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Biomedical subjects

P Lim

Publications and source records attributed to P Lim.

At least 37 records · Page 2Linked to original sources
PubMed1999

A randomized, placebo-controlled study of topiramate in primary generalized tonic-clonic seizures. Topiramate YTC Study Group.

BACKGROUND AND OBJECTIVE: Topiramate is effective as adjunctive treatment of partial-onset seizures in adults. The efficacy and safety of topiramate as adjunctive therapy for the treatment of primary generalized tonic-clonic (PGTC) seizures were investigated in a randomized, double-blind, placebo-controlled study. METHODS: Eighty patients, 3 to 59 years old, who experienced three or more PGTC seizures during an 8-week baseline phase were randomly assigned to treatment with either topiramate (n = 39) or placebo (n = 41). Topiramate was titrated to target doses of approximately 6 mg/kg/day over 8 weeks and maintained for another 12 weeks. RESULTS: The median percentage reduction from baseline in PGTC seizure rate was 56.7% for topiramate patients and 9.0% for placebo patients (p = 0.019). The proportion of patients with 50% or higher reduction in PGTC seizure rate was 22/39 (56%) and 8/40 (20%) for the topiramate and placebo groups, respectively (p = 0.001). The median percentage reduction in the rate of all generalized seizures was 42.1% for topiramate patients and 0.9% for placebo patients (p = 0.003). The proportions of patients with 50% or higher reductions in generalized seizure rate were 18/39 (46%) and 7/41 (17%) for the topiramate and placebo groups, respectively (p = 0.003). The most common adverse events were somnolence, fatigue, weight loss, difficulty with memory, and nervousness. Treatment-limiting adverse events occurred in one patient in the topiramate group (anorexia and weight loss) and one in the placebo group (granulocytopenia and thrombocytopenia). CONCLUSION: Topiramate is well-tolerated and effective for the adjunctive treatment of PGTC seizures.

Adolescent↗
PubMed1999

Low-risk endometrial carcinoma: assessment of a treatment policy based on tumor ploidy and identification of additional prognostic indicators.

OBJECTIVES: The aims of this study were (1) to assess a treatment policy for patients with low-risk endometrioid endometrial carcinoma where adjuvant treatment decisions have been based on ploidy status of the tumor, and (2) to screen diploid, low-risk tumors for additional features of prognostic significance. METHODS: Between 01/1992 and 08/1996, 406 patients were referred to the B.C. Cancer Agency-Vancouver Clinic with typical endometrial adenocarcinomas limited to <50% myometrial invasion and no vascular space invasion or grade 3 disease on pathology review ("low-risk stage I endometrial carcinoma"). Patients were prospectively assigned to treatment groups based on tumor ploidy. Those patients with aneuploid tumors (n = 91) were treated with adjuvant vaginal vault radiotherapy while those with diploid tumors (n = 315) were followed and treated only at relapse. The hysterectomy specimens from all 14 patients in the untreated, diploid group who relapsed, as well as 28 stage- and grade-matched diploid controls who did not fail, were analyzed by immunohistochemical staining for estrogen receptor (ER), Bcl-2, and p53 proteins. RESULTS: There were no significant differences in the stage (Ia vs Ib) and grade (G1 vs G2) distribution for the diploid and aneuploid groups. Overall median age was 64 years (range 27-90 years) and was also not significantly different for the two groups. The median follow-up for the entire cohort is 45 months (range 1-76 months). There have been 14 failures in the diploid group and 4 failures in the aneuploid group with actuarial 5-year disease-free survival rates of 95.0 and 95.2%, respectively (P = NS). Eight of the failures in the diploid group occurred at the vaginal vault and were all subsequently salvaged with radiotherapy. All but 1 of the failures in the aneuploid group were considered incurable. Of the 14 diploid tumors from patients who failed, 7 stained positively for p53, compared to 4 of 28 diploid controls (P = 0.02). No significant differences were seen in the diploid tumors that recurred, compared to controls, with respect to Bcl-2 or ER expression. CONCLUSIONS: Patients with diploid, low-risk stage I endometrial cancers have excellent prospects for relapse-free and overall survival. Patients with aneuploid tumors treated with adjuvant radiotherapy have the same risk of relapse as untreated patients with diploid tumors; however, their ultimate survival may be lower as a smaller proportion of aneuploid failures are salvageable. While p53 expression in diploid tumors is associated with increased risk of relapse, Bcl-2 and ER are not useful prognostic indicators in this setting.

Adult↗
PubMed1999

Carbogen inhalation in cervical cancer: assessment of oxygenation change.

OBJECTIVE: Our objectives were (1) to examine tumor oxygenation measured with an Eppendorf pO(2) histograph, prior to and during carbogen (95% oxygen, 5% carbon dioxide) breathing in patients with primary cervical cancer; and (2) to assess the feasibility of delivering external beam radiation therapy and concurrent carbogen to patients treated for cervical cancer. METHODS: Pretreatment tumoral pO(2) measurements were obtained using an Eppendorf pO(2) histograph in patients with primary cervical cancers while breathing room air and after 4 min of carbogen breathing. Patients able to tolerate the carbogen inhalation were asked to inhale it for 4 min prior to and during all external beam radiation therapy. RESULTS: Two sets of pO(2) measurements were obtained from 25 patients. The average median pO(2) increased from 8 mm Hg when breathing room air to 96 mm Hg after carbogen breathing. Twenty-four of 25 patients tolerated the carbogen; they inhaled carbogen during their daily external beam radiation therapy. All 24 patients completed their planned course of external beam radiation therapy and daily concurrent carbogen without significant difficulty. CONCLUSION: (1) Carbogen inhalation increased the average median pO(2) value 10-fold and decreased the percentage of values </=2.5 and 5 mm Hg. (2) Carbogen inhalation is feasible during external beam pelvic radiation.

