Singap Med J
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A retrospective study on the outcome of 130 consecutive patients with a previous lower segment Caesarean section who delivered in Kandang Kerbau Hospital, Singapore from January to June 1989 was performed. Seventy-six percent of these patients were selected for a trial of labour and 24% of the patients had a repeat (elective) Caesarean section. Vaginal delivery was achieved in 65% of patients chosen to undergo a trial of labour. ⋯ More vaginal deliveries (p < 0.05) were achieved when oxytocic infusion was used in selected cases during the trial of labour. Maternal morbidities were higher in patients who had a failed trial of labour (57%) and repeat elective Caesarean section (20%) than those who had a successful trial of labout (10%). Management of patients with a previous lower segment Caesarean section may present a dilemma, but if properly conducted, the outcome can be favourable.
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The intensive care unit provides multisystem support and therapy to critically ill patients, and represents an expensive part of hospital medicine. This survey validates the use of APACHE II as a severity scoring system that allows reliable prediction of outcome of intensive care patients in Singapore. ⋯ Patients with sepsis fared poorer than expected from their APACHE II scores, and stroke patients needing intensive care admission had an extremely poor prognosis (mortality rate of 85.7%). High APACHE II scores are associated with invasive haemodynamic monitoring.
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We report our experience on the use of fibreoptic bronchoscopy in the diagnosis of pulmonary tuberculosis. The case records of 1,274 patients who underwent fibreoptic bronchoscopy at the National Tuberculosis Centre, Kuala Lumpur, Malaysia during a three-year period were reviewed. In 120 of them the final diagnosis was tuberculosis. ⋯ Six patients had diagnosis confirmed by other means while in 36 others (30%) it was based on clinical features and supportive basic investigations. There were no complications noted. We conclude that while sputum examination remains the mainstay for diagnosing pulmonary tuberculosis, fibreoptic bronchoscopy serves as a safe and useful adjunct.
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This is a retrospective and descriptive study of 44 Filipino maids who had a psychiatric illness in Singapore and were admitted to the state psychiatric hospital. Of those with psychosis, one quarter was diagnosed to have a Brief Reactive Psychosis, 2 had a Depressive illness, whilst 3 had a Schizophrenic illness. One-fifth had symptoms of an Atypical Psychosis. ⋯ Auditory hallucinations, present in twenty-six of the group, and delusions, present in sixteen, were the main symptomatology discussed. The delusions had mainly sexual and religious themes. Seven had a history of suicidal attempts.
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Advances in microcomputer hardware and software technology have made computerised outpatient medical records practical. We have developed a programme based on the Summary Time-Oriented Record (STOR) system which complements existing paper-based record keeping. ⋯ Context sensitive child windows display details of plans of management in the RFE window and clinical notes in the PL window. The benefits of such innovations to clinical decision making and practice based research and its medico-legal implications are discussed.