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Biomedical subjects

M Ip

Publications and source records attributed to M Ip.

At least 55 records · Page 3Linked to original sources
PubMed1996

Recurrence of a choroidal neovascular membrane in a patient with punctate inner choroidopathy treated with daily doses of thalidomide.

PURPOSE: To determine whether thalidomide therapy can prevent a recurrence of a choroidal neovascular membrane in a patient with punctate inner choroidopathy. METHODS: Case report. In a 38-year-old woman with bilateral punctate inner choroidopathy, thalidomide therapy was initiated three days after laser photocoagulation of a choroidal neovascular membrane. RESULTS: The patient had a recurrence of the choroidal neovascular membrane eight months after the start of thalidomide therapy. CONCLUSIONS: The failure of thalidomide to prevent a recurrence of a choroidal neovascular membrane in this patient suggests that this medication may have only a limited benefit in preventing recurrences of choroidal neovascular membranes.

Adult↗
PubMed1996

Migration and lymphatic spread of calcified paraffinomas after breast augmentation.

A 62 year old Chinese woman presented 25 years after having both breasts augmented with paraffin injections. Development of paraffinomas and multiple episodes of paraffin-related mastitis eventually resulted in bilateral mastectomies. The unusual distribution of migrated calcified paraffinomas in the thoracic wall and its lymphatic system is documented on computed tomography.

Calcinosis↗
PubMed1996

Paecilomyces varioti fungemia in a bone marrow transplant patient.

Paecilomyces varioti, a fungus resembling penicillium spp, has been described in conjunction with impaired host defence or foreign body implants. We report a case of Paecilomyces varioti catheter-related fungemia that occurred during neutropenia in an allogeneic BMT patient receiving antifungal prophylaxis with fluconazole. Successful treatment was achieved by removal of central venous catheter, intravenous amphotericin B and oral itraconazole.

Bone Marrow Transplantation↗
PubMed1995

Waterhouse-Friderichsen syndrome complicating primary biliary sepsis due to Pasteurella multocida in a patient with cirrhosis.

Pasteurella multocida is an opportunistic pathogen causing bacteraemia in patients with liver dysfunction. A fulminant case of acute cholecystitis and septicaemia caused by P multocida, complicated by Waterhouse-Friderichsen syndrome without skin haemorrhage, is reported in a previously healthy 64 year old Chinese woman. The patient presented with a six hour history of sudden onset epigastric pain, vomiting, chills, and rigors. A presumptive diagnosis of cholangitis with septicaemic shock was made. Disease progression was rapid and the patient died within eight hours of symptom onset. This case is further proof that skin and mucosal haemorrhages are not an essential feature of Waterhouse-Friderichsen syndrome and this condition should be suspected in all patients presenting with sudden illness and fulminant septicaemia.

Bacteremia↗
PubMed1995

Pulmonary melioidosis.

Melioidosis is the name given to all diseases caused by the bacterium Pseudomonas pseudomallei. Melioidosis is a tropical disease and prevails in parts of Southeast Asia, northern Australia, and Central and South America. However, in recent years, cases of melioidosis have been reported in the United States and other areas. The organism can infect any organ system, although the lung is the most common organ affected. Pulmonary melioidosis presents either as an acute fulminant pneumonia or as an indolent cavitary disease. In northeastern Thailand, the incidence of P pseudomallei infection is extremely high with significant mortality. One of the key problems with treating melioidosis is its recalcitrance to therapy and high relapse rate. In addition, this Gram-negative rod is resistant to aminoglycosides. In nonendemic regions, patients with melioidosis more typically present with reactivation disease occurring months to years after initial exposure to the organism. The pulmonary disease is mainly in the apices and resembles tuberculosis. With the increasing mobility of people throughout the world and the influx of immigrants from endemic to nonendemic areas, it is important that clinicians be aware of this disease. This article will review the epidemiology, clinical presentations, diagnosis, and treatment of pulmonary melioidosis.

Burkholderia pseudomallei↗
PubMed1995

Fatal rickettsial meningitis in Hong Kong: a need for rapid laboratory diagnosis.

