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Article ; Online: Choledochal cysts. Part 3 of 3: management.

Singham, Janakie / Yoshida, Eric M / Scudamore, Charles H

Canadian journal of surgery. Journal canadien de chirurgie

2010 Volume 53, Issue 1, Page(s) 51–56

Abstract: Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of ... ...

Abstract	Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 3, we discuss the management of choledochal cysts, thus completing our comprehensive review.
MeSH term(s)	Choledochal Cyst/complications ; Choledochal Cyst/surgery ; Duodenostomy ; Enterostomy ; Female ; Hepatic Duct, Common/surgery ; Humans ; Pancreatitis/complications ; Pregnancy ; Pregnancy Complications/therapy
Language	English
Publishing date	2010-01-25
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	410651-9
ISSN	1488-2310 ; 0008-428X
ISSN (online)	1488-2310
ISSN	0008-428X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Choledochal cysts: part 2 of 3: Diagnosis.

Singham, Janakie / Yoshida, Eric M / Scudamore, Charles H

Canadian journal of surgery. Journal canadien de chirurgie

2010 Volume 52, Issue 6, Page(s) 506–511

Abstract	Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 2, we explore the details surrounding diagnosis, describing the presentation and imaging of the disease.
MeSH term(s)	Choledochal Cyst/diagnosis ; Humans
Language	English
Publishing date	2010-02-23
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	410651-9
ISSN	1488-2310 ; 0008-428X
ISSN (online)	1488-2310
ISSN	0008-428X
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Article ; Online: Möbius syndrome.

Singham, Janakie / Manktelow, Ralph / Zuker, Ronald M

Seminars in plastic surgery

2010 Volume 18, Issue 1, Page(s) 39–46

Abstract: Möbius syndrome is classically defined as combined congenital bilateral facial and abducens nerve palsies, although it may also be associated with a myriad of other craniofacial, musculoskeletal, cardiothoracic, endocrinologic, and developmental ... ...

Abstract	Möbius syndrome is classically defined as combined congenital bilateral facial and abducens nerve palsies, although it may also be associated with a myriad of other craniofacial, musculoskeletal, cardiothoracic, endocrinologic, and developmental disorders. The problem that most patients complain about, however, is the inability to smile and close their lips while eating. Although the etiology of this syndrome is still unknown, scientific support has been growing for the hypothesis that it is due to an embryological disruption of subclavian artery development. The treatment of choice for facial reanimation in these patients is a neurovascular free muscle transfer, ideally using the gracilis muscle with direct repair of the gracilis muscle's motor nerve to the masseteric branch of the trigeminal nerve. If the masseteric nerve is unavailable, a partial hypoglossal or accessory nerve may be used. These operations, enhanced by the effects of cerebral plasticity, may allow Möbius patients to reach their goals of satisfactory spontaneous smiles.
Language	English
Publishing date	2010-06-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2077828-4
ISSN	1536-0067 ; 1535-2188
ISSN (online)	1536-0067
ISSN	1535-2188
DOI	10.1055/s-2004-823122
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Article ; Online: Choledochal cysts: part 1 of 3: classification and pathogenesis.

Singham, Janakie / Yoshida, Eric M / Scudamore, Charles H

Canadian journal of surgery. Journal canadien de chirurgie

2009 Volume 52, Issue 5, Page(s) 434–440

Abstract	Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 1, we discuss the background of the disease, describing the etiology, classification, pathogenesis and malignant potential of choledochal cysts.
MeSH term(s)	Bile Duct Neoplasms/epidemiology ; Bile Duct Neoplasms/pathology ; Bile Duct Neoplasms/surgery ; Cell Transformation, Neoplastic/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst/classification ; Choledochal Cyst/pathology ; Choledochal Cyst/surgery ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Precancerous Conditions/pathology ; Risk Assessment ; Severity of Illness Index ; Treatment Outcome
Language	English
Publishing date	2009-09-24
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	410651-9
ISSN	1488-2310 ; 0008-428X
ISSN (online)	1488-2310
ISSN	0008-428X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Choledochal cysts: analysis of disease pattern and optimal treatment in adult and paediatric patients.

