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Biomedical subjects

E C Tan

Publications and source records attributed to E C Tan.

At least 55 records · Page 3Linked to original sources
PubMed1991

Clinical profile of elderly urinary incontinence in Singapore: a community-based study.

The prevalence of urinary incontinence in the elderly aged 65 years and above was found to be 4.6% (42 out of a total of 919 respondents), in a community-based study in Singapore. Urinary incontinence was defined as leakage of urine on at least two occasions in the previous one month. The clinical profile of 30 out of the 42 (71%) subjects were studied. There was equal distribution of male and female subjects. Eighteen (60%) of the subjects were below 75 years of age. Twenty-five (83.3%) subjects had severe incontinence. Twenty-four (80%) had the incontinence for more than one year. Despite the high percentage of patients with severe incontinence, only nine (30%) used some form of aid. Incontinence in our very old (75 years and above) was not related to frailty or physical dependence. Seven of the subjects (23.3%) were found to have functional incontinence associated with cognitive impairment. These patients were unable to indicate their toilet needs. They also had associated physical disability as well as double incontinence, and their carers were under stress. Ten of the subjects had pure urge incontinence. Seven of them had an underlying central nervous system disorder, suggesting that destrusor hyperreflexia may be the underlying cause for urinary incontinence in this group. All except one in this group had more than one possible precipitating factor for their incontinence. Eleven subjects had symptoms suggestive of outlet obstruction, although only two were found to have proven outlet obstruction. None of the female subjects had pure stress incontinence.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1990

In situ extracorporeal shock wave lithotripsy for upper ureteral stones using the EDAP LT-01 lithotriptor.

We reviewed 64 cases of upper ureteral stones treated between December 1986 and June 1988. Upper ureteral stones were defined as stones in the ureter distal to the ureteropelvic junction and proximal to the S1 vertebra. All stones were treated in situ with no invasive procedures done before treatment. The over-all success rate in rendering patients free of stones by extracorporeal shock wave lithotripsy monotherapy was 75%. Of the patients 25% required auxiliary procedures, such as percutaneous ultrasonic lithotripsy. The average duration of treatment for each stone was 88 minutes and the average storage energy used was 208 units.

Adult↗
PubMed1990

Piezoelectric extracorporeal shock wave lithotripsy by EDAP LT-01: the Singapore experience.

One hundred and eighty patients with stones in the calyces, renal pelvis, upper, middle, and lower ureter were treated by piezoelectric extracorporeal shock wave lithotripsy using the EDAP LT-01 lithotripter. The size of the stones treated ranged from 0.5 cm to 6.5 cm with the vast majority (94%) measuring less than 3.0 cm. Forty-eight patients (27%) had multiple stones in the renal collecting system. Successful fragmentation occurred in 79%, partial fragmentation in an additional 17%, and no fragmentation in 4%. Forty percent of patients required repeated treatment with an average of 2.3 sessions. Of those patients treated, none required general anesthesia, however, analgesia was needed in 121 patients (67%). Urosepsis occurred in 4% and 0.5% developed intrarenal hematoma. There was no mortality or loss of renal units in this series. The auxiliary procedure rate was 15% (percutaneous nephrolithotripsy 5%, ureteroscopic manipulation 9%, and open surgery 1%). The 3-month stone-free rate was 64%.

Humans↗
PubMed1990

[Spinal arteriovenous malformations in Klippel-Trénaunay-Weber syndrome: case report].