A 22-year-old Chinese male, investigated elsewhere for fever and myalgia, was transferred to our hospital drowsy, unresponsive to commands and with a petechial rash. Partially treated meningococcal meningitis was suspected and high-dose antibiotics were immediately started. Rising Weil-Felix titres occurred too late for anti-rickettsial therapy to prevent a fatal outcome. Subsequent specific serology showed rising titres against Rickettsia conori. The desirability of more rapid and reliable methods of laboratory diagnosis of rickettsial infection is evident.

Adult↗
PubMed1995

Acute clonorchiasis.

A 42-year-old Chinese woman developed 3 weeks of swinging fever, rash, malaise, and discomfort at the right upper quadrant of the abdomen. Acute Clonorchis sinensis infection eventually became evident and the patient responded to praziquantel. Although acute infestation is usually asymptomatic, occasional cases suffer severe symptoms and present difficulties in clinical diagnosis. Clonorchiasis is endemic in South East Asia. With the increasing popularity of travel to these countries and the global migration of Asians, physicians need to be aware of the condition. Treatment with praziquantel is effective and prevents the serious sequelae of chronic infection.

Acute Disease↗
PubMed1994

Pulmonary functions in congenital scoliosis.

STUDY DESIGN: Thirty-six patients with congenital scoliosis underwent full clinical and radiologic evaluation of their deformity and their full pulmonary functions. OBJECTIVES: This study observed pulmonary functions in congenital scoliosis in detail, evaluated pulmonary functions in nonsurgically treated patients, and established whether, in surgically treated patients, there are any differences between those with multiple thoracic anomalies and those with lumbar or one of two thoracic anomalies. SUMMARY OF BACKGROUND DATA: Eighty-six of our patients in both groups (surgically and nonsurgically treated) showed abnormal increases in residual volumes, indicating a restrictive pattern of lung function. The results of their pulmonary functions were analyzed using predicted values to eliminate age affect. METHODS: Pulmonary functions were assessed using the Gould 5000IV Computerized Pulmonary Function System. RESULTS: Overall, mean total lung capacity was 89% of predicted value, and mean vital capacity and forced vital capacity were 74% of predicted value. The mean residual volume was significantly increased, being 154% of predicted value. Nonsurgically treated patients showed normal total lung capacity (mean 99.8% of predicted value); this mean value was 82% of predicted value in surgically treated patients. CONCLUSION: Vital capacity was found to be significantly reduced in surgically treated patients (68% of predicted value), especially in those patients who had multiple thoracic anomalies. We believe that children with congenital scoliosis due to multiple anomalies should be operated on at an early age before deformity is too severe.

Adolescent↗
PubMed1994

Changes in regional ventilation during histamine bronchial challenge in stable asthma.

Our objective was to examine the changes in regional ventilation during histamine-induced bronchoconstriction in stable asthma. We measured regional ventilation by a new method which measures regional distribution of inhaled 127Xe during tidal breathing by a gated method and, by simultaneously measuring 99mTc counts from labelled macroaggregates, allowed for changes in lung shape during the breathing cycle. We studied 10 asthmatic patients [forced expiratory volume in 1 s (FEV1 2.04-4.37 litres)] and measured, in addition to the regional ventilation, oxygen saturation (SaO2), minute ventilation (VE) and tidal volume (Vt) before and after inhaling enough histamine to lower FEV1 by > 20% and/or SaO2 by > 4%. Histamine inhalation reduced FEV1 by 0.44-1.15 liters and SaO2 by 0-4%. It increased VE and functional residual capacity (FRC) in 8 of the 10 patients. The FEV1 fall did not correlate with the SaO2 fall, VE or FRC changes. Histamine inhalation increased apical ventilation in most patients, but the changes in regional ventilation in the left and right lungs were asymmetrical in 17 out of the 30 lung regions studied (upper, middle and lower paired regions in 10 patients). These results demonstrate that histamine bronchial challenge causes uneven regional ventilation. Any resultant change in ventilation-perfusion balance may be the underlying mechanism of oxygen desaturation seen in this procedure and in spontaneous attacks of asthma.

