97 results on '"Tay, K. H."'
Search Results
2. Effective dose estimates for cone beam computed tomography in interventional radiology
- Author
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Kwok, Y. M., Irani, F. G., Tay, K. H., Yang, C. C., Padre, C. G., and Tan, B. S.
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- 2013
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3. CT appearance of complications related to thoracic endovascular aortic repair (TEVAR): a pictorial essay
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Pua, U., Tay, K. H., Tan, B. S., Htoo, M. M., Sebastian, M., Sin, K., and Chua, Y. L.
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- 2009
- Full Text
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4. Image-guided percutaneous transhepatic removal of fish bone from liver abscess: Educational Exhibit
- Author
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Gogna, A, Wong, K M, Alijumah, A, and Tay, K H
- Published
- 2013
5. Temporary inferior vena cava filters – review of insertion, complications and retrievability: Scientific Exhibit
- Author
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Gogna, A, Chan, S, Htet, A, Lo, R, Robertson, J, Ramamurthy, S, Patel, A, Too, C W, Tan, B S, Tay, K H, and Irani, F G
- Published
- 2013
6. Complications of lower limb endovascular interventions and their management: 197 - Educational Exhibit
- Author
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Gogna, A, Irani, F G, Ramamurthy, S, Teo, T KB, Yeow, T N, Tan, B S, Tay, K H, Lo, R, and Taneja, M
- Published
- 2012
7. Novel oral anticoagulants
- Author
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Khoo, C. W., Tay, K.-H., Shantsila, E., and Lip, G. Y. H.
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- 2009
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8. Anticoagulation variability: is it the physician, patient or hospital?
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Tay, K. H., Lip, G. Y. H., and Lane, D. A.
- Published
- 2009
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9. Randomized clinical trial of 0·2 per cent glyceryl trinitrate ointment for wound healing and pain reduction after open diathermy haemorrhoidectomy
- Author
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Tan, K.-Y., Sng, K. K., Tay, K.-H., Lai, J.-H., and Eu, K.-W.
- Published
- 2006
10. LAPAROSCOPIC CHOLECYSTECTOMY – AN AUDIT of OUR TRAINING PROGRAMME in SINGAPORE: 25
- Author
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Tay, K H
- Published
- 2005
11. BILE DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY: A COLLECTIVE EXPERIENCE OF FOUR TEACHING HOSPITALS AND RESULTS OF REPAIR
- Author
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Ooi, L. L. P. J., Goh, Y. C., Chew, S. P., Tay, K. H., Foo, E., Low, C. H., Ch'ng, H. C., Chan, S. T. S., and Soo, K. C.
- Published
- 1999
12. Laparoscopic drainage of liver abscesses
- Author
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TAY, K. H., RAVINTHARAN, T., HOE, M. N. Y., SEE, A. C. H., and CHNG, H. C.
- Published
- 1998
13. Drug Eluting Stents in Infrapopliteal Arterial Disease: A Pilot Safety Study in an Asian Population
- Author
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Damodharan, K., Patel, A., Irani, F. G., Mark Burgmans, Gogna, A., Tay, K. H., Lo, R. H. G., Too, C. W., Leong, S., Venkatanarasimha, N., Chan, S., Win, H. H., Sivanathan, C., and Tan, B. S.
- Published
- 2017
14. Percutaneous Endovascular Treatment to Salvage Non-Maturing Arteriovenous Fistulas in a Multiethnic Asian Population
- Author
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Tham, W. P., Mark Burgmans, Tan, B. S., Tay, K. H., Irani, F. G., Gogna, A., Patel, A., Lo, R. H. G., Chng, S. P., Choong, H. L., and Chan, S. X. J. M.
- Subjects
Interventional radiology ,Chronic renal disease ,Haemodialysis ,Angioplasty - Published
- 2017
15. Suppression of PP2A is critical for protection of melanoma cells upon endoplasmic reticulum stress
- Author
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Tay, K H, primary, Jin, L, additional, Tseng, H-Y, additional, Jiang, C C, additional, Ye, Y, additional, Thorne, R F, additional, Liu, T, additional, Guo, S T, additional, Verrills, N M, additional, Hersey, P, additional, and Zhang, X D, additional
- Published
- 2012
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16. Fluoroscopy-guided, transcervical, selective salpingography and fallopian tube recanalisation
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Anil, G., primary, Tay, K. H., additional, Loh, S. F., additional, Yong, T. T., additional, Ong, C. L., additional, and Tan, B. S., additional
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- 2011
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17. Vascular access
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Santos, C., primary, Ventura, A., additional, Gomes, A. M., additional, Pereira, S., additional, Almeida, C., additional, Seabra, J., additional, Segelmark, M., additional, Mattsson, L., additional, Said, S., additional, Olde, B., additional, Solem, K., additional, Yu, X., additional, Zhang, B., additional, Sun, B., additional, Mao, H., additional, Xing, C., additional, Gruss, E., additional, Portoles, J., additional, Tato, A., additional, Lopez-Sanchez, P., additional, Jimenez, P., additional, de la Cruz, R., additional, Furaz, K., additional, Martinez, S., additional, Mas, M., additional, Andres, M. M., additional, Corchete, E., additional, Kim, Y. O., additional, Kim, H. G., additional, Kim, B. S., additional, Song, H. C., additional, Choi, E. J., additional, Ibeas, J., additional, Vallespin, J., additional, Fortuno, J. R., additional, Rodriguez-Jornet, A., additional, Grau, C., additional, Merino, J., additional, Branera, J., additional, Perendreu, J., additional, Granados, I., additional, Mateos, A., additional, Jimeno, V., additional, Moya, C., additional, Ramirez, J., additional, Falco, J., additional, Gimenez, A., additional, Garcia, M., additional, Morgado, E., additional, Pinho, A., additional, Guedes, A., additional, Guerreiro, R., additional, Mendes, P., additional, Bexiga, I., additional, Silva, A., additional, Marques, J., additional, Neves, P., additional, Shibata, K., additional, Iwamoto, T., additional, Murakami, T., additional, Ono, S., additional, Kaneda, T., additional, Kuji, T., additional, Kawata, S., additional, Satta, H., additional, Tamura, K., additional, Toya, Y., additional, Yanagi, M., additional, Umemura, S., additional, Yasuda, G., additional, Yong, O. L., additional, Lim, W. W. L., additional, Yong, K. M., additional, Tay, K. H., additional, Lim, E. K., additional, Yang, W. S., additional, Tan, S. G., additional, Choong, H. L., additional, Hill, A., additional, Blatter, D., additional, Kim, S. Y., additional, Min, J.-K., additional, Park, W. D., additional, Rodriguez- Jornet, A., additional, Marcet, M., additional, Vinuesa, X., additional, Mateo, A., additional, Fernandez, M., additional, Rivera, J., additional, Shibahara, H., additional, Shibahara, N., additional, Takahashi, S., additional, Kanaa, M., additional, Wright, M. J., additional, Sandoe, J. A. T., additional, Freudiger, H., additional, Dupret, J., additional, Jacquemoud, M.-C., additional, Rossi, L., additional, Kampouris, C., additional, Hatzimpaloglou, A., additional, Karamouzis, M., additional, Pliakos, C., additional, Malindretos, P., additional, Roudenko, I., additional, Grekas, D., additional, Costa, A. C., additional, Santana, A., additional, Neves, F., additional, Costa, A. G. d., additional, Chaudhry, M., additional, Bhola, C., additional, Joarder, M., additional, Lok, C., additional, Coentrao, L., additional, Faria, B., additional, Frazao, J., additional, Pestana, M., additional, Sun, X.