Singap Med J
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Seventy-five adult asthmatic patients with clinical remission underwent spirometry. Only 8.3% of the subjects demonstrated normal spirometry. The others had reduced vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum mid-expiratory flow rate (MMF) and peak flow rate (PEFR). This study demonstrates that asthma can cause irreversible airflow obstruction and there is a poor relationship between symptoms in asthmatics and their respiratory function test results.
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The study was conducted to ascertain the time it takes an ambulance team to reach a patient and transport the patient to an emergency department after a 995 call. One hundred and sixty-two cases brought to two emergency departments (Singapore General Hospital and Tan Tock Seng Hospital) between 11 March 1992 and 16 March 1992 were studied. The information was obtained from ambulance officers of the Singapore Civil Defence Force. ⋯ With the present level of staff in Singapore, basic life support care starts 11.40 minutes and advanced life support care 30.50 minutes after a 995 call. These times are unacceptable if it involves a cardiac arrest or a trauma patient. Factors which cause these long time intervals include traffic congestion, inadequate public education, location of patient (whether on ground level or highrise) and distance from the emergency departments.
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Psychiatric disorders and physical illnesses often coexist. Although there is evidence of high psychiatric morbidity in general hospital patients, only a small percentage are referred to the consultation-liaison psychiatrist. The paper describes and discusses the common psychiatric conditions encountered and referred in general hospitals. ⋯ The major diagnostic categories of these referrals are organic psychotic disorders, functional psychoses and neurotic disorders. Some broad guidelines are listed for the referring physician. Patients presenting with suicidal ideations or attempts, suspected emotional psychiatric disturbance, a history of psychiatric illness, an apparent incompetence in giving consent for medical procedures and those with diagnostic and management problems could be referred to the psychiatrist.
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Comparative Study
Comparison of the results of spinal fusion for spondylolisthesis in patients who are instrumented with patients who are not.
Eighty-five patients who had surgery for spondylolisthesis were studied retrospectively both clinically and radiologically to determine if instrumentation lead to better fusion rates and clinical outcome. Degenerative spondylolisthesis accounted for 57 cases and patients who had instrumentation did have a better fusion rate and clinical outcome, with 60% of patients having complete relief from pain. In the group with isthmic spondylolisthesis (28 patients), there was also an improved fusion rate with instrumentation. ⋯ The improved fusion rate radiologically with instrumentation did not translate to better clinical results with regard to pain relief and disability. One patient developed ascending epidural haematoma with instrumentation and resulted in paraplegia. She had incomplete recovery during the follow-up.
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Patients with the Hb beta + [IVS 1-5 (G-->C)] clinically presented as beta-thalassaemia intermedia and remained asymptomatic in the absence of blood transfusions. With or without blood transfusions the patients were short and had moderate to marked thalassaemia facies. ⋯ The serum ferritin and serum alanine transaminase levels were significantly raised in the patients who were given blood transfusions. In the presence of blood transfusions, and absence of adequate iron chelation therapy, splenectomy became an inevitable event at some stage of the disease because of increasing transfusing requirements.