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Displaying publications 81 - 100 of 148 in total

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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
Detection of Mycobacterium tuberculosis in bronchoalveolar lavage from patients with sputum smear-negative pulmonary tuberculosis using a polymerase chain reaction assay

Liam CK, Chen YC, Yap SF, Srinivas P, Poi PJ

Respirology, 1998 Jun;3(2):125-9.
PMID: 9692522

The objective of this study was to evaluate the utility of a polymerase chain reaction (PCR) assay in detecting Mycobacterium tuberculosis in bronchoalveolar lavage (BAL) specimens of patients suspected of having active pulmonary tuberculosis (TB) but who were sputum smear-negative. Patients undergoing investigation for suspected pulmonary TB at the University Hospital, Kuala Lumpur, and who were sputum smear-negative underwent fibreoptic bronchoscopy and BAL. One portion of each lavage specimen was submitted for smear examination for acid-fast bacilli and mycobacterial culture and the other portion assayed by PCR for the presence of a 562-base pair DNA segment belonging to the insertion sequence IS986, unique to the M. tuberculosis complex. As controls, lavage specimens from patients with other lung lesions were also similarly tested. The PCR assay gave a positivity rate of 80.9% (55 of 68) compared with 8.8% of smear examination and 7.4% of culture for detecting M. tuberculosis in BAL specimens. The assay was positive in two of 45 BAL specimens from 35 control subjects. The PCR assay was more sensitive than smear and culture in detecting M. tuberculosis in BAL specimens of patients with sputum smear-negative pulmonary TB.
An investigation of aeroallergens affecting urban Malaysian asthmatics

Sam CK, Soon SC, Liam CK, Padmaja K, Cheng HM

Asian Pac J Allergy Immunol, 1998 Mar;16(1):17-20.
PMID: 9681124

We investigated the aeroallergens affecting 200 asthmatics from the University Hospital in Kuala Lumpur, Malaysia and found 164 (82%) patients with skin prick test (SPT) reactivity to one or more of a panel of 14 allergens, which included indoor and outdoor animal and plant aeroallergens. Reactivity was most frequent to the indoor airborne allergens, with 159 (79.5%) reacting to either or both house dust mite (Dermatophagoides) species and 87 (43.5%) to cockroach. The SPT reactivity to house dust mites corresponded with the finding that patients found house dust to be the main precipitant of asthmatic attacks.
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.
PMID: 10967989

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)
Hypercalcaemia in patients with newly diagnosed tuberculosis in Malaysia

Liam CK, Lim KH, Srinivas P, Poi PJ

Int J Tuberc Lung Dis, 1998 Oct;2(10):818-23.
PMID: 9783529

University Hospital, Kuala Lumpur, Malaysia.
Cryptococcosis at the University Hospital, Kuala Lumpur

Doi SA, Tan CT, Liam CK, Naganathan K

Trop Doct, 1998 Jan;28(1):34-9.
PMID: 9481195

We review our experience with 27 cases of pulmonary and meningeal cryptococcosis at the University Hospital, (Kuala Lumpar, Malaysia) where this is the most common cause of adult meningitis in patients without debilitating illnesses. Of the 27 cases analysed, six presented primarily with pulmonary symptomatology which usually were mainly cough, chest pain and low grade fever. The rest presented with primarily central nervous system (CNS) symptomatology of which headaches and fever were the most consistent symptoms although a third of these patients also had pulmonary lesions noted on chest radiographs. Treatment in all cases was with amphotericin B and 5-fluorocytosine and usually till a total cumulative dose of 1.5 g of amphotericin had been reached (an average of 10 weeks). Primary pulmonary presentations, if symptomatic, were treated as per CNS cryptococcosis due to the high likelihood of CNS dissemination. Incidental pulmonary cryptococcoma found on routine chest radiographs were confirmed by biopsy under ultrasound or fluoroscopy guidance and booked for surgical resection. Death usually occurred early in patients who presented late. Once patients responded to therapy, mortality was usually avoided. The only cause of morbidity in survivors was visual impairment or blindness, and this was attributed mainly to intracranial hypertension with residual deficits determined by the measures taken to lower intracranial pressures. Our experience suggests that: (i) symptomatic patients should have combination therapy with 5-fluorocytosine and amphotericin B till at least a cumulative dose of 1.5 g amphotericin B is reached irrespective of whether they have primary CNS or pulmonary symptomatology; (ii) non-symptomatic pulmonary cryptococcoma could be treated primarily by surgical resection; (iii) visual failure or papilloedema should be treated aggressively; and (iv) prognosis is good with adequate therapy and early presentation.
Dyspnoea in young adults due to pulmonary lymphangitic carcinomatosis from gastric carcinoma

