Ann Acad Med Singap
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Ann Acad Med Singap · Nov 1998
Risk factors for predicting mortality in a paediatric intensive care unit.
Rapid advances in critical care technology and rising cost of medical care have spurred the development of outcome analysis including mortality risk prediction. The main objective of this study was to assess the risk factors contributing to mortality in our paediatric intensive care unit (PICU). This is a cohort study, consisting of consecutive admissions to the PICU from 1 January to 31 December 1997. ⋯ Univariate analysis showed that need for mechanical ventilation, renal replacement therapy, presence of MODS involving 3 or more organs and PRISM III-24 scores were significantly associated with outcome (P < 0.0005). Relative risk of mortality in the presence of MODS and PRISM III-24 scores > or = 8 were 11.3 (95% CI: 3.3 to 38.3) and 15.8 (95% CI: 2.0 to 127.8), respectively. Using Cox Proportional Hazards model, the relative risk of mortality for any new admission could be calculated by the equation RR = e0.1032 x P, where P = PRISM III-24 scores.
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Ann Acad Med Singap · Nov 1998
Computed tomographic and magnetic resonance imaging findings in paranasal sinus involvement in nasopharyngeal carcinoma.
Nasopharyngeal carcinoma (NPC) may spread to the paranasal sinuses. This retrospective study describes the features of paranasal sinus involvement in NPC on computed tomography (CT) and magnetic resonance imaging (MRI). One hundred and fourteen patients with histologically proven NPC underwent staging with both CT and MRI. ⋯ Using MRI as the standard, the rates of CT separating tumour from inflammation are: maxillary sinus (100%), sphenoid sinus (43%) and ethmoid sinus (25%). Histological confirmation of tumour involvement in the paranasal sinuses is not available. It is important to separate sinusitis from tumour infiltration as prognosis and treatment planning may be affected.
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Ann Acad Med Singap · Nov 1998
Is it feasible to use magnesium sulphate as a hypotensive agent in oral and maxillofacial surgery?
We report the results of a feasibility study using intravenous magnesium sulphate for deliberate hypotension in 16 ASA 1 patients undergoing major oral and maxillofacial surgery. All the patients received a standard nitrous oxide, oxygen, isoflurane, opioid and muscle relaxant anaesthetic. Magnesium sulphate was infused at 40 g/h until the mean arterial pressure reached 55 +/- 5 mmHg, followed by a maintenance dose of 5 g/h until 30 minutes prior to the end of surgery. ⋯ On completion of surgery, the prothrombin time was significantly increased (P < 0.05), and the partial thromboplastin time significantly decreased (P < 0.05) in all the patients (when compared to preoperative values); the clinical significance of this is unclear. The use of intravenous magnesium sulphate for deliberate hypotension is feasible in ASA 1 patients using a standard nitrous oxide, oxygen, isoflurane, opioid and muscle relaxant technique. This study forms the basis for a larger controlled study where the issues of postoperative sedation and weakness and coagulopathy can be dealt with in greater detail.
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Ann Acad Med Singap · Nov 1998
Case ReportsA case report of heparin resistance due to acquired antithrombin III deficiency.
A case of heparin resistance and its management during cardiopulmonary bypass is reported. A patient with a history of post-infarct angina and arrhythmias was treated with intravenous heparin infusion for five days prior to myocardial revascularisation surgery. ⋯ This phenomenon of heparin resistance was postulated to be due to consumption of circulating antithrombin III as a result of prior heparinisation. Treatment with fresh frozen plasma restored heparin effectiveness.