Induction of tumour necrosis factor-alpha release by hypoxia.
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Cell Hypoxia↗
Biomedical subjects
Y C Lim
Publications and source records attributed to Y C Lim.
Pulmonary involvement by Hodgkin's disease mimicking pneumonia.
A 24-year-old man who was initially thought to have nocardiosis of his mediastinal lymph node which progressed to involve his right lung, had to undergo a right pneumonectomy when he failed to respond to treatment with sulphadiazine. Histology of the right lung specimen and a subsequent axillary lymph node biopsy revealed that he actually had lymphocyte-depleted Hodgkin's disease.
Adult↗
A case of tracheal obstruction during oesophageal removal of a foreign body.
A patient was admitted with an impacted foreign body in the oesophagus. Repeated attempts to remove it during oesophagoscopy proved difficult and caused obstruction of the trachea during manipulation of the foreign body. A smaller endotracheal tube was subsequently placed in the trachea relieving the obstruction.
Esophagoscopes↗
A comparison of alfentanil, esmolol, lidocaine, and thiopental sodium on the hemodynamic response to insertion of headrest skull pins.
STUDY OBJECTIVES: To compare the effects of four techniques for preventing or blunting the hypertensive response to the insertion of Mayfield headrest skull pins: intravenous (IV) alfentanil (ALF), esmolol (ESM), thiopental sodium (TPL), and local anesthesia using plain lidocaine (Xylocaine; XYL). DESIGN: Randomized open study. PATIENTS: 40 adult patients undergoing intracranial or spinal surgery requiring the use of Mayfield headrest skull pins for head positioning and immobilization. INTERVENTIONS: 20 minutes after anesthetic induction, and 2 to 3 minutes prior to the insertion of headrest skull pins, one of three drugs was administered IV: ALF 10 mcg/kg, ESM 1 mg/kg, or TPL 1.5 mg/kg. The fourth drug, XYL, was administered by injection into the scalp. MEASUREMENTS AND MAIN RESULTS: Blood pressure and heart rate (HR) were recorded immediately prior to and after pin insertion with balanced general anesthesia, and at 30, 60, 120, and 180-second intervals after pin insertion. The measurements were compared with the immediate preinsertion values. In the ALF and XYL groups, there was no significant increase in mean arterial pressure (MAP) or HR for any of the measurement periods. MAP was elevated immediately on pin insertion and for up to 2 minutes in the TPL group, and for up to 3 minutes in the ESM group (p < 0.05). HR changes were seen in the TPL group for up to one minute (p < 0.05). Increases in systolic blood pressure were seen in the TPL and ESM groups for up to 3 minutes, and in diastolic blood pressure for up to 2 minutes (p < 0.05). No other significant changes were observed. CONCLUSIONS: IV ALF and local injection of XYL in the scalp prevent the hemodynamic response to the insertion of skull pins in anesthetized patients. Neither ESM nor TPL prevented the hypertensive response. Local anesthetic injection into the scalp requires coordination between the anesthesiologist and surgeon, it carries the risk of needle stick injury, and it must be repeated if the surgeon repositions the headrest. The rapid onset and short half-life of ALF, coupled with the absence of hemodynamic effects at the dose used, makes this drug an alternative to the use of XYL injection.
Adrenergic beta-Antagonists↗
Early experience of video-assisted thoracoscopic surgery.
Consecutive 25 patients (M/F:18/7) underwent video-assisted thoracoscopic surgery (VATS) for various chest illnesses. These included nine cases of pneumothorax, three cases of pericardial effusion, three cases of pleural effusion, four cases of lung lesion requiring either incisional or excisional biopsy, two cases of empyema, one case of traumatic haemothorax, and three cases of mediastinal lesion. The mean age was 36.2 years (range 19-78 years). A total of forty-three procedures were performed. The mean durations of intrapleural chest-tube requirement and hospitalisation following VATS alone were 4.5 days (range: 0-13 days) and 8.3 days (range: 2-25 days) respectively. No intraoperative complication and VATS procedure-related mortality reported. Apart from simple analgesics such as paracetamol or tramadolol, no opiate analgesia was given to patients undergoing only VATS. The results support that VATS is a safe and effective procedure in the management of pulmonary, mediastinal, pericardial and pleural diseases and the treatment of persistent and recurrent spontaneous pneumothorax.