A 19-year-old man was admitted with the chief complaint of a sudden onset of thoracic pain and paraplegia. His right lower limb had progressively enlarged since he was 3 months old. Transient paraparesis had occurred recurrently since the age of 3. Physical examination on admission revealed that there were multiple warts on his face, trunk and right extremities. The right lower limb was thicker and longer than the left one, and the temperature was 1 degree C higher in the right side. Neurological examination revealed paraplegia and severe impairment of all sensory modalities below Th4 with bilateral clonus. Radiological examination showed lordosis of the thoracic spines with thinning of the pedicles of Th4 to Th6. Selective spinal angiography showed a juvenile type of arteriovenous malformation involving the cord of Th2 to Th6 with multiple feeding arteries, and a glomus type of the lower thoracic cord with the feeding arteries from Adamkiewicz's artery and the right Th10 intercostal artery. MRI showed the cord enlargement of Th2 to Th6 and within it the nidus was identified. Spinal arteriovenous malformations associated with Klippel-Trénaunay-Weber syndrome were noticed. The patient underwent interruption of the main feeding artery and removal of the dilated vessels located in the dorsum of the thoracic cord. Postoperative course was uneventful with slight improvement of clinical symptoms. Klippel-Trénaunay-Weber syndrome is manifested by a triad of symptoms: 1) hemihypertrophy of the extremities, 2) cutaneous hemangiomas and 3) arteriovenous fistula or varicose veins of the involved limbs. Nineteen cases of Klippel-Trénaunay-Weber syndrome associated with spinal arteriovenous malformation have been reported. The pathogenesis has been suggested to be due to developmental abnormalities.

Adult↗
PubMed1989

Punch technique--an alternative approach to the repair of pierced earlobe deformities.

The punch technique of repairing pierced earlobe deformities is a practical and simplified alternative to the usual method of repair. The procedure can easily be performed in any dermatology office since the instruments required are very basic. The technique is presented in a series of illustrations, and the results are cosmetically acceptable.

Ear Deformities, Acquired↗
PubMed1989

Mechanism of cerebral vasospasm--contractile proteins in smooth muscle of bovine cerebral artery.

Understanding of the pathogenesis of cerebral vasospasm requires basic study of the contraction mechanism of cerebral arteries. In this study, the morphological and biochemical properties of actomyosin from bovine cerebral arteries were examined. Arrays of thick and thin filaments were clearly seen on electron micrographs of a cross section of a muscle strip stretched to 1.5 times its normal length in Krebs-Ringer solution. The diameters of the thick and thin filaments were 110.0 +/- 19.9 A and 51.0 +/- 8.0 A, respectively. The average ratio of thick to thin filaments was about 1:15 to 1:16. The gel pattern of Ca2+-sensitive actomyosin extracted from bovine cerebral arteries revealed the presence of myosin, actin, and tropomyosin, but not skeletal troponin. The Mg-ATPase activity of actomyosin was greatly enhanced in the presence of Ca2+. Rapid superprecipitation occurred after the clearing phase, when 1 mM Mg-ATP was added to a suspension of actomyosin with 10(-5) M Ca2+. This superprecipitation did not occur with a lower Ca2+ concentration of 10(-8) M. Intracellular free Ca2+ appears to play a crucial role in the regulation of contraction and relaxation of cerebral arterial smooth muscle.

Actins↗
PubMed1989

Percutaneous ultrasonic lithotripsy--its role in the management of renal and upper ureteric stones.

Percutaneous ultrasonic lithotripsy (PUL), a new technique used in the treatment of renal stones has been shown to be safe and effective with low morbidity. 54 of the 57 patients (95%) were successfully treated by this method and all were done as a single stage procedure. 39 patients (68%) in this series were either unsuitable or had failed extracorporeal shock wave lithotripsy (ESWL). No mortality occurred in this series and one patient with staghorn stone required a nephrectomy due to severe secondary haemorrhage. Though PUL is technically more difficult to perform, it is a better alternative than open renal surgery and is complementary to ESWL especially in the treatment of the more complicated renal stones.

Adult↗
PubMed1989

Antegrade ureteroscopy and ultrasonic lithotripsy in the treatment of difficult upper and middle ureteric stones.

34 patients with difficult upper and middle ureteric stones were treated by antegrade ureteroscopy with ultrasonic lithotripsy over a 2-year period. 14 patients (41 percent) had failed extracorporeal wave lithotripsy and another 20 patients (59 percent) were considered unsuitable for extracorporeal shock wave lithotripsy due either to obstruction associated with urosepsis or renal failure. Thirty patients (88 percent) had large stones with a transverse diameter from 10 to 20mm in size. Thirty-three of the 34 patients (97 percent) were successfully treated by this method with minimal morbidity. Of the 7 patients with residual stones, only one needed transurethral ureteroscopic removal and another by piezoelectric extracorporeal shock wave lithotripsy. This technique is a safe and effective method in removing impacted upper and middle ureteric stones for patients who have failed or are unsuitable for extra-corporeal shock wave lithotripsy treatment.

