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Y K Kueh

Publications and source records attributed to Y K Kueh.

At least 19 recordsLinked to original sources
PubMed2004

Clinico-pathological analysis of myelodysplastic syndromes according to French-American-British classification and international prognostic scoring system.

INTRODUCTION: The aim of this study was to analyse the clinico-pathological features of a cohort of patients with myelodysplastic syndromes (MDS). MATERIALS AND METHODS: The clinical and pathological data of 43 MDS patients over a 3-year period were reviewed. Survival analysis was performed according to the French-American-British (FAB) classification and International Prognostic Scoring System (IPSS) using the Kaplan-Meier method. Selected published studies for comparison were identified from MEDLINE search. RESULTS: The patients were followed up for a median duration of 175 days (range, 2 to 1044 days). The median survival for refractory anaemia (RA) and refractory anaemia with ringed sideroblasts (RARS) has not been reached, but that for refractory anaemia with excess blasts (RAEB), refractory anaemia with excess blasts in transformation (RAEB-T) and chronic myelomonocytic leukaemia (CMML) was 250 days, 49 days and 44 days, respectively. The median survival for the low-risk and intermediate-1 IPSS categories has not been reached, while that for the intermediate-2 and high-risk categories was 58 days and 49 days, respectively. The survival analyses, according to the FAB classification and IPSS system, were statistically significant (P <0.05). Comparison of our data with those from neighbouring and Western countries revealed both similarity and disparity. We also noted different cytogenetic information in our cohort of patients. CONCLUSIONS: We found distinctly unique cytogenetic and clinico-pathological characteristics in our MDS patients. However, whether true biological differences exist among MDS patients in different geographies and populations with different genetic and environmental backgrounds require further large multinational study.

Adolescent↗
PubMed2000

Static cytometry identifies hyperdiploid childhood ALL.

Hyperdiploid acute lymphoblastic leukemia of childhood has long been identified with a good prognosis. Identification of this subgroup before treatment commences would enable the most appropriate regimen to be selected. Static cytometry permits an assessment of the DNA content of morphologically selected interphase cells. The blast cells from seven retrospective and seven prospective cases were studied and the ploidy levels compared with the bone marrow karyotype. Static cytometry rapidly identified the hyperdiploid karyotype and, as it was performed specifically on blast cells, it also identified the percentage of these blast cells that were hyperdiploid.

Aneuploidy↗
PubMed2000

Clinical characteristics and treatment outcome of 218 patients with non-Hodgkin's lymphoma in a Singaporean institution.

A retrospective analysis of 218 patients with non-Hodgkin's lymphoma (NHL) seen at a single institution in Singapore over a ten-year period was conducted. Twenty percent, 56% and 24% of patients had low-, intermediate- and high-grade disease respectively using the Working Formulation, and 25% of patients immunophenotyped had T-cell NHL. Forty-nine percent had primary extranodal disease, with the commonest sites of involvement being the gastrointestinal tract, nasal cavity, and tonsils. 86% and 73% respectively of patients with intermediate and high grade disease received combination chemotherapy as first line treatment, with CHOP being the most commonly used regime. Seventy-four percent of patients with low grade lymphoma received first line chemotherapy, 5% each was treated with radiotherapy or surgery alone, and 21% was treated symptomatically. Patients with low grade B-cell lymphoma had a 5-year survival of 80% and 10-year survival of 42%. One-year survival for intermediate and high grade B-cell lymphoma was 76% and 42%, while 2-year survival was 67% and 42% respectively. 1-, 2-, and 3-year survival for patients with T-cell lymphoma was 67%, 46% and 37% respectively. The difference in survival between low-, intermediate- and high-grade B-cell lymphoma was statistically significant (p = 0.0018 using the log rank test), but that between B- and T-cell lymphoma was not. Using the Cox regression model, International prognostic index, grade and extranodal disease were found to be statistically significant predictors of survival (p = 0.0001, p = 0.0157, p = 0.0343) respectively.

Adolescent↗
PubMed1998

Characteristics and prognosis of KI-1 positive anaplastic large cell lymphoma in Asians.

BACKGROUND: Ki-1 positive anaplastic large cell lymphoma is a rare type of non-Hodgkin's lymphoma (NHL), and has not been extensively described in Asian patients. AIM: To evaluate the clinical characteristics, prognostic factors and treatment outcome of Ki-1 positive lymphoma in an Asian community. METHODS: A retrospective analysis of all patients with CD30 antigen positive anaplastic large cell lymphoma from 1987 to 1996 in a single institution. RESULTS: Of 218 patients with NHL, ten (5%) were identified with Ki-1 positive anaplastic large cell lymphoma. Eight were Chinese, two Indians. The male:female ratio was 1.5:1, and the median age was 32 years. Seven patients presented with B-symptoms, and five had stage III/IV disease. The majority (seven of ten) was low- or low-intermediate risk according to the International Prognostic Index (IPI). Four out of five cases immunophenotyped showed a T-cell origin. Five out of eight patients who received first-line combination chemotherapy achieved a complete remission. Two relapsed, with one being re-induced into a durable second remission. One patient with recurrent cutaneous lymphoma received solely radiotherapy and was disease-free at 20+ years from diagnosis. At analysis, two patients had died, five were disease-free at four, 27, 78, 89 months and 20 years respectively, and three were alive with disease. The IPI appears to have prognostic significance. CONCLUSION: Incidence and clinical characteristics in our Asian patients were similar to those described in Western populations. The IPI appears to have prognostic relevance. In approximately one-third of patients, long term survival can be achieved with standard treatment.