Liam CK, Looi LM, Pailoor J, Alhady SF

Ann Acad Med Singap, 1989 Nov;18(6):713-6.
PMID: 2624423

Three cases of progressive dyspnoea in young female adults due to pulmonary lymphangitic carcinomatosis are reported. The underlying primary neoplasm was gastric carcinoma in all 3 cases. The diagnosis was not suspected in 2 patients because of their young age.
The diagnosis of lung cancer in the era of interventional pulmonology

Liam CK, Lee P, Yu CJ, Bai C, Yasufuku K

Int J Tuberc Lung Dis, 2021 01 01;25(1):6-15.
PMID: 33384039 DOI: 10.5588/ijtld.20.0588

Advances in bronchoscopic and other interventional pulmonology technologies have expanded the sampling procedures pulmonologist can use to diagnose lung cancer and accurately stage the mediastinum. Among the modalities available to the interventional pulmonologist are endobronchial ultrasound-guided transbronchial needles aspiration (EBUS-TBNA) and transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for sampling peribronchial/perioesophageal central lesions and for mediastinal lymph node staging, as well as navigational bronchoscopy and radial probe endobronchial ultrasound (RP-EBUS) for the diagnosis of peripheral lung cancer. The role of the interventional pulmonologist in this setting is to apply these procedures based on the correct interpretation of clinical and radiological findings in order to maximise the chances of achieving the diagnosis and obtaining sufficient tissue for molecular biomarker testing to guide targeted therapies for advanced non-small cell lung cancer. The safest and the highest diagnosis-yielding modality should be chosen to avoid a repeat sampling procedure if the first one is non-diagnostic. The choice of site and biopsy modality are influenced by tumour location, patient comorbidities, availability of equipment and local expertise. This review provides a concise state-of-the art account of the interventional pulmonology procedures in the diagnosis and staging of lung cancer.
Seropositivity and risk factors of Toxocara canis infection in adult asthmatic patients

Rouhani-Rankouhi SZ, Kow KS, Liam CK, Lau YL

Trop Biomed, 2020 Sep 01;37(3):599-608.
PMID: 33612775 DOI: 10.47665/tb.37.3.599

This cross-sectional study involving 86 adult asthmatic patients aimed to determine the relationship between Toxocara seropositivity and severity of asthma in adult asthmatics and investigate the risk factors for Toxocara infection. In all cases, T. canis IgG level was measured using an anti-Toxocara IgG enzyme-linked immunosorbent assay kit. Total serum IgE and eosinophil count were also determined. The anti-Toxocara IgG seropositivity was 68.6% among asthmatic patients. There were no statistically significant associations between Toxocara seroprevalence and other risk factors, clinical symptoms of asthma and high level of total serum IgE and eosinophilia. Pet ownership could be an important risk factor for Toxocariasis. Having a pet at home and wheezing were significantly associated with Toxocara seropositivity in adult asthmatic patients.
Squamous cell carcinoma antigen as an adjunct tumour marker in primary carcinoma of the lung

Cheah PL, Liam CK, Yap SF, Looi LM

J Clin Pathol, 1994 Jun;47(6):535-7.
PMID: 8063936

AIMS: To determine (1) the detection rate of primary carcinoma of the lung by serological assay of CEA (carcinoembryonic antigen); and (2) whether addition of seroassay of squamous cell carcinoma related antigen before treatment improves detection sensitivity.
METHODS: A prospective study spanning 27 months was conducted at the University Hospital, Kuala Lumpur. Serum CEA (Abbott IMx) and serum squamous cell carcinoma antigen (Abbott IMx) from patients clinically suspected of having primary carcinoma of the lung, were assayed using the microparticle enzyme immunoassay method.
RESULTS: Thirty seven cases of histologically confirmed primary lung carcinoma were studied. Of these, 17 were squamous cell carcinomas, 10 adenocarcinomas, nine small cell carcinomas, and one large cell carcinoma. The patients' ages ranged from 34-82 years. The male:female ratio was 3.6:1. Squamous cell carcinoma antigen was raised above the cutoff value of 1.5 ng/ml in 94.1% of squamous cell carcinomas, 20.0% of adenocarcinomas, and 11.1% of small cell carcinomas. By comparison, CEA was raised above the cutoff value of 3.0 ng/ml in 70.6% of squamous cell carcinomas, 77.8% of small cell carcinomas, and 100% of adenocarcinomas. CEA and squamous cell carcinoma antigen were not raised in the patient with large cell carcinoma and in 14 healthy volunteers. None of 15 patients with a variety of benign lung diseases showed a rise of CEA, while two patients--a 25 year old Indian woman with pneumonia and a 64 year old Malay man with bronchial asthma--had raised squamous cell carcinoma antigen values above the cutoff. Serum CEA and squamous cell carcinoma antigen values did not seem to correlate with stage or degree of differentiation of the tumours.
CONCLUSIONS: The findings suggest that CEA is a good general marker for carcinoma, particularly adenocarcinoma. In contrast, squamous cell carcinoma antigen is more specific for squamous carcinoma.
Fulltext Epithelial-to-mesenchymal transition (EMT) causing acquired resistance to afatinib in a patient with epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma

