1.A Pilot Study of Calcineurin Inhibitors (CNIs) and Steroid Avoidance Immunosuppressive Protocol among Living Donor Kidney Transplant Recipients.
Henry K OH ; Philip DING ; Nancy A SATMARY
Yonsei Medical Journal 2004;45(6):1143-1148
Calcineurin Inhibitors (CNIs) and Corticosteroids have been the main immunosuppressive agents in solid organ transplantation. Many studies have confirmed the positive impacts of withdrawal/avoidance of these agents, separately, on their side effect profiles. A pilot study was performed avoiding both agents among low-immunological-risk living donor kidney transplant recipients at a single center. Seventeen recipients were maintained on the double avoidance protocol during the study period beginning July 2002 through December 2003. Three rejection episodes occurred (out of ten) among related donor kidney recipients and six episodes (out of seven) among unrelated donor kidney recipients. Although most of the rejections were reversed with a short course of corticosteroids, the protocol was revised to exclude the unrelated donor kidney recipients. There were higher incidences of wound complications among recipients who received the initial loading dose of Sirolimus. Double avoidance of CNIs and corticosteroids is possible in living donor kidney transplant recipients with an acceptable incidence of rejection. Proper management of the side effects of Sirolimus could further minimize the incidence of rejection. A multi-center randomized study is recommended in order to recognize the benefits of avoiding CNIs and corticosteroids in renal transplant recipients.
Adrenal Cortex Hormones
;
Adult
;
Aged
;
Antibodies, Monoclonal/*therapeutic use
;
Calcineurin/antagonists & inhibitors
;
Chimeric Proteins/*therapeutic use
;
Drug Therapy, Combination
;
Enzyme Inhibitors
;
Female
;
Glucocorticoids/*therapeutic use
;
Humans
;
Immunosuppressive Agents/*therapeutic use
;
*Kidney Transplantation
;
*Living Donors
;
Male
;
Methylprednisolone/*therapeutic use
;
Middle Aged
;
Mycophenolic Acid/*analogs & derivatives/*therapeutic use
;
Pilot Projects
;
Sirolimus/*therapeutic use
2.Retrospective Study of The Outcome of Primary Repair of Arteriovenous Fistula (AVF) Aneurysm and Pseudoaneurysm in Secondary Hospital Setting (Kajian Retrospektif Pembaikian Primer Ateriovenous Fistula (AVF) Aneurisma dan Pseudoaneurisma di Hospital Sekunder)
Ong Xin Zen ; Ling Li Fan ; Philip Ding Hsin Loong ; Chong Kar Hon ; Goh Neng Xiang
Malaysian Journal of Health Sciences 2023;21(No.1):9-14
Aneurysms and pseudoaneurysm are commonly encountered with arteriovenous vascular access for haemodialysis.
They are difficult complications to manage. Due to the limited number of vascular centers available, patients were
unable to seek treatment until further complications arise. The technique of partial aneurysmectomy and primary repair
was adopted as the method of repair in this study. A total of 20 cases underwent the surgery from 2019 to 2020. Among
the 20 cases, one patient had two pseudoaneurysms at different location which requires her to undergo the procedure
twice. The successful cannulation rate post repair was 70% whereas the overall complication rate was 35% which might
be attributed to the small sample size. Overall, this study demonstrated that AVF aneurysm and pseudoaneurysm can be
safely treated with this approach and can be done effectively in non-vascular centers by general surgeons.
3.Clinical presentation of cardiac myxoma in a Singapore national cardiac centre.
Phong Teck LEE ; Rilong HONG ; Philip Yk PANG ; Yeow Leng CHUA ; Zee Pin DING
Singapore medical journal 2021;62(4):195-198
INTRODUCTION:
Cardiac myxoma is the most common cardiac tumour. In this study, we summarise our 17-year experience with the clinical presentation of cardiac myxoma at National Heart Centre Singapore, Singapore.
METHODS:
Between January 2000 and December 2016, retrospective data was reviewed for all consecutive patients who underwent surgical resection of cardiac myxoma. Patients' clinical characteristics were reviewed and described.
RESULTS:
A total of 67 (18 male, 49 female; mean age 53.1 ± 13.5 years) patients underwent cardiac myxoma resection. There were 19 (28.4%) patients with asymptomatic cardiac myxoma. There were no significant differences in gender; body habitus and myxoma size; and haemoglobin, white blood cell or platelet counts between patients with symptomatic and asymptomatic myxoma. However, the number of asymptomatic cardiac myxomas seemed to follow an increasing trend from 19.4% (period 2000-2008) to 36.1% (period 2009-2016), suggestive of an 'era effect'.
CONCLUSION
In our study, a majority of patients were women, with a wide age range of 18-78 years. The diagnosis of asymptomatic cardiac myxoma was present in 28.4% of patients, with an increasing trend for incidence over the years. This is possibly due to increased opportunistic screening (with electrocardiography and clinical examination) as well as higher usage of medical imaging.