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Biomedical subjects

L H Tan

Publications and source records attributed to L H Tan.

At least 19 recordsLinked to original sources

Neonate with vein of Galen malformation and heart failure: serial changes in plasma B-type natriuretic peptide following endovascular embolization.

We report a neonate with vein of Galen malformation (VGM) who developed congestive heart failure (CHF) early after birth. Serial changes in plasma B-type natriuretic peptide (BNP) following an endovascular embolization procedure for VGM were mirrored in his clinical CHF status. The plasma BNP level markedly increased to 1800 pg/ml (normal, <100 pg/ml) in accordance with the severity of CHF. It rapidly decreased to 356 pg/ml during the first week after endovascular embolization for VGM. In the following 3 weeks there was an unexpected upward trend in plasma BNP despite echocardiography revealing normal biventricular function. After additional evaluation and treatment for CHF, BNP decreased again and the patient's clinical status concurrently improved. The patient was discharged with a normal BNP level. Monitoring serial plasma BNP provides valuable information regarding the need for additional evaluation or treatment of newborns with CHF and may be used to document improvement.

Central Nervous System Vascular Malformations↗

Anaesthesia for implantation of the Jarvik 2000 Flowmaker LVAD.

The Jarvik 2000 Flowmaker is an intraventricular continuous axial flow left ventricular assist device. We describe the anaesthetic management and considerations for five patients with end-stage heart failure who underwent implantation of the Jarvik 2000 Flowmaker as a bridge to transplantation or as destination therapy.

Adult↗

Effect of oil loading on microspheres produced by spray drying.

Oil-loaded microspheres were produced by spray drying emulsions consisting of fish oil and modified starch suspensions with different oil loadings. The emulsion stability was assessed by oil droplet size analysis. Microspheres were characterized in terms of size, morphology, yield and microencapsulation efficiency. It was found that an increase in oil loading resulted in emulsions containing larger oil droplets. This corresponded with larger mean microsphere diameters and rounder microspheres. However, high oil loadings produced lower yields and affected microencapsulation efficiencies.

Desiccation↗

Lymphomas involving Waldeyer's ring: placement, paradigms, peculiarities, pitfalls, patterns and postulates.

INTRODUCTION: This review revisits Waldeyer's ring lymphomas as classified by the World Health Organisation. MATERIALS AND METHODS: Sources of data include international studies on Waldeyer's ring lymphomas as well as from personal observations gleaned from lymphoma statistics of Singapore General Hospital, Changi General Hospital, Tan Tock Seng Hospital and National University Hospital within the last decade or so. RESULTS: Waldeyer's ring shares many of the histopathological trends of the rest of mucosa-associated lymphoid tissue (MALT), such as the high frequency of diffuse large B-cell lymphomas, and the relative rarity of follicular lymphomas in spite of its rich endowment with reactive lymphoid follicles. However, extranodal marginal zone lymphoma or "MALToma" may not be as frequently encountered as in other mucosal sites. Furthermore, the placement of Waldeyer's ring is unique in that stark comparisons with the lymphopathology of the immediately anterior oronasal cavities can be made, with intriguing peculiarities such as the abrupt reversal of the ratio of B-cell to T/NK-cell lymphoma frequency upon crossing the imaginary line that separates the 2 regions. The differential diagnosis with regionally common lymphoma mimics, in particular reactive parafollicular hyperplasia and nasopharyngeal undifferentiated (lymphoepithelial) carcinoma of Schmincke pattern, both often aetiologically related to Epstein-Barr viral infection, is also discussed. CONCLUSIONS: Recognition of the peculiarities and patterns of Waldeyer's ring lymphomas is important for accurate pathologic assessment. Postulates that attempt to account for the patterns and peculiarities of Waldeyer's ring lymphopathology can be used to direct further research.

Diagnosis, Differential↗

Localized morphological brain differences between English-speaking Caucasians and Chinese-speaking Asians: new evidence of anatomical plasticity.

Deformation field morphometry was applied to magnetic resonance images to detect differences in brain shape between English-speaking Caucasians and Chinese-speaking Asians. Anatomical differences between these two groups were limited to gyri in the frontal, temporal and parietal lobes, which are known (through functional imaging studies) to differentiate Chinese speakers from English speakers. We interpret these anatomical differences as evidence of neural plasticity shaped by the process of language acquisition during childhood. While anatomical plasticity due to manual skill acquisition (e.g. in musicians) has been established, to our knowledge this is the first report of a brain anatomical difference attributable to a learned cognitive strategy.