Singham, Janakie / Schaeffer, David / Yoshida, Eric / Scudamore, Charles

HPB : the official journal of the International Hepato Pancreato Biliary Association

2008 Volume 9, Issue 5, Page(s) 383–387

Abstract: Background: Choledochal cysts are dilations of the biliary tree. Although commonly reported in Asian populations, the incidence outside of Asia is as low as 1:150 000. The largest series of patients with choledochal cyst disease outside of Asia is this ... ...

Abstract	Background: Choledochal cysts are dilations of the biliary tree. Although commonly reported in Asian populations, the incidence outside of Asia is as low as 1:150 000. The largest series of patients with choledochal cyst disease outside of Asia is this one, studying 70 patients treated in Vancouver between 1971 and 2003. Patients and methods: This was a retrospective chart review. Results: In all, 19 paediatric and 51 adult patients were evaluated; 21% of paediatric and 25% of adult patients were Asian. All paediatric patients had type I or IV cysts, whereas adult patients represented the different subtypes. Abdominal pain was the presenting symptom in 79% of children and 88% of adults, vomiting was present in 42% of children and 63% of adults and jaundice was seen in 31.5% of children and 39% of adults. Ultrasound was used in 94.7% of children, and ERCP in 80% of adults. In all, 84% of paediatric patients, 100% of adult patients with type I cysts and 85.7% of adult patients with type IV cysts received complete cyst excision and Roux-en-Y hepaticojejunostomy. Complications in both groups were low. Conclusions: Although Vancouver does have a large Asian population, this does not explain how common choledochal cysts are in this city. Although some authors argue that paediatric and adult disease are caused by different aetiologies, presentation patterns in our study between the two groups were very similar. We recommend complete cyst excision and Roux-en-Y hepaticojejunostomy as the surgery of choice, and advocate early surgery after diagnosis to promote ease of surgery and prevention of future complications.
Language	English
Publishing date	2008-03-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2131251-5
ISSN	1365-182X
ISSN	1365-182X
DOI	10.1080/13651820701646198
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Article: The impact of patient education on the quality of inpatient bowel preparation for colonoscopy.

Rosenfeld, Greg / Krygier, Darin / Enns, Robert A / Singham, Janakie / Wiesinger, Holly / Bressler, Brian

Canadian journal of gastroenterology = Journal canadien de gastroenterologie

2010 Volume 24, Issue 9, Page(s) 543–546

Abstract: Background: For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.: Objectives: To assess the impact of patient education, in the form of both counselling and written instructions, ...

Abstract	Background: For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult. Objectives: To assess the impact of patient education, in the form of both counselling and written instructions, on bowel cleanliness at colonoscopy. Methods: A total of 38 inpatients at a tertiary care hospital in Vancouver, British Columbia, who were referred to the gastroenterology service for colonoscopy were enrolled in the present study. Sixteen patients were randomly assigned to the intervention group, while 22 patients comprised the control group. Both groups received a clear liquid diet and 4 L of a commercially available bowel preparation. The intervention group also received a brief counselling session and written instructions outlining the methods and rationale for bowel preparation before colonoscopy. Bowel cleanliness was assessed by the endoscopist using a five-point rating scale. Results: The two groups were similar with respect to demographics, the indication for colonoscopy and findings at colonoscopy. The median bowel cleanliness scores in the control group and the enhanced-instruction group were 3.0 and 2.0, respectively (P=0.001). Conclusion: Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.
MeSH term(s)	Aged ; Cathartics/administration & dosage ; Colonoscopy/methods ; Directive Counseling/methods ; Female ; Humans ; Male ; Patient Education as Topic/methods
Chemical Substances	Cathartics
Language	English
Publishing date	2010-11-30
Publishing country	Canada
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	639439-5
ISSN	1916-7237 ; 0835-7900
ISSN (online)	1916-7237
ISSN	0835-7900
DOI	10.1155/2010/718628
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Efficacy of maintenance subcutaneous hepatitis B immune globulin (HBIG) post-transplant for prophylaxis against hepatitis B recurrence.