Endoscopy↗
PubMed1988

Carcinoma in situ of the urinary bladder--the Singapore experience.

Carcinoma in situ of the urinary bladder has been described since 1952. However, it was not well recognised as a clinical entity until recently when we are more aware of its clinical significance, that a large proportion progresses to muscle invasive cancer and becomes life threatening, and therefore more aggressive management is needed. From 1980 to 1984 over a period of 5 years, we studied the records of 130 patients with transitional cell carcinoma of the urinary bladder. Eighty-two (63%) were staged as superficial carcinoma while 48 (37%) were diagnosed as muscle invasive cancer (Tables II, III & IV). Out of the 82 cases of superficial carcinoma, 12 (11%) were found to have associated carcinoma in situ of the bladder. Diagnosis depends on a high index of suspicion, urinary cytology and biopsies of not only the obvious papillary or solid tumours but also any abnormal bladder mucosa and random bladder biopsy. Management is a problem and controversial. We have been using intensive intravesical chemotherapy with thiotepa and mitomycin, and if there is evidence of deep muscle invasion, then more aggressive therapy such as cystectomy would be advised. Management of these 12 cases and the problems we encountered are discussed.

Carcinoma in Situ↗
PubMed1987

Transurethral ultrasonic lithotripsy for ureteric stones under direct vision.

With the development of the operating uretero-renoscope, and high frequency ultrasound generator, ureteric stones which otherwise would require open operative procedure can now be removed transurethrally with minimum morbidity and rapid recovery of patient. After preliminary cystoscopy, the ureteric orifice is dilated with flexible metal dilator or ureteric balloon dilator to size 15F. The rigid operating uretero-renoscope of 11F is then introduced and passed up to the stone. A 5F ultrasound probe is then passed through the uretero-renoscope to make contact with the stone. Stone disintegration with ultrasound is done under direct vision, and the fragments aspirated or removed with the help of forceps or Dormia basket. Of the first 70 patients done within 2 years from July 1984 to August 1986, 66 (94%) had their stones successfully removed by this procedure. It can be performed without radiological control and routine stenting of the ureter is not necessary. Serious complications included two perforation of the ureter and late development of ureteric strictures in another two patients. One patient had occlusion of the lower ureter requiring reimplantation.

Adult↗
PubMed1984

Endoscopic surgery of the lower urinary tract.

Endoscopic Surgery of the lower urinary tract was popularised in Singapore about a decade ago. Since then it has been established as the treatment of choice not only for obstructing prostates, but also for stones, carcinoma of the urinary bladder and management of neurogenic bladder, haemorrhagic chronic radiation cystitis, ureteric obstruction and urethral strictures. The main advantages of endoscopic surgery are lack of post-operative pain and minimum morbidity and mortality. Patients' recovery is rapid thus saving much needed hospital beds. However, endoscopic surgery requires special training and special equipment to get good results. If not properly done serious complications including the death of patients can occur. A plea is made for the setting up of a special division or department of Urology in Singapore to carry out this work and to train our young surgeons in this field.

Cystitis↗
PubMed1984

Transurethral resection of large obstructing prostates above the weight of 40 grams.

A series of 62 cases of transurethral resection of large obstructing prostates above 40 grams is presented. The weight of resected prostates ranged from 41 to 84 grams with an average of 54.5 grams. The average rate of resection was 0.7 gm/min. Though 74.2% of patients were in clinical grade II and III categories, no mortality occurred and serious complications were minimum. 71% of patients were discharged within a week. On the whole, the results were satisfactory although clot retention (11.3%) was a more common complication following transurethral resection of large prostate. Transurethral resection is a safe and acceptable alternative to open prostatectomy even for large prostates.

Aged↗