Poh ME, Liam CK, Rajadurai P, Chai CS

J Thorac Dis, 2018 Jul;10(7):E560-E563.
PMID: 30174934 DOI: 10.21037/jtd.2018.06.122

We report the first case of epithelial-to-mesenchymal transition (EMT) as the cause of acquired resistance to the second-generation EGFR-tyrosine kinase inhibitor (TKI), afatinib in a patient with advanced non-small cell lung cancer (NSCLC) harboring a sensitizing EGFR mutation. Patients with EGFR-mutant NSCLC inevitably develop acquired resistance while on EGFR-TKI treatment. EMT which renders cancer cells more invasive and migratory is one of the mechanisms of acquired resistance to EGFR-TKIs and correlates with a poor prognosis. Possible therapeutic strategies in patients with EMT include blocking M2 muscarinic receptor signalling, targeting EMT with histone deacetylase inhibitors such as entinostat and MEK-inhibitors such as selumetinib, inhibition of microRNAs, immunotherapy and inhibiting fibroblast growth factor receptor-1.
Fulltext Single nucleotide polymorphism in the promoter of the human interleukin-13 gene is associated with asthma in Malaysian adults

Radhakrishnan AK, Raj VL, Tan LK, Liam CK

Biomed Res Int, 2013;2013:981012.
PMID: 23865080 DOI: 10.1155/2013/981012

Asthma susceptibility genes are mapped to a region on human chromosome 5q31-q33, which contains a cluster of proinflammatory cytokine genes such as interleukin-13 (IL-13), which is associated with asthma. This study investigated the allele frequencies of two single nucleotide polymorphisms (SNPs) (-1111C>T and 4257C>A) in the IL-13 gene between asthmatics and healthy volunteers as well as the relationship between these SNPs and IL-13 production. DNA extracted from buffy coat of asthmatic and control subjects was genotyped using the PCR-RFLP method. Amount of IL-13 produced by mitogen-stimulated peripheral blood leucocytes PBLs (PBLs) was determined by ELISA. The frequencies of the -1111C and 4257G wild-type alleles were 0.52 and 0.55 in asthmatics and were 0.67 and 0.56 in controls. A significant (P < 0.05) association was found between genotype and allele frequencies of SNP at position -1111C>T between asthmatic and control groups (OR, 1.810; 95% CI = 1.184 to 2.767; P < 0.05). The mitogen-stimulated PBLs from asthmatics produced higher amounts of IL-13 production (P < 0.001). The 4257GA heterozygous and 4257AA homozygous mutant alleles were associated with higher IL-13 production in asthmatics (P < 0.05). Our results show that the -1111T mutant allele are associated with asthma and the 4257A mutant alleles are associated with elevated IL-13 production.
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
Fulltext Accuracy of lung cancer staging in the multidisciplinary team setting

Liam CK, Liam YS, Poh ME, Wong CK

Transl Lung Cancer Res, 2020 Aug;9(4):1654-1666.
PMID: 32953539 DOI: 10.21037/tlcr.2019.11.28

Accurate staging of lung cancer is of utmost importance in determining the stage-appropriate treatment and prognosis. Imaging tests which include contrast-enhanced computed tomography (CT) examination of the chest to include the liver and adrenal glands and 18-fluoro-2 deoxyglucose positron emission tomography (PET)/CT scan facilitate the initial tumor node metastasis (TNM) staging of the disease and provide guidance on the optimal biopsy site and biopsy method. The diagnostic and staging approach should be tailored to the individual patient according to risk, benefit, patient preferences, and available expertise. Diagnosis and staging should preferably be accomplished with a single procedure or the least number of invasive procedures if more than one is needed. Ideally, centers managing lung cancer patients should have a multidisciplinary thoracic oncology board prescribing personalized evidence-based management tailored to each individual patient. Multidisciplinary team (MDT) meetings provide a platform for key experts from various disciplines to contribute specific advice on the management of each individual patient. As assessment of mediastinal lymph node involvement is an important component of lung cancer staging, optimal mediastinal staging can be achieved with a variety of techniques that can be discussed and performed by the various specialists in the MDT. Despite a relative paucity of quality evidence that MDT contributes to improvements in lung cancer survival outcomes, this approach has evolved to become the standard of care in many centers around the world. Thoracic MDT has resulted in more focused and timely investigations for histopathologic diagnosis and disease staging which translate into earlier treatment initiation. Moreover, there is increasing evidence that MDT care facilitates and allows access to investigations that lead to improved accuracy of tumor and nodal staging. However, there is still a paucity of evidence on the accuracy of lung cancer staging in the MDT setting.
Anaplastic lymphoma kinase (ALK) mutations in patients with adenocarcinoma of the lung

Mohamad N, Jayalakshmi P, Rhodes A, Liam CK, Tan JL, Yousoof S, et al.

