Medications for Parkinson’s disease (PD) is effective for several years, but is followed by motor fluctuations, dyskinesias and progression of bradykinesia and rigidity. This...

The Changi General Hospital is a new regional hospital in the eastern part of Singapore catering to a population of about 750 000. Planning...

Critical care medicine as a specialty has grown rapidly, both clinically and academically, over the past 25 years. In the USA, certification of competence...

Hyperkalaemia is a common biochemical derangement in the intensive care unit reflecting a diversity of systemic perturbations such as acute renal failure, rhabdomyolysis, extracellular...

The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The...

The origins of withholding medical support are found in ancient times. More than two millennia ago, Hippocrates (460 to 361 BC) stated that the...

The last decade has seen a progressive change in the style of management of severe acute renal failure (acute renal failure which requires the...

The intensive care unit (ICU) is a complex environment in which multidisciplinary expertise has been shown to enhance clinical outcomes. For example, the availability...

In 1980, Furchgott and Zawadzki demonstrated that the relaxation of isolated arteries to acetylcholine required the presence of endothelial cells. This response was mediated...

Acute respiratory distress syndrome (ARDS) was first described by Ashbaugh et al in 1967. The original authors detailed the presence of tachypnoea, hypoxaemia, decreased...

Multisystem organ failure occurs in a large proportion of critically ill patients and is a major cause of death in this group of patients....

The first major general severity adjustment system, the Acute Physiology and Chronic Health Evaluation (APACHE) system, was published in 1981. Since then, APACHE, the...

Central to the combined diagnostic and therapeutic approach to the critically ill subject is the evaluation of both the basal physiologic status and its...

The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and...

Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s....

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...

Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill...

Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously...

Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique...

Malaria is an important and common infectious parasitic disease globally. It is associated with significant morbidity and mortality, especially in endemic areas. This article is...

The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed...

Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present. This article...

Diabetes insipidus (DI) is a syndrome characterised by the excretion of abnormally large volumes of dilute urine. It occurs uncommonly in neurosurgical patients, but...

Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993. This article is available only...

Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute...

The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) scoring systems are widely used...

The Singapore General Hospital is a 1700-bedded tertiary hospital with subspecialty intensive care units (ICUs), i.e. Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU, Medical ICU,...

Critical care is costly as it is labour intensive and involves expensive life support technology. In the United States, the intensive care units (ICUs)...

Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have...

Acoustic neuroma (vestibular schwannoma) patients have greatly benefited from technical advances in neurosurgery. In fact, the evolution of acoustic neuroma surgery is a microcosm...

The outlook for sufferers of severe head trauma is extremely poor. Some 20% of patients died before significant treatment can be administered, and nearly...

A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla. This article is available only...

Fractures of the atlas comprise approximately 25% of all injuries to the atlanto-axial complex, 10% of all injuries of the cervical spine, and about...

Both intubation and extubation are processes associated with blood pressure and heart rate flux. While many studies have been carried out on the changes...

Neurointensive care has come into being in the past decade as a recognised subspecialty. Pioneering neurointensivists in the United States, such as Allan Ropper...

Preoperative shaving for cranial neurosurgical procedures, as recommended in textbooks, is still a traditional practice in Singapore. Hair has been associated with uncleanliness and...

Schwannomas are extra-axial neoplasms derived from the nerve sheath of peripheral or cranial nerves. They represent approximately 8% of all intracranial tumours, arising predominantly...

Cleidocranial dysplasia is an autosomal dominant skeletal disorder characterized by short stature, brachycephaly, delayed closure of the fontanelles and sutures, Wormian bones, midface hypoplasia,...

Patients who talk after traumatic brain injury (TBI) and then subsequently deteriorate into a coma are defined as those with an initial Glasgow Coma...

Trauma remains the fifth most common cause of death in Singapore; it contributed 6.7% of mortality in 2001. Head injury contributes to a significant...

Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly occurring in immunocompromised patients. It may present in several forms: meningitis, mycotic...

Recognising that severe head injury is a major health problem with significant mortality and morbidity, numerous epidemiological and outcome studies have been conducted in...

Historically, surgery for intractable epilepsy was performed with the patient awake for at least some part of the procedure to facilitate cortical mapping and...

Brain tumours in pregnancy are rare with an incidence of 15 per 100,000 and previous reports have shown variable outcomes. We present a case...

Sepsis is a common and life-threatening medical condition which has high incidence and mortality rates. Health care professionals are increasingly familiar with this syndrome,...