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Biomedical subjects

R Leong

Publications and source records attributed to R Leong.

7 recordsLinked to original sources
PubMed2006

Aspergillus fumigatus pacemaker lead endocarditis: a case report and review of the literature.

The diagnosis of fungal endocarditis requires a high index of clinical suspicion. Rarely, pacemaker implantation may be a risk factor for the development of fungal endocarditis. A 71-year-old man with a history of multiple transvenous pacemaker manipulations and fever of an uncertain source is described. A diagnosis of culture-negative pacemaker endocarditis was established only after repeat transthoracic echocardiography. Amphotericin B was instituted; however, the patient developed a cerebral infarct and died. Postmortem examination demonstrated Aspergillus fumigatus within a large pacemaker lead thrombus, tricuspid and aortic valve vegetations, and septic pulmonary and renal emboli. The present report describes the clinical and pathological features of a rare case of Aspergillus fumigatus pacemaker lead endocarditis and suggests that serial echocardiograms may be effective in the early detection of pacemaker lead vegetations. The diagnostic features and therapeutic management of pacemaker lead endocarditis are reviewed.

Aged↗
PubMed2004

Effect of Helicobacter pylori eradication on treatment of gastro-oesophageal reflux disease: a double blind, placebo controlled, randomised trial.

BACKGROUND: The role of Helicobacter pylori eradication in the management of gastro-oesophageal reflux disease (GORD) is controversial. We hypothesised that H pylori eradication leads to worsened control of reflux disease. METHODS: Consecutive patients with weekly reflux symptoms were prospectively recruited for endoscopy and symptom evaluation. Patients were enrolled if they had H pylori infection and required long term acid suppressants. Eligible patients were randomly assigned to omeprazole triple therapy (HpE group) or omeprazole with placebo antibiotics (Hp+ group) for one week. Omeprazole 20 mg daily was given for eight weeks for healing of oesophagitis and symptom relief. This was followed by a maintenance dose of 10 mg daily for up to 12 months. The primary study end point was the probability of treatment failure within 12 months, which was defined as either incomplete resolution of symptoms or oesophagitis at the initial treatment phase, or relapse of symptoms and oesophagitis during the maintenance phase. Predictors of treatment failure were determined by Cox's proportional hazards model. RESULTS: A total of 236 GORD patients were screened and 113 (47.9%) were positive for H pylori; 104 (92%) patients were included in the intention to treat analysis (53 in the HpE group and 51 in the Hp+ group). Thirty one patients (30%) had erosive oesophagitis at baseline. H pylori was eradicated in 98% of the HpE group and in 3.9% of the Hp+ group. Overall, 15 patients (28.3%) in the HpE group and eight patients (15.7%) in the Hp+ group had treatment failure. The 12 month probability of treatment failure was 43.2% (95% confidence interval (CI) 29.9-56.5%) in the HpE group and 21.1% (95% CI 9.9-32.3%) in the Hp+ group (log rank test, p = 0.043). In the Cox proportional hazards model, after adjustment for the covariates age, sex, erosive oesophagitis, hiatus hernia, degree of gastritis, and severity of symptoms at baseline, H pylori eradication was the only predictor of treatment failure (adjusted hazard ratio 2.47 (95% CI 1.05-5.85)). CONCLUSION: H pylori eradication leads to more resilient GORD.

Aged↗
PubMed1985

A model for signal transmission in an ear having hair cells with free-standing stereocilia. II. Macromechanical stage.

A model of the signal-processing properties of the macromechanical system of the alligator-lizard middle and inner ear is developed. The model is based on measurements (as a function of tone frequency) of ossicular and basilar-membrane motion and of acoustic input-admittance at the tympanic membrane before and after alterations of middle-ear and inner-ear structures. From the structure of the ear, we formulate an equivalent electric network consisting of six admittance blocks and two transformers. The admittance blocks represent the mechanical properties of particular structures, e.g. the tympanic membrane (TM), the ossicle, the TM-ossicular joint, the vestibule, the basilar membrane and the helicotrema. The transformers represent the conversions from acoustical to mechanical variables performed by the TM-ossicular system and by the columella footplate. The block admittances and transformer ratios are inferred from the measurements, and each admittance is approximated by a network with a few simple elements. The resulting model fits the experimental results satisfactorily, allows correlations between specific structures and response behavior, and predicts the macromechanical transfer function. This transfer function acts as the first stage of a model of the alligator-lizard auditory periphery (Weiss et al., Weiss and Leong, 1985, Hearing Res. 20, 131-138, 157-174, 175-195). In the model the frequency dependence of basilar-membrane motion (1) is determined primarily by the tympanic membrane and extracolumella in the middle frequencies and (2) is affected by the helicotrema at low frequencies and the TM-ossicular joint at high frequencies.