-f., additional, Yang, Y., additional, Wang, J., additional, Lin, H.-l., additional, Li, J.-j., additional, Yao, L., additional, Zhao, J.-Y., additional, Zhang, Z.-m., additional, Lun, L.-d., additional, Zhang, J.-r., additional, Zhang, Y.-m., additional, Li, M.-x., additional, Jiang, S.-m., additional, Wang, Y., additional, Zhu, H.-y., additional, Chen, X.-m., additional, Caeiro, F., additional, Carvalho, D., additional, Cruz, J., additional, Ribeiro dos Santos, J., additional, Nolasco, F., additional, Bartlett, R., additional, Pandya, B., additional, Viana, N., additional, Machado, S., additional, Gil, C., additional, Lucas, C., additional, Mendes, A., additional, Barata, J., additional, Freitas, L., additional, Campos, M., additional, Rikker, C., additional, Juhasz, E., additional, Toth, A., additional, Vizi, I., additional, Tornoci, L., additional, Rosivall, L., additional, Tovarosi, S., additional, Cho, S., additional, Kim, S., additional, Lee, Y.-j., additional, Kanai, H., additional, Harada, K., additional, Nasu, S., additional, Shinozaki, M., additional, Esenturk, M., additional, Zengin, M., additional, Ogun, F., additional, Akdemir, A., additional, Colak, C., additional, Pekince, G., additional, Gerasimovska, V., additional, Oncevski, A., additional, Gerasimovska-Kitanovska, B., additional, Sikole, A., additional, Kiselev, N., additional, Chernyshev, S., additional, Zlokazov, V., additional, Idov, E., additional, Bacallao Mendez, R., additional, Avila, A., additional, Salgado, J., additional, Llerena, B., additional, Badell, A., additional, Aties, M., additional, Severn, A., additional, Metcalfe, W., additional, Traynor, J., additional, Boyd, J., additional, Kerssens, J., additional, Henderson, A., additional, Simpson, K., additional, Roca-Tey, R., additional, Samon, S., additional, Ibrik, O., additional, Roda, E., additional, Gonzalez, J. C., additional, Viladoms, J., additional, Bamidis, P., additional, Liaskos, C., additional, Papagiannis, A., additional, Vrochides, D., additional, Frantzidis, C., additional, Sarafidis, P., additional, Lasaridis, A., additional, Chryssogonidis, I., additional, Nikolaidis, P., additional, Perndreu, J., additional, Moyses Neto, M., additional, Ferreira, V., additional, Martinez, R., additional, Tercariol, C. A. S., additional, Lima, D. A. F. S., additional, Figueiredo, J. F. C., additional, Costa, J. A. C., additional, Alayoud, A., additional, Hamzi, A., additional, Akhmouch, I., additional, Aatif, T., additional, Oualim, Z., additional, Jankovic, A., additional, Ilic, M., additional, Damjanovic, T., additional, Djuric, Z., additional, Popovic, J., additional, Adam, J., additional, and Dimkovic, N., additional
- Published
- 2011
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18. Apoptosis of human melanoma cells induced by inhibition of B-RAFV600E involves preferential splicing of bimS
- Author
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Jiang, C C, primary, Lai, F, additional, Tay, K H, additional, Croft, A, additional, Rizos, H, additional, Becker, T M, additional, Yang, F, additional, Liu, H, additional, Thorne, R F, additional, Hersey, P, additional, and Zhang, X D, additional
- Published
- 2010
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19. Cystatin B inhibition of TRAIL-induced apoptosis is associated with the protection of FLIPL from degradation by the E3 ligase itch in human melanoma cells
- Author
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Yang, F, primary, Tay, K H, additional, Dong, L, additional, Thorne, R F, additional, Jiang, C C, additional, Yang, E, additional, Tseng, H-Y, additional, Liu, H, additional, Christopherson, R, additional, Hersey, P, additional, and Zhang, X D, additional
- Published
- 2010
- Full Text
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20. What "Drives" the Link Between the Renin-Angiotensin-Aldosterone System and the Prothrombotic State in Hypertension?
- Author
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Tay, K.-H., primary and Lip, G. Y. H., additional
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- 2008
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21. Challenges facing anticoagulation among the elderly and frail
- Author
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Tay, K. H., primary, Lane, D. A., additional, and Lip, G. Y. H., additional
- Published
- 2008
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22. BILE DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY: A COLLECTIVE EXPERIENCE OF FOUR TEACHING HOSPITALS AND RESULTS OF REPAIR
- Author
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Ooi, L. L. P. J., primary, Goh, Y. C., additional, Chew, S. P., additional, Tay, K. H., additional, Foo, E., additional, Low, C. H., additional, Ch'Ng, H. C., additional, Chan, S. T. S., additional, and Soo, K. C., additional
- Published
- 1999
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23. Duplex ultrasonography arteriography as first-line investigation for peripheral vascular disease.
- Author
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Wong, T H, Tay, K H, Sebastian, M G, Tan, S G, Wong, Ting Hway, Tay, Kiang Hiong, Sebastian, Mathew G, and Tan, Seck Guan
- Abstract
Introduction: The gold standard for evaluation of the lower extremity arterial tree is catheter angiography. Duplex arterial-occlusive imaging or duplex ultrasonography arteriography, a noninvasive technique, is used as the first-line investigation in patients with peripheral vascular disease at our centre. Based on the results of duplex imaging, patients who require angiographic intervention then proceed with simultaneous catheter arteriography and intervention. This study aimed to compare the results of duplex imaging alone as the first-line investigation against the eventual results of catheter angiography, and to assess the impact of the former on patients' clinical outcomes.Methods: All cases involving patients who underwent duplex imaging followed by angiographic intervention, from May 2008 to February 2009, were discussed at weekly interdisciplinary meetings. Only patients who underwent lower limb imaging were included in the study. Those who were involved in grafts and stent surveillance studies, as well as those with incomplete duplex images were excluded.Results: During the study period, 113 duplex imaging studies of the lower limb followed by percutaneous transluminal angioplasty were performed at our hospital for peripheral vascular disease. The iliac artery was visualised in 40 images, but could not be visualised in 73 images. There was a potential change in management in three cases due to radiological differences between the duplex images and angiography films.Conclusion: In our series, duplex imaging was found to be accurate enough to guide initial clinical management of patients with peripheral vascular disease. This modality is the preferred first-line investigation for such patients at our centre. [ABSTRACT FROM AUTHOR]- Published
- 2013
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24. Cystatin B inhibition of TRAIL-induced apoptosis is associated with the protection of FLIPL from degradation by the E3 ligase itch in human melanoma cells.
- Author
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Yang, F., Tay, K. H., Dong, L., Thorne, R. F., Jiang, C. C., Yang, E., Tseng, H.-Y., Liu, H., Christopherson, R., Hersey, P., and Zhang, X. D.
