MyMedR

Fulltext Early experience of video-assisted thoracoscopic surgery

Lee YM, Lim YC, Liam CK, Majid A

Med J Malaysia, 1996 Mar;51(1):109-13.

Consecutive 25 patients (M/F:18/7) underwent video-assisted thoracoscopic surgery (VATS) for various chest illnesses. These included nine cases of pneumothorax, three cases of pericardial effusion, three cases of pleural effusion, four cases of lung lesion requiring either incisional or excisional biopsy, two cases of empyema, one case of traumatic haemothorax, and three cases of mediastinal lesion. The mean age was 36.2 years (range 19-78 years). A total of forty-three procedures were performed. The mean durations of intrapleural chest-tube requirement and hospitalisation following VATS alone were 4.5 days (range: 0-13 days) and 8.3 days (range: 2-25 days) respectively. No intraoperative complication and VATS procedure-related mortality reported. Apart from simple analgesics such as paracetamol or tramadolol, no opiate analgesia was given to patients undergoing only VATS. The results support that VATS is a safe and effective procedure in the management of pulmonary, mediastinal, pericardial and pleural diseases and the treatment of persistent and recurrent spontaneous pneumothorax.

Fulltext Use of pressurised aerosol inhalers among patients attending the Chest Clinic and Primary Care Department of University Hospital, Kuala Lumpur

Liam CK, Lo YL, Yap BH, Low SH, Ariwalagam M

Med J Malaysia, 1993 Sep;48(3):273-9.

PMID: 8183138

Eighty consecutive patients who came to collect their prescriptions for pressurised aerosol inhalers at the Pharmacy of the University Hospital, Kuala Lumpur, were interviewed regarding their use of the pressurised inhaler. Their inhaler technique was also assessed. A significant proportion inhaled the steroid aerosol before the bronchodilator and 23.5% used the steroid inhaler for relief of acute dyspnoea. Only 28.8% of the 80 patients performed correctly all 6 steps necessary for the proper use of inhalers. The most common mistake was the failure to inhale slowly and deeply. Patients who had used the device for more than 5 years performed better, while correct inhaler technique was not dependent on the patient's sex, age or level of education.

Study site: Chest clinic, University Malaya Medical Centre (UMMC)

Fulltext Intrapulmonary bronchogenic cyst presenting with haemoptysis

Liam CK

Med J Malaysia, 1994 Dec;49(4):404-5.

PMID: 7674976

A 36-year-old man presented with haemoptysis and his admission chest radiograph showed a large thin walled cystic lesion with an air-fluid level in the left lower lobe. The pathological diagnosis of the lesion, which was removed by a left lower lobe resection, was an intrapulmonary bronchogenic cyst.

Fulltext Pulmonary involvement by Hodgkin's disease mimicking pneumonia

Liam CK, Wong KT, Lim YC

Med J Malaysia, 1997 Mar;52(1):84-6.

PMID: 10968059

A 24-year-old man who was initially thought to have nocardiosis of his mediastinal lymph node which progressed to involve his right lung, had to undergo a right pneumonectomy when he failed to respond to treatment with sulphadiazine. Histology of the right lung specimen and a subsequent axillary lymph node biopsy revealed that he actually had lymphocyte-depleted Hodgkin's disease.

Fulltext Recurrent re-expansion pulmonary oedema complicating rapid decompression of large pneumothoraces

Liam CK, Jaafar S

Med J Malaysia, 1991 Jun;46(2):199-202.

PMID: 1839427

A young male who developed ipsilateral pulmonary oedema on two occasions as a complication of treatment of pneumothoraces involving the left lung is reported. The importance of large pneumothoraces, the rapidity of decompression and the application of suction to the pleural space as factors predisposing to the development of re-expansion pulmonary oedema is well demonstrated by this case. The re-expansion pulmonary oedema was more severe on the second occasion when the lung had collapsed for a longer duration compared to the first pneumothorax which was of more recent onset.

Fulltext Culture-positive thoracic empyema in adults

Liam CK, Pendek R, Navaratnam P, Hassan H, Puthucheary SD, Abdul Majid A, et al.

Med J Malaysia, 1990 Jun;45(2):169-76.