Acoustics↗
PubMed1985

A model for signal transmission in an ear having hair cells with free-standing stereocilia. III. Micromechanical stage.

Measurements have shown that the sound-induced motion of free-standing stereocilia of hair cells in the alligator lizard cochlea exhibits tonotopically organized frequency selectivity that is correlated with the geometry of the stereociliary tuft. We propose a model in which basilar-membrane motion causes vibration of the receptor organ which drags the stereocilia back and forth through the endolymph. The stereociliary tuft is represented as a rigid rod attached to the cuticular plate by a compliant hinge. Viscous and inertial forces exerted by the endolymph on the rod are computed approximately. A transfer function, H mu(f), is derived that relates rod angular displacement to basilar-membrane velocity. H mu(f) has low- and high-frequency slopes of 10 and -20 dB/decade, respectively. The resonant frequency of H mu(f) depends on the dimensions of the rod because this frequency is inversely proportional to the square root of the product of the moment of inertia of the rod, which depends on rod dimensions, and the compliance of the hinge, which does not. In most respects, measurements of frequency selectivity and tonotopic organization of hair cells and cochlear neurons in the alligator lizard, can be accounted for by an input transfer function, HI(f) = Hm(f)H mu(f)Ha(f), where Hm(f) is the macromechanical transfer function that relates sound pressure at the tympanic membrane to basilar-membrane velocity (Rosowski et al., 1985, Hearing Res. 20, 139-155), and Ha(f) is a first-order lowpass filter. Mechanisms that could produce the additional lowpass filter process are discussed.

Animals↗
PubMed1985

A model for signal transmission in an ear having hair cells with free-standing stereocilia. IV. Mechanoelectric transduction stage.

A model is described for mechanoelectric transduction in hair cells with free-standing stereocilia in the alligator lizard cochlea. The model relates the angular displacement of the stereocilia to the receptor potential in the absence of the hair cell's membrane capacitance whose effect is considered elsewhere (Leong and Weiss, 1985, in preparation). The model consists of two parts: a population of membrane ionic channels and an electric network that relates the channel conductance to the equivalent resistance of the hair cell. The membrane ionic channels tend to open when the stereociliary tuft is displaced toward the kinocilium (or basal body) and tend to close when the tuft is oppositely displaced. The fraction of channels that is open for a given tuft displacement is governed by Boltzmann statistics and the energies of open and closed configurations of the channels are separated by a single energy barrier whose height depends on the angular displacement of the stereociliary tuft. The resulting channel conductance is a hyperbolic-tangent type function of the angular displacement of the stereociliary tuft. The channel conductance is coupled to the rest of the hair cell by an equivalent electric network containing constant resistance and a capacitance. The Thévenin equivalent resistance change across the basolateral membrane of the hair cell, called the transducer function, is also a hyperbolic-tangent type function of angular displacement. The parameters of the channel conductance and the values of resistances in the hair-cell electric model determine the scale factors and the location of the operating point of this hyperbolic-tangent type function. The hyperbolic-tangent type function is a specific example of a class of monotonically decreasing and saturating, or sigmoidal, transducer functions. The spectral properties of sigmoidal transducer functions are examined for sinusoidal angular displacements of amplitude theta. General results are obtained for arbitrary sigmoidal transducer functions; particular results are obtained for the hyperbolic-tangent type function. General conclusions concerning spectral components of the resistance change include: all spectral components are independent of the frequency of the angular displacement; the constant or DC component can be positive or negative; the fundamental component is 180 degrees out of phase with the angular displacement, i.e. the resistance decreases when the stereocilia are displaced towards the kinocilium; for small values of theta, the magnitude of the nth harmonic tends to grow as theta n for n greater than 0; the zeroth harmonic or DC component grows as theta 2.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMedDate not supplied

Epulis granulomatosa: extraction sequellae.

Epulis granulomatosa is a post-surgical lesion emanating from an extraction socket. It can be misdiagnosed with lesions of similar appearance, for example, foreign body or pyogenic granulomas, or as a herniation of the maxillary sinus. Based on clinical appearance and microscopic description, granulomas all appear to represent essentially the same lesion. However, pathonomonically, the epulis granulomatosa emanates only from an extraction socket; the other granulomas can be found anywhere in the body.

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