Displaying publications 61 - 80 of 148 in total

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  1. Liam CK, Pang YK, Shyamala P, Chua KT
    Med J Malaysia, 2007 Aug;62(3):268-73; quiz 274.
    PMID: 18246927
    During normal sleep the tone of the pharyngeal airway dilator muscles is decreased resulting in upper airway narrowing and increased resistance to airflow. Nasal obstruction may result from a variety of anatomical abnormalities such as septal deviation, nasal polyps, adenoid hypertrophy and rhinitis such as allergic rhinitis, acute viral rhinitis, vasomotor rhinitis and non-allergic rhinitis with nasal eosinophilia syndrome. Disordered breathing during sleep can both result from and be worsened by nasal obstruction. In children, nasal obstruction due to enlarged tonsils and adenoids results in a switch to oral breathing which may lead to the adenoid faces because of changes in the craniofacial structures during growth that predispose to disordered breathing during sleep.
  2. Pang YK, Liam CK, Leow CH, Shyamala P, Zal AR
    Med J Malaysia, 2006 Jun;61(2):147-50.
    PMID: 16898303 MyJurnal
    Many studies have shown that tracheobronchial stenting is effective in relieving respiratory distress secondary to major airway obstruction due to lung or oesophageal cancer. A retrospective review on the benefits and complications of self-expandable metallic stent (SEMS) insertion through flexible bronchoscopy for the palliative treatment of upper airway obstruction in University Malaya Medical Centre was performed. Ten patients underwent this procedure. Relief of dyspnoea was immediate following stent insertion in all patients. Stent migration occurred in one patient and three patients had restenosis of the central airway. We conclude that tracheobronchial stenting via flexible bronchoscopy is feasible and safe.
  3. Wong CH, Chua CJ, Liam CK, Goh KL
    Aliment Pharmacol Ther, 2006 May 1;23(9):1321-7.
    PMID: 16629937 DOI: 10.1111/j.1365-2036.2006.02888.x
    BACKGROUND: The causal association between gastro-oesophageal reflux disease (GERD) and difficult-to-control asthma is unclear.
    AIM: To determine the prevalence of GERD and response to proton pump inhibitor therapy in patients with difficult-to-control asthma.
    METHODS: Consecutive patients with difficult-to-control asthma as defined by persistent and recurrent symptoms despite on optimal asthmatic medications were recruited for the study. GERD was diagnosed by symptoms, gastroscopy and 24-h oesophageal pH monitoring. All patients were prescribed a course of lansoprazole 30 mg daily for 8 weeks. Improvement to treatment was assessed by a change in pulmonary symptom score and also by patient's subjective assessment of improvement.
    RESULTS: Seventeen of 30 (56.7%) patients with difficult-to-control asthma were diagnosed with GERD. Pulmonary symptom score improved significantly only in patients with GERD (35.0 to 21.0; P = 0.002). Twelve of 16 (75%) patients with GERD reported an improvement in asthma symptoms; 1 of 11 (9.1%) without GERD reported mild symptom improvement. There was no significant change in peak expiratory flow rate and forced expiratory volume.
    CONCLUSIONS: More than half of patients with difficult-to-control asthma were diagnosed with GERD. In these patients the severity of asthma improved significantly with potent acid suppression therapy. This underlines the critical role of acid reflux in this subset of patients with difficult-to-control asthma.
    Study site: Respiratory clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  4. Liam CK, Goh CT, Isahak M, Lim KH, Wong CM
    Asian Pac J Allergy Immunol, 2001 Jun;19(2):79-83.
    PMID: 11699724