PMID: 2152022

Twenty-nine adult patients with culture-positive thoracic empyema were seen at the University Hospital Kuala Lumpur from 1984 to 1988. Cough, fever, chest pain, dyspnoea and weight loss were the common presenting symptoms. The empyema in 16 patients was associated with primary bronchopulmonary infections, nine occurred following thoracentesis of culture-sterile pleural effusions, two occurred as post-thoracic surgery complications, one following a subdiaphragmatic abscess and one as a result of a stab wound. The most common culture isolates were Streptococcus milleri, Pseudomonas aeruginosa and Klebsiella pneumoniae. Closed tube thoracostomy, the most common form of drainage procedure employed, was able to effect a cure or control of the empyema in 11 out of 19 patients in whom it was used.

Fulltext Haemangioma-thrombocytopenia syndrome--a case report

Liam CK, Nuruddin R

Med J Malaysia, 1989 Sep;44(3):263-6.

PMID: 2626143

A 29 year old Chinese female who presented with spontaneous purpura, was found to have gross hepatomegaly and thrombocytopenia. The thrombocytopenia responded to steroid therapy but relapsed when the dose of steroid was tapered down. Subsequent investigations revealed that the hepatomegaly was due to a large haemangioma of her liver. For symptomatic hepatic haemangioma, surgical excision is the treatment of choice; this was refused by the patient.

Fulltext Significant morbidity associated with asthma: a need for increased doctor and patient education

Liam CK

Med J Malaysia, 2003 Oct;58(4):471-4.

PMID: 15190620

Application of 18F-FDG PET-CT in the management of pulmonary nodule and mass - a pictorial review

Wong TH, Tan TH, George UR, Kow KS, Liam CK

Med J Malaysia, 2019 Jun;74(3):250-256.

PMID: 31256186

BACKGROUND: Lung cancer is one of the leading causes of cancer-related mortality worldwide. Pulmonary nodules are commonly encountered in clinical practice because of the recent implementation of low-dose CT lung screening programme, incidental finding on cardiac CT or CT for nonthoracic related disease. 18F-FDG PET-CT plays an important role in the management of pulmonary nodules.

METHODS: In this pictorial review, we present six different scenarios of using 18F-FDG PET-CT in the management of suspicious pulmonary nodule or mass. The advantages and limitations of 18F-FDG PET-CT and Herder model are discussed.

RESULTS: 18F-FDG PET-CT with risk assessment using Herder model provides added value in characterising indeterminate pulmonary nodules. Besides, 18F-FDG PET-CT is valuable to guide the site of biopsy and provide accurate staging of lung cancer.

CONCLUSION: To further improve its diagnostic accuracy, careful history taking, and CT morphological evaluation should be taken into consideration when interpreting 18FFDG PET-CT findings in patients with these nodules.

Fulltext Therapeutic intervention scoring system in medical intensive care

Adam BA, Liam CK, Abdul Wahab AS

Med J Malaysia, 1989 Jun;44(2):134-9.

PMID: 2626120

A scoring system based on therapeutic intervention on critically ill patients called the therapeutic intervention scoring system (TISS) was used to assess the quantity of care provided in a medical intensive care unit. Besides observing the unit census, the severity of illness and the work load were studied. The survival rate was 77 percent. The non-survivors had admission TISS points higher than the survivors and their mean daily TISS was more than 20 points. The survivors at discharge had a mean TISS of five points. The work load showed that a nurse can effectively manage two patients who together may accumulate 24 TISS points per day. TISS points per patient rather than bed occupancy is a better indicator of the nurse's work load. Admission criteria and procedures before death certification are outlined.
Comment in: Delilkan AE. Therapeutic intervention scoring system in medical intensive care. Med J Malaysia. 1989 Dec;44(4):361-2

Mucinous carcinoma (colloid carcinoma) of the lung diagnosed by fine needle aspiration cytology: a case report

Jayaram G, Yaccob R, Liam CK

Malays J Pathol, 2003 Jun;25(1):63-8.

PMID: 16196380

Mucinous carcinoma of the lung, also known as colloid carcinoma, is an uncommon tumour that is rarely encountered in fine needle aspiration (FNA) cytological practice. A 64-year-old Chinese male presenting with blood stained sputum and hoarseness of voice was discovered to have a 3 cm sized mass in the left lung. Neither bronchial washings nor transthoracic FNA yielded positive results at this stage. Six months later the patient returned to the hospital with a larger tumour and mediastinal lymphadenopathy. Transbronchial lymph node FNA, reported as negative for malignancy showed normal, hyperplastic and mildly atypical bronchial epithelial cells as well as a few single cells and extracellular mucin. Transthoracic FNA of the lung lesion performed under computed tomographic guidance showed characteristic cytological features of this tumour, establishing the diagnosis.

