CONCLUSION: Although active induction of new IgE specificities by immunotherapy was not really proven, the observations in this study indicate that monitoring of IgE against purified (major) allergens is necessary to evaluate changes in specific IgE in a reliable way.

Allergens↗
PubMed1996

Once daily mometasone furoate aqueous nasal spray is as effective as twice daily beclomethasone dipropionate for treating perennial allergic rhinitis patients.

BACKGROUND: Perennial allergic rhinitis is chronic and persistent, may lead to a constellation of secondary complaints including sinusitis, mouth-breathing, and some symptoms resembling a permanent cold, and often requires constant medical intervention. Well-tolerated nasal corticosteroids, alone or in combination with antihistamines, have been found to be very effective in treating this condition. OBJECTIVE: To compare the effectiveness and tolerability of mometasone furoate aqueous suspension, a new once daily nasal spray, to placebo vehicle and to beclomethasone dipropionate, administered twice daily, in patients with perennial allergic rhinitis. METHODS: This was a randomized, double-blind, placebo-controlled, double-dummy, parallel group study, in 427 patients age 12 years and older at 24 centers in Canada and Europe. Patients allergic to at least one perennial allergen, confirmed by medical history, skin testing, and adequate symptomatology were eligible to receive one of the following regimens for 3 months: mometasone furoate, 200 micrograms only daily; beclomethasone dipropionate, 200 micrograms twice daily (400 micrograms total dose); or placebo vehicle control. The primary efficacy variable was the change from baseline in total AM plus PM diary nasal symptom score over the first 15 days of treatment. RESULTS: Three hundred eighty-seven patients were valid for efficacy. For the primary efficacy variable, mometasone furoate was significantly (P < or = .01) more effective than placebo and was indistinguishable from beclomethasone dipropionate. Similar trends were seen among individual symptoms, physician symptom evaluations, and therapeutic response. There was no evidence of tachyphylaxis. All treatments were well tolerated. CONCLUSIONS: Mometasone furoate nasal spray adequately controls symptoms of perennial allergic rhinitis, offers the advantage of once daily treatment, and is well tolerated.

Administration, Intranasal↗
PubMed1995

Grass pollen immunotherapy induces highly cross-reactive IgG antibodies to group V allergen from different grass species.

Sera from two groups of patients receiving grass pollen immunotherapy were tested on IgG reactivity with group V allergen from six different grass species. One group of patients was treated with a mixture of 10 grass species, and the other with a mixture of five. Only Lolium perenne, Dactylis glomerata, and Phleum pratense were present in both mixtures. Although Anthoxanthum odoratum and Secale cereale were absent from the mixture of five, IgG responses to Ant o V and Sec c V were comparable in both patient groups. This reactivity was inhibited for 92-99% with L. perenne extract, illustrating the cross-reactive nature of the IgG antibodies. The presence of A. odoratum and S. cereale in the mixture resulted in only minor amounts of species-specific anti-group V IgG. These results indicate that application of just one grass species in immunotherapy might be sufficient to induce an IgG response that covers other relevant Gramineae species as well.

Allergens↗
PubMed1992

Miliary tuberculosis presenting with thyrotoxicosis.

A male patient is described who presented with thyrotoxicosis, and a large painful neck mass. From the excised mass and stomach aspiration Mycobacterium tuberculosis was cultured and a diagnosis of miliary tuberculosis was made. The thyrotoxicosis was attributed to tuberculous thyroiditis.

Adult↗