Ann Acad Med Singap
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Ann Acad Med Singap · Nov 1996
Noninvasive positive-pressure ventilation for acute respiratory failure in a medical intensive care unit in Singapore.
The main advantage of noninvasive ventilation over conventional mechanical ventilation is in the avoidance of endotracheal intubation and its related complications. Currently, the role of noninvasive ventilation in the management of patients with acute respiratory failure is still not firmly established. We conducted a prospective study to evaluate the efficacy of nasal positive pressure ventilation in patients with acute respiratory failure. ⋯ Successfully supported patients tolerated the device with improved gas exchange, hence avoiding endotracheal intubation. The mean duration of support was 19.2 hours. There were major associated complications, e.g. gastric distention or aspiration.
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Ann Acad Med Singap · Nov 1996
Comparative Study Clinical TrialAbnormal thyroid and adrenocortical function test results in intensive care patients.
A prospective, cohort study of 75 consecutive patients requiring management in the medical intensive care unit (MICU) of the Singapore General Hospital was carried out over a five-month period to determine thyroid and adrenocortical profiles and evaluate their use in predicting patient outcome. Up to 88% of patients had at least one abnormal thyroid function and 77% had abnormal adrenocortical function test results. There were significantly lower triiodothyronine, thyroxine and free thyroxine, but not thyrotropin levels, and higher cortisol levels in non-survivors compared to survivors (all P < 0.01). ⋯ The APACHE II (acute physiology and chronic health evaluation II) score alone predicted outcome with 71% accuracy, and in combination with triiodothyronine and cortisol levels improved accuracy to 84%. The use of dopamine alone predicted outcome with 74% accuracy, and in combination with triiodothyronine and cortisol levels, improved accuracy to 84%. Measurements of total triiodothyronine and cortisol concentrations on admission to the MICU, and consideration of the use of dopamine improve on the APACHE II score in outcome prediction.
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Ann Acad Med Singap · Sep 1996
Review Case ReportsCystic nodal metastasis in occult tonsil carcinoma--a case report.
A "branchial cyst" in a patient above 40 years old may turn out to be a malignant cystic nodal metastasis from a primary tumour in the tonsil. We present a case of a 45-year-old woman in whom an initial mistaken diagnosis of branchial cyst was made. The neck mass was discovered to be malignant and the left tonsil was subsequently implicated as the primary source. Older patients with cystic neck masses should be managed on the presumption that these may possibly be metastatic lesions from a primary oropharyngeal tumour.
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Ann Acad Med Singap · Sep 1996
Biography Historical ArticleHow I developed laparoscopic cholecystectomy.
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Ann Acad Med Singap · Jul 1996
Unplanned returns to the accident and emergency department--why do they come back?
An audit of unplanned returns by patients to the Accident and Emergency Department was carried out recently in Toa Payoh Hospital. This was done for a period of eleven months for the year 1994. A total of 166 unplanned patient returns were studied. ⋯ Another 14.5% of patients were found to have wrong or missed diagnoses at the initial visit, the two most important of which were appendicitis and bleeding from the gastrointestinal tract. It is hoped that such an audit will serve to identify areas for improvement in patient care. It can also be a useful tool for measuring and improving the performance of individual Emergency Room doctors, or a group of doctors.