- Subjects
- *
MELANOMA , *APOPTOSIS , *CYSTATINS , *PROTEOLYTIC enzymes , *RNA , *GENETICS - Abstract
Past studies have identified a number of distinct mechanisms that contribute to the resistance of melanoma cells against apoptosis induced by TNF-related apoptosis-inducing ligand (TRAIL). In this report we show that cystatin B is another endogenous inhibitor of TRAIL-induced apoptosis. Cystatin B-deficient melanoma cell lines established by shRNA knockdown displayed increased apoptosis that was associated with enhanced activation of caspase-8 induced by TRAIL. This was not related to the inhibitory effect of cystatin B on the lysosomal cysteine proteases, cathepsin B and L, as they did not have a role in TRAIL-induced apoptosis in most melanoma cell lines even when cystatin B was inhibited. Instead, sensitization of melanoma cells to TRAIL-induced apoptosis by inhibition of cystatin B appeared associated with decreased stability of FLIPL as the levels of FLIPL were reduced because of shortened half-life time in melanoma cells deficient in cystatin B. In contrast, over-expression of cystatin B increased the levels of FLIPL, decreased the amount of the E3 ligase Itch associated with FLIPL, and reduced FLIPL ubiquitination. Inhibition of Itch by siRNA restored the levels of FLIPL and blocked sensitization to TRAIL-induced apoptosis associated with deficiency in cystatin B. Taken together, these results indicate that cystatin B regulates Itch-mediated degradation of FLIPL and thereby TRAIL-induced apoptosis in melanoma cells. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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25. A brief history of interventional radiology in Singapore and its current status.
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Teo, T. K. B., Tan, B. S., and Tay, K. H.
- Subjects
- *
INTERVENTIONAL radiology , *ANGIOGRAPHY , *RADIOLOGISTS , *HOSPITALS - Abstract
X-ray services were first established in Singapore in 1898. With the opening of the General Hospital in 1926, there was subsequent increase in workload. However, a radiology department was not formed until the 1950s. Angiography was introduced in the same decade initially for diagnosis. By the 1960s and 1970s, both vascular and non-vascular interventions were performed. Subsequently, interventional radiology experienced exponential growth, with newer technology and better facilities established over the past 3 decades. With more trained interventional radiologists, the service is currently available in all public hospitals and in most private hospitals in Singapore today. It is envisaged that structured training and formal credentialing will be established, eventually leading to recognition of interventional radiology as a specialty in its own right. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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26. Comparison of pharmacological thrombolysis with mechanical thrombectomy in thrombosed arteriovenous fistulas and grafts: a systemic review and meta-analysis.
- Author
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Tay TKC, Rehena G, Zhuang KD, Irani FG, Gogna A, Too CW, Chong TT, Tan BS, Tan CS, and Tay KH
- Subjects
- Humans, Thrombosis, Vascular Patency, Treatment Outcome, Fibrinolytic Agents therapeutic use, Thrombolytic Therapy methods, Arteriovenous Shunt, Surgical adverse effects, Arteriovenous Shunt, Surgical methods, Thrombectomy methods, Graft Occlusion, Vascular diagnostic imaging
- Abstract
Aim: To compare the effectiveness and safety of pharmacological thrombolysis and mechanical thrombectomy., Material and Methods: This review was conducted in accordance with the PRISMA guidelines. Pooled proportions and subgroup analysis were calculated for primary and secondary patency rates, technical success, clinical success, major and minor complications rates., Results: This systematic review identified a total of 6,492 studies of which 17 studies were included for analysis. A total of 1,089 patients comprising 451 (41.4 %) and 638 (58.6 %) patients who underwent thrombolysis and mechanical thrombectomy procedures, respectively, were analysed. No significant differences were observed between thrombolysis and mechanical thrombectomy procedures in terms of technical success, clinical success, major and minor complications rates, primary and secondary patency rates; however, subgroup analysis of overall arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) demonstrated a significantly higher rate of major complications within the AVF group (p=0.0248)., Conclusion: The present meta-analysis suggests that pharmacological thrombolysis and mechanical thrombectomy procedures are similarly effective and safe; however, AVFs are subject to higher major complications compared to AVGs., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2024
- Full Text
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27. Deeper may not be better: relationship between catheter dysfunction and location of the catheter tip in right-sided tunnelled haemodialysis catheters.
- Author
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Soh NYT, Tan BS, Chan SJM, Patel A, Gogna A, Zhuang KD, Tashi S, Venkatanarasimha N, Tay KH, and Chandramohan S
- Subjects
- Humans, Jugular Veins diagnostic imaging, Renal Dialysis, Retrospective Studies, Vena Cava, Superior diagnostic imaging, Catheterization, Central Venous adverse effects, Catheterization, Central Venous methods, Central Venous Catheters
- Abstract
Aim: To examine the relationship between catheter tip location and catheter dysfunction in the context of tunnelled central venous catheters (CVCs) for haemodialysis., Materials and Methods: This was a retrospective study of 993 haemodialysis patients who underwent insertion of tunnelled CVCs of step-tip design via the right internal jugular vein (IJV). Based on intra-procedural radiographs, the catheter tip was characterised as being in the superior vena cava (SVC), cavo-atrial junction (CAJ), or deep right atrium (DRA). Patients were tracked for 90 days post-procedure for complications resulting in catheter replacement, and these were compared between cohorts. Statistical analysis was performed with Pearson's chi-square and Fisher's exact tests for categorical variables and two-sample t-test and one-way analysis of variance (ANOVA) for continuous variables., Results: Ninety-five patients (9.6%) experienced catheter dysfunction necessitating replacement within 90 days of insertion. Tip location in SVC was associated with lower occurrence of catheter dysfunction (1.9%) as compared with the CAJ (8%) and DRA (11%; p=0.049). Catheter replacement due to other complications (catheter-associated bacteraemia, cuff dislodgement, exit-site infection, external catheter damage) showed no statistically significant relation to location of the CVC tip., Conclusion: When utilising tunnelled CVCs with a step-tip design inserted via the right IJV, location of the catheter tip in the SVC is associated with reduced occurrence of catheter dysfunction as compared to either the CAJ or DRA., (Copyright © 2022 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2022
- Full Text
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28. Corrigendum to "Re: does reducing radiation levels for procedures affect image quality and radiation to proceduralists? A double-blinded randomized study of two protocols" [76 (2) e1-e10].
- Author
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Zhang Z, Phang CC, Tan RY, Pang SC, Chandramohan S, Zhuang KD, Sulaiman MS, Tay KH, Chong TT, and Tan CS
- Published
- 2021
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29. Does reducing radiation levels for procedures affect image quality and radiation to proceduralists? A double-blinded randomised study of two protocols.