Adult↗

A case of severe leptospirosis with pancytopaenia.

Pancytopaenia is a rare clinical presentation of severe leptospirosis. We would like to report a case of severe leptospirosis that progressed to pancytopaenia despite initial penicillin therapy. The patient needed a second course of antibiotic with doxycycline to improve his persistent symptoms and cytopaenia. Persistent pancytopaenia in severe leptospirosis and its management were reviewed.

Doxycycline↗

Anaesthetic considerations for lung volume reduction surgery--a case report.

INTRODUCTION: This case describes some of the unique problems faced by the thoracic anaesthesiologists during anaesthesia for lung volume reduction surgery. CLINICAL PICTURE: The usual pulmonary function requirements for lobectomy are normally not met in these patients with severe emphysema. TREATMENT: Maintenance of the functional residual capacity of the lung and normocapnia during anaesthesia are not as important. Instead problems due to barotrauma and dynamic hyperinflation from positive pressure ventilation are. OUTCOME: Modification of ventilation strategy and providing an anaesthetic tailored towards early extubation is the cornerstone of the anaesthetic plan. CONCLUSION: A good understanding of the respiratory physiology in patients with severe emphysema is essential.

Aged↗

Seroepidemiology of toxoplasmosis among HIV-infected patients and healthy blood donors.

A cross-sectional study was carried out in University of Malaya Medical Centre, Kuala Lumpur. Blood samples from 100 HIV-infected patients and 203 Healthy Blood Donors (HBD) were collected and anti-Toxoplasma antibodies were detected by using conventional ELISA. The seroprevalence of toxoplasmosis in HIV/AIDS and Healthy Blood Donors were found to be 21% and 28.1% respectively. There was no significant association between the seroprevalence of toxoplasmosis and various possible risk factors i.e. contact with cat, consumption of undercooked meat and history of blood transfusion in both groups. No significant differences between Toxoplasma seroprevalence in HIV/AIDS and Healthy Blood Donors in association with presence of single or multiple risk factors were found. The mean CD4 count among HIV/AIDS patients in this study was 202.23 cell/cumm. There was no significant association between CD4 count and seropositivity for Toxoplasma antibodies in HIV/AIDS patients.

Adolescent↗

An fMRI study with written Chinese.

Event-related functional magnetic resonance imaging (ER-fMRI) was used to investigate how the human brain processes phonology and transforms a word's visual form (orthography) into phonological form during reading in logographic Chinese, a writing system that differs markedly from alphabetic languages. We found that reading aloud of irregular words produced larger MR signal intensity changes over extensive regions involving left infero-middle frontal cortex, left motor cortex, right infero-frontal gyri, bilateral anterior superior temporal areas, and anterior cingulate cortex. Right superior parietal lobule, the cuneus in bilateral visual cortex, and thalamus participated in the processing of irregular, but not regular, words. These findings were discussed in comparison to neuroimaging findings from alphabetic languages, as well as in relation to models of reading.

Adult↗

The neural system underlying Chinese logograph reading.

Written Chinese as logographic script differs notably from alphabets such as English in visual form, orthography, phonology, and semantics. Thus, research on the Chinese language is important to advance our understanding of the universality and particularity of the organization of language systems in the brain. In this study, we examine the neural systems associated with logographic reading using functional magnetic resonance imaging. Two experimental tasks were devised, one based on semantic decision and the other on homophone decision. Compared to the fixation baseline, peak activations resulting from semantic as well as homophony decisions were localized in the left middle frontal gyrus (BA 9). Left inferior frontal cortex also mediated Chinese processing. In addition, more right hemisphere cortical regions (i.e., BAs 47/45, 7, 40/39, and the right visual system) were involved in reading Chinese relative to reading English. This is attributed to the square shape of the logograph which requires an elaborated analysis of the spatial information and locations of various strokes comprising the logographic character. We suggest that the left middle frontal area (BA 9) coordinates and integrates the intensive visuospatial analysis demanded by logographs' square configuration and the semantic (or phonological) analysis required by the present experimental tasks. Our study has implicated brain regions common to both logographic and alphabetic languages as well as brain regions specialized in processing logographs.