Singham, Janakie / Greanya, Erica D / Lau, Kirby / Erb, Siegfried R / Partovi, Nilu / Yoshida, Eric M

Annals of hepatology

2010 Volume 9, Issue 2, Page(s) 166–171

Abstract: Background: Patients who receive liver transplantation for chronic hepatitis B infection require long-term combination therapy with hepatitis B immunoglobulin (HBIG) and oral antiviral medication to prophylax against graft re-infection. This study ... ...

Abstract	Background: Patients who receive liver transplantation for chronic hepatitis B infection require long-term combination therapy with hepatitis B immunoglobulin (HBIG) and oral antiviral medication to prophylax against graft re-infection. This study examines the efficacy and patient preference of subcutaneous (SC) administration of HBIG in maintaining anti HBs titres > 100 IU/L. Materials and methods: 12 patients who were stable while receiving our standard IM HBIG protocol received an alternate formulation by SC injection, consisting of 10 mL (3120 IU) HBIG as 4 x 2.5 mL SC injections. SC injection were repeated as soon as titres reached 100-150 IU/mL during the 3 month study period. A questionnaire was administered upon study entry and exit to subjectively assess patient preference. Results: Anti- HBs Cmax after first injection was 441.6 IU/L +/- 81.5, and Tmax was 7.1 +/- 3.2 days. SC injections were required every 56 days, which compared well to the frequency of required IM injections prior to study enrollment of 45 days. The patients mean ratings of pain on a 0-10 scale were 5 for the IM route and 1.6 for the SC route. All patients preferred the SC injections to the IM. Conclusion: SC administration of HBIG can effectively maintain anti HBs levels above the requisite 100 IU/L while substantially decreasing patient discomfort and improving patient satisfaction, and therefore becomes a very attractive alternative to IM HBIG injections. Further studies and wider use of SC HBIG based on this study may alter the standard practice of transplantation centers
MeSH term(s)	Adult ; Aged ; Antiviral Agents/therapeutic use ; British Columbia ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Hepatitis B Antibodies/blood ; Hepatitis B Vaccines/administration & dosage ; Hepatitis B, Chronic/complications ; Hepatitis B, Chronic/prevention & control ; Hepatitis B, Chronic/surgery ; Humans ; Immunoglobulins/administration & dosage ; Injections, Intramuscular ; Injections, Subcutaneous ; Liver Transplantation/adverse effects ; Male ; Middle Aged ; Patient Preference ; Pilot Projects ; Prospective Studies ; Secondary Prevention ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome
Chemical Substances	Antiviral Agents ; Hepatitis B Antibodies ; Hepatitis B Vaccines ; Immunoglobulins ; hepatitis B hyperimmune globulin (XII270YC6M)
Language	English
Publishing date	2010-04
Publishing country	Mexico
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2188733-0
ISSN	1665-2681
ISSN	1665-2681
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Article ; Online: Familial hypobetalipoproteinemia-induced nonalcoholic steatohepatitis.

Lam, Mindy C W / Singham, Janakie / Hegele, Robert A / Riazy, Maziar / Hiob, Matti A / Francis, Gordon / Steinbrecher, Urs P

Case reports in gastroenterology

2012 Volume 6, Issue 2, Page(s) 429–437

Abstract: Familial hypobetalipoproteinemia (FHBL) is a rare genetic disorder of lipid metabolism that is associated with abnormally low serum levels of low-density lipoprotein (LDL) cholesterol and apolipoprotein B. It is an autosomal co-dominant disorder, and ... ...