- Author
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Zhang Z, Phang CC, Tan RY, Pang SC, Chandramohan S, Zhuang KD, Sulaiman MS, Tay KH, Chong TT, and Tan CS
- Subjects
- Adult, Clinical Protocols, Double-Blind Method, Female, Fluoroscopy, Humans, Male, Prospective Studies, Angiography, Digital Subtraction methods, Angioplasty methods, Graft Occlusion, Vascular surgery, Mechanical Thrombolysis methods, Radiation Dosage, Radiation Exposure statistics & numerical data
- Abstract
Aim: To evaluate the ultra-lose dose imaging protocol (ULDP), compared to the standard low-dose imaging protocol (LDP), which are used for haemodialysis access, in terms of radiation exposure and image quality., Material and Methods: This was a single-centre, institutional review board-approved, prospective, double-blinded randomised controlled study to compare radiation exposure and image quality of the ULDP and LDP. Ten proceduralists, two radiographers, and 11 nurses were enrolled. Radiation exposure during 80 procedures (40 angioplasties and 40 thrombolysis) was recorded (direct radiation to patients from protocol report and scattered radiation to participants from the RaySafe i2 real-time dosimetry system). Baseline characteristics of procedure were recorded. Image quality was assessed subjectively using questionnaires based on the five-point Likert scale after each procedure., Results: Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses (0.506±0.430 versus 0.847±0.965 μSv/s, p=0.044; 0.571±1.284 versus 1.284±1.007 mGy/s, p<0.001; and 0.052±0.071 versus 0.141±0.185 μSv/s, p=0.005, respectively). No significant difference in image quality or duration of procedure was observed (all p values >0.05)., Conclusion: Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses without compromising the image quality or duration of procedure., (Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2021
- Full Text
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30. Planning and coordination of the radiological response to the coronavirus disease 2019 (COVID-19) pandemic: the Singapore experience.
- Author
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Tsou IYY, Liew CJY, Tan BP, Chou H, Wong SBS, Loke KSH, Quah RCW, Tan AGS, and Tay KH
- Subjects
- COVID-19, Coronavirus Infections epidemiology, Health Resources, Humans, Organization and Administration, Pandemics, Pneumonia, Viral epidemiology, Radiography, Thoracic, Radiology Department, Hospital, Singapore epidemiology, Tomography, X-Ray Computed, Coronavirus Infections diagnostic imaging, Pneumonia, Viral diagnostic imaging
- Abstract
Coronavirus disease 2019 (COVID-19) has spread fast and extensively around the world, with significant mortality and morbidity. As this is a respiratory infection, chest radiography and computed tomography (CT) are important imaging techniques in the work-up of this disease. Given its highly infectious nature, cross-infection within the healthcare setting and radiology departments needs to be addressed actively and prevented. We describe the response of radiology departments in Singapore to this pandemic, in terms of diagnosis, re-configuration of the department, re-organisation and segregation of staff, infection control, managerial, and leadership issues., (Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2020
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31. Screening for impaired renal function in outpatients before iodinated contrast injection: Comparing the Choyke questionnaire with a rapid point-of-care-test.
- Author
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Too CW, Ng WY, Tan CC, Mahmood MI, and Tay KH
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- Diabetes Mellitus, Female, Humans, Kidney Function Tests, Male, Middle Aged, Outpatients, Renal Insufficiency diagnosis, Renal Insufficiency prevention & control, Risk Assessment, Sensitivity and Specificity, Surveys and Questionnaires, Contrast Media adverse effects, Creatinine blood, Glomerular Filtration Rate, Point-of-Care Systems, Renal Insufficiency chemically induced
- Abstract
Rationale and Purpose: To determine the usefulness of the Choyke questionnaire with a creatinine point-of-care test (POCT) to detect impaired renal function amongst outpatients receiving intravenous iodinated contrast in a tertiary centre., Materials and Methods: Between July and December 2012, 1361 outpatients had their serum creatinine determined by POCT and answered the Chokye questionnaire just before their examination., Results: Four hundred and eighty (35.2%) patients had at least one 'Yes' response. Forty-four patients (3.2%) had estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) and 14 patients (1.0%) have eGFR <45 mL/min/1.73 m(2). Sensitivity, specificity, positive predictive value and negative predictive value of the Choyke criteria in detecting patients with eGFR <60 mL/min/1.73 m(2) are respectively: 65.9%, 65.8%, 6.0% and 98.3% and to detect eGFR <45 mL/min/1.73 m(2): 92.9%, 65.3%, 2.7% and 99.9%. Only 'Yes' responses to 'Have you ever been told you have renal problems?' and 'Do you have diabetes mellitus?' were statistically significant in predicting eGFR <45 mL/min/1.73 m(2), with odds ratio 98.7 and 4.4 respectively., Conclusion: The Choyke questionnaire has excellent sensitivity and moderate-to-good specificity in detecting patients with <45 mL/min/1.73 m(2), below this level it has been shown that risk of contrast induced nephropathy increases significantly, making it an effective screening tool. Also the use of POCT can potentially reduce waiting time., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2015
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32. Adipocytes contribute to resistance of human melanoma cells to chemotherapy and targeted therapy.
- Author
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Chi M, Chen J, Ye Y, Tseng HY, Lai F, Tay KH, Jin L, Guo ST, Jiang CC, and Zhang XD
- Subjects
- Adipocytes cytology, Cell Line, Tumor, Cell Proliferation drug effects, Cisplatin pharmacology, Culture Media, Conditioned pharmacology, Docetaxel, Histone Deacetylase Inhibitors pharmacology, Humans, Keratinocytes metabolism, Keratinocytes pathology, Leptin deficiency, Leptin genetics, MAP Kinase Kinase Kinases antagonists & inhibitors, MAP Kinase Kinase Kinases genetics, MAP Kinase Kinase Kinases metabolism, Molecular Targeted Therapy, Phosphatidylinositol 3-Kinases genetics, Phosphatidylinositol 3-Kinases metabolism, Phosphoinositide-3 Kinase Inhibitors, Protein Kinase Inhibitors pharmacology, Proto-Oncogene Proteins c-akt antagonists & inhibitors, Proto-Oncogene Proteins c-akt genetics, Proto-Oncogene Proteins c-akt metabolism, RNA, Small Interfering genetics, RNA, Small Interfering metabolism, Receptors, Leptin antagonists & inhibitors, Receptors, Leptin genetics, Receptors, Leptin metabolism, Signal Transduction, Taxoids pharmacology, Adipocytes metabolism, Antineoplastic Agents pharmacology, Drug Resistance, Neoplasm genetics, Gene Expression Regulation, Neoplastic, Keratinocytes drug effects
- Abstract
Epidemiological evidence has linked the development and progression of several cancers including melanoma with obesity. However, whether obesity impinges on responses of cancer cells to treatment remains less understood. Here we report that human adipocytes contribute to resistance of melanoma cells to various therapeutic agents. Exposure to media from adipocyte cultures (adipocyte media) increased cell proliferation and reduced sensitivity of melanoma cells to apoptosis induced by diverse chemotherapeutic drugs, including the DNA-damaging drug cisplatin, the microtubuletargeting agent docetaxel, and the histone deacetylase inhibitor SAHA. This was associated with increased activation of PI3K/Akt and MEK/ERK signaling, and was attenuated by a PI3K or MEK inhibitor. The effect of adipocyte media on melanoma cells was, at least in part, due to the interaction between the adipokine leptin and its long form receptor OB-Rb, in that immunodepletion of leptin in adipocyte media or siRNA knockdown of OB-Rb in melanoma cells reversed the increase in Akt and ERK activation, enhancement in cell proliferation, and importantly, protection of melanoma cells against the drugs. In support, recombinant leptin partially recapitulated the effect of adipocyte media on melanoma cells. Of note, OB-Rb was increased on the surface of melanoma cells compared to melanocytes, whereas leptin short form receptors appeared to be suppressed post-transcriptionally, suggesting that OB-Rb was selectively upregulated in melanoma cells. Collectively, these results indicate that adipocytes contribute to the resistance of melanoma cells to chemotherapeutic drugs and agents targeting the PI3K/Akt and MEK/ERK pathways, and suggest that inhibition of the leptin/ OB-Rb system may be useful to improve the efficacy of multiple therapeutic approaches in the treatment of melanoma.