Adult↗
Intraoperative transesophageal echocardiography in orthotopic liver transplantation in a patient with hypertrophic cardiomyopathy.
With improvements in the surgical technique for orthotopic liver transplantation, patients with significant underlying systemic disease are considered candidates for transplantation, thus increasing the complexity of the medical management of these patients and necessitating additional monitoring in order to minimize the anesthetic risk. We describe the anesthetic management of orthotopic liver transplantation for a patient with severe hypertrophic cardiomyopathy and mitral insufficiency. In this case, transesophageal echocardiography proved useful in the management of the postreperfusion period of the surgical procedure.
Anesthesia↗
The effect of acute hypocapnia on middle cerebral artery transcranial Doppler velocity during orthotopic liver transplantation: changes at reperfusion.
This study examines the effects of acute hypocapnia, instituted prior to reperfusion of the graft liver, on the middle cerebral artery (MCA) Doppler blood flow velocity response to reperfusion during orthotopic liver transplantation in humans. Seventeen patients with chronic liver disease underwent continuous, noninvasive Doppler imaging of the MCA. Hyperventilation to an end-tidal Pco2 of 25 +/- 1 mm Hg was associated with a decrease in mean MCA flow velocity (FVm) from 51.6 +/- 5.7 to 37.0 +/- 3.3 cm/s (P < 0.05). After reperfusion, the Paco2 increased from 32 +/- 1 to 40 +/- 1 mm Hg (P < 0.05), mean arterial pressure (MAP) decreased from 76 +/- 3 to 60 +/- 2 mm Hg, and the FVm increased from 37.0 +/- 3.3 to 54.0 +/- 4.7 cm/s (P < 0.05). FVm increased postreperfusion despite prior hyperventilation, decreased MAP, and abrupt increases in central venous and pulmonary artery pressure, but FVm did not exceed the prereperfusion level. In 10 of the 17 patients, the baseline FVm versus Paco2 response slopes and Paco2 measured postreperfusion were used to predict the FVm response to Paco2 after reperfusion. The slopes were similar to those reported for anesthetized patients without liver disease. Predicted FVm exceeded measured FVm in 9 of the 10 patients. We conclude that mild hyperventilation prior to reperfusion of the graft liver prevents FVm increases above prereperfusion baseline level.
Acute Disease↗
Video-assisted thoracoscopic surgery for pneumothorax.
Five cases of spontaneous pneumothorax were treated with video-assisted thoracoscopic surgery (VATS). These included four cases of recurrent pneumothorax and one case of persistent pneumothorax. The mean age was 33 years. The identified bullae were eliminated with either endoloop ligation (in one patient) or stapled excision (in four patients). There were no recurrences reported in a mean follow-up of 9.4 months. In conclusion, VATS offers an equally effective and less morbid alternative to open thoracotomy in the management of primary spontaneous pneumothorax.
Adult↗
Immediate detection of carotid arterial thrombosis by transcranial Doppler monitoring.
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Aged↗
Intraoperative monitoring of brainstem auditory evoked potentials during resection of a cavernous hemangioma in the fourth ventricle: an indirect monitor of the fifth and seventh nerves.
This case demonstrates the use of brainstem auditory evoked potentials (BAEPs) to monitor cranial nerve function. Changes in BAEPs were associated with cranial nerve dysfunction in the trigeminal nerve on the ipsilateral side and the facial nerve on the contralateral side.
Adult↗
Near infrared cerebral spectroscopy in adults.
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Cerebral Arteries↗
HDR intraluminal brachytherapy for lung tumours--a case report.
The lung is a common site for cancer to occur, for both primary as well as metastases. The presence of such tumours can give rise to symptoms such as haemoptysis, cough, breathlessness and pneumonia. In most cases, treatment is strictly for palliation. We present a case report of a patient with an endobronchial metastasis from a primary hypernephroma which recurred following external beam radiotherapy. He was treated with a single fraction of intraluminal brachytherapy to a dose of 10Gy at 1 cm from the axis on a High Dose Rate Ir192 Remote Afterloading Machine. There were no adverse effects following treatment. On follow-up 7 months later, the patient did not have any further recurrence of breathlessness although his disease had progressed at other sites.
Adult↗
Evaluating in-house anti-serum against B cells with flow cytometry.
