Singap Med J
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Review Case Reports
Obturator hernia: diagnosis and treatment in the modern era.
Obturator hernia is a rare variety of abdominal hernia that nonetheless is a significant cause of morbidity and mortality, especially in the elderly age group. This article aimed to review the diagnosis and management of obturator hernia by describing the anatomy, clinical presentation, predisposing factors, diagnostic modalities and management in the modern era. ⋯ We conclude that the rapid evaluation by CT of the abdomen and pelvis and surgical intervention are possible, thereby reducing the morbidity and mortality of patients with obturator hernia. An algorithm for the management of obturator hernia is proposed.
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Foreign body aspiration in the airway of children is a life-threatening clinical situation. Endoscopic retrieval alone is successful in the majority of patients. Occasionally, open surgical intervention in the form of tracheostomy, thoracotomy and bronchotomy and/or pulmonary resection is needed. We analysed the specific indications for tracheostomy during the removal of airway foreign bodies in our study. ⋯ Tracheostomy is occasionally indicated in foreign body extraction, when they are subglottic in location and impacted, or are large foreign bodies that get obstructed at the glottic chink during removal.
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Previous studies report the spectrum of thyroid function abnormalities in critically-ill neonates. In this study, we evaluated the thyroid status in critically-ill neonates, and determined whether thyroid function abnormalities are more common in sick neonatal infants. ⋯ Thyroid function abnormalities are more common in infants under intensive care and most of them manifested as "euthyroid sick syndrome"; abnormal screening tests may be due to the transient elevation of TSH during recovery from illness. Therefore, only in cases in which TSH rises more than 15-20 mIU/L or TSH remains high for a month or longer, that treatment is needed, while other cases must be followed up by serial determination of TSH and FT4. The levels of FT3 and FT4 during the illness were not affected by the duration and severity of the illness.
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Clinical predictors of abnormal computed tomography findings in patients with altered mental status.
While non-contrast computed tomography (CT) of the brain can be used to rapidly identify patients with altered mental status (AMS) in the emergency department (ED), with an acute intracranial bleed or infarct, a wide variation in its use exists. The aim of this pilot study was to identify the clinical predictors of an abnormal CT result in ED patients with AMS. ⋯ We identified seven clinical predictors of an abnormal CT result in AMS patients. Future research in prospective studies is needed to validate these findings.
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Spinal cord compression is a very debilitating condition and could be secondary to many causes. Urgent magnetic resonance (MR) imaging of the spine is crucial in making the diagnosis and guiding further management. Our objectives were to assess the nature of MR imaging requests, the diagnostic yield, and the subsequent management according to relevant MR imaging findings. ⋯ The urgent MR imaging spine service was able to react promptly with a high diagnostic yield. One-third of the patients with vertebral metastasis had multiple levels involved, and imaging of the whole spine would be useful.