Abstract	Familial hypobetalipoproteinemia (FHBL) is a rare genetic disorder of lipid metabolism that is associated with abnormally low serum levels of low-density lipoprotein (LDL) cholesterol and apolipoprotein B. It is an autosomal co-dominant disorder, and depending on zygosity, the clinical manifestations may vary from none to neurological, endocrine, hematological or liver dysfunction. Nonalcoholic fatty liver disease is common in persons with FHBL, however progression to nonalcoholic steatohepatitis is unusual. We describe here a patient with a novel APOB mutation, V703I, which appears to contribute to the severity of the FHBL phenotype. He had liver enzyme abnormalities, increased echogenicity of the liver consistent with steatosis, very low LDL cholesterol at 0.24 mmol/l (normal 1.8-3.5 mmol/l) and an extremely low apolipoprotein B level of 0.16 g/l (normal 0.6-1.2 g/l). APOB gene sequencing revealed him to be a compound heterozygote with two mutations (R463W and V703I). APOB R463W has previously been reported to cause FHBL. Genetic sequencing of his first-degree relatives identified the APOB V703I mutation in his normolipidemic brother and father and the APOB R463W mutation in his mother and sister, both of whom have very low LDL cholesterol levels. These results suggest that the APOB V703I mutation alone does not cause the FHBL phenotype. However, it is possible that it has a contributory role to a more aggressive phenotype in the presence of APOB R463W.
Language	English
Publishing date	2012-07-03
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2440540-1
ISSN	1662-0631 ; 1662-0631
ISSN (online)	1662-0631
ISSN	1662-0631
DOI	10.1159/000339761
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Möbius Syndrome

Singham, Janakie / Manktelow, Ralph / Zuker, Ronald M

Seminars in Plastic Surgery

2004 Volume 18, Issue 01, Page(s) 39–45

Keywords	Möbius syndrome ; facial paralysis ; facial diplegia ; facial reanimation ; gracilis flap transfer
Language	English
Publishing date	2004-01-01
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2073299-5
ISSN	1536-0067 ; 1535-2188
ISSN (online)	1536-0067
ISSN	1535-2188
DOI	10.1055/s-2004-823122
Database	Thieme publisher's database

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Article ; Online: Efficacy of maintenance subcutaneous hepatitis B immune globulin (HBIG) post-transplant for prophylaxis against hepatitis B recurrence†

Janakie Singham / Erica D. Greanya / Kirby Lau / Siegfried R. Erb / Nilu Partovi / Eric M. Yoshida

Annals of Hepatology, Vol 9, Iss 2, Pp 166-

2010 Volume 171

Abstract: Background. Patients who receive liver transplantation for chronic hepatitis B infection require long-term combination therapy with hepatitis B immunoglobulin (HBIG) and oral antiviral medication to prophylax against graft re-infection. This study ... ...

Abstract	Background. Patients who receive liver transplantation for chronic hepatitis B infection require long-term combination therapy with hepatitis B immunoglobulin (HBIG) and oral antiviral medication to prophylax against graft re-infection. This study examines the efficacy and patient preference of subcutaneous (SC) administration of HBIG in maintaining anti HBs titres > 100 IU7L.Materials and methods. 12 patients who were stable while receiving our standard IM HBIG protocol received an alternate formulation by SC injection, consisting of 10 mL (3120 IU) HBIG as 4 x 2.5 mL SC injections. SC injection were repeated as soon as titres reached 100-150 IU/mL during the 3 month study period. A questionnaire was administered upon study entry and exit to subjectively assess patient preference.Results. Anti-HBs Cmax after first injection was 441.6 IU/L ± 81.5, and Tmax was 7.1 ± 3.2 days. SC injections were required every 56 days, which compared well to the frequency of required IM injections prior to study enrollment of 45 days. The patients mean ratings of pain on a 0-10 scale were 5 for the IM route and 1.6 for the SC route. All patients preferred the SC injections to the IM.Conclusion. SC administration of HBIG can effectively maintain anti HBs levels above the requisite 100 IU/L while substantially decreasing patient discomfort and improving patient satisfaction, and therefore becomes a very attractive alternative to IM HBIG injections. Further studies and wider use of SC HBIG based on this study may alter the standard practice of transplantation centers.
Keywords	Hepatitis B ; Immune globulin ; Liver transplantation ; Subcutaneus ; Prophylaxis ; HBIG ; Specialties of internal medicine ; RC581-951
Subject code	610
Language	English
Publishing date	2010-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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