- Published
- 2014
- Full Text
- View/download PDF
33. Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: implications for planning 90Y radioembolization?
- Author
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Burgmans MC, Too CW, Kao YH, Goh AS, Chow PK, Tan BS, Tay KH, and Lo RH
- Subjects
- Adult, Aged, Brachytherapy methods, Embolization, Therapeutic methods, Female, Humans, Male, Middle Aged, Prognosis, Radiopharmaceuticals, Reproducibility of Results, Sensitivity and Specificity, Angiography, Digital Subtraction methods, Hepatic Artery diagnostic imaging, Liver Neoplasms therapy, Multimodal Imaging methods, Positron-Emission Tomography, Technetium Tc 99m Aggregated Albumin, Tomography, X-Ray Computed methods, Yttrium Radioisotopes therapeutic use
- Abstract
Purpose: To compare the hepatic falciform artery (HFA) detection rates of digital subtraction angiography (DSA), computed tomography hepatic arteriography (CTHA) and 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography with integrated CT (SPECT/CT) and to correlate HFA patency with complication rates of yttrium-90 (90Y) radioembolization., Material and Methods: From August 2008 to November 2010, 79 patients (range 23-83 years, mean 62.3 years; 67 male) underwent pre-treatment DSA, CTHA and 99mTc-MAA scintigraphy (planar/SPECT/CT) to assess suitability for radioembolization with 90Y resin microspheres. Thirty-seven patients were excluded from the study, because CTHA was performed with a catheter position that did not result in opacification of the liver parenchyma adjacent to the falciform ligament. DSA, CTHA and 99mTc-MAA SPECT/CT images and medical records were retrospectively reviewed., Results: A patent HFA was detected in 22 of 42 patients (52.3%). The HFA detection rates of DSA, CTHA and 99mTc-MAA SPECT/CT were 11.9%, 52.3% and 13.3%, respectively (p<0.0001). An origin from the segment 4 artery was seen in 51.7% of HFAs. Prophylactic HFA coil-embolization prior to 90Y microspheres infusion was performed in 2 patients. Of the patients who underwent radioembolization with a patent HFA, none developed supra-umbilical radiation dermatitis. One patient experienced epigastric pain attributed to post-embolization syndrome and was managed conservatively., Conclusion: The HFA detection rate of CTHA is superior to that of DSA and 99mTc-MAA SPECT/CT. Complications related to non-target radiation of the HFA vascular territory rarely occur, even in patients undergoing radioembolization with a patent HFA., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
34. Ministry of health clinical practice guidelines: clinical blood transfusion.
- Author
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Koh BC, Chong LL, Goh LG, Iau P, Kuperan P, Lee LH, Lim LC, Ng HJ, Sia A, Tan HH, Tan LK, Tay KH, Teo LT, Ting WC, and Yong TT
- Subjects
- Clinical Trials as Topic, Evidence-Based Medicine, Female, Humans, Male, Singapore, Blood Transfusion methods, Blood Transfusion standards, Guidelines as Topic, Practice Guidelines as Topic
- Abstract
The Health Sciences Authority (HSA) and the Ministry of Health (MOH) publish clinical practice guidelines on Clinical Blood Transfusion to provide doctors and patients in Singapore with evidence-based guidance for blood transfusion. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the HSA-MOH clinical practice guidelines on Clinical Blood Transfusion, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=25700). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
- Published
- 2011
35. Self-expanding nitinol stents in recanalisation of long-length superficial femoral artery occlusions in patients with critical limb ischaemia.
- Author
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Taneja M, Tay KH, Sebastian M, Pasupathy S, Lin SE, Teo T, Low R, Irani FG, Chng SP, Dewan A, and Tan BS
- Subjects
- Angiography, Blood Vessel Prosthesis Implantation methods, Female, Femoral Artery diagnostic imaging, Humans, Male, Middle Aged, Peripheral Vascular Diseases diagnostic imaging, Retrospective Studies, Blood Vessel Prosthesis Implantation instrumentation, Femoral Artery surgery, Limb Salvage, Peripheral Vascular Diseases surgery, Stents
- Abstract
Introduction: This study aims to evaluate our experience with self-expanding nitinol stent- enabled recanalisation of long-length occlusions (30 cm or more) of the superficial femoral artery (SFA)., Methods: 573 patients underwent 842 lower limb interventions from August 2006 to December 2008. A retrospective review of patients undergoing recanalisation of long-length SFA occlusions with self-expanding nitinol stents and an evaluation of their patency and impact on limb salvage, were done., Results: 22 patients (mean age 62.5 years, male: female ratio 11:11) underwent 22 long-length SFA stenting procedures. The spectrum of critical limb ischaemia included rest pain (five), ulcer (six) and gangrene (11). Length of occlusions varied from 30 cm to 45 cm (average length 36.4 cm). Five patients had stents placed through the ipsilateral popliteal artery approach, and the rest had stents placed through the femoral artery approach. All patients were followed up over an average duration of 12 months. One patient died due to associated medical conditions during this period. Six out of 21 (28.6 percent) of the stents thrombosed completely on one year follow-up. Of these, two patients underwent amputation, one patient had a bypass, and the stent in two patients were recanalised with balloon angioplasty. All remaining patent stents showed varying degrees of stenoses at one year. The overall limb salvage rate at one year following stent placement was 81 percent., Conclusion: Our experience showed the beneficial result of long-length SFA stent placement with good limb salvage outcome. Repeat interventions may be required to maintain the patency of stents in these patients.
- Published
- 2009
36. Endovascular aortic repair: the experience of two tertiary institutions in Singapore.
- Author
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Gill SS, Sebastian MG, Tan SG, Chia KH, Tan BS, and Tay KH
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Singapore, Stents, Time Factors, Treatment Outcome, Aorta surgery, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation methods
- Abstract
Introduction: Endovascular aortic repair (EVAR) has gained prominence as a means of treating aortic disease, with lower perioperative morbidity and mortality compared to open surgery. This article aimed to describe the experience of two tertiary hospitals in a Southeast Asian population., Methods: A retrospective review of 100 consecutive patients undergoing EVAR in two hospitals in Singapore was conducted. This included patients undergoing elective as well as emergency repair., Results: The mean duration of follow-up was 31.8 months. The mean aneurysm size was 6.3 cm and the mean length of stay was 12.1 days. 64 percent of the patients were of American Society of Anesthesiologists class III or above. The deployment success was 98 percent. Major complications (acute myocardial infarction, pneumonia, cerebrovascular accidents, renal failure, colonic infarction and spinal cord infarction) occurred in 18 patients. Perioperative mortality occurred in six percent of cases. The endoleak rate was 28 percent. Both patients with colonic infarction had a single patent internal iliac artery post-procedure, and end-stage renal failure., Conclusion: Our results are comparable to published experiences in aortic stenting. Our population possibly had a higher incidence of short common iliac arteries. Revascularisation of internal iliac arteries should be considered for patients with end-stage renal failure and a single patent internal iliac artery.