The applications of antibodies, be it monoclonal or polyclonal, in the diagnostic and research fields are well established. The disadvantage is the high cost of commercially available antibodies. In a diagnostic establishment like ours which also functions as a training ground for laboratory related personnel, it is beneficial to be able to produce in-house reagents. Therefore, we have undertaken this project to produce a rabbit polyclonal antibody against B lymphocytes. We found that the rabbit was a good choice because the titre of antibody produced was high and positive reactions were still detected at a dilution of 1:38400. The antibody showed significant positive reaction only with the lymphocyte subpopulation. A positive reaction was observed between the immunized rabbit serum and B lymphocytes but not T lymphocytes. This shows that the antibody was B lymphocyte specific. There was a positive correlation between the percentage of B lymphocytes labelled using the commercial anti-CD19 monoclonal antibody and the in-house polyclonal antibody (n = 13, r = 0.7, p = 0.02). However, the percentage of cells labelled by the in-house polyclonal anti-B was lower than that by the commercial monoclonal anti-CD19. The fluorescence intensity of the polyclonal antibody was lower than that of the monoclonal. In general, the performance of the in-house polyclonal antibody can be considered as satisfactory. The rabbit serum was stored at -20 degrees C and no significant loss of activity was detected for over a period of 19 months.
B-Lymphocytes↗
Acute intestinal pseudo-obstruction due to malignant thymoma.
Acute intestinal pseudo-obstruction has been associated with various diverse aetiologies, including several types of malignancies. Malignant thymoma has never been reported before as a cause of acute intestinal pseudo-obstruction. We report here a case of malignant thymoma presenting as acute intestinal pseudo-obstruction. Existing literature on malignant causes of intestinal pseudo-obstruction is also reviewed and discussed.
Adult↗
The distribution of immunoregulatory cells in the peripheral blood of normal Malaysian adults.
The distribution of immunoregulatory cells in the peripheral blood of an individual has now been established as an important tool in helping the management of several diseases. It is necessary to set the normal ranges of these cells for the laboratory. We have undertaken in this study to establish the reference ranges for normal Malaysian adults. We found that the mean percentages of T cells, B cells, T Helper cells (CD4), T suppressor cells (CD8), NK cells and the ratio of CD4/CD8 were 70.91%, 11.38%, 38.15%, 37.76%, 17.45%, and 1.00 respectively. There was no significant difference between the sexes. In certain parameters, there was significant differences between Malay, Chinese and Indians. The Chinese and Indians were significantly different in the distribution of B cells and in the CD4/CD8 ratio. In the case of CD4 and NK cells, the Indians were different from the other two groups.
Adult↗
Immunostaining of formalin-fixed, paraffin-embedded tissues for malignant lymphomas.
With the advent of new monoclonal antibodies that are applicable to formalin-fixed, paraffin embedded sections, immunophenotyping is becoming increasingly important in the diagnosis and classification of lymphomas. However, multiple factors such as fixation, trypsinization and even type of antibodies used have certain effects on the final outcome of the staining procedure. In this paper we report our experience and the problems encountered in our laboratory when we first tried to establish a workable immunostaining protocol for formalin-fixed, paraffin embedded tissue sections using the immunoalkaline phosphatase technique.
Alkaline Phosphatase↗
In-house microcomputer software package for management of histopathology reports.
A system for computerising histopathology records developed in-house using dBASE IV on IBM-compatible microcomputers in a local area network is described. The software package uses a horizontal main menu bar with associated pull-down submenus as interface between the machine and the user. It is very easy to use. The package provides options for selecting databases by years, entering/editing records, browsing data, making multi-characteristics searches/retrievals, printing data, and maintaining databases that includes backing-up and repairing corrupted databases.
Database Management Systems↗
Surgical management of intrathoracic aortic aneurysm.
The pathology, clinical features, indications for surgery and the results of intrathoracic aneurysm are analysed in thirty-nine consecutive patients who underwent surgery at Singapore General Hospital from January 1986 through December 1990. There were twenty cases of non-dissecting aneurysm and nineteen cases of dissecting aneurysm or aortic dissection. The 30 day survival for the twenty patients with non-dissecting aneurysm was sixteen patients (80%). The best results were obtained in patients with aortic root aneurysms. The overall 30-day survival for the nineteen patients with aortic dissection was twelve patients (64%). The mortality was especially high in patients with acute aortic dissection (46%). Recent advances in the management of these aneurysms make early recognition and diagnosis mandatory to achieve the best results.
Adult↗