Ann Acad Med Singap
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Ann Acad Med Singap · Jul 1998
Review Case ReportsThe alien hand sign--case report and review of the literature.
The alien hand sign refers to a group of signs which include a feeling that the hand is foreign together with autonomous activity, as if the hand is driven by an external agent. These features are commonly associated with frontal and callosal lesions. We report the alien hand sign in a man with left medial cortical infarct, presenting with autonomous grasping and groping with his right upper limb, denial of ownership of his limb, and dissociative phenomena including self restriction and intermanual conflict.
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Ann Acad Med Singap · Jul 1998
Review Case ReportsHyperthyroidism with gynaecomastia as the initial complaint: a case report.
Although gynaecomastia is a well-documented manifestation among male patients with hyperthyroidism, it is extremely rare to present as the initial or chief complaint in a subject with undiagnosed hyperthyroidism. We report a case of a 38-year-old Chinese man presenting with painful enlargement of both breasts of one month's duration. Examination revealed bilateral tender gynaecomastia. ⋯ Hyperthyroidism was confirmed biochemically. Treatment of thyrotoxicosis resulted in resolution of the gynaecomastia. This case report demonstrates that gynaecomastia may predominate over the commonly recognised, more manifest and urgent symptoms of hyperthyroidism.
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Ann Acad Med Singap · Jul 1998
Serum ferritin and iron status in the general population of Singapore, 1993 to 1995.
The National University of Singapore Heart Study is a cross-sectional survey of cardiovascular risk factors in persons aged 30 to 69 years from the general population of Singapore, with 957 persons having measurements of serum ferritin. For males aged 30 to 69 years, mean serum ferritin concentrations were highest in Chinese (236 micrograms/L), followed by Malays (175 micrograms/L) and then Indians (132 micrograms/L). For females aged 30 to 49 years (pre-menopausal), mean levels were higher in Chinese (61 micrograms/L) and Malays (55 micrograms/L) than Indians (30 micrograms/L), and likewise for the 50 to 69 years age group (post-menopausal) where the mean values were 144 micrograms/L for Chinese, 141 micrograms/L for Malays, and 85 micrograms/L for Indians. ⋯ Only 0.4% of males and no females had serum ferritin > or = 1000 micrograms/L. Levels of serum ferritin were somewhat higher than that reported in the USA. The overall iron status in Singapore seems to be satisfactory, although pre-menopausal females (especially Indians) have a fairly high rate of iron deficiency and these females need to be identified and treated with iron supplementation.
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Ann Acad Med Singap · May 1998
Impact on quality of patient care and procedure use in the medical intensive care unit (MICU) following reorganisation.
We conducted this retrospective, cohort study to evaluate the quality of patient care and procedure use in the medical care unit (MICU) following reorganisation and staffing by an intensivist. Consecutive admissions to an adult MICU in a university affiliated hospital during two 3-month periods, August to October 1993 (Period 1, n = 112) and January to March 1994 (Period 2, n = 127) were analysed. In Period 1, the MICU was run under the open system in which patient care was provided by the individual attending physicians. ⋯ Reorganisation of the MICU in Period 2 resulted in reduced length of MICU stay for survivors. Hence, we believe that coverage by a dedicated ICU team and active respiratory care by a respiratory therapist during office hours were beneficial for the care of the critically ill. There was also a noticeable increase in the use of invasive monitoring.
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Ann Acad Med Singap · May 1998
APACHE II and SAPS II are poorly calibrated in a Hong Kong intensive care unit.
This study seeks to determine if the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) model predictions are well calibrated in our adult Intensive Care Unit (ICU) patient population. 1064 successive ICU discharges were enrolled with 222 deaths at hospital discharge. APACHE II predicted 287.44 deaths, thus giving an APACHE II standardised mortality ratio (SMR) of 0.77 (95% confidence interval +/- 0.07). ⋯ The area under the Receiver Operating Characteristic plot for SAPS II risk of death was 0.87 (95% confidence interval +/- 0.028) while that for APACHE II risk of death was 0.88 (95% confidence interval +/- 0.026). Although the APACHE II and SAPS II models provide good discriminatory performance this study finds the APACHE II and SAPS II models to be poorly calibrated in that they over-predict mortality in our ICU population.