2.Methacholine Challenge Test as an Adjunctive Investigative Tool in Patients with Asthma-Like Symptoms: The Sabah Experience
Siew Teck Tie ; J L Wong ; A Beniyamin ; A HO ; S K K Kannan ; A R Jamalul Azizi
The Medical Journal of Malaysia 2012;67(2):204-206
Introduction: Patients with asthma-like symptoms pose a
diagnostic dilemma when physical examination is normal.
The usual practice in Malaysia would be to give empirical
asthma treatment. Bronchial challenge test (BCT) is widely
used in many countries to diagnose asthma objectively but it is not widely available in Malaysia.
Objective: To describe our experience with BCT using
methacholine at Queen Elizabeth Hospital as a supporting
tool in the investigation of patients with asthma-like
symptoms.
Methodology: Review of case notes of patients who
underwent BCT from July 2008 till April 2009. BCT was
performed via dosimeter technique. Results were classified
as high hyper responsiveness if the provocative dose of
methacholine required to achieve 20% fall in FEV1 (PD20) was less than or equal to 0.125 μmol, moderate hyper
responsiveness if PD20 was between 0.125 to 1.99 μmol or
mild hyper responsiveness if PD20 was between 2.00 to 6.6
μmol. PD20 of more than 6.6 μmol constitutes a negative MCT.
Results: 29 patients had BCT during the study period. 19
cases were included in this review. The age ranged from 13
to 70 years old. There were 12 males and 7 females. Duration of symptoms ranged from 2 weeks to 23 years. BCT was positive (mild or moderate hyper responsiveness) in 10 out of 19 patients. No patient had high bronchial hyper
responsiveness.
Conclusions: BCT is a useful adjunctive tool in the
investigation of patients presenting with asthma-like
symptoms. This test obviates empirical asthma treatment.
BCT should be made available in all major hospitals in
Malaysia.
3.Drainage of multiloculated tuberculous pleural effusion by medical thoracoscopy: When and why should it be considered?
Sze Shyang KHO ; Swee Kim CHAN ; Mei Ching YONG ; Siew Teck TIE
The Medical Journal of Malaysia 2018;73(1):49-50
Tuberculous pleural effusion (TBE) is a common encounterin our region. Up to 50% of patients with TBE will developresidual pleural thickening (RPT) which can lead tofunctional impairment. However, the need of drainageremains controversial. We report a case of end-stage renalfailure patient who presented with right multiloculatedtuberculous pleural effusion which was drained via amedical thoracoscope. Patient reports immediate relief ofbreathlessness post procedure and one month follow upshown significant improvement of RPT. We also discussedthe current perspective on the rationale of TBE drainage andthe role of medical thoracoscope in TBE management.
4.Radial probe endobronchial ultrasound (R-EBUS) guided transbronchial cryobiopsy in the diagnosis of peripheral solitary pulmonary nodule
Kho Sze Shyang ; Tie Siew Teck
The Medical Journal of Malaysia 2019;74(4):349-351
Solitary pulmonary nodule (SPN) always raises suspicion for
early lung cancer, in which accurate and less invasive
biopsy is needed. We report a case of transbronchial
cryobiopsy of right upper lobe SPN under radial
endobronchial ultrasound (R-EBUS) guidance after an
inconclusive computed tomography guided transthoracic
needle aspiration. A diagnosis of Stage 1B adenocarcinoma
of the lung was made. Patient subsequently underwent
curative right upper lobectomy after ruling out mediastinal
lymph node involvement. To the best of our knowledge, this
is the first report of R-EBUS guided transbronchial
cryobiopsy case reported from Malaysia.
5.The great masquerade: Empyema thoracis as an unusual presentation of primary lung malignancy
Larry Nyanti ; Kho Sze Shyang ; Tie Siew Teck
The Medical Journal of Malaysia 2019;74(1):79-81
Primary lung malignancy presenting as empyema is rare,
with a reported incidence of 0.3%. We report a case of a 60-
year-old man presenting with unilateral pleural effusion;
diagnostic thoracocentesis confirmed Salmonella
empyema. Post-drainage, chest radiograph showed
persisting right hemithorax opacity; subsequent computed
tomography revealed a right lung mass with right upper lobe
bronchus obliteration. Percutaneous biopsy confirmed
advanced stage lung adenocarcinoma. We discuss the
mechanism of post-obstructive pneumonia in lung cancerassociated
empyema and the utility of bedside ultrasound in
diagnosis of lung masses. Clinicians are alerted to the
possibility of lung malignancy in elderly patients presenting
with empyema.
6.Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle
Nai-Chien HUAN ; Sze Shyang KHO ; Larry Ellee NYANTI ; Hema Yamini RAMARMUTY ; Muhammad Aklil Abd RAHIM ; Rong Lih HO ; Shan Min LO ; Siew Teck TIE ; Kunji Kannan Sivaraman KANNAN
Tuberculosis and Respiratory Diseases 2025;88(1):181-189
Background:
In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times.
Methods:
We report on a series of 31 patients who underwent dry MT with artificial pneumothorax induction using Veress needle under thoracic ultrasonography (TUS) guidance. A procedure was considered technically successful if it met all the following criteria: successful pneumothorax induction, allowing smooth insertion of the semi-rigid thoracoscope; absence of immediate significant procedural-related complications; and no delayed complications such as persistent air leaks, defined as leakage lasting more than 5 days necessitating extended chest tube placement.