Adolescent↗
PubMed1998

L-asparaginase induced intracranial haemorrhage in acute lymphoblastic leukemia.

A 20-year-old national serviceman with acute lymphoblastic leukaemia, developed a large left parieto-occipital haemorrhage 7 days after completion of induction chemotherapy. Severe hypofibrinogenemia had been noted while he was receiving L-asparaginase. The haemorrhage could not be attributed to thrombocytopenia, disseminated intravascular coagulopathy, arterio-venous malformation, berry aneurysm or leukaemic infiltration because each of these causes was carefully investigated into and excluded. We conclude that the intracranial haemorrhage was likely L-asparaginase induced, an uncommon but recognised complication associated with L-asparaginase therapy.

Adult↗
PubMed1996

Wilson's disease presenting as haemolytic anaemia and its successful treatment with penicillamine and zinc.

Haemolysis is an uncommon first manifestation of Wilson's disease. We describe a young woman who presented with episodic haemolysis and abnormal liver functions; the diagnosis of Wilson's disease was not made until nine months later. She responded well to a combination of penicillamine and zinc. This report underscores the importance of considering Wilson's disease as a cause in a patient with haemolysis of uncertain aetiology, since the disease can be successfully treated in the early stages. the mechanism of oxidative damage to erythrocytes by the excessive copper and the present role of zinc therapy are also discussed.

Adult↗
PubMed1995

Tuberculosis and invasive pulmonary aspergillosis in a young woman with a myelodysplastic syndrome.

A 29-year-old Chinese woman developed pyrexia, multiple skin abscesses and bilateral fine nodular lung infiltrates about 3 months after the commencement of therapy for idiopathic thrombocytopenic purpura (ITP). Pseudomonas aeroginosa was isolated from the abscesses but multiple blood and sputum cultures, as well as a broncho-alveolar lavage did not yield any microorganisms. The persistence of fever and pulmonary infiltrates warranted an open lung biopsy which provided a definitive diagnosis of tuberculous-aspergillus granulomatous lung disease. Bone marrow re-examination revised the primary haematological disorder to that of a trisomy 8 associated myelodysplastic syndrome.

Adult↗
PubMed1995

Treatment of acute promyelocytic leukaemia in first relapse with all-trans retinoic acid.

A 27-year-old Chinese woman with acute promyelocytic leukaemia in first relapse after the initial conventional induction chemotherapy 18 months earlier was treated with all-trans retinoic acid (ATRA) at an initial dose of 45 mg/m2 and subsequently increased to 65 mg/m2 on day 15. Complete remission was achieved after a total of 40 days of ATRA alone. Serial marrow examinations during induction showed progressive maturation of myelopoiesis without bone marrow hypoplasia. There was a significant reduction in number of cells with the t(15;17) translocation when complete remission was achieved. ATRA was very well-tolerated. The symptoms of dry skin and intermittent headache were self-limiting.

Adult↗
PubMed1995

Adult idiopathic thrombocytopenic purpura (ITP)--a prospective tracking of its natural history.

Thirty-seven Asian patients (30 women, 7 men) with chronic idiopathic thrombocytopenic purpura (ITP) followed prospectively for 4 to 15 years showed a highly variable clinical course. The women as a group had a much lower initial platelet count than the men (28 x 10(9)/l versus 54 x 10(9)/l). All the women but only 2 men required treatment for symptomatic thrombocytopenia. Six women developed secondary autoimmune disorders (4 systemic lupus erythematosus and 2 Evan's syndrome) after 14 to 33 months of clinical follow up. Although their responses to corticosteroid therapy were suboptimal when initiated for ITP, these 6 patients uniformly demonstrated a complete platelet response when corticosteroid treatment was re-introduced following the evolution of secondary autoimmune disorders. Four of the 5 untreated men were over 55 years of age. Their mild to moderate thrombocytopenia was discovered incidentally and they remained symptom-free after a follow up of at least 5 years. The overall response rates of this cohort of Asian patients to corticosteroid therapy and splenectomy are compared with those reported from the West. Three deaths are recorded in this study, one from intracranial haemorrhage and 2 gram negative septicaemia in steroid-dependent postsplenectomy patients. The variable behaviour of this cohort of ITP patients emphasises the need for individualised management. Asymptomatic thrombocytopenia can be observed without treatment. Two fatalities from gram negative septicaemia in asplenic, steroid-dependent patients caution against the hasty recommendation of splenectomy for refractory ITP.