Administration, Inhalation↗
PubMed1999

Dundee step test: a simple method of measuring the blood pressure response to exercise.

The exercise systolic blood pressure (BP) response provides prognostic information over and above that of resting clinic BP in both normotensive and hypertensive individuals. We have developed a 3-min step test as a method of measuring the exercise systolic BP. Healthy volunteers and patients referred for assessment of hypertension took part in validating this exercise test. We assessed the reproducibility of the exercise systolic BP response, and this was compared with that obtained using the cycle ergometry at an equivalent workload. We also compared the baseline characteristics, BP profiles and exercise systolic BP responses in different subject groups. The intra-observer coefficient of variation assessed in 25 subjects was 5.9% with a mean difference of 1.8 mm Hg. The values for between observer were 8.3% and 2.5 mm Hg respectively. Exercise systolic BP measured with the step test correlated with that of cycle ergometer (n = 37, r = 0.93, P < 0.01). Exercise systolic BP data from healthy volunteers (n = 107) showed a normal distribution. An exercise systolic BP of >/=180 mm Hg was greater than 2 standard deviations from the mean and was taken as an abnormally high BP during exercise. There was a positive correlation between exercise BP and increasing age in healthy volunteers (r = 0.57, P < 0.01). This was also present in hypertensive subjects (n = 46, r = 0.48, P = 0.001), however the slope of this relationship was twice as steep as in the normal subjects. Hypertensive subjects with high exercise systolic BP had significantly higher clinic BP, ABPM and a greater BP rise during exercise. The Dundee step test is quick, reproducible and may be prognostically useful.

Adult↗
PubMed1999

Replantation of fingertip amputation by using the pocket principle in adults.

There are several treatment modalities for zone 1 or zone 2 fingertip amputations that cannot be replanted by using microsurgical techniques, such as delayed secondary healing, stump revision, skin graft, local flaps, distant flaps, and composite graft. Among these, composite graft of the amputated digit tip is the only possible means of achieving a full-length digit with a normal nail complex. The pocket principle can provide an extra blood supply for survival of the composite graft of the amputated finger by enlarging the area of vascular contact. The surgery was performed in two stages. The amputated digit was debrided, deepithelialized, and reattached to the proximal stump. The reattached finger was inserted into the abdominal pocket. About 3 weeks later, the finger was removed from the pocket and covered with a skin graft. We have consecutively replanted 29 fingers in 25 adult patients with fingertip amputations by using the pocket principle. All were complete amputations with crushing or avulsion injuries. Average age was 33.64 years, and men were predominant. The right hand, the dominant one, was more frequently injured, with the middle finger being the most commonly injured. Of the 29 fingers, 16 (55.2 percent) survived completely and 10 (34.5 percent) had partial necrosis less than one-quarter of the length of the amputated part. The results of the above 26 fingers were satisfactory from both functional and cosmetic aspects. Twenty of the 29 fingers, which had been followed up for more than 6 months (an average of 16 months), were included in a sensory evaluation. Fifteen of these 20 fingers (75 percent) were classified as "good" (static two-point discrimination of less than 8 mm and normal use). From the overall results and our experience, we suggest that the pocket principle is a safe and valuable method in replantation of zone 1 or zone 2 fingertip amputation, an alternative to microvascular replantation, even in adults.

Adolescent↗
PubMed1998

Highly complex chromosomal rearrangement of chromosome 9 in a case of chronic myeloid leukemia.

A 63-year-old man with chronic myeloid leukemia (CML) was found to have a new complex Philadelphia translocation. All of the bone marrow cells had a rearrangement of a five-way translocation, t(9;22;10;12;1), involving a single chromosome 9. The patient went into blast crisis two years after initial diagnosis and the karyotype remained unchanged. He died in blast crisis 10 months later. We believe this case is a unique 5-way translocation in which four chromosomes were translocated to a single chromosome.

Chromosomes, Human, Pair 1↗
PubMed1998

Papillary serous and clear cell carcinoma limited to endometrial curettings in FIGO stage 1a and 1b endometrial adenocarcinoma: treatment implications.

OBJECTIVE: The aim of this study was to review the significance of papillary serous and clear cell carcinoma in Stage 1a and 1b adenocarcinoma of the endometrium where this histological subtype is confined to the endometrial curettings and is absent in the hysterectomy specimen. METHODS AND MATERIALS: Three hundred twenty patients with Stage 1a or 1b adenocarcinoma of the endometrium without lymphovascular space invasion or evidence of FIGO Grade 3 histology demonstrated in the hysterectomy specimen were referred to the British Columbia Cancer Agency, Vancouver Clinic, between January 1992 and July 1995. These charts were retrospectively reviewed. RESULTS: On pathology review, eight patients were found to have evidence of papillary serous or clear cell carcinoma confined to the uterine curettings. Five patients also had Grade 1 or 2 endometrioid adenocarcinoma without lymphovascular space involvement seen in the hysterectomy specimen. All patients were managed expectantly. None of these 8 have recurred with a median follow-up of 3 years. CONCLUSION: A clinical dilemma arises when there is evidence of papillary serous or clear cell carcinoma limited to the endometrial curettings where there is no associated adverse pathological features seen in the hysterectomy specimen. In our series of patients treated expectantly, it appears that a small bulk of aggressive disease seen only in the curettage specimen does not adversely impact disease-free survival.

Adenocarcinoma↗
PubMed1998

Irreducible Galeazzi injury.

We present a case of a Galeazzi-type of fracture dislocation with an irreducible distal radioulnar joint. This is illustrated by intraoperative pictures which may assist others who find themselves faced with this injury.

Adult↗