Results:
Complete pneumothorax induction was achieved in 25 cases, resulting in an 80.6% technical success rate; however, biopsies were successfully performed in all cases. The most frequent histopathological diagnoses were malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No procedural complications were reported.
Conclusion
These results indicate that TUS-guided dry MT utilizing a Veress needle is technically feasible and secure when performed by experienced MT practitioners in TUS.
7.Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle
Nai-Chien HUAN ; Sze Shyang KHO ; Larry Ellee NYANTI ; Hema Yamini RAMARMUTY ; Muhammad Aklil Abd RAHIM ; Rong Lih HO ; Shan Min LO ; Siew Teck TIE ; Kunji Kannan Sivaraman KANNAN
Tuberculosis and Respiratory Diseases 2025;88(1):181-189
Background:
In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times.
Methods:
We report on a series of 31 patients who underwent dry MT with artificial pneumothorax induction using Veress needle under thoracic ultrasonography (TUS) guidance. A procedure was considered technically successful if it met all the following criteria: successful pneumothorax induction, allowing smooth insertion of the semi-rigid thoracoscope; absence of immediate significant procedural-related complications; and no delayed complications such as persistent air leaks, defined as leakage lasting more than 5 days necessitating extended chest tube placement.
Results:
Complete pneumothorax induction was achieved in 25 cases, resulting in an 80.6% technical success rate; however, biopsies were successfully performed in all cases. The most frequent histopathological diagnoses were malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No procedural complications were reported.
Conclusion
These results indicate that TUS-guided dry MT utilizing a Veress needle is technically feasible and secure when performed by experienced MT practitioners in TUS.
8.Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle
Nai-Chien HUAN ; Sze Shyang KHO ; Larry Ellee NYANTI ; Hema Yamini RAMARMUTY ; Muhammad Aklil Abd RAHIM ; Rong Lih HO ; Shan Min LO ; Siew Teck TIE ; Kunji Kannan Sivaraman KANNAN
Tuberculosis and Respiratory Diseases 2025;88(1):181-189
Background:
In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times.
Methods:
We report on a series of 31 patients who underwent dry MT with artificial pneumothorax induction using Veress needle under thoracic ultrasonography (TUS) guidance. A procedure was considered technically successful if it met all the following criteria: successful pneumothorax induction, allowing smooth insertion of the semi-rigid thoracoscope; absence of immediate significant procedural-related complications; and no delayed complications such as persistent air leaks, defined as leakage lasting more than 5 days necessitating extended chest tube placement.
Results:
Complete pneumothorax induction was achieved in 25 cases, resulting in an 80.6% technical success rate; however, biopsies were successfully performed in all cases. The most frequent histopathological diagnoses were malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No procedural complications were reported.
Conclusion
These results indicate that TUS-guided dry MT utilizing a Veress needle is technically feasible and secure when performed by experienced MT practitioners in TUS.
9.Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle
Nai-Chien HUAN ; Sze Shyang KHO ; Larry Ellee NYANTI ; Hema Yamini RAMARMUTY ; Muhammad Aklil Abd RAHIM ; Rong Lih HO ; Shan Min LO ; Siew Teck TIE ; Kunji Kannan Sivaraman KANNAN
Tuberculosis and Respiratory Diseases 2025;88(1):181-189
Background:
In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times.
Methods:
We report on a series of 31 patients who underwent dry MT with artificial pneumothorax induction using Veress needle under thoracic ultrasonography (TUS) guidance. A procedure was considered technically successful if it met all the following criteria: successful pneumothorax induction, allowing smooth insertion of the semi-rigid thoracoscope; absence of immediate significant procedural-related complications; and no delayed complications such as persistent air leaks, defined as leakage lasting more than 5 days necessitating extended chest tube placement.
Results:
Complete pneumothorax induction was achieved in 25 cases, resulting in an 80.6% technical success rate; however, biopsies were successfully performed in all cases. The most frequent histopathological diagnoses were malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No procedural complications were reported.
Conclusion
These results indicate that TUS-guided dry MT utilizing a Veress needle is technically feasible and secure when performed by experienced MT practitioners in TUS.
10.Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle
Nai-Chien HUAN ; Sze Shyang KHO ; Larry Ellee NYANTI ; Hema Yamini RAMARMUTY ; Muhammad Aklil Abd RAHIM ; Rong Lih HO ; Shan Min LO ; Siew Teck TIE ; Kunji Kannan Sivaraman KANNAN
Tuberculosis and Respiratory Diseases 2025;88(1):181-189
Background:
In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times.
Methods:
We report on a series of 31 patients who underwent dry MT with artificial pneumothorax induction using Veress needle under thoracic ultrasonography (TUS) guidance. A procedure was considered technically successful if it met all the following criteria: successful pneumothorax induction, allowing smooth insertion of the semi-rigid thoracoscope; absence of immediate significant procedural-related complications; and no delayed complications such as persistent air leaks, defined as leakage lasting more than 5 days necessitating extended chest tube placement.
Results:
Complete pneumothorax induction was achieved in 25 cases, resulting in an 80.6% technical success rate; however, biopsies were successfully performed in all cases. The most frequent histopathological diagnoses were malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No procedural complications were reported.
Conclusion
These results indicate that TUS-guided dry MT utilizing a Veress needle is technically feasible and secure when performed by experienced MT practitioners in TUS.