Adult↗

Cerebral hemodynamic response in Chinese (first) and English (second) language processing revealed by event-related functional MRI.

Comparative functional neuroimaging studies using the block design paradigm have previously demonstrated that there are no significant differences in the location of areas of cerebral activation when native Chinese speakers independently process single words or sentences in both the Chinese (first) and English (second) languages. While it has also been documented that significant domains of brain response include the inferior to middle left frontal lobe, the latency, amplitude and duration of the associated hemodynamic changes during isolated neural processing of Chinese and English languages still remain unknown. The aim of this study, therefore, was to examine the characteristics of the hemodynamic alterations in the above-mentioned regions with event-related functional MRI (ER-fMRI) when native Chinese speakers performed verb generation tasks in both the Chinese (first) and English (second) languages. Our results demonstrate the presence of a similar neural activity-induced hemodynamic response in the inferior to middle left frontal lobe during both tasks. Further, there were also no statistically significant differences among the variables that described the hemodynamic response curves. These findings strongly imply that the underlying neural mechanism for Chinese (first) and English (second) language processing may be similar in native Chinese speakers.

Adult↗

2-octylcyanoacrylate-assisted microvascular anastomosis: comparison with a conventional suture technique in rat femoral arteries.

Standard microvascular anastomosis using only sutures is a well-established and successful technique; however, it is time-consuming and may cause vessel narrowing, needle trauma, and tissue reaction. The authors' hypothesis was that 2-octylcyanoacrylate could simplify microvascular anastomosis and reduce wall trauma and reaction. End-to-end anastomoses of the femoral arteries were performed in 20 adult rats. Each animal served as its own control. The time taken for each anastomosis (from first stitch to release of clamps) was noted, and the patency assessed. At day 7, the anastomoses were reassessed for patency, and the vessels evaluated histologically. 2-octylcyanoacrylate reduced the need to insert more sutures. Anastomotic time in the study group was statistically significantly shorter (p < 0.001), and the patency rate was 90 percent, compared to 85 percent with the standard suture technique. There was also less intense inflammatory reaction, with fewer foreign-body granulomata. This is the first report on the use of 2-octylcyanocrylate, currently approved for cutaneous use, for vessel anastomosis. Further work on the biomechanics and long-term histologic effects will be carried out. 2-octylcyanoacrylate has the potential for simplifying and improving the patency rates of arterial microanastomosis.

Anastomosis, Surgical↗

Reading Chinese characters for meaning: the role of phonological information.

Two experiments with the Stroop paradigm were conducted to investigate the role of phonological codes in access to the meaning of Chinese characters. Subjects named the ink color of viewed characters or color patches. Key items were color characters, their homophones with the same tone, homophones with different tones, and semantic associates. Apart from finding the usual Stroop interference effect, homophones produced significant interference in the incongruent condition, provided that they had the same tone as the color characters. The interference effect from homophones, however, was significantly smaller than that from color characters. Semantic associates generated an interference effect in the incongruent condition, an effect of the same magnitude as the effect from the same-tone homophones. Finally, in the congruent conditions, all the key items yielded facilitations compared to neutral controls, though the facilitation from color characters was larger than the facilitations from other types of characters. These findings suggest that phonological codes in Chinese are activated obligatorily and provide early sources of constraint in access to meaning.

Cognition↗

The role of phonological codes in integrating information across saccadic eye movements in Chinese character identification.

Prior research has generally assumed either that phonological codes do not contribute to Chinese character identification or that they do so only through a look-up process at the character level. In 3 experiments, a homophone seen parafoveally aided the identification of a target character that was fixated following an eye movement to the preview location. Moreover, high-frequency phonetically regular characters were named faster than high-frequency, phonetically irregular characters. Thus, both lexical and sublexical phonological codes of Chinese characters are involved early in the process of character identification. Orthographic information from the preview was also used in character identification, as orthographically similar previews facilitated target identification as well. The evidence for the extraction of semantic information from parafoveal previews was mixed, as synonym previews facilitated in Experiment 2 but not in Experiment 1.

Adult↗