- Published
- 2009
37. Use of magnetic resonance imaging in evaluation of placental invasion.
- Author
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Teo TH, Law YM, Tay KH, Tan BS, and Cheah FK
- Subjects
- Adult, Female, Humans, Pregnancy, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Retrospective Studies, Ultrasonography, Prenatal, Magnetic Resonance Imaging methods, Placenta Accreta diagnosis, Prenatal Diagnosis methods
- Abstract
Aim: To review and describe the magnetic resonance imaging (MRI) features in patients with suspected placental invasion and correlate the findings with surgery and pathology findings., Materials and Methods: A retrospective review was undertaken of the MRI images of seven consecutive patients with ultrasound findings suspicious for placental invasion. Two experienced MRI radiologists, blinded to the pathology and surgery findings, reviewed the MRI. The pathology or surgical findings were used as the reference standard to establish accuracy and concordance with the MRI findings., Results: Three MRI features described in an earlier series were consistently present in the patients with placental invasion: lower uterine bulging, heterogeneous placenta, and dark intraplacental linear bands on T2-weighted images., Conclusion: MRI features, which were described in patients with placental invasion in an earlier series, were useful in establishing the presence and depth of placental invasion.
- Published
- 2009
- Full Text
- View/download PDF
38. Prognostic factors in patients with acute liver failure undergoing live donor liver transplantation.
- Author
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Rajekar H, Wai CT, Majeed TA, Lee KH, Wong SY, Leong SO, Singh R, Tay KH, Soosaynathan C, and Tan KC
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Creatinine blood, Female, Humans, International Normalized Ratio, Liver drug effects, Liver injuries, Liver Function Tests, Liver Transplantation mortality, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Analysis, Survivors, Liver Failure, Acute surgery, Liver Transplantation physiology, Living Donors
- Abstract
Mortality from acute liver failure (ALF) is high. Live donor liver transplantation (LDLT) is the treatment of choice for ALF in Asia, because cadaveric donors are rare. We sought to review our results in ALF patients with undergoing LDLT at our center. One hundred two LDLTs were performed at our center from April 2002 to November 2007, 15 (14%) because of ALF. Mean (SEM; median, range) follow-up was 1,065 (189; 1400; 3-2046) days. Nine patients (60%) had acute exacerbation of chronic hepatitis B; and 6 (40%) had drug-induced liver injury. Age was 47 (3; 50; 27-65) years. Ten patients (67%) were men. At transplantation, laboratory values were included bilirubin, 449 (35) micromol/L; creatinine concentration, 182 (32) mmol/L. The international normalized ratio was 2.4 (0.2). The Model for End-Stage Liver Disease (MELD) score was 34 (2). Both inpatient and long-term mortality was 20% 3 of 15 patients died. The 5-year survival was 80%. Compared with survivors, patients who died had a significantly higher creatinine concentration 289 vs 155 micromol/L, international normalized ratio (3.4 vs 2.1), MELD score (47 vs 32). We conclude that despite being sick with median and mean MELD scores of 32 and 34, 80% of patients with ALF can achieve good long-term survival after LDLT.
- Published
- 2008
- Full Text
- View/download PDF
39. Experience of the transplant team is an important factor for posttransplant survival in patients with hepatocellular carcinoma undergoing living-donor liver transplantation.
- Author
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Majeed TA, Wai CT, Rajekar H, Lee KH, Wong SY, Leong SO, Singh R, Tay KH, Chen J, and Tan KC
- Subjects
- Hepatitis B, Chronic complications, Hepatitis B, Chronic surgery, Hepatitis C, Chronic complications, Hepatitis C, Chronic surgery, Humans, Liver Transplantation mortality, Middle Aged, Patient Care Team statistics & numerical data, Patient Selection, Postoperative Period, Survivors, Time Factors, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Liver Transplantation statistics & numerical data, Living Donors, Patient Care Team standards
- Abstract
Living-donor liver transplantation (LDLT) is an effective treatment for patients with unresectable hepatocellular carcinoma (HCC). However, it remains controversial whether expanded listing criteria can be used for LDLT. We aimed to review results of LDLT for patients with HCC at our center. Patients with HCC were accepted for LDLT if there was no extrahepatic spread on computed tomography (CT) and positron emission tomography CT scan. Transarterial chemoembolization was performed before LDLT to control the tumors. Sirolimus or everolimus was used as part of the immunosuppressive protocol for all patients. Over the last 6 years, 35 of the 102 (34%) LDLT were performed at our center for HCC. Age (mean +/- SEM) was 55.3 +/- 1.3 years; 28 patients (80%) were men. Eight (23%) had LDLT performed in 2002 or 2003 (period 1), and 27 (77%) in 2004 to 2007 (period 2). Eleven (31%) were within and 23 (69%) were outside the Milan criteria. After 583 +/- 76 days follow-up, nine (25%) died, three of recurrent HCC. Three-year survival was significantly better in period 2 than in period 1 (90% vs 13%; P < .001). Although the 3-year survival for those within Milan criteria was better than those outside Milan criteria, the difference did not reach statistical significance (86% vs 57%; P = .26). Six (17%) had HCC recurrence, of whom five died. We concluded that reasonable medium-term survival can be obtained for patients with HCC. The experience level of the transplant team seemed to be the most important predictor of patient outcome.
- Published
- 2008
- Full Text
- View/download PDF
40. Retrospective audit of the acute management of stroke in two district general hospitals in the uk.
- Author
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Faluyi OO, Omodara JA, Tay KH, and Muhiddin K
- Abstract
Background: There is some evidence to suggest that the standard of acute medical care provided to patients with cerebrovascular disease is a major determinant of the eventual outcome. Consequently, the Royal College of Physicians (RCP) of London issues periodic guidelines to assist healthcare providers in the management of patients presenting with stroke., Objective: An audit of the acute management of stroke in two hospitals belonging to the same health care trust in the UK., Method: Retrospective review of 98 randomly selected case-notes of patients managed for cerebrovascular disease in two acute hospitals in the UK between April and June 2004. The pertinent guidelines of RCP (London) are highlighted while audit targets were set at 70%., Results: 84% of patients presenting with cerebrovascular disease had a stroke rather than a TIA, anterior circulation strokes were commonest. All patients with stroke were admitted while those with TIAs were discharged on the same day but most patients with TIA were not followed up by Stroke specialists. Most CT-imaging of the head was done after 24 hours delaying the commencement of anti-platelets for patients with ischaemic stroke or neurosurgical referral for haemorrhagic stroke. Furthermore, there was a low rate of referral for carotid ultrasound in patients with anterior circulation strokes. Anti-platelets and statins were commenced for most patients with ischaemic stroke while diabetes was well controlled in most of them. However, ACE-inhibitors and diuretics such as indapamide were under-utilized for secondary prevention in such patients. Warfarin anti-coagulation was underutilized in patients with ischaemic stroke who had underlying chronic atrial fibrillation. While there was significant multi-disciplinary team input, dysphagia and physiotherapy assessments were delayed. Similarly, occupational therapy input and psychological assesment were omitted from the care of most patients., Conclusion: Hospital service provision for the management of cerebrovascular disease needs to provide appropriate specialist follow up for patients with TIA, prompt radiological imaging and multi-disciplinary team input for patients with stroke. Furthermore, physicians need to utilize appropriate antihypertensives and anti-coagulation more frequently in the secondary prevention of stroke.
