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Tsai WH, Chien MN, Dai SH, Chan YK. Acromegaly with initial negative oral glucose tolerance test: a case report. J Med Case Rep 2023; 17:333. [PMID: 37543629 PMCID: PMC10404368 DOI: 10.1186/s13256-023-04064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/03/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Acromegaly can be diagnosed by a growth hormone value ≥ 1 µg/L following an oral glucose tolerance test. However, normal growth hormone suppression following oral glucose tolerance test may not exclude acromegaly. CASE PRESENTATION We present a case of a 55-year-old Chinese man with pituitary macroadenoma incidentally noted after a traffic accident. He reported feet enlargement in the past few years. At the beginning, elevated insulin-like growth factor-1 was noted with growth hormone value < 1 µg/L after oral glucose tolerance test. Fracture-related high insulin-like growth factor-1 was suspected. Insulin-like growth factor-1 decreased gradually but was still above the upper limit of normal . However, he suffered from dizziness 1 year later and insulin-like growth factor-1 increased again. Besides, secondary hypocortisolism developed. The size of the pituitary macroadenoma was stationary. Follow-up oral glucose tolerance test showed a growth hormone value > 1 µg/L. Endoscopic endonasal approach to the remove pituitary macroadenoma was performed subsequently. After the resection of the pituitary macroadenoma, pathology showed positive staining of growth hormone and prolactin. Insulin-like growth factor-1 normalized as well. CONCLUSIONS Suppressed growth hormone after oral glucose tolerance test cannot exclude acromegaly, and some patients may have only mild or no clinical presentation of acromegaly. Patients with pituitary microadenoma or macroadenoma and elevated insulin-like growth factor-1 should be closely monitored for signs/symptoms of acromegaly and hypopituitarism.
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Affiliation(s)
- Wen-Hsuan Tsai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Ming-Nan Chien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Shuen-Han Dai
- Department of Pathology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Yun-Kai Chan
- Division of Neurosurgery, Department of Surgery, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC.
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Fedoruk KA, Chan YK, Williams CE. Scholarship in anesthesiology: the role of critical appraisal, literature review, quality improvement, journal club, and presentation skills. Int J Obstet Anesth 2023; 54:103639. [PMID: 36841065 DOI: 10.1016/j.ijoa.2023.103639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/27/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
If asked to describe the term "anesthesiologist scholar", one may receive a variety of definitions depending on the individual's area of practice, location in the world, and the generation in which they trained. In this article, we review the roles of five core elements that make an anesthesiologist a "scholar": skills in critical appraisal, literature review, quality improvement, journal club participation, and presentation delivery. Although this list of scholarly components is not comprehensive, review of each element's role in the everyday practice and training of physicians will offer insight into their evolution and may offer a glimpse into the future of anesthesiologist scholars. Overall, through the dissemination, recognition, and support of scholarship through these practices, we will continue to achieve meaningful outcomes for our patients and promote a culture of collaboration worldwide. We should ensure that these topic areas become a bedrock of medical education globally, and we must foster opportunities for those who have already completed training to develop and master these skills as a part of their clinical and academic practice.
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Affiliation(s)
- K A Fedoruk
- Center for Academic Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Y K Chan
- Department of Anaesthesiology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - C E Williams
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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Hsu PY, Hsieh LC, Wang YH, Chen SJ, Chan YK, Shen KH, Wang YP. Olfactory Outcomes After Middle Turbinate Resection in Endoscopic Transsphenoidal Surgery: A Prospective Randomized Study. Otolaryngol Head Neck Surg 2022; 167:964-970. [PMID: 35316101 DOI: 10.1177/01945998221086202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Endoscopic endonasal transsphenoidal surgery is safe and effective for sellar and parasellar tumor removal. Partial middle turbinate (MT) resection is sometimes performed to optimize the surgical field and facilitate postoperative care. Disturbances in olfaction are concerning because of the lack of randomized studies in this field. STUDY DESIGN Prospective randomized trial. SETTING Single academic medical center. METHODS We resected the lower halves of bilateral MTs in the resected group and laterally fractured bilateral MTs in the preserved group. Olfactory outcomes and sinonasal conditions were assessed by using the validated Taiwan Smell Identification Test and Lund-Kennedy Endoscopy Score, respectively. Forty-nine patients were enrolled in the final analysis, of whom 23 underwent partial MT resection. RESULTS The average Taiwan Smell Identification Test result was 36.9 one month after surgery, with a significant change of -4.4 ± 3.1 (mean ± SD; P < .01) from baseline. The impact was not significant at 3 months (-2.1 ± 2.6, P = .13) or 6 months (0.3 ± 2.0, P = .79). Between the MT resection and preservation groups, there were no significant differences at postoperative 1 month (P = .60), 3 months (P = .86), and 6 months (P > .99). Lund-Kennedy Endoscopy Score was still higher at 3 months (P = .006) after surgery but returned to the preoperative level at 6 months (P = .63). CONCLUSIONS Endoscopic endonasal transsphenoidal surgery may affect olfaction at 1 month after surgery, and olfactory function is expected to return after 3 months. Partial MT resection did not result in additional olfactory loss. It is safe to perform partial MT resection during surgery without compromising the olfactory outcomes.
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Affiliation(s)
- Pei-Yuan Hsu
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei.,School of Medicine, Mackay Medical College, New Taipei City.,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City
| | - Yu-Hsuan Wang
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Shiu-Jau Chen
- School of Medicine, Mackay Medical College, New Taipei City.,Department of Neurosurgery, Mackay Memorial Hospital, Taipei
| | - Yun-Kai Chan
- Department of Neurosurgery, Mackay Memorial Hospital, Taipei
| | - Kuang-Hsuan Shen
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Ying-Piao Wang
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei.,School of Medicine, Mackay Medical College, New Taipei City.,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City
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Jiang JY, Leu YS, Wang YP, Chan YK, Chen TY. A Giant Schwannoma Extending from Medial Portion of Middle Cranial Fossa to Parapharyngeal Space and Deep Parotid Space. Ear Nose Throat J 2022:1455613221086031. [PMID: 35349782 DOI: 10.1177/01455613221086031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Trigeminal schwannomas are rare tumours comprising 0.2% of all intracranial tumours and 0.5% of all head and neck tumours. Patients with trigeminal schwannomas presented with facial hypoesthesia and pain. We presented a case with left bulging oropharynx. The CT scan showed a 3.8x2.6x4.9cm left parapharyngeal tumour compressed to the oropharynx and middle cranial fossa. We performed 3 ways in two times of operation to excise the whole tumour. We chose the transoral approach for parapharyngeal space, trans-parotid approach for deep parotid part and the endoscopic endonasal trans-pterygoid approach and trans-maxillary with Canine fossa trephination for intracranial lesions. The pathology showed schwannoma. A huge schwannoma extended from intracranial to several spaces is difficult to resect just by one approach. We should separate the tumour to several parts by clinical image before the operation and design a plan to remove the whole tumour in different approach. The different space of tumour involvement had several ways to access. We needed to choose the less harm but with better surgical field.
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Affiliation(s)
- Jing-Yi Jiang
- Department of Otolaryngology-Head and Neck Surgery, 36897MacKay Memorial Hospital, Taiwan
| | - Yi-Shing Leu
- Department of Otolaryngology-Head and Neck Surgery, 36897MacKay Memorial Hospital, Taiwan
| | - Ying-Piao Wang
- Department of Otolaryngology-Head and Neck Surgery, 36897MacKay Memorial Hospital, Taiwan
- School of Medicine, MacKay Medical College, Taiwan
| | - Yun-Kai Chan
- Division of Neurosurgery, Department of Surgery, 36897MacKay Memorial Hospital, Taiwan
| | - Tung-Ying Chen
- Department of Pathology, 36897MacKay Memorial Hospital, Taiwan
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Chan YK, Novalo Goto ES, Fachini Jardim Criado R, Criado PR. Allergic contact dermatitis by ophthalmological medications in Brazil: experience of a dermatology department. Eur Ann Allergy Clin Immunol 2021; 53:280-283. [PMID: 33728833 DOI: 10.23822/eurannaci.1764-1489.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Topical treatments in ophthalmologic therapy are significant for the development of allergic contact dermatitis (ACD) in the periorbital region. Preservatives, antibiotics, glucocorticoids, and beta-blocker eye drops are defined as drugs with the highest sensitizing potential. The unavailability of patch test batteries containing substances of ophthalmological use makes it difficult for this diagnosis. In the present report, we describe six patients who developed ACD induced by different agents presenting in eye drops, confirmed with the cutaneous patch tests. The ACD diagnosis due to ophthalmic medications can be challenging, since many different agents can cause it, and the sensitivity of these cutaneous tests is low. Thus, early diagnosis is essential to avoid the complications of ACD on the skin and ocular disorders related to chronic periorbital eczema.