    The objective of this study was to determine the relationship between asthma symptoms and the degree of airway obstruction as measured by the forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) in a group of 64 asthmatic patients with clinically stable disease attending a university-based urban asthma clinic. Asthma symptoms did not correlate with the degree of airway obstruction as measured by prebronchodilator PEFR (total asthma symptom score vs PEFR: r = -0.214, p = 0.104, n = 59) and only correlated poorly with prebronchodilator FEV1 (total asthma symptom score vs FEV1: r = -0.256, p = 0.041, n = 64). These results lend support to the recommendation that airway obstruction should be measured objectively when assessing patients with chronic persistent asthma.
    Study site: Asthma clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  5. Lim KH, Tan LH, Liam CK, Wong CM
    Chest, 2001 Nov;120(5):1728-31.
    PMID: 11713160
  6. Lim KH, Liam CK, Vasudevan AE, Wong CM
    Respirology, 1999 Sep;4(3):299-301.
    PMID: 10489679 DOI: 10.1046/j.1440-1843.1999.00195.x
    A 62-year-old man presented with a 3-month history of chronic non-productive cough and unexplained fever. Further questioning revealed that he had headaches and myalgia. Bilateral thickened temporal arteries were noted on physical examination. The erythrocyte sedimentation rate was 96 mm in 1 h. A biopsy specimen of the left temporal artery showed inflammatory changes consistent with the diagnosis of giant cell arteritis. Commencement of prednisolone resulted in rapid and dramatic resolution of his symptoms. Physicians should be aware of respiratory symptoms in patients with giant cell arteritis in order to avoid delay in diagnosis and therapy of this condition.
  7. Liam CK, Lim KH, Wong CM, Tang BG
    Int J Tuberc Lung Dis, 1999 Apr;3(4):300-9.
    PMID: 10206500
    SETTING: An urban university teaching hospital.
    OBJECTIVES: To determine patients' attitudes to tuberculosis and their knowledge of the disease, and factors associated with treatment compliance.
    DESIGN: All adult patients commenced on treatment for tuberculosis from September 1994 to February 1996 were interviewed on initiation of treatment. To assess patient compliance with treatment, hospital clinical records were reviewed retrospectively.
    RESULTS: A total of 135 patients with a mean age (±SD) of 41.9 (±17.4) years (range 15–84 years) were interviewed. The patients had limited understanding and knowledge about tuberculosis. There was a negative correlation between patient age and tuberculosis knowledge score (r = −0.18, P = 0.038). Patients with tertiary education had better knowledge than the others. Of 118 patients who were followed-up in our chest clinic, 80 (67.8%) completed the prescribed treatment. Compliance with treatment and follow-up was not affected by age, sex, ethnic group, educational level, occupation, extent of knowledge, tuberculosis symptoms, hospitalisation for tuberculosis or duration of the prescribed treatment regimen. There was a trend toward poorer compliance among patients who equated disappearance of tuberculosis symptoms with cure of the disease.
    CONCLUSIONS: Malaysian patients with newly diagnosed tuberculosis attending a university teaching hospital had misconceptions and limited knowledge about the disease and its treatment. Educational background was an important determinant of a patient's level of knowledge about tuberculosis. Compliance was not affected by patient characteristics. Adequate counselling and education of patients and close relatives on tuberculosis and the necessity for prolonged treatment may help to improve treatment compliance.
    Study site: Chest clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  8. Wong CM, Lim KH, Liam CK
    Respirology, 2003 Mar;8(1):65-8.
    PMID: 12856744
    OBJECTIVE: In southeast Asia, pulmonary tuberculosis (TB) is the most frequently presumed diagnosis for haemoptysis. This study was designed to assess the causes of haemoptysis, the diagnostic yield of causes in different diagnostic modalities and the distribution of older patients.