- Published
- 2008
- Full Text
- View/download PDF
41. Conservative management of placenta accreta: review of three cases.
- Author
-
Tong SY, Tay KH, and Kwek YC
- Subjects
- Adult, Female, Humans, Placenta Accreta surgery, Pregnancy, Obstetric Surgical Procedures methods
- Abstract
Placenta accreta occurs when the placenta is abnormally adherent to the uterus, often resulting in complications in the peripartum period such as severe haemorrhage, a possible need for caesarean hysterectomy, and even severe injuries to pelvic organs. There has been a gradual shift towards conservative management of placenta accreta, involving uterine and placental conservation, with the main aim being to reduce pelvic injury and haemostasis with the aid of intervention radiology by means of insertion of occluding balloons into the internal iliac arteries. This strategy has previously been shown to reduce morbidity and mortality in carefully selected cases of placenta accreta. We review three cases of successful uterine conservation performed in our institution.
- Published
- 2008
42. Gadolinium-enhanced magnetic resonance angiography in renal artery stenosis: comparison with digital subtraction angiography.
- Author
-
Law YM, Tay KH, Gan YU, Cheah FK, and Tan BS
- Subjects
- Adult, Aged, Artifacts, Female, Humans, Kidney Transplantation, Male, Middle Aged, Postoperative Complications diagnosis, Retrospective Studies, Sensitivity and Specificity, Singapore, Angiography, Digital Subtraction, Contrast Media, Gadolinium DTPA, Image Processing, Computer-Assisted, Imaging, Three-Dimensional, Magnetic Resonance Angiography, Renal Artery Obstruction diagnosis
- Abstract
Objectives: To evaluate the accuracy of gadolinium-enhanced magnetic resonance angiography in assessing renal artery stenosis compared to catheter digital subtraction angiography., Design: Retrospective study., Setting: Singapore General Hospital., Patients: Records of patients who underwent magnetic resonance angiography as well as digital subtraction angiography for assessment of renal artery stenosis from January 2003 to December 2005 were reviewed., Results: There were 27 patients (14 male, 13 female) with a mean age of 62 (range, 44-77) years. There were 10 patients with renal transplants; their native renal arteries were not evaluated. Each of the two experienced interventional and body magnetic resonance radiologists, who were blinded to the results, reviewed the digital subtraction angiography and magnetic resonance angiography images respectively. Digital subtraction angiography was used as the standard of reference. A total of 39 renal arteries from these 27 patients were evaluated. One of the arteries was previously stented and could not be assessed with magnetic resonance angiography due to severe artefacts. Of the remaining 38 renal arteries, two were graded as normal, seven as having mild stenosis (<50%), eight as having moderate stenosis (> or =50% but <75%), and 21 as having severe stenosis (> or =75%). Magnetic resonance angiography and digital subtraction angiography were concordant in 89% of the arteries; magnetic resonance angiography overestimated the degree of stenosis in 8% and underestimated it in 3% of them. In the evaluation of clinically significant renal artery stenosis (> or =50%) with magnetic resonance angiography, the overall sensitivity, specificity, positive predictive value, and negative predictive value were 97%, 67%, 90%, and 86% respectively. The sensitivity and specificity of magnetic resonance angiography in transplant renal artery stenosis was 100%. CONCLUSION. Our experience suggested that gadolinium-enhanced magnetic resonance angiography is a sensitive non-invasive modality useful in the assessment of clinically significant renal artery stenosis.
- Published
- 2008
43. The contrasting presentation and management of pseudoangiomatous stromal hyperplasia of the breast.
- Author
-
Sng KK, Tan SM, Mancer JF, and Tay KH
- Subjects
- Adolescent, Angiomatosis diagnostic imaging, Angiomatosis pathology, Angiomatosis surgery, Breast Diseases diagnostic imaging, Breast Diseases pathology, Breast Diseases surgery, Breast Neoplasms diagnosis, Diagnosis, Differential, Female, Humans, Hyperplasia diagnosis, Mammaplasty, Radiography, Angiomatosis diagnosis, Breast Diseases diagnosis, Stromal Cells pathology
- Abstract
Pseudoangiomatous stromal hyperplasia of the breast is a benign entity characterised by dense, collagenous proliferation of mammary stroma, forming interanastomosing capillary-like spaces lined by slender spindle cells. These spaces are not true vascular spaces, hence the term "pseudoangiomatous". We report two 14-year-old girls, who presented to us with pseudoangiomatous stromal hyperplasia of the breast. We believe that our patients represent two of the youngest ethnic Chinese females to be reported with this rare condition. The development of such a rapidly enlarging lesion often leads to anxiety and concern about malignancy, and emphasises the importance in appropriate diagnosis and management. We discuss the aetiology, clinical presentation, radiological and pathological features, as well as management of this unusual condition.
- Published
- 2008
44. Management of pyogenic liver abscesses - percutaneous or open drainage?
- Author
-
Chung YF, Tan YM, Lui HF, Tay KH, Lo RH, Kurup A, and Tan BH
- Subjects
- Aged, Digestive System Surgical Procedures adverse effects, Drainage methods, Humans, Liver Abscess, Pyogenic diagnosis, Liver Abscess, Pyogenic mortality, Male, Middle Aged, Minimally Invasive Surgical Procedures adverse effects, Minimally Invasive Surgical Procedures methods, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Survival Rate, Digestive System Surgical Procedures methods, Endoscopy methods, Liver Abscess, Pyogenic surgery
- Abstract
This pictorial essay aims to review the literature on the management of pyogenic liver abscess, focusing on the choice of drainage. Articles on the treatment of pyogenic liver abscess, accessed through a MEDLINE search using PubMed, were reviewed. A case series of the authors' experience with clinicopathological correlation is presented to highlight the indication and outcome of each modality of drainage. Intravenous antibiotic is the first line, and mainstay, of treatment. Drainage is necessary for large abscesses, equal to or larger than 5 cm in size, to facilitate resolution. While percutaneous drainage is appropriate as first-line surgical treatment in most cases, open surgical drainage is prudent in cases of rupture, multiloculation, associated biliary or intra-abdominal pathology. Percutaneous drainage may help to optimise clinical condition prior to surgery. Laparoscopic drainage is a feasible surgical option with promising results in the future. Liver resection is reserved for concomitant localised intrahepatic disease and tumour, after control of sepsis. The final verdict on the outcome of percutaneous versus open surgical drainage of pyogenic liver abscesses requires further studies in a controlled trial setting. Nevertheless, in current good clinical practices, the choice of therapy needs to be individualised according to patient's clinical status and abscess factors. They are complementary in the management of liver abscesses.
- Published
- 2007
45. Endovascular stent graft treatment of leaking thoracic aortic tuberculous pseudoaneurysm.
- Author
-
Loh YJ, Tay KH, Mathew S, Tan KL, Cheah FK, and Sin YK
- Subjects
- Aneurysm, False pathology, Aneurysm, False surgery, Aorta, Thoracic pathology, Aorta, Thoracic surgery, Humans, Male, Middle Aged, Radiography, Tuberculosis, Cardiovascular diagnostic imaging, Tuberculosis, Cardiovascular surgery, Aneurysm, False microbiology, Aorta, Thoracic microbiology, Stents, Tuberculosis, Cardiovascular pathology
- Abstract
Mycobacterium tuberculosis infection is one of the leading causes of death from communicable diseases worldwide. However, the incidence of leaking thoracic aortic tuberculous pseudoaneurysms is rare as a complication. Conventional treatment of a leaking tuberculous pseudoaneurysm involves surgery with graft interposition or patch repair. With the emergence of stent graft treatment as a viable option for leaking pseudoaneurysms, we report a 63-year-old man who had his leaking toracic aortic tuberculous pseudoaneurysm treated with endovascular stent grafting.