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Affiliation(s)
- Y K Chan
- Department of Dermatology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - E S Novalo Goto
- Department of Dermatology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | - P R Criado
- Department of Dermatology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
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Yang JS, Liu KX, Kadimcherla P, Chu L, Deng ZL, Chan YK, Liu P, Liu TJ, Hao DJ. Can the Novel LumboIliac Triangle Technique Based on Biplane Oblique Fluoroscopy Facilitate Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Patients with L5-S1 Disc Herniation Combined with High Iliac Crest? Case-Control Study of 100 Patients. Pain Physician 2020; 23:305-314. [PMID: 32517397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) via the transforaminal approach is difficult at L5-S1 in patients presenting with high iliac crests (HIC). The conventional wisdom is that measurement using lumbar radiography, computed tomography (CT), or magnetic resonance imaging (MRI) is necessary. OBJECTIVES The objective of this study was to introduce a lumbo-iliac triangular (LI-Tri) technique based on biplane oblique fluoroscopy and verify whether it facilitated transforaminal PELD for patients with L5-S1 lumbar disc herniation (LDH) combined with HIC. STUDY DESIGN A retrospective analysis. SETTING All data were from Honghui Hospital in Xi'an. METHODS One hundred patients with L5-S1 LDH combined with HIC were treated with PELD. The LI-Tri technique was used in the first 50 patients (applied group). The other 50 patients were classified as the nonapplied group, in which the conventional technique was performed. Clinical outcome evaluation included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. The intervals of follow-up were scheduled at 1 day and 1, 3, 6, 12, and 24 months postoperatively. RESULTS No significant difference was observed with respect to demographic information (P < .05, respectively). There were 8 patients in the nonapplied group with difficult punctures. Together with the remaining 50 patients, the puncture was successful with the LI-Tri technique. The mean operative duration was shorter in the applied group (55 vs 70 min, P < .01). Compared to the preoperative data, only the back pain VAS and ODI in the nonapplied group were nonsignificantly lower at one day postoperatively (P > .05, respectively). With the exception of the back pain VAS and ODI at one day postoperatively, no significant differences were observed in the 3 parameters at other time points postoperatively between 2 groups (P > .05, respectively). LIMITATIONS The study is limited by its retrospective, nonrandomized controlled design. CONCLUSIONS For patients with L5-S1 LDH combined with HIC treated by transforaminal PELD, the LI-Tri technique is simple and effective in preoperative evaluations, locating the skin entry point and guiding the puncture trajectory. Compared to the conventional technique, it shows advantages in terms of reducing intraoperative surgical duration and promoting fast postoperative recovery. KEY WORDS Endoscopic discectomy, iliac crest, L5-S1 disc, PELD, percutaneous, transforaminal.
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Affiliation(s)
- Jun-Song Yang
- Department of Spinal Surgery Hong-Hui Hospital Xi'an Jiaotong University
| | | | | | - Lei Chu
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Zhong-Liang Deng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Yun-Kai Chan
- Division of Neurosurgery, Department of Surgery, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Peng Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Tuan-Jiang Liu
- Department of Spinal Surgery Hong-Hui Hospital Xi'an Jiaotong University
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Yang JS, Liu KX, Chu L, Chan YK, Fan H, Li XM, Liu P, Liu TJ, Hao DJ. Cocktail Treatment with a Gelatin Sponge Impregnated with Ropivacaine, Dexamethasone, and Vitamin B12 Promotes Early Postoperative Recovery after Percutaneous Endoscopic Lumbar Discectomy: A Retrospective, Case-Controlled Study. Pain Physician 2020; 23:E211-E218. [PMID: 32214306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) can only relieve mechanical compression but cannot directly reduce the inflammatory reaction of the adjacent nerve root, which contributes to persistent pain and physical disabilities postoperatively. Numerous studies have explored the application of epidural steroids after an open lumbar discectomy in relieving pain by reducing local inflammatory reactions and further peridural scar formation. OBJECTIVES To explore that whether "cocktail treatment" in which a gelatin sponge was impregnated with ropivacaine, dexamethasone, and vitamin B12 promoted early postoperative recovery after PELD. STUDY DESIGN Retrospective, case-controlled study. SETTING All data were from Hong-Hui Hospital in Xi'an. METHODS Between January 2016 and January 2017, 100 patients of single-level lumbar disc herniation were treated with PELD in our hospitals. The cocktail treatment was applied in the first 50 patients (group cocktail), and an equal size gelatin sponge without drugs was used in the other 50 patients as control (group noncocktail). The clinical outcome evaluation included the Visual Analog Scale (VAS) score for back and leg pain and Oswestry Disability Index (ODI) score. RESULTS There was a significant difference in the mean periods of return to work (4.25 ± 1.88 weeks in the cocktail group and 5.18 ± 2.19 weeks in the noncocktail group) (P < 0.01). Compared with the preoperative data, a significant improvement in VAS scores of back pain and sciatica and ODI were observed in each follow-up interval (P < 0.05, respectively). In the noncocktail group, there were visible fluctuations in the 3 indicators within the first week after surgery. This phenomenon was not observed in the cocktail group, a difference that was statistically significant (P < 0.05, respectively). In further follow-up, no significant differences were observed between the 2 groups (P > 0.05, respectively). LIMITATIONS The nonrandomized, single-center, retrospective design is a major limitation of this study. CONCLUSIONS The "cocktail treatment" with a gelatin sponge impregnated with ropivacaine, dexamethasone, and vitamin B12 promotes early and satisfactory back and leg pain relief and fast functional recovery after PELD. KEY WORDS Endoscopic lumbar discectomy, lumbar disc herniation, steroids, nerve root block, gelatin sponge.
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Affiliation(s)
- Jun-Song Yang
- Department of Spinal Surgery Hong-Hui Hospital Xi'an Jiaotong University
| | | | - Lei Chu
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Yun-Kai Chan
- Division of Neurosurgery, Department of Surgery, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Hong Fan
- Department of Spine Surgery Honghui Hospital Xi'an Jiaotong University
| | - Xuan-Ming Li
- Department of Orthopaedics, Dazhu County People's Hospital, Dazhou, Sichuan, China
| | - Peng Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Tuan-Jiang Liu
- Department of Spinal Surgery Hong-Hui Hospital Xi'an Jiaotong University
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Goh PK, Chiu CL, Wang CY, Chan YK, Loo PL. Randomized Double-blind Comparison of Ketamine-Propofol, Fentanyl-Propofol and Propofol-Saline on Haemodynamics and Laryngeal Mask Airway Insertion Conditions. Anaesth Intensive Care 2019; 33:223-8. [PMID: 15960405 DOI: 10.1177/0310057x0503300211] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg.kg-1 (n=30), fentanyl 1 μg.kg-1 (n=30) or normal saline (n=30), before induction of anaesthesia with propofol 2.5 mg.kg-1. Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P=0.010) or saline (P=0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0–8.0)] and fentanyl groups [median 7.0, interquartile range (6.0–8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75–9.25); P=0.024]. The incidence of prolonged apnoea (>120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg.kg–1 improves haemo-dynamics when compared to fentanyl 1 μg.kg–1, with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).
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Affiliation(s)
- P K Goh
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Ortolani O, Conti A, Chan YK, Sie MY, Ong GSY. Comparison of Propofol Consumption and Recovery Time in Caucasians from Italy, with Chinese, Malays and Indians from Malaysia. Anaesth Intensive Care 2019; 32:250-5. [PMID: 15957725 DOI: 10.1177/0310057x0403200215] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Differences in sensitivity to anaesthetic drugs may exist among different ethnic groups. Allelic variants for drug metabolizing isoenzymes and pharmacokinetic differences may account for a variable response to some anaesthetic drugs. This study was designed to compare propofol consumption and recovery characteristics in four ethnic groups: Chinese, Malays, and Indians in Malaysia and Caucasians in Italy. Patients undergoing total intravenous anaesthesia with propofol and fentanyl were evaluated for propofol consumption and recovery time. The Bispectral Index (BIS) was used to maintain the same anaesthesia depth in all patients. The BIS value, the response to verbal stimuli and eye-opening time were used to assess recovery. After propofol discontinuation the BIS values returned to baseline in 11±4.2 min for Caucasians, in 12.5±5.1 min for Chinese, 15.9±6.3 min for Malays and 22.1±8.1 for Indians. Time to eye-opening was 11.63±4.2 min in Caucasians, 13.23±4.9 min in Chinese, 16.97±5.2 min in Malays and 22.3±6.6 min in Indians. The propofol consumption was significantly lower in Indians compared to the other three groups (P<0.01). The recovery of Indians was much slower compared to Chinese, Malays and Caucasians. The recovery time of Malays is significantly slower compared to Chinese and Caucasians. Differences in propofol consumption and recovery time were not significant between Chinese and Caucasians, but the ratio recovery time/propofol consumption was significantly lower in Caucasians compared to all the other groups.