    METHODS: All patients presenting to the University of Malaya Medical Centre, Kuala Lumpur, Malaysia with haemoptysis were recruited prospectively and evaluated.

    RESULTS: One hundred and sixty patients were evaluated for haemoptysis; 71 (44.4%) were aged 60 years or more. Significantly more patients smoked in the older age group (P = 0.002). The main causes of haemoptysis in the older patients were bronchogenic carcinoma (49.3%), pneumonia (11.3%), bronchiectasis (8.6%), cryptogenic (5.6%) and active TB (4.2%). Significantly more older patients had carcinoma (P < 0.001), while the younger patients more often had TB (P < 0.001). Chest pain was significantly more common in the older patients (P = 0.025), particularly in patients with carcinoma. Bronchoscopy alone or combined with CT of the thorax was significantly more diagnostic in the older patient (P = 0.006).

    CONCLUSION: Bronchogenic carcinoma is the commonest cause of haemoptysis in patients aged 60 years and above. Presumptive anti-TB therapy should not be encouraged despite the regional high prevalence of TB.

  9. Wong CM, Lim KH, Liam CK
    Respirology, 2003 Mar;8(1):107-9.
    PMID: 12856752
    Pregnancy complicated by lung cancer has been rarely reported. The regional incidence of this complex situation is likely to increase in the future and optimal management needs to be established to better deal with this situation. We report two patients with metastatic lung cancer complicating pregnancy to highlight the evaluation and management difficulties associated with this problem and to contribute to the limited information in the literature.
  10. Lim KH, Lim YC, Liam CK, Wong CM
    Chest, 2001 Mar;119(3):955-7.
    PMID: 11243981
  11. Tan LH, Kamarulzaman A, Liam CK, Lee TC
    Infect Control Hosp Epidemiol, 2002 Oct;23(10):584-90.
    PMID: 12400887
    To determine the occupational risk of Mycobacterium tuberculosis infection among healthcare workers (HCWs) and to examine the utility of tuberculin skin testing in a developing country with a high prevalence of bacille Calmette-Guerin vaccination.
  12. Wong CMM, Lim KH, Liam CK
    Med J Malaysia, 2002 Dec;57(4):515-23; quiz 524-5.
    PMID: 12733182
  13. Liam CK, Lim KH, Wong CMM
    Med J Malaysia, 2000 Mar;55(1):21-8.
    PMID: 11072486
    Tuberculosis and malignancy are two common causes of exudative pleural effusions. In this retrospective study of 52 patients with tuberculous pleural effusions and 32 patients with malignant effusions, the median age of patients with malignant effusions (68.5 years) was older than that of patients with tuberculous effusions (34.5 years) (p < 0.001). Both types of effusion occurred more frequently on the right side and there was no difference between them in terms of right-sided dominance. A higher percentage of patients with malignant pleural effusions (44%) presented with large effusions than patients with tuberculous effusions (12%) (x2 = 11.33, p = 0.001). A higher proportion of patients with tuberculous effusion had lymphocyte predominant effusions and tuberculous effusions had higher lymphocyte percentage, lower red cell count, and higher protein content. However, there was considerable overlap of these characteristics of both types of effusions.
  14. Lim KH, Liam CK, Wong CMM
    Med J Malaysia, 2000 Jun;55(2):265-7.
    PMID: 19839158
    An asymptomatic subject with radiographic changes due to welders' siderosis is described. This condition has not been well recognized and described in our community. Siderosis of the lung is generally considered to be a benign condition not associated with respiratory symptoms. However, recent reports have associated welding with various disorders of pulmonary function as well as lung cancer. There is a need for future epidemiological studies to better define the risk of long term welding.
  15. Liam CK, Aziah AM, Lim KH, Wong CMM
    Med J Malaysia, 2000 Sep;55(3):304-7.
    PMID: 11200708
    Forty patients were treated with ofloxacin for community acquired lower respiratory tract infections. Eighteen pathogens were isolated in sputum; Streptococcus pneumoniae (4) and Haemophilus influenzae (4) were the most common, followed by Klebsiella pneumoniae (3), Klebsiella spp. (2), Staphylococcus anreus (2), Pseudomonas spp. (2), and Pseudomonas aeruginosa (1). Ofloxacin 200 mg every 12 hours was administered for an average of 3.7 days intravenously followed by 5.4 days orally. Response to therapy was judged to be cure in 38 (95%; 95% C.I., 85%-95%) patients, failure in one (2.5%) and "indeterminate" in one (2.5%).
  16. 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.
  17. Lee YM, Lim YC, Liam CK, Aljafri M
    Med J Malaysia, 1995 Dec;50(4):334-8.
    PMID: 8668053
    Five cases of spontaneous pneumothorax were treated with video-assisted thoracoscopic surgery (VATS). These included four cases of recurrent pneumothorax and one case of persistent pneumothorax. The mean age was 33 years. The identified bullae were eliminated with either endoloop ligation (in one patient) or stapled excision (in four patients). There were no recurrences reported in a mean follow-up of 9.4 months. In conclusion, VATS offers an equally effective and less morbid alternative to open thoracotomy in the management of primary spontaneous pneumothorax.
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