Adult↗
PubMed1994

Decreased bone mineral density in premenopausal asthma patients receiving long-term inhaled steroids.

Inhaled corticosteroids have become a key element in the maintenance treatment of bronchial asthma. It is well-known that long-term systemic steroid use causes osteoporosis, whereas its inhaled counterpart has been believed to be devoid of such a side-effect. However, recent studies showed that administration of inhaled corticosteroids was associated with biochemical evidence of derangement in bone turnover. We therefore studied bone mineral density (BMD) by dual energy x-ray absorptiometry in 30 patients (18 females, 12 males) with bronchial asthma treated with steroids, essentially by the inhaled route only (both nasal and tracheobronchial), and compared them with healthy subjects individually matched for age, sex, menopausal status, and body mass index (BMI). There was a significant decrease in BMD in the patient group at the hip (neck of femur, p = 0.007; trochanter of femur, p = 0.034; Ward's triangle, p = 0.016) and the lumbar area of the spine (L2-4, p = 0.041). Further analysis showed that this difference from control subjects was mainly seen in the female patients and not in the male patients (neck of femur, p = 0.049; Ward's triangle, p = 0.025; lumbar spine, p = 0.039). In the female patients, there was significant negative correlation of BMD of the lumbar area of the spine and the trochanter of femur with daily inhaled steroid dose and positive correlation of BMD of the trochanter with BMI.

Absorptiometry, Photon↗
PubMed1993

Effect of antibiotics on sputum inflammatory contents in acute exacerbations of bronchiectasis.

We studied the changes in sputum neutrophil chemotactic activity (NCA) and elastolytic activity (EA) in acute exacerbations of bronchiectasis before and after treatment with oral antibiotics. Twelve patients who chronically produced sputum were assessed in the stable state, and when they subsequently developed symptoms of acute exacerbations, prior to initiation of antibiotics, during 2 weeks of antibiotics, and at 2 and 6 weeks after stopping antibiotics. NCA was measured using modified Boyden's technique with multiwell chemotaxis chamber, and EA with N-succinyl-trialanine-p-nitroanilide as elastase substrate. All 12 patients had NCA (49.3 +/- 8.69% FMLP response) and EA (50.5 +/- 17.1 mU per 100 microliters) in their sputum in the stable state. At acute exacerbation, there was significant increase in NCA (P < 0.001) and EA (P < 0.05). All responded clinically after 1 week of antibiotics, and this was associated with a decrease in NCA and EA back to the levels in stable state. A further week of antibiotics did not result in further decline of NCA or EA. Three patients had another acute exacerbation clinically between 2-6 weeks after stopping antibiotics and their NCA and EA rose again. In the other nine patients, both NCA and EA at 2 and 6 weeks post-treatment were similar to pre-exacerbation levels. Our findings suggest that short course antibiotics effectively control the upsurge in inflammatory activity in acute exacerbations, but has little effect on chronic airway inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

Disseminated skeletal tuberculosis with skull involvement.

We report a patient with widespread osteolytic lesions, including extensive involvement of the skull, due to Mycobacterium tuberculosis. Response to treatment with antituberculosis drugs was slow with appearance of new lesions while on therapy despite a sensitive organism. Excision of diseased skull bone was eventually done, after which no new lesions appeared in the ensuing 14 months.

Adolescent↗
PubMed1993

Isoniazid induced encephalopathy in dialysis patients.

Three dialysis patients with extrapulmonary tuberculosis developed confusion 4-14 days after commencement of treatment with anti-tuberculosis drugs, despite the use of prophylactic pyridoxine. Full recovery of conscious state resulted within 1 week in all patients after stopping isoniazid. In 2 patients confusion recurred on rechallenge of the drug. The risk factors of isoniazid induced encephalopathy and the dosage of isoniazid in uraemic patients were discussed.

Adult↗
PubMed1993

Multivariate analysis of factors affecting pulmonary function in bronchiectasis.