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Affiliation(s)
- O Ortolani
- University of Florence, Dipartimento di Area Critica Medico Chirurgica, Sezione di Anestesia e Rianimazione, Unita 'Anestesia e Rianimazione Sperimentali, University of Naples "Federico II", Naples, Italy
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Chan YK, Wong WY. [Robotic head and neck surgery at the Chinese University of Hong Kong]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:1056-1060. [PMID: 30550146 DOI: 10.13201/j.issn.1001-1781.2018.14.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Indexed: 11/12/2022]
Abstract
Introduction:Robotic surgery in the head and neck region has been used to approach many different areas within the head and neck region. Here we describe our experiences of its application at The Chinese University of Hong Kong.Methods:This is a retrospective review of all cases operated by the two authors since Jan 2015 at the Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong.Results:Twenty-four cases were performed with the da Vinci S or da Vinci Xi systems. Twenty-one cases were performed with the novel flexible robotic da Vinci SP system. There were no serious adverse events requiring a return to the operating room. Early results from the da Vinci SP have been previously published in seven patients that demonstrated the ability to reach the nasopharynx, oropharynx, hypopharynx, larynx and also retropharyngeal lymph nodes. There were no conversions to alternative surgical approaches. There were no serious adverse events or adverse events related to the use of this system.Discussion:In conclusion, through our experiences at The Chinese University of Hong Kong we have found the da Vinci robotic systems to be useful and safe in performing TORS and addressing pathologies in the neck through the retroauricular approach.
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Affiliation(s)
- Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery,The Chinese University of Hong Kong
| | - W Y Wong
- Department of Otorhinolaryngology, Head and Neck Surgery,The Chinese University of Hong Kong
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Scuffham PA, Ball J, Horowitz JD, Wong C, Newton PJ, Macdonald P, McVeigh J, Rischbieth A, Emanuele N, Carrington MJ, Reid CM, Chan YK, Stewart S. Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial. Eur Heart J 2018; 38:2340-2348. [PMID: 28531281 PMCID: PMC5843128 DOI: 10.1093/eurheartj/ehx259] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/27/2017] [Indexed: 12/28/2022] Open
Abstract
Aims To determine if an intensified form of heart failure management programme (INT-HF-MP) based on individual profiling is superior to standard management (SM) in reducing health care costs during 12-month follow-up (primary endpoint). Methods and results A multicentre randomized trial involving 787 patients (full analysis set) discharged from four tertiary hospitals with chronic HF who were randomized to SM (n = 391) or INT-HF-MP (n = 396). Mean age was 74 ± 12 years, 65% had HF with a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling. Study groups were well matched. According to Green, Amber, Red Delineation of rIsk And Need in HF (GARDIAN-HF) profiling, regardless of location, patients in the INT-HF-MP received a combination of face-to-face (home visits) and structured telephone support (STS); only 9% (`low risk') were designated to receive the same level of management as the SM group. The median cost in 2017 Australian dollars (A$1 equivalent to ∼EUR €0.7) of applying INT-HF-MP was significantly greater than SM ($152 vs. $121 per patient per month; P < 0.001), However, at 12 months, there was no difference in total health care costs for the INT-HF-MP vs. SM group (median $1579, IQR $644 to $3717 vs. $1450, IQR $564 to $3615 per patient per month, respectively). This reflected minimal differences in all-cause mortality (17.7% vs. 18.4%; P = 0.848) and recurrent hospital stay (18.6 ± 26.5 vs. 16.6 ± 24.8 days; P = 0.199) between the INT-HF-MP and SM groups, respectively. Conclusion During 12-months follow-up, an INT-HF-MP did not reduce healthcare costs or improve health outcomes relative to SM.
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Affiliation(s)
- P A Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, N78_2.42 The Circuit, Nathan, Queensland 4111, Australia
| | - J Ball
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - J D Horowitz
- Department of Cardiology, Queen Elizabeth Hospital, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - C Wong
- Department of Cardiology, Western Health (Footscray Hospital), Melbourne Medical School, The University of Melbourne, Grattan St, Parkville, Victoria 3010, Australia
| | - P J Newton
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, New South Wales 2007, Australia
| | - P Macdonald
- Heart Failure and Transplant Unit, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW 2010, Australia
| | - J McVeigh
- Department of Cardiology, Prince of Wales Hospital, Barker St, Randwick, NSW 2031, Australia
| | - A Rischbieth
- National Heart Foundation of Australia, 500 Collins St Melbourne, Victoria 3000, Australia.,Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - N Emanuele
- National Heart Foundation of Australia, 500 Collins St Melbourne, Victoria 3000, Australia
| | - M J Carrington
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Mary MacKillop Institute for Health Research, NHMRC of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
| | - C M Reid
- NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Kent St, Bentley, Western Australia 6102, Australia
| | - Y K Chan
- Mary MacKillop Institute for Health Research, NHMRC of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
| | - S Stewart
- Mary MacKillop Institute for Health Research, NHMRC of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
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Wong D, Chan YK, Bek T, Wilson I, Stefánsson E. Intraocular currents, Bernoulli's principle and non-drainage scleral buckling for rhegmatogenous retinal detachment. Eye (Lond) 2018; 32:213-221. [PMID: 29350687 DOI: 10.1038/eye.2017.312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 11/09/2022] Open
Abstract
For many years, it is not fully understood how non-drainage scleral buckling surgery brings about spontaneous reattachment of the detached retina when retinal breaks remain open at the end of surgery. Various explanations have been put forward, but none more interesting than the effect of fluid currents associated with eye movements. One such explanation involved the physics of the Bernoulli's principle. Daniel Bernoulli was an eighteenth century Swiss mathematician and he described an equation based on the conservation of energy. The sum of pressure energy, potential energy and kinetic energy remains constant. Bernoulli's equation usually applies to closed system such as the flow of fluid through pipes. When fluid flows through a constriction, the speed of fluid increases, the kinetic energy increases. If there was no change in elevation (potential energy), then the increase in kinetic energy must be accompanied by a decrease in pressure energy. In ophthalmic surgery, the Bernoulli's effect is the basis for venturi pumps that drive vitrectomy and phacoemulsification machines. This essay expounds on how Bernoulli's effect might be relevant to scleral buckling for retinal detachment repair. In the era when vitrectomy is increasing the primary surgical operation for retinal detachment, the pervasive advice is to emphasise the importance of patient adopting head posture and remaining still postoperatively. The exception is non-drainage scleral buckling surgery. Early postoperative mobilisation may be vital to achieve reattachment.
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Affiliation(s)
- D Wong
- Royal Liverpool University Hospital, Liverpool, UK
| | - Y K Chan
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong SAR, China
| | - T Bek
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - I Wilson
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - E Stefánsson
- Landspitali University hospital, University of Iceland, Reykjavík, Iceland
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Stefánsson E, Chan YK, Bek T, Hardarson SH, Wong D, Wilson DI. Laws of physics help explain capillary non-perfusion in diabetic retinopathy. Eye (Lond) 2018; 32:210-212. [PMID: 29350688 DOI: 10.1038/eye.2017.313] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/03/2017] [Indexed: 01/09/2023] Open
Abstract
The purpose is to use laws of physics to elucidate the mechanisms behind capillary non-perfusion in diabetic retinopathy. In diabetic retinopathy, loss of pericytes weakens capillary walls and the vessel dilates. A dilated capillary has reduced resistance to flow, therefore increased flow in that vessel and decreased in adjoining capillaries. A preferential shunt vessel is thus formed from the dilated capillary and the adjacent capillaries become non-perfused. We apply the laws of Laplace and Hagen-Poiseuille to better understand the phenomena that lead to capillary non-perfusion. These laws of physics can give a foundation for physical or mathematical models to further elucidate this field of study. The law of Laplace predicts that a weaker vessel wall will dilate, assuming constant transmural pressure. The Hagen-Poiseuille equation for flow and the Ostwald-de Waele relationship for viscosity predict that a dilated vessel will receive a higher portion of the fluid flow than the adjoining capillaries. Viscosity will decrease in the dilated vessel, furthering the imbalance and resulting in a patch of non-perfused capillaries next to the dilated 'preferential' shunt vessel. Physical principles support or inspire novel hypotheses to explain poorly understood phenomena in ophthalmology. This thesis of pericyte death and capillary remodelling, which was first proposed by Cogan and Kuwabara, already agrees with histological and angiographical observations in diabetic retinopathy. We have shown that it is also supported by classical laws of physics.