Adult↗
PubMed1994

Multiple myeloma: the National University Hospital (NUH) experience.

The aim of this retrospective study was to define the characteristics of local patients with multiple myeloma. Twenty-nine de novo cases were accrued from October 1986 to January 1992 at the National University Hospital of Singapore. Features like median age of presentation, sex distribution, the incidence of IgG, IgA and light chain subtypes were similar to published data. However IgD myeloma appeared to be more common here and it tended to be more advanced at presentation. Objective response rate to treatment with the melphalan-prednisolone combination was about 40% with a median survival of 18 months.

Adult↗
PubMed1993

Hepatic candidiasis: persistent pyrexia in a patient with acute myeloid leukaemia after recovery from consolidation therapy-induced neutropenia.

Fever, a frequent manifestation in acute leukaemia patients who develop treatment-induced neutropenia, usually resolves when the neutrophil count returns to normal irrespective of whether an infective agent is isolated or not. A persistent pyrexia following neutrophil recovery and associated with multiple negative microbiological cultures should signal a careful search for a deep-seated fungal infection in any leukaemic patient who is complete remission. We report here a 39-year-old Chinese man with acute myeloid leukaemia in first complete remission whose unresolved fever after recovery from consolidation therapy-induced neutropenia was ultimately confirmed to be caused by focal hepatic candidal microabscesses by an open liver biopsy.

Adult↗
PubMed1992

Acute deep vein thrombosis in hospital practice.

A recent cross sectional study on symptomatic acute deep vein thrombosis at the National University Hospital (NUH) in Singapore found a frequency rate of 0.79 per 1000 patient admissions. A total of 39 patients were accrued over 18 months, 36 with deep vein thrombosis alone and three complicated by pulmonary embolism. No sex or ethnic predilection was observed in this cohort of hospitalised patients. Twenty-eight (71.8%) patients were 40 years or older. Majority (89.7%) of patients had at least two predisposing factors. While prolonged bedrest and operative procedures featured equally frequently in patients above and below 40 years, neoplasms were predominantly associated with the former and protein C or S deficiency primarily with the latter. The exhaustive laboratory confirmation of an inherent thrombotic tendency is recommended only for patients below 40 years of age.

Acute Disease↗
PubMed1992

Severe myelodysplasia with monosomies 5 and 7 presenting with rapidly fatal Sweet's syndrome.

A 57 year-old Chinese man with anaemia and thrombocytopenia due to monosomies 5 and 7-associated myelodysplasia developed progressive Sweet's syndrome. Recurrent episodes of cutaneous manifestations responded dramatically to corticosteroid therapy. However, progressive pulmonary infiltrates unresponsive to antimicrobial therapy resulted in respiratory failure and death.

Adrenal Cortex Hormones↗
PubMed1991

Case report: Tuberculous hepatic and splenic abscess.

Tuberculous abscess of the liver is rare and delay in diagnosis is common. The case of a 66-year-old Singaporean Chinese female with tuberculous liver abscess is reported. The abscess had an unusual septated ('honeycomb-like') ultrasonographic and computed tomographic appearance and the diagnosis was made with difficulty from material aspirated from the hepatic lesion.

Abscess↗
PubMed1991

HTLV-1 associated T cell lymphoma in South East Asia: case report and family study.

Geographic clustering of human T cell lymphoma/leukaemia virus type 1 (HTLV-1) infection is well recognised, particularly in south western Japan, parts of West and Central Africa, the south eastern United States and the Caribbean islands. Sporadic cases have been reported in many other parts of the world. The first case of HTLV-1 associated leukaemia/lymphoma (ATLL) in South East Asia is reported. Contact tracing showed a high incidence of carriers among the relatives.

Carrier State↗
PubMed1991

A non-fatal case report of acute fatty liver of pregnancy.

Acute fatty liver of pregnancy (AFLP) is a potentially fatal disorder that typically complicates the third trimester of pregnancy. Unrecognised, acute fatty liver of pregnancy may rapidly progress to fulminant hepatic failure, disseminated intravascular coagulation, acute renal failure and death. The outcome is highly favourable, with complete hepatic recovery, if the diagnosis is made early and pregnancy terminated promptly. The diagnostic criteria of AFLP are met if third trimester jaundice is associated with hyperuricaemia, the presence of nucleated red blood cells in the peripheral blood film and hepatic attenuation values consistent with fatty infiltration by at least one imaging technique. We report here a 38 year old Chinese woman with acute fatty liver of pregnancy, a non-fatal case complicated by extrahepatic manifestations of disseminated intravascular coagulation, haemorrhage and renal dysfunction.

Acute Disease↗