Fulltext Non-classical Bordetella sp. (closely related to Bordetella hinzii and Bordetella pseudohinzii) lower respiratory tract infection in a patient with extensive bronchiectasis: a case report

Loong SK, Liam CK, Karunakaran R, Tan KK, Mahfodz NH, AbuBakar S

J Int Med Res, 2024 Jan;52(1):3000605231214464.

PMID: 38216150 DOI: 10.1177/03000605231214464

An increasing number of reports have described the pathogenic nature of several non-classical Bordetella spp. Among them, Bordetella hinzii and Bordetella pseudohinzii have been implicated in a myriad of respiratory-associated infections in humans and animals. We report the isolation of a genetically close relative of B. hinzii and B. pseudohinzii from the sputum of a woman in her early 60s with extensive bronchiectasis who presented with fever and brown colored sputum. The isolate had initially been identified as Bordetella avium by API 20NE, the identification system for non-enteric Gram-negative rod bacteria. Sequencing of the 16S rDNA, ompA, nrdA, and genes used in the Bordetella multilocus sequence typing scheme could not resolve the identity of this Bordetella isolate. Whole-genome single nucleotide polymorphism analysis positioned the isolate between B. hinzii and B. pseudohinzii in the phylogenetic tree, forming a distinct cluster. Whole-genome sequencing enabled the further identification of this rare organism, and should be considered for wider applications, especially the confirmation of organism identity in the clinical diagnostic microbiology laboratory.

Asthma in Asia: Physician perspectives on control, inhaler use and patient communications

Price D, David-Wang A, Cho SH, Ho JC, Jeong JW, Liam CK, et al.

J Asthma, 2016 09;53(7):761-9.

PMID: 27096388 DOI: 10.3109/02770903.2016.1141951

OBJECTIVE: We examined the physician perspectives on asthma management in Asia.

METHODS: An online/face-to-face, questionnaire-based survey of respiratory specialists and primary care physicians from eight Asian countries/region was carried out. The survey explored asthma control, inhaler selection, technique and use; physician-patient communications and asthma education. Inclusion criteria were >50% of practice time spent on direct patient care; and treated >30 patients with asthma per month, of which >60% were aged >12 years.

RESULTS: REALISE Asia (Phase 2) involved 375 physicians with average 15.9(±6.8) years of clinical experience. 89.1% of physicians reporting use of guidelines estimated that 53.2% of their patients have well-controlled (GINA-defined) asthma. Top consideration for inhaler choice was asthma severity (82.4%) and lowest, socio-economic status (32.5%). Then 54.7% of physicians checked their patients' inhaler techniques during consultations but 28.2(±19.1)% of patients were using their inhalers incorrectly; 21.1-57.9% of physicians could spot improper inhaler techniques in video demonstrations. And 79.6% of physicians believed combination inhalers could increase adherence because of convenience (53.7%), efficacy (52.7%) and usability (18.9%). Initial and follow-up consultations took 16.8(±8.4) and 9.2(±5.3) minutes, respectively. Most (85.1%) physicians used verbal conversations and least (24.5%), video demonstrations of inhaler use; 56.8% agreed that patient attitudes influenced their treatment approach.

CONCLUSION: Physicians and patients have different views of 'well-controlled' asthma. Although physicians informed patients about asthma and inhaler usage, they overestimated actual usage and patients' knowledge was sub-optimal. Physician-patient interactions can be augmented with understanding of patient attitudes, visual aids and ancillary support to perform physical demonstrations to improve treatment outcomes.

Common fears of patients undergoing bronchoscopy

Poi PJ, Chuah SY, Srinivas P, Liam CK

Eur Respir J, 1998 May;11(5):1147-9.