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Affiliation(s)
- E Stefánsson
- Landspitali University Hospital, University of Iceland, Reykjavík, Iceland
| | - Y K Chan
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong SAR, China
| | - T Bek
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S H Hardarson
- Institue of Physiology, University of Iceland, Reykjavik, Iceland
| | - D Wong
- Royal Liverpool University Hospital, Liverpool, UK
| | - D I Wilson
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
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Chan YK, Budgett SC, MacGibbon AK, Quek SY, Kindleysides S, Poppitt SD. Small particle size lipid emulsions, satiety and energy intake in lean men. Physiol Behav 2016; 169:98-105. [PMID: 27890592 DOI: 10.1016/j.physbeh.2016.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/26/2016] [Accepted: 11/19/2016] [Indexed: 01/17/2023]
Abstract
Lipid emulsions have been proposed to suppress hunger and food intake. Whilst there is no consensus on optimal structural properties or mechanism of action, small particle size (small-PS) stable emulsions may have greatest efficacy. Fabuless®, a commercial lipid emulsion reported in some studies to decrease energy intake (EI), is a small-PS, 'hard' fat emulsion comprising highly saturated palm oil base (PS, 82nm). To determine whether small-PS dairy lipid emulsions can enhance satiety, firstly, we investigated 2 'soft' fat dairy emulsions generated using dairy and soy emulsifying agents (PS, 114nm and 121nm) and a non-emulsified dairy control. Secondly, we investigated a small-PS palmolein based 'hard' fat emulsion (fractionated palm oil, PS, 104nm) and non-emulsified control. This was a 6 arm, randomized, cross-over study in 18 lean men, with test lipids delivered in a breakfast meal: (i) Fabuless® emulsion (FEM); (ii) dairy emulsion with dairy emulsifier (DEDE); (iii) dairy emulsion with soy lecithin emulsifier (DESE); (iv) dairy control (DCON); (v) palmolein emulsion with dairy emulsifier (PEDE); (vi) palmolein control (PCON). Participants rated postprandial appetite sensations using visual analogue scales (VAS), and ad libitum energy intake (EI) was measured at a lunch meal 3.5h later. Dairy lipid emulsions did not significantly alter satiety ratings or change EI relative to dairy control (DEDE, 4035kJ; DESE, 3904kJ; DCON, 3985kJ; P>0.05) nor did palm oil based emulsion relative to non-emulsified control (PEDE, 3902 kJ; PCON, 3973kJ; P>0.05). There was no evidence that small-PS dairy lipid emulsions or commercial Fabuless altered short-term appetite or food intake in lean adults.
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Affiliation(s)
- Y K Chan
- Human Nutrition Unit, University of Auckland, Auckland, New Zealand; School of Biological Sciences, University of Auckland, Auckland, New Zealand.
| | - S C Budgett
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - A K MacGibbon
- Fonterra Research and Development Centre, Palmerston North, New Zealand
| | - S Y Quek
- Department of Food Science, University of Auckland, Auckland, New Zealand
| | - S Kindleysides
- Human Nutrition Unit, University of Auckland, Auckland, New Zealand
| | - S D Poppitt
- Human Nutrition Unit, University of Auckland, Auckland, New Zealand; School of Biological Sciences, University of Auckland, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
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Affiliation(s)
- M Y Cheung
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - C L Lai
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Wilson H Y Lam
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - James S K Lau
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Aaron K H Lee
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - G G Yuen
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Y K Chan
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - W L Tsang
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Shrestha S, Chan YK, Razali FN. Anesthetic Management for a Parturient with Facioscapulohumeral Muscular Dystrophy Undergoing Caesarean Section. Nepal j obstet gynaecol 2016. [DOI: 10.3126/njog.v10i2.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant muscle disorder characterized by progressive weakness and wasting of facial, shoulder girdle and upper arm muscles. Anesthetic management for the parturient with muscular dystrophy is very challenging for anesthesiologists because general as well as regional anesthesia may cause deleterious effect to the patient. We report a case of 28 years parturient with Facioscapulohumeral muscular dystrophy that underwent elective caesarean section under combined spinal epidural anesthesia. Intraoperative and postoperative period were uneventful however the motor block was prolonged. Regional anesthesia especially combined spinal epidural anesthesia can be safely used to provide anesthesia for caesarean section in patients with muscular dystrophy.
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Jorstad HT, Chan YK, Scholte op Reimer WJM, Doornenbal J, Tijssen JGP, Peters RJG. Nurses' perspectives on nurse-coordinated prevention programmes in secondary prevention of cardiovascular disease: a pilot survey. Contemp Nurse 2015; 51:96-106. [PMID: 26572788 PMCID: PMC4784499 DOI: 10.1080/10376178.2015.1119032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Secondary prevention of coronary artery disease (CAD) is increasingly provided by nurse-coordinated prevention programs (NCPP). Little is known about nurses’ perspectives on these programs. Aim: To investigate nurses’ perspectives/experiences in NCPPs in acute coronary syndrome patients. Methods: Thirteen nurses from NCPPs in 11 medical centers in the RESPONSE trial completed an online survey containing 45 items evaluating 3 outcome categories: (1) conducting NCPP visits; (2) effects of NCPP interventions on risk profiles and (3) process of care. Results: Nurses felt confident in counseling/motivating patients to reduce CAD risk. Interventions targeting LDL, blood pressure and medication adherence were reported as successful, corresponding with significant improvements of these risk factors. Improving weight, smoking and physical activity was reported as less effective. Screening for anxiety/depression was suggested as an improvement. Conclusions: Nurses acknowledge the importance and effectiveness of NCPPs, and correctly identify which components of the program are the most successful. Our study provides a basis for implementation and quality improvement for NCCPs.
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Affiliation(s)
- H T Jorstad
- a Department of Cardiology , Academic Medical Center - University of Amsterdam , Meibergdreef 9, 1100 DE Amsterdam , The Netherlands
| | - Y K Chan
- a Department of Cardiology , Academic Medical Center - University of Amsterdam , Meibergdreef 9, 1100 DE Amsterdam , The Netherlands
| | - W J M Scholte op Reimer
- b Amsterdam University of Applied Sciences , Nicolaes Tulphuis, Tafelbergweg 51, 1105 BD Amsterdam , The Netherlands
| | - J Doornenbal
- a Department of Cardiology , Academic Medical Center - University of Amsterdam , Meibergdreef 9, 1100 DE Amsterdam , The Netherlands
| | - J G P Tijssen
- a Department of Cardiology , Academic Medical Center - University of Amsterdam , Meibergdreef 9, 1100 DE Amsterdam , The Netherlands
| | - R J G Peters
- a Department of Cardiology , Academic Medical Center - University of Amsterdam , Meibergdreef 9, 1100 DE Amsterdam , The Netherlands
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Abstract
A macrocephalic girl presented with generalised epilepsy due to focal cortical dysplasia. She later developed multiple hamartomatous lesions and was diagnosed to have Cowden syndrome. The diagnosis was confirmed by identification of a novel frameshift mutation in the PTEN gene of the patient.
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Affiliation(s)
- K M Cheung
- Department of Paediatrics, Caritas Medical Centre, Shamshuipo, Hong Kong
| | - C W Lam
- Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Y K Chan
- Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Hong Kong
| | - W K Siu
- Kowloon West Cluster Laboratory Genetic Service, Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - L Yong
- Department of Surgery, Caritas Medical Centre, Shamshuipo, Hong Kong
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Vaithilingam RD, Safii SH, Baharuddin NA, Karen-Ng LP, Saub R, Ariffin F, Ramli H, Sharifuddin A, Hidayat MFH, Raman R, Chan YK, Rani NA, Rahim RA, Shahruddin N, Cheong SC, Bartold PM, Zain RB. Establishing and managing a periodontal biobank for research: the sharing of experience. Oral Dis 2014; 21:e62-9. [PMID: 24930489 DOI: 10.1111/odi.12267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/12/2014] [Accepted: 06/08/2014] [Indexed: 12/30/2022]
Abstract
Periodontal bio-repositories, which allow banking of clinically validated human data and biological samples, provide an opportunity to derive biomarkers for periodontal diagnosis, prognosis and therapeutic activities which are expected to improve patient management. This article presents the establishing of the Malaysian Periodontal Database and Biobank System (MPDBS) which was initiated in 2011 with the aim to facilitate periodontal research. Partnerships were established with collaborating centres. Policies on specimen access, authorship and acknowledgement policies were agreed upon by all participating centres before the initiation of the periodontal biobank. Ethical approval for the collection of samples and data were obtained from institutional ethics review boards. A broad-based approach for informed consent was used, which covered areas related to quality of life impacts, genetics and molecular aspects of periodontal disease. Sample collection and processing was performed using a standardized protocol. Biobanking resources such as equipment and freezers were shared with the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS). In the development of the MPDBS, challenges that were previously faced by the MOCDTBS were considered. Future challenges in terms of ethical and legal issues will be faced when international collaborations necessitate the transportation of specimens across borders.
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Affiliation(s)
- R D Vaithilingam
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Shariffuddin II, Rai V, Chan YK, Muniandy RK. Safe delivery of two parturient women in severe metabolic acidosis. BMJ Case Rep 2014; 2014:bcr-2014-205135. [PMID: 24862427 DOI: 10.1136/bcr-2014-205135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Care of an acutely ill parturient is particularly difficult when we have to balance the needs of both mother and the fetus to survive. The literature suggests there should be emphasis on stabilising the mother's condition. In dealing with metabolic acidosis, however, we believe delivering the baby early might not only relieve the threat of the acidosis on the mother, it may be the only way to deliver a live baby. We report two parturient women with severe metabolic acidosis which was considerably reduced very soon after the delivery and how our timely delivery resulted in the birth of two neurologically intact babies.
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Affiliation(s)
| | - Vineya Rai
- Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Y K Chan
- Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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Hussain Khan Z, Chan YK. SAPS II, SAPS III versus markers of tissue oxygen delivery: discerning their role in predicting outcome for cardiopulmonary arrest. Minerva Anestesiol 2012; 78:1313-1315. [PMID: 23222997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Bishop FL, Rea A, Lewith H, Chan YK, Saville J, Prescott P, Elm EV, Lewith GT. Complementary medicine use by men with prostate cancer: a systematic review of prevalence studies. Prostate Cancer Prostatic Dis 2010; 14:1-13. [DOI: 10.1038/pcan.2010.38] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Sivarani S, Chan YK, Liam CK, Kumar G, Abdullah BJ, Mahadeva S. Education and Imaging. Gastrointestinal: massive intraperitoneal haemorrhage in a young woman with hereditary hemorrhagic telangiectasia. J Gastroenterol Hepatol 2010; 25:1587. [PMID: 20796159 DOI: 10.1111/j.1440-1746.2010.06469.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- S Sivarani
- Department of Medicine, Faculty of Medicine, University of Malaya Kuala Lumpur, Malaysia
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Cheung KM, Yeung YW, Chan YK, Ko CH. Comparison of oesophagogastroduodenoscopy findings and diagnostic value in neurologically impaired children and 'normal' children. Hong Kong Med J 2008; 14:465-468. [PMID: 19060346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES To review the oesophagogastroduodenoscopy findings in children with severe neurological impairment and 'normal' children, over a 7-year period from 2000 to 2007. DESIGN Retrospective study. SETTING Paediatric Unit of Caritas Medical Centre, Hong Kong. MAIN OUTCOME MEASURES The frequencies of Helicobacter pylori status, peptic ulceration, and oesophagitis were compared. The diagnostic value of oesophagogastroduodenoscopy in these two groups of children was also examined. PATIENTS Patient data were retrieved from the Hospital Authority Clinical Management system, excluding those under surgical care. The children were divided into two groups: 'normal' and neurologically impaired. Their demographic data, indications for oesophagogastroduodenoscopy, endoscopy diagnoses, and Helicobacter pylori status were compared, as was the diagnostic value of oesophagogastroduodenoscopy. RESULTS From 2000 to 2007, 223 oesophagogastroduodenoscopies were performed in 176 patients aged 3 to 22 years; 134 were performed in 'normal' children (median age, 14; range, 3-22 years) and 89 in neurologically impaired children (median age, 12; range, 3-20 years). The three most common indications in 'normal' children were: epigastric pain (60%), gastro-intestinal bleeding (13%), and vomiting (7%). In neurologically impaired children, they were gastro-intestinal bleeding (51%), assessment for percutaneous endoscopic gastrostomy (27%), and follow-up for previous lesions (9%). Among 'normal' children, 14 had duodenal ulcers (associated with Helicobacter pylori in 13), but no patients had gastric ulcers or oesophagitis. Among neurologically impaired children, one had a Helicobacter pylori-negative duodenal ulcer, and four had gastric ulcers (three were Helicobacter pylori-positive). Twenty-four neurologically impaired children had oesophagitis. Neurologically impaired children had significantly more oesophagitis and gastric ulcers (P<0.001 and P=0.004, respectively) but less duodenal ulcers (P=0.024). In 111 children who had gastric biopsies, the Helicobacter pylori infection rate was 35% (31% in 'normal' children and 43% in the neurologically impaired). The diagnostic value was 37% in 'normal' children and 81% in the neurologically impaired (P<0.001). The overall diagnostic value of oesophagogastroduodenoscopy was 50%. CONCLUSION The clinical presentation and endoscopic findings in 'normal' and neurologically impaired children were discrepant. Oesophagogastroduodenoscopy appeared to confer greater diagnostic value in neurologically impaired than 'normal' children. Diagnostic values in our unit were comparable to reports from western studies.
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Affiliation(s)
- K M Cheung
- Department of Paediatrics, Caritas Medical Centre, Shamshuipo, Kowloon, Hong Kong.
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Mak SS, Yuen ML, Li C, Chan YK, Mo KF, Lee KM, Chan SJ. Exploratory Analysis of the Bacteriological Status of Post-irradiation Wounds and Its Relationship to Healing. Clin Oncol (R Coll Radiol) 2006; 18:519-24. [PMID: 16969981 DOI: 10.1016/j.clon.2006.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIMS To investigate the bacteriological status of post-irradiation wounds and its relationship to wound healing in patients with nasopharyngeal cancer. MATERIALS AND METHODS One hundred and forty-six nasopharyngeal cancer patients with post-irradiation wounds on one or both sides of the neck were studied prospectively. Swabs were taken from the wounds at the initial study visit for bacteriological examination. A further swab for culture was taken when possible signs of infection developed. Wound healing was assessed on alternate days with respect to wound condition, the presence of clinical infection and healing time. RESULTS The results showed that most of the post-irradiation wounds were colonised with bacteria. This was not associated with clinical signs of infection in any instance. There was no association between wound healing time and the presence of organisms, the identity of organisms, the number of species of organisms, or the use of antibiotics. CONCLUSIONS The presence of bacteria in post-irradiation wounds, in the absence of clinical signs of wound infection, is not a barrier to wound healing. Oncology practitioners should recognise the unique features of radiation-induced wounds and skin reactions with confidence and provide appropriate treatment as needed.
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Affiliation(s)
- S S Mak
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China.
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Chuah KH, Mansor M, Rajen G, Wang CY, Chan YK. Technique of anaesthesia in pulmonary hypertension and thrombophilia in early pregnancy. Med J Malaysia 2006; 61:114-6. [PMID: 16708749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Pulmonary hypertension in pregnancy is a rare condition but is associated with a high mortality. We report the case of a 29 year old female in early pregnancy with Protein C and S deficiency with recurrent deep venous thrombosis and pulmonary embolism and subsequent secondary pulmonary hypertension. The patient was counselled and consented for termination of pregnancy with tubal sterilization. She was administered continuous spinal anaesthesia with invasive monitoring. The successful anaesthetic management of this condition is described.
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Affiliation(s)
- K H Chuah
- Department of Anaesthesiology, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur 59100, Kuala Lumpur
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27
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Lo WYF, Li JYW, Chan YK, Lai LSW, Yeung YW, Lo STH, Tsui WMS, Ng CS. Instability of clonality in gastric lymphoid infiltrates: a study with emphasis on serial biopsies. Am J Surg Pathol 2006; 29:1582-92. [PMID: 16327430 DOI: 10.1097/01.pas.0000188031.40836.00] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The evolution of low-grade B-cell mucosa-associated lymphoid-tissue (MALT) lymphoma of the stomach is a multistage process, reflected in the histologic continuum from Helicobacter pylori-chronic gastritis, to low-grade and high-grade lymphoma. Interestingly, in daily gastric biopsy sign-out, the authors observed that some biopsies showed monoclonality on polymerase chain reaction (PCR) even though there were no definite histologic features of malignancy and vice versa. To address the question, the authors studied the endoscopic gastric biopsies at first presentation of 46 patients to examine any clonality differences among various histologic patterns within the spectrum of MALT lymphoma evolution. The gastric biopsies were reviewed histologically and graded according to the Wotherspoon-Isaacson histologic scoring system from grade 0 (normal) to grade 5 (MALT lymphoma). The clonality of cases in each grade was determined by performing nested PCR for immunoglobulin heavy chain (IgH) gene rearrangement using FR2/JH and FR3/JH primer sets. The monoclonality rates among different grades were as follows: grade 2, 6.3% (1 of 16); grade 3, 27.3% (3 of 11); grade 4, 83.3% (5 of 6); grade 5, 69.2% (9 of 13). Statistically significant difference of monoclonality rate is demonstrated in histologic grade 4 versus grades 2 and 3, and grade 5 versus grade 2 (P < 0.05, Fisher exact test). The authors went on to examine the progress of disease by following up the clinical status, histologic changes, and clonality fluctuation of these cases. Four of the 8 patients with monoclonality on PCR, but no definite lymphoma at first presentation later progressed to frank MALT lymphoma. Our study shows that, during the progression to MALT lymphoma, there is an instability of clonality. Clonality can fluctuate between polyclonality, oligoclonality, and monoclonality, none of which defines an irreversible stage for progression to MALT lymphoma. Monoclonality is a risk factor for development of MALT lymphoma. Those cases with dense gastric mucosal lymphoid infiltrate (without definite MALT lymphoma) and monoclonality on PCR need to be closely monitored and Helicobacter infection promptly treated if present. In combination with clinicohistologic examination, PCR can serve as a complementary tool in arriving at a definite diagnosis of MALT lymphoma in cases with borderline histologic features.
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Affiliation(s)
- William Y F Lo
- Pathology Service, Caritas Medical Centre, Kowloon, Hong Kong, China.
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Poppitt SD, Leahy FE, Keogh GF, Wang Y, Mulvey TB, Stojkovic M, Chan YK, Choong YS, McArdle BH, Cooper GJS. Effect of high-fat meals and fatty acid saturation on postprandial levels of the hormones ghrelin and leptin in healthy men. Eur J Clin Nutr 2005; 60:77-84. [PMID: 16118648 DOI: 10.1038/sj.ejcn.1602270] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Ghrelin and leptin play a role in control of food intake and adiposity but mechanisms regulating these hormones in man are poorly defined and evidence that dietary fats may have adverse effects is inconclusive. We investigated whether high-fat meals, which differed in saturated fatty acid (SFA) content acutely modified these hormones. DESIGN Randomised, double-blind, crossover trial. A high-fat (HF) test meal (59 +/- 4 g fat; 71% of energy as fat) was given for breakfast on two occasions. Meals comprised either high (approximately 70:30) or low (approximately 55:45) saturated:unsaturated fatty acid (SFA:USFA) ratio. Fasting and postprandial measurements of serum total ghrelin (RIA), leptin (enzyme-linked immunosorbent assay (ELISA)) and insulin (RIA) were made over 6 h. Postprandial measurements were also made at 10 and 24 h following a fat-exclusion lunch, snack and dinner. SUBJECTS A total of 18 lean, healthy men. RESULTS There was no significant effect of the fatty meal (time, P > 0.05), nor a differential effect of SFA:USFA ratio (treatment*time, P > 0.05) on ghrelin over 6h. Leptin decreased in response to both HF treatments (time, P < 0.001) but increased SFA content did not further inhibit hormone secretion (treatment*time, P > 0.05). There was no significant correlation between ghrelin or leptin and circulating insulin (P>0.05). CONCLUSION We conclude that HF diets may adversely effect serum leptin, although the circadian decrease may account in part for this response. Increasing dietary SFAs had no deleterious effects on leptin or total ghrelin.
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Affiliation(s)
- S D Poppitt
- Human Nutrition & Metabolic Unit, University of Auckland, Auckland, New Zealand.
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Chan YK, Chiu KY, Cheng SW, Ho P. The incidence of deep vein thrombosis in elderly Chinese suffering hip fracture is low without prophylaxis: a prospective study using serial duplex ultrasound. J Orthop Surg (Hong Kong) 2004; 12:178-83. [PMID: 15621903 DOI: 10.1177/230949900401200208] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate the incidence of deep vein thrombosis (DVT) among elderly Hong Kong Chinese patients suffering from acute hip fracture and to analyse the risk factors associated with DVT. METHODS A total of 100 consecutive Chinese hip fracture patients with a mean age of 80 years were investigated serially using duplex ultrasound scans preoperatively and at 1 week, 3 to 6 weeks, and 3 months postoperatively. No chemoprophylaxis or prophylaxis against DVT was given. RESULTS 95 patients completed 3 duplex scans during hospitalisation; 5 (5.3%) of them were found to have developed DVT over the ilio-femoral venous segment. Of the 90 patients who had no DVT, 73 were reassessed 3 months after operation; one of them was found to have developed calf DVT. Older patients, chairbound or dependent patients, and patients living in institutions carried a higher risk of developing DVT. CONCLUSION This prospective study shows that the incidence of DVT developing after acute hip fracture in Chinese geriatric patients was low. We therefore do not recommend routine chemoprophylaxis for elderly patients with hip fracture.
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Affiliation(s)
- Y K Chan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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Abstract
We describe a Chinese woman who developed severe heart failure 3 years from the onset of systemic lupus erythematosus (SLE). Endomyocardial biopsy confirmed lupus myocarditis, with focal infiltrates of small lymphocytes and some polymorphic neutrophils. The conventional treatment for cardiac failure plus oral prednisolone failed to bring clinical and echocardiographical improvement until the addition of intravenous (i.v.) 'pulse' cyclophosphamide. Three weeks after i.v. cyclophosphamide treatment, there was significant improvement of her heart failure symptoms with improvement in the ejection fraction from 19% to 63%.
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Affiliation(s)
- Y K Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PRC.
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Chan YK, Wong CK, Hsieh DPH, Ng SP, Lau TK, Wong PK. Application of a toxicity identification evaluation for a sample of effluent discharged from a dyeing factory in Hong Kong. Environ Toxicol 2003; 18:312-316. [PMID: 14502583 DOI: 10.1002/tox.10130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A first toxicity identification evaluation (TIE) was conducted in three phases using the Microtox test to identify the major toxicant(s) in effluent discharged from a dyeing plant in Hong Kong. In Phase I toxicity characterization indicated that anions were likely to be the major toxicants for the entire effluent. In Phase II concentrations of sulfite and other anions in the original and the anion exchange resin-treated effluent samples were determined by ion chromatography. Anions, which were found in the effluent at comparatively high concentrations and were suspected of being responsible for the toxicity to luminescent bacteria, were selected for further study in Phase III. Investigation in Phase III using the spiking and mass balance approaches confirmed that the sulfite ion was the major toxicant in the effluent.
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Affiliation(s)
- Y K Chan
- Environmental Science Program, The Chinese University of Hong Kong, Shalin, N.T., Hong Kong, SAR, China
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Abstract
Mesangial lupus nephritis was thought to be a mild form of lupus nephritis. However, case reports suggest that this type of nephritis could be associated with a high rate of transformation to more serious classes. We retrospectively reviewed the clinical features, clinical response at one year following treatment, as well as the long-term outcome of patients with mesangial lupus nephritis identified on their first renal biopsy. The possible clinical parameters that may predict poor outcome were examined. Nineteen patients with a median duration of follow-up of 9.6 (2.5-11.4) years were identified. At one year after biopsy, eight patients achieved complete remission, two patients achieved partial remission and nine patients had no response. Of the 10 responders, four relapsed after a median duration of 53 (42-97) months. Nine out of 10 patients (six nonresponders and four responders who relapsed) who underwent a second biopsy showed transformation to a higher grade nephritis. The long-term outcome remained favourable in nine patients. Responders and patients who were given angiotensin-converting enzyme inhibitors were associated with favourable long-term outcome. Our data highlight that renal biopsy should be repeated early in Chinese patients with mesangial nephritis who failed to respond to treatment in order to identify those who may require intense immunosuppressive therapy.
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Affiliation(s)
- L S Tam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Chan YK, Chiu KY, Yip DKH, Ng TP, Tang WM. Full weight bearing after non-cemented total hip replacement is compatible with satisfactory results. Int Orthop 2003; 27:94-7. [PMID: 12700932 PMCID: PMC3460654 DOI: 10.1007/s00264-002-0419-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2002] [Indexed: 10/25/2022]
Abstract
Two matched groups of 29 patients underwent hydroxyapatite-coated non-cemented total hip replacement. One group was started on immediate protected-weight-bearing walking and the other group was started on immediate full-weight-bearing walking. They were followed up regularly for 2 years. They were assessed with Harris hip score clinically and Engh's criteria of osteo-integration radiographically. No difference was found between the two groups. All patients had excellent clinical outcome after hip replacement, and all femoral stems were stable radiographically. Patients can walk with full weight bearing safely immediate after hydroxyapatite-coated non-cemented total hip replacement.
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Affiliation(s)
- Y K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, 5/F Professorial Block, Pokfulam, Hong Kong S.A.R., China.
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Chiu CL, Mansor M, Ng KP, Chan YK. Retrospective review of spinal versus epidural anaesthesia for caesarean section in preeclamptic patients. Int J Obstet Anesth 2003; 12:23-7. [PMID: 15676316 DOI: 10.1016/s0959-289x(02)00137-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2002] [Indexed: 10/27/2022]
Abstract
A 5-year retrospective survey of anaesthesia for caesarean section for mild/moderate and severe preeclampsia was performed, covering the period between 1 January 1996 and 31 December 2000. One hundred and twenty-one cases of non-labouring preeclamptic patients receiving spinal or epidural anaesthesia for caesarean section were included for analysis. Comparisons were made of the lowest blood pressures recorded before induction of anaesthesia, during the period from induction to delivery and the period from delivery to the end of operation. The decreases in blood pressure were similar after spinal and epidural anaesthesia. The use of intravenous fluids and ephedrine were also comparable in the two anaesthetic groups. There was no difference in maternal or neonatal outcome. Our result supports the use of spinal anaesthesia in preeclamptic women.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Chan YK, Ng KP, Chiu CL. Trends in obstetric anaesthesia and analgesia over a ten year period in the University Malaya Medical Centre, Kuala Lumpur. Int J Obstet Anesth 2002; 11:176-9. [PMID: 15321544 DOI: 10.1054/ijoa.2002.0954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Available data for obstetric care in the University Malaya Medical Centre, Kuala Lumpur from 1987 to 1999 were reviewed. Despite incomplete data, we were able to determine fairly well the practice of obstetric anaesthesia and analgesia in the unit, and the changes over the years. There was a decline in the use of general anaesthesia for both elective and emergency caesarean sections from 41.3% and 69.4% respectively in 1995 to 21.6% and 26.9% respectively in 1999. By 1999, regional anaesthesia had become the most common method of anaesthesia administered in both elective (14.3% epidural and 63.5% spinal) and emergency (30.2% epidural and 42.6% spinal) caesarean sections. The percentage of patients delivering vaginally who received epidural analgesia appeared to have stabilised at about 8 to 9% in the last few years, with a gradual decline in the total instrumental delivery rate from a high of about 12% to the pre-epidural rate of 7%.