Impaired pulmonary function is of prognostic importance in bronchiectasis. To assess the factors affecting pulmonary function in bronchiectasis, we studied the clinical features, atopic status, bronchial responsiveness, systemic inflammatory indices, and sputum characteristics including volume, purulence, leucocyte count, neutrophil chemotactic activity, elastolytic activity (EA) and bacteriology in 82 Chinese patients. The majority of patients had impaired spirometry with airflow obstruction but normal carbon monoxide diffusing capacity. Multivariate analysis showed that factors significantly associated with worse lung function were: bronchial hyperresponsiveness, concomitant asthma, higher serum globulin, higher peripheral leucocyte count, lower serum albumin, greater sputum volume, diffuse disease and older age. When subjects with clinical asthma were excluded, similar factors were identified, and in addition, longer duration of disease, presence of eosinophils in sputum and higher sputum EA were significantly related to worse spirometry. Most of the identified factors reflect a state of inflammation. Thus the findings suggest that persistent inflammation plays an important role in the deterioration of lung function in bronchiectasis.

Bronchial Provocation Tests↗
PubMed1991

The effect of in vitro and in vivo dexamethasone on human neutrophil function.

There is a significant fall in PMN chemotaxis to the peptide FMLP in response to increasing concentrations of dexamethasone in vitro. The response fell in a dose related manner from a control value of 53.7 SE +/- 9.6 cells per high power field (cpf) to 47.3 SE +/- 8.1 at 10(-6) M (p less than 0.05) and 24.7 +/- 8.9 at 10(-3) M (p less than 0.025). A similar response was observed for the chemoattractants zymosan activated serum and the sol phase of purulent sputum. The effect was independent of protein synthesis or the period of incubation. Twelve milligrams of dexamethasone taken daily by 6 healthy volunteers resulted in a significant (p less than 0.025) reduction in the chemotactic response of PMN to 10(-8) M FMLP (from 29.5 +/- 1.55 to 13.7 +/- 1.8 cpf) which was apparent within 2 hours of taking the first dose. This effect was sustained for the three days on which dexamethasone was taken but returned to normal 7 days after the last dose had been administered. Dexamethasone therapy had no effect on unstimulated PMN superoxide anion production either in vitro or in vivo. The in vivo effect on neutrophil function occurred at mean serum dexamethasone concentrations of 1.26 (+/- 0.28) X 10(-7) M on day 1, 1.44 (+/- 0.15) X 10(-7) M on day 2 and 1.31 (+/- 0.13) X 10(-7) M on day 3. Thus we conclude that dexamethasone concentration which inhibit PMN chemotaxis in vivo are much lower than those required to exert the same effect in vitro.

Chemotaxis, Leukocyte↗
PubMed1991

Analysis of factors associated with bronchial hyperreactivity to methacholine in bronchiectasis.

Nonspecific bronchial hyperreactivity (BHR) has been reported to occur in patients with bronchiectasis. To evaluate this further, we studied 77 patients with stable bronchiectasis (noncystic fibrosis) with special reference to the prevalence of BHR to methacholine (MCh), and its relation to lung function, sputum characteristics, concommitant asthma, and atopy. The concentration of MCh required to produce a fall of 20% in forced expiratory volume in 1 s (FEV1), PC20, was determined by Wright's nebulization tidal breathing method. BHR defined by a PC20 greater than or equal to 8 mg/ml was found in 21 of 47 (45%) subjects who underwent bronchial challenge. Presence of BHR was positively associated with low baseline spirometric values, diagnosis of asthma, long duration of disease, and elevated total IgE on univariant analysis, and was significantly related to FEV1/forced vital capacity (FVC) ratio and asthma on multiple regression analysis. Ten of the 21 hyperreactive subjects did not have clinical asthma, whereas all 11 of 22 subjects with clinical asthma who underwent bronchial challenge were hyperreactive. Among those with BHR, there was a positive correlation between PC20 and baseline FEV1. When patients were further classified into asthmatic and nonasthmatic subjects, a positive correlation between PC20 and FEV1 was seen only in those without asthma. Frequency of infective episodes and inflammatory score of sputum assessed by average daily volume, purulence, and leukocyte count did not differ significantly in the groups with and without BHR. These results suggest that BHR in patients with bronchiectasis is associated with coexistent asthma and worse spriometric values, and not with the severity of bronchial sepsis.

Adult↗