PMID: 9648970

In the world of medical literature, little has been reported about the fears of patients undergoing bronchoscopy. The aim of this study was to identify the common fears of patients undergoing fibreoptic bronchoscopy and to determine whether any factors might contribute to reducing these fears. One hundred and four consecutive patients undergoing bronchoscopy were interviewed. Sixty one patients expressed fear about the procedure, as follows: afraid of pain (33); afraid of breathing difficulties (11); afraid of oropharyngeal irritation (5); afraid of the bronchoscopy findings (2); afraid of sedation, cross-infection and nasal lignocaine spray, respectively (3); and unable to be specific (7). There was no difference between the "no fear" and "fearful" groups in ethnicity, source of referral, education, previous endoscopy, doctors' explanation and the patients' understanding of the procedure and its indication. "Fearful" patients were significantly younger (t=2.082, p=0.037) and female (chi2=4.180, p=0.038). Doctors were more likely to explain the indication for bronchoscopy than how it would be performed (chi2=6.403; p=0.011), and patients were more likely to understand why they needed a bronchoscopy than how it would be performed (chi2=21.505; p<0.001). Fear preceding bronchoscopy is independent of patients' demographic features except for age and gender. Doctors tend to explain "why" but not "how" the procedure is performed. Provision of detailed information about sensations that are likely to be experienced in bronchoscopy could be used to allay some of these common fears.

Parapharyngeal space lipoma causing sleep apnoea

Abdullah BJ, Liam CK, Kaur H, Mathew KM

Br J Radiol, 1997 Oct;70(838):1063-5.

PMID: 9404213

Lipoma of the parapharyngeal space is very rare, only three cases having been reported in the literature. A parapharyngeal space lipoma causing obstructive sleep apnoea has not been reported before. A 60-year-old man presented at the ear, nose and throat (ENT) clinic with a history of loud snoring associated with sleep apnoea secondary to a right parapharyngeal space lipoma. The causes of sleep apnoea and the radiological features of a parapharyngeal space lipoma are discussed.
Study site: ENT clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Fulltext Sclerosing haemangioma of the lung

Liam CK, Wong KT

Singapore Med J, 1995 Jun;36(3):333-4.

PMID: 8553108

An asymptomatic middle-aged women was investigated for a lung nodule detected on routine chest X-ray. Percutaneous needle biopsy revealed it to be a sclerosing haemangioma which was subsequently removed by a left lower lobectomy. The literature on this uncommon benign lesion is reviewed.

Fulltext Lady Windermere syndrome: an inappropriate eponym for an increasingly important condition

Kasthoori JJ, Liam CK, Wastie ML

Singapore Med J, 2008 Feb;49(2):e47-9.

PMID: 18301826

Non-tuberculous mycobacterial infection (NMI) occurs in elderly women with no pre-existing lung disease, and this has been termed the Lady Windermere syndrome. NMIs are increasing in prevalence and an increasing number of pulmonary mycobacterial infections is due to non-tuberculous mycobacteria. The diagnosis is often difficult because the organism is not readily isolated or cultured, and the condition may not be considered by the radiologist. We report NMI in a 64-year-old woman, based on clinical and radiological findings. Although termed the Lady Windermere syndrome, the name does not correspond to the character in Oscar Wilde's play; hence the eponym is not widely used.

Fulltext Diagnostic yield of flexible bronchoscopic procedures in lung cancer patients according to tumour location

Liam CK, Pang YK, Poosparajah S

Singapore Med J, 2007 Jul;48(7):625-31.

PMID: 17609823

This study aims to determine whether the diagnostic yield of flexible bronchoscopy sampling procedures in patients with lung cancer was dependent on tumour location.

Fulltext Pleural effusions: role of commonly available investigations

How SH, Chin SP, Zal AR, Liam CK

Singapore Med J, 2006 Jul;47(7):609-13.

PMID: 16810434

Previous studies have reported high rates of undetermined causes of pleural effusions. We aimed to find out the proportion of pleural effusions in which the aetiology is uncertain despite commonly available investigations.

Fulltext Recurrent acute pulmonary oedema associated with obstructive sleep apnoea

Liam CK, Liao CM, Kannan P

Singapore Med J, 1994 Aug;35(4):411-3.

PMID: 7899906

A patient had recurrent acute nocturnal pulmonary oedema following an anterior myocardial infarction despite a normal maximal stress electrocardiogram. He had a history of chronic heavy snoring and other symptoms to suggest a diagnosis of obstructive sleep apnoea (OSA) which was supported by an overnight sleep study. The recurrent acute pulmonary oedema was most likely due to a combination of poor left ventricular function and obstructive sleep apnoea.

Displaying publications 41 - 60 of 148 in total