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Affiliation(s)
- Y K Chan
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Abstract
OBJECTIVE Central nervous system correlates of the visceral hyperalgesia documented in patients with irritable bowel syndrome are limited. Reproducible cerebral evoked potentials can be recorded in response to rhythmic balloon distension of the rectum in healthy adults. Irritable bowel syndrome patients and healthy subjects were studied to compare the characteristics of mechanically-evoked rectal cerebral potentials obtained during fasting and after the ingestion of a standard meal. METHODS Twenty-two pairs of age-matched healthy female subjects and female irritable bowel syndrome patients were studied. Cerebral evoked potentials were recorded in response to rhythmic rectal distension (two distension series each of 100 repetitions at 0.8 hertz); cerebral evoked potential recordings were repeated after a 1000 kcal (46% fat) liquid meal. Trait and state anxiety questionnaires were also completed. RESULTS Compared to healthy subjects, irritable bowel syndrome patients demonstrated higher prevalence of cerebral evoked potential early peaks (latency < 100 ms) postprandially, and uniformly shorter cerebral evoked potential latencies both before and after feeding. CONCLUSION These findings provide further objective evidence for defective visceral afferent transmission in irritable bowel syndrome patients.
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Affiliation(s)
- Y K Chan
- Department of Gastroenterology, Royal North Shore Hospital, University of Sydney, Australia
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Shen DH, Khoo US, Xue WC, Ngan HY, Wang JL, Liu VW, Chan YK, Cheung AN. Primary peritoneal malignant mixed Müllerian tumors. A clinicopathologic, immunohistochemical, and genetic study. Cancer 2001; 91:1052-60. [PMID: 11251959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Primary peritoneal malignant mixed Müllerian tumors (MMMTs) are rarely reported in the literature. METHODS The clinical, pathologic, and immunohistochemical features of five cases of MMMT of female peritoneum were analyzed. The tumors were also investigated for expression of hormone receptors, specific BRCA-1 mutations, and clonality. RESULTS The patients' ages ranged from 33 to 67 years. They presented with abdominal pain or mass. One case of peritoneal MMMT was associated with a synchronous endometrial carcinoma whereas another case was detected 2 years after the diagnosis of a primary adenocarcinoma of the fallopian tube. One patient died 1 month after diagnosis whereas 2 patients died with disease within 1 year. Both carcinomatous and sarcomatous elements are present in all the tumors. Squamous differentiation was noted in two cases. Heterologous elements, including chondroid, rhabodomyoblastic, and osteoid differentiation were detected in all tumors. Immunohistochemical studies confirm the biphasic differentiation with variable demonstration of neural and smooth muscle differentiation. All five MMMTs were negative for estrogen and progestogen receptors although the related endometrial and tubal carcinomas were positive. Heteroduplex analysis used to screen for specific BRCA-1 mutations were negative in all five MMMTs. Clonality study of the two MMMTs found in association with endometrial carcinoma and tubal carcinoma was inconclusive. CONCLUSIONS Our study confirmed that primary peritoneal MMMTs were aggressive tumors with poor prognosis. The presence of synchronous or metachronous genital carcinomas suggests multifocal tumorigenesis from tissue of same embryologic origin. The lack of hormone receptor in these tumors indicates deviation from hormonal control. Specific BRCA-1 mutations found in ovarian carcinoma in Chinese patients could not be detected in our series.
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Affiliation(s)
- D H Shen
- Department of Pathology, People's Hospital, Beijing Medical University, Beijing, China
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Affiliation(s)
- Y K Chan
- Department of Anesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chiu CL, Chan YK, Ong GS, Delilkan AE. A comparison of the maintenance and recovery charcateristic of sevoflurane-nitrous oxide against isoflurane-nitrous oxide anaesthesia. Singapore Med J 2000; 41:530-3. [PMID: 11284610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND To compare the maintenance and recovery characteristics of sevoflurane and isoflurane anaesthesia in Malaysian patients. METHOD This is a prospective, open labelled, randomized, controlled study. Sixty unpremedicated ASA I or II patients (aged 18-50 years), scheduled for elective breast lump excision were randomly allocated to receive either isoflurane or sevoflurane for the maintenance of anaesthesia following fentanyl and propofol intravenous induction. The systolic, diastolic, mean arterial blood pressure and heart rate were measured. The speed of recovery was measured by time to eye opening, time to following simple command, and time to correctly giving own names and address. The incidence of postoperative complication was also recorded. RESULTS The trend of systolic blood pressure was significantly higher in the isoflurane group as compared to the sevoflurane group for the duration of anaesthesia (p < 0.001, by ANOVA for repeated measurement) but the trend of heart rate was similar for both groups. The recovery time was faster in the isoflurane group. [mean time of eye opening (SD) = 6.8 (2.2) vs 10.7 (4.4) min, p < 0.001; mean time of sticking tongue out (SD) = 7.9 (2.9) vs 11.5 (4.7) min, p < 0.01; mean time of giving own name (SD) = 7.8 (2.7) vs 11.8 (4.8) min, p < 0.001, mean time of giving own address (SD) = 8.4 (2.9) vs 12.0 (4.7) min, p < 0.01]. No major adverse effects were encountered postoperatively and the incidences of minor adverse effects were low in both groups. CONCLUSION We concluded that sevoflurane is a safe alternative to isoflurane but in these short procedures, awakening time was surprisingly slower than after isoflurane.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Abstract
We present a case of headache following epidural anaesthesia for caesarean section. The patient did not exhibit the classical features of post dural puncture headache and the cause was uncertain. The headache was complicated by post partum seizure and a history of pregnancy-induced hypertension. A diagnostic lumbar puncture had to be done to exclude meningitis as she had a raised white blood count. An epidural blood patch performed 12 days post partum resolved the headache immediately.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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41
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Abstract
A survey was conducted in several countries in the Far East in an attempt to determine the practice of obstetric analgesia and anaesthesia there. Survey forms were sent to a total of 11 countries but in the end responses from only four countries were able to provide useful information. Responses from Singapore, Hong Kong, Taiwan and Malaysia covered between 44.9% (Singapore) and 24.6% (Malaysia) of their countries' total deliveries in 1997 and were thought to be adequate to give an impression of the obstetric analgesia and anaesthesia services in their respective countries, although this would not necessarily be completely accurate. From our survey, we found that the availability of regional analgesia for labour paralleled the economic status of the country and that a significant number of caesarean sections are conducted under regional anaesthesia, mainly spinals.
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Affiliation(s)
- Y K Chan
- Department of Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Flather MD, Weitz JI, Yusuf S, Pogue J, Sussex B, Campeau J, Gill J, Schuld R, Joyner CD, Morris AL, Lai C, Théroux P, Marquis JF, Chan YK, Venkatesh G, Jessel A. Reactivation of coagulation after stopping infusions of recombinant hirudin and unfractionated heparin in unstable angina and myocardial infarction without ST elevation: results of a randomized trial. OASIS Pilot Study Investigators. Organization to Assess Strategies for Ischemic++ Syndromes. Eur Heart J 2000; 21:1473-81. [PMID: 10952840 DOI: 10.1053/euhj.1999.2005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS To compare effects of heparin and hirudin on biochemical markers of coagulation. METHODS AND RESULTS Patients (n=395) with unstable angina or myocardial infarction without ST elevation were randomized to a 72-h infusion of one of three regimens: unfractionated heparin (bolus of 5000 IU followed by an infusion of 1200 IU. h(-1)), low-dose hirudin (HBW 023; 0.2 mg. kg(-1)bolus followed by 0.10 mg. kg(-1). h(-1)) or medium-dose hirudin (0.4 mg. kg(-1)bolus followed by 0.15 mg. kg(-1). h(-1)). Infusions were adjusted to maintain an activated partial thromboplastin time of between 60-100 s. Activated partial thromboplastin time, prothrombin fragment 1.2 (F1.2), thrombin antithrombin III complex and D-dimer were measured before, during and after the infusion. Median activated partial thromboplastin time was similar in the two groups early on, but was significantly lower in the heparin group than in the combined hirudin group 48 h after starting the infusion (53 s and 75 s, respectively;P<0.001), and 6 h after stopping (31 s and 46 s, respectively;P<0.001). Median F1.2 levels were not significantly different between the groups during the infusion. Median thrombin antithrombin III levels in the heparin and hirudin groups were 2.8 microg. l(-1)and 2.3 microg. l(-1), respectively, at 6 h (P<0.001), and 3.0 microg. l(-1)and 2.3 microg. l(-1), respectively, at 48 h (P<0.001). Median D-dimer levels were 320 ng. ml(-1)and 260 ng. ml(-1)48 h after starting the infusion in the heparin and hirudin groups, respectively (P<0.001), and 415 ng. ml(-1)and 280 ng. ml(-1), respectively (P<0.001) 6 h after stopping. D-dimer levels were significantly elevated above baseline values in both groups 24-48 h after stopping the infusions. CONCLUSIONS The greater reduction of thrombin antithrombin III and D-dimer during the hirudin infusion supports the hypothesis that hirudin is a more potent antithrombin agent than heparin. Increased D-dimer levels after stopping heparin or hirudin suggest that there is an ongoing pro-coagulant state. These results point to the greater efficacy of hirudin in preventing early clinical events (death, myocardial infarction and refractory ischaemia) compared with heparin that have been observed in large randomized trials. Persistent activation of coagulation afterstopping infusions in our study suggests that a longer course of antithrombotic treatment may be needed to pacify the thrombus.
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Affiliation(s)
- M D Flather
- Hamilton Health Sciences Corporation Research Centre, Hamilton, Ontario, Canada
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Abstract
A healthy parturient under spinal anaesthesia for Caesarean section lost consciousness for an hour, 20 min after the intrathecal injection of 2 ml of 0.5% heavy bupivacaine. The patient was haemodynamically stable before losing consciousness. The differential diagnosis is discussed.
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Affiliation(s)
- Y K Chan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Abstract
OBJECTIVES To prospectively study the intervention rate, duration of labour, malpositions, fetal outcome, maternal satisfaction, voiding complications and adverse events in healthy primigravidae in spontaneous labour at term following epidural analgesia. METHODS A prospective randomized study involving 55 patients in the epidural group and 68 in the control pethidine--inhalational entonox group. RESULTS There were significantly more obstetric interventions (instrumental deliveries) in the epidural group (p < 0.01). The total duration of labour and the duration of the second stage was prolonged in the epidural group (p < 0.01). There were more malpositions at the second stage of labour in the epidural group (p < 0.02). There were no differences in fetal outcome (Apgar scores and Special Care Nursery admissions). Patients in the epidural group were consistently happier with their method of pain relief (p < 0.01). Two patients required blood patches while another 2 patients had persistent backache post epidural analgesia. CONCLUSION Epidural analgesia in primigravidae in spontaneous labour at term led to an increased instrumental delivery rate, prolonged duration of labour, greater rate of malpositions in the second stage, increased oxytocin requirements but with no difference in fetal outcomes but with happier mothers as compared to the control group.
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Affiliation(s)
- E W Leong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tsui WM, Lam PW, Lee KC, Ma KF, Chan YK, Wong MW, Yip SP, Wong CS, Chow AS, Lo ST. The C282Y mutation of the HFE gene is not found in Chinese haemochromatotic patients: multicentre retrospective study. Hong Kong Med J 2000; 6:153-8. [PMID: 10895137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To detect two novel mutations (C282Y and H63D) of the HFE gene in Chinese patients with hepatic iron overload. DESIGN Multicentre retrospective study. SETTING Four public hospitals, Hong Kong. PARTICIPANTS Fifty Chinese patients who presented from January 1987 through December 1999 with hepatic iron overload from various causes. MAIN OUTCOME MEASURES The DNA from liver biopsy samples was tested for HFE mutations by restriction fragment length polymorphism analysis. RESULTS The sample DNA quality was unsatisfactory for analysis of the C282Y mutation in one case and the H63D mutation in nine cases. The C282Y mutation was not detected in any of the 49 satisfactory samples. Three of the 41 samples were heterozygous for the H63D mutation and only one was homozygous, giving an allele frequency of 6.1%. Of the three H63D-heterozygotes, one had beta-thalassaemia major, one had beta-thalassaemia minor, and one had hereditary spherocytosis. None of the 12 patients who were presumed to have primary haemochromatosis were positive for either mutation. CONCLUSIONS The classical form of human leukocyte antigen-linked hereditary haemochromatosis appears to be absent form this locality. The H63D mutation is found in a minority (9.8%) of the patients, in whom it may act synergistically with an erythropoietic factor.
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Affiliation(s)
- W M Tsui
- Department of Pathology, Caritas Medical Centre, Kowloon, Hong Kong
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Abstract
OBJECTIVE A survey covering 30% of the deliveries in Malaysia was done to determine the practice of obstetric anaesthesia and analgesia for 1996. RESULTS From the survey, it was found that the regional anaesthesia rate for caesarean section was 46% in the government hospitals compared to 29.2% in the private hospitals, with spinal anaesthesia being the most common regional anaesthetic technique used in both types of hospitals. The epidural rate for labour analgesia was only 1.5% overall for the country. Epidural analgesia services were available in all private hospitals whereas 17.6% of government hospitals surveyed did not offer this service at all. CONCLUSIONS Although the use of epidural analgesia for labour was low in Malaysia, the overall rate of regional anaesthesia for caesarean section (41.9%) is very much in keeping with the standards of safe practice recommended by the United Kingdom.
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Affiliation(s)
- Y K Chan
- Department of Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Abstract
BACKGROUND While there is great interest in measuring the efficacy of root surface debridement, there is little consensus on how this might be best achieved. The aim of this study was therefore to compare four different methods of assessing root surface debridement in their ability to discriminate between ultrasonically instrumented root surfaces and non-instrumented control surfaces. METHODS Single-session subgingival root debridement was performed by an experienced operator on 30 teeth prior to their extraction. Following extraction, efficacy of root surface debridement was measured by percentage of remaining calculus, instrument efficiency, modified instrument efficiency, and percentage apical plaque border. In addition, the effect of probing depth landmark (apical plaque border versus connective tissue attachment) on outcomes was assessed. RESULTS The results indicated that percentage apical plaque border demonstrated highly statistically significant differences between instrumented and control surfaces (P= 0.02). No other assessment method was able to discriminate between instrumented and non-instrumented surfaces, and this may be a function of the low amount of root surface calculus in the experimental sample. In addition, choice of probing depth landmark had a notable effect on the outcomes for instrument efficiency and modified instrument efficiency. Ninety-five percent limits of agreement of interexaminer reproducibility were found to be much higher than intra-examiner measurement for all four methods of assessment. CONCLUSIONS Percentage apical plaque border appeared to be potentially more useful than other methods for assessing the efficacy of debridement of periodontally involved root surfaces, particularly for measuring instrument penetrability.
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Affiliation(s)
- Y K Chan
- Department of Periodontology, Eastman Dental Institute, London, UK
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Chiu CL, Chan YK, Ong G, Delilkan AE. A comparison of the induction and emergence characteristics of sevoflurane and halothane in children. Med J Malaysia 1999; 54:346-51. [PMID: 11045061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
This open labelled, randomised, controlled study was designed to compare the induction and recovery characteristics of sevoflurane and halothane anaesthesia in children. Forty American Society of Anaesthesiologist (ASA) physical status class 1 or 2 children (aged 1-10 year, weighed less than 25 kg) scheduled for elective urological procedure lasting less than one hour were allocated randomly to receive either sevoflurane (group S, n = 20) or halothane (group H, n = 20). The induction time in children receiving sevoflurane was significantly shorter than in those receiving halothane (mean (SD) 46 (13.6) second vs 69 (19.4) seconds, p < 0.005). The emergence from anaesthesia was also faster in children receiving sevoflurane than in those receiving halothane (mean (SD) 9 min (4.3 min) vs 21 min (8.9 min), p < 0.001). No major adverse effects were encountered in each group. We concluded that sevoflurane is comparable to halothane in Malaysian children.
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Affiliation(s)
- C L Chiu
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur
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Ting SM, Li P, Lau FL, Chan YC, Chan YK, Lai PW, Choi K, Au A, Cheung B, Tse CY. Acute bereavement care in the emergency department: does the professional-supported volunteers model work? Eur J Emerg Med 1999; 6:237-43. [PMID: 10622390 DOI: 10.1097/00063110-199909000-00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aims of our study were to study the early impact of bereavement and to evaluate the effectiveness of the bereavement care given by our multidisciplinary team to close relatives of a sudden death, measured by the intensity of grief reaction (Texas Revised Inventory of Grief). The study sample consisted of close relatives of patients certified dead at the accident and emergency department (AED) between March 1996 and February 1997. The relatives received immediate care at the AED and were supported continually by the members of the bereavement care team. The control sample (without acute bereavement care) consisted of close relatives contacted by the liaison nursing officer in the previous year. The intensity of grief reactions were assessed by the volunteer grief counsellors at 6 months. The mean score of the intensity of grief reactions were 41.8 and 34.6 in the control (n = 11) and study (n = 18) groups respectively among high risk sample (p = 0.04). However, in the low risk sample, the mean scores were 35.3 and 30.2 in the control (n = 18) and study (n = 25) groups respectively (p = 0.11). Our study suggests that the bereavement care was especially effective in reducing the intensity of the grief at 6 months in the high risk group.
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Affiliation(s)
- S M Ting
- Accident and Emergency Department, United Christian Hospital, Kowloon, Hong Kong, China
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