- Published
- 2007
46. Management of adult choledochal cyst.
- Author
-
Tan SS, Tan NC, Ibrahim S, and Tay KH
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anastomosis, Roux-en-Y, Cholangiocarcinoma complications, Cholangiopancreatography, Endoscopic Retrograde, Cholecystolithiasis complications, Choledochal Cyst classification, Female, Humans, Hypertension, Portal complications, Liver Cirrhosis complications, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Biliary Tract Surgical Procedures methods, Choledochal Cyst complications, Choledochal Cyst surgery
- Abstract
Introduction: Choledochal cyst is a rare benign biliary disease mostly presenting during childhood. Adult presentation is rare and associated diseases and complications are common. This paper aims to review the management of adult patients who presented to our institution with choledochal cyst, focusing on their presentation, preoperative investigations, surgical treatment given and postoperative course., Methods: A retrospective review of all our choledochal cyst patients from January 2000 to August 2004 was performed. Data collected included demographics and clinical information., Results: There were ten patients, eight female (80 percent) and two male (20 percent). The average age at presentation was 38.6 (range 16-81) years. The commonest presenting complaints were obstructive biliary disease (nine out of ten, 90 percent). There were seven Type I (70 percent), one type IVA (10 percent), one type IVB (10 percent) and one (10 percent) with Caroli's disease. Two patients had concomitant cholangiocarcinoma (20 percent). Three patients had associated cystolithiasis and one patient had pancreatitis. One patient had early cirrhosis due to her disease. Six patients underwent total cyst excision with a Roux-en-Y hepaticojejunostomy. One patient who previously had a biliary bypass underwent further resection of her cyst and Whipple's operation because of development of cholangiocarcinoma in the distal remnant cyst. They are currently well with no surgical complications. The average length of follow-up was 16 months (range six months to three years)., Conclusion: Adult patients with choledochal cyst have associated biliary problems such as the presence of cholangiocarcinoma, cystolithiasis, cholecystitis and liver cirrhosis with portal hypertension. They tend to present similar to obstructive biliary disease. The best surgical option for these patients is a total cyst excision together with a Roux-en-Y hepaticojejunostomy.
- Published
- 2007
47. Delayed fungal infection following augmentation mammoplasty in an immunocompetent host.
- Author
-
Tian HH, Tan SM, and Tay KH
- Subjects
- Adult, C-Reactive Protein analysis, Female, Humans, Immunocompetence, Mycoses diagnosis, Prosthesis-Related Infections diagnosis, Time Factors, Breast Implantation, Breast Implants adverse effects, Prosthesis-Related Infections microbiology, Trichosporon
- Abstract
We report an unusual case of infection of a breast implant with Trichosporon spp. in an immunocompetent host. There has only been one other reported case in the published literature. The patient was a healthy 27-year-old woman who presented with pain and swelling 17 months after augmentation mammoplasty with a saline implant. Ultrasound-guided aspiration of the effusion surrounding the implant yielded Trichosporon spp. on culture. Oral therapy with fluconazole was commenced, and the implant was salvaged. The nature of this fungi, its mode of transmission and treatment are reviewed. The implications and management of implant infections are also discussed. Physicians should be aware that infection may be delayed, and cultures should be performed for aerobic and anaerobic organisms as well as acid-fast bacilli and fungi. Prompt and appropriate antimicrobial treatment may arrest the infection, sparing the patient the morbidity of a surgical drainage or implant removal.
- Published
- 2007
48. Delayed diagnosis of chronic mesenteric ischaemia.
- Author
-
Woon CY, Tay KH, and Tan SG
- Subjects
- Anastomosis, Surgical, Angiography, Blood Flow Velocity, Blood Vessel Prosthesis Implantation methods, Chronic Disease, Diagnosis, Differential, Hepatic Artery surgery, Humans, Ischemia etiology, Ischemia surgery, Male, Mesenteric Artery, Inferior diagnostic imaging, Mesenteric Artery, Superior diagnostic imaging, Mesenteric Artery, Superior surgery, Mesenteric Vascular Occlusion complications, Mesenteric Vascular Occlusion surgery, Middle Aged, Prognosis, Time Factors, Tomography, X-Ray Computed, Ultrasonography, Doppler, Duplex, Ischemia diagnosis, Mesenteric Vascular Occlusion diagnosis, Mesentery blood supply
- Abstract
Chronic mesenteric ischaemia is a rare disease. Patients typically present with a protracted course of vague abdominal symptoms and profound weight loss, leading to a delay in diagnosis. If untreated, it progresses to bowel infarction, which has a poor prognosis. Once diagnosed, however, it can be easily remedied via endovascular stenting or open surgery. Symptom reversal is prompt and patients rapidly achieve premorbid habitus. We report a 58-year-old man in whom the diagnosis was missed for two years, during which numerous investigations were performed. The diagnosis was eventually revealed on angiography, and he was cured by mesenteric bypass surgery. For patients with the triad of chronic, unrelenting weight loss, sitophobia (food fear) and postprandial abdominal pain, this condition must be considered, and actively sought after with angiography.
- Published
- 2007
49. Finding hepatic portal venous gas in an adult patient: its significance.
- Author
-
Gan HN, Tan KY, Chong CK, and Tay KH
- Subjects
- Fatal Outcome, Humans, Liver Circulation, Liver Failure, Acute, Male, Middle Aged, Portal Vein diagnostic imaging, Radiography, Embolism, Air etiology, Enterocolitis, Necrotizing complications, Ischemia complications, Pneumatosis Cystoides Intestinalis complications, Pneumonia complications, Portal Vein pathology
- Abstract
Portal venous gas is a well-established radiological finding in neonates. With the advancement in diagnostic imaging, more cases are being reported in adults. We present a 55-year-old man with radiological findings of both portal venous gas and pneumatosis intestinalis secondary to ischaemic necrotising enterocolitis, with subsequent fatality. The significance of finding portal venous gas and its possible aetiology is discussed.
- Published
- 2006
50. Successful management of a bleeding duodenal varix by endoscopic banding.
- Author
-
Tan NC, Ibrahim S, and Tay KH
- Subjects
- Duodenoscopy, Humans, Ligation methods, Liver Cirrhosis complications, Male, Middle Aged, Duodenum blood supply, Gastrointestinal Hemorrhage therapy, Varicose Veins therapy
- Abstract
Endoscopic treatment of bleeding duodenal varices is less invasive than the usual surgical options. However, there is limited experience with endoscopic treatment of bleeding duodenal varices, especially with that of endoscopic ligation. We report a 55-year-old man with a bleeding duodenal varix that was successfully ligated endoscopically. He has been followed up for nine months with no recurrence of bleeding. Endoscopic ligation may offer a new and effective treatment modality for bleeding duodenal varix.
- Published
- 2005
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