Br J Biomed Sci, 2017 Oct;74(4):176-180.
PMID: 28705139 DOI: 10.1080/09674845.2017.1331520

BACKGROUND: Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death. Approximately 2-16% of NSCLC patients with wild-type epidermal growth factor receptor (EGFR) harbour anaplastic lymphoma kinase (ALK) mutations. Both EGFR and ALK mutations occur most commonly in Asian patients with NSCLC. As targeted therapy is available for NSCLC patients with these mutations, it is important to establish reliable assays and testing strategies to identify those most likely to benefit from this therapy.
MATERIALS AND METHODS: Patients diagnosed with adenocarcinoma of the lung between 2010 and 2014 were tested for EGFR mutations. Of these, 92 cases were identified as EGFR wild type and suitable candidates for ALK testing utilising immunohistochemistry and the rabbit monoclonal antibody D5F3. The reliability of the IHC was confirmed by validating the results against those achieved by fluorescence in situ hybridisation (FISH) to detect ALK gene rearrangements.
RESULTS: Twelve (13%) cases were positive for ALK expression using immunohistochemistry. Of the 18 evaluable cases tested by FISH, there was 100% agreement with respect to ALK rearrangement/ALK expression between the assays, with 11 cases ALK negative and 7 cases ALK positive by both assays. ALK tumour expression was significantly more common in female compared to male patients (29.6% vs. 6.2%, P
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 cerebral infarcts secondary to marantic endocarditis in a patient with adenocarcinoma of the lung

Tai ML, Tan EC, Ang CC, Liam CK

Singapore Med J, 2016 Sep;57(9):524-5.
PMID: 27663211 DOI: 10.11622/smedj.2016157
Fulltext Lung cancer staging now and in the future

Liam CK, Andarini S, Lee P, Ho JC, Chau NQ, Tscheikuna J

Respirology, 2015 May;20(4):526-34.
PMID: 25682805 DOI: 10.1111/resp.12489

For a long time lung cancer was associated with a fatalistic approach by healthcare professionals. In recent years, advances in imaging, improved diagnostic techniques and more effective treatment modalities are reasons for optimism. Accurate lung cancer staging is vitally important because treatment options and prognosis differ significantly by stage. The staging algorithm should include a contrast computed tomography (CT) of the chest and the upper abdomen including adrenals, positron emission tomography/CT for staging the mediastinum and to rule out extrathoracic metastasis in patients considered for surgical resection, endosonography-guided needle sampling procedure replacing mediastinoscopy for near complete mediastinal staging, and brain imaging as clinically indicated. Applicability of evidence-based guidelines for staging of lung cancer depends on the available expertise and level of resources and is directly impacted by financial issues. Considering the diversity of healthcare infrastructure and economic performance of Asian countries, optimal and cost-effective use of staging methods appropriate to the available resources is prudent. The pulmonologist plays a central role in the multidisciplinary approach to lung cancer diagnosis, staging and management. Regional respiratory societies such as the Asian Pacific Society of Respirology should work with national respiratory societies to strive for uniform standards of care. For developing countries, a minimum set of care standards should be formulated. Cost-effective delivery of optimal care for lung cancer patients, including staging within the various healthcare systems, should be encouraged and most importantly, tobacco control implementation should receive an absolute priority status in all countries in Asia.
Fulltext Advanced right lung adenocarcinoma with ipsilateral breast metastasis

Liam CK, Pang YK, Poh ME, Kow KS, Wong CK, Varughese R

Respirol Case Rep, 2013 Sep;1(1):20-2.
PMID: 25473531 DOI: 10.1002/rcr2.14

Breast metastases from non-small cell lung carcinoma are rarely reported. We report a case of a female patient with primary adenocarcinoma of the lower lobe of her right lung presenting with a massive right-sided malignant pleural effusion. The tumor harbored an epidermal growth factor receptor insertion mutation in exon 20 but was anaplastic lymphoma kinase translocation negative. She did not respond to treatment with erlotinib. First- and second-line cytotoxic chemotherapy resulted in stable disease as the best responses. She developed right breast metastasis 20 months after her initial presentation. The rarity of the condition and the likely mechanism of the